Hearing ImpairmentDeafness and Hearing Loss

By Kasia Zarzecki

Workshop #1What did you hear today?

Did you hear the door open?

Did you hear your teacher’s tone change?

Did you listen to the morning weather?

Did you listen for instructions?

In the next 45 seconds, list everything you heard today.

Hearing is critical to speech and language development, communication and learning.

Children with hearing loss continue to be underidentified and underserved. YOU can help.

Definition of the disability

Children who are deaf or have hearing loss receive special education and related

services under the federal disability

category hearing impairment.

Definition of the disability

Under IDEA deafness and hearing impairment are defined as:

Deafness means a hearing loss that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, [and] that adversely affects a child’s educational performance. (PL 108- 446)

Hearing loss means a loss in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but that is not included under the definition of deafness in this section. (PL 108-446)

What’s the difference?

According to the National Institute of Deafness and Other Communication Disorders, about 28 million people are deaf or

hearing impaired. That’s 1 out of every 10 people!

A child who is deaf cannot use hearing to understand speech.

Most deaf people, hear some sounds through residual hearing, they

use vision as the primary way to learn and communicate.

A child who has a hearing impairment can use hearing to

understand speech, usually with the help of

a hearing aid. The speech and language skills of the child may

be delayed.

Prevalence

• About 2 to 3 out of every 1,000 children are born deaf or with a hearing impairment.

• During the 2009-2010 school year, 70,548 students aged 6-21 received special education services under the disability category of hearing impairment.

• 1.2% of all school- aged children received special education services in 2009-2010

• In special education classes, the number of students with a hearing loss is higher than this amount because some children are counted under a primary disability (ex. learning disability, intellectual disability, etc.)

The ways in which hearing impairment affects children:

1) It causes a delay in developing speech and language skills (receptive and expressive communication)

2) The language deficit results in learning problems which cause reduced academic achievement

3) Communication difficulties that come with the disability result in social isolation and poor self- esteem.

4) It may impact vocational choices.

Share your story!

Do you have any students in your class or have you observed in a classroom where a child had hearing loss?

What were some classroom accommodations for this student?

Workshop #2

Characteristics

● There are three main qualifications that should always be included when discussing hearing impairments:

○ First, students who receive special education due to hearing loss comprise an extremely heterogeneous group.

○ Second, the effects of hearing loss on a child’s communication and language skills, academic achievement, and social and emotional functioning are influenced by many factors.

■For example: ● The type and degree of hearing loss.● The age at onset.● The attitudes of the child’s parents and siblings.● Opportunities to acquire a first language.● The presence or absence of other disabilities.

Characteristics Continued

○ Third, generalizations about how deaf people are supposed to act and feel must be viewed with extreme caution.

■For instance Lane (1988) stood against the “so-called psychology of the deaf” stating how within many different cultures, individuals with hearing impairments will differ.

■Reflecting upon how “the characteristics of deaf people are alike but should be aware of the paternalistic posture of hearing experts”.

Specific Characteristics

● Deaf children, especially those with prelingual hearing loss of 90 dB or greater, are at a great disadvantage in acquiring English literacy skills, especially reading and writing.○ Reading and writing involve graphic representations of a

phonologically based language, the deaf child who has not benefited from exposure to a rich grammatical model of spoken English must strive to:■ decode■ comprehend■ produce text based on a language for which s/he may

have little or no understanding

Specific Characteristics

● Visual Phonics is a great approach to teaching letter-sound correspondence.○ Visual Phonics is a multisensory system of hand cues and

written symbols that represent sounds.

Visual Phonics Chant: YouTube Video http://www.youtube.com/watch?v=diC6bHdKGzs

Specific Characteristics

• Deaf children, especially those with prelingual hearing loss of 90 dB or greater, are at a great disadvantage in acquiring English literacy skills, especially reading and writing.

• The speech of many children with hearing loss may be difficult to understand due to: – Omitting speech sounds they cannot hear.– Speaking too loudly or softly– Speaking in an abnormally high pitch– Speaking with poor inflection– Speaking at an improper rate

Let Us Elaborate...

