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When Children are Deaf or
Hard-of-HearingEnsuring a Quality Assessment
& Thoughtful Placement
Presented By
Dee Ann Wilson, M.S.
Educational Audiologist
Northwest School for Deaf and Hard-of-Hearing ChildrenNWSDHH School District Support Team Independent Contractor
Jen Morris, M.Ed
Teacher of the Deaf
Northwest School for Deaf and Hard-of-Hearing Children
Erin Crafton, M.S., CCC-SLP
Speech-Language Pathologist
Northwest School for Deaf and Hard-of-Hearing ChildrenEdmonds School District
Learning Objectives
1. List two different types of hearing assistance technologies
and 2 limitations of them
2. List at least four different evaluation areas to consider when
assessing a student who is deaf or hard-of-hearing
3. List 3 factors to consider when determining LRE for a DHH
student
A deaf child walks into your school...
What do you do?
Times Are Changing
● More D/HH students are being educated in
the mainstream
● Early identification, improved technology,
push toward inclusion
● Over 75% of D/HH students are educated in
the mainstream*
● In 2014, 40% of deaf babies received cochlear
implants**
*http://www.raisingandeducatingdeafchildren.org/2014/01/01/deaf-and-
hard-of-hearing-students-in-the-mainstream/
**https://www.nidcd.nih.gov/about/strategic-plan/2012-2016/science-
capsule-cochlear-implants
What Makes D/HH Students
Different?
● Hearing age vs. chronological age
● Possibility of language deprivation, especially if
later identified
● Decreased incidental learning
● Decreased world knowledge (schema for learning
new information)
● Family and peer interactions can be affected;
feelings of isolation
● Often incomplete access to language, regardless
of modality
Immediate Considerations
● Put ADA accommodations into place immediately; do not wait for a re-
evaluation to be completed
● DM system, interpreter, CART, other assistive tech
● Determine primary language/modality of student○ Sometimes easier said than done
○ Don’t make assumptions!
● Records request – be sure to get audiology reports from provider, outside
therapists, private SLP, plus their school records. Obtain signed releases.
Quick Facts About Hearing Loss
● 2 to 3 out of every 1,000 babies are born with hearing loss
● 30% of children born with hearing loss have had gestational illness,
prematurity, or other complications
● About 40% of children with hearing loss exhibit another disability
● 90% of D/HH children are born to hearing parents
● About 20% of children with a genetic hearing loss have a syndrome
http://www.hearinglikeme.com/hearing-loss-simulator/
https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
http://dallashearingfoundation.org/facts/
https://www.cdc.gov/ncbddd/hearingloss/data.html
Assemble Your Evaluation Team -- ACTIVITY!
YOUR EVALUATION TEAM:
● Members of evaluation team, the Usual Suspects:
○ Psychologist
○ Audiologist
○ Speech-Language Pathologist
○ Teacher of the Deaf, if possible
● Other team members to consider:
○ Occupational Therapist
○ Physical Therapist
○ Teacher of the Visually Impaired
○ Orientation and Mobility Specialist
Time to Assess!
Ensure student’s amplification devices are
functioning
Use DM system if indicated
Test student one-on-one
Face student for oral instructions
Quiet and well-lit test room
Hearing Aids? Or Cochlear Implant?
Hearing Aids Cochlear Implant
New Technologies
Hybrid Baha
Variety of Wearing Options
DM Systems (a.k.a. FM Systems, RM-HAT)
Always consists of: 1. Transmitter for the talker
2. Receiver(s) for the listener
Premise: Improve the signal (teacher) to noise ratio
Latest generation: Digital signal
Dynamic microphone
Improved noise algorithms
Beam-forming microphones
Academic Assessment
All these should be tested: Listening
comprehension, Following Directions, Working
Memory, Phonics, pre-Reading, pre-Math, Oral
Expression
WIAT-III (Wechsler Individualized Achievement
Test, age 5+)
KTEA-3 (Kaufman Test of Educational
Achievement, age 4+)
QRI (Qualitative Reading Inventory)
Other Factors…
Qualification for SDI does not require only
consideration of standard scores; it is a
team decision (e.g., qualifying for reading
SDI as a kindergartener)
Do not WAIT until 3 years later to do
academic testing to qualify them. They
may qualify now in early reading skills,
listening comp, pre-academics….
