Transitioning from Age 3 to School Age

When a child transitions out of Early Intervention at the age of three and prepares to enter a preschool setting, their needs, goals and accommodations must be defined. This process from transferring from an IFSP to an IEP is commonly referred to as transition.  The IEP document will contain important goals and objectives to address a child’s unique needs as they prepare for kindergarten.  Under Individuals with Disabilities Education Act (IDEA) every state is responsible for ensuring services are available to eligible children from birth to age 5 through Part C or Part B.  Follow these four simple guidelines to ensure a smooth transition for the families and their children.

Children who are deaf and hard of hearing most likely receive supports of Early Intervention through an Individualized Family Service Plan (IFSP) until age 3 under Part C (Early Intervention) services. An IFSP supports the family of a child with a disability while addressing specific needs of the child and how they function.  This is done through an Individualized Educational Program (IEP) and falls under Part B (Early Childhood Special Education) services once they turn three years old.

Four Considerations to a Smooth (t)Transition

1. Help families prepare!

Arguably most important when considering the transition from an IFSP to an Individualized Education Plan (IEP), is to help your families prepare for changes in services and service providers.  Since family needs and desires will differ greatly based on the individual needs of their deaf or hard of hearing child, be sure to offer a variety of options to help families navigate the transition process.  Consider connecting the family with other families in their area who have already made the transition, arrange a visit to the new classroom and discuss program options and communication modes.   Work with your families to understand their priorities and concerns as their child transitions to preschool.  Generally, these conversations and process’ happen during the spring so a plan is in place for the start of the school year in fall.  However, it’s never too early to begin considering specific needs for the children you support and having those honest discussions with the families/caregivers!

2. Out-of-pocket Costs

Be sure to explain to families their potential out-of-pocket costs and services their child may be entitled to.  Early Intervention (Part C services) provided through an IFSP including evaluations, assessments and service coordination comes with no expense to a family.  Depending on the state EI program rules, services including but not limited to assistive technology, audiology, vision services and speech-language therapy may be provided at the expense of a family, however, per IDEA, however, families cannot be denied services due to their inability to pay.  Early Intervention services must be provided in a child’s natural environment and can take place in the home, childcare setting, local park, etc.  Once a child transitions to an IEP, all services must be provided through the public school and at no cost to families.

3. The Decision Makers

Identify the lead agency in your state to ensure the delivery of programs and services according to the federal regulations supporting Parts C and B of IDEA. The designated lead agency may be the same agency for both Part C and B or two different agencies.  Often, a state program housing Early Intervention will be the lead agency for Part C services and your state’s Department of Education will be the lead agency for Part B services.  The lead agency(ies) must ensure services and programs provided to eligible children and families under IDEA meet federal requirements in order to receive federal financial assistance. The local school district will conduct eligibility determination and individual educational planning as appropriate.

4. Eligibility

A parent/caregiver’s consent must be received to complete an evaluation, referral or placement in order to receive Part B services.  During an evaluation, assessment tools, strategies and evaluation data is compiled from parents, teachers and other professionals who work with the child.  Tests must be administered in the child’s native language and selection of assessments tailored to the suspected disability area .  The process to determine eligibility (from Part C to Part B) happens within 60 days of the referral of the initial evaluation or the date the child turns age 3, if the IFSP team has not determined that no further services are necessary. 

Parents must be given the opportunity to be a part of this ‘eligibility team’ and may obtain their own independent educational evaluation (IEE). The IEE may be paid at their own expense or possibly by the school system.  ).  The one question an eligibility team is looking to answer is ‘Does the child have a disability and need special education and required services?’ Once eligibility for special education services has been determined and a disability category has been assigned, a written plan of service (IEP) is required based on the child’s individual need(s). The IEP will include goals and objectives. The extent of needs identified will be used by the IEP team when determining the frequency, type and location of services. 

Knowledge truly is power and equipping yourself and families with resources and knowledge can help make the transition easier for students and parents.  A prepared team can ease the bridge to school age for students and parents.

Author: Teri Urban

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The post 4 Considerations for Smooth (t)Transition first appeared on Supporting Success For Children With Hearing Loss.

1. Communication Can Be Tough!

A child who is DHH may have to work harder than his/her hearing peers while at school, so during summer vacation, it’s ideal to create an environment where auditory access isn’t compromised. However, getting together at a large family gathering or at the pool or beach can quickly lead to a meltdown if too noisy or overstimulating and not accessible. When seeing large groups of family and friends, it’s always a good idea to remind them of some simple rules that benefit your child, such as tapping the child on the shoulder and saying their name to get their attention before talking to them.   Encourage the child to speak up from an early age and to never be embarrassed to say when they didn’t understand something. It can be a challenge for some parents and caregivers to point out the hearing difference of their child, but the more you can show your child that you are accepting of them and encourage them to speak up, the stronger and more confident they will be advocating as they grow.

If your child uses a Remote Microphone System (RMS) at school, you may want to consider purchasing one for personal use to bring along to restaurants, the park, and bike rides.  If your child will be playing with friends and they are responsible (as responsible as a small child can be), encourage them to give the RMS to their friends to wear. This small gesture can encourage self-advocacy, especially as they enter secondary school and will likely be responsible for passing the RMS to each of their teachers. It will also show their friends that your child does hear differently and sometimes needs different things to help them hear, and that’s okay! Ask your child’s audiologist about remote microphone hearing technology.

2. Pals with Hearing Loss are Priceless!

If your child is in a school mainstream setting, use the summer to tailor their social circles to ones where communication is effective for them – which is chatting with other deaf and hard of hearing peers!  Take advantage of all the summer has to offer and build some trips or family outings around events in your area where deaf/hard of hearing events are being offered.  Or connect with families to allow the children to Zoom, text, or otherwise chat through media frequently throughout the summer.

It’s important that our children have the opportunity to grow and understand their self-concept.  There are many national organizations whose focus is connecting families of deaf and hard of hearing children with each other.  We suggest reaching out to your local Hands & Voices chapter or AG Bell chapter to see what is being offered in your state.  These organizations are known to offer a variety of events throughout the year including gatherings, picnics, fundraisers, etc. where your child will be able to meet others just like them.  If connecting virtually fits better with your family, look no farther than the American Society for Deaf Children.  ASDC offers Friends Like Me, a virtual platform hosted weekly by a DHH Adult Mentor.  Choose from different age groups and modes of communication (oral, ASL or both).

Your child may also enjoy attending a summer camp that is geared towards deaf and hard of hearing children.  Many adults who are DHH say their camp experiences as a child were some of the most memorable pieces of their childhood and a time when they could make connections easily with other children who were like them.   There are many sleep-away and day camps that offer programs geared towards all the different age-groups and communication modalities.

3. Reading Rocks!

As a parent, you want what is best for your child.  You want them to succeed in school, ensure they have all the tools needed and not fall victim to what’s referred to as the ‘summer slide’.  Reading is perhaps the easiest, most simple thing that can be done anywhere and anytime to help develop vocabulary, literacy and attention skills!  Preferably, read books that have main characters who are deaf and hard of hearing so the child can better relate by seeing characters like themselves. See our children’s booklist!

Children who are deaf and hard of hearing benefit from having rich conversations, filled with new vocabulary and the chance the understand new words and concepts.  Check with your local library to see what summer programs they offer.  Oftentimes, summer reading programs for children come with prizes once they reach their reading goal which could be a great incentive!  Let book selections be steered by your child’s interest.  Consider reading books that have slightly advanced vocabulary that your child hasn’t been exposed to yet, such as the word ‘yacht’ instead of ‘boat’.  Cherish those teachable moments as to what a yacht is and that different objects, although the same, can have different words to describe them.

We also suggest enabling the captions on everything your child watches whether it’s a movie, TV show or YouTube video.  Even if your child isn’t a proficient reader, captions will encourage your child to begin pairing the written word with the spoken word.  It will also ensure, if they are a reader, that they won’t be missing out on their favorite movie or show.  If your child will be sleeping at a friend’s house, ask the parents if they could enable captions on the screen.  If you are going to a movie theater, plan accordingly and make sure the movie either offers open captions (on the screen), closed captioning glasses or a handheld device for your child to use.  Arrive at the theater early to give the staff time to program the glasses or hand-held device to your selected movie.  It can take additional time to plan but your child will be happy when they can laugh along and understand what’s being said!

4. Water Sports and Wet Tech – Oh No!

The idea of spending the day at the beach or pool with a child who is deaf or hard of hearing can take some additional planning to be a sure a good time is had by all.  If your child uses amplification that is not waterproof, you’ll want to be sure they have a waterproof case and a safe place to store their devices when not in the water.  If your child utilizes cochlear implants and they have a waterproof case, but sure to pack that in your beach bag along with any retention tools.   Look into Ear Gear, which is a water-resistant sleeve that fits over the hearing device to guard against expensive repairs due to sweaty heads (or running through the sprinkler – oops – moments). Regardless of amplification, be sure to bring extra batteries along or recharge your batteries the night before.  If your child is on a swim team and is having trouble following along, talk to the swim coach before practice.  Let them know your child cannot hear once their devices are off and they are in the water.  If you don’t use a visual support (such as American Sign Language or Cued Speech) perhaps your child and coach can develop signs/gestures so they can follow along and ‘see’ when the whistle is blown instead of relying on their hearing, for example.

