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.

Hearing and Deafness

My son has AIED [Autoimmune Inner Ear Disease, a syndrome involving progressive hearing loss]. He began losing his hearing a little over two years ago at the age of 10. He currently has a profound to moderate sensorineural, bilateral loss. The loss is progressive. He obviously has acquired speech and language as a hearing child. What impact am I looking for as we go forward? Prior to the loss he tested at or above for reading levels, now his reading scores are below grade level. He still makes A’s and B’s in all subjects except math. He does struggle. He attends a small public school with no deaf education resources.

Question from L.W., Missouri. Posted March 3, 2015.
Response from Elizabeth Marcinkus - Gallaudet University

With any child with hearing loss, it is important to monitor different areas of development. The first is language. Based on your description, I am assuming he is using auditory/oral skills. You have indicated that his expressive (spoken) language is on target, but it is also important to monitor his receptive language skills. With the progressive nature of his hearing loss, does he still have good access to spoken language? This may impact his overall functioning, especially in school.

I am not sure what kind (if any) of hearing technologies (hearing aids, cochlear implant, FM system, etc.) he is using, but unless he is using a signed-based language, making sure that he has good audibility is key. If audibility is a concern, providing information in a visual form may be beneficial. His educational needs should also be monitored. It sounds like he continues to do well in school and that is great! If you notice that he is starting to struggle, it is important to question why. Is he understanding what goes on in class? Could support services be provided to help him stay on target? It is important to work with his school to make sure his needs are met. I would work with them to see if he is eligible for an IEP or 504 plan (if he doesn’t already have one). Talk with his teachers, administrators, speech-language pathologists, deaf educators, etc. See if they can work to support his need for deaf education resources.

Finally, it sounds like your son may have had an stressful few years. Often overlooked, it is important to monitor the psychosocial impact of his hearing loss. Does he have a good understanding and acceptance of his hearing loss? Does he have a support system of friends, especially any with hearing loss? Feelings of isolation or questions/concerns about his hearing loss may impact his life. Working with a school psychologist may be beneficial. I hope these suggestions are helpful as you work to provide the best for your son!

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.

How many children between the ages of 2 to 3 years old are deaf or have hearing loss? Are there hospitals for these kids?

Question from G.C., California. Posted February 24, 2014.

According to the National Institute on Deafness and Other Communication Disorders (NIH), 2 to 3 children out of 1000 are born deaf or hard of hearing (at least 95% of them born to hearing parents). Another 2 to 3 out of 1000 will become deaf or hard of hearing by age 3 due to severe otitis media (ear infections) or other illnesses/accidents.

It is unclear why you might think they need hospitals, other than for the usual medical reasons, but there are audiology (e.g., for hearing aid fitting) and speech-language clinics (for those who will use spoken language rather than or in addition to sign language) in a variety of settings including medical centers, universities, and private practices.

I am living in India and fostering a 6 year old boy who has 95% hearing loss. He used to live in an orphanage and came into my foster care in July. Prior to this no one noticed that he was deaf. I want to look into getting cochlear implants for him, but have been told that because of his age and that he has gone 6 years having no auditory input, the CIs won’t work. Thoughts?”

Question from N.C., India. Posted October 30, 2013.

Amazing that this child went six years until his hearing loss was discovered. This used to happen more than we would like to admit here in the United States, but thanks to newborn hearing screening we are usually able to diagnose hearing loss much earlier now.

Several things that make me curious relate to whether or not to pursue the option of cochlear implantation. I am curious as to whether this little guy has any vocalizations and how he makes his needs known. Do you have a sense whether he is bright and learns quickly? The reason I ask this is that sometimes children who are quick learners are able to slide under the radar and perform well in many arenas and their hearing loss gets over-looked. Alternatively, children who have multiple developmental delays in motor skills, learning, self-care, and if they have a lot of health issues as well, their hearing loss goes undetected as other health issues are the focus of intervention. I am also curious as to whether he ever had some hearing. If he does have the ability to vocalize he may have had hearing at one point in time.

