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.

Latest Questions and Answers

I have a 6 year old with CIs, implanted at 11 months; he has perfect speech. We have a IEP meeting soon, and they want to discontinue speech support. He is mainstreamed and has difficulty staying focused in the classroom. Any help at all we can get for his meeting, we would greatly appreciate. Currently we have a ToD an hour a day five days a week, an educational Interpreter, and right now speech 1 day a week for a half hour in a group setting. That is what they are looking to discontinue.

Question from L.W., New York. Posted March 5, 2016.
Response from Linda J. Spencer - New Mexico State University

Speech Language Services are not only limited to working on speech production. Our scope of practice includes vocabulary development, pre-teaching concepts, teaching advanced language structures, phonological awareness skills, comprehension of language as it relates to processing text and creating text, executive functioning including memory, judgement and pragmatics. It is rare to find a deaf child who has skills in all these areas that develop without careful intervention and monitoring. Speech-language clinicians are intrinsic to optimal development of these skills, and this is the tack I would take in this meetings. [Try to find an advocate who can support this in the IEP meeting and make sure it is written into the program.]

I really want to know if the Informed Consent for a Clinical Trial is only read by a deaf person or there is an interpreter during the procedure who is able to help the volunteer to better understand what is written. Is a Video Interpreting (relay) service (VIR) usually employed or a Computer Assisted Realtime Transcription (CART) service? Do you think that a platform with VIR service could help the deaf person’s understanding?

Question from V.Z., Italy. Posted March 1, 2016.

Essentially, the answer to your question is “it depends on the individual.” For most deaf individuals, at least in the United States, reading an appropriately-worded informed consent document is sufficient. It is the responsibility of both the researcher/medical professional and their institutional ethics review panel to ensure that the document is, indeed, “appropriately worded.”

For deaf individuals with lower levels of literacy, of course a sign language interpreter would be helpful (either live or via VIR). The kind of interpreting, in that case, also would need to depend on the individual, because there are deaf adults (as well as children) who do not have fluent sign language skills. Those who are low-language, for example, would need very different kinds of interpreting than those who are skilled in Italian Sign Language. Deaf individuals who are “oral,” also might need support with an informed consent document, either through further explanation or more simplified language.

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) .

Question from C.H., British Columbia. Posted February 18, 2016.

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.

My son got a cochlear implant at the age of 2 years; now he is 6 years old and he talks well. Will he be capable to learn the ISCE syllabus in school?

Question from P.R., Bangalore. Posted January 24, 2016.

The ICSE (Indian Certificate for Secondary Education) is a national entrance examination in India administered by the Council for the Indian School Certificate Examinations. Neither the cochlear implant nor your son’s speech will be the determining factor in your son’s studying for and performance on the ICSE. How well he does depends on his mastery of the content in the subjects covered by the syllabus and his academic/cognitive abilities. Your son may need additional support for this effort, just as he might for his regular school subjects. But, his hearing loss should be no more of a barrier in preparing for secondary school examinations.

I work with a profoundly deaf junior (16 years old). It is evident that he has severe processing problems because he cannot do the following:

1) Answer comprehension questions at the premier/pre-primer levels/1st grade (he can decode passages at the first grade level according to a reading specialist)
2) Express himself well or gather his thoughts
3) Has no inkling about the meaning of a thesis statement
4) Does not understand figurative language
5) Often misunderstands a teacher’s questions and has great difficulty following group discussions
6) Has limited peripheral vision
7) Has great difficulty retaining vocabulary words

Are there special tests to figure out what is going on with him? All of his previous IEPs indicate that he has been reading at the first grade level. There is no evidence of significant improvement in his reading skills.

I have exhausted the reading and writing strategies I used with this student. What seems to be effective with him is the Reading Milestones program that has very simple, direct questions. It does not include figurative language at all. He can write very simple sentences—not compound or complex sentences.

Question from B.D., Virginia. Posted November 4, 2015.

It sounds like you have made some important observations about your student and are warranted in your concern about the lack of improvement in his skills. From the areas of weakness that you have shared, however, it seems likely that there is something going on that is above and beyond a reading problem. You describe concerns with both expressive and receptive language skills, retaining information, and visual weaknesses in addition to specific reading skills of decoding and comprehending written English.

