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 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.
Response from John Macko - NTID Center on Employment

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.


How is it that deaf and blind children learn to physologically communicate? In other words, how does one part of the brain compensate for another in the deaf and blind?

Question from S.M., North Carolina. Posted April 24, 2012.

The best answer to the question comes from Dr. Jude Nicholas of the Resource Center for the Deafblind and Haukeland University Hospital, Bergen, Norway. Dr. Nicholas has an excellent article on the Deafblind International Website  http://www.deafblindinternational.org/PDF/Active%20Touch%20Article.pdf

In short, the answer involves  the sense of touch ,including tactile sensation, tactile perception, and tactile cognition. Studies have demonstrated that individuals who are deafblind are more experienced in recognizing stimuli through active touch than are sighted-hearing individuals. This then leads to superior performance on tasks involving the tactile cognition tasks of tactile working memory and tactile memory. Individuals who are deafblind encode tactile spatial information more efficiently than do individuals who are sighted and hearing. Increased tactual experiences thus enables neuroplasticity or the reorganization of the nervous system.

I have a question about personal FM system compared with soundfield. Our school district says that our daughter 3 years old is too young to give accurate feedback on if the Fm is working properly so they do not advice us to use it. Our daughter has severe hearing loss, uses hearing aids both ears, but tests low average on language skills as of now. No other concerns. We will be transitioning into the school system soon. They have a self contained class room with soundfield but we feel that a regular setting is least restrictive for her and want to find out which system to ask for in that setting.

Question from A.R., Florida. Posted March 16, 2012.

I am absolutely flummoxed at the school district’s position, and cannot think of one piece of evidence to support their recommendation.   The FM is an excellent solution in this case. The personal FM has a ‘boot’ which fits onto the individual’s personal hearing aids.  The teacher wears a microphone and transmitter, and the teacher’s voice is transmitted directly to the child’s hearing aid.  The statement that a three-year old is not able to tell if the FM is working correctly makes no sense, because the child is wearing a hearing aid and the child either has the skills to indicate the hearing aid is working correctly or not.  The same premise of operation will be at work with the FM system.  Infants can use FM systems, infants wear hearing aids, CIs and we all learn to read their behavior to assess whether the system works correctly and eventually the child becomes an accurate reporter. I  worked in a preschool classroom where all the 3-year olds used personal FM systems.  The FM system can and should be given a “listening check” each day.  The FM system will allow your child to be placed in a most appropriate environment.  It will cut down on background noise and give her a ‘direct link” to the teacher’s voice, where a sound field system will not.

There are several websites that can inform the district personnel how to do daily listening tests on the hearing aid and the FM system.




Need help in finding appropriate strategies for a 7th grader that has been diagnosed with ABNORMAL AUDITORY PERCEPTION. Would a 504 be appropriate or CST referral? His overall grades are not bad a solid B range however, on his standardized test scores were not proficient. Any suggestions??

Question from N.S., New Jersey. Posted October 2, 2011.

I am not familiar with the use of the term “Abnormal Auditory Perception” in the auditory sense.  I have heard the term used to describe a phenomena that is related to neurological insult or traumatic head injury in the context that the auditory centers in the brain “fire at random” and may yield an auditory hallucination type of experience, such that an old conversation is in a way “replayed” or “reheard”.  I am thinking that the term you may be referring to can be called by one of these terms:   Central Auditory Processing Disorder (CAPD) or Auditory Processing Disorder  (APD), rather than Abnormal Auditory Perception.   An Auditory Processing Disorder is when the actual ears or hearing parts of the ears work just fine.  The child hears quiet sounds such as leaves rustling, whispers, etc.  If a child is given a hearing test that tests the threshold ability of listening to sounds across all frequencies, they will typically do fine.  In CAPD/APD, the problem arises in discerning what is said, especially if there is noise in the background.  These children may exhibit a variety of classroom issues such as trouble following directions, or telling the difference between sounds that sound alike. These children tend to ask for lots of repeats and they may have trouble with spelling, reading and understanding the language of the classroom. They may do much better in classes where they do not have to rely on listening, or in classes that are “hands on”.  For children with CAPD/APD, it is essential they have a full CAPD workup, and yes a Child Study Team evaluation will be very important. You will need to find a local audiologist who is able to do a CAPD test battery or a university clinic with a Communicative Disorders/Speech Pathology/Audiology program. As these middle school  to high school years approach and classes become more “lecture based” accommodations may mean the difference between a very frustrated and lost student and one who is able to cope with listening and understanding information presented in the classroom.