The mentality of ‘the more the merrier’ isn’t always better when it comes to our children and social settings, especially around the water or during other fun summer activities, as large groups can be difficult to navigate.  Keeping your fun time limited to one other friend for your child can allow them to be more engaged in the conversation and able to follow along more easily.  Of course, not all children are the same, however, if your child also has trouble navigating group settings, pay attention to this when scheduling playdates at the pool or beach.  If you are going to be with a large group around the water, make sure you carve out some time for your child to interact in a small group and have some downtime when they can use their amplification devices.

5. Check, Check, Check!

When summer is in full swing, the last thing you may want to do is schedule a doctor appointment.  However, it’s important to consider scheduling an appointment with your child’s audiologist before the start of the school year.  You want to give your child all the tools they need to succeed once back in the classroom, so making sure their hearing hasn’t changed, ear molds are a proper fit, there aren’t cracks in the tubing, and cochlear implant map and hearing aid programs have been adjusted will give your child the confidence they need to enter the classroom.  Here is a handout with great information and things to remember about wearing hearing devices.

Enjoy the lazy days of summer with your child and cherish life’s teachable moments while on summer vacation!

Author: Teri Urban parent@success4kidswhl.com                                                               

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The post 5 Ways to Support Deaf or Hard of Hearing Children Over the Summer first appeared on Supporting Success For Children With Hearing Loss.

Select any of the questions below to be directed to resources that will help you to understand this issue

• Effect on Learning

What are the possible effects the hearing loss can cause at school? My child is now old enough to be starting school. How might his hearing loss affect his education? What should I know before I meet with the school team?  How will I know what to ask for?

• Responsibility for Devices

How can my child learn to be responsible for his hearing devices? What should I expect, when?  My child wears hearing devices (hearing aids or cochlear implants). What should he be doing to take care of them? How does this change as he gets older? What should I expect?

• Starting School

What information can I share with the school as my child starts a new school year or in a new school?  My child is starting preschool (or  in elementary school). What should I share with his new teacher? What should I be aware of when I meet with the school team? How will I know what to ask for?

• Tiredness

Listening is hard work when you aren’t able to hear all of the speech sounds! Children with hearing loss are usually more fatigued than their typically hearing friends or siblings. For a brief article on this topic from Britain, download Tiredness in Deaf Children

• Ear Infections

Will having many ear infections impact my child’s learning? My son has had ear infections since he was a tiny infant. Now he doesn’t say his words clearly. Can this be because of the many ear infections he has had?

• Resistance and Identity

As my child with hearing loss has gotten older, he doesn’t want to wear his hearing aids. Why? What can I do?  I have a child with hearing loss who is in upper Elementary (or Middle School, Jr. High, High School). He still seems to have learning challenges. Sometimes he resists wearing his hearing aids. What can be done to know that his needs are being met?

• Noise and Hearing

Can hearing loss be caused by noise? Is this a big deal?  We just found out that our child has a permanent hearing loss, but it’s only in one ear. This doesn’t seem like a big deal What should we know?

The post School-Aged Children with Hearing Loss first appeared on Supporting Success For Children With Hearing Loss.

Decreased speech perception translates into decreased comprehension, especially of novel words and new information. Most students who are deaf and visual communicators primarily receive communication from their classroom interpreter with little meaningful conversation or information exchange directly with peers. Regardless of the communication modality, progress through the curriculum at the same rate as class peers assumes that the student is fully participating and has received the same information as those peers. It’s all about access!

The law requires the IEP be reviewed at least once a year to determine if the child is achieving the annual goals (Section 1414(d)(4)(A)). The IEP team must revise the IEP to address any lack of expected progress and anticipated needs.

We need to not only strive to close language and learning gaps, we need to simultaneously support our students in keeping up with the day-to-day learning in the classroom. We MUST monitor progress to know if full access is truly occurring and to ensure that our students are keeping pace with classroom expectations. Without appropriate support, the trajectory of educational performance shown above is all too likely.

Students who are deaf or hard of hearing with no other learning issues – with full access to school communication – CAN progress at the expected rate IF they are receiving the appropriate intensity of focused support.

Compare Progress from Year-to-Year

Review your student files semi-annually for young children and annually for later elementary school-age students. If available, look at norm-referenced test results, like the high-stakes tests or language evaluations. Have the student’s percentile scores or standard scores stayed consistent? With your focused intervention and appropriate supports, have the student’s percentile scores improved? Or, like the previous figure depicts, has the student experienced inappropriate access and insufficient supports causing a decrease in performance over time?

For example, consider a student who scored in overall reading in

• grade 2 at the 48^thpercentile
• grade 3 at the 38^th percentile
• grade 5 at the 30^th percentile

The student still continues to fall within 1 standard deviation from the mean, or within the ‘average’ range. However, a drop of 18 percentile points over 3 years raises the question about adequate yearly progress and if the access accommodations and intensity of services have truly ‘leveled the playing field’ for the student with hearing loss. The school team may not be concerned because the student still scores ‘average’ but to a professional with a background in the impact of hearing loss on learning, this trend should demand that more focused and appropriate supports/access accommodations be provided.

Needed Supports for Keeping Pace in the Classroom

Background, or world knowledge is necessary to build surface level understanding of a specific topic. Prior knowledge is an excellent predictor of performance. Our students tend to have ‘Swiss cheese language’ with unpredictable knowledge gaps in vocabulary and concepts. They also are often limited in the number of attributes they use to describe objects or concepts, further contributing to their gaps and limited world knowledge. Imagine learning about the conquistadors if you lacked knowledge of geography, discoveries of early explorers, and that there are different countries and they may desire different things. Previewing and reviewing new vocabulary is critical for the student to ‘keep up.’

Filling the gaps. We can expect that surface learning will take longer for students with hearing loss than their typically hearing peers. Students who have a less complete understanding of surface level information are not going to benefit to the same degree, or at the same rate, during interactive activities meant to move them to deeper understanding.  “Closing the language gaps” is not just something that is a nice extra touch to provide to our students if there is a teacher of the deaf available; it is necessary for deeper learning. Add to this the fact that reduced listening ability often delays literacy skill development and slows reading fluency. Just teaching vocabulary, without sufficient phonological awareness, will not develop the reading fluency the students need for comprehension at the pace of peers. Filling in the gaps in prior knowledge is necessary if a child is to be able to develop the surface learning that is prerequisite to developing deeper understanding. Without this surface learning, a deeper understanding is not possible.

Conversational inequalities. Research⁴ has indicated that during one-on-one conversations in a quiet setting, students who are hard of hearing have conversational skills equivalent to their hearing peers. In a typical mainstream classroom, students with hearing loss make fewer overall communication attempts than their hearing peers. They also often seem unaware when their peers try to initiate conversation and do not attempt to maintain the conversation. When they attempt to maintain the conversation, they generally use one-to two-word phrases and do not add new information. The research found that in a 1:1 conversation, 75% of the conversation maintenance attempts by children with hearing loss were appropriate compared to 100% for hearing peers. They frequently tried to maintain the conversation by bringing up a topic that was unrelated to the conversation. In other words, they were not aware enough of the content of the conversation to contribute information, so they brought up a new topic.

Educational practices that seek to move students to deeper understanding typically involve interaction with peers. This is often very challenging for students with hearing loss when acoustic access inequality in the classroom results in conversational misunderstandings for students with hearing loss. This provides a powerful argument for the use of hearing assistance technology (HAT) that will improve perception of peer voices in 1:1 or group settings.

Challenges repairing breakdowns. Another aspect of conversation relates to what a person does when they do not fully understand. One study⁵ found that persons with hearing loss were able to cue into changes in topic but had much more difficulty when a shift in topic was made during the conversation. The research findings can be summarized as, “the more predictable the conversation, the fewer the likely breakdowns.” The teacher needs to be aware of this issue when pairing the student with different partners or groups. Moving to a quieter area for discussion will not ensure full participation by the student with hearing loss but it will make participation easier and more likely. Including him or her in a group that is more likely to stick to the topic will heighten the value of the exercise for the learner with hearing loss.

Keeping up in the classroom is a challenge for children with hearing loss due to access issues that interfere with understanding conversational communication and the gaps in knowledge resulting from decreased auditory access since infancy (or sign communication with limited language models since infancy). Filling the gaps of vocabulary and phonological awareness is necessary for students to keep up with class expectations for developing surface learning. Access to classroom discussion and for all group activities is a prerequisite for deep learning to occur. Providing the appropriate access technology is a necessity to facilitate deeper learning to occur within the classroom. Selecting appropriate group partners and honing communication repair skills is also critical to students with hearing loss achieving at the same rate and to the same level as peers.