● Children with hearing loss learn concrete words such as:○ Tree, run, and book.

More easily than abstract words such as:○ before, after, equal to, and jealous.

● They also have difficulty with function words such as:○ the, an, are, and a.

● Many children tend to omit endings of words- due to the grammar and structure of English often not following logical rules.

Let Us Elaborate...On Students Speech

● The reason for why many students speech impediments are due to:

■ Not being able to hear one’s own speech, making it difficult for one to monitor how loud or soft they speak.

■ Omitting speech sounds such as /s/, /sh/, /f/, /t/, and /k/ all sounds they can NOT hear.

■ High pitched or sounds mumbled due to improper stress or inflection.

Specific Characteristics

● As a group, students who are deaf and hard of hearing lag far behind their hearing peers in academic achievement, and the achievement gap usually widens as they grow older.

○ Especially reading and math.○ The average deaf student who leaves high school at age 18 or 19 is reading

around the level of a fourth grader (Kuntze 1998).○ Their mathematics performance is leveled to be at a range of fifth and sixth

grade (Traxler, 2000).○ 30% of deaf students leave school functionally illiterate (Paul & Jackson,

1993). ● Being said though- as a teacher never doubt a student's intelligence due to their

academic performance! ○ Deafness itself imposes no limitations on the cognitive capabilities of

individuals.○ Some deaf students read very well and will excel academically (Karchmer &

Mitchell, 2011; Williams & Finnegan, 2003).

Specific Characteristics

● Children with severe to profound hearing losses often report feeling isolated and unhappy in school, particularly when their socialization with other children with hearing loss is limited.

○ Social problems are more frequently found in children with mild or moderate hearing loss compared to students who have severe to profound losses (ASHA, 2011a).

○ The slightest hearing loss can cause a child to miss important auditory information. For example a student can miss the tone of the teacher’s voice when being told to get out their mathematics workbooks, which can lead to the student being considered inattentive, distractible or immature (Easterbrooks, 1999).

Assessment

● Auditory brain-stem response and otoacoustic emission are two methods of screening for hearing loss in infants.

○ The auditory brain-stem response and otoacoustic emission are the two most commonly used methods of screening for hearing loss in infants that measure physiological reactions to sound.

● The auditory brain-stem response involves sensors to be placed on the scalp and then measure electrical activity as the infant responds to auditory stimuli.

● The otoacoustic emission screening is when a tiny microphone is placed in the baby’s ear to detect “echoes” of hair cells in the cochlea as they vibrate to sound (Ross & Levitt, 2000)

Assessment Continued

● A formal hearing test, using an audiometer, to generate an audiogram, which graphically shows the intensity of the faintest sound an individual can hear 50% of the time at various frequencies.○ The examiner uses an audiometer which is an electronic device that generates pure

tones at different levels of intensity and frequency.

○ Most audiometers deliver tones in 5-dB increments from 0 to 120 dB, with each decibel level presented in a variety of frequencies.

● The child being tested can receive the sound either through earphones or through a bone vibrator. The child is instructed to then press a button when they hear a sound and to release it when they hear no sound.

Results..● Results are then plotted on a chart called an audiogram.

Miscellaneous and Alternative Assessments

● The speech reception threshold (SRT) is the lowest decibel level at which the individual can repeat half of the words, being measured and recorded for each ear.

Classification of Hearing Loss

● Hearing loss is classified as slight, mild, moderate, severe or profound, depending on the degree of hearing loss. ○ It is very important to recognize that no two children have the same exact pattern

in hearing, even if their responses on hearing assessments are similar.

○ Children hear sounds with differing degrees of clarity, and the same child’s hearing ability may vary from day to day.

● Figure 9.5 is very helpful reference tool to refer to when classifying hearing loss and effects on speech and language and expected educational needs.

Etiology (What causes it?)

Most of the time the cause of hearing impairments is undetermined

Causes of Deafness: About one half of all children born deaf acquired it from genetic abnormalities.

Genetic hearing loss may be caused by autosomal dominant, autosomal recessive, or X- linked (related to the sex chromosome).

