How to talk to someone with hearing loss or auditory processing disorder

I work right near the Northwestern University Hearing Clinic, and the other day I had a chance to pick up a flyer with suggestions for effective communication with people who have hearing loss.  The flyer assumes these will be adults with hearing aids, but most of the suggestions would probably work just as well for kids and adults with brain-based hearing problems.

I've included all their tips but re-organized them and added some notes on why they're such good advice.

For the speaker
Making hearing easier: Attention.
1. Get the person's attention before speaking to them.
Note: In my experience, this is key!  It takes extra effort and attention to process what someone is saying to you if you have auditory processing problems.  If you first have to redirect your attention to the person speaking to you, you may miss the first few words they said and start off at a disadvantage.  Some parents and teachers get a child's attention by touching him or her lightly on the shoulder, but make sure your listener is OK with this before attempting to get their attention this way--some people don't like to be touched.  Calling their name, walking directly in front of them, or catching their eye can also get their attention.

Allowing for Visual Compensation

1. Use facial expressions and gestures to get your meaning across.  Visual cues such as facial expression and body language can help fill in some missing information for a hearing impaired listener.  At the very least, even if the listener can't make up enough words to understand the content, they will understand the emotional message and something of the purpose of the communication. At best, knowing the emotional context can help them distinguish between similar-sounding possible words. Some people even learn to lip-read.

2. When speaking, position yourself so the listener is within 3 feet of you and can see your face clearly.  Make sure there is adequate lighting in the room.
Note: This makes it possible for your listener to perceive the above cues.


1. Sit or stand facing the person you're talking to. If walking, move towards them, NOT away from them.
Note: The obvious benefit is that the person will be able to read your visual cues, but there are also auditory benefits.  When you speak, your voice travels ahead of you.  If you're facing the person, the sound waves travel directly towards them and they get the benefit of the full signal.  If you're facing away from the person, the sound is traveling away from them and they lose some of the signal.

2. Speak slowly and deliberately, but do NOT over-exaggerate mouth movements.
Note: When they recommend speaking deliberately, the key is to enunciate clearly--vowels are easier to hear accurately than consonants.  Danni Brendan (@dannilion on Twitter) tells me that overexaggerating mouth movements makes lip reading difficult or impossible.

Make it easier to hear: Increase signal, Eliminate Noise
1. Do NOT chew gum, eat, smoke, or cover mouth when speaking.
Note: Poor hearing can be considered a "signal to noise" issue.  When people hear, their brains need a certain amount of meaningful signal from the environment to turn a sound into information.  Too much noise--whether from fluctuations in activity in their own brains or background noise in the environment--interfere with processing.  For this reason, everyone hears worse in high-noise situations such as crowded parties with loud background music, talking on the phone (where sound is distorted), or listening to someone with an unfamiliar foreign accent.  People with hearing loss or auditory processing problems will be more impaired in these situations, as well as more likely to have difficulty hearing in situations where signal would be adequate for most people.  Chewing gum, eating, smoking, or covering the mouth either muffle or distort the sound of your speech, limiting the signal your listener gets and increasing the noise.  Don't do it.

2. Turn off distracting background noise (e.g., TV, radio, dishwasher, etc.).
Note: This literally reduces "noise."  This is a biggie for me personally--I can't understand what someone in the next room is saying if I'm washing the dishes.

3. When in public, attempt to sit away from noisy places.

4. Do NOT yell when speaking to someone wearing a hearing aid--it will only distort your voice.

5. When in public, attempt to sit away from noisy places.

Get creative.
1. If your message has been misunderstood, REPHRASE the words, don't just say the same thing over and over.

2. Write down key words, if necessary.
Note: Seriously, people underestimate the degree to which writing can help.  (On a related note, writing can also help people who are reluctant to speak..  A handful of the 5-8 year old participants I've ran in studies this past two years were able to participate even though they refused to do more than whisper a single word at a time, because they could get across the information I needed by pointing and writing).

3. Ask the listener occasional questions to make sure they're understanding you.
Note: It's best to do this matter-of-factly and not with openers such as "because you might not be able to hear what I'm saying...."  This should be obvious, but I've known people who apparently resent having to adjust for people with auditory processing problems, and behave passive-aggressively.

Advice for the Listener
1. If you have a hearing aid, use it daily, and make sure it's working properly.

2. Face the speaker, and pay attention to ttheir lip movements, facial expressions and gestures.  If possible, make sure there is adequate lighting for this.  If you need glasses to see these details, make sure you're wearing them.

3. Do NOT attempt conversation from different rooms.
Note: This advice also applies to the speaker!

4. Turn off background noise (e.g., TV, radio, dishwasher).

Asking for Information
1. If you do not hear, or think you may have misunderstood, ask for repetition or clarification.
Note: This can be embarrassing, but it's better than not understanding at all, or misunderstanding and making the speaker think you weren't paying attention or didn't care.

2. Specifically, if you miss part of the message, repeat the part you did hear.  Saying "WHAT???" all the time can be annoying.
Note: More to the point, if you just say "WHAT???" most speakers will simply repeat the exact same thing they just said in the exact same words with the exact same intonation, and you probably will miss the same part again. The speaker isn't a mind-reader and doesn't understand what makes speech easy or hard to understand; help them help you.

3. Don't pretend you heard what was said.  Instead, be active in the conversation.
Note: Pretending you heard when you really didn't can interfere with participating in the conversation, because you now have to devote attention to hiding your lack of understanding instead of just focusing on trying to hear.  However, in some situations where interrupting the flow would be bad and your comprehending every detail isn't that important (e.g., attending a talk at a conference), pretending to hear may actually be a better strategy.

1. Remind the speaker you have trouble with your hearing.  Be assertive.
Note: This is socially acceptable if you're an older adult with a hearing aid, the intended audience of the flyer.  If you're a younger adult with normal hearing and a brain-based hearing problem, there might be more negative effects to disclosing, and certain times may be more appropriate than others.  For example, I've been told that one should disclose a disability after the interview process, but as soon as possible after being hired (so it can't interfere with your admission, but you won't be seen as using it as an excuse).

2. Relax, it isn't necessary to get every word.  Your brain will fill in the gaps.  Concentrate on what you heard, not what you miss.
Note: Good advice, because when you're anxious about not hearing, you'll actually miss more.  Compensating for hearing problems can be exhausting, so it's especially important to take care of your mental health.