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.

Cochlear Implants and Hearing Aids

I had an audiologist tell me that 99% of the time when you add sign support to an implanted student the language level/development drops. I respectfully disagreed – Your thoughts?

Question from R.S., California. Posted May 17, 2012.
Response from Marc Marschark - NTID

Thoughts aside, there is no published evidence we know of to indicate that this is the case. You might recommend the following to the audiologist: Spencer, L. J., Gantz, B. J. & Knutson, J. F. (2004). Outcomes and achievement of students who grew up with access to cochlear implants. Laryngoscope, 114, 1576 –1581. They found that high school students with implants who also had sign language interpreters in the classroom were performing at a level comparable to their hearing peers, a result normally not obtained with longer-term use of implants by students without sign language support.

I am the parent of a 17 year old male with a Nucleus 24 cochlear implant. He signs and speaks and has been going to a great high school, but is having difficulties in his reading and comprehension. He is currently reading around a 6 grade level. Are there any programs you would recommend to bring his levels up? I am being recommended Fariview (total communication) and Linda Mood Bell (oral only) by different sources and they are completely different from one another.

Question from E.D., California. Posted May 3, 2012.

Congratulations to you and your son for all of your diligence with reading.

Does your son read 6th grade text fluently (between 120 and 150 words read orally per minute) and accurately  (decoding 95 to 100 percent of the words or about one error for every 20 words)?  Fluent reading does not mean reading fast but your son should use a speed for reading that reflects the mood and expression of the text.  If he reads in a slow and labored manner, he will have difficulty comprehending text.  There are some programs that focus on fluency (i.e. Read Naturally) but your son would need to have the auditory ability to distinguish the text read orally and then try to copy that text.  Often times though enhancing background knowledge, vocabulary and comprehension strategies fluency increases.   Repeated reading and some practice with chunking words into phrases have shown some success.

Once someone reads at the sixth grade level they tend to already be able to decode but have difficulty with more complex vocabulary and language structures.  At http://www.meadowscenter.org/vgc/downloads/special_ed/SEDsecondaryoriginal/2000_enhance_read_2_SE.PDF  there are wonderful resources from the Vaughn Gross Center for Reading and Language (through the University of Texas at Austin) that provide strategies for all parts of the comprehension process (from activating prior knowledge, to monitoring and using repair strategies, summarizing, using  visual imaging, asking questions and reflecting on the text).

Not knowing your son it would be hard to pick where to begin but ask yourself if he can decode words well (recognize the printed word)
-  if yes don’t spend time teaching sound symbol
-  if he struggles with the sounds of words and decoding, Lindamood-Bell and other companies have some great programs (LIPS, Seeing Stars) that may be of benefit.

Can he only say the words but not understand the meaning of the words?
-  then lots of language
-  possibly bits of Fairview may be a tool to help with understanding the various sign meanings (concepts) of different sight words)
-  pre-expose to a variety of text specific words, concepts and there meanings

Does he read words quickly enough to make meaning from the words he reads?
-  rereading, or partner reading
-  chunking and phrasing of text
-  Read Naturally or possibly Vocaroo (can record online)

Does he engage himself in the reading process by using comprehension strategies while reading?
-  If he decodes at about the 6th grade level, I would focus on text based vocabulary and comprehension strategies.
-  He should be able to establish a purpose for reading, see the text structure and begin to ask the right questions to aid in comprehension.

Developing the type of academic language and vocabulary necessary to succeed although daunting can be done.  Three cheers for encouraging your son and keep up the great work.

 

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.

http://www.pepnet.org/faq/faq02.asp

http://www.asha.org/docs/html/GL2002-00010.html

http://www.phonak.com/

My son is 5 yrs old & HOH and we are hearing parents. my wife and I have been debating if we should get a Cochlear implant for our son. I have been looking to speak with a hearing parent that has a HOH child that didnt go with a cochlear implants. We have spoken with hearing parents that choose to get a CI for their child. As a parent, this is one of the hardest decisions to make and we want to make an informed one. If you know anyone that can fulfill this request, it would help our family come closer to a decision. Are there kids in Deaf schools that have cochlear impants? If so, did they go mainstream initially and still had problems adapting? thanks

Question from R.E., New Jersey. Posted February 13, 2012.

