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.

Education

We are a small state with a generic inclusion policy for all students with a disability, which means that deaf students must attend their local school and are supported by itinerant ToD and/or interpreters. Our numbers are small and decentralised so most deaf children attend schools where they are the only deaf child. I would like to influence the Education Department policy to allow deaf children the choice of enrolling ‘out of area’ to be educated in a setting with other deaf and hard-of-hearing students, but I need some research evidence to present to the Department before they will consider this. Can anyone please help with some research supporting the need for deaf children to have access to deaf peers and role models for their linguistic, social and emotional development?

Question from M.R., Australia. Posted August 3, 2017.
Response from Marc Marschark - NTID

As much so we talk about the importance of “supporting the need for deaf children to have access to deaf peers and role models for their linguistic, social and emotional development,” the evidence is remarkably thin. What current evidence (as opposed to testimonials) there is comes primarily from co-enrollment programs, programs that include a critical mass of deaf students in inclusive classrooms that include both a general education teacher and a teacher of the deaf. You can find a description of co-enrollment and access couple of relevant articles through the Raising and Educating Deaf Children website. Two book chapters listed below specifically emphasize the benefits of being with a critical mass of deaf peers for linguistic and social-emotional development, respectively. At this point, however, we do not yet have much evidence to indicate strong effects of co-enrollment on academic achievement. More research is definitely needed.

Further reading:

Tang, G., Lam, S. & Yiu, K.-M. (2014). Language development of severe to profoundly deaf children studying in a sign bilingual and co-enrollment environment. In M. Marschark, G. Tang, & H. Knoors (Eds.), Bilingualism and bilingual deaf education (pp. 313–341). New York, NY: Oxford University Press.

Yiu, K.-M. & Tang, G. (2014). Social integration of deaf and hard-of-hearing children in a sign bilingual and co-enrollment environment. In M. Marschark, G. Tang, & H. Knoors (Eds.), Bilingualism and bilingual deaf education (pp. 342–367). New York, NY: Oxford University Press.

I am a state-wide consultant for schools and early intervention programs. The mother of a 1st grade student called me asking for help with the school who has recommended that her child repeat 1st grade in the fall, because she “just needs one more year for things to click” (the child has cytomegalovirus). She uses an interpreter in school and has bilateral cochlear implants. She is a bilingual child, but in a mainstream class and a school thathas no deaf education specialist or anyone with experience working with this population. So their expertise is limited and their recommendations often not appropriate for educating a deaf child who is bilingual.

I am looking for research on retention and the impact this has and why this decision may or may not be the best for this child. I would love to hear from any expert who can guide me to resources I can share with the family and the school.

Question from K.L., Arkansas. Posted July 27, 2017.

There is no research to support either grade retention or “social promotion” as a beneficial intervention for students who are performing below grade or age-equivalent standards. When talking about grade retention specifically, the evidence suggests that grade retention is more detrimental than helpful to students. Students who are retained tend to have poorer self-esteem than their peers. They are also less likely to graduate from high school. This holds true for students with and without disabilities. Apparently the only study that has involved deaf students showed that if they had ever been held back a year, they performed more poorly on achievement tests in reading and mathematics in high school.

When students are retained, they often experience a short-term boost in their academic achievement (perhaps because the material is now familiar), but that boost does not maintain throughout their school years. Instead of grade retention or social promotion, the National Association of School Psychologist (NASP) recommends implementing evidence-based, culturally-responsive instructional interventions that are directly linked to the student’s needs (find their parent information document here). The invention instruction should be paired with progress monitoring in order to adjust instruction as the student’s needs change. Carefully-planned intervention instruction based on the child’s needs is a more appropriate plan of action than grade retention. NASP advises that if the team and parents decide that grade retention is appropriate, then simply repeating the grade is not enough. The student must also be provided the intervention instruction mentioned previously.

I want my daughter to go to a school with a full program for students with hearing loss. My child’s school is recommending a closer program to home that only offers ASL. My daughter had to repeat 9th grade because I believe she didn’t have the necessary accommodations. Is a school that offers ASL adequate? The other school has a team of audiologists, speech pathologists, career coaches for students with hearing loss.