Considerations for Monitoring Progress

ASL Content Standards – K – 12.  Whichever communication modality is used by a student, he or she must have the skills to adequately communicate both receptively and expressively.  Most families at this point prefer that their child learn to listen and speak. This preference does not always result in a child who has school entry skills. Whether the family has chosen to use sign from birth, or it is the modality deemed to be most effective for learning by a school team due to child’s lack of progress learning to listen and speak – a student must progress through learning ASL in a developmental sequence to prepare them to make academic gains at least at the rate of their class peers. Developed by Gallaudet, the ASL Content Standards for K-12 grade students  were developed to ensure that children learn ASL in much the same way that hearing children in the US acquire and learn English. The Standards are a huge step forward in determining the student instruction needed and monitoring progress of ASL knowledge and use.

CURRICULUM BASED MEASURES: There is a need for functional assessments to monitor students’ academic performance. Curriculum based measures provide a specific approach to measuring student learning that includes repeated measurement (weekly, monthly) across extended periods of time using general outcome indicators that are sensitive in the rate of change demonstrated in the performance of a task of the same difficulty. While curriculum-based measures (CBM) have been commonly used in public education, it is appropriate to consider CBM use for students who are deaf/hard of hearing specifically. Developed as part of a grant from the U.S. Office of Special Education Programs, the University of Minnesota has developed extensive progress CBM materials designed specifically for students who have hearing loss and/or language differences. Go to the Education Resources for Teachers of Deaf/Hard of Hearing Students resource page for extensive training resources for teachers and specific means to monitor student progress. This truly is an amazing resource and would be great for professional learning collaboratives or self-study. The measures take only a few minutes each week!

MAZE ASSESSMENT: Monitoring performance via the MAZE assessment is a common form of curriculum-based measurement. Maze presents sentences or short stories with every 7th word missing. The student must select which of 3 words best fits the missing word in the sentence. Clearly, as can be seen in the bar graph, even our students with hearing loss who do not have IEP services and supports are not performing like their age peers. Learn more about creating MAZE reading passages here.

Monitoring Progress of Expanded Core Skills

Expanded core curriculum refers to those skills that students with hearing loss need to learn to be able to access the general education curriculum and fully participate. Even if a student is provided access to effective communication as required by Title II of the ADA, he or she still needs to learn the skills to independently, and confidently, navigate as a person with hearing loss in a mainstream setting. These areas will not be taught specifically and yet they must be learned if full participation in the classroom is expected.

Per the Iowa Expanded Core Curriculum guidance, hearing loss adds a dimension to learning that requires explicit teaching, such as information gained through incidental learning. It has been estimated that for persons without hearing loss, 80% of information learned is acquired incidentally. No effort is required. Any type of hearing loss interrupts this automatic path to gain information. This incidental information must be delivered directly to students who are deaf or hard of hearing.  Two hierarchies for self-advocacy are the Guide to Self-Advocacy Skill Development and the Student Expectations for Advocacy and Monitoring (SEAM).

Most teachers without specialized training related to hearing loss do not have the expertise to address the unique needs of students who are deaf or hard of hearing. Therefore, IFSP & IEP team collaboration with educational audiologists and teachers of students who are deaf or hard of hearing is necessary in addressing academic and social instruction and the assessment of these areas. In order to close this information gap, the Expanded Core Curriculum for Students who are Deaf or Hard of Hearing (ECC-DHH) was developed. Texas has developed a Livebinder with extensive information about ECC and resources to support implementation.

Collect and use data in planning for next year’s student success!

References:

1. 1. Fisher, Frey, Hattie (2016) Visible Learning for Literacy Grades K-12: Implementing the Practices that Work Best to Accelerate Student Learning. Corwin/SAGE, Thousand Oaks, California
2. 2. Yoshinaga-Itano (2010). The longitudinal language learning of infants and children with hearing loss. ASHA Virtual EHDI Conference, October.
3. 3. Meyer, Kym (8/17/2017). Wait – There’s a Student with Hearing Loss Coming into My Class? Webinar viewable at https://www.youtube.com/watch?v=r3ytOawiYuI&feature=youtu.be
4. 4. Duncan (2001). Conversational skills of children with hearing loss and children with normal hearing in an integrated setting. The Volta Review, 101(4), 193-211.
5. 5. Caissie (2002). Conversational topic shifting and its effect on communication breakdowns for individuals with hearing loss. The Volta Review, 102(2), 45-56

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The post Learning Progress Equal to Peers? first appeared on Supporting Success For Children With Hearing Loss.

Students with hearing devices are typically educated in their neighborhood schools and are the only ones in their grade or the school to have a hearing loss. Everyone wants students to have a good experience in school. Often part of this desire by families is for their child to not feel singled out as ‘different.’ While it is true that our students are just ‘normal kids who happen to be hard of hearing or deaf’, it is also true that having a hearing loss means that they will be different in some ways from their peers.

What does this approach mean for the student?

It does not take calling attention to the hearing loss for the class peers to recognize that there is a hearing loss – or something – different about the child. In any group where the same people are together day after day the fact that one of the group wears hearing devices will soon become known. Either by seeing the hearing devices, or by experiencing the child not responding typically in certain situations (listening in noise, distance, fast/quiet conversations, etc.) the other students will identify the child as being different.

Psychosocial development informs us that between age 4-6 years that children are learning what is acceptable and not acceptable to the peer group. Research has indicated that early rejection by peers is associated with persistent academic and social difficulties. By including the child with hearing loss in the mainstream environment without letting the peers know anything about the child’s hearing devices or communication needs the child faces exclusion from the peer group and often has no knowledge or strategies to cope with the situation.

Example of cascading effects of not informing peers of the hearing loss/hearing devices:

Jimmy is excited to start kindergarten. The first day when he is sitting with the  group the boy next to him says loudly “What are those things in your ears.” Jimmy has always been around his family and others who know about the hearing aids so he hasn’t been prepared for questions like these. He feels confused and ashamed. He says, “They’re my hearing aids.” The other boy makes a grab for the aid so he can see it better and they get into a tussle. The teacher calls them out to stop fighting. On the first day of kindergarten Jimmy learned that his hearing aids get him in trouble, and other kids look at him funny. The students don’t know what ‘those things’ are or why he needs them so they start to tease and avoid him. Even though he has worn hearing aids as long as he can remember, he starts to wonder what would happen if he ‘forgets’ them at home…

Setting the stage for rejection of hearing devices

We develop our identifies by defining ourselves as members of various groups. To develop a healthy identity where it is okay to be a person who uses hearing devices, a child must be exposed to, and interact with, other children who use hearing devices. In the current model of full inclusion, it is becoming less and less likely that a student with hearing devices will see another student who is hard of hearing. As the acceptance of peers becomes more important in grade 2 and increases throughout middle school, it becomes more likely for the child who uses hearing devices to want to be ‘normal’, meaning not use hearing aids and/or a DM system. It is not surprising that there are now reports of more children rejecting hearing devices, especially DM systems, at earlier ages than previously, when they had regular interactions with peers who used hearing devices.

What can be done to develop students who feel good about themselves
and ready to deal with peer acceptance issues?

• Before he enters kindergarten if possible, prepare the child that he will be asked questions
  • Other kids probably haven’t seen a child using hearing aids and won’t know what they are
  • He will be asked questions about what the hearing devices are and why he uses them
  • Other children may want to handle the devices and he needs to be able to discourage this appropriately, so they are not broken
  • People do not understand what it means to have a hearing loss.

• Work with the child to develop an understanding of what a hearing loss is, and what that means
  • He knows he is the kid in the family that wears hearing aids but is likely to not have a clear understanding of why.
  • Use materials like the CHILD checklist questions and the My World tool (soon to be an app!) to discuss how the hearing loss means he has a smaller ‘listening bubble’ and challenges listening in noise, at a distance, and when people talk fast or have accents.
  • The hearing aids help him – A LOT! Unless he understands what it means to have a hearing loss and how the hearing aids help him, he won’t be able to explain it to others when they ask or to advocate for himself when he knows he will have a hard time hearing and understanding.

• • Inservice the class peers
    • Whether the child wants to play a role in talking about hearing and listening with his classmates or not, an adult needs to set the stage for student acceptance (teacher, parent, DHH specialist)
    • Discuss the importance of hearing and being a good listener in the classroom. What happens if someone can’t hear as well as others? Some children are born with ears that do not work as well as other peoples and they use hearing aids. Etc.
    • It is especially hard to understand in noise and when someone is talking at a distance. This makes it seem like the person could be ignoring you, but that is not true.
    • Read a book to the class, like Eggbert the Slightly Cracked Egg roughly for preschool through grade 2, Friends, Like You for grades 2-5, and El Deafo for grades 3-6.
    • Discuss how to be respectful when talking to others. Get their attention first, etc.
    • Demonstrate the use of the DM system. Allow the child to ‘shine’ as the teacher steps away and quietly asks a question that the rest of the class cannot hear but the child using the DM system can answer.
    • Answer questions – the classmates will be curious!