Academic Assessment
● Interpret phonological tests (e.g., Pseudoword Decoding) with caution
● Low scores in Listening Comprehension and Following Directions often
indicate that the child will have difficulty in the mainstream setting
“On rectangle A, fold on the solid line, and on Rectangle B, fold on the dotted line,
not the solid line” (language load, auditory memory, split-attention )
● Check that amplification is on and working before testing
● Does the examiner speak/sign the student’s language? ○ Signing Exact English, American Sign Language, English, Spanish, etc.
● With deafness, if the home language is Spanish (or Korean or..) it may not be
the student’s language
● If an interpreter is used, remember to “interpret” results with caution
Cognitive Assessment
● Are nonverbal measures most appropriate?○ Verbal scores are highly correlated with success in school
● Even with nonverbal measures, do they understand the instructions?
● Consider “listening fatigue”
● What about normative samples??○ If we are considering a mainstream placement, we want to compare performance to typical
peers
○ Are we testing their cognition or their listening skills?
● Typical cognitive assessments can underestimate DHH intelligence (especially
when late identified, inconsistent amplification, inconsistent language access,
missed opportunities for world knowledge)
Social-Emotional Assessment
Possibilities to consider:
● Immature social skills due to reduced
opportunities for peer interactions
● Self-concept and isolation
● Often causes delay in theory of mind
development
● Early maternal attachment
● Deafness co-occurring with another
condition (e.g., autism)○ Depending on provider, autism can be
overdiagnosed or underdiagnosed in DHH students
● More likely to report being bullied or teased
Audiological Assessment
● Putting listening devices on a student DOES
NOT give them normal hearing
● Hearing loss: type, degree, configuration,
bilateral/unilateral, symmetry
● Middle ear status
● Speech reception thresholds
● Word recognition in quiet, in noise
● Aided information
● History: age at onset, age at amplification,
quality of amplification/fit, consistency of use,
language exposure at home, complicating
medical factors
Auditory Skills Assessment
● Auditory perception skills:
detection, discrimination,
identification, understanding
● Speech perception:
discrimination of speech in
variety of circumstances
● Self-perception
● Self advocacy
● Communication repair
● Classroom observation
Classroom Observation
● Classroom acoustics
● Teacher’s vocal quality (loudness, rate of
speech, accent, mannerisms)
● Behavior of class
● Background noise
● Seating arrangement
● Lighting, visual access to materials &
speech-reading
● Awareness of difficult listening conditions
● Self-advocacy
● Ability to follow oral instruction; reliance on other
cues
● Effectiveness of classroom and personal
amplification
Speech and Language Assessment
● D/HH students can be misleading… social conversation can sound intact, but
language gaps are still present
● BICS vs. CALP
● Unpredictable holes
● Possibility for difficulty with higher
levels of language (e.g., nonliteral
language, inferences, pragmatic
language)
● ELL considerations?
● Communication repair
○ “Deaf Nod” or bluffing
Now What?
● The evaluation will drive the IEP
● Communication Options
○ Listening and Spoken Language (LSL)
○ American Sign Language (ASL)
■ Deaf culture
■ Fully fledged language separate from English
○ Signing Exact English (SEE)
■ Based on ASL signs, put into English word order with English word
endings
○ Cued Speech
■ Handshapes that represent each sound
● Can represent different languages or accents
Washington State Educational Definitions
“DEAFNESS” means a hearing impairment that is so severe that the student is
impaired in linguistic information through hearing, with or without amplification,
that adversely affects a student’s educational performance.
“HEARING IMPAIRED” means an impairment in hearing, whether permanent or
fluctuating, that adversely affects a student’s educational performance but that is
not included under the definition of deafness.
Placement Decisions
● Options for placement
○ Mainstream program with no support or a 504
○ Mainstream placement with itinerant TOD and/or interpreter
○ Regional D/HH placement in public school
■ Edmonds School District (ASL), Tacoma Public Schools, Seattle Public
Schools, Highline SD, Federal Way (SEE self-contained classroom)
○ Separate day school?
■ Northwest School for Deaf and Hard-of-Hearing Children (SEE, PK-8)
■ Listen and Talk (LSL, Ages 3-5)
■ Hearing, Speech and Deafness Center (ASL, ages 3-5)
○ Residential school: Washington School for the Deaf (ASL)
What does LRE look like for D/HH students?
