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.

Early Intervention and Preschool

Is there research to support why an additional year of preschool is considered appropriate for a child who is deaf and uses cochlear implants to develop language skills rather than moving on to kindergarten placement?

Question from A.H., Virginia. Posted March 4, 2014.
Response from Christie Yoshinaga Itano - University of Colorado

There does not appear to be any literature on this nor any general conclusions about what is or is not appropriate. It would definitely depend on the individual child and a full assessment of that child’s abilities.

Is there any research available which supports the decision to send hard-of-hearing children to preschool early? We have families sending their children to school during the spring semester (age 2 turning 3), as opposed to waiting for fall enrollment following the 3rd birthday.

Question from S.R., Iowa. Posted December 27, 2013.

I am not aware of any research that supports (or recommends delaying) the decision to send hard-of-hearing children to preschool when they initially turn 3 as opposed to waiting until the fall enrollment following their 3rd birthday.  Children eligible for special educational programming may transition to preschool when they are three years old.  The value of preschool education (e.g., child-centered programming that is center-based) for children who are hard of hearing varies child to child and depends upon many factors such as: 1) individual characteristics and needs of the child, 2) quality of the child’s home and/or other environments to promote language learning and overall development, and 3) quality of the preschool program. Programming may be full time or part-time and may be fully child-centered or include a family-child component. Family involvement in the transition from early intervention to preschool and the determination of services needed to support their child’s development is essential.

It is well-established that early identification and intervention (e.g., specialized support and collaborative family-centered services well-before one year of age) improve the overall outcomes for children who are deaf or hard of hearing.  The Joint Committee on Infant Hearing Position Statement of 2007 recommends that all children who are deaf or hard of hearing with permanent congenital bilateral or unilateral hearing loss, including those with permanent conductive or neural hearing conditions, receive early intervention programming. The Position Statement emphasizes that children with all types and ranges of hearing differences are at increased risk for delays in multiple areas of development.  Outcomes gained as a result of early intervention may be lost in subsequent years without continued and appropriate services.

Children who are hard of hearing are dependent upon the quality of the auditory environment for language development because they are likely to rely primarily on listening and speaking for communication.  Studies point to the importance of the quantity and quality of the language in the child’s environment as well as the child’s opportunities to engage in conversations as factors that influence language development.  There is evidence that suggests that children who are hard of hearing require even more exposure to language than children who are hearing to attain the same outcomes as their hearing peers. Quantity and quality of language input varies according to the adults with whom the child interacts on a daily basis. While some parents and caregivers provide rich, age-appropriate and meaningful language exposure others do not. Another variable is auditory access.  In order to obtain maximum benefit from the auditory input, the child’s hearing technology must provide good quality access to language, must be monitored to assure that it is functioning as designed, and must be used consistently.  The listening environment must also be conducive to maximize auditory access.

Both deaf and hard-of-hearing children benefit from a preschool program that includes professionals with the knowledge and skills to support specialized early learning opportunities and who attend to the individual needs of the child and the quality of the language environment.  Some children who have just turned three years old and are hard of hearing may do well at home or in another environment with consultative services from specialists who can provide family members and other caregivers with support to ensure that the language-learning environment is appropriate and accessible to the child.  Other children will be better off in a well-designed program with educators and other professionals with specialized skills. The measure of effectiveness of any learning environment, i.e., home, childcare program or preschool program, is child outcomes. Children who are hard of hearing should demonstrate the same outcomes as their normally hearing peers.  Monitoring of the child’s progress using appropriate and comprehensive measures should determine the effectiveness of the child’s learning environment and identify any additional supportive services needed.

I just found out that all of the children in our son’s deaf and hard of hearing Total Communication program are only receiving approximately 18 minutes per week each of speech therapy. Is there any research that we can use to request more SLP time?

Question from N.P., Alberta. Posted October 7, 2013.

This is a really important question.  I don’t know that there has been any research that specifically relates to the question of amount of speech therapy time.  The question is also difficult because the ages of the children are not indicated.  Optimally, programs would determine intensity of service based upon a child’s needs, the child’s current functioning including current speech-language delay, the history of service, and the progress over time.  Individual therapy with a speech/language pathologist (SLP), which appears to be the question posed, or individual therapy with a professional trained to provide speech, auditory skills, or what is referred to as listening and spoken language services differs in programs across the United States.  If we have been following a child from early childhood and we can document growth over time from having individual services, which may include home intervention or clinic-based therapy, we would use this data to justify services for individual children.  I believe that there is a study conducted by Ann Geers and Jean Moog that found that amount of individual intervention was related to spoken language outcomes of children with cochlear implants.  However, I don’t know if the information was ever published.

