It’s a common misconception that hearing aids “fix” hearing loss like glasses “fix” vision loss. While hearing aids are prescribed for those with hearing loss, hearing aids don’t fix hearing loss. Children with hearing loss haven’t yet developed auditory skills, therefore they will need to have direct instruction in auditory skill development, to understand what they are hearing. In order to provide auditory skill development instruction, teachers need to know how typically developing children develop auditory skills in order to determine the needs of a student with hearing loss.

Before beginning instruction in auditory skill development, assessment is absolutely necessary. Use an assessment that has been vetted as appropriate for children with hearing loss.  Use assessments that will yield results that help determine where exactly instruction should begin. Check out this resource that will help to determine what assessments are appropriate here.

After assessment, teachers and therapists can target areas that will need to have direct instruction.

What do you do with the results of assessment? First, build your knowledge of typical auditory development.

After determining what skill area(s) the student is currently in need of developing, begin instruction with the areas of skill deficits.¹Auditory skills are typically defined in 4 areas of concentration:

• Detection: Detection is the ability to respond to the presence or absence of so It is the essential first step in learning to listen.
• Discrimination: Discrimination is the ability to perceive similarities and differences between two or more speech stimuli. In discrimination activities, same-different tasks are often used. (Example: dog vs. dogs, “Do they sound the same or different?”)
• Identification: Identification is the ability to label by repea.ng, poin.ng to or wri.ng the speech stimulus hear
• Comprehension: Comprehension is the ability to understand the meaning of speech by answering questions, following directions, paraphrasing, or participating in a conversation.

While there is a hierarchy of auditory skill development these skills are not developed independently of one another. Auditory skills are developed in tandem, however instruction can be delivered specifically in each auditory skill development concentration. Consider these factors when evalua.ng and determining service delivery: age on onset, age of amplification, access to consistent auditory training, and language rich environments should be considered when determining type and amount of services for children with hearing loss.

Children need constant exposure to language. Developing language and auditory skills are critical for students who are learning to use amplification. Amplifying a student’s hearing levels doesn’t automatically develop their ability to identify, locate, discriminate, and comprehend what they are hearing. In addition, according to the auditory scaffolding hypothesis, deafness may especially affect cognitive abilities related to learning, recalling, and producing sequential information.  In addition, research indicates that

²Although it is common to consider deafness as affecting the sense of hearing alone, we argue that because sound is the primary gateway to understanding temporal and sequential events, auditory deprivation may result in significant disturbances on a wide range of other tasks (Conway, Karpicke, & Pisoni, 2007). For instance, Bavelier, Dye, and Hauser (2006) have argued that deafness results in a reorganization of cortical function. Therefore, losing the sense of audition early in development may set up a cascade of complex effects that alter a child’s entire suite of perceptual and cognitive abilities, not just those directly related to hearing and the processing of acoustic signals.

According to the auditory scaffolding hypothesis, deafness may especially affect cognitive abilities related to learning, recalling, and producing sequential information. A delay or disorder in domain-general sequencing skills, triggered by lack of auditory stimulation at an early age, could provide a significant impediment to normal development. Indeed, previous work suggests that the profoundly deaf show disturbances in (non-auditory) functions related to time and serial order, including immediate serial recall (Marschark, 2006). (“The Importance of Sound for Cognitive Sequencing Abilities: The Auditory Scaffolding Hypothesis – PMC”).

In conclusion, amplification providing access to sound, access to spoken language, and direct instruction in auditory skill development, will impact a student’s ability for cognitive sequencing.  Early amplification and targeted therapy enhances a student’s probability for auditory-cognitive success.

Works Cited:

¹Compiled by Denise Wray et. al., University of Akron, 2007 from: Erber, N. (1977) “Evalua.ng Speech Perception Ability in Hearing Impaired Children” [Bess, Fred H. (ed): Childhood deafness: Causation, Assessment, and Management.] New York, Grune & StraKon. Estabrooks, W. (2006). Auditory-Verbal Therapy and Practice. Washington, DC: A.G. Bell

²Conway, Christopher M et al. “The Importance of Sound for Cogni.ve Sequencing Abili.es: The Auditory Scaffolding Hypothesis.”  Current directions in psychological science vol. 18,5 (2009) 275-279. Doi:10.1111/j. 1467-8721.2009.01651.x

Author: Michelle Andros, MSEd

Click here to download this article.

The post Hearing Aids are NOT “Glasses” for the Ears first appeared on Supporting Success For Children With Hearing Loss.

In order to understand how students with hearing loss learn to read, it is important for educators to understand how students with typical hearing learn to read.  Learning to read is a process that relies heavily on language development.  Since brains are wired for the development of language, children with typical hearing (TH) build a foundation for reading, from the time of birth.  Language development relies on a child’s ability to acquire the fundamentals of language through audition and exposure to features of listening and spoken language. So what happens when a child doesn’t have access to auditory input that is required for natural acquisition of language?  

There are multiple variables that contribute to a child’s ability to read.  Not only for children who have hearing loss, but for TH children as well.  Access to language rich environments are crucial for expanding a child’s exposure to a variety of vocabulary as well as building background knowledge for children to hinge new information on when new experiences are encountered.  In addition, incidental learning helps children promote language acquisition. Incidental learning is learning that occurs unintentionally, from activities where learning is not a conscious goal for the learner.  The more experiences; the more a child learns from their natural environment.  

A child who has hearing loss, lacks the opportunity to fully interact and experience auditory information. Therefore, it’s crucial to provide alternative pathways for these children to access information.  Variables such as age of onset of hearing loss, age of identification, type and degree of hearing loss, access to hearing assistive technology, the impact of hearing assistive technology, exposure to sign language, consistency of sign language exposure, early intervention opportunities, and educational setting (inclusive education in the home school district, school for DHH, etc) all play a significant role in a child’s fundamental language and reading abilities.  Children with hearing loss, who were identified at birth, given amplification as early as possible, exposed to consistent language models, and given early intervention services will have stronger fundamentals than a child who was not identified, not amplified, and not exposed to language and learning through consistent opportunities.  

Historically, children with hearing loss have struggled to access phonological awareness skills, one of the fundamental strands for reading proficiency. Thanks to technology advances and the use of Visual Phonics, students with hearing loss, particularly hearing loss that affects language acquisition and audibility of speech sounds, are able to access speech sounds through alternative pathways or with the use of residual hearing amplified by technology.  According to the Florida Center for Reading Research, the Essentials for Reading Success include information about how to use data from assessments, response to intervention, the features of effective instructions (including differentiated instruction), and evidence-based practices to teach the critical components of reading.  

