I am a hearing, fluent ASL signer who is considering adopting a deaf child from a developing country. I have very limited information about his health history or hearing beyond the fact that the child “does not hear or speak at all.” The child’s estimated birth date is March 2012 and he has been living in an orphanage since being abandoned by his birth family for a couple(?) years. He is reported to imitate other children well and generally be content and happy. There does not seem to be any exposure to signed language and I assume zero early intervention or auditory assessments made. I am very aware of the importance of early language exposure. I can provide a signing environment probably from age 4.5 onward. I am wondering if you would see any benefit to his overall cognitive, social-emotional and academic development in also pursing a CI? Is it possible for a child to “catch up” from such a late start? I know that amongst older Deaf people this situation of coming to language late is not as unusual as it is today. My hope for my child would be that they would be able to become a critical thinker, I don’t place as much value on speech skills as I do on the possible boost to English literacy that might come from auditory input a CI could provide. I am an interpreter and I am trained as an elementary school teacher (though I don’t teach deaf kids) .
The benefits that you seek from a CI are not usually achieved by children whose families have not invested significant resources into auditory-based instruction (speech perception and production) from the time of implant, throughout the school years. That investment entails placing a high value on acquiring spoken language and being willing and able to commit time and energy toward the process. On the flip side, however, there is no guarantee that investing a high level of desire and effort will have the payoff that you wish for your child.
Your child’s auditory brain areas will not be fully mature until his early teens. It remains open to learning, even learning language, although those areas may be allocated to visual processing without acoustic stimulation prior to about age 7. So, you are working with a long list of unknowns, inevitable in the situation of adoption, especially when a child is born in a developing country. For example, you believe your child to be deaf. It may very well be true that your child is deaf; or maybe not. Even a moderate conductive hearing loss could account for apparent lack of hearing (thereby, ruling out a CI); or there may be an anatomical abnormality of the outer or middle ear, possibly reversible; or auditory neuropathy affecting neural transmission of sound to the brain. Or something else.
Among the unknowns is the child’s experience in utero and during birth; his early nutrition, diseases, and accidents; his genetic makeup; and whether he met nonverbal developmental milestones. There is no information about his speech motor skills. It would be informative to learn whether he attempts to communicate his needs (grunt, point, gesture, pull an adult to a relevant place). While he is said to be content and happy and imitates other children, does he engage in play with others? Does he recognize and comprehend symbols (for example, match pictures to objects)?
A CI is not a magic bullet. At the outset, with an uncertain history like your child’s, even CI candidacy may be difficult to ascertain. Following audiologic and development assessments, there is a requisite trial with a well-fit hearing aid. If a CI is obtained, benefit will be measured in small steps, focusing on gradual growth: whether the child accepts the new input, shows increased environmental sound awareness, turns to familiar voices, demonstrates changes in vocalizations. Many small steps precede the desired big gains. Catch-up, were it achievable, is very unlikely to be demonstrable early on. Your plan is to provide a signing environment, and speech appears to be of indeterminate value. Without a plan to provide consistent auditory (spoken) stimulation at home and at school, the CI will be significantly hampered in the facilitation of spoken language learning and positive effects on literacy and academic performance. Parents who consider a CI for their children often do so with the intention to get the most out of the tool. They speak to their child. They provide instruction that will help the child to speak. They stay the course through the school years.
Importantly, handle the transition from orphanage to home, first and foremost. Take time to tend to the emotional attachments with your child as much as you focus deliberately on his cognitive and academic development. Your child should feel safe and loved, without pressure to perform, as you establish communication through your relationship. Gently, consistently, reward all efforts to communicate. Initial stimulation should not be overwhelming. Your commitment to parenting will support your child’s learning. Be prepared to begin at the beginning, as if welcoming a new baby, with silly songs and first picture books.
Then, find the best pediatric audiologist in your region and make an appointment for a complete audiologic assessment. Follow up on all recommendations without delay. Filling in the unknowns will confirm your thinking one way or the other regarding speech and move you from a hypothetical answer to a personalized response on CI candidacy and estimates of CI benefit. If you choose a CI or a hearing aid, ensure consistent use and daily wear time. Minimize background noise in the house and at school. Focus the child on listening. Model spoken language and emphasize sound before vision. Use “listen cues” and wait time to establish listening attention. Then be expectant. And be patient. Keep in mind that hearing age will be more relevant than chronologic age.
I work as a teaching assistant in a primary school and work one to one with a deaf child aged 4. The main educational focus for this child is to develop their understanding and ability to use sign language however I’m not sure which way would be the best way to teach this?
I am able to use a basic level of sign language. The student has picked up some signs on their own like drink, toilet and food; however, this is a very slow process, does anyone have any tips?
Your question which is massively important for the pupil with whom you are working. You clearly recognise that the situation you describe is not working, and you are absolutely right to voice your concern.
For this or any child to acquire a language, accessible, fluent language models are necessary, and consistent use is essential. That means that if sign language is the goal, the child will need to be surrounded by fluent and consistent language at school and at home. This may be a huge challenge for the whole family, but it’s an essential ingredient to long-term success. It would be helpful to have them look into NDCS family sign language curriculum.
It would appear from the description of your situation that both you and this child are being put in an untenable position. It is unreasonable for you to be given the responsibility to teach the child sign language: a highly-skilled sign language user trained to work with young children in an educational setting, ideally a native signer, is needed for the child’s future language, cognitive, and social-emotional development. With only a handful or words/signs at the age of four there should be a clear, focussed and frequently monitored language development programme in place for this pupil. If the child already has had extensive exposure to sign language, it also might be worthwhile requesting a cognitive evaluation just in case there are other factors at play.
The circumstances will of course be more complicated than you are able to express in a few short sentences, and it is important, therefore, that a much more detailed and extensive review of the situation is undertaken. In the first instance, you need to discuss this with the class teacher, SENCo and teacher of the deaf as soon as possible.
I have a seven month old daughter just diagnosed with profound hearing loss. What are the main things I should be doing with her immediately (apart from starting sign language, which we did before she was officially diagnosed) to promote her language and literacy acquisition down the track?
You are already doing the most important thing: asking questions. Next, but not unrelated, you should look into family-centered early intervention programs. Descriptions of these, the issues you need to be aware of, and the questions you should be asking can be found in two articles recently published and available from the Journal of Deaf Studies and Deaf Education. Click on “Read Highlighted Articles for FREE.”
Meanwhile, enjoy your daughter and engage in as much communication as possible by talking to her, signing to her, and through touch. Just remember to get her (visual) attention before communicating. You will do great!
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?
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.
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?
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.
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.
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?
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.
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.
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.