One of my grandsons was born deaf. Although there is no history of deafness in the family, my daughter’s doctor said that her son’s condition is probably genetic. Can you explain?

Question from M.U., Maryland. Posted August 23, 2011.

This is a great question, since it is often believed that if something is genetic it has to be “running in the family.”  Most parents, and even some health professionals, are surprised to learn that 50% of hearing loss has a genetic basis. However, a child can have a genetic-related hearing loss even if no one in the family has hearing loss. Therefore, it is very important that parents, like your daughter, follow through with referrals to a clinical geneticist—even as they are addressing their child’s hearing and communication issues. Learning more about the cause of your grandson’s hearing loss can help doctors understand the complete picture of his health. Most children with hearing loss do not have other health problems, but a few do. A referral to a genetics doctor may help find these problems so that your daughter and her family can make the best possible decisions about your grandson’s healthcare.

A new brochure, Hearing Loss, Genetics and Your Child has been designed both to connect families like yours with genetics professionals, and to prepare them for a genetics appointment. The brochure also answers other questions families may have, such as who will pay for genetic testing, and contains basic facts on genetics-related hearing loss. The brochure was developed by a team of medical geneticists, genetic counselors, audiologists, parent advocates, and health science information specialists led by Kathleen Arnos, PhD, FACMG, Professor of Biology and Genetics Program Director at Gallaudet University in Washington DC, whose career has been devoted to understanding genetics and hearing loss. It is being distributed by the National Coordinating Center for the Regional Genetic and Newborn Screening Services Collaboratives (NCC), housed at the American College of Medical Genetics (ACMG), which funded its development.

Hearing Loss, Genetics and Your Child is available in printed and downloadable pdf formats. It is written in layperson’s terms and is available in both English and Spanish.  It can be accessed electronically at no cost at www.nccrcg.org under the “Resources” tab. If you have any further questions about the hearing loss brochures, or would like to connect with the National Coordinating Center, you can contact either Matthew Tranter (mtranter@acmg.net) or Judith Benkendorf, MS, CGC (jbenkendorf@acmg.net) or by calling 301-718-9603.

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.

I have a daughter that has a bilateral severe to profound hearing imparement. She is a well adjusted child socially and does not see herself as different. This confidence that she puts out gives most adults and teachers the impression that she is a normal hearing child. She is behind grade level but when prompted she is at the second grade level and is not the lowest in her grade. The teacher does not recognize that it may not be that she doesn’t understand the concepts but that she has difficulty expressing her answers in the written and spoken language. She is the only case within the district and therefore I am not sure that the district and teachers have taken the time to make themselves aware of her learning abilities and how to evulate them. She has the services of a TOD this year and has in the past but I don’t feel they are using her in the right areas at this time. She also gets a Signs Skill Couch but she is not used to the best of her ability either, the teacher seems very intimidated by having another person in the room that has some control of teaching, even if it is only my daughter doing it. I am looking for an easy way to explain my daughter, her learning style and ability of understanding. I am not sure that they get how her hearing imparement affects the other areas of her life. She does not have that distinct tone to her voice as most hearing impared people do. It is not understood why she sounds normal but that allows others to assume she is normal.
What is the easiest way for me to present my daughter to others so that they can begin to understand her difficulties and hearing abilities?

Question from D.B., New York. Posted March 4, 2011.

Here are two resources that provide audio for what different degrees of hearing loss “sound” like.   It would probably be helpful for your daughter’s teachers to listen to the simulations so that they can experience the degree to which your daughter is missing out on the speech occurring in the classroom.



In addition, it would probably be helpful for the Teacher of the Deaf to put together a resource packet for the classroom teachers about what to expect from a child who is deaf during classroom instruction.  You can actually ask the school district to write teacher training by the TOD into your daughter’s IEP, making it a requirement for those teachers working with your daughter to attend the training.

Another suggestion is to develop a profile about your daughter based on YOUR vision of your daughter and how she functions and works at home and in school to personalize her situation to those teachers.  Include pictures and anecdotes, almost like a scrapbook, to connect them with your daughter and her needs.

