Download Children Who Are Deaf or Hard of Hearing

Chapter 10
Children Who Are Deaf
or Hard of Hearing
Historical Overview
• Debate over how to teach communication skills
– oralism vs. gestures:
–
–
–
–
Heinicke (Germany) – oral speech
de l’Épée (France) – gestures
Gallaudet (US) – gestures
Graham Bell (US) – oralism
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• Total Communication Method
– Coined in the 70s by Holcomb
– Combines the use of American Sign Language (ASL)
with oral speech
– Currently the emphasized educational approach
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• About 12% of the US population has some
degree of hearing loss; that includes 3 million
children under 18.
• Because profound hearing loss is a lowincidence disability, many schools have difficulty
providing students with needed supports
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Definitions
• Hearing losses are defined in terms of (1) the
degree of loss, (2) the age at which the loss
occurs, and (3) the type of loss.
• The terms used with hearing loss are
deafness—a hearing impairment that is severe
enough that the child cannot process linguistic
information through hearing, even when using
amplification or hearing aids, and adversely
affects the child’s educational performance
(Council for Exceptional Children, 2006);
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Definitions
• Hard of hearing—meaning all other categories
of loss, and a loss of 27 to 70 dB (see Table
10.1) and central auditory processing disorders.
• Central auditory processing disorder (CAPD
is an auditory processing disorder characterized
by difficulties with sound localization; auditory
discrimination; understanding speech sounds
against a noisy background; auditory
sequencing, memory, and pattern recognition;
sounding out words; and reading
comprehension.
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• The following chart shows the degree of
impairment and the corresponding description.
The loss is measured in decibels (dB), which is
the intensity—power or pressure—of the sound.
The frequency of the sound is the pitch and is
measured in hertz (Hz). The human ear hears
16 Hz to 16,000 Hz and speech sounds are from
250 Hz to 4,000 Hz. See Table 10.1 in the text
for more descriptions, causes, and sounds
heard at different degrees of hearing loss.
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Degree of Hearing Loss
Degree of Impairment
Description
Up to 15 dB
15-20 dB
20-40 dB
40-60 dB
60-80 dB
81+ dB
Normal
Slight
Mild
Moderate
Severe
Profound
Note: Decibel loss refers to results from the better unaided ear averaged
across the speech frequencies, source www.asha.org
(February,
2008)
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Speech reception for children with
varying degrees of hearing loss
Profound loss:
would hear nothing, not even that someone was talking.
Severe loss (Volume would be as faint as a whisper):
---ee --i-- -i--, --ee –ow –ey -u-!
Moderate loss (Volume would be faint but not as soft as a whisper) :
---ee --i-- mi--, --ee –ow –ey ru-!
Marginal loss (Volume would be diminished more than with a severe cold) :
---ee bli-- mi--, --ee –ow –ey run!
Mild loss(Volume is slightly diminished):
--ree blin- mi--, --ee –ow they run!
Normal hearing:
Three
mice,
see
how they run!
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• The outer ear is comprised of the pinna, the
temporal bone, and the auditory canal, or
external auditory meatus.
• The middle ear is composed of the tympanic
membrane, or eardrum, and the three ear
bones: the malleus, the incus, and the
stapes. The stapes lies next to the oval
window, called the gateway to the inner ear.
• The inner ear contains the cochlea and the
vestibular apparatus and the cochear, or
auditory, nerve. Problems with hearing can
be due to either the structure or function of
the ear.
http://www.ehow.com/video_4399799_partsauditory-system.html
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Figure 10.2: Ear (Anatomy)
From Freberg, L., (2006). Discovering biological psychology. 192. Used by permission of Houghton Miffl in
Harcourt Publishing Company.
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Categories of Hearing Loss
• Hearing losses can be classified into four
categories: conductive losses, sensorineural
losses, mixed losses, and central auditory
processing losses. The first three types of
hearing loss are considered to be due to
problems with auditory acuity, or the ability
to take in sounds and get these to the brain
successfully. The fourth type of hearing loss
is an auditory processing difficulty, which
means that the individual can “hear” the
sounds, but has problems understanding
them
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• A conductive hearing loss, usually within the
60- to 70-dB range, occurs when the intensity
of sound reaching the inner ear is reduced
and the sound does not fully reach the
auditory nerve. These types of losses can be
reduced through amplification, medical
treatment, or surgery.
• Sensorineural hearing losses are caused by
defects within the inner ear. Hearing loss can
result from problems in the outer ear as well
as the inner ear. This condition is referred to
as a mixed hearing loss.
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• Central auditory processing losses are
usually associated with problems or changes
in reception within the brain. These
individuals may have difficulties with sound
localization; auditory discrimination;
understanding speech sounds against a
noisy background; auditory sequencing,
memory, and pattern recognition; sounding
out words; and reading comprehension
(ASHA, 2005; Salvia et al., 2007). (Please see
Table 10.1.)