Unless one has been done recently, given the lack of progress in academic skills and some more general areas of concern, a comprehensive psychoeducational or neuropsychological evaluation that includes assessment of language seems warranted in order to identify the specific cause(s) of the lack of academic progress. This will help to rule-in or –out an underlying language disorder or other cognitive issues that may impact reading. With this information, the student’s educational team will likely be able to better plan more specific academic accommodations that target the underlying areas of difficulty. Given the complexity of this profile, an evaluator with experience assessing deaf children is highly recommended.

With all of the said, it sounds like you are struggling to find appropriate resources to support this student’s reading in your classroom. Again, while the best first step is to get a better sense of the underlying difficulties in order to best support his overall academic learning, the following book may off same helpful strategies to use in the classroom to target various reading skills, including deciding, vocabulary building, fluency, and comprehension: http://www.proedinc.com/customer/productView.aspx?ID=3971. Additionally, the Clerc center offers some specific reading resources that may also be of help: https://www.gallaudet.edu/clerc-center/info-to-go/literacy/literacy-it-all-connects/reading-to-students.html.

I have a 6 year old daughter who has a severe loss, and who identifies as Deaf. She is being declassified as deaf for being at grade level. That is, she currently has an interpreter during the school day except at lunch and has been getting 80 minutes a day instruction (pull out) from a teacher of the deaf and speech therapy 2 days a week speech individually and 1 day a week in a group. The school now wants her to receive only 40 minutes a day from the teacher of the deaf and speech therapy in a group once a week. My daughter works very hard to be at grade level, and the school won’t take in account that this is why she is doing so well. How do we make them understand that she still needs services. Perhaps some kind of assessments can help with this? We’ve already had speech, learning and psychological assessments.

Question from G.R. – Somewhere USA. Posted October 8, 2015.

It sounds like the school is not declassifying the your daughter but decreasing services. Yes, they can do that if they have data that indicates that she is currently successful in learning. It sounds like they what to see if she can be successful with 40 hours instead of 80 hours of ToD services. Unfortunately, IDEA is not in place to ensure that all children excel. Instead, IDEA’s role is to ensure a free and appropriate education, which means to ensure that the student has the opportunity passes and does not fail. At this point the school will need to monitor your daughter’s progress carefully. Her services may nor may not increase based on the progress she makes. Perhaps an outside evaluator who specializes in deaf and hard-of-hearing issues can build a case for additional services.

Although you do not indicate anything about the results of the assessments that already have been conducted, the implication is that they have not supported the case you are trying to make. That may give the school support for a “trial” with reduced services. However, the test or assessment is only as good as the person who is administering and interpreting the results. If this was not the case previously, perhaps it would help to find a person in the area who specializes in deaf and hard-of-hearing issues – the School for the Deaf in your state likely offers such services or can provide recommendations. The point is that a specialist in the field of deaf and hard-of-hearing issues will be able to place the findings in context and build a rationale for the services that are necessary. For example, memory is an important component of any assessment with regards to reading. The other piece that is important as mentioned is progress monitoring. Does the school have a Response to Intervention system set-up? Do they use Dibels or AimsWeb to track the child’s progress. It may turn out that these changes do not affect your daughter’s performance, but if you can’t prevent the change, you need to ensure that the school is carefully monitoring progress.

My 10 year old daughter is fitted was fitted with a cochlear implant at the age of 3+. Overall, the CI has been beneficial to her. She has always attended a mainstream school with 3 sessions of speech therapy weekly. Academically, she has demonstrated strong potential – averaging decent scores in test and exams – with a lot of remedial teaching by her therapist and several hours of study with lesson teachers and self study (a lot of hard work…I wonder how she copes, but she is a strong child) The teachers in school have no special education training and haven’t been able to teach her in a way that enables her to be adequately imparted in class. As she approaches high school I am looking for high schools either in the UK or US that can accommodate her learning difference. So studying wouldn’t have to be so difficult. She is quite brilliant and it will be a shame for her not to be given the enabling environment to reach her full potential. Her only mode of communication is written and spoken language.

Question from Y.D., Nigeria. Posted August 18, 2015.

The answer to your question would be different in the United States and the United Kingdom.

If you are interested in your daughter attending a residential (“boarding”) school for the deaf in the U.S., and you are not a resident, state-supported schools for the deaf are not an option. There are several private residential schools for the deaf that your daughter could attend if she qualifies and you are willing to pay full fees. However, virtually all of those schools utilize sign language (to a greater or lesser extent) as well as spoken or written English. Aside from schools for the deaf, regular (“public”) schools in the U.S. are required to provide deaf children with appropriate accommodations. It’s a bit more complicated than that, but the generalization will suffice for the present purposes because the U.S. does not have public boarding schools.