First of all, I think you need to assure that this boy has access to language. As a child with profound hearing loss without amplification/implants he will need to have access to a signed language so that he can learn to communicate with the world. At this point, access to language (sign) is a main priority. In addition, I would also encourage you to advocate for a cochlear implant evaluation. He may indeed be a wonderful candidate. We know that children who learn quickly, who have had hearing, who have support to learn to listen and who are exposed to speech consistently will learn to produce the sounds of their language and within 4 years of CI listening experience, they may be able to produce a majority of the sounds, even if they get a relatively late start.

My 11 year old son has only become deaf over the last two years, the result of a neurological condition. He has good vocabulary, great speech and rounded communication skills following 10 years of growing up in the hearing world. His reception method is primarily speechreading, supported by some residual hearing. (His deafness is Auditory Neuropathy Spectrum Disorder – which for him particularly impacts speech perception).

Some professionals are recommending that he fully embraces Total Communication, becomes more integrated with Deaf peers and in particular learns British Sign Language. I am not sure. He has no experience of signing (other than basic alphabet), and has a preferred an oral/aural approach. I want to help him learn more about Deaf culture, but I’m keen that we take advantage of his 10 years of open communication to make sure that he doesn’t lose the ‘advantage’ he’s had.

Is anyone aware of any research on “late” presenting deafness in children, and the pluses and minuses of investing in BSL at this age.

Question from S.M., London. Posted October 21, 2013.

It might be useful to separate out the two issues in this questions, that of diversity of language support and Deaf culture.

In terms of the language issue, the first thing to stress is that  there are no ‘minuses’ of learning some BSL or Sign-Supported English (SSE)  at any age. Nothing will be lost; there can only be gains if you opt for this type of environment.  Your son may find BSL useful for learning or for socialising at some point (or a bit of both)  or, more likely, find that  SSE is a useful mediating  tool for mixed deaf and hearing interactions and some support for listening and also literacy development (now or in the future). In either case, learning BSL and meeting and learning with other deaf children will be supportive and will not  change his spoken language trajectory, only add  a layer of support.  Most children that he meets will probably also be using a mix of sign and spoken language for different purposes at  different times and you will find in any TC setting that this flexibility  is normal and  expected and managed by the hearing and deaf adults.

With regard to the other question, about Deaf culture,  entering into some sort of TC environment  will immediately offer your son  access to diverse deaf children and adults. In itself this will extend his understanding  of deafness  as he sees other ways of being and interacting in an environment where deaf and hearing  children and adult rub along together. This is perhaps a more natural way to  engage with Deaf community and culture which is entirely contextualised and nowhere near as overwhelming as seeing Deaf culture as a very separate land.

Given, as you say,  the advantage that your son has had, I would suggest that keeping his communication options open would be linguistically and culturally positive and enriching if this would sit comfortably with family routines, practices and  preferences.

My boyfriend has a 3 year old son who was late on his speech, so we decided to take him to see a doctor. He has seen a neurologist and taken a BAER test which indicated that he had profound hearing loss in the left ear and severe in the right. He is very smart and his motor skills have always seemed high for his age. Were just confused on what are all the options it could be… we have been referred to the children’s hospital, but it wont be for a while. If any one has dealt with this or has any advice we would appreciate it. We’re just kind of lost on where do we go from here. (When he was born he passed his hearing test.) Also he seems to have behavior problems, and the docs say its just his age, but we feel it could be more. He has really bad anger problems and is very moody. Could that be because he can’t hear or should we look into other things like ADHD or bipolar syndrome?

Question from A.H., California. Posted April 5, 2013.

Based on the basic information provided, my thoughts are that your 3 year old boy’s anger and moodiness  is related more to his hearing loss and communication frustrations.   His behaviors may look like he has attention difficulties (i.e.,  easily distracted, impulsive, daydreaming). However, these behavior may because he cannot hear and uses his vision for information.  Sometimes parents have a difficult time differentiating whether the child’s hearing loss is contributing to disobedient behavior, or, whether the child’s attention and willfulness is creating communication difficulties.