From your question, it appears that what you really need is to talk to some other parents who have been in your situation with their own deaf children. I am going to put you in touch with someone “off-line,” but you also might look into checking out an organization that supports families with a deaf or hard-of-hearing child (see our Partners tab). In the meantime, let me provide a few facts:

Sure, there are plenty of deaf children in schools for the deaf who have cochlear implants. Deaf children vary widely, and whether they use spoken language and/or sign language, have hearing aids and/or cochlear implants, and are in a mainstream classroom (with or without support), a school for the deaf, or something in between will depend on the characteristics of the individual child. None of these is mutually exclusive. For example, some children with cochlear implants use sign language, some children without them use spoken language, and choosing the right school placement is often a difficult decision for parents.

If your son is really hard of hearing and not deaf (or has less than a severe to profound hearing loss), he is not going to qualify for a cochlear implant. If he has not had a recent evaluation by a pediatric audiologist, that should be the first step. Implants do not magically turn deaf children into hearing children and, in fact, most children with cochlear implants function like hard-of- hearing children. So, a mainstream classroom may or may not be appropriate. What you need is a careful evaluation by a full IEP team to make sure that wherever your son goes to school they can build on his strengths and accommodate his needs.

I have a daughter who is deaf and has a cochlear implant. She is an oral student in 7th grade and mainstreamed in the public school. The Speech Language Pathologist at the school who gives her speech therapy has never worked with a child with a cochlear implant and has very little experience working with deaf children. What are my rights to have a qualified SLP work with my daughter and not this district appointed SLP?

Question from K.T., California. Posted February 9, 2012.

A very good question! In California, the School District (LEA) is required to provide the appropriate Designated Instructional Services (DIS) for special education students who reside in their school district.  Appropriate Related Services are an IEP decision, and one that you will need to discuss with your school district and your daughter’s school. This is a common experience for students that are mainstreamed in their neighborhood schools. Typically, the Speech and Language Pathologist (SLP) is not specifically trained in working with students with cochlear implants. Students who attend Regional Deaf Programs have SLP staff that are trained in working with deaf students with cochlear implants. So, the next step would be looking into the modification of your daughter’s IEP.

I have a friend with a nineteen year old son who has had a cochlear implant for years. He is having some emotional and behavioral issues and I am asking if there are support groups, numbers, websites, etc. where the parents could find him some help and also maybe some help for them as well. It would be in the Dayton, Ohio area. Can you help in any way?

Question from C.Y., Ohio. Posted January 30, 2012.

The Miami Valley Regional Center offers a variety of support services for children who are deaf and hard of hearing. Click here<http://www.mcescregionalcenter.com/hearing.html> to find a list of contacts, information on field trips and outings for young people, as well as a list of resources specifically for families. If you act quickly, your friend’s son may be able to join a group heading to see the Dayton Gems at Hara Arena on February 25th. Use one of the contacts listed on the website to find out more information.

Another local resource for your friend would be the Deaf Community Resource Center<http://www.dcrcohio.com/DKTC1109.html> in Dayton, which offers a Deaf Teen and Kids Club.

State resources include Ohio Hands & Voices <http://www.ohiohandsandvoices.org/>, a parent support organization, as well as the Center for Outreach Services <http://www.ohioschoolforthedeaf.org/outreach>. The Center for Outreach Services provides professional development for school districts and opportunities for families to come together for various events. If your friend is interested in learning more about transition and life after school, he/she may be interested in attending an upcoming conference focused on this topic co-sponsored by the Outreach Center and Cincinnati Children’s Hospital. Contact the Outreach Center for more information.

I am an SLP and I have a student with bilateral cochlear implants. He is 15 now and received his 1st implant at age 3 and his 2nd implant at age 13. In his world, he has always been the only hearing impaired person. Do you have any suggestions for educating him and exposing him to deaf culture?

Question from N.W., New York. Posted December 1, 2011.

If he is comfortable with his current identity and the purpose of exposing him to deaf culture is to give him an expanded sense of his identity then you could have him skim through Jack Gannon’s publication of Deaf Heritage  ( NAD, 1980. Silver Spring, MD).  This would give him a historical sense of community, culture, and communication issues that help him relate to the experience of being deaf.

If he uses sign language (or wants to), identifying a mentor who could take him to a deaf sponsored social event could be beneficial.  Or, there may be a cochlear implant group the meets in his local area that may be of interest (yes, many kids with implants also sign).  Also, depending on his school environment there may be a course offerings there (or at a local community college) concerning the deaf experience that would help him explore his a sense of personal and/or cultural identity.

More importantly,  his comfort with self, his curiosity about the deaf experience, and what intrinsically motivates him at the current time to learn about what it means, for him, to be deaf may  involve a process of  self-determining what, if anything, he is ready to explore at the present time about his lived experiences.