• He WILL be teased. What should he do?
  • While some children will ask about the hearing devices because they are curious, others will tease the child. Discuss teasing:
    • Why do children tease?
    • Is he the only one who gets teased? Only kids with hearing aids get teased?
    • How should he avoid bullying situations?
    • Practice responses to typical questions and teasing situations
  • Refer to Building Self-Confidence and Resilience to Maximize Acceptance for materials on teaching for resilience to teasing

• Make regular connections between DHH peers is critical for success
  • Children who connect with others who have similar hearing loss and device use will be more self-confident and resilient to peer pressure. Holding regular group meetings digitally (i.e., Skype, Zoom, etc.) among students to meet instructional goals for self-advocacy is an effective way to increase student success – socially, emotionally, and academically!

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The post We Want Him to be “Normal”… first appeared on Supporting Success For Children With Hearing Loss.

If a student who was low vision was continually knocking into people, desks, and classroom walls due to the inability to clearly see everything, a vision specialist would likely be called in to assist the student in developing appropriate orientation and mobility skills. A student with hearing loss often incompletely hears, misses spoken information, or misunderstands what is said. Self-Advocacy training is to a student with hearing loss what orientation and mobility training is to a student with visual impairment.

Students do not know what they didn’t hear because they didn’t hear it – yet they are held accountable for receiving and fully understanding this information. Full participation in the classroom requires that a student recognize when a communication breakdown occurs, and self-advocate for their listening and learning needs. Students who are deaf or hard of hearing must have the knowledge and skills to access accommodations and support in any setting and as an integral part of an independent adulthood. Ideally, students would have instruction in self-advocacy from preschool through grade 4 (about age 10). As they reach the tween and teen years, focus should change on supporting the student’s ability to problem-solve communication issues as part of their self-determination of future goals.

Components of Self-Advocacy: Following are basic questions that students with hearing loss typically require instruction in so that they can understand their hearing needs and respond appropriately.

Self-Advocacy

1. 1. What does it mean to have a hearing loss?
2. 2. Why do I have problems understanding (relate to hearing loss and language issues)?
3. 3. How does my hearing loss affect me (school, socially)?
4. 4. When do I have problems understanding what people say?
5. 5. How important are my hearing devices?
6. 6. How do I know when my hearing devices are not working?
7. 7. What should I do when they are not working?
8. 8. What can I do when I know I have not heard what was said (specific self-advocacy & communication repair strategies)?

Self-Determination

1. 1. How much am I willing to have the hearing loss impact how well I do in school (planning/future goals)?
2. 2. When is it critical for me to disclose my hearing loss (problem solving)?
3. 3. What are my legal rights to access, supports, and services?

From the US Office of Civil Rights:

We need to encourage students to understand their disability.

• They need to know the functional limitations that result from their disability.
• Understand their strengths and weaknesses. Be able to explain their disability to others.
• Be able to their difficulties in the past, and what has helped them overcome such problems.
• This should include specific adjustments or strategies that might work in specific situation.
• They must practice explaining their disability, as well as why they need certain accommodations, supports, or services.

U.S. Department of Education, Office for Civil Rights, Transition of Students With Disabilities to Postsecondary Education: A Guide for High School Educators, Washington, D.C., 2007

He does not know what he did not hear.

This reality underlies the requirement to teach self-advocacy, specifically teaching the student about what he does hear, does not hear and under what conditions, and how to use situational awareness to recognize when he likely missed information. Some knowledge of hearing loss teaching and assessment resources:

1. 1. Advocacy in Action Self-Advocacy Curriculum
2. 2. Audiology Self-Advocacy Checklist – Elementary School  Middle School  High School
3. 3. Building Skills for Success in the Fast-Paced Classroom
4. 4. ELFLing
5. 5. Monkey Talk Self-Advocacy Game
6. 6. Phonak Guide to Access Planning
7. 7. Recorded Functional Listening Evaluation Using Sentences (FLE)
8. 9. Steps to Success Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Hearing Device Use and Troubleshooting

Some knowledge of hearing device use teaching and assessment resources:

1. 1. Advocacy in Action Self-Advocacy Curriculum
2. 2. Building Skills for Independence in the Mainstream
3. 3. SEAM – Student Expectations for Advocacy & Monitoring Listening and Hearing Technology (PDF)
4. 4. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Self-Advocacy Strategies

Some knowledge of self-advocacy skills teaching and assessment resources:

1. 1. Advocacy in Action Self-Advocacy Curriculum
2. 2. Building Skills for Independence in the Mainstream
3. 3. Building Skills for Success in the Fast-Paced Classroom
4. 4. COACH: Self-Advocacy & Transition Skills for Secondary Students who are Deaf/Hard of Hearing
5. 5. Guide to Self-Advocacy Skill Development: Suggestions for Sequence of Skill Attainment (PDF)
6. 6. Monkey Talk Self-Advocacy Game
7. 7. Phonak Guide to Access Planning
8. 8. SCRIPT 2^nd Ed: Student Communication Repair Inventory & Practical Training
9. 9. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing
10. 10. What’s the Problem Game

Success in the general education setting requires an ongoing instruction program in self-advocacy skills needs, including hearing aid independence, to be a part of the services provided to students with hearing loss as part of their IEP or 504 Plan.

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A research study from 2006¹ delved into the ingredientsfor success for students with hearing loss. While the article focused on students who were orally educated, many of the factors also apply to students who are visual communicators in the inclusive education environment.

The findings resulted from a series of focus groups with young people with hearing loss, their parents, and itinerant teachers of the deaf and hard of hearing. The findings support that successful inclusion requires a commitment from various sources and respectful partnerships among the school team, including parents.

Low Incidence, but More Children than You May Think – Increasing numbers of infants with hearing loss continue to be early identified within the United States, however the most recent data (2016) indicates that, of more than 65,000 infants failing newborn hearing screening, over 16,500 (25%) were lost to follow up and did not go through the diagnostic process. Approximately 10% of babies failing hearing screen are identified with hearing loss. Thus, it can be surmised that more than a thousand babies who were lost to follow up each year will enter school with hearing loss without the benefit of early intervention. Of the 2016 babies identified with hearing loss for whom early intervention data was reported, almost 20% never received early intervention services. While early hearing loss detection and intervention (EHDI) in the US has been a huge success in the last 20 years, it is clear that we continue to have a significant proportion of children with congenital hearing loss who are unidentified, and/or receive no timely intervention despite failing newborn hearing screening. Add to this number the children with progressive or otherwise acquired hearing loss who passed newborn hearing screening. These children too are likely to have gone without timely early intervention resulting in a developmental impact that is a educational crisis. It has been reported that approximately 7% of children in school have some degree of unilateral or bilateral hearing loss, or 25 times as many children in school with hearing loss as there are at birth.

Educational Impact – Due to this and other factors, children with hearing loss can often have significant language delay (i.e., more than 6 months), resulting in their difficulty not only catching up in their areas of delay, but also keeping pace in the inclusive classroom for which significant communication access barriers are an everyday reality. The goal of an appropriate educational placement is to match the needs of the student to the continuum of services available in a school or school district. The strong move to full inclusion within the US has reduced the number of day school, center-based and resource room settings specific to students with hearing loss, creating a landscape that increasingly looks ‘one-size-fits-all’ – the inclusive setting.

It is critical for parents, school teams, and especially specialists in the education of children with hearing loss to fully understand what is required for these children to succeed in their neighborhood schools. Inclusion focuses on acceptance rather than exclusion of children with disabilities in the classroom, school and community. It is being accepted as having overall beneficial effects. For more information on inclusion benefits and the specific serious considerations for students with hearing loss refer to the October 2017 Supporting Success Update article, Is the Inclusion Model Good for Students with Hearing Loss?

Predictors of Successful Inclusion

These predictors have often focused on the individual characteristics of the students themselves. It has been common to place pressure on the students themselves, holding them primarily responsible for their own success or failure within the mainstream. The characteristics include:

• Early identification of hearing loss
• Early and consistent use of amplification (in the case of visual learners it would be early and consistent use of fluent, vocabulary rich ASL skills or other form of visual communication)
• Early family-oriented infant and preschool programming
• High level of parental involvement in early childhood
• Knowledgeable development of auditory and spoken language skills (in the case of visual learners, knowledgeable development of visual communication skills)
• Early placement into regular school (between age 3-6) with support services as required
• Reading/writing ability commensurate with peers
• High levels of speech intelligibility
• Good organizational skills
• Proactive, determined to succeed and enthusiastic about learning
• Taking responsibility for their own educational success by keeping up with homework, planning/reading ahead, and requesting help as necessary
• Advocating for their own needs including active problem-solving skills to address their communication and learning challenges
• Being outgoing, having a good sense of humor, and being open to discussing and explaining the hearing loss to others

What is success?

There are a variety of ways in which ‘success’ has been defined, including:

• Academic achievement
• Receptive/expressive language
• Performance on standardized measures of learning

These elements do not ensure that a student will be able to make a successful adjustment to adult living. Success in inclusive settings needs to be defined in terms of social development, along with communication and academic achievement.