In most cases, parents need to address communication issues before assuming defiant behavior. For example, parents must make eye contact  instead of talking to the child from a location where the child does not see the parent. There are many more communication strategies and tips for parents.  At this time, seeking out professionals who work with children who have  ommunication disorders is a suggestion, especially if your community does not have psychologists who have expertise in working with families who have deaf members. You also might check to see if there is a local chapter of Hands & Voices or contact the American Society for Deaf Children for advice.

I am looking for listening comprehension programs for elementary HH/CI students. Again, I find checklists but few programs for what we used to call ‘auditory training’. All are either for young, early implanted (Dave Sindrey for example) or teenagers (music and phone use). I have used the SPICE program… but is that all?

Question from K.M., Vermont. Posted February 8, 2013.

I am delighted to see that you are investigating different listening comprehension programs.  There are several out there and more that are being developed all the time.  It is a bit interesting that many of the materials are now being hosted by the Implant Corporations, but in a way it makes sense.  They employ the people who do the work and creative aspects.  I know that the cost of developing materials is very high and the market is relatively sparse compared to other products, so this may be why Implant Corps can absorb the cost.  (example– you mentioned Sindry, and his work is now available through these websites). Here is a resource list of my favorites for elementary age:

Hearing Rehabilitation Foundation materials—many are developed by Geoff Plant and are very good  http://www.hearf.org/Materials.html

Hear at Home
Speech Stuff
Rhythm, Rhyme & Song
Speech Rhymes
Step by Step

Goldberg Stout, G., & Windle J. Developmental Approach to Successful Listening II  (DASL)
Tye-Murray, N. (2002). Conversation Made Easy. Three 6-set CD-ROM Training Programs. Central Institute for the Deaf, St. Louis, MO.

Have you tried the CI company’s websites?  Each company offers a multitude of materials ranging from reproducible materials, listening logs, listening activities etc, which are not just telephone use or music, and many are free to donload. Activities are appropriate for CI users or Hearing Aid users.  See, for example the Listening Room by Advanced bionics http://www.hearingjourney.com/Listening_Room/preview.cfm?langid=1

Cochlear Corporation offers their HOPE website which has so many resources, some to purchase, some are training seminars, some are apps for IPad (it is WONDERFUL) http://hope.cochlearamericas.com/

MedEL offers the BRIDGE http://www.medel.com/us/rehabilitation/  and this site again has items to purchase items to download for free.

*For many of these sites, you do need to register and login in, but that is a small price to pay for the wealth of information you receive.  Do register and you will see so many listening tasks and activities.

My sister is deaf and she needs a job. How can we help her and other deaf boys and girls get jobs?

Question from M.A., Kenya. Posted January 10, 2013.

There are many areas to address, such as getting training or education in the field you are interested in, developing a resume, practicing interview skills, and so forth. “Networking”  is also one of the best way to find a job.  Networking is making contact with people you know and letting people know what your skills, experience, and strengths are.   Research has shown that 75-80% of people find jobs through networking.

Job-seekers can network with everyone, everywhere, and all the time.  It is important for job seekers to network with friends, relatives, businesspeople, doctors, clergy, clubs, teachers…etc.  It can be scary and a challenge for deaf individuals to know what to say.  Here are some suggestions, “I’m looking for a job, do you know anyone whom I could contact?, can you think of 5 companies where I should apply?, do you know other people who could be helpful?”.

Networking can help you grow in your  area of interest and as a person.  Every time you go up to a stranger, talk to them, and get through that little wall of fear, you’re boosting your self-confidence.  That confidence is what people see in you even before you communicate.

Once a child has been identified as deaf or hard of hearing, what is generally next for his/her parents? Does New York State have a deaf mentoring system in place? What does early intervention (EI) look like for deaf and hard-of-hearing kids in this state? Where can parents turn for information?

Question from S.R., New York. Posted June 22, 2012.

Here in New York, after a child is identified as having a hearing loss, the audiology clinic typically provides the family information about contacting Early Intervention for the county in which the family resides.  Whether there is a mentoring program or not depends on who the EI service provider is.   There is no formal mentoring program run through EI for hearing parents of deaf children.

