Total communication, not to be confused with simultaneous communication, includes "the learning of formal signs, natural gestures, fingerspelling, body language, listening, lipreading and speech " ("Total Communication "). Not every one of these tools is completely necessary in acquiring language, but it helps the children to also function better socially and within the deaf community. The formal signs and fingerspelling are both a part of sign language, which differs depending on the country or region. For example, American Sign Language (ASL) is not the same as British Sign Language (BSL); Americans who know ASL may not necessarily understand BSL. One method to teach total communication involves the child learning how to move their lips in front of a mirror with pictures of words and then having the child repeatedly practice signing and speaking the word. .
Most hearing children learn to speak and are able to have oral conversations before they can read, For children of prelingual deafness, that is not the case; prelingual deaf children must learn phonetics, sign language, and to read almost simultaneously. All children, hearing or not, must learn that written and spoken words consist of smaller letters and sounds, or in other words, they must gain a phonological awareness. Phonological awareness and orthographic awareness, the understanding of "the representation of the sounds of a language by printed symbols ", together create the alphabetic principle needed to read. However, a deaf child's lack of hearing drastically impacts their ability to learn and execute phonological and orthographic awareness. Still, this is where the deaf child begins learning to speak, usually at a deaf institute of some kind.
While teaching these phonetics, teachers at deaf institutes also teach their students how to use sign language, and then use sign language to further and ease the students into the process.