Elements necessary for success include:

• the need for detailed planning and close examination of educational alternatives based on the abilities and needs of the individual child prior to classroom placement
• in-depth in-service training for teachers and other professionals
• ongoing support of students and teachers in facilitating inclusion and
• the importance of psycho-social considerations in planning for successful educational placements

Barriers to Success

• Classroom teachers who lack information, preparation, and/or interest in understanding the effects of hearing loss on communication development and academic performance
  • Teachers unwilling to invest the additional time and effort required to teach the student effectively
  • Teachers who have negative attitudes toward inclusion generally or towards integrating students with hearing loss in particular
  • Teachers who are unwilling to maintain communication with parents or solicit their involvement
  • Underestimating the potential abilities of students with hearing loss; having reduced expectations with respect to learning or social behavior
  • Drawing excessive attention to the student’s hearing loss
  • Teacher unwillingness to use assistive technology and learn adapted teaching strategies in order to make information more accessible to students with hearing loss
• Itinerant teachers who
  • are inflexible in scheduling individual sessions according to the student’s class schedule
  • set limits for the student, such as opposing enrollment in foreign language or music classes
  • spotlight the student with hearing loss by drawing excessive attention to their hearing challenges
• Peer barriers
  • Were perceived as acting either as barriers to the inclusion of the student, lacking in sensitivity to hearing loss and the needs of these peers including overemphasizing the hearing loss and making the students feel conspicuous
  • Having new peer groups frequently throughout their school career, resulting in the need to constantly disclose the hearing loss and deal with peer reactions, questions, comments
  • Resentment towards the child with hearing loss due to perceived favoritism or reduced classroom demands
  • Peers who tease the students or intentionally exclude them from social activities during school, especially in later elementary years through high school
• Administrative barriers
  • Lack of openness to a team approach to inclusion, including parents as partners
  • Lack of consistency in services provided
  • Placement in classrooms with large student-teacher ratios
  • Lack of budgetary consideration for the purchase of assistive hearing/communication technology and acoustic modifications
  • Lack of commitment to funding resource support services for both teachers and students
• Parent barriers
  • Unfamiliarity with the educational system
  • Lack of advocacy skills or unwillingness/inability to take the time needed to advocate with the school and/or work with their children at home
  • Abdicating responsibility for the child’s learning once they enter school, rather than maintaining an ongoing involvement in their child’s educational progress
• Additional barriers posed by the student with hearing loss
  • Being shy and lacking assertiveness, which reinforces unwillingness to participate socially and academically

 Facilitators to Success

• The role of the itinerant teacher was the most frequent and important facilitator to inclusion mentioned across all groups (teachers, parents, students)
  • Developing individualized programs to promote language, social and academic skills
  • Sensitizing classroom teachers and peers to issues related to hearing loss and use of classroom hearing/communication technology
  • Consulting regularly with classroom teachers
  • Coordinating school-based services and programs
  • Encouraging families as well as the students to take responsibility for the proper functioning of hearing aid technology
  • Supporting skill development and situations that promote student independence
  • Respecting student opinions related to selection of elective classes and having input into use of assistive technology in class
• Cooperative Principals who support the roles of support professionals
  • Support role of the itinerant teacher
  • Support and encourage the classroom teacher’s efforts to facilitate the student’s effective learning
  • Support budgetary considerations to promote success of students with hearing loss
  • Promoting a team approach to case management that emphasizes the inclusion of parents
  • Provision for the continuity of services from support professionals over several years
  • Establishing an atmosphere of acceptance within the school
  • Developing a strong volunteer network in the school
  • Sensitivity to the need for a reduced teacher-student ratio in the classroom
• Classroom teachers who have positive attitudes toward the concept of inclusion
  • Flexibility toward assignments and testing
  • Open to suggestions by the itinerant teachers
  • Open to use of classroom hearing/communication technology
  • Facilitative teaching strategies (i.e., facing the class while teaching, writing notes and assignments on the board, providing class notes, speaking at a slightly slower rate, facilitating the use of buddies and notetakers in class, providing hands-on opportunities for learning)
  • Communicating regularly with parents
  • Sensitive to the needs of students with hearing loss
  • Attitude wherein they “feel like they can make a difference” in the education of the child with hearing loss
  • Individual attention
• Classroom hearing/communication technology used consistently and appropriately
  • Technology is readily accessible to teachers/student
  • Technology is up-to-date
  • Technology is maintained in good working order
  • Technology is not forced upon the student
• Peers who
  • are perceived as acting as facilitators to the inclusion of the student, with sensitivity to hearing loss and the needs of these peers without making them feel conspicuous
  • are willing to act in the role as notetaker
  • are willing to act as communication, academic, and social interpreters for students with hearing loss
  • attend the same school and classes with the student over time, establishing long-term relationships with a body of peers who know the student, his needs, and accept the student for who he is
• Parents who have an assertive attitude and actively advocate to obtain essential services for their children in a school setting
  • Become aware of educational policies/procedures relating to placement and evaluation of progress
  • Membership on local school board or parent committees
  • Attending program review committees
  • Building a positive relationship with the itinerant and classroom teachers and administrators
  • Helping with homework, follow up on topics and concepts discussed in class, and ongoing intensive work on the language (and speech) development of their children

Students with Hearing Loss who are English Language Learners

A recent article² on students with hearing loss who are English language learners (DHH EL) identified the lack of appropriate assessments and resources specifically designed for students who are DHH EL. Service providers must adapt resources from other sources or develop their own resources to meet the needs of these students. The article states that collaboration between the general education teacher, EL teachers, and special education teachers should focus on a) identifying specific content and/or skills that can be taught or reinforced by EL teachers and/or special education teachers; b) ensuring that instruction in these concepts and/or skills will be consistent across teachers and programs, and c) preventing gaps, redundancies, and/or conflicts in instruction.

Summary

Full inclusion of students with hearing loss is becoming more common. It is important for specialists in the education of students with hearing loss to recognize the internal and external factors that facilitate student success in these settings, and also the barriers to this success. Successful inclusion requires commitment from numerous sources. The provision of adequate support systems of students, teachers, and parents is an essential component of inclusion. It is facilitated when there is a partnership between knowledgeable families, professionals and children. Students with hearing loss themselves cannot be held solely responsible for the success or failure of their integrated experiences. The majority of barriers to successful inclusion are associated with the lack of knowledge, negative attitudes, and insensitivity of other key players in the inclusion process.

References

1. Eriks-Brophy, A., Durieux-Smith, A., Olds, J., Fitzpatrick, E., Duquett, C., and Whittingham, J. (2006). Facilitators and Barriers to the Inclusion of Orally Educated Children and Youth with Hearing Loss in Schools: Promoting Partnerships to Support Inclusion. The Volta Review, 106(1), 53-88.

Becker, S.J. & Bowen, S.K. (2018). Service Providers’ Perspective on the Education of Students Who are Deaf or Hard of Hearing and English Learners. American Annals of the Deaf, 163(3), 356-373

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It has been said that reading is parasitic on language, but more fundamentally, verbal language learning is reliant on hearing the sounds of speech throughout everyday activities and environments. Therefore, phonological skills reflect a child’s fine-tuned auditory perception ability. The 2000 National Reading Panel, in their report: Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction, stated that “the best predictor of reading difficulty in kindergarten or first grade is the inability to segment words and syllables into constituent sound units (phonemic awareness).” Whether a child has the residual hearing for this fine auditory discrimination or teaching/learning is via cued speech or visual phonics, it is clear that children with hearing loss must hone their phonemic awareness skills if they are ever to achieve the reading fluency needed to keep up in secondary school.

Phonologic Awareness

Based on this necessary foundation, it is critical that we (1) assess the phonological awareness ability of all young children with hearing loss (see recommended assessments below), and (2) teach to the phonemic awareness weaknesses identified^{4, 5, 6}. Reading Reflex provides a sound teaching methodology that will enhance the learning of students who are deaf or hard of hearing. Yes, this teaching may take 30-60 minutes PER DAY during most of one school year for 4, 5, or 6-year-olds and NO, we cannot assume that they will learn it ‘through the air’ at the same rate or to the necessary proficiency as their hearing classmates. Chipper Chat provides a means functionally assess the 12 areas of phonological awareness, teach to very specific skills, and to continually monitor progress. It can be used for honing PA skills even into secondary school.

Comprehension

“Vocabulary knowledge is knowledge; the knowledge of a word not only implies a definition, but also implies how that word fits into the world⁷“.  Students who learn vocabulary through multiple and varied activities have an increased likelihood of retaining and comprehending word meanings and their proper applications⁸. Using materials that provide meaning of words visually, simple definitions, and sentences, such as the Vocabulary Enhancement Glossary can be very beneficial to students with hearing loss. Reading fluency cannot be achieved by working on phonemic awareness alone. A student must also be able to quickly identify and understand the words spoken. With the typical ‘Swiss cheese language’ of children with hearing loss, lack of comprehension due to missing vocabulary is more of a norm, than an exception. Quick functional assessment of comprehension through use of the cloze procedure can be very revealing.

