Raising and Educating a Deaf Child

International experts answer your questions about the choices, controversies, and decisions faced by the parents and educators of deaf and hard-of-hearing children.

Language and Communication

I have a seven month old daughter just diagnosed with profound hearing loss. What are the main things I should be doing with her immediately (apart from starting sign language, which we did before she was officially diagnosed) to promote her language and literacy acquisition down the track?

Question from M.W., Switzerland. Posted November 16, 2014.
Response from Marc Marschark - NTID

You are already doing the most important thing: asking questions. Next, but not unrelated, you should look into family-centered early intervention programs. Descriptions of these, the issues you need to be aware of, and the questions you should be asking can be found in two articles recently published and available from the Journal of Deaf Studies and Deaf Education. Click on “Read Highlighted Articles for FREE.”

Meanwhile, enjoy your daughter and engage in as much communication as possible by talking to her, signing to her, and through touch. Just remember to get her (visual) attention before communicating. You will do great!

I am needing help with explaining how an 11th grade student who is deaf with ASL as his first language and English as his second language and uses an ASL interpreter in class is struggling with learning Latin IV. He uses a CI and hearing aid.

Question from A.D., Ohio. Posted October 30, 2014.

Research on deaf signers who have ASL as their first/preferred language has clearly shown that their skills in using spoken/written English vary enormously. Those who acquire ASL earliest tend to be better at English overall than those who learn ASL later, but many do struggle with English as it is for them a second language (just as learning say French would be for a native English speaker). Learning then additional spoken/written languages beyond English is even more challenging for the deaf student, particularly when they are being taught alongside hearing students via interpreters. This would be like a native English speaker who can read and write French as a foreign language trying to learn Latin as an additional language in a class full of monolingual French speakers where the class was taught exclusively in spoken French and interpreted (just for that one student) into spoken English. There has been very little research on acquisition of additional/foreign languages by deaf signers in these kinds of situations, but it is clear that such a student must be given proper support in order to achieve the same level of success as his hearing peers.

We have a 5 year old, bilaterally implanted son who has been mainstreamed into a general education kindergarten. He is awesome at reading people’s body language and just assuming answers to questions. He is an awesome parrot. [But these do not mean he is understanding fully.] The school continues to say that he is a typical 5-year-old boy and that he has adjusted well to being mainstreamed.

He is a very visual child, and we use sign language and spoken language to communicate at home, but the school says they cannot accommodate that, even though we know that there is an interpreter around the corner who has a contract with the school. Is there any way to get sign language into the classroom? We were originally told that if they got an interpreter for him they would need to get one for every foreign language student in the school. Which we know is against the law.

He went to the deaf school for half a day last year in Pre-K, and were told that that was all they could offer him, as he is so advanced due to us working so hard with him. But his working so hard has come back to bite us. He now comes home tired and burned out, not wanting to listen to us anymore. All we want is for him to get the same education as his hearing peers, please help!

Question from L.W., New York. Posted October 9, 2014.

You and your child are going through a difficult time that needs to be resolved as soon as possible. Your mentioning that he is in a mainstream setting suggests that he has had an evaluation through special education and has an Individualized Education Program (IEP). If he has, I would suggest requesting a meeting to review his current placement. If an evaluation was not done, you can request a referral for an evaluation through special education.

Your child is entitled to have access to the curriculum and to instruction in the classroom based upon the evaluation and the IEP (it is important that the assessment regarding modalities of instruction be done by someone knowledgeable with regard to hearing loss). If that access requires an interpreter, then it is the school department’s responsibility to provide that service, assuming that it is part of the IEP. There should be no negative consequences for your child because he has had opportunities (with your support) to develop his skills. The goal of special education is to insure that all children achieve to the greatest extent possible given their capabilities. Your son’s strong abilities are no less worthy of support than if he was weak in the same domains.

With regard to the school’s response to your request, not speaking English is not a disability. A child who is a native speaker of a language other than English does not qualify for special education services. That argument is a “red herring” and has nothing to do with your son’s situation.