Autosomal Dominant hearing loss:

when one parent carries to gene for hearing loss (and usually has hearing loss), passes the gene onto the child. In this case, the

probability of the child acquiring a hearing loss in 50%. About 20% of inherited deafness is caused by dominant inheritance.

Etiology continued...

Autosomal recessive hearing loss:

when both parents have typical hearing and carry a recessive gene for hearing loss. In this case, there is a 25% chance of a

child acquiring hearing loss.

Approximately 80-90% of inherited hearing loss is caused by autosomal recessive hearing loss.

X- linked hearing loss:

when the mother carries the recessive trait for hearing loss on the sex chromosome and passes it onto the male offspring but not to females.

X-linked hearing loss results in only 2-3% of all cases

More causes:Deafness:- When rubella is contracted by an expecting mother, the child runs the risk of acquiring deafness along with other illness such as vision loss and heart disorders. This is especially dangerous if an expecting mother attracts rubella in the first trimester of pregnancy. After a scare in 1970, a vaccine to prevent rubella was introduced.

- Another major cause of deafness is prematurity. If a child is delivered early or has a low birth weight, deafness is a risk.

Hearing Loss:

- The most common medical diagnosis for children is a common ear infection called Otitis Media. If not treated, fluid can build-up and the eardrum can rupture > this causes permanent ear loss.

- Meningitis causes profound hearing loss. This is when bacteria or a virus affect the central nervous system. It can destroy the sensitive apparatus of the inner ear.

Most common work related injury in the U.S:

Noise ExposureA common cause of hearing loss is the repeated exposure to noisy environments. This hearing loss occurs gradually when a person is exposed to hazardous noise levels at work. A person usually does not realize his/her hearing is being damaged until it is too late.

Some noisy environments:

- motorcycles

- jet aircraft

- target shooting

- amplified music

Placement of studentsPublic school or residential schools

• Parents of children who are deaf or have hearing loss can choose to put their children in residential schools or local public schools. MOST students who are deaf attend local public schools. 54% of students with hearing loss are in general education classrooms with students who can typically hear, 17% attend resource room for part of the day and 16% are educated in separate classrooms.

• Of the total amount of students who are deaf, 8% attend special day schools and 4% attend residential schools for the deaf.

Where should the child be educated?

General Education classroom Separate classroom

-PRO: academic advances -PRO: social advances

-CON: Students are more likely to view (Students can relate to one another)

hearing loss as a disability when

oral language is the primary language of - CON: No educated with a diversity of

instruction learners

-CON: unequal access to curriculum

Whatever the classroom may be quality of instruction is the most important factor to determining a successful student.

Postsecondary EducationSince the 1980s the percentage of students with hearing loss has significantly risen. 40% of students with hearing loss go on to attend college (Gallaudet Research Institute, 2005).

• Gallaudet University in Washington D.C offers undergraduate and graduate programs for students with hearing loss. Some subjects include liberal arts, sciences, business and education.

• Rochester Institute of Technology offers accredited programs for the deaf through the National Technological Institute for the Deaf (NTID). Together the pair provides programs in computer science, photography, hotel management, and medical technology.

Both Gallaudet and RIT are supported by the federal government and each enrolls 1,500 students who are deaf

or hard of hearing into their programs.

Related Services ● Technologies that amplify or provide sound include:

○ Hearing Aids ○ Assistive Listening devices○ Cochlear Implants

● Technologies and supports that supplement or replace sound include:○ Educational Interpreters○ Speech-to-text Translation○ Television Captioning ○ Text Telephones○ Alerting Devices

Related Services...● Hearing aids is a form of stimulating and using residual hearing (Council for

Exceptional Children) that is like a miniature public address system, with a microphone, an amplifier, a receiver, and controls to adjust volume and tone.

○ Hearing aids can come in a variety of designs and can be worn behind the ear, in the ear completely in the ear canal, on the body, or incorporated into eyeglass frames.

● Assistive Listening Devices is used as another strategy for stimulating and using residual hearing (Council for Exceptional Children) it solves problems caused by distance, noise and reverberation in the classroom.