Syntax/Grammar

Poor syntactical development will result in weak reading and writing development. By the time most typically hearing students are age 5-6 they understand and can use basic grammar and syntax in their speech, writing, and to help understand meaning. Due to decreased exposure to verbal language, it is likely that the student with hearing loss will not learn these rules at the same rate, or as completely as their age peers. Poor syntax hampers students in their effort to access and apply their known vocabulary to the reading process. As with phonological awareness, functional assessment of syntax/grammar knowledge is necessary so that pinpointed instruction can occur. Cracking the Grammar Code provides free functional assessments and workbooks with activities to build skills at the point at which the deficit is identified on the assessment. We cannot assume that there is ‘no problem’ nor that the student will ‘catch up’ with exposure in the classroom.

Summary

The tried and true methods of meaningfully reviewing vocabulary before reading a story or new content unit is important for almost all student IEPs. This does not mean simply having the student spit back the new words and brief meanings of each. Simple vocabulary review is tutoring. While some review at home and by a paraprofessional at school will be of benefit, there is intensive work (usually 1:1) to be done to build the web of understanding based on what the student already knows. Strengthening the attributes of each word will further build the web of understanding.

Truly exploring the word in relation to building the overall knowledge base is teaching. Vocabulary instruction, with focus on phonological awareness and syntax/grammar, is the ‘bread and butter’ of teaching students with hearing loss.

Resources

1. Dehaene S. (2009). Reading in the Brain: The Science and Evolution of a Human Invention. New York: Penguin.

2. Beck DL, Flexer C. Listening is where hearing meets brain…in children and adults. Hearing Review. 2011;18(2):30-35. http://www.hearingreview.com/2011/02/listening-is-where-hearing-meets-brain-in-children-and-adults/

3. One World Literacy Foundation: http://www.oneworldliteracyfoundation.org/index.php/why-support-owl/iliteracy-statisctics.html

4. TOPEL – Test of Preschool Early Literacy (norm-referenced ages 3-6 years)

5. PAT-2 – Phonological Awareness Test 2 (norm-referenced ages 5-9 years, gr K-4)

6. Phonological Awareness Chipper Chat (functional assessments for each of the 12 areas of PA to foster focused instruction)

7. Stahl, S. (2005): https://www.readnaturally.com/research/5-components-of-reading/vocabulary

8. Pressley, M. & Woloshyn, V. (1995). Cognitive strategy instruction that really improves children’s academic performance. Cambridge, MA: Brookline Books.

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This article focuses on the ‘unseen’ challenges that children with hearing loss often experience when trying to keep up in the regular education setting.v

On the way to deeper understanding: For students with hearing loss, keeping pace in moving to a deeper level of understanding can be very challenging. A favorite study was reported by Christie Yoshinaga-Itano in 2010² and considered language learning of students with hearing loss from age 4 to age 7. There were 4 categories of results: children who were delayed at age 4 and still language delayed at age 7 (45%), those who had language within the normal range and 4 and still did at 7 (35%), those who actually closed their language learning gap from age 4 to age 7 (15%), and 10% of the children had language within the normal range at age 4, but due to lack of access and/or appropriate instructional support, developed a learning gap by age 7. Clearly, it cannot be assumed that just because a student has ‘okay’ language at school entry that they will be able to keep up with class expectations across the academic years.

Background, or world knowledge is necessary to build surface level understanding of a specific topic. Prior knowledge is an excellent predictor of performance. Our students tend to have ‘Swiss cheese language’ with unpredictable knowledge gaps in vocabulary and concepts. They also are often limited in the number of attributes they use to describe objects or concepts, further contributing to their gaps and limited world knowledge. Imagine learning about the conquistadors if you lacked knowledge of geography, discoveries of early explorers, and that there are different countries and they may desire different things.

Examples of Student Misunderstanding of Teacher Instruction³ 

“The Indians were dying because of the drought and the famine.” Student asked: “Why were they dying if they had all that fish?”  Lack of discrimination between d/t and f/s. Student thought the words ‘trout’ and ‘salmon’ were said.

Book Chicka Chicka Boom Boom was being read aloud by the teacher: “A told B and B told C, I’ll meet you at the top of the coconut tree.” At the end of the lesson, when asked to retell what was said the student replied, “Today we learned about cocoon trees.”  Thereby demonstrating that the vocabulary ‘coconut tree’ needed to be pretaught and connected to knowledge of other trees before the teacher read the story.

Filling the gaps. We can expect that surface learning will take longer for students with hearing loss than their typically hearing peers. Students who have a less complete understanding of surface level information are not going to benefit to the same degree, or at the same rate, during interactive activities meant to move them to deeper understanding.  “Closing the language gaps” is not just something that is a nice extra touch to provide to our students if there is a teacher of the deaf available; it is necessary for deeper learning. Add to this the fact that reduced precision listening ability often delays literacy skill development and slows reading fluency. Just teaching vocabulary, without sufficient phonological awareness, will not develop the reading fluency the students need for comprehension at the pace of peers. Filling in the gaps in prior knowledge is necessary if a child is to be able to develop the surface learning that is prerequisite to developing deeper understanding. Without this surface learning, a deeper understanding is not possible.

Conversational inequalities. Research⁴ has indicated that during one-on-one conversations in a quiet setting, students who are hard of hearing have conversational skills equivalent to their hearing peers. This includes skills for initiating a conversation, maintaining a dialogue over several turns, shifting the topic, and terminating the conversation. In a typical mainstream classroom, there are many choices for communication partners along with background noise, reverberation, and listening at distances beyond 3 feet that interfere with speech perception of students who are hard of hearing. Students with hearing loss make fewer overall communication attempts than their hearing peers. They also often seem unaware when their peers tried to initiate conversation and did not attempt to maintain the conversation. When they attempt to maintain the conversation they generally use one-to two-word phrases to maintain the communication and do not add new information. The research found that in a 1:1 conversation, 75% of the maintenance attempts by children with hearing loss were appropriate compared to 100% for hearing peers. They frequently tried to maintain the conversation by bringing up a topic that was unrelated to the conversation. In other words, they were not aware enough of the content of the conversation to contribute information, so they brought up a new topic.

Thus, educational practices to move to deeper understanding by way of interaction with peers is often very challenging for students with hearing loss. As can be inferred by the research, in quiet settings listening by students who are hard of hearing often approaches or equals peers. Therefore, it is the acoustic access inequality in the classroom that results in conversational challenges for students with hearing loss. This provides a powerful argument for the use of hearing assistance technology (HAT) that will improve perception of peer voices in 1:1 or group settings.

Challenges repairing breakdowns. Another aspect of conversation relates to what a person does when they do not fully understand. One study⁵ found that persons with hearing loss were able to cue into changes in topic but had much more difficulty when a shift in topic was made during the conversation. The research findings can be summarized as, the more predictable the conversation, the fewer the likely breakdowns. If a student is sitting with a group who maintains their focus on the problem-solving task, the level of understanding is likely much higher than if the student was in a group who wandered off topic repeatedly.  The teacher needs to be aware of this issue when pairing the student with different partners or groups. Moving to a quieter area for discussion will not ensure full participation by the student with hearing loss, but will make participation easier and more likely. Including him or her in a group that sticks to the topic will heighten the value of the exercise for the learner with hearing loss.

Keeping up in the classroom is a challenge for children with hearing loss due to access issues that interfere with understanding conversational communication and the gaps in knowledge resulting from decreased auditory access since infancy (or sign communication with limited language models since infancy). Filling the gaps of vocabulary and phonological awareness is necessary for students to keep up with class expectations for developing surface learning. Access to classroom discussion and for all group activities is a prerequisite for deep learning to occur. Providing the appropriate access technology is a necessity to facilitate deeper learning to occur within the classroom. Selecting appropriate group partners and honing communication repair skills is also critical to students with hearing loss achieving at the same rate and to the same level as peers.

References:

1. Fisher, Frey, Hattie (2016) Visible Learning for Literacy Grades K-12: Implementing the Practices that Work Best to Accelerate Student Learning. Corwin/SAGE, Thousand Oaks, California

2. Yoshinaga-Itano (2010). The longitudinal language learning of infants and children with hearing loss. ASHA Virtual EHDI Conference, October.

3. Meyer, Kym (8/17/2017). Wait – There’s a Student with Hearing Loss Coming into My Class? Webinar viewable at https://www.youtube.com/watch?v=r3ytOawiYuI&feature=youtu.be

4. Duncan (2001). Conversational skills of children with hearing loss and children with normal hearing in an integrated setting. The Volta Review, 101(4), 193-211.

5. Caissie (2002). Conversational topic shifting and its effect on communication breakdowns for individuals with hearing loss. The Volta Review, 102(2), 45-56

2017 © Karen L. Anderson, PhD, Late November Update, Supporting Success for Children with Hearing Loss http://successforkidswithhearingloss.com This information is not intended as legal advice.