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Hearing Loss
•
•
•
•
Conductive Losses
Sensorineural Losses
Mixed Losses
Central Auditory Processing Losses
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Age of Onset of Hearing Loss
• Congenital - present at birth
• Acquired - occurs after birth
• Pre-lingual deafness – before language acquired
(no oral skills)
• Post-lingual deafness – after basic
language/speech skills acquired
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Deafness & Hearing Loss Prevalence
• 31.4 million persons in U.S. (about 10% general
population) have some degree of hearing loss
• 70,767 children (ages 6-21) received special
education in school under the category of
“hearing impairment”.
• Represents 1.3% of all students with disabilities
Better Hearing Institute, 2008
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Causes of Hearing Loss
• Approximately 50 percent of hearing losses have genetic
causes, and 50 percent are due to environmental
causes. Sometimes genetic conditions are associated
with other disabilities; examples are Down syndrome
and cleft palate.
• Seventy documented genetic syndromes exist, as well
as many other single genetic causes of deafness and
partial deafness. Environmental effects that begin before
birth are associated with illness or infections (TORCHS).
Noise pollution, infections after birth such as otitis media
and meningitis, asphyxia during the birth process, and
premature birth can also cause hearing loss.
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• Congenital loss is a hearing loss or deafness
that was present at birth.. Acquired hearing loss
is a hearing loss or deafness that has occurred
in either childhood or adulthood.
• Prelinguistic deafness refers to hearing loss or
deafness that occurs prior to acquired speech
and language, and is usually associated with
genetic or prenatal causes. Postlinguistic
deafness refers to hearing loss that occurs after
some language and speech have begun.
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• Pure-tone audiometry, the most common means
of determining hearing loss, can be used in
children from age 3 and older. The audiometer
presents pure tones in a range of sounds,
measures of frequencies, and intensities. These
are recorded on a graph called an audiogram,
which determines the range and degree of
hearing loss. Audiologists use behavioral
observation audiometry to test hearing in
children younger than 3 years of age. Play
audiometry is conducted in pleasant
environments with toys that move and make
sounds.
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• Auditory brainstem response (ABR) uses a small
microphone to determine whether the hair cells
in an infant’s ear respond to sound. If there is no
response, further testing is advised (Green,
2000).
• c. Bone Conductor Test
• For children younger than 3 years of age, a
bone conductor test can be administered. This
test measures the movement of sound through
the hearing system to the brain. The reception of
sound in the brain, recorded on a graph as the
brain’s response to vibrations, is compared
against a chart of similar responses by those
with hearing loss and used to determine the
degree of hearing loss.
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• Infants with hearing loss will still cry and babble;
as their peers began speaking, children with
hearing loss will begin using gestures. If they
are not taught a sign system, they develop their
own “home sign.”
• Communication problems associated with
hearing loss can cause social problems. Family
support, early intervention, and
professional/educational supports are key.
Mastering a communication system – whether
oral language or sign - is critical
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• Play Audiometry
• Play audiometry tests are conducted in a
pleasant environment with toys that move and
make sounds. The toys are used to elicit
responses, such as eye blinks and changes in
respiration or heartbeat (slower heartbeats
indicate attention).
http://video.google.com/videoplay?docid=43224
80960497088329#
• http://www.ehow.com/video_4399800_hearingtest-demonstration.html
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• Deaf culture has its own language – ASL – and
cultural norms.
• Many individuals who are deaf are bilingual –
they are fluent in both ASL and English (for
writing and reading). Many use “code switching”
to move between languages.
• Some specialists advocate for teaching ASL as
a first language and English as a second
language.
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Assessing a Hearing Loss
•
•
•
•
Pure-tone audiometry
Auditory brainstem response
Bone-conductor test
Play audiometry
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Problems arising
without early intervention
Degree
Description
If no intervention 0-1yr
Up to 26 dB
Normal
No problems
27-40 dB
Slight
Mild dysfunction in
language learning
41-55 dB
Mild
Auditory learning
dysfunction, mild speech
problems
56-70 dB
Moderate
Speech problems,
inattentive learning
dysfunction
71-90 dB
Severe
Severe speech problems,
inattentive learning
dysfunction
91+ dB
Profound (Extreme)
Same as above
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Characteristics
• Cognitive Development
• Language Development
• Social and Personal Adjustment
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Cognitive Development
• The majority of children with hearing loss
possess normal intelligence. Because
intelligence tests are mainly verbal, the
assessment of cognitive abilities is somewhat
skewed for children with hearing loss (Paul &
Quigley, 1994). ). A child who has not heard the
sounds of the language will not be able to
decode print if he or she is taught in the usual
method of matching speech sounds—
phonemes—to print.
