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

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.

How many children between the ages of 2 to 3 years old are deaf or have hearing loss? Are there hospitals for these kids?

Question from G.C., California. Posted February 24, 2014.

According to the National Institute on Deafness and Other Communication Disorders (NIH), 2 to 3 children out of 1000 are born deaf or hard of hearing (at least 95% of them born to hearing parents). Another 2 to 3 out of 1000 will become deaf or hard of hearing by age 3 due to severe otitis media (ear infections) or other illnesses/accidents.

It is unclear why you might think they need hospitals, other than for the usual medical reasons, but there are audiology (e.g., for hearing aid fitting) and speech-language clinics (for those who will use spoken language rather than or in addition to sign language) in a variety of settings including medical centers, universities, and private practices.

The high school I work at as an educational sign language interpreter will soon be enrolling a young girl from a refugee camp. The student has a hearing loss, but it is not known to what degree. She has had no formal learning experiences except for a few years in the refugee camp she lived in. I would like some resources in order to help the student be as successful as possible. At this point, she will be mainstreamed because there is not a teacher of the deaf full time at this high school. Can you suggest some good resources to tap into in order to help this student with language acquisition?

Question from S.C., Colorado. Posted February 11, 2014.

This profile of a student arriving from a refugee camp, sadly, is not uncommon.

A principle that Dr. Gilbert Delgado established in his groundbreaking book The Hispanic Deaf, published in 1984, is that above all, each student has to be dealt with on a case-by-case basis. This seems like common sense, but unfortunately, we often hope that there are solutions that we can pull off the shelf or recommend for whole categories of students.

With that principle I mind, I can recommend the following:

Where is she coming from? Are there other refugees from the same refugee camp and country in the school district? What resources exist in the community for this group of refugees. People who are providing community support for the refugees should have more information that can be relevant. It is important to network.

How does the student communicate with her family and people in her environment?

If she is hard of hearing, does she speak? What language? What language does the family speak?

Does she use gestures and home signs?

The student’s hearing loss should be determined as soon as feasible.

If the student is hard of hearing, and high school age, hearing aids are not likely to be effective without one-to-one therapy.  This may be a goal a little further down the road.

Placing a student with a hearing loss in mainstreamed classes with an interpreter is not an appropriate placement. Unless she and the interpreter share a sign language, she has no access.

If she doesn’t know English, under Federal law, including Title IV of the Civil Rights Act, her language needs must be addressed. “ELL students must be provided with alternative services until they are proficient enough in English to participate meaningfully in the regular program.” https://www2.ed.gov/about/offices/list/ocr/qa-ell.html

Regarding resources for language acquisition, all students entering special education are required to have a full educational evaluation. These professionals should, after evaluating the student, provide goals for language and literacy development. Materials used should be at a basic level, and because she is an adolescent, not designed for very young children. If there are other hearing students in the district who also lack formal schooling, what has been done for them?  Does the district have ESOL specialists? What materials does the district have for teaching English to students new to the language?

These are very broad and general suggestions for a complex issue. Without more specific details, such as how the student communicates, family language, specifics about the school district, it is difficult to be specific. Finally, a sign language interpreter should not be responsible for language development of this student. I do not believe this satisfies Federal Law requirements for alternative services to assure acquisition of English.

I work in schools in Madrid Spain. We are debating the usefulness of Cued Speech for reading in deaf children with CIs. What are the latest results on this and how generalizable to Spanish children are these results?

Question from M.P., Spain. Posted February 5, 2014.

There are reasons to believe that Cued Speech may help deaf children with cochlear implants to learn to read and write. Cochlear implants provide auditory information that may be not precise enough to develop accurate phonological representations. Consequently, the reading and spelling skills of children with implants may be delayed compared to the acquisition of these skills by hearing children (with the same instruction). Those children who receive Cued Speech combined with the audio-visual input may develop more precise phonological representations, and better phonemic awareness which is an important skill for learning to read.

There are at least two empirical studies showing better reading, spelling, and reading related skills in deaf children with cochlear implants exposed to Cued Speech compared to deaf children with implants and not exposed to Cued Speech:

Leybaert, J., Bravard, S., Sudre, S., & Cochard, N. (2009). La adquisicion de la lectura y la orthographia en ninos sordos con implante coclear : Efectos de la Palabra Complementada. In : M. Carillo & A.B. Dominguez (Eds). Dislexia Y Sordera. Lineas actuales en el estudio de la lengua escrita y sus dificultades  (pp. 201-219). Malaga: Aljibe.

Bouton, S., Bertoncini, J., Serniclaes, W. & Colé, P. (2011) Reading and reading-related skills in children using cochlear implants: Prospects for the influence of cued speech. Journal of Deaf Studies and Deaf Education, 16, 458-473. 

I have a 5 year old son with mild to moderate, sensorineural bilateral hearing loss. He is currently in private school and his teacher identified him as needing an FM system. Who is responsible for providing/paying for the system – the public school, private school or parents? He does not have an IEP, only a 504 plan with the private school. Thanks for any guidance or information.

Question from M.R., New York. Posted January 16, 2014.

Given the fact that your five year old son does not have an IEP, the public school does not have any responsibility to provide equipment. A 504 plan includes  accommodations to the academic program. You may consider referring your son to the home district for an evaluation. If it is determined that his hearing loss is effecting his progress through the academic program, he would receive an IEP, and the school would be responsible for providing such equipment.

A word of caution, however: If the loss is minor and he is doing well in school it is unlikely he will be found to be eligible. As his teacher was the one who recommended an FM system, I would suggest you meet with the private school and investigate how they can provide it. I would also suggest if that fails if the home district could be approached about offering a loaner.

What is the average ACT score for students with a unilateral hearing loss? Is it lower than the national average for hearing students? My daughter has microtia/atresia of her left ear and is a great student but has taken the exam multiple times with a highest score of a 26. Wondering if her hearing loss is some of the issue.

Question from K.W., Michigan. Posted January 3, 2014.

As far as we can tell, ACT (American College Test) scores are not available for sub-populations like students with unilateral hearing losses