Instruction in literacy includes the critical components of reading for proficiency, taught in an explicit, direct-instruction approach.   

• Phonological Awareness
• Phonics
• Fluency
• Vocabulary
• Comprehension

All components must be in place in order to ultimately achieve reading mastery.  What we know about students with hearing loss is that students who are DHH struggle to master phonological awareness and phonics due to lack of access to sound.  The median reading level of deaf students indicates subpar achievement.  Approximately 10% of deaf students read beyond the 8th grade level.  These statistics are alarming.  

“Learning to read at age-appropriate levels is a problem for many, but not all, students who are born deaf. Regardless of whether they speak or sign, the median reading level of deaf students indicates subpar achievement. Approximately 10% of deaf students read beyond an eighth grade level (Traxler, 2000). This statistic indicates that there are many skilled readers in the deaf population. The challenge is to discover what factors distinguish them from unskilled readers (Belanger, Baum, & Mayberry, 2010; Chamberlain & Mayberry, 2008). Only then can effective diagnostic and educational programs be devised to ameliorate the problem. Moreover, understanding the nature of proficient reading in individuals who are deaf promises to elucidate theoretical models of reading development and disabilities.”

With statistics like this it means only one thing…Students who are DHH need to be provided with early amplification, language rich environments, explicit reading instruction in the main component areas of reading, and given access to language through consistent modes of communication.  

References

Mayberry, R.I., del Giudice, A.A., & Lieberman, A.M. (2011). Reading achievement in relation to phonological coding and awareness in deaf readers: A meta-analysis. Journal of Deaf Studies and Deaf Education, 16(2), 164-188.

The post Brains are Wired for Language, NOT Reading! first appeared on Supporting Success For Children With Hearing Loss.

Unfortunately, NO hearing technology fully restores normal hearing. There is no doubt that consistently worn, modern hearing devices provide more access to speech than ever before BUT we can never assume that there will be no functional impact, even if a student seems to be performing ‘okay’ in the classroom. We can infer the impact of hearing loss on precision hearing from a student’s audiogram, but only functional measures will identify the degree to which the hearing loss actually impacts educational performance. One of our jobs is to determine just how much of an improvement occurs when student’s use personal and/or classroom hearing devices.

Being closer to the person talking will help the listener with hearing loss to hear more loudly and clearly. Hearing devices amplify sound and make it seem louder and clearer at ear level for persons with hearing loss, but never ‘corrects’ hearing to a normal hearing level. Therefore, students with hearing loss have smaller ‘listening bubbles’ or shorter listening ranges than their typically hearing peers. Hearing aids and FM/DM/HAT systems do not restore normal hearing, but they DO provide much improved access to verbal communication that would otherwise be auditorily impossible to the child with hearing loss.

Focused Consideration of Access Needs

Universally, students with hearing loss have greater difficulty accessing verbal communication in both large and small group instruction within the typical classroom environment. It is not a question of IF a student needs accommodation, it is a question of verifying WHEN, under what conditions, WHICH accommodations are necessary to level the access playing field. Schools are required¹ to ensure that communication for students who are deaf or hard of hearing is as effective as communication for others to afford an equal opportunity to reach the same level of achievement as that provided to others. Functional hearing is necessary to identify and cannot be revealed by an audiogram or speech and language evaluation. Refer to the White Paper on Estimating Access and the Cascading Impact handout for more information.

Gathering functional information about educational performance is every bit as important as considering academic performance². The communication access issues of our students require them to work harder, expending more energy, often to receive less information than their typically hearing peers. An audiogram informs us of access in a quiet setting but cannot provide sufficient information about the educational impact of hearing loss. Functional performance issues require appropriate access accommodations. They may also warrant instruction in self-advocacy skills, social interaction, or other aspects of the Expanded Core Curriculum that need specific and direct teaching.

When considering the impact of hearing loss and trying to help others to understand it, we can think about it in two ways: impact on precision hearing and impact on functional performance.

Precision hearing can be inferred from audiometric information. The Speech Audibility Audiogram for Classroom Listening represents speech audibility for 35 dB HL (soft speech) and 50 dB HL (louder than conversational level speech) inputs and is based on the figure shown left. It represents 5 dB bands of hearing levels (i.e., 20-25 dB). You can consider a student’s hearing thresholds with hearing aids and also without hearing aids. This tool is most applicable to flat configurations of hearing loss. Audibility means the speech energy that is available for a student to figure out what was said. Think of it as having 100 puzzle pieces if you have normal hearing, and therefore normal audibility. If a student has aided hearing in the 25- 30 dB range he would have only 25% audibility for soft speech (like hearing a classmate answer a question from across the room) and 81% audibility for teacher speech, especially  when the teacher is further than 6 feet away. Using this tool helps to make the point that a student can ‘hear’ but not receive all of the information necessary for comprehension, especially unfamiliar information. The information from the Speech Audibility Audiogram has been converted to teacher inservice handouts representing how speech perception is typically effected when hearing aids or cochlear implants are used. See the Impact of Hearing Loss on Listening, Learning and Social Interactions handouts. They include typically missing speech sounds at classroom distances.

We can also identify precision hearing systematically to identify the speech sounds that are challenging for the student to hear consistently. One tool that can be used is the Iowa Medial Consonant Test that presents the student with consonant sounds in a format like ee-x-ee or aa-x-aa (like ee-pee, ee-tee). If a child has a hearing loss between 26-70dB, optimally fit hearing aids and has had some attention to auditory development then he should be able to score 100% on this test from 3 feet without visual cues. It can be performed with ee-x-ee at 3 feet and aax-aa at 10 feet so you can compare the difference in speech perception.

Precision hearing can also be determined by eliciting the Ling sounds at different distances. The discovery process defined in the Early Listening Function checklist has been revised using Ling Sounds. To complete the ELFLing checklist the teacher would say the Ling sounds starting from 15 feet away from the student, who would repeat the sounds heard. The teacher would then move to 10 feet and repeat the Ling sounds, then 6 and 3 and finally 1 foot if there are still sounds that the child has been unable to consistently repeat. Typically it becomes evident that the louder vowel sounds can be detected consistently from a much further distance than  the sh/ch and especially the s/th sounds. It is important to repeat the ELFLing in the presence of low background noise to show how detrimental background noise is to precision listening.