This particular question, while an important one, is a difficult one to research because the needs of the child determine the intensity of service that each individual child might require.  Because most programs, unfortunately, are not evidence-based, that is, withdecisions about service provision are determined by data collected by the program, we are left without evidence that could help families.  In Colorado, we have used the Colorado Individual Performance Profile to determine the intensity of service and time per week of special services.  However, we have not specified how that service would be delivered, for exmaple, in individual instruction in speech therapy versus in group intervention, specialized classroom.

Is there a Preschool Development Checklist for Deaf and Hard of Hearing that I can use and apply to my students? I am looking for a standard baseline for Deaf and Hard of Hearing students at preschool level. I want to know what are the expectations of skills and abilities for D/HH children should have at a certain age such as between 3 years to 5 or 6 years old.

Question from A.W., Iowa. Posted September 7, 2013.

I am not aware of a “standard baseline” specifically for children who are deaf or hard of hearing at the preschool level.  Deaf and hard-of-hearing children are so very different that it would be nearly impossible, to develop standards that would be meaningful or appropriate for every child.  There are many factors that influence the development and performance of these children, and therefore, it’s imperative to consider each child individually.  In general, however, the benchmarks for children who are deaf or hard-of-hearing should be the same as those for their hearing peers provided they are similar in other developmental areas.  For example, we should hold the same developmental expectations for children who have similar cognitive abilities regardless of whether they are deaf, hard of hearing or hearing.

Each state has developed Early Learning Standards to address expectations for children at the preschool level.  These standards provide a road map for development and expectations for all preschoolers.  Some preschool programs for children who are deaf and hard of hearing are also using the Creative Curriculum and their assessments as guidelines for development. See the following website for more information about this program:  https://www.teachingstrategies.com/page/ccs_overview.cfm

Children who are deaf or hard of hearing need frequent comprehensive assessments and monitoring to assure that they are making age and individually appropriate progress.  You might want to refer to the Laurent Clerc National Deaf Education website for a listing of assessment tools that can provide guidance in a variety of developmental areas http://www.gallaudet.edu/clerc_center/information_and_resources/cochlear_implant_education_center/resources/suggested_scales_of_development_and_assessment_tools.html

In addition to these assessments, the Visual Language and Visual Learning Center (VL2) at Gallaudet University has some excellent documents specifically related to language and literacy including a recently released (June 2013) Research Brief on ASL milestones and family involvement written by Charlotte Enns and Liana Price.

http://vl2.gallaudet.edu/assets/section2/news267.pdf

You may find these documents helpful as you consider expectations for the children in your program.

I have my son’s IEP meeting coming up soon and I’m not sure if I’m going the right track. My son will be 3 soon. He has moderate sensorineural hearing loss in both ears. When he was born, he had mild/moderate hearing losses. I would really like for him to learn ASL and I feel the earlier the better. I have been doing research and it seems like it would benefit him. However, the class I am looking into has no children who use spoken language, so that would be coming entirely from teachers. I am really excited, but whenever I’ve had the chance to speak to audiologist, speech therapist, or teachers about this, I receive a questioning look, and they tell me that he should go into an oral-only program. What should I do?

Question from L.L., California. Posted August 1, 2013.

First of all, you are definitely on the right track!  Children who are deaf or hard of hearing should have the opportunity to acquire American Sign Language and spoken language (to the maximum extent possible).  You have both the right and responsibility to advocate for what is in your child’s best interest. The challenge is ensuring that your child’s educational program provides him with the resources to make this possible. On your side is the legislation (IDEA Part C) that supports parents as equal members of the IFSP team. There are also best practice principles such as those included in Supplement to the 2007 Joint Committee on Infant Hearing Position Statement. See: http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2013-0008.full.pdf

Your expertise and knowledge of your child’s strengths, abilities and needs are invaluable. In addition, according to IDEA, your goals and priorities for your child must be recognized. Your child will be transitioning into preschool and educational programming will soon be covered under IDEA Part B. My suggestion is that you request that a Communication Plan be developed for your child and included in your child’s IFSP/IEP as he transitions to preschool.  Some states have included a communication plan as part of the IDEA process. There are several examples of communication plans available online. You might want to look at http://pattan.net-website.s3.amazonaws.com/files/materials/forms/Comm-Plan120210.pdf  as an example.

It’s important that you continue to work closely with your child’s IFSP/IEP team as you develop a communication plan that will ensure that your child has the opportunities to acquire language and communication through the modalities (hearing, seeing) that are most accessible to him. This would include opportunities to communicate with peers and adults who use ASL and also those who use spoken language.