○ It consists of setting up a radio link between the teacher and the student, the teacher wears a small microphone transmitter and the student then wears a receiver that doubles as a personal hearing aid.

● Cochlear implants bypasses damaged hair cells and stimulates the auditory nerve directly. This is surgically implanted under ones skin containing four basic parts:

○ An external microphone

○ An external speech processor

○ Transmitter

○ Receiver/stimulator

Technologies and Supports that Supplement or Replace Sound

● Sign Language Interpreters (sometimes called transliteration) have made it possible for many deaf and hard-of-hearing students to successfully complete college and other post-secondary programs.

○ Interpreting involves signing the speech of a teacher or other speaker for a person who is deaf.

● Speech-to-Text Translation involves computer-aided speech-to-text translation that increases access by deaf students to live presentation.

● Text Telephones also called “TT” or “TTYs” for teletypes or “TDDs” for telecommunication devices for the deaf- all enable the user to send a typed messages over telephone lines to anyone else who has a TT. So in other words texting for hearing impaired.

Workshop #3 Teach simple sign language to the class to promote

an inclusive classroom community

Link: http://www.youtube.com/watch?v=CS-6hFyXSM4

What is the sign for “thank you”? What is the sign for “bathroom”?

What is the sign for “wash”?

Accommodations ● The breakdown of where deaf or hard of hearing are within

classrooms:○ Half of the students who are deaf or hard of hearing are educated in regular

classrooms.

○ Approximately 17% attend resource rooms.

○ 16% are served in separate classrooms.

○ 8% go to special schools.

○ 4% attend residential programs.

● All of the professional and parent organizations involved in deaf education have voiced their position statements strongly in favor of continuing within their placements. No one involved is being forced, everyone involved is willing and have voiced to be included.

Accommodations...

Access to the language and communication process is best suited to ones:

○ Individual needs and preferences.○ Effective instruction with meaningful curriculum. ○ Self Encouragement

These are all important key factors to improving the future of people who are deaf or hard of hearing.

Instructional Methodologies...

● Over the years, there have been a countless amount of different theories, philosophies, materials developed to improve teaching children who are deaf. Although throughout the years there has always been three approaches that are most frequently used or

emphasized:○ Oral/Aural Approaches○ Total Communication

○ The Bilingual Bicultural Approach

Oral/Aural Approaches• Educational programs with an oral/aural approach view speech

as essential for students who are deaf and function in the hearing world.

● There is a large focus on training students in producing and understanding speech and language, and incorporating it into all aspects of the child’s education.

● Today about one fourth of special schools and educational programs for students who are deaf or hard of hearing identify themselves as solely oral/aural programs.

● Since speech is the primary communication mode in classrooms attended by 52% of deaf and hard-of-hearing students, there has been an increase in the oral approach.

Oral/Aural Approaches...

● A child who attends a program with an oral emphasis uses several means to develop residual hearing and the ability to speak as intelligibly as possible. Including methods that emphasize auditory, visual and tactile learning.

● Specific attention include amplification, auditory training, speech reading, the use of technological aids, and above all talking.

● Children in these programs are required to express themselves and learn to understand others through speech alone.

Oral/Aural Approaches...

Within oral/aural instructional methodologies amplification, auditory training, speechreading, cued speech and the use of technological aids are all key factors to help students who are deaf or hard of hearing. ● Auditory training is for young children with hearing loss that

begins by teaching awareness of sound.● Speechreading is the process of understanding a spoken

message by observing the speaker’s lip movements, facial expressions, eye movements and body gestures.

● Cued speech supplements oral communication with a visual system of hand signals that represent the 44 phonemes of spoken English.

Grab a Partner!

★Let’s all try Speechreading!★Each partner should take a turn and try

to understand what the other is communicating to the other without using any sounds.

★Speechreading can be very tricky and has many limitations!

Total Communication

● The approach of total communication refers to an educational philosophy as well as to a mode of communication.

● Educators who teach using this methodology usually maintain the simultaneous presentation of English language by speech and manual communication, being signing and fingerspelling, making it possible for children to use either one or both types of communication.