If you are interested in your daughter attending a boarding school for the deaf in the United Kingdom, your daughter qualifies, and you are willing to pay the fees, there is at least one “oral” school for deaf students where your daughter would receive the necessary support services. Generally, however, private (fee-paying) boarding schools in the UK are not required to provide accommodations for deaf children. State-supported regular schools are required to do so, but it is unclear whether the relatively new, state boarding schools are similarly required to provide accommodations or are willing to accept deaf students. (The National Deaf Children’s Society has been working on this front.)You would need to seek them out through the State Boarding Schools’ Association.

Yet another possibility is homeschooling.

Curriculum Officers in my school are saying that phonemic awareness is not critical in learning to read and write because Deaf children don’t hear sounds and cannot be phonemically aware before learning to read and write. How critical is phonemic awareness in the scheme of deaf students learning to read?

Question from P.R., Australia. Posted May 29, 2015.

It is well documented that developing phonological sensitivity is a necessary aspect of learning to read and write for all hearing learners. Phonological sensitivity is an umbrella term that encompasses both phonological and phonemic awareness; that is the broad array of abilities and skills associated with manipulating the sound structures of a spoken language (e.g., alliteration, rhyming, blending, segmenting). These are critical in order to make sense of the systematic relationship underlying the mapping of sound onto print in the processes of both decoding (word reading) and encoding (spelling), especially in an alphabetic language such as English. The essential role that phonological sensitivity plays in reading and writing development does not change because the learner has a hearing loss.

Some deaf children develop these phonological skills via an auditory route in a similar fashion to their hearing peers through the use of hearing technologies such as hearing aids and cochlear implants. For those children for whom the auditory route is not possible or needs to be supplemented, visual strategies such as Visual Phonics or Cued Speech Language can be used. Research has shown that these approaches are effective in developing phonological sensitivity even in profoundly deaf students.

It should be emphasized that phonology alone (i.e., decoding and encoding in the absence of language) is not sufficient for becoming a fluent reader and writer. However, if deaf learners do not develop phonological sensitivity and the ability to decode and encode with ease and automaticity, they will face challenges in learning to read and write, and in developing age-appropriate literacy outcomes.

For further information on the importance of phonological sensitivity in the literacy learning process, you could visit the Reading Rockets website.

For information specific to teaching phonology to deaf learners, you could look at this information from the Clerc Center in the U.S. and the National Deaf Children’s Society in the UK.

We adopted our daughter when she was seven… no one had ever noticed that she was 95% deaf in her right ear. Now, as a beautiful 14-year-old we have noticed that while she is comfortable in public in our company, she gets overwhelmed in public. While shopping, she needs to stay very close to us, because I think, she doesn’t know how to filter out the sounds that are relevant to her situation. Consequentially, she is reluctant to attend events, activities, or shopping with kids her own age. This fall, she will be attending our local high school with 3,500 other students. Are there some exercises that we can practice to help her prepare for this? We live in a rural area with little or no programs available. She also has some other learning issues.

Question from L.B., California. Posted April 10, 2015.

Your observations of your daughter are astute, and kudos for being her advocate. Single-sided deafness (one normally hearing ear and one ear with significant or total loss of hearing) results primarily in difficulty localizing sounds and hearing in noise, skills that rely heavily on two ears. Public places are typically very noisy and have poor acoustics; therefore the shopping mall, the gym, and the birthday party all may present challenges for your daughter to understand what people are saying.

Though many children with single-sided deafness develop speech and language on track, we know that they are at increased risk for academic challenges, and many, like your daughter, experience frustration and negative social consequences. Speaking openly to your daughter about her hearing loss and encouraging her to advocate for herself will be of great value to her. There are also actions you can take to ensure she receives the best medical management and social and educational outcomes. The first step is obtaining an evaluation by an otolaryngologist (Ear, Nose, and Throat doctor) and a hearing assessment from a pediatric audiologist. It’s important to receive a diagnosis and explore potential causes of the hearing loss to determine if there are any associated conditions or risk for further hearing loss. There may be medical treatment for certain kinds of hearing loss. There are also several types of hearing technology that may be recommended for children with single-sided deafness, such as a bone-anchored hearing aid (BAHA), which is surgically placed in the bone behind the ear, or a contralateral routing of signal (CROS) hearing aid in which a microphone picks up sounds from the side of the deaf ear and sends them to hearing ear.