I’m a pediatric occupational therapist who only occasionally works with deaf children. I don’t have time (or a library) to read papers and books about deaf children. Is there something like Cliff’s Notes on deaf kids?

Question from R.P., Virginia. Posted July 16, 2014.

Yes, Virginia, there is a Santa Claus. (sorry!)

Raising and Educating Deaf Children is a new site offering objective, evidence-based information for policy-making and practice associated with raising and educating deaf children – with an eye to improving them. New eBulletins are posted quarterly; each includes sections on The Issue, What We Know, What We Don’t Know, and Implications about various topics, all written so as to be accessible to parents as well as professionals.  eBulletins include Further Readings with content offered free of charge by Oxford University Press.

What language/sign system/ communication mode is best in regards to educating deaf children? In particular, does using SEE correlate to higher reading and writing levels when compared to ASL, total communication, or Sim Comm? Many times people argue that SEE is best because a certain school or program’s students have higher reading levels. To me that is not evidence based data. There are many factors that can contribute to higher reading levels at a certain school when compared to another school or program. Looking at one aspect is not enough unless the schools are identical in all other areas. Is there any evidence based research to support SEE? Also, is it possible to use elements of SEE, but still continue signing ASL or conceptually?

Question from L.L., Texas. Posted June 30, 2014.

I just love loaded questions! Here’s an answer many people will dislike:

There is no language/sign system/communication mode that is “best in regard to educating deaf children.” Certainly, you can find proponents (and data) to support any of the ones you listed. What that tells you is that different things work for different children in different settings. Generally, forms of manually-coded English were created to help deaf children acquire English literacy skills. Generally, they have not proven more successful over the long term than American Sign Language (ASL) or anything else, but the comparison is not a simple one. Proponents of ASL as a link to literacy typically cite data showing that early ASL (e.g., from deaf parents) supports early literacy. So does early spoken language (e.g., from a cochlear implant). The key is early access to fluent language and being surrounded by it in formal and informal settings.   There are programs that use SEE, ASL, SimCom, and other systems that report successful reading achievement in their students. The data from these programs vary in how strong they are, but, again, what this shows is that when deaf children are surrounded by consistent language they will excel. SimCom, for example, has been criticized for not being “a true language,” but has been found to work as well as anything else in the classroom, at least in high school and college. And children in a real total communication school (i.e., SimCom, ASL, assistive listening devices, etc.) have been found to read as well or better than peers in a well-known bilingual program (in which over one third of the children had deaf parents) (see Knoors & Marschark, 2012, below). SEE is an English-based sign system; ASL has a completely different grammar. Many deaf and hearing people use signing with English word order and characteristics of ASL, but trying to mix in SEE signs rather than using ASL signs seems an unnecessary complication. The goal is to give young deaf children a foundation for language (signed and/or written/spoken). Unfortunately, there is no simple solution.

Further reading

Knoors, H. & Marschark, M. (2012). Language planning for the 21st century: Revisiting bilingual language policy for deaf children. Journal of Deaf Studies and Deaf Education, 17, 291-305.

Schick, B. (2011). The development of American Sign Language and manually coded English systems. In M. Marschark & P. Spencer (Eds.), The Oxford handbook of deaf studies, language, and education, Volume 1, second edition (pp. 229–240). New York: Oxford University Press.

My 4 year old son has been diagnosed with severe sensorineural hearing loss in both ears. He was not born this way; we believe he lost his hearing sometime between 2.5 and now. He was just diagnosed in June and he will be getting his first pair of hearing aids at the end of July. I’ve been told by his ENT and Audiologist that we need to make a decision about cochlear implants (CIs) very soon. My son had lots of vocabulary and speech sounds; he now is a little difficult to understand but communicates with family and friends. My question is where can I find good information about CIs and also why must I rush to make a decision?

Question from M.H., New Jersey. Posted June 27, 2014.