We are in the process of establishing an integrated communty kindergarten for 4 year old children. Is there any research that indicates what is the ideal ration of deaf to hearing children in this setting. There will be a total of 21 children in the group.

Question from V.M., Australia. Posted July 23, 2013.

Co-enrollment programs for mixed groups of deaf and hearing students have been created in several countries (Italy, United States, Australia, Hong Kong, and the Netherlands are the only ones we know of). Spencer and Marschark (2010) described co-enrollment this way: “The defining characteristic of this approach is that a “critical mass” of students with hearing loss, instead of an isolated child or two, attends class with hearing students…. Although a 1:1 ratio of deaf or hard of hearing to hearing students might be ideal, the demographics of hearing loss generally do not allow such a ratio being achieved.” Antia, Kreimeyer, Metz, and Spolsky (2011) suggested that such a program can be successful if students with hearing loss make up one-fourth to one-third of the class.” A forthcoming book (2014) will include descriptions of several of the above programs including language, academic achievement, and social-emotional outcomes. In in the meantime, here are some references::

Antia, S., Kreimeyer, K., Metz, K., & Spolsky, S. (2011). Peer interactions of deaf and hard-of-hearing children. In M. Marschark & P. Spencer (Eds.), The Oxford handbook of deaf studies, language, and education, volume 1, second edition (pp. 173–187). New York: Oxford University Press.

Kreimeyer, K., Crooke, P., Drye, C., Egbert, V., & Klein, B. (2000). Academic benefits of a co-enrollment model of inclusive education for deaf and hard-of-hearing children.  Journal of Deaf Studies and Deaf education 5, 174-185.

Stinson, M. S., & Liu, Y. (1999). Participation of deaf and hard-of-hearing students in classes with hearing students. Journal of Deaf Studies and Deaf Education, 4, 191–202.

Wauters, L.N., & Knoors, H.E.T. (2008). Social integration of deaf children in inclusive settings. Journal of Deaf Studies and Deaf Education, 13, 21-36.

I need advice on my child’s upcoming IEP. He was diagnosed at birth with sensorineural hearing loss ( moderate). He will be turning 3 soon and the Local Education Authority District is taking over. We toured the Special Education preschool, and it lacks any children whom are DHH. Composition is mostly ADD, Autistic, and delayed children, which leads to a somewhat hectic/noisy environment. No FM system, teacher is an SLP but not sure if credentialed for DHH. Do we have a leg to stand on legally if we decide not to sign the IEP? The district has no DHH specific programs available, so the private school my child was sent to is an option.

Question from M.C., California. Posted May 7, 2012.

In developing a child’s Individualized Education Program (IEP) under the Individuals with Disabilities Education Act (IDEA), the IEP team must evaluate a child’s needs, set annual goals, and determine services before placement is determined.  If school personnel are proposing a placement before evaluation is done,and goals and services are determined, the school is not complying with IDEA.

Further, in developing the IEP the IEP team must consider “special factors” for deaf and hard of hearing students:  ”[I]n the case of a child who is deaf or hard of hearing, consider the child’s language and communication needs, opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode . . .” The IEP team also must consider the child’s need for assistive technology. And the school must ensure that parents have an opportunity to be part of the group that decides placement.

The U.S. Department of Education has clarified what the a Free Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE) is for a deaf or hard of hearing child: “Meeting the unique communication and related needs of a student who is deaf is a fundamental part of providing a free appropriate public education (FAPE) to the child. Any setting, including a regular classroom, that prevents a child who is deaf from receiving an appropriate education that meets his or her needs including communication needs is not the LRE for that individual child.” (Deaf Students Education Services Policy Guidance http://www2.ed.gov/about/offices/list/ocr/docs/hq9806.html)

In my view the right approach is to work with the school to
1. ensure appropriate evaluations are performed by qualified assessors – what is your child’s language level, primary language, how does your child communicate with others, what are the tools and approaches that support him in communication;

2. develop annual goals that will help your child reach appropriate developmental milestones and access the general education curriculum – for many deaf children goals are needed in the area of language and communication; and

3. determine appropriate services, based on goals, by qualified providers – providers could be teachers of the deaf, speech-language pathologists, sign language specialists, others.

Then the child must be placed in a setting where his IEP can be implemented.  This could be within the district, outside the district, public or private.  Services and settings must be provided at no cost to the parent.  If, after going through these three steps, you become aware of a setting that will support your child’s IEP, you should recommend this to the school district.  Often I hear from parents that they are the ones educating the educators, not the other way around.

Don’t settle for services and settings that don’t meet your child’s needs.  Be an active participant in the development of your child’s IEP and subsequent placement.