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Special education students are first and foremost general education students. Many, if not most, school districts in the US are actively embracing the inclusion model of education, in which all students are educated in the mainstream classroom, regardless of the diversity of their needs.

Students who are deaf and hard of hearing (DHH) have special needs but not they are not due to learning disorders like most other special education populations. The primary difference between students with hearing loss and their classmates is that they do not access speech as fully. Background noise and distance have exaggerated effects on the student with hearing loss as compared to typically hearing peers. Students who are DHH-only have learning gaps and unique needs secondary to access to communication issues, not learning disorders.

Basics of inclusion:

Inclusion in education is an approach to educating students with special educational needs. Inclusion rejects the use of special schools or classrooms to separate students with disabilities from students without disabilities (source). Some inclusive classes use a collaborative team teaching (or co-teaching) model with a special education teacher in the room all day. Other inclusive classes have special education teachers ‘push in’ at specific times during the day. Both teachers are available to help all students. Studies show that inclusion is beneficial for all students – not just those who receive special education services.

Summary of the legal framework supporting appropriate education of students with hearing loss:

• Hearing loss fills the ADA/504 criteria as a life limitation that places a student at high risk for functional and/or performance needs. All students with hearing loss are eligible for 504 Plans and appropriate accommodations.
• Students with hearing loss should be evaluated to determine their level of unique needs including the need for auxiliary aids, related services, and specialized instruction necessary to address academic and/or functional performance issues.
• A high level of academic success does not preclude the need for specialized services or supports. Hearing loss will cause the student to have to expend additional time and effort to comprehend and fully participate, typically with less information perceived due to fragmented hearing, which impacts the ability to function and learn as compared to others.
• Specialized services are tailored to meet the student’s unique needs and should provide the support(s) needed for the student to be able to make progress similar to their cognitive peers, as the access issues caused by hearing loss are not learning disorders impacting the level to which a student with hearing loss can learn.

Refer to the end of this article for more specifics and sources of this legal framework.

Changing face of deaf education:

Our students: While the majority of students with hearing loss (DHH-only) appear to have academic skills at the same level, or within 6 months, of age peers, we do continue to have a group that have significant delays. Although almost all students with congenital hearing loss are identified shortly after birth, we still have about 35% of parents who are unresponsive (source), choosing to not receive early childhood services, having no access to effective EI services, or not attaining consistent amplification use and/or effective use of visual communication. When performed, these actions together minimize the predictable delays observed at school entry. Students with hearing loss are not a heterogeneous population and, while their needs may appear similar to other special needs groups, they have unique needs that set them apart, such as the need to develop auditory skills, sign language expertise, awareness in how their hearing loss impacts them, skills in use/troubleshooting hearing devices, and eventually become competent in self-advocacy skills if they are to become full participants in the classroom. These skills are not extensions of the general education curriculum but are necessary for the student to access/perform in general education at the level of peers.

Changing district policies:
In the US, we are in a very challenging period for deaf education as many schools have moved toward the inclusion model, which (strongly) discourages any pull-out services by special educators. For students with hearing loss, this move to inclusion is being applied to all students, whether skills are commensurate with classmates or multiple years of delay are present. The inclusion model then means that these itinerant teachers ‘push-in’ to regular classes to try to address IEP goals rather than pulling students out for specific teaching, or only provide consultative services to school staff.

Detriments/specific issues for children with hearing loss in inclusive settings:

• Intrinsic challenges of performing with a hearing loss in a classroom: A 2014 extensive literature review (source) examined how children who are deaf or hard of hearing interact with hearing peers in inclusive settings. Children who are DHH have many barriers to communicating, initiating and/or entering into social groups, and maintaining interactions with hearing peers, even though today they are more likely to be identified in early life and fitted with advanced sensory aids from a very young age. Fewer communication interactions occur between children who are DHH and their hearing peers, even when a child has a cochlear implant. Children who are DHH can often understand their peers when in a quiet environment but have difficulty expressing complicated linguistic content. The success rate of children with DHH when initiating communication and maintaining social interactions are much lower as compared to hearing peers, complicated by vocabulary, social interaction, and acoustic challenges. They have been found to be more often rejected or ignored by their hearing peers, who are also impatient when asked to repeat themselves. In summary, children who are DHH face great difficulties in communicating, initiating/entering, and maintaining interactions with hearing peers in inclusive settings.

• Lack of meeting DHH unique needs: The inclusion model prevents all the necessary skills from being taught as these skills are designed to improve functional performance and are not an extension of academic skills. Said another way, skills necessary for the student with hearing loss to be able to appropriately access and benefit from the general education environment can only be taught outside of the mainstream classroom. Specifically, it is not possible to teach many auditory development skills because of the noise present in the typical classroom. Developing an awareness of the impact of hearing loss on listening, learning and socialization and hearing device management are specific to our students and teaching does not fit into a small group instructional model as the students are typically the only ones with hearing loss in their schools. These are just two examples of unique needs that are highly unlikely to be met in an inclusive special education model. As an analogy, how could a low vision student be taught orientation and mobility skills within an inclusion classroom? It should not be surprising that the environmental and direct teaching requirements to meet the unique needs of students with limited or no hearing would also be incompatible within the inclusion classroom. In addition, it can be presumed that the typical fragmented auditory perception plus gaps in vocabulary cause students with hearing loss results in a more limited comprehension of surface learning information when the class moves to activities to promote deeper understanding, such as problem-based or small group learning. If a student lacks sufficient surface knowledge, moving to these activities prematurely is ineffective to, and may delay, the overall learning process¹.

• Itinerant DHH model applied to the inclusion model to meet student needs: The move to provide specialized instruction at a student’s neighborhood school has necessitated the growth of the itinerant DHH teacher service model, in which itinerant teachers of the deaf/hard of hearing go to an average of 10 schools per week, and serve an average of 15-25 students². The number of DHH teachers available in many districts is often insufficient to allow them to provide the intensity of pull-out services required for students with hearing loss to (a) make up language delays missed by lack of access, (b) maintain progress at the expected rate due to decreased access to classroom communication on a daily basis, and (c) teach specifically to develop auditory or sign language skills, build self-advocacy skills, and address other skills unique to the student with hearing loss. The inclusion model presumes that supports will be provided within the classroom. In the inclusion model, the itinerant DHH teacher will be unable to spend all day or very unlikely to spend a portion of every school day in one student’s classroom.

• Lack of sufficient intensity to meet unique needs: While language delays, auditory or sign language development, building self-advocacy skills, and other skills unique to the student with hearing loss could be efficiently taught in a pull-out model of sufficient intensity, having to provide this teaching as push-in services severely decreases the time available to specifically teach the needed skills. If a student with hearing loss is 6 months behind age peers, an itinerant DHH teacher cannot maintain a year’s growth and make up the existing delay with only twice a week 30 minute 1:1 teaching sessions. If this same itinerant DHH teacher is now expected to both close the student’s 6-month delay and support keeping pace with classroom learning, it is not possible to do so in a push-in model that allows only small group or team-teaching, which rarely can be directly focused on meeting the needs of the single student with hearing loss. Some students are 1-2+ years delayed due to late identification or lack of communication access (auditory or sign) prior to school entry who are also being placed in inclusive classrooms with the unrealistic assumption that their unique needs will be able to be met through this model. The benefits of inclusion do not replace nor supercede the need for appropriate intensity to appropriately meet the unique needs of the student with hearing loss.

• Lack of peers with hearing loss: Many of our students are the only one in their school with hearing devices, have no role models, and rarely or never see another DHH student. Across all educational models (center-based, specialize resource, local groupings, one-and-only), approximately 25% of students reject their hearing devices³. Those who are ‘one-and-onlies’ are 5 times more likely to reject hearing devices as compared to students who spend time daily or weekly with a cohort of DHH peers. In many school districts it is a rarity for more than 10% of secondary students who are ‘one-and-onlies’ to consistently use FM/DM systems or even their personal hearing aids. Not using amplification severely decreases access to instruction and results in either the student working immensely harder to keep up, the student performing much more poorly, or both. This high rejection rate can be interpreted as a strong sign that the unique social-emotional needs of these students are not being met. These students require connections with other students who sign or use amplification devices to be able to develop a healthy identity as a person with a hearing loss and as a strategy for exchanging self-advocacy strategies. Teaching to achieve understanding of the impacts of hearing loss, self-advocacy skills to support full participation, and addressing significant social-emotional needs are not unimportant nor perfunctory if the expectation is meet the unique needs of students who are deaf/hard of hearing and prepare them for further education or employment. Due to the move away from center-based programs, addressing the social-emotional needs of students has often been a significant challenge for the itinerant DHH teacher providing 1:1 services. The ability to do so within the inclusion model is remotely possible, or more likely, impossible to achieve.

Benefits of the inclusion model for students with hearing loss

The 5 benefits specified in italics below were taken from this source. Comments have been added to each to relate these benefits to the unique needs of students with hearing loss.