Norm-Referenced Option – Functional listening is also critical to determine. An audiogram informs us of access but cannot provide information about the educational impact of hearing loss. We can infer the impact on precision hearing, but only functional measures will identify the degree to which the hearing loss is actually impacting educational performance. We now have a norm-referenced instrument to obtain information about both precision listening and some information about functional listening. The Developmental Test of Auditory Perception (DTAP) is appropriate for ages 6-18 years and has 5 subtests with language-based and nonlanguage-based items. The normative sample provides a strong basis to show that our students can have adverse educational performance issues.

Impact on Functional Performance. The Functional Listening Evaluation is a MUST to perform on every student with hearing loss! With the clarification of ADA clearly requiring every child with hearing loss to be ensured equally effective communication as their peers, it is necessary to determine just how effective a student’s ability to perceive speech really is under various conditions. We no longer have the luxury of performing the FLE “when I have time” or “only when asked.” The Recorded FLE has been designed to simplify the process for obtaining this information quickly and easily. With practice, performing the FLE should take only about 15-20 minutes. It also can be an important learning tool for students to better understand their own hearing loss and listening challenges.

Another assessment of functional performance using hearing in the classroom is the Listening Inventory For Education – Revised Student Appraisal continues to be one of the most effective means to gain information from students to identify and quantify their listening challenges. If you have not heard of the LIFE-R or taken time to try it, do so this year! It will change how you write goals for self-advocacy and how you inservice teachers! The LIFE-R is available FREE in a format you can complete with students online. Fillable version of the LIFE-R checklists (student appraisal, teacher appraisal, before LIFE, after LIFE, with photos) are on Takeout.

In summary, the job of hearing devices is to improve the audibility of speech, allowing students to perceive much more of verbal instruction and all other spoken communication more fully. By funneling more audible speech information into the brain, the student is able to access more of the curriculum. For our hard of hearing students, hearing devices can be considered the gateway to their educational and social success. For the impact of hearing loss to be minimized optimally, students who are hard of hearing need well fit hearing aids or implants, the devices need to function appropriately, and the student needs to be willing to use the devices in school, and preferably all waking hours.

Invest the time to identify a child’s level of access to speech under typical school conditions. There is no replacement for the critical information obtained by doing a Functional Listening Evaluation. Students with typical hearing score 95%+ in quiet and 90%+ in noise. If a student has been trained to routinely respond to Ling sound audibility checks, take the time to perform the ELFLing, which systematically identifies the ability to perceive the Ling sounds at different distances. If you only have a few minutes, at least do the Iowa Medial Consonant Test, which is a fast check of audibility for specific consonant sounds. If a child has 25-70 dB hearing levels and has worn hearing aids for some time, then a 100% score is expected.

Hearing aids should be fit so that students with hearing loss of 25-70 dB can perceive all of the speech phonemes in quiet from 3 feet without watching the speaker’s face. If you have a student who does not seem to be able to do this, bring the issue to the attention of the family and audiologist. If hearing devices are the gateway to learning, removing any barrier to that gateway can only benefit the student’s performance.

References

1. Summary of ADA information related to students with hearing loss.
2. IDEA Eligibility Determination – Section 300.304(b)(1)

The post Hearing Devices – Tools, Not Miracles first appeared on Supporting Success For Children With Hearing Loss.

It would be a lot easier if we had one-size-fits-all services for our students with hearing loss, but the law requires we tailor service delivery to every student’s individual needs. Student needs cannot be appropriately dictated by degree of hearing loss, hearing technology, their age or any other factor. Only with data can we develop appropriate education plans. This article will review this tailoring process and variables that must be considered.

Since students present with varying degrees and types of hearing loss, a full evaluation of the student’s strengths and weakness should be completed by a multidisciplinary team that includes the Teacher of the Deaf/Hard of Hearing (TODHH).  For an example of checklists specific to different team members, look at the Access to Curriculum Inventory.

It’s critical to know if the student is accessing auditory information in small and large groups, in noise and in quiet, in ideal acoustical settings and those with the least ideal acoustics (i.e., the gym or cafeteria). Knowing how well the student follows classroom routines, comprehends auditory directions, and their level of class participation, will help the team determine the time and delivery method for hearing support services.  The student’s age of identification can help gauge the amount of language they may have been exposed to in a natural setting as well as auditory skill development and self-advocacy skill development.

Considerations:

Once the team determines the amount of service provision, then the team must determine the appropriate model for service delivery or type of service. Some students do better in settings that they are pulled from the general education setting and receive instruction in a 1:1 setting for hearing support.  Other students do better in the general education setting with the hearing support teacher co-teaching in an inclusion model.  This is all determined by the IEP team once all evaluation information, including the impact of communication barriers, has been reviewed and considered.

The team will make a recommendation for amount of services, both direct (face time directly with the student) and indirect service time that includes monitoring and consultation for the student. TODHH often collaborate with the general education teachers, Speech-Language Pathologists, Educational Audiologists, parents and other staff members as part of their consultation time. When documenting this in the IEP the team must remember to address service time as in how often, for how long and how the students will be delivered services and location of service.

Once the team makes a decision on service delivery, amount of time per school year, frequency, duration, location and model of services, the team can add that information to the IEP and, if necessary, reconvene to adjust as appropriate.

Take caution that you allow enough time to appropriately delivery instruction in the area of need, allow enough time for practicing skills and progress monitoring skills. If the student has a secondary transition plan, be sure to allot time for adequately addressing activities and instruction in secondary transition.

Consultation and monitoring takes time so be sure to allocate time to email teachers, consult with other professionals, contact the parents and gather data for progress monitoring.

Resources:

Hearing Itinerant Service Rubric from District of Lake County Hearing Itinerant Program provides a matrix to assist teams in ensuring students have an adequate amount of time and that the service delivery models are appropriate to meet the students needs. See PDF here.

The Region 4 Deaf or Hard of Hearing (DHH) Itinerant Teacher Professional Learning Community (PLC) in Houston, Texas created a rubric to help teachers gauge service delivery.

Models of Support Services (availability of services from an itinerant teacher of the deaf/hard of hearing)

For more information on

• the Inclusion Model please see the article, Is the Inclusion Model Good for Students with Hearing Loss? Supporting Success Bimonthly Update article, Early October 2017.
• the Adverse Educational Affect please see the article Support for Showing Adverse Educational Affect Due to Hearing Loss
• involving the TODHH on a Multidisciplinary Team please refer to the article Why Involve the Teacher of the Deaf/Hard of Hearing on the Assessment Team and the IEP?