My son is 4years/10 months old. What should his Deaf/Hard of hearing preschool be focusing on during his last yer before Kindergarten??

Question from J.A., New York. Posted October 17, 2011.

Every child has unique strengths and areas that are developing. You, your child’s teacher and other specialists know your son best and, therefore, are in the best position to know what he needs. Of course, we want all children who are deaf or hard of hearing to demonstrate the same linguistic, cognitive, social and emotional, and motor skills that are expected of hearing children as they enter kindergarten. A strong foundation in language (comprehension as well as expressive language), early literacy, and cognitive development (problem solving, concept development, etc.) are especially important. Children who are entering kindergarten with both hearing and deaf children will also need strong interpersonal/social skills for interacting and communicating with their peers and teachers. In preparation for the transition to kindergarten, you may want to consult the document posted on the Hands and Voices website: Bridge to Preschool: Navigating a Successful  Transition. This resource provides some excellent information for transitions to kindergarten and can help ensure that the transition is smooth.  http://www.handsandvoices.org/pdf/TransRevised0107.pdf

In addition to planning for transition, you should encourage the current program to develop a Communication Plan for your son. See this document for more information on communication plans:   http://www.handsandvoices.org/pdf/communication_plan.pdf

We are a large school district that continually battles to maintain our Deaf Ed pre-school, self-contained, for 2 year olds. We firmly believe the benefits for a Deaf child entering school even for half a day at the age of 2 to 2 1/2 with other D/HH peers has immeasurable outcomes. However, the district keeps pushing for the entrance age of 3. Do you have any information that would support our efforts to see to it that these little ones receive language as early as possible? We do have teachers going into the home as soon as the child is identified but truly believe the interaction at age 2 with like peers is so beneficial.

Question from C.C., Iowa. Posted April 23, 2011.

I do not know of any empirical evidence that shows that children benefit from group work as a 2 year old.  What we do know, though, is that children do learn language from their peers.  But my question is whether this happens at the young age of 2 years or is it more likely at 3 years of age when children play more interactively.  This probably depends on the cognitive/play skills of the child.

My suggestion is to collect some information while you can.  If you were to collect developmental information about these children and if you show one year’s growth in communication/language in one year’s time, then you might be well on your way to showing the value of this group.

In most states, it is unusual for programs like this to start at 2 years of age.  I’m impressed that yours does.  If you were to collect some evidence it may help others working in other programs as well as your own effort.  It seems logical that there is an advantage.  More stimulation has to be good, right? But in today’s climate, it’s becoming an expectation to have evidence to show the benefit.

My two-year-old daughter is deaf. Where can I find videos like My Baby Can Read to help teach her how to read and use sign language. I have found that Signing Time is geared toward hearing children and does not present the signs well enough. I can’t seem to find FUN videos for my two-year-old to help us learn. There need to be more materials toward children with hearing loss that include motion, don’t you think? Or, am I alone in this thought?

Question from B.D.. Posted March 25, 2011.

First of all, give yourself a pat on the back for knowing the critical part parents play in the literacy process.  You are your child’s first and best teacher.  Initially it’s all about language and providing your child full access to the world around them.  This entails giving your child a consistent way to communicate, learn and make a link between speech/signs and print.  Through your consistent model of language, your child can identify, comment and think about the things he’ll later read about.(i.e  a rabbit is a furry animal with long ears).  We do know that all deaf or hearing children need to recognize alphabet letters quickly and accurately and if possible link those letters to their sound (Visual Phonics cue) or lip formation.  So always remember to turn on the Closed Captions for television shows and movies.

I’m not sure where your family lives but many schools for the deaf offer a Sharing Reading Program.  Shared Reading ( a program developed at Gallaudet ) provides a deaf mentor along with DVDs to teach parents how to share classic children’s literate in ASL.

One website that might provide some helpful resources Is the Center for Accessible Technology in Sign (CATS).  CATS is dedicated to providing accessibility to learning via sign language. CATS’ goal is to enhance language, literacy and general world knowledge by providing tools that make text, captions, video, web pages, and multimedia accessible to deaf users, particularly children. – http://www.cc.gatech.edu/program/cats/

Also available through CATS

1001Books in ASL – http://www.cc.gatech.edu/program/cats/1001%20books/index.htm

Also, many libraries have available an ASL Access Video Collection (with over 200 ASL videos for loan).  Currently they are housed in 28 locations nationwide, in 14 states and the District of Columbia (Current Locations).- http://www.aslaccess.org/locations.htm

Born to Sign – http://www.signwithme.com/002_browse_signs.asp

There is also a ASL Vlog and Video – http://www.aslvlog.net/index.php?c=28