It sounds as if your child’s loss predominantly occurred after he acquired verbal speech and auditory language, so his deafness is categorized as “post-lingual.”  This means your son’s brain has a memory of what speech sounds like, even if that memory and how to reproduce it are fading a bit. That is one reason why implantation is recommended sooner rather than later – research has demonstrated that the shorter the lag between onset of the hearing loss and input from a cochlear implant, the better the child does.  We believe that is because the auditory memory (part of that auditory path design) has had less time to “forget” the sounds of speech.  There are lots of research articles that talk about keeping that time-frame short between onset of hearing loss and use of the CI, although outcomes are more variable than they might appear.

The signal from the hearing aid is amplified speech and other sounds, so your son will hear things at a louder level with his aids.  The sounds will be distorted and some sounds may not be transmitted very well (sounds like /sssss/ and /shhhhhh/).  His brain and his ears are connected by a path of nerves (the auditory path), and the signals that the ears receive must be interpreted by the brain.  There is big difference between the signal provided by a hearing aid (loud speech) and the signal transmitted by the cochlear implant (kind of like Stephen Hawking’s electronic speech).

Without knowing more details as to the cause of the hearing loss, it is unclear whether there are specific reasons for recommending earlier implantation – some audiologists and ENTs simply believe that CIs are for almost every deaf children and the sooner the better. However, I can tell you that there are some conditions that can cause a bony growth to happen in the cochlea (which is the organ if hearing) and, if so, this growth begins after the hearing loss in a gradual and slow manner.  If this occurs, the longer one waits, the more difficult it can be to insert the electrode of the cochlear implant.

There may be other reasons your healthcare providers are wanting you to make a decision, but you need to do your homework first. One of the predictors of children’s success with CIs, literally, is how much time their parents spend getting information on the subject. Here are two links that let you compare what the signals of a hearing aid sound like and the signals of a Cochlear Implant sound like

https://www.youtube.com/watch?v=1l37lzLIgQU

http://www.etc.cmu.edu/projects/tatrc/?page_id=371

Here are some article review links:

http://www.scielo.br/scielo.php?script=sci_pdf&pid=S1808-86942012000200019&lng=en&nrm=iso&tlng=en

https://ore.exeter.ac.uk/repository/handle/10871/11533

[Ed. – For more, very objective information visit the UK’s Ear Foundation]

Our district audiologist wants to put all DHH students on personal FM and remove the class soundfields altogether. I find conflicting research on this. The DHH teachers don’t want to get rid of the class soundfield systems. Can you please confirm either the benefits or detriment of keeping the soundfield in place in addition to personal FMs?

Question from E.W., California. Posted June 12, 2014.

By class soundfield system, I assume you mean a room equipped with two or more speakers that broadcast the desired signal into the desired space.  The problem with these systems is that everyone in the room is exposed to the signal and, depending upon where the deaf or hard-of-hearing student is sitting, there could loss of signal strength over distance.  Personal FM systems have the advantage of being set up specifically for the user, whether the individual is using a hearing aid (s), a cochlear implant, or both.  The signal is clear, coming directly from the teacher to the student.  The signal does not lose strength over classroom distance, and the teacher can use one microphone to connect to several students at the same time.  Also, there is no “carry over” into adjoining classes as there might be with a sound field system (depending upon the decibel level of the signal).  In my opinion, the FM is superior though more expensive. Two additional notes:  (1) Students with milder hearing losses may do best with soundfield system while those with severe to profound losses are likely to do better with FM. (2) It is unclear why a person would remove an existing soundfield system unless maintenance is an issue.

Is there any evidence-based research regarding consistency with interpreters in a mainstream setting? If a student has the same interpreter for a number of years, does this in itself, negatively impact a student’s progress if the student’s use of the accommodations and interpreter is a positive one? My daughter, who is in a mainstream setting, has requested the same interpreter for the 3rd year. I do not see any problem with this; however, I was unsuccessful in finding supportive/non-supportive research, articles, etc. about this issue.

Question from W.W., Florida. Posted June 8, 2014.

No one I have contacted has been able to cite research on this issue, so the simple answer to your question seems to be “no.” Stories shared over the years, though, have never yielded a negative about a deaf student having the same interpreter year after year….and even throughout the school years and into college. One male college student (still with his first, female, school interpreter) said that the early puberty years were a little strange at first, but he was glad he had not changed. High-quality educational interpreters are hard to find in many places. If your daughter has a good one and everyone is  happy, there is no reason to change. Having a variety of sign language models likely would be beneficial for her language development. However, it seems best to have consistency in school terminology and support from someone who knows your daughters strengths as well as her needs. You can find her other language models in other settings.