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• Because phonemic awareness, or the ability to
use speech sounds, may be limited for children
who are deaf or hard of hearing, alternative
methods must be used to teach reading
(McGough & Schirmer, 2005; Trezek & Wang,
2006). If reading and writing are approached in
the traditional auditory way, a child who has not
heard the sounds and structure of language will
have difficulty decoding print. However, if the
child is taught in a visual form (ASL), his or her
chances greatly improve (Marschark, 2000).
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• In summary, through improved teaching
strategies, earlier intervention, new technology,
and medical treatments (cochlear implants),
children who are deaf or hard of hearing are
making solid gains in learning to read. Please
refer to the text for promising elements of
reading instruction for children who are deaf or
hard of hearing and discuss the techniques with
class.
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Language Development
• How do hearing losses affect a child’s language
development, and what can be done to
maximize communication potential?
• Petito and Marentette (1991) suggest that
infants are innately predisposed to learn
language and do so by simulating the
environment with babbling and/or babbling-like
gestures. Children with hearing loss use
gestures. It becomes essential for those who
interact with these children to learn the meaning
of these gestures.
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• The ability to independently generate the rules
of grammar (syntax and word order) tends to
disappear after age 6 in most children.
Therefore, if a child can be reached before age
6, that child has a greater chance of building on
what he or she has learned.
• The use of consistent, continual visual
communication can greatly enhance the
language development of any child with hearing
loss (Solnit, Taylor, & Bednarczyk, 1992). The
teacher’s and the parents’ ability to sign helps
the child in language development. It also
benefits the child’s social skills, peer interaction,
and play.
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• Social and Personal Adjustment:
• Many children with hearing loss experience
some difficulty in adjusting to a hearing-biased
world. It is not surprising, then, that many seek
communities of citizens who also have hearing
losses (Guralnick, 2001). Early identification and
intervention, increased parent training,
technological aids, and sign-language
interpreters can improve the social adjustment of
children who are deaf.
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• A curriculum called Promoting Alternative
Thinking Strategies (PATHS) teaches selfesteem and interpersonal competencies and is
useful for elementary-age children (Calderon &
Greenberg, 2000). It should be noted that the
Deaf community exists as a separate cultural
group within our society (Moores, 2000), with
ASL as their common language. Membership in
the Deaf community is a part of the individual’s
identity, and allegiance to the group is often
strong.
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Adapting the Learning Environment
• Students who are deaf or hard of hearing, like
most other populations of students with special
needs, are a heterogeneous population (Wachs,
2000). Because of this, each child will need an
individualized educational program (IEP), and
most will require services provided within all
three tiers of the RTI model.
• Early intervention is extremely important in
developing the communication skills of children
with hearing loss. Most early intervention
strategies also focus on the parent, providing a
homeschool intervention approach.
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• Preschool and elementary educational settings
demand that the teacher be skilled in working with
a child with hearing loss (and preferably have
some knowledge of ASL) to provide better visual
instructional strategies. One area that must be
addressed is reading instruction, specifically if
phonics instruction (auditory in nature) is used as
the primary means of teaching reading.
• If secondary students are several grade levels
behind their classmates, it is difficult to provide
adequate services within the general education
classroom. Wherever the child is taught, however,
there is little that should impair the child’s learning
if the teacher is willing to use more visual
communication strategies.
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• Children with hearing loss should be frequently
assessed as their needs change over time. A
multidisciplinary team including audiologists,
speech-language pathologists, and parents,
must meet to construct the IEP.
• RtI is important as many children with hearing
loss spend much of their day in the general ed
classroom:
– Tier I: more hands on activities
– Tier II: small group reading skills instruction
– Tier III: instruction in the use of hearing aids or ASL
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• Adapting Curriculum
• Research has shown that programs for students
who are deaf or hard of hearing should
concentrate on reading training, cognitive
strategies, and accelerated training for students
with high potential, and tutoring, and cooperative
parent programs that encourage academic
achievement at home.
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• Children with prelinguistic hearing loss are often
already identified before they come to school.
However, some postlinguistic hearing losses
and mild or moderate hearing losses do not
appear until the child’s social environment is
broadened through the school environment. If a
teacher suspects a hearing loss, he or she can
ask a series of questions for initial referral
purposes: (1) Does the child appear to have a
physical problem associated with the ears? (2)
Does the child articulate sounds poorly and
particularly omit consonant sounds? (3) When
listening to sound recordings (radio, television,
and music), does the student turn the volume up
so high that others complain? (?
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• 4) Does the student cock the head or turn
toward the speaker in an apparent effort to hear
better? (5) Does the student frequently request
that what has just been said be repeated? (6) Is
the student unresponsive or inattentive when
spoken to in a normal voice? (7) Is the student
reluctant to participate in oral activities
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