Question from I.L., California. Posted July 25, 2017.

There are two aspects to your question. First, with regard to language, you do not say whether your daughter has spoken language skills or relies exclusively on sign language. If she has spoken language skills, you want a program that supports those skills (with audiologists, speech pathologists, technology, etc.) as well as any sign language skills she might have. In that case, a school that offers only ASL is not adequate. Second, any deaf or hard-of-hearing student, regardless of their preferred/stronger language modality, will benefit from career coaches and other support/advising services. Both these services and the language-related services you want for your daughter can be built into her Individualized Education Program (IEP). Recent research shows that ending interventions and support services available in elementary school can create real challenges for deaf or hard-of-hearing students if they are ended too early. Many if not most such students will need and benefit from continued support into the high school years. More services are always better then fewer services!

Have there been research studies on how best to develop early intervention supports in developing countires for young children who are deaf and their families?

Question from R.B., Somewhere USA. Posted March 16, 2017.

Not exactly. Most importantly, different countries and cultures have different needs. There is often an assumption on the part of us do-gooders that what works in Western countries is exportable. However, interventions, family support structures, and educational methods that fail to fit with the contexts into which they are being imported cannot be optimally effective, if they are effective at all. With regard to education, there is a forthcoming book from Oxford University Press on exactly this issue: Deaf Education Beyond the Western World- Context, Challenges and Prospects, but it is still close to a year from publication.

With regard to universal newborn hearing screening and early intervention, there is a book chapter that you might find informative: Leigh, G., Newall, J. P., & Newall, A. T. (2010). Newborn screening and earlier intervention with deaf children: Issues for the developing world. In M. Marschark & P. Spencer (Eds.), The Oxford Handbook of Deaf Studies, Language, and Education, Volume 2 (pp. 345-359). New York, NY: Oxford University Press.

“Research” into such issues would need be on a country-by-country (if not region-by-region) basis with regard to each content area of interest (e.g., early intervention, social-emotional functioning, education). You would need to search for such writings individually (by country and topic). There is unlikely to be any general research applying to developing countries that would be helpful.

I currently live in a state that does not have a listening and spoken language program for deaf children with cochlear implants. A bordering state has such a program. My county’s district will not allow my child to go there. Is there a law that they are in violation of? Do I have the right to have my child attend this LSL school?

Question from C.L., Indiana. Posted February 2, 2017.

It is difficult to give a definitive answer without having more information. However, the guiding principle for placement decisions is the IEP. So, if your child has an IEP that calls for the delivery of services that only an LSL School can provide, and the district does not have appropriate services that meet the needs as stated in the IEP, then the district would be required to find a placement that could provide those services.

As far as “rights” go, there is the right to compliance with the regulations on the part of the district. For example, if an evaluation is requested, the district is required to provide one in a timely fashion in order to be available for review at an IEP team meeting. If you feel that the evaluation and/or IEP recommendations are inappropriate, you have the right to reject the IEP. That is, the IEP process should determine the placement based on assessment data. You and your child have the right to that, but not to an alternative placement unless it can be demonstrated that what was being offered by the district does not meet the goals of the IEP. Parental wishes are considered but not binding.

p.s. The same standard would apply through any appeals process.

Can cochlear implants cause a distraction to learning in the classroom for some children. If so, how does a parent know?

Question from S.J., Indiana. Posted November 21, 2016.

When cochlear implants are properly working and appropriate habilitation (e.g., speech-language) services are in place, cochlear implants should not distract children from learning in the classroom. In fact, cochlear implants offer the potential for the child to acquire auditory-verbal information that might otherwise be missed. However, deaf children with cochlear implants are at greater risk for executive functioning delays (which include distractibility and attention problems), compared to hearing children. The causes of these executive functioning delays appear to be speech perception/language delays and early hearing loss, not the implant itself. Research indicates that significant executive functioning delays (which can cause distractibility and attention problems) occur in less than half of children with cochlear implants, but that the rate of executive functioning delays in children with cochlear implants is about 3-5 times greater than that of hearing children.