I have a son with Bilateral CIs who is 3 yrs old and has been hearing for 2 yrs now. Should we start sign language now to develop his identity? Or should we wait when he is older so he does not get confused and his oral language deteriorates?

Question from E.C., Somewhere…. Posted September 11, 2011.

Perhaps an answer slightly different than what you were expecting: Research has demonstrated that the learning of sign language by deaf children with cochlear implants can support their spoken language or be independent of it. There is no evidence that signing and speaking will lead to confusion or the deterioration of spoken language. Indeed, bilingualism leads to a variety of cognitive and language advantages in deaf and hearing children. Among deaf children, signing can also help in catching information that might be missed auditorally.

Meanwhile, there does not appear to be any research indicating that learning sign language will affect the development of identity, although it is certainly the case that sign language is frequently described as an essential part of the identity of a Deaf individual. As your son gets older and socializes with other deaf individuals, knowing how to sign could be a real asset.

Learning to sign can only be positive for your son (and you). The available evidence suggests that you should “go for it.”

Our child got his first implant at 5 and his second at 7. He is 8 now and only speak in 5-6 word (grammatically incorrect) sentences and understands slightly more. He can only read at the Kindergarten level. We were at a poorly run school so we moved to a great private oral school 8 months ago. He’s gaining language and literacy skills, but we fear its not fast enough to close the gap. I know we have not been at this school very long and should give it time, but time is something we ran out of long ago. I don’t want a 20 year old who has no usable language and can’t read, but I also feel that switching to ASL will hinder reading even more. What do I do?

Question from J.D., Missouri. Posted August 21, 2011.

Okay, I confess: My first thought was “Who can I get to answer this for me?” The (my) problem is that you’ve touched on several realities of having a deaf child that tend to bring out philosophies and controversy, while frequently ignoring the evidence. The realities according to the research: (1) Almost all deaf children have difficulty learning to read. (2) “Oral” education does not eliminate language delays. (3) Learning sign language does not interfere with learning spoken language (for children with or without cochlear implants), but it won’t lead to print literacy either. (4) Cochlear implants are tremendous help for many deaf children, but it does not make them hearing children. Unfortunately, there is no simple or single answer to your situation…shared by many if not most parents of deaf children.

With regard to reading, my best advice is to look at the answer to the posting by Dawn M. (March 1, 2010), as suggested in the previous post. With two cochlear implants, assuming they are both functioning and have been mapped properly, you are doing all you can for your son’s speech and hearing. If you think about how long he was without full access, however, you should not expect him to catch up in any less time than that – he is that far behind in “figuring out” spoken language and has to be catching up as well as learning anew. Having a sign language prior to acquiring spoken language can be a real benefit for deaf children, but I do not know of any research looking at adding sign language in a situation like yours. But it can’t hurt. If anyone claims either that it will confuse your son or help him learn to read – you will be told both – ask for the published evidence (it’s not there).

If you are not sure that both implants are working as well as possible, have them checked and possibly re-mapped. If your son is receiving speech therapy, stick with it. If there is the opportunity for him to learn ASL and/or interact with other deaf children who use ASL, give it a try. If he takes to it, it’s working for him. If he doesn’t, it isn’t. Most importantly, studies that have looked at students with the best literacy skills point to parent involvement as the key. Read with your son, be a model who enjoys reading, and be involved without being too pushy.

I have a 9 year old daughter who was born deaf in left ear and lost half of her hearing in her right ear at age 3. By age 5 she lost all the hearing in her right ear. She recieved a cochlear implant at age 5 and has struggled in school with everything. She is in third grade, but most of her skills range from kindergarten to first grade. She is in special ed, but we are in a rural school with a special ed teacher who has no experience with deafness. Do you have any suggestions for helping her learn to read? She also has seizures I know this has an impact on her performance in school.

Question from E.D., Arkansas. Posted August 19, 2011.

With regard to your reading question, I suggest you take a look at the question from Dawn M. posted March 1, 2010, and the very helpful answer from Karen Roudybush; you can search by date or name. Reading is a continuing challenge for deaf children, regardless of where they live, what kind of school setting they are in, and whether or not they have a cochlear implant. There are a number of helpful online resources available, but as Karen Roudybush emphasizes, the key is “read, read, read.”

Presumably, you have already addressed the seizures issue with a pediatrician. In addition, you might want to chat with a school psychologist (there will be one serving the district, you may need to find out when s/he will be in town), because the seizures may have social as well as academic implications.