Parents are approved for EI based on their child’s “diagnosis” and need.  They work with an EI service coordinator to develop an IFSP (Individual Family Service Plan).  Services are approved and parents are guided through the list of service providers with which EI has subcontracts for providing services.  Here in Rochester, for example, the Rochester School for the Deaf is one of those agencies.

There is no chapter of a parent support group such as Hands & Voices in this part of New York, but there may be in other areas.

My almost 3-year-old daughter has a moderate to almost severe hearing loss in both ears (55-65 db). She uses ASL and also speaks while signing though her signing is more developed. She wears two hearing aids, since she was 1 year old. We use ASL at home (I am deaf myself) and also speak, at the same time. She is receiving services at a regional program and attends school a few times a month with other deaf children. This will soon increase to 2 mornings a week when she turns 3. We decided to add another school/Childcare, 2 mornings a week, that has all hearing students and the staff all knows a few signs while one staff knows more ASL though not fluent. That one staff isn’t always present. My concern is this: I believe she would benefit from more sign support either through an interpreter or a family friend (due to cost) to help serve as a bridge. She sometimes appears lost while looking around the classroom. She has had a difficult adjustment period though they have recently added more sign information and that has helped. Her regional teacher feels this school provides more auditory development for her, to hear and speak. There is a concern she may cling to whoever signs and not socialize much. I question whether anyone truly understands how much she catches with her aids. I wonder if it is best to provide extra sign support in the beginning and then taper off as needed when her abilities are clearly known. People have said she is only at the “other” school about 7 hours each week and all other times, she gets ASL. Will providing more sign support in this environment hinder her hearing / speaking abilities later?

Question from T.K., Oregon. Posted May 3, 2012.

The short answer to your question about whether or not sign language support will interfere with eventual spoken language development is an unqualified – NO.  There is no evidence that signing interferes with speech if speech is feasible for a child and supported by her auditory and oral-motor abilities.  How lucky for your daughter that she has fluent adult models for both ASL and English at home – and at the same time no less! The bigger issue seems to be what kinds of information your child has access to in the preschool class where less signing is available from the adults and virtually no signing is available from the children. Given your comment about her “difficult adjustment,” your child may benefit from more “scaffolding” for both social interaction and vocabulary learning in the new preschool setting. Providing more help in the beginning meets her immediate needs – always a good idea in the long run.  It would be unwise to suppose that she is able to function in one modality – hearing, at one school and another modality – vision, in the other.  Though she will almost certainly acquire two languages, she is one child with a singular need for optimal, that is to say dual, inputs in every linguistic encounted.

Satisfying social interaction is the most natural and powerful motivation for language learning.  If socializing is a goal – and it should be at age 3, then having supportive adults to help navigate interactions with age peers is a good idea. This help could come from an interpreter or family friend as you suggest, if their role is clearly defined and reinforced by the other adults in the classroom.  If learning language through listening and auditory skills are a goal, but the context is a preschool with hearing children who cannot sign, some kind of adult mediation is certainly warranted. Though always a risk when using interpreters, the signing adult need not be the sole source of either auditory or signed language input.  Perhaps activities could be devised wherein the signing adult teaches a hearing age peer to be a partner in listening games. Similarly, the signing adults could serve as on-the-spot tutors for the hearing children to learn signs for key words that support spoken language vocabulary in the course of play-based interactions.

That your child is looking around confused, though distressing emotionally, is a good indicator that she knows that she does not know, and she is looking for a way in – an access modality. This sensitivity to needing language input is hard to teach, but something that her teachers can exploit every day.  Given that the limits of her auditory-only reception are uncertain for now, and that she is looking for input on the hands, she should be given routine access to concurrent, or at the very least sequential, signed and spoken English whenever ASL is not being used. Routine access means that the speech she cannot perceive is supported by signs on the spot and the signs she knows are associated with spoken English words that will eventually become the basis of her ability to develop text literacy i.e., reading and writing.