The information within this article has been derived from sections of the law, Office of Special Education Program comments and discussion provided at the U.S. Department of Education’s Individuals with Disabilities Education Act (IDEA). The guidance provided in this website helps clarify the intent of IDEA and may be useful to professionals and parents alike who are trying to advocate appropriate services and supports for children with hearing loss. This article is not legal advice.

Author: Michelle Andros, MSEd.

Click here to download this article

The post Student Services: One Size Doesn’t Fit All first appeared on Supporting Success For Children With Hearing Loss.

We are providing a brand-new teacher tool takeout Back- to-School checklist, to help TODHH be sure you haven’t forgotten any crucial beginning of the year tasks which help make your school year more successful.  

Virtual Platforms and Hearing Assistive Technology

TODHH can use a virtual platform to deliver effective back-to-school inservices. Presenting information to teachers via virtual methods can reduce time and redundancy.

• Video yourself and emailing teachers can save time and travel, and in-servicing all the teachers at once, rather than individually are a few helpful timesavers. Zoom, Screencastify, or record yourself on a Google Meet!

• If you decide to create and record a PowerPoint for teachers, add interesting graphics and even your Bitmoji! Click here for a tutorial on how to create and add Bitmojis. (Thank you Sarah Wanasek). Keep the information on the slides minimal but elaborate in your explanations.

• If you are uncomfortable videoing yourself, there are videos available online for almost all types of HAT devices. Thanks to Amanda Ball Levy, AuD, we can access her videos and cheat sheets online here

• Be sure to in-service teachers about Hearing Assistive Technology (HAT) and remind them about the mute button! Discuss times when they should have the HAT transmitter muted, i.e., in the bathroom, in the hallway, when speaking privately to other adults, and when the child is not in the general vicinity. Practicing hygienic HAT transitions are still highly recommended and should be included in the back-to-school in-service discussions.

Access to Instruction

Access to instruction is paramount for students with hearing loss, so be sure to observe
 the students in the general education classroom and provide feedback to the teacher.

• Collect data for tracking access to instruction by using the (ATCI),
  then inservice teachers on reducing barriers to access. 
• Review the student’s specially designed instruction goals (SDIs) with the general education teachers and be sure to update your records with any new summer audiological information. 

Most teachers don’t have time for long in-service meetings at the beginning of the school year. Provide only the most important information in your first meeting with the teacher(s). 

In subsequent weeks, sprinkle in additional information, using Tips for Teachers Working with Students who have Hearing Loss or. Renowned educational audiologist Jim Bombicino recorded 10 short (2 minute) videos that are intended to be shared with classroom teachers. Share each video up to 50 times. You choose which topic you want to send to whom. Simply type in the teacher email addresses, include your brief message, and send! All of the teachers will receive an email identifying you as the sender with a video link and passcode. They can watch videos twice.  You may need to ensure your school firewall allows these emails to be received. Want to show Tips for Teachers videos during your face-to-face or e-meeting with teachers? The videos are now included with all Takeout subscriptions. For only $36 you can get the Teacher Subscription with access to all Tips for Teachers videos, plus our Kool Kidz Vidz and the Teacher Tools Library, plus discounts on purchasing Takeout items.

TIPS FOR TEACHERS   The Tips for Teachers video topics are:

• Use and placement of the wireless microphone
• Introducing the microphone to the class
• Noise through the microphone
• Muting the microphone
• Watching videos effectively
• Connecting to media
• Small group learning sessions
• Classroom noise
• Moving around the classroom
• Facing the student

Tips for Teachers videos include demonstration of listening with hearing devices in the classroom. Included with the videos are in-service handouts and the Emailable Tips for Teachers, Emailable Tips for Teachers: Specific Early Childhood.

Keep the Information Simple

Whether its virtual or in-person, back-to-school in-services can be overwhelming to teachers so keep the information simple and include necessary information during the first meeting.

Include:

1. the student’s type and degree of hearing loss,
2. implications of the hearing loss in the general education setting, and
3. specially designed instruction that the general education teachers need to know and provide for the student while in the regular education classroom. 

Make sure that you are explaining the child’s hearing loss in terms that the general education teachers can understand.  Remember they don’t have the same educational background as a TODHH, so terms like “moderate to severe, bilateral, high frequency hearing loss” doesn’t mean anything to them. 

• Using an audio or video simulation of hearing loss can help! See the simulations available on Supporting Success. Also, Audio Clips to Simulate Hearing Loss on Takeout.
• Takeout item: Converting Skeptics into Supporters with Listening Simulations.
• Another option for sensitizing teachers of young children about hearing loss and communication needs is to share The Elephant in the Room recorded story book that simulates listening with hearing loss and challenges.
• You can always do a quick demo by having teachers plug their ears! A built-in, quick inservice tool to raise awareness that even if you can ‘hear’ doesn’t mean it is easy to understand. Explore this idea.

Use the Audiogram of Familiar Sounds to map out the student’s hearing loss and help teachers visualize the sounds that the student may have difficulty hearing.  Even better, break down the hearing loss to estimate the percent audibility and which speech sounds are audible in soft speech, conversation, and teacher speech. See the Impact of Hearing Loss on Listening, Learning, and Social Interactions handouts from Takeout.

Let Students Do the Inservicing!

A confident presentation and/or summary handout by the student with hearing loss may get much more of the teacher’s attention than (just) a meeting with the TODHH. Find the ‘Hearing and Me’ template from Phonak. Have your students create a Self-Determination and Transition brochure, using this template from Takeout.

Tools and Tips to Help

One of our goals at Supporting Success for Children with Hearing Loss is to help professionals and families stay up to date on the newest information in the field, and to help teachers reduce the stress of paperwork and creating materials on your own, which takes time, effort and money. 

Regardless of experience, beginning of the year IEPs can be a source of anxiety for all teachers in Special Education.  Another all-NEW Resource in Teacher Tool Takeout is the IEP Checklist.  This tool will help keep you organized all year long, and help IEPs be aligned and effective.  Check it out!

Don’t Re-Invent the Wheel

Progress monitoring can take hours away from instruction.  Regular education teachers are instructing and collecting data on the same students as YOU.  During beginning of the year inservices, communicate the goals and needs to the regular education teacher so that you aren’t collecting the same student data.  If they are monitoring the progress of the student in the classroom, then piggyback on that and save yourself time.  Assessments like Dibels, Aimsweb, and Curriculum Based assessments can yield the information you need for ESY data, Baseline data, and progress monitoring data. 

