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.

Social, Emotional and Behavioral Development

I have a 9 yr old child with bilateral sensorineural hearing loss who has been aided since age 1. He is in third grade. Up until very recently he has thrived (very intelligible, performed at grade level in school.) but recently he is struggling with reading comprehension. Most disturbing is he has withdrawn from classmates during recess and is refusing to participate in group work in the classroom. He is contantly getting into altercations with other children exhibiting great frustration and anger. I believe that he is socially immature and this is the root cause of the problem due to his hearing loss. Is this common and what services can I get to help him.

Question from S.M., Colorado. Posted March 20, 2011.
Response from Joel Grover - Western Pennsylvania School for the Deaf

For children, hearing or deaf, who are prone to difficulties like those of your son, it is not uncommon for those to emerge in third or fourth grade. Not knowing your son’s degree of hearing loss makes it a little tougher to answer your question, and it is unclear whether his speech intelligibility has declined along with his reading comprehension. The wording of your question, however, suggests that his speech, hearing, reading comprehension, and behavior issues may be intertwined.

Assuming that your son relies primarily on spoken language, his ability to process auditory information will strongly affect his learning style and have multiple effects on (intentional and incidental) academic and social learning. He is at a point in school where complex language requirements increase in a variety of areas and it is often at this age that deaf and hard-of-hearing children begin to experience more difficulty academically and socially. Reading becomes more abstract. Children are asked to infer meaning from text rather than just going back to find a more concrete answer. Deaf and hard-of-hearing children in many countries therefore exhibit reading difficulties at this age, regardless of whether they use sign language or spoken language.

Although your son may have intelligible speech, it does not mean that language development is developing typically and we cannot expect his reading and written expression ability to go beyond his language ability. Socially he may be missing many of the nuances of communication that are taking place at this age, and children who were once tolerant become much less so as they grow older. If he is somewhat immature socially, other kids are going to be more drawn to their socially compatible peers. Unfortunately it’s also at this age when kids can begin to make fun of those who are different or who are perceived different from themselves. I’m sure your son is bright enough to be noticing this even if he can’t express what’s happening.

I suggest first having a good language evaluation. Please go far beyond one word vocabulary tests and have a speech-language therapist offer suggestions. I also would consider directly teaching age-appropriate social skills and expectations. This is an area that grows in leaps and bounds from incidental learning. I would suggest finding a counselor or school psychologist who can work with him on these issues.

Is it essential to address hearing loss before a child reaches the age of seven years?

Question from W.T., England. Posted March 8, 2011.

Absolutely!! The ideal age for addressing hearing loss (effective parenting techniques, effective exposure to language, consideration of assistive listening devices, etc.) is from birth. Recent research has demonstrated that when deaf children are identified and receive early intervention services within the first six months of life, their language abilities are much more likely to fall within the normal range for hearing children by the time they enter school. Strategies for ensuring effective access to language, supporting social-emotional development, and all of the other issues noted above are essential as early as possible in order to ensure normal development…and providing them after the age at which hearing children are starting to aquire language definitely is not “normal.”

All of that said, “better late than never.” If those early opportunities have been missed, the situation calls for even more vigorous, concerted efforts by all involved.

Could you help me understand something? My niece and her boyfriend and two children live in a apartment above me and her 4 year old son was born deaf, they run and jump all day and night, they go to bed around 1am and get up around 11:30 am everyday. I tried talking talking to her about the noise and she said I don’t understand my son is deaf and he can’t be put on a schedule and she has no control over him(that is what she said). I told her No I don’t know what it is like to raise a deaf child, but he’s a child he needs boundaries to be a productive adult and she said I just don’t understand. Could you help me?

Question from T.M., Michigan. Posted February 24, 2011.

As you probably have suspected, this does not have anything to do with the four-year-old being deaf; it has to do with parenting. It is true that young deaf children will not be able to hear how much noise they are making, but that does not seem to be an issue for young hearing children either. There is absolutely no reason why a deaf child should not have the same boundaries and be just as well behaved as a hearing child. It may be, however, that his parents have not established an effective means of communication with him, so that they are unable to effectively explain themselves or control his behavior. An early intervention program is an essential part of young deaf child’s life, especially if he has hearing parents. All parties will benefit, and early intervention has positive effects for language development, social development, and early achievement.