The best way to know if a child has more distractibility and attention problems than the average child in the classroom is to have the teacher rate the child’s behavior compared to other children in the classroom. Sometimes, teachers will alert parents about concerns in take-home notes or at conferences, but it is often very helpful if a teacher can complete a standardized behavior checklist that compares the child to other children of the same age. Parents may also notice problems with distractibility and attention problems at home. When significant concerns are present, it is recommended that the parents talk to the teacher and to the child’s doctor about these problems, seeking more in-depth evaluation from a psychologist if necessary.

If you are concerned about problems that a potentially poorly-functioning cochlear implant might be causing for a child in the classroom, it is recommended that you first check with the child’s audiologist and speech-language pathologist. The audiologist can check the implant to be sure that it is functioning properly; the speech-language pathologist can discuss any habilitation, speech perception, or language processing problems that might be occurring. A problem with the normal functioning of the implant could be distracting to the child.

I am looking for research based articles on Evidence Based Practices to teach literacy to children who are deaf. We are currently using multiple interventions one of which is Visual Phonics. I cannot find any research to support this as an evidence-based practice. Do you have any resources or suggestions?

Question from A.C., Vermont. Posted November 5, 2016.

Depending on the age of your students and their hearing abilities, Visual Phonics may be an effective strategy to improve your students’ phonological awareness skills and ability to sound out words. However, the long-term relationship between Visual Phonics instruction and decoding is unclear. Narr (2008) discovered that the number of years Visual Phonics had been part of instruction did not correlate with the decoding abilities of these readers.

Two other instructional strategies that you may consider if you have older readers or those with little functional hearing are: lexicalized fingerspelling and morphological instruction. Lexicalized fingerspelling is rendering the fingerspelled word smoothly. The fingerspelled word looks more like a fingerspelled loan sign. During instruction, the sign, lexicalized fingerspelling and the printed word should be presented simultaneously to the students. Later, the students can link the lexicalized fingerspelled word to the printed word (Haptonstall-Nykaza & Schick, 2007) more reliably.

Morphological instruction includes teaching affixes and root word meanings and the rules for combining morphemes as part of daily literacy instruction. Morphemes are the smallest part of the language that retains meaning (uni + cycle = unicycle). Morphemes tend to be spelled the same across words even when they are pronounced differently (magic vs. magician). Teaching DHH students morphemes and their meanings allow them to read using patterns that are accessible through the printed word. The students can break down the word into its morphemes, determine the meanings of the morphemes, and reconstruct the word to determine the word’s meaning (Trussell & Easterbrooks, 2015). Morphology instruction gives the students the tools to decode the words for meaning and improves their reading comprehension through vocabulary (Nunes, Burman, Evans, & Bell, 2010).

Evidence-base

Visual Phonics for young students:

Bergeron, J., Lederberg, A., Easterbrooks, S., Miller, E., & Connor, C. (2009). Building the alphabetic principle for children who are deaf or hard of hearing. Volta Review, 109(2–3), 87–119.

Lederberg, A. R., Miller, E. M., Easterbrooks, S. R., & Connor, C. M. D. (2014). Foundations for literacy: An early literacy intervention for deaf and hard-of-hearing children. Journal of Deaf Studies and Deaf Education, 19(4), 438–455. http://doi.org/10.1093/deafed/enu022

Miller, E. M., Lederberg, A. R., & Easterbrooks, S. R. (2013). Phonological Awareness: Explicit Instruction for Young Deaf and Hard-of-Hearing Children. Journal of Deaf Studies and Deaf Education. http://doi.org/10.1093/deafed/ens067

Beal-Alvarez, J., Lederberg, A., & Easterbrooks, S. (2011). Grapheme-phoneme acquisition of deaf preschoolers. Journal of Deaf Studies and Deaf Education, 17(1), 39–60. http://doi.org/10.1093/deafed/enr030