Mainstream Placement: Accommodations
Common accommodations:
● Preferential seating
● Extended Time
● Assess individually or in a small group to reduce distraction
● Visual alarms
● Check for understanding
● Closed captioning, CART (Communication
Access Real-time Translation), Interact-AS
● Amplification, use of FM/DM system
● Reader and/or scribe
● Notetaker/study guides
● Pre-teaching of Vocabulary
● Visuals
Interact-AS
Mainstream Placement: Acoustics
Acoustical Society of America -
American National Standards
Guidelines for classroom acoustics:
● Reverberation Time 0.6 sec
max.
● Background Noise 35 dBA
max.
WAC sets limits for mechanical noise
in classrooms
Adverse Effects of Noise on Learning
● Children are more affected by noise than adults
● Children do not habituate to learning in noise
● Most detrimental when learning new or complex information
● Children with history of noisy environments give up faster on tasks
● Even non-auditory tasks are affected (short-term memory, reading, writing)
Acoustic Modifications
● Carpeting
● Acoustic ceiling tiles
● Absorbent wall treatments
● Noise reducers on chair legs (hard
floors)
● Turn off or relocate noise sources
● Close doors, windows
● Use classroom sound distribution
system
● Give instruction only when quiet
● Move student to a different classroom
● Consider ALL learning environments
throughout the week
Classroom & Personal Amplification
Scope of Practice: Audiologist selects, fits, and monitors amplification
CLASSROOM SYSTEMS -
Classroom Auditory Distribution System (CADS) = Sound Field System
PERSONAL / EAR-LEVEL SYSTEMS -
Personal amplification device, DM system, or combination
Monitoring & Maintenance of Amplification
WACs state that the SCHOOL is responsible for ensuring amplification is working
● Critical that amplification devices be CHECKED and MONITORED
● School personnel need TRAINING and TOOLS for this task
● Liability!
● FM daily check sheet -- document, document, document!
http://www.successforkidswithhearingloss.com
Mainstream Placement: Itinerant TOD
Questions to consider:
-- Is the student reading on grade level?
--Do their language scores (CELF, CASL, etc) show that their Expressive/Receptive
language skills fall within the average range so that they can access Gen Ed.
content?
--Self-Advocacy is common goal area; can be provided by a great SLP, or a TOD
--Will the student have access to same-age peers at their communication level in
their communication modality?
Can a mainstream
placement provide
F.A.P.E.?
Support for the DM System,
Captions, etc.
*My student wears his DM, but he never
uses it at P.E. (clear team expectations)
*My student has a DM, but he doesn’t tell
me when it isn’t working (secret signal)
*My student doesn’t like to use the DM at all
(incentive/reward chart)
*My student has to walk to the nurse’s office
to change her hearing aid batteries (find a place
in the classroom)
All About My Hearing
Accommodations I Need
Teacher or Class Presentation
References and Further Reading
● https://successforkidswithhearingloss.com/wp-
content/uploads/2014/06/Teacher-Topics-Challenges-of-the-School-
Psychologist.pdf
● https://successforkidswithhearingloss.com/2017/12/04/one-cost-of-being-
the-lone-dhh-kid-the-need-to-assess-socialemotional-issues/
● http://www.nasponline.org/assets/Documents/Research%20and%20Policy/Po
sition%20Statements/ServingStudentsWhoAreDeaf.pdf
● https://successforkidswithhearingloss.com/wp-
content/uploads/2018/10/Resources-Addressing-the-Need-to-Include-
Children-with-Hearing-Loss.pdf
Resources
● Center for Childhood Deafness and Hearing Loss (CDHL)○ http://www.wsd.wa.gov/about-wsd/cdhl-wsd/
● Washington Sensory Disabilities Services (WSDS)○ https://www.wsdsonline.org/
● Hands and Voices (national and state chapters)○ https://wahandsandvoices.org/
● Supporting Success for Children with Hearing Loss○ https://successforkidswithhearingloss.com
● Northwest School for Deaf and Hard-of-Hearing Children School District
Support Team○ https://www.northwestschool.com/programs/school-district-support/
● Independent Consultants
Contact Us
● Erin Crafton, Speech-Language Pathologist○ [email protected]
● Jen Morris, Teacher of the Deaf○ [email protected]
● Dee Ann Wilson, Educational Audiologist○ [email protected]