I work in a supported living home with four men that have developmental disabilities. One is a young man (mid-20s) who has been deaf since birth and has been diagnosed with moderate mental retardation. His expressive ASL is rudimentary — pretty much limited to basic requests for food, activities, and people. His receptive ASL is more advanced, including understanding such things as orientation to time, place, what’s coming up and so on. Some staff come to us with ASL background, and new staff are required to learn ASL. When we involve any ASL interpreters, however, it’s a struggle to get him to pay attention. Instead, he looks bored and disinterested. We’re not sure how much he understands.

Our main concern is that some days he hurts himself severely by hitting himself in the head, or pounding his head into a floor, wall or furniture. We’ve done behavior analyses and solid positive behavior supports, and virtually eliminated all triggers we can control. And he’s on medications that have helped to moderate his anxiety a little. Nowadays he hurts himself when he encounters ordinary stressors, such as not being able to drink a housemate’s soda, or having to wait a couple minutes for food at a restaurant. Also, sometimes he wakes up in the middle of the night pounding himself in the head — we don’t know why.

We think his issues are made worse by communication barriers. We really want to find/devise ways for him to communicate to us when he is angry, frustrated, sad, etc., using ASL, PECS, pictures — in ways that are less violent. He does not seem to know the difference between different emotions and only mimicks what we sign when we try. When he is asked what he feels he only responds with a “thumbs up” and smiles — even while crying and striking himself. Any ideas on how to help him recognize and express his emotions? And how to help him manage his anger?

Question from D.R. Washington. Posted February 4, 2011.

There are any number of reasons that this person could be having behavioral problems. The communication environment is certainly a good place to start looking. Sometimes people think that because clients like these do not sign well, that they do not need to work with fluent ASL users. I believe the reverse is the case. The more impaired a person’s communication abilities are, the more they need staff with extraordinary signing abilities. By extraordinary signing abilities I mean people working at the Deaf interpreter level It sounds like this person may be in a group home with hearing peers and staff at varying sign levels but with many beginners. A plan to teach staff beginning sign language is likely to be very inadequate.

But he also has moderate mental retardation and we don’t know what other neurological complications so I wouldn’t assume that the problem is “just communication.” Helping him develop an emotional vocabulary, using pictures, stories, very skilled signers, could be part of a treatment plan. I don’t think this can be done without very skilled signers involved, but you’d also need to draw on pictures, act things out, perhaps use toys for storytelling. When teaching coping skills to people with this kind of significant cognitive and language impairments, you generally are limited to very simple sensori-movement interventions: rocking in a chair, hugging a weighted stuffed animal, some kinds of massage. Generally, occupational therapists with training in sensorimovement interventions are the people best able to help with this. There are chapters or sections on this in both of my last two books. See in particular the chapter by Trikakis, Curci and Stromm in Mental Health Care of Deaf People.

Medication may be part of a treatment plan. Has a good psychiatrist, preferably with experience with deaf persons with cognitive and language impairments, been involved? I know that is easy to recommend and hard to find. I would worry about medication as the primary intervention and certainly as the only intervention. In that case, medication is often used primarily to sedate the person. But, when there is severe self harm or aggression, medication usually has to be included in the treatment plan.

These kind of enquiries are difficult because people seem to assume there are quick, easy solutions that could be summarized with a few recommendations. I think they need to bring in some consultants. I’d start with a communication consultant who could assess not only the communication skills of the client but the suitability of the communication environment of this group home. If the behavioral analysis was done without consideration of the language environment, or genuine skill in assessing the communication with deaf people, it may well miss the forest for the trees. I’d also suggest an Occupational Therapy consultant with background in sensorimovement work. Then probably a behavioral psychologist with background in working with cognitive and language impaired deaf people.

How do (or should) disciplinary approaches for the deaf differ in schools as compared to the disciplinary approaches their hearing counterparts receive?

Question from R., Colorado. Posted January 19, 2011.

In theory, there should be no difference. The only caution here is that it is important to ensure that there is effective communication with deaf children to ensure that they understand exactly why then are being disciplined. Depending on the age and language skills of the child, one also might want to be cautious about ensuring cognitive understanding. Deaf children frequently lag behind hearing peers in the understanding of emotions and mental states of others. It therefore is important that they understand the underlying reason for the discipline and not just that they got caught.