Benefit #1: Differentiated Instruction

All students learn differently. This is a principal of inclusive education. One key teaching strategy is to break students into small groups. By using small groups, teaching can be tailored to the way each student learns best. This is known as differentiated instruction. Teachers meet everyone’s needs by presenting lessons in different ways and using Universal Design for Learning (UDL). For example, they may use multisensory instruction. In math, that may mean using visual aids and manipulatives like cubes or colored chips to help kids learn new concepts. (See more examples of multisensory math techniques.)

Differentiated instruction and UDL are very positive aspects of inclusive education. Many students with hearing loss benefit with attention to learning syntax, morphology, vocabulary, reading comprehension, etcetera, which would be amenable to differentiated instruction and small group learning. Since students with hearing loss are so low incidence, they would likely be grouped with students who are learning disabled or who have language disorders. Teaching to disorders is not necessarily the same as closing gaps due to delays, especially when the gaps can be very spotty (“Swiss cheese language”). A DHH student’s reason for not understanding is likely to be related to fragmented hearing, which would benefit from acoustic highlighting, stating information in different ways, or support via sign language, which would likely not occur in teaching a group of students. The quality of a sign language interpreter directly impacts the level of comprehension of the student who is DHH and a visual or visual plus auditory communicator. Many school districts do not hire fully qualified sign language interpreters which inadvertently undermines the outcomes of many students who are deaf (source). Teaching to the vocabulary development needs of students who are hard of hearing or deaf is not likely to be sufficient in a small group learning situation within the inclusive environment.

Benefit #2: Supportive Teaching Strategies

In an inclusive classroom, teachers weave in specially designed instruction and support that can help students make progress. Kids may be given opportunities to move around or use fidgets. And teachers often put positive behavioral interventions and supports (PBIS) in place. These strategies are helpful for all students—not only for students with learning and attention issues.

Teaching strategies that support quieter classrooms during communication would be excellent for the student with hearing loss. The fact that inclusive classrooms tends to group students to work together more often than traditional classrooms will result in an overall noisier environment. While some supportive teaching strategies may indeed be good for the student with hearing loss, it can be assumed that some will be detrimental as well. Per Title II of the American’s with Disabilities Act, the consistent use of necessary accommodations must always be kept in mind (source). Teacher accommodations during lecture are often consistently implemented. As about 1/3 of the school day is devoted to group learning activities (source), use of accommodations to reduce noise can be very problematic to consistently implement. Although there have been some technological advances, it continues to be difficult to achieve consistent and effective use of the FM/DM system in small group discussions due to the communication dynamics of active discussion.

Benefit #3: Reduced Stigma

Inclusive classrooms are filled with diverse learners. That lets kids talk about how everyone learns in their own way. They may find that they have more in common with other kids than they thought. This can go a long way in reducing stigma for kids with learning and attention issues. It can also help kids build and maintain friendships.

Diversity in the classroom is a plus for any student with ‘differences.’ Students will naturally come to see themselves as belonging to one or more groups within the classroom setting. Most classrooms will have students who have LD, ESOL, attention issues, etc. Since it is unlikely that there is another student with hearing loss in class, the result is that these students will emotionally and/or intellectually strive to join a group where they find acceptance. Therefore, the urge to reject hearing aids and ‘become LD’ or ‘become one of the kids who don’t comply’ may be even stronger in an inclusive setting than in more traditional educational models. Due to the hearing loss, the social communication issues (especially in noise) will continue to set them apart, even among their ‘chosen’ groups, which will continue to be a basis for teasing or bullying. Without the opportunity to leave the class to meet with someone knowledgeable in DHH who can help them work through identity and emotional issues related to hearing loss, the student who is deaf or hard of hearing may feel even more isolated and unsuccessful socially in an inclusive class than they would in a pull-out model of support.

Benefit #4: Effective Use of Resources

In more traditional special education settings, many kids are “pulled out” for related services, like speech therapy or for other specialized instruction. An inclusion class often brings speech therapists, reading specialists and other service providers into the classroom. These professionals can provide information and suggestions to help all students.

Increased focus on basic communication skills, vocabulary, syntax, morphology, improving comprehension – all are issues where inclusive settings would be of benefit. The itinerant DHH teacher going in to the mainstream may be able to work with a small group that includes the student with hearing loss on these issues. It is unlikely that the itinerant DHH teacher will be able to address the needs that are truly unique to students with hearing loss. DHH teachers are increasingly challenged by school administration with “What do you that is different than the SLP or LD teacher?” In the inclusive model in general, strategies specific to teach reading to DHH are not appropriate to use in a group, or self-advocacy skills that feature focusing on what was heard so the student can appropriately request clarification of information missed, or other needs unique to students with hearing loss are NOT appropriate to teach to a group of students who all do not have hearing loss. If the only skills that are applicable to teach in inclusive settings are the communication and academic supports that can also be provided by SLPs and LD teachers, then the value of having a highly trained teacher specifically for students with hearing loss is likely to be dismissed as unnecessary. With this in mind, it is projected that the greater the implementation of fully inclusive settings, the less valued and effective will be the teacher of the deaf/hard of hearing AND the students’ unique needs specific to hearing loss will go unmet, with increasing numbers of students performing more poorly academically, socially, emotionally, and/or behaviorally over time. Inclusion is beneficial to students with hearing loss, but only to the degree that the student is able to learn effectively and the appropriate level of support is provided.

 Benefit #5: High Expectations for All

Individualized Education Program (IEP) goals should be based on the academic standards for your state. Those standards lay out what all students are expected to learn in math, reading, science and other subjects by the end of the school year. Differentiated instruction and co-teaching in a general education classroom make it easier for students with standards-based IEPs to be taught the same material as their classmates. In some schools, only certain classrooms are inclusion classes. In that case, schools may assign general education students randomly to inclusive or non-inclusive classes. Other schools may choose students who benefit from the emphasis on meeting the needs of all learners at all ability levels.

Common core standards based IEPs strongly support development of skills that result in full participation in the classroom, and therefore have a positive influence on the education of students with hearing loss. Unlike students with hearing however, the unique needs that must be met for students with hearing loss to become full participants in the classroom are beyond that of their classmates, and distinctly different than other special education populations. Achieving goals to address the unique performance needs secondary to hearing loss largely requires pull-out services into environments supportive for learning these listening, social, and self-advocacy goal areas.

Summary
The inclusion model of special education has been adopted by many school districts throughout the US. The positives of having a diverse learning community, implementing differentiated learning, varied teaching strategies, and universal design for learning principles are all beneficial aspects of the inclusion model. Many students – both regular education and special education students – thrive in inclusion classrooms. The participation of all children is a purpose of inclusive practice and classroom activities. However, it cannot be assumed that social communication and interaction between children who are D/HH and hearing peers will occur naturally. It is essential that opportunities for all children to interact with each other must be appropriately designed, supported, and developed in inclusive educational practice.

Specialized services, by law, are tailored to meet the student’s individual needs. In the case of DHH-only students, an appropriate inclusion/support network is needed to provide the support(s) for them to be able to make progress commensurate with their cognitive peers. Meeting all the unique needs of students with hearing loss within the inclusive classroom environment is at best unrealistic, if not highly unlikely. The student with hearing loss does not know what he does not hear because he did not hear it. Specific teaching needs to occur if the student is to be able to successfully identify and request appropriate support when faced with road blocks. If the statement “He hears just fine” continues to be made by school staff, we can assume that the unique access and learning needs of students with hearing loss are not being adequately or appropriately met within the inclusion environment.

As a continuum of services and supports are required by IDEA to allow individual needs to be met, the fully inclusive model cannot be put forth as the only model of special education support provided by a school district. Gone are the days when most student with hearing loss were educated primarily in a center-based DHH-specific program. Despite the move away from this intensive model, students with hearing loss do continue to require some pull-out services by persons specialized in the unique educational needs of students who are deaf and hard of hearing so that they can learn necessary skills to allow them equal access to, and the ability to fully participate in, the general education setting. Hearing loss is not a learning disorder. Hearing loss is a communication access issue that is predictive of listening, interaction, and learning challenges. The inclusion environment is GOOD for students with hearing loss, as long as they are receiving the specialized support they require to keep pace in the classroom AND their access and learning needs are fully supported during ALL classroom activities.

Karen L. Anderson, PhD, Director, Supporting Success for Children with Hearing Loss, Early October Bimonthly Update, 2017. http://successforkidswithhearingloss.com This information is not intended as legal advice.

References:

1. D., Frey. N., & Hattie, J. (2010). Visible Learning for Literacy: Implementing the Practices that Work Best to Accelerate Student Learning. PP 36-44.

2. Survey results: Role/Duties of an Itinerant Teacher of the Deaf/Hard of Hearing. Conducted by Supporting Success for Children with Hearing Loss, April – May 2017 (267 respondents).

3. Survey results: Children Rejecting Hearing Devices: Who, Why, When? Conducted by Supporting Success for Children with Hearing Loss, August 2016 – April 2017 (88 respondents representing a total caseload of 1863 students with hearing loss).

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