And here’s an addition of further readings from Christine Monikowski (NTID) who noted that many school districts have guidelines concerning time limits for interpreters working with a single student (typically 3 years)…to insure “professional boundaries” are adhered to:

Crosby, P. (1998, November/December). Looping in middle school: Why do it? Teaching Pre K-8, 29(3), 46-47.

Elliot, I. (1998, November/December). When two years are better than one. Teaching Pre K-8, 29(3), 38-41.

Nichols, J. D. (2002, September). The impact of looping and non-looping classroom environments on parental attitudes. Educational research quarterly, 26(1), 23-41

I have a 5 yr old son who was born deaf; he has a serve/profound hearing loss. He has limited sign language and no speech. His behavioral is the problem. I just can’t seem to control him – he is so active. Is there anything i can do to help him so he can be able to focus more and be able to learn?

Question from R.A., Florida. Posted April 22, 2014.

Language is crucial to children learning how to regulate their emotions and their behavior.   In children with very limited language, great patience is required from adults, as these children are missing an important tool.  There is no simple solution, but Ross Greene has argued that all children want to be good and would be good if they could.  Behavior that is not cooperative or compliant is not because children want to misbehave, but because they cannot organize to do what is asked.  The adult’s job is to remember this point (easier said than done!) and help them learn to organize.  The area of psychology that has had the greatest success dealing with behavior difficulties in children with low levels of communication has been Applied Behavior Analysis.  This approach, though, requires effort from the adult who is practicing it, reinforcing children for approximations of cooperative behavior and not allowing and certainly not reinforcing uncooperative behavior.   There are specialists in most urban areas who provide ABA services, both in schools and in home; you might ask about that.

Additionally, use pictures, drawings, or photos of the child doing the desired activity and keep them handy (laminating them helps) to point out to the child what is desired of him along with rewards that will be given immediately upon cooperation.  Start with very low expectations so that children are rewarded quickly, easily, and frequently and then gradually make the expectations greater.  Remember also that children often have much more energy than adults, so finding ways for a child to expend his or her energy before asking them to do more quiet activities (e.g., household chores, homework, coming to the dinner table) will be important.  Rewards should be things that the child truly enjoys and that can be given easily and cheaply.  No need for trips to Disney World, but play time with particular games, favorite foods, or other enjoyable activities should be used.  Rewards may need to change as well since children will tire of things.

This approach does not always work quickly and in fact when first employed, behavior tends to get worse as children believe they must be more uncooperative to get what they got before.  But, with time and patience, it can make a difference.

Can you please suggest some good articles, research or data to support having a TOD in a classroom with a 5 year old with significant delays “across the board” (the student has bilateral CIs, no sign language, extreme speech delays [apraxia?])?

Question from J.B., Vermont. Posted April 2, 2014.

Given the huge individual differences among deaf children with multiple challenges, this is an impossible question to answer. You really are (or should be) looking for information relevant to a very specific child, and we don’t have much to go on.  How significant are the delays?  Is the child using the CIs successfully?  What is the cause of the extreme speech delays? Has there been an assessment that suggests apraxia or is that a guess, and if the latter, based on what? Does the child not use sign language because s/he has not responded to it or because s/he has not been exposed to it?

You can find articles and chapters about the educational needs of deaf children with additional disabilities (see below), but you really want to know why that 5year-old should have a teacher of the deaf.  You will not get that from an article.  You are going to need a comprehensive evaluation done by people who know what they are doing and can communicate effectively with the child.  There is no one right answer; it depends on the needs of each child.

Further reading:

Mauk, G. W. & Mauk, P. P. (1998). Considerations, conceptualizations, and challenges in the study of concomitant learning disabilities among children and adolescents who are deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 3, 15-34.

Vreeland, J. (2014). Educating deaf children with multiple challenges.
www.raisingandeducatingdeafchildren.org