We wish you all the best of luck getting the school year underway.  Staying organized, collecting data and effective use of time for back-to-school in-services will help iron out the wrinkles that the beginning of the school year can create. 

Author: Michelle Andros, MEd

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The post Teachers of the Deaf are Superheroes, but They Can’t be Everywhere at Once! first appeared on Supporting Success For Children With Hearing Loss.

Challenges

It’s challenging to extract speech amid varying levels of unwanted noise. We use two ears together to localize sound and more easily locate the person speaking. Sound localization guides us where to focus our attention. Most students with hearing loss will have difficulty with sound localization thereby causing them confusion about who is speaking.

Trying to listen to speech when unwanted noise is present is a challenge both outdoors and indoors, especially in rooms where sound reverberates. High pitch voices, low pitch voices, fast speaking rates, accents – all can contribute to a listener’s ability to differentiate the person speaking from the background noise or other people talking at the same time.  Although newer hearing aids have the ability to scan environments and automatically adjust functions to compensate for the additional sounds, hearing aid users still report that background noise and environments with multiple people talking continue to be a significant challenge.

Improve Access

As a first step, provide accommodations in the classroom such as: reducing background noise, using personal Hearing Assistive Technology, and seating a student preferentially, (with 3-6 feet from the sound source). Even with accommodations it is unlikely that the student will be able to access information in noisy environments with the same comprehension level as their hearing peers. Training students to listen in a variety of settings should be incorporated into auditory learning goals and monitored frequently.

Get Baseline Data

The audiogram may provide some understanding of a student’s ability to discriminate speech from information.  Speech discrimination scores (SDS) and word recognition scores (WRS) yield information for speech presented in a quiet environment, and speech recognition thresholds (SRT) yield scores from phonetically balanced word lists, presented above an individual’s hearing threshold.  However, it’s difficult for teachers of the deaf and hard-of-hearing, and speech-language pathologists to ascertain the child’s ability to access speech, while in the presence of noise, simply from looking at a student’s audiogram.

The handouts Impact of Hearing Loss on Listening, Learning, and Social Interactions  use audiogram information to predict speech perception.

Evaluating the ability of students with hearing loss, to access, listen, and gain an understanding of what is being presented orally, in the midst of noise, can be difficult for teachers but can be accomplished, even in itinerant settings.  It is strongly suggested that the Functional Listening Evaluation Using Sentences, the ELFLing or the Developmental Test of Auditory Perception be used to obtain functional listening in noise baseline data. Refer to our course on administering the FLE and the White Paper on Estimating Access of Communication Effectiveness for more information.

Obtain functional data about a student’s ability to comprehend under a variety of types of noise, and signal-to-noise levels (speech above quiet background noise versus louder noise or competing voices). Teachers should create compromised listening situations with environmental background noise as well as situations where there are multiple people speaking at once, like in a restaurant, to assess their student’s ability to accurately understand speech in noise.  Signal-to-noise ratios should be manipulated to provide authentic results to the testing session. The teacher reads words and phrases consistently speaking at about 65 decibels, while the background noise is manipulated and require students to answer questions or repeat what was heard verbatim.  Scores should be collected for a variety of auditory tasks and testing conditions should be consistent for each student.

Speech in Noise Training

Teaching students to listen in the presence of background noise helps students train their brains to focus on the auditory stimuli.  Practicing these skills helps students extract meaning from noisy situations, which helps minimize access barriers for communication.  Listening in noise can also encourage students to use compensatory strategies and advocate for accommodations.  Students may employ strategies such as speechreading, asking for others to repeat what they are saying, asking others to face them when speaking, advocating for a quieter environment, using HAT in class, and reducing the distance between the speaker and listener. All communication repair and other accommodation strategies can help the student gain meaning from communication in noise.

Students with hearing loss tend to report that they aren’t aware that they have missed information, therefore they don’t always advocate for communication access.

Teachers can use real life situations to assist students with LIN by using compromised environments such as lunchroom, playground, assemblies, concerts, or extracurricular activities.  Have the student practice listening to the teacher while natural background noise provides a barrier.  Ready-made materials with questions can be used, reading passages from core content textbooks and answering questions, or having students repeat after hearing sentences from a children’s books are all ideas for stimuli to use while listening in typical background noise.   Using a sound-level meter application on a cell phone or a purchased SLM, measure the level of background noise.

Then, speaking around 60-65db, have the student try and repeat what is said or answer questions appropriately.  Teachers must be cautious about the natural instinct to raise their voices when speaking, in attempts to speak over the level of noise. Practice listening in noise without visual cues, but allow speechreading intermittently to maintain motivation. Teachers can also create compromised listening situations, using background noise from pre-recorded environmental sounds (download the Classroom Noise Audio File) or sounds of people talking.  Again, a sound level meter is necessary to monitor the level of signal to noise ratios so you control the level of difficulty and can show true progress.

Practicing these skills on a regular basis can easily be incorporated into daily lessons for self-advocacy skill building, auditory training skills, compensatory strategies and for secondary transition preparation.

Identifying barriers to communication which limit auditory access is a skill that needs to be taught to students with hearing loss.

Author: Michelle Andros

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The post It’s a Noisy World! We CAN Improve Listening in Noise Ability first appeared on Supporting Success For Children With Hearing Loss.

What is incidental learning?¹

It is some form of indirect, additional, unplanned learning within an informal or formal situation.

In our environment…

Walking through the store, driving to work, watching TV.

Social interactions…

Talking with friends, family, neighbors, classmates, teachers.

In the Workplace and/or Classroom…

Listening to workshops, the radio, listening to announcements.

When is the skill of incidental learning typically learned?²

Infant word learning begins as a slow, laborious task that involves frequent repetitions of words in meaningful contexts. During the second year of life, however, the nature of word learning changes to where most typically developing 18- to 24-month-olds learn new words incidentally, without direct adult instruction and with only limited exposures to the words’ labels and referents. This is shown by the fact that between the ages of 18 months and 18 years, children learn an average of 9–10 new words a day (P. Bloom, 2000; Templin, 1957).

Researchers suggest that a child acquires language based on how engaged they are in the social situation, the effort they put in to trying to understand the information, and their level of desire to understand. In order for a potential learning situation to be useful, the child must find it worthy of their attention and energy. The child’s desire to rectify what they know, with what words they just heard and, how important they feel it is to make sense of what was heard, is the motivation for word learning.