That said, two other words of caution: First, there is a tendency among teachers not to hold deaf students to the same behavioral (and academic) standards as hearing students. That’s a mistake. Second, research with parents indicates that when they have lesser communication skills appropriate to their deaf child, they are more likely to use punishment (because they can’t fully explain what the child has done wrong). Both of these tendencies only lead to bigger problems later.

I am an interpreter working in a center based program with a newly identified kindergarten student who has a profound hearing loss, has no language and just got new hearing aides. I normally can work with children very easily, but this student is a real challenge. The student is much like a “seeing” Helen Keller. The student has been allowed to do whatever they want and the family overly sympathetic towards the child. The student screams, claws, pinches, refuses to move when asked to do something and is very manipulative. I act out requests, I have other hearing students act out requests (i.e; sit down, line up, time to stop coloring, walk to the bus). Do you have ANY suggestions about what I can do to get through to this child.

Question from K.R., Colorado. Posted January 10, 2011.

This likely is not something you can handle yourself. The child seems a good candidate for applied behavior analysis (ABA).  This is a fairly intense form of rewarding positive behaviors while prohibiting negative behaviors.  It is often done in a one-on-one basis.  This is a very common form of intervention used in schools for working with autistic children.  You might try to coordinate with the autism or severe developmental disorders programs and perhaps get some consultation from them.  These kinds of behaviors can be changed, but they do require fairly intensive and patient work.  Typically one behavior will be the focus of change, while tolerating some of the others, until the child begins to change what they do.  Also, if the child has been given free reign, then he or she has developed the very strong view that whatever they want can be gotten and whatever they don’t wish to do need not be done.  Teaching them that they must be different will require time and energy.

It appears that some work needs to be done with the family as well, and partnering with a clinical program likely would involve a family-centered approach.

I have a profoundly deaf kindergarten student and the parents cannot read or write in Spanish or English. The child has average IQ based on our assessments. We are having her annual review IEP in January and need to discuss the resources available to them at our Schools for the Deaf. This family has been negligent once with this child and Department of Social Services took her away, then returned her. We have evidence the neglect is reoccurring. I am just looking for anything in Spanish that perhaps the parents could read to help them understand the needs of this child.

Question from K.B., North Carolina. Posted December 31, 2010.

We have put you in touch with the school for the deaf in your region. Hands & Voices has some useful materials in Spanish, including The Book of Choice. Other Spanish resources can be found on their website (http://www.handsandvoices.org).  Choose RESOURCES and enter SPANISH in the search bar on the main index page. However, if the parents do not read Spanish, these resources will not help much. The A.G. Bell Association for the Deaf (http://www.agbell.org) also offers a variety of resources in Spanish (search their site for “Spanish”).  Your best bet after the school for the deaf would be to contact the Department of Social Services about obtaining the help of an interpreter.

A colleague in Madrid, Maria Quereda Herrera, suggested three possible sources of information. First, at www.mihijosordo.org there is plenty of information (some pages are still under construction but they will be ready very soon) about having a deaf child. She also recommended two books: Ayudar a los niños sordos and Hablando nos entendemos los dos. Una guía para padres sobre cómo ayudar a sus hijos a comunicarse.

The information about the first one is included at www.mihijosordo.org but also, you can downloaded it free through this link: http://www.hesperian.info/assets/Sordos/Sordos_Libro_Completo_2008. The second book is Hablando nos entendemos los dos. Una guía para padres sobre cómo ayudar a sus hijos a comunicarse by Ayala Manolson (2007). The Hanen Centre. It can be found at the following link: http://www.hanen.org/MyHanen/Store/default.aspx

My granddaughter is 12 yrs old and was first implanted at 2.5 yrs. She was born at 26 wks and weighed less than 2lbs, although you couldn’t tell by looking at her now. She is mainstreamed in school and has an interpreter. She does enjoy her ‘down’ time in the evening by not wearing her processor and will only watch tv with the captioning on. On weekends, she only wears it about 50% of the time. She did become bilateral this year, and refuses to wear the second one except at school. She also, refuses to use ASL and prefers to ‘read lips’. my questions is- is this typical? or could she be confused about who she is as far as being a deaf person who uses a prosthesis? how does one help a child understand they are who they are regardless of hearing or not?