The next step is requesting an evaluation for special education services from the school system through an Individualized Education Program (IEP). That should include not only assessments of hearing but also the impact of the hearing loss on academics and social and emotional function. This is especially important if your daughter is exhibiting learning difficulties. Whether or not she is determined to qualify for special education services, the school is required by the Individuals with Disabilities Act to provide equal access to communication for your daughter, both in the classroom and at all school events. In cases of single-sided deafness this could mean, among other things, preferential seating, captioned media, and/or the use of an FM system where the teacher or speaker uses a microphone that transmits sounds directly to an ear piece worn by the student. It is critical that your daughter’s teachers be aware of and monitor her performance in class. Request contact with the school district’s educational audiologist, who will be your daughter’s ally.

Last, but not least, your daughter may benefit from counseling. Depending on her needs, she may be better served by either an aural rehabilitationist (speech-language therapist or audiologist) or a clinical psychologist or social worker, or both. Aural rehabilitation therapy focuses on developing listening skills, communication strategies, navigating hearing assistive technology, and self-advocacy, whereas counseling focuses more on social/emotional concerns.

For more information two great links are:

I am a TOD on the high school level. I have been for 18 years. I had four years in the preschool. I am a self-contained teacher and an Inclusion teacher. I was wondering if you had a suggested materials for me to use in the classroom. I currently teach World History. My students have very low Lexile levels. My biggest struggle is reading comprehension and my boss constantly telling me I need to ask higher order questions to my students. My students struggle with basic questions: who, what, where, when, …. My vice principal has a special education degree. I have tried to explain that my deaf students think and process information differently than the special needs and regular education students. Also can you suggest any books that I should read to help me in the classroom with my students? My students’ parents do not sign and two out of three students come from Spanish-speaking homes.

Question from K.W., New Jersey. Posted March 20, 2015.

My favorite high-interest, low-reading level materials are published by Steck-Vaughn. The World History book is “World History and You” by Vivian Bernstein which is a 2nd-3rd grade reading level. They also have similar books for other Social Studies courses (America’s Story, World Geography and You). They are short reading selections and include activities and assessments. AGS also publishes social studies books, which are written at a 4th grade level. Reading A-Z is another program that has leveled readers about various topics that may include some information that you are covering. Unfortunately, there are not many other options that I have found that work well with students who are deaf and hard-of-hearing who are reading significantly below grade level. If those texts don’t match up with my student’s needs, I tend to rely on teacher made materials and websites such as edhelper.com and enchantedlearning.com.

If your students are having difficulty reading the material, perhaps you could have the students put the reading portion on hold at first. I’ve had success by pre-teaching new vocabulary with pictures, then story telling and having the students do a non-reading/writing activity (role-playing, make a picture book together, create a time-line with titles/pictures only, etc.) Once they understand the concepts “through the air”, the students can then apply that to the text.

As far as books that you can read, there is a lot of information out there about embedding formative assessment, which has helped me recently in my classroom with struggling learners. Try publications by Dylan Wiliam.

Strategies that I feel are necessary for student success are:
• Visuals – Use as many visuals as you can find.
• Repetition – After the initial instruction, take some time each day to warm up by touching on previous information and do this often.
• Vocabulary – So many students have difficulty reading simply because they don’t recognize the words. This happens even with simple words that they actually DO know the meaning of, but just don’t recognize the written word. Step up your vocabulary study with vocabulary notebooks, word walls, etc. Use pictures along with simple definitions and even pictures of the signs when able. Avoid definitions from the dictionary, which can be confusing for students who are deaf and hard of hearing. Quizlet.com (there is also an app available) is a fantastic way for students to practice vocabulary. It gives the option to add a definition and/or picture for each vocabulary word, as well as games and assessments.
• Real Life Connections – Find a way to connect the information to the students’ real life. This could be by paralleling English to Spanish (written, spoken or signed) or events that have occurred in their everyday life.

I agree that it IS extremely difficult for students to be able to answer higher level questions if they are struggling with basic WH- questions. To improve your students reading comprehension, critical thinking skills, and ability to answer questions, consider trying readtheory.org. It is a tool that offers reading exercises for all ages and reading ability levels. The students start off by answering lower level questions, and as they become more skilled in doing this, they move on to higher level questions. This may be ideal for your students because it gives you the freedom to individualize for each student. In addition, it also gives you analytical statistics for each student about their ability to answer higher order questions, so you can have data to show your boss to back up the way that you question your students.