Tucci, S. L., & Easterbrooks, S. R. (2013). A syllable segmentation, letter-sound, and initial sound intervention with students who are deaf or hard of hearing and use sign language. The Journal of Special Education. http://doi.org/10.1177/0022466913504462

Trezek, B., Wang, Y., Woods, D., Gampp, T., & Paul, P. (2007). Using visual phonics to supplement beginning reading instruction for students who are deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 12(3), 373–84. http://doi.org/10.1093/deafed/enm014

Visual Phonics for Middle School Students:
Trezek, B., & Malmgren, K. W. (2005). The efficacy of utilizing a phonics treatment package with middle school deaf and hard-of-hearing students. Journal of Deaf Studies and Deaf Education, 10(3), 256–71. http://doi.org/10.1093/deafed/eni028
Fingerspelling:

Haptonstall-Nykaza, T. S., & Schick, B. (2007). The transition from fingerspelling to English print: Facilitating English decoding. Journal of Deaf Studies and Deaf Education, 12(2), 172–83. http://doi.org/10.1093/deafed/enm003

Morphology instruction:

Trussell, J. W., & Easterbrooks, S. R. (2015). Effects of morphographic instruction on the morphographic analysis skills of deaf and hard-of-hearing students. Journal of Deaf Studies and Deaf Education, 20(3), 229–241. http://doi.org/10.1093/deafed/env019

My son is deaf and also has autism. Is there any research related to a dual disability? The current school system in our county is trying to remove his sign interpreter and replace with someone who signs of a toddler level, he is in middle school. Any information would be helpful.

Question from J.B., Florida. Posted October 3, 2016.

The Raising and Educating Deaf Children website (www.raisingandeducatingdeafchildren.org) recently posted a series of bulletins on deaf children and autism (see the July 2016 postings). There are several that should be useful for you. In addition to the information contained in the bulletins themselves and addresses of the authors, you will find free access to research articles from Oxford University Press.

My granddaughter is 19, she is hearing impaired and has just come to live with me. She went to school in the Caribbean. She would like to attend college but I don’t know where or how she should start: whether she should go to high school and do the high school diploma or get her GED and move on from there. What do you think she should do? So far, there is no high school in the area with a program for deaf students.

Question from J.C., Florida. Posted September 29, 2016.

The Florida Department of Education has a dedicated page for finding information about services for school age students who are deaf or hard of hearing (DHH) in the State of Florida. Here is the link: http://www.fldoe.org/academics/exceptional-student-edu/ese-eligibility/deaf-or-hard-of-hearing-dhh.stml Every county has a DHH Coordinator Contact which can be found here: http://app4.fldoe.org/EESSContacts/ . Every county must offer students who are DHH a full continuum of services from ages 3 to 21. Some of the smaller counties must collaborate to provide services. An explanation of the continuum of services can be found in the “Florida’s Education Opportunities for Students with Sensory Impairments” http://www.fldoe.org/core/fileparse.php/7690/urlt/0070161-edoppsensory.pdf.

As for the age of the student, I would recommend they start with the guidance counselor at the local high school to see if any school credits will transfer from the Caribbean. At 19 she may still have time to earn a standard diploma, but it depends when her birthday is because she only has until she is 21. Florida does have a 3-year diploma option. Only a guidance counselor can determine if it is possible to earn a standards diploma.

The young woman should also apply for Vocational Rehabilitation: http://www.rehabworks.org/. They can help guide the student to post-secondary options. If the student wants to attend college, then they would need to speak with the college about what programs are available for students with disabilities to earn their GED and then a postsecondary program. http://www.stateofflorida.com/colleges-in-florida.aspx I am most familiar with North East Florida where there is Florida State College at Jacksonville and St. Johns River State College have bridge programs and are experienced at working with students who are DHH.

Another resource is Florida Centers for Independent Living, http://www.floridacils.org/. They have 15 centers statewide. They provide resources, training and support.

The final resource that may assist the family is the Family Network on Disabilities (FND), http://fndusa.org/. They provide support and information sharing for children ages birth to 26.