At the age of two, many children with hearing loss are (1) still struggling to use amplification all waking hours, or (2) their hearing families continue to be challenged to learn sign language vocabulary at a rate typical of a two-year-old, and/or (3) there has been a lack of services by an early intervention provider who is experienced and knowledgeable about how to minimize the far-reaching impact of hearing loss on child development. While children with hearing loss are still struggling to consistently ACCESS communication, their hearing peers are developing expertise in using overhearing to drive language development. Indeed³, even when hearing technology is used effectively, a language gap will almost always be present between DHH learners and hearing peers.

Nevermind…

Too often when a student misses information and asks a peer or adult to repeat, they are told ‘nevermind’, ‘shhhh’, or ‘it’s not important.’  Yet, being included in communication occurring around them is vitally important.¹ Those who have hearing privileges take informal and incidental learning for granted and may not realize the marginalization phenomenon that have been placed on students who are deaf and hard of hearing because ongoing, dynamic, fluid surrounding conversations are spoken-laden. As such, many of these students are marginalized to the periphery of their school community, becoming relegated to the role of bystanding⁵, not realizing how accessing incidental information impacts learning or development of knowledge.⁴

Most places have addressed the issues of accessibility during formal instruction, but the access issue continues beyond the formal instruction. Accessing incidental learning opportunities can boost literacy and vocabulary development. Access to incidental learning fosters an individual’s fund of knowledge, starting at home and continues within the community. Ultimately, incidental learning is a lifelong, social, and academic phenomenon. Historically, we have placed the problems associated with incidental learning on the children when the issue is actually a societal attitude. Instead of focusing on what DHH individuals cannot do or have limited access to, a better solution may be to conceptualize how we all can make the environment accessible for them.⁴

Unfortunately, no magic answer…

What can we do?

1) ENSURE ACCESS – appropriate hearing technology used consistently and/or sign/captions available to include peer interactions as much as possible.

2) Control the environment. Even the best personal hearing devices are not as effective in noise. Quieter environments, even if it means a room next door, could make the difference between inclusion and frustrated bystander. Linking with students who are willing supporters and friends may help a student cope.

3) Age-appropriate self-advocacy instruction. Requesting clarification can be done in a way to encourage ‘nevermind’ or to motivate the speaker to repeat.⁶  Students bear some responsibility in participating.

4) TRULY DISCUSS AND PLAN how to decrease the ‘bystander phenomena’

TALK ABOUT INCIDENTAL LEARNING AND IT’S CRITICAL IMPORTANCE

Parents, teachers, SSPs, and administrators should engage in discussions, during Individual Education Program (IEP) meetings, and request that accessible incidental learning opportunities should be created beyond classroom instruction. Such decisions cannot be based on staff availability, funding, or convenience. Considerations should include hiring qualified Deaf and hard-of-hearing personnel and promoting environments that would encourage a critical mass of students with hearing loss, where there are more opportunities for members to share a common, intelligible, and accessible language. A strategy might be an implementation of a center program where DHH students from neighboring districts converge.⁴

References

1. All Roads Lead to Understanding: Incidental Learning Right from the Start – PPT
2. Incidental Word Learning in a Hearing Child of Deaf Adults
3. Word and World Knowledge Among Deaf Learners with and without Cochlear Implants
4. Incidental Learning with Deaf and Hard of Hearing Students
5. Positioned as Bystanders: Deaf Students’ Experiences and Perceptions of Informal Learning Phenomena
6. SCRIPT – Student Communication Repair Inventory & Practical Training

Author: Karen L. Anderson, PhD
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The post Keys to Incidental Learning first appeared on Supporting Success For Children With Hearing Loss.

Hearing and listening are the cornerstones for learning for almost all children.  If a child cannot clearly hear or attend to spoken information, speech and learning spoken language will likely be impacted. This means that hearing loss can cause learning challenges related to academic achievement, communication difficulties, and potentially result in social isolation, poor self-concept and even have an impact on eventual vocational choices.

>The early identification of hearing loss and early intervention services work to minimize these adverse effects by providing improved access to verbal and/or visual language. Parents who learn about their child’s hearing loss and how to talk about it with the child and others, will have a positive impact on their child’s self-image and growth.

Research has indicated that indicated five out of every 1,000 children are impacted by hearing loss. Children may be born with hearing loss or may acquire hearing loss after birth from illness, trauma, ototoxic medications, noise exposure and genetic factors¹. The earlier hearing loss is identified the earlier interventions can begin. While most states and provinces in North America now identify hearing loss at birth through newborn hearing screening programs, there remain hearing losses that may not be identified at birth that require assessment by an audiologist to determine the type and degree of hearing loss.

While it is considered to be a “low incidence” disability, hearing loss still affects a large number of children in the school systems who are trying to listen and learn through auditory systems that are not equal to that of their peers. Listening and learning with a hearing loss comes with challenges and as a result, children with hearing loss may face both educational and social-emotional barriers.

In addition, 30-40% of children with hearing loss have additional learning issues.  Learning about these potential difficulties will prepare you and your child for their journey through childhood and beyond.

It is often overwhelming for parents to be told that their child has a hearing loss. There is often a period of grief, loss and uncertainty (“what does this mean for my child?”) followed by a learning curve as parents navigate health and education systems, learning how to best advocate for their child.

Each child needs their parents to move forward, one step at a time. With early diagnosis, appropriate technology, good language models and the unconditional love and support of the family, the child will have the opportunity to fulfill their potential.

Identifying a Hearing Loss: This section provides information about identifying hearing loss from birth, hearing loss in young children due to ear infections and identifying hearing loss in school-aged children.

Next Steps After Screening   What should happen after a child has failed a hearing screening? What if they are actually diagnosed with a hearing loss? What are the next steps? This section explores what to expect once the child has failed a hearing screening or that child has been found to have a hearing loss.

Types of Hearing Loss  This section provides information about normal hearing sensitivity, the causes and different types/degrees of hearing loss, and related options for improving the outcomes of the child so development can be as typical as possible.

Hearing Loss Plus – additional disabilities  30-40% of all children with hearing loss have one or more additional disabilities. Read here for more information on understanding hearing loss plus.

The Impact of Hearing Loss Because hearing loss is invisible, it is hard to really understand just how much it can affect a child’s day-to-day life and lifelong potential. This section provides information about how hearing loss can impact listening/learning and social-emotional growth.