● Total communication has become the most widely used method of instruction in schools for the deaf.

● A survey completed using 137 schools for the deaf, 66% of those schools use the total communication method.

Total Communication

● Within the total communication method there are two strategies that are frequently used being Manually coded English and Fingerspelling.○ Manually Coded English which consist of several

educationally oriented sign systems such as:■ Signing Essential English (Anthony, 1971)■ Signing Exact English (Gustafson, Pfetzing & Zawolkow,

1980)■ Signed English (Bornstein, 1974).

Total Communication

● Fingerspelling is the manual alphabet used to spell out proper names for which no signs exist and to clarify meanings.○ Fingerspelling is an integral part of American Sign Language

(ASL) and an important aspect of becoming bilingual in English and ASL (Haptonstall-Nykaza & Schick, 2007).

○ Consists of 26 distinct hand positions, one for each English letter.

Total Communication

American Sign Language and the Bilingual-Bicultural Approach

● ASL is a visual-spatial language in which the shape, location, and movement pattern of the hands; the intensity of motions; and the signer’s facial expressions all communicate meaning and

content. ○ American Sign Language is the language of the deaf culture

in the United States and Canada.■ Although ASL has it own rules of phonology, morphology,

syntax, semantics, and pragmatics- it does not correspond with written or spoken English.

An ASL video dictionary is available at : www.handspeak.com

Materials/Equipment● Treatment for hearing loss varies depending on the cause of the hearing impairment.

Some children may need hearing aids. Hearing aids come in different forms. Some fit behind the ear and others make sounds louder. Hearing aids are adjusted by the audiologist so that sounds are amplified so the child can hear clearly.

● If hearing loss is so severe that a hearing aid is not enough then a cochlear implant is recommended. A cochlear implant is surgically implanted. A small microphone picks up the sound waves and sends them directly to the scalp.

Important Vocabulary: congenital deafness- when someone is born without hearing

post-lingual deafness- when someone loses hearing later in life (after learning to hear and speak)

Hearing Aids and Cochlear Implants are called FM systems

Classroom AdaptationsTo help a child with hearing loss succeed:

• Provide all directions in writing • Provide whatever will be discussed in class in writing • Provide a copy of whatever you are reading to the class in writing • When speaking to the class use as many visual aids as possible (such as posters,

charts, big books, chalk board, slide shows or SmartBoard)• Use hand gestures and body language • Use sign language • Write content information (such as historical dates, spelling words, vocabulary,

math examples, or facts) on the board or provide a guided review sheet • Meet with the student 1-on-1 sometime during each day to review content and

lesson material • make yourself available to the student for questions • Allow student to take books that were read- aloud home to review • Place the student in the front of the room, away from doors and windows• speak slowly, loudly and clearly

More tips for success: • Avoid multiple verbal directions instead model what to do • Provide visual outlines and graphic organizers • Write homework on the board for students to copy or give a homework sheet at

the beginning of the week • Have student repeat directions back to you • Pair the student with a buddy for assistance • Use a cue with the student such as nodding his/her head to see if they

understood the directions clearly • Teach the whole class sign language to develop a sense of community • Use similar directions as much as possible • Provide multi sensory learning opportunities • Repeat the comments or questions students said • Provide captions to videos • Circular seating arrangements allows students who have hearing loss the best

advantage to hearing and seeing the whole class • Ensure accommodations during field trips (the teacher may have to call in

advance or plan ahead of time)

Workshop #4

Hearing Loss in the ClassroomHere is a video that shows how a child with hearing loss feels in the classroom.

Start the video from 1:40: http://www.youtube.com/watch?v=ln8NHzVfJkQ

What other accommodations would you have made as the teacher?

Organizations and Agencies Alexander Graham Bell Association

AG Bell is an international membership organization of

• parents of children who are deaf and hard of hearing

• adults with hearing loss

• professionals.

The web site provides general hearing loss information, book recommendations, financial aid and scholarships, and action alerts on legislative developments. Separate sections support teens with hearing loss (an interactive website devoted to teen issues and hearing loss), adults with hearing loss (supporting action on the local and national level and the mentoring of young children who are deaf or hard of hearing) and parents (providing emotional support, information, referral to appropriate services and advocacy).