I have a son who is deaf…or so we thought. We had an ABR done recently, and he has no permanent hearing loss. Great news! I still feel that he has hearing issues. Small ear canals, frequent ear infections, but no permanent hearing losses. He also has oromotor issues that are congenital. He can’t drink, can’t eat more than purees, drools, right sided weakness, low tone, etc. He’s had 4 oral surgeries. It makes sense that he can’t talk. He did say his first word this summer, “Go!” So, I want him to learn ASL. He started at 30 signs 6 months ago, and now he has a vocabulary in excess of 250 signs.

We had an IEP meeting last week. brought 3 doctor reports and a speech therapist report that all indicate that he needs to be taught sign language in his classroom. The school “accepts” but will not teach ASL. They want him to use an iPad with pictures. I feel that all of his gains in speech are linked to his sign language acquisition.

I did reach out to the school for the deaf. We are signed up to do some of their outreach programs. He’s not deaf, so they won’t/can’t help us. I want my son in a Total Communication class. There is one about 20 minutes from our house.

How can we get what (we feel) our son needs?

Question from M.G., New York. Posted September 7, 2016.

If a finding of special needs is found (which clearly is the case) then the child is eligible for special education. At that point, it does not matter how the school “feels” about the recommendations, the school has to provide services based upon the assessments to provide access to the curriculum. Rejecting sign language because he is hearing is not an appropriate determination if the assessments indicate that as an adoption that will facilitate access to instruction and social interaction. This is a child with multiple needs and the recommendations that were cited do not come close to the extensive level of support the child will need to be able to be successful. Pull out services will not suffice at least not during his early childhood years and the need to intervene comprehensively to promote development is necessary.

So, first, the school should assess the child’s language level, both receptively and expressively. This is the starting point. Then goals should be developed based on the needs identified during the assessment. The overall goal should be achievement of age-level language skills. Age level skills will enable him to access the general education curriculum. The Individuals with Disabilities Education Act emphasizes age appropriate skills and access to the same educational material that other children receive, that is the general education curriculum. In other words, the school should be attempting to get the child’s skills to the same level of his peers so that he can participate in the classroom similar to his peers, to the extent possible. Will using an iPad with pictures do that? It’s hard to see how. The fact that you can show that he is succeeding using sign language is helpful.

Once goals are developed, then the services should be determined, such as teaching sign language by a trained teacher. After the services are agreed upon, then placement is made. The placement must be based on the child’s needs and services. If there is a total communication class that would fit the method used in the class, that would seem to be a more appropriate choice. If there is any capacity for spoken language, a simultaneous communication approach may be better in the long run.

Sounds simple, but I know when you are advocating for your child it is not easy. In the end, litigation may be the only way forward, with the experts lined up prepared to make recommendations based on their findings and to have the school system respond on how they will fulfill the requirements. Hopefully, it will not come to that. Meanwhile, a few tools you can use:

First, if you believe that the school has not done an appropriate assessment of his language skills you should request they do (or re-do) that right away. Also, are his goals consistent with getting him to the level of his peers (and helping him continue to progress)? They should be.

Second, as for placement, when a school refuses to change the placement of a child (or for other purposes), it must inform the parents of the reasons. This is called “Prior Written Notice.” See the form developed by the U.S. Department of Education at http://idea.ed.gov/download/modelform2_Prior_Written_Notice.pdf. As you can see, the school must explain the reasons why it refuses the placement, based on evaluation procedures, assessments, and records. You can request that the school provide the information required on this form.

Another law that applies in this case is the Americans with Disabilities Act (ADA). Among other things, that law requires schools to ensure that students with speech disabilities can receive information from, and convey information to, others. This communication must be as effective as communication with students without disabilities. The U.S. Department of Education has issued guidance on the ADA and effective communication at https://www.ada.gov/doe_doj_eff_comm/doe_doj_eff_comm_faqs.htm. Under the ADA schools must give “primary consideration” to the request of the student or parent.