Describing Hearing Loss to Teachers and Peers  Children who have a hearing loss are at educational and social-emotional risk. Parents, teachers, audiologists and other professionals should work together with the child, to understand the hearing loss and to advocate for their listening needs. This section provides resources about how to explain the impact of hearing loss to teachers and peers.

Frequently Asked Questions about Hearing Loss    Read here for answers to some common questions regarding hearing loss.

Hearing Loss Identification   “Does my child have a hearing loss?”

Hearing loss is invisible – it is not always apparent that a child is having hearing difficulties. US Hospitals routinely perform hearing screening on infants in the first 24-48 hours after birth. If an infant fails the initial screening, he or she is usually scheduled for a second screening a few weeks later. However, sometimes infants who pass the hearing screening at birth may exhibit signs of hearing loss as they age.

Hearing loss may be identified at birth or any time thereafter. If there are any concerns regarding a child’s ability to hear (at home or school) do not hesitate to have their hearing tested. It is never a waste of time for an audiologist to report that a child has normal hearing.

The Hearing Loss Identification and Next Steps section provides background into what to consider if you’ve found out your child may have a hearing loss. Under the Hearing Loss Identification section you will also find pages on:

• Hearing Loss Identification and Diagnosis
• Hearing Screening Resources
• He Failed Hearing Screening! What’s Next?
• Questions Families Often Ask About their Child with Hearing Loss

There are different types of hearing loss.  

Hearing Loss – Information on Specific Types

• What is ‘normal’ hearing for children?
• Relationship of Hearing Loss to Listening and Learning
• Auditory Neuropathy Dyssynchrony Spectrum Disorder (ANSD)
• Ear Infections and Learning
  • Cholesteatoma – What is it and how can it effect learning?
• Hearing Loss Caused by Noise
• Hyperacusis – Over-sensitivity to sound
• Mild Hearing Loss and Learning
• Permanent Conductive Hearing Loss – Atresia, Microtia, Etc. 
• Unilateral Hearing Loss – hearing loss in only one ear

About 30-40% of children with hearing loss have additional learning issues

Hearing Loss PLUS Additional Disability(ies)

Because hearing loss is invisible, it is hard to really understand just how much it can effect a child’s day-to-day life and lifelong potential.

Rather like trying to describe a new color of the rainbow that is not visible to most people, it is challenging to describe the affects and potential impact of hearing loss.   Describing the IMPACT of hearing loss.  Go to this page for a list of many simulation audio and video materials that assist in understanding how hearing loss truly can impact listening, development, access to instruction, socialization and overall learning.

• Demonstrations: Simulations of Listening with Hearing Loss and Hearing Devices
• Relationship of Hearing Loss to Listening and Learning – handouts on 9 hearing loss levels
• Inservicing the Classroom Teacher
  • Emailable Tips for Teachers
  • Teacher Guidance – Using FM in the Classroom
• Understanding Your Student’s Hearing Using the Desired Sensation Level Approach

Revised March 2017. Our sincere thanks to Krista Yuskow for her contributions to this content. 

The post Hearing Loss – Identification, Impact and Next Steps first appeared on Supporting Success For Children With Hearing Loss.

Author: Brenda Balch, M.D., AAP EHDI Chapter Champion for CT

The leading cause of sensorineural hearing loss is heredity, but many people don’t realize that the second most common cause of SNHL in children is due to Congenital Cytomegalovirus or cCMV. It is also the most common congenital viral infection in the United States and resulting hearing loss may be preventable. CMV can cause wide variation in hearing loss, including progressive loss.

What is CMV?

Cytomegalovirus is a herpes virus that causes minimal to no symptoms in most people. In the U.S, by age 40, most of us have evidence of a past infection. CMV becomes a concern in primarily two scenarios – in a pregnant woman or in a severely immunocompromised individual. Most women are unaware of CMV and the risk of infection during pregnancy.

What is the size of the CMV problem?

cCMV is the most common congenital viral infection in the United States. Approximately 1 out of every 200 infants are infected with CMV prior to birth. With 3.8 million births in the US in 2018 we can assume that 19,000 children were infected with CMV.

Of those who are infected, how many children end up with hearing loss?

Of the 1 in 200 infants infected with cCMV, approximately 10% will be “symptomatic” and have serious symptoms at birth that may include microcephaly, enlarged liver/spleen, cerebral palsy, cognitive impairment, vision loss and sensorineural hearing loss(SNHL). Another 10% – 20% of the 200 infected infants are “asymptomatic” will have or go on to develop SNHL. Using the 3.8 million births in the US in 2018 as an example again, 1900 would have had symptomatic CMV and 950-1900 would have had asymptomatic CMV that caused hearing loss.

Audiological follow-up data for 860 children with congenital CMV. Dahle et al 2000, extrapolated by Walter 2017

CMV is so common! Can’t we test for it before it causes hearing loss and other problems?

Presently, most infants are not tested for cCMV at birth. Infants with obvious symptoms of cCMV are being tested, and in a few states with recent legislation, those infants who fail their newborn hearing screen are tested. If an infant is not tested for cCMV by 3 weeks of age, any positive test after 3 weeks of age may indicate an acquired infection rather than a congenital infection. It is therefore difficult to estimate what proportion of SNHL is due to congenital CMV in children outside of the newborn period.

How is CMV spread?

Cytomegalovirus is primarily spread through saliva, mucous and urine. Infants and young children are commonly shedding the virus. Small children have behaviors that are more likely to lead to the transmission of CMV. Women of child bearing age should be aware of the risks of congenital CMV and methods of prevention. Women who are pregnant or planning on becoming pregnant can take precautions that may reduce their risk of exposure to CMV. Clinical studies with antivirals for CMV and trials for a CMV vaccine are ongoing.

How can we prevent CMV?

Educators who work with young children are at greater risk of contracting CMV and can help to prevent transmission of CMV by treating all body fluids as if they are infectious.

This includes:

• Wash hands frequently with soap and water, lathering for at least 15 seconds
• Avoid kissing a child near the nose or mouth
• Do not put things in your mouth that have been in a child’s mouth such as a pacifier, cups, utensils or food
• Wear gloves for all contact with body fluids, and always wash hands after removing gloves
• Use EPA approved disinfectants to frequently clean workplace surfaces that may be contaminated with body fluids
• Do not use diaper wipes to clean potentially contaminated workplace surfaces
• Disinfect small toys or objects that may have been contaminated with body fluids

Any and all children, both in the classroom and in the home, or extended family setting, may potentially transmit CMV to a woman of childbearing age or a pregnant woman. It is prudent to use good hygiene precautions in all of these settings.