Very friendly website: http://listeningandspokenlanguage.org/

American Society for Deaf Children (ASDC)

ASDC is a national, non-profit membership organization providing support, encouragement, and information to families raising children who are deaf or hard of hearing. ASDC's primary mission is to advocate for the highest quality programs and services for parents so they can make informed choices about their children’s educational, communication, personal and social needs. Membership includes access to materials from ASDC's resource list and their free lending library, a subscription to their newsletter, and more.

The website: http://www.deafchildren.org/

Auditory/Oral School of NYAn Auditory/Oral Early Intervention and Preschool Program servicing hearing impaired children and their families. Programs include: Early Intervention (center-based and home-based), preschool, integrated preschool classes with children with normal hearing, multidisciplinary evaluations, parent support, individual auditory-verbal therapy, speech, occupational and physical therapies, music therapy, complete audiological services, cochlear implant habilitation, mainstreaming, ongoing support services following mainstreaming.The school is located in Brooklyn, New York.

Lexington School for the Deaf The school is located in Jackson Heights, New York. It provides children who are deaf with vocational, hearing and speech services and mental health services. This is the largest School for the Deaf in New York State with about 351 students. Lexington students come from all over the five boroughs, and a number of students have other disabilities in addition to deafness, including mobility and mental impairments. Lexington prepares all students to continue on to college, vocational education, job training, or a placement that will support them to live a responsible, productive life.

Center for Hearing and Communication This New York Center offers hearing testing, hearing fitting, free hearing screening, speech and language therapy and free captioned phones. The center offers its visitors a lot f helpful information which parents of children with hearing loss will find useful such as different hearing technologies and motivational stories.

Recreational programs in New York • Rhinelander Children’s Center

Rhinelander Children’s Center offers education, arts and recreational programming for children who are deaf children. On weekdays,it offers Early Childhood classes, Nursery School and a comprehensive After School Program for children up to age 12. On Saturdays, Rhinelander houses New York City’s only weekend program for deaf children and teens. In the summer, Rhinelander has a day camp for 3-6-year olds.Rhinelander is located on the upper East Side of Manhattan

• Camp Abilities Signs of Fun is a summer camp for children who are deaf and hard of hearing, blind or who have multiple disabilities. It is located in Brockport New York. It is a one week sports camp where children receive one to one instruction daily. Counselor positions for Camp Abilities are still open.

HandsOn Hands On is a non- profit organization is NYC that provides access to the arts

and cultural programs for children who are deaf and hard of hearing. Individuals involved in HandsOn put on theaters performances in NYC.

www.handson.org

Hearing Loss Association of America- New York State

This is an educational advocacy organization of people working together across NYS to promote issues of importance for New Yorkers with Hearing Loss.

www.hearingloss.org

Parents of Hearing Impaired Children Support Group Meetings are held every first Wednesday of each month in New Hyde Park. To find out more information the telephone number is: 718- 470- 8631

Children’s Literature Dina The Deaf Dinosaur by Carole Addabbo

Dina the deaf dinosaur. Her parents won't let her use ASL

I'm Deaf and It's Okay by Lorraine Asltine, Evelyn Mueller, & Nancy Tait

A young boy hates being deaf until he befriends a deaf teenage boy.

Mandy by Barabara D. Booth

Picture book format. Mandy, a deaf girl, touches readers with her perceptions of sound.

WebliographyHandspeak- http://www.handspeak.com/Google ImagesHandson- www.handson.orgHearing Loss Association of America- www.hearingloss.org Teaching & Learning Phonemic Awareness and Phonics

Instruction- http://www.csun.edu/~rf4497/pubs/Friedman%20Narr%20%282006%29.pdf

The Child First Campaign- http://www.ceasd.org/child-first/child-first-campaign

Children’s Fiction for Deaf- http://www.myshelf.com/deaf/children.htm

Professional Literature

Heward, William L. Exceptional Children: An Introduction to Special Education. N.p.: n.p., n.d. 310-41. Print.