My son was born premature and has auditory neuropathy (AN). He is now six years old and in the first grade. If you walked up to him, he could hold a conversation with you and you probably wouldn’t even know it. But he is having trouble in school. He currently uses a FM System. We are unsure if it is beneficial for him. I have found very few people who know a lot about AN and have been very frustrated as a parent. I am a teacher and work with my son a lot at home. He can produce all of his letter sounds and is starting to read. Some of the question that his teacher and I have are: How do we get him to let us know when the fm system is not working? How successful has the FM system been with other children with auditory neuropathy and how can we tell if it is beneficial to him? Do all children with AN have a short attention span? Every time my son has gotten tubes we have noticed a big difference in his behavior and hearing. Heonly has one tube in at this time because the other could not be put in. He has not had any ear infections, but can having tubes help his hearing in any way? He also gets very frustrated and aggravated over the simplest things and this behavioral get worse we he is not hearing.

Question from Stacie F., Avon Park, FL. Posted November 19, 2009.

First, a brief description of auditory neuropathy (AN) for those unfamiliar with it:  Auditory neuropathy is to find clinically as any hearing loss, ususally present in both ears, in which the outer parts of the auditory hair cells seem to function normally, but the electrical characteristics of the impulses put out by the hair cells are abnormal.  Current thinking is that either the inner part of the hair cells do not work correctly or perhaps that the synapes (the point of information transfer) between the hair cell and the auditory nerve do not work correctly.  So, people with AN have decreased ability to perceive and understand speech with functionally hearing losses from mild to profound.

Babies born prematurely, or who have too much bilirubin (from breakdown of red blood cells), or those who have to take some antibiotics that are toxic to the auditory nerve have a higher incidence of AN. For children with profound hearing losses via AN may receive cochlear implants, and in general those children perform in a similar way to a child without auditory neuropathy who has an implant (there is a lot of variability in how well CI kids do).  In your son’s case, you do not mention how much of a hearing loss he has, or how well his speech production is, but you say he is able to name letters and is beginning to read.  You also mention he wears an FM system. These pieces of information lead me to believe that he has acquired oral communication and this is an excellent sign.

The idea of using an FM system, if he relatively good hearing thresholds, is to decrease the distance between the source of the sound and his ears in order to decrease sound interference, and make his listening conditions “easier” or less taxing. In order to get him to be consistently able to report when his FM system is not working, I would start by having “checks” several times a day.  Before the check, see if he can tell you whether it is working GREAT, OKAY or NOT SO GOOD. Then have the teacher, speech pathologist, aid etc. produce these “Ling sounds,” (ah, ee, oo, sh, s, and mm), one at a time, while standing beside him, so he cannot lipread.  After each sound is produced, see if he can identify the sound.  The goal is that he will become an accurate “reporter” of how well he is hearing with the system.  You will know it is working if he seems to be less frustrated or less “taxed” by listening when he is using the system.  Think of it this way: Have you ever been to a talk where the speaker is at the front of the room and you are in row 20, but the people in front of you in row 19 are talking, whispering and laughing.  You are desperately trying to make out what the speaker is saying but you need to listen with all your might.  This is akin to what your son must do all day long.  Even if the FM sytem is delivering the speaker’s voice right to him he still has to listen very hard and concentrate every listening minute of the day.  It very well may look as if he has attention problems.

It is hard to parse out whether the issues are attention related or fatigue related, but fatigue seems most likely given your descriptions of his increased frustration when he has ventilating tubes in place.  If he has fluid in his ears, this can make his hearing worse…for example a whisper that he could normally hear when he has no fluid, would need to be presented quite a bit louder even for him to pick up the sound.  In summary, you have a little guy who is working twice or three times as hard all day long in order to decipher what is said, and he is going to need more “breaks” or down time.  I would suggest frequent breaks, small class size, extra tutoring, and shortened assignments when needed if he is slower to finish.  In addition, his teachers will always need to receive training so they can see how to speak with “clear speech” (slightly slower, more pauses, and with clear articulation …think of President Obama as a good model of clear speech). The teachers will also need to understand that he has to watch them talk and that he may benefit from speech-reading them. If they are giving directions while they are facing the board, or from a side view, he may have a harder time.  With time his educational team and your son will begin to recognize the signs of  fatigue, when needs a break and when he is doing well.