Resources

• https://cdc.gov/cmv/index.html
• JCIH 2019 position statement

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The post An Often Unknown Cause of Hearing Loss in Children first appeared on Supporting Success For Children With Hearing Loss.

At the start of each school year, thousands of students enter classrooms with teachers who have never encountered a child with hearing loss.
The following list summarizes key needs of students who are deaf or hard of hearing and the critical role of teachers to set the stage for student success in the mainstream classroom.

Key Points to Keep in Mind About Learners who are Hard of Hearing

1. Hearing loss is an access issue, not a learning disorder. Job #1 is to ensure that the student receives the same amount of instruction and classroom communication as peers. The student’s learning issues are due to missing parts of communication experienced in the past and throughout every day.

2. Hearing devices do NOT restore normal hearing. Children who are hard of hearing continue to miss bits and pieces of what is said, especially when farther than 3 feet from the speaker, in noise, not able to see the speaker’s face, or when unfamiliar vocabulary is used. Using FM/DM/HAT hearing devices consistently helps to level the playing field for optimal access to classroom communication.

3. You will ‘see’ that the student hears based on his or her behavior. It is easy to assume that the student perceived 100% of what you or peers said. Instead students are often trying to fill in the blanks for unheard speech sounds. Cat, cap, calf, cast may all sound like ‘ca’; rhyming words like drought/trout, few/blue, and countless others will be mistaken for one another. Extra processing time is necessary.

4. There is typically a need for the teacher to provide more repetition, to use a slower rate of speech, and to ensure the student is able to see the face of the person talking. Even with an effort by the teacher to make sure these modifications happen consistently, the student may have a harder time keeping up with the pace of learning due to continuing difficulty fully accessing all that is said around him or her.

5. Group work and social situations can be especially challenging due to multiple speakers, fast speech, and background noise. Social awkwardness or ‘being out of step’ socially can often occur.

The Jul-Sep 2018 issue of Volta Voices provided the following information.

What Teachers Can DO to Help a Student with Hearing Loss

How to identify a communication breakdown

• Confused facial expression
• Inattentiveness
• Disinterest/withdrawal
• Frustration, anger or anxiety’
• Bluffing, smiling and nodding
• Inappropriate responses, such as changing subjects or off-topic responses
• Body gestures like a shrug
• Hesitation in responding or interrupting
• Not taking turns in conversation

Classroom Tips for Teachers – Speaking

• Stand or sit close to the child (3 feet is ideal at the hearing device microphone level if possible)
• Make sure the child has good visual access to the speaker’s face
• Stand still as much as possible when you are talking
• Speak clearly at a slightly slower rate with slightly increased intensity. Emphasize key words. Do NOT over enunciate
• Use natural gestures, exaggerated prosody, and facial expressions

Classroom Tips for Teachers – Engaging

• Ask for clarification: “What did you hear?” and “What are you going to do?” Look for clues that the child did not understand you. Do NOT ask yes/no questions such as “Did you hear me?” or “Do you understand?”
• If the child does not understand, simplify and shorten sentences. Rephrase with simple, more familiar vocabulary.
• Touch the child, call his name, make eye contact or give a visual signal when instructions are given: “Listen: this is important” or “Look at me.”
• Expect the child to participate in classroom discussions and group work.
• If you do not understand the child, repeat what you did understand and ask for the rest of the information: “Yes we are on chapter 3. What did you want to know about the instructions?”
• Repeat the essence of a classmate’s question or answer. Direct the child’s attention to the person speaking by pointing to them as you call on them to answer, and/or say their name.
• State the topic before initiating discussion and state when the topic changes. Preface a change in activity by stating, “Next, we will talk about…” or “Now we are talking about…”

Classroom Tips for Teachers – In the Classroom

• Provide lists to the parent and/or educational support staff prior to lessons with themes and vocabulary for pre-teaching.
• Ensure good lighting and recognize that dim lighting will impede the child’s ability to use visual cues. Do not stand in front of a brightly lit window as that interferes with speechreading.
• Ask classmates to speak one at a time during discussions.
• Use multimedia supports, visual aids, and hands-on demonstrations as much as possible.
• Make sure all visual/audio media is captioned.
• Make sure the child has the correct patch cords to allow use of the FM/DM/HAT system for any lessons or assessments provided by computer or media device. Do not assume that headphones will be sufficient to allow the child to hear with their hearing devices.
• If you or classmates are reading aloud, provide the book or a copy of the print for the child to follow along.
• Provide a written summary of any video material or any material that is read aloud.
• Modifications may be necessary, such as one or more peer note takers, extra time on in class assignments and tests, modifications of reading and written assignments, alternative tests, or allowance for oral tests or providing testing in a quiet room.

How a Teacher can Manage Peer Conversations

If a peer does not understand a child with hearing loss, the teacher can help the child:

• Repeat at a slower rate, use louder speech, or shorter sentences. “Did you say….?”
• Repeat, emphasizing key words
• Rephrase
• Add more information. “What happened next?” and “When did this happen?”
• Write it or use gestures. Ask the child with hearing loss to “show me”.

When the Child with hearing loss does not understand a peer, a communication breakdown has occurred. A repair strategy is needed. Ask the peer to:

• Repeat what was originally said (say it again)
• Rephrase what was said, using different words or breaking it into shorter sentences
• Elaborate by using more information to clue in the listener (tell me more)
• Cue by providing background information to focus on the topic and building from the known
• Spell out the letters to emphasize sounds in the misunderstood word or words
• Ask: “What did you hear? Did you say … or ….?

Heading into the Mainstream: Preparing your child for mainstream schooling also means preparing the teacher in the classroom. Velvet Buehler, MA, CCC, SLP/A. July-September 2018. https://www.agbell.org/Portals/26/PDFs/Volta-Voices-Jul-Sep-2018-Final.pdf.compressed.pdf?ver=2018-08-21-161818-920

Additional Resources

• Dear Classroom Teacher Letter
• Dear Classroom Teacher – You have a student with hearing loss (brief article)
• Refer to the Heading into the Mainstream article for tips for how parents can prepare their children for a good experience in the mainstream school setting.
• The Impact of Hearing Loss
• Describing the Impact of Hearing Loss to Parents/Teachers

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