Question from C.C., Georgia. Posted December 9, 2010.

For some, wearing the CI all the time can be tiring and overstimulating, which is probably why your granddaughter would rather have it off during her “down” time. It appears she is willing to wear the CI in school, so that is a plus. I am wondering if she wanted to go bilateral, and why she did…. perhaps adjusting to the bilateral is proving to be difficult for her if she wants the first CI off during her “down” time. It often helps to use these cues to understand what your granddaughter wants. If she refuses to use ASL, and is the only deaf person in her school, she might feel she stands out too much as someone different, when teenagers want to be like everyone else and not different. One way to help her feel it’s ok to be who she is might be to search for opportunities where she can meet other young deaf teens like her, with cochlear implants, or deaf teens in general. If you have no opportunities in your area, there are summer camps that encourage this. You could google deaf summer camps on the internet and check this out. There’s lots of information out there.

Our son is 7 yrs, he has had his implant 4 yrs in January. His speech is delayed by 3 years. He has been diagnosed with moderate autism. We have applied for second implant, and believe that he will benefit from this. Could you tell us if bilateral implant would help our son to develop his speech, behavior and social?

Question from R.C., United Kingdom. Posted October 21, 2010.

Bilateral implantation is becoming the treatment of choice, given that our brains are wired for auditory input from two ears, and that we typically provide two hearing aids for all children. Some initial encouraging studies suggest that bilaterally implanted children may reap some of the benefits of “two-ear” listening, such as localization of sound and increased ability to understand speech in the presence of background noise. Your child’s case is more complex, given the autism spectrum diagnosis. My litmus test would be this: Does he show clear and consistent benefit from his cochlear implant? If the answer is yes, then our best prediction would be that he would benefit even more from having binaural implants. If he resists wearing one cochlear implant or shows no benefit from it, then getting a second one would be unwarranted. I have a patient in my practice quite similar to your son, as you describe him. After his second implant, he became more tuned in to auditory input, his speech production improved greatly, although he still requires relies upon sign plus oral input for most communication situations. Social and behavioral challenges are a hallmark of autism spectrum disorder, and remain a challenge for my patient. I would not want you to think that bilateral cochlear implants “cure” autism, but do feel that the more contact a child has with his environment and thus, the more security he feels, the less negative behaviors we may observe, including less emotional disregulation and self-stimming. I might add that, if you and your team feel your son would benefit from a second implant, you would be wise to do this as soon as possible, as shorter periods of time between the two implants have been shown to correlate with better binaural listening performance.

My daughter is 2 years old. She has severe/profound hearing loss and has had a cochlear implant for about 10 months. She is also developmentally delayed, however her comprehension and communication skills are continuously advancing. I am having problems implementing discipline with her. She understands the word “no” but often ignores it. She laughs if I spank her hand and constantly tests me by taking her CI off and throwing it. She is too young for a stool type time out. I have recently started putting her in her crib for time out. Any suggestions on how I may begin to curb her behavior before it gets too out of hand? I know she is in the terrible 2′s, but I think its a little worse than it should be.

Question from Savannah, GA. Posted September 14, 2010.

The first thing to do is to decide if her behavior always happens during certain times.  For example, does she always misbehave when you are busy with other things.  This might mean she has found that being naughty will get your attention.  Another example might be that she only misbehaves when her implant is on.  That could mean several different things about the implant or how your daughter is “hearing” what’s coming through the implant.  Your daughter’s audiologist or speech therapist (as a first point of contact) should be called in to help.

If there does not seem to be a pattern to when she misbehaves, then the two words for you are consistency and redirection.  You need to decide which “rules” are the most important to enforce.  Don’t pick too many as to overwhelm your daughter, but do make sure they are the most important rules to you. For example, no crossing the street without an adult; say please and thank you when you want something.  Then be consistent in your expectations about those rules and make sure your daughter follows through with them.  Consistently direct your daughter to do what it is you want her to do; when you catch her about to break a rule, redirect her attention to an appropriate activity.  This all sounds simple, but takes a lot of work on the parent’s part.  Don’t give up!  This will take a while, but once she realizes that you will not waver in what you expect her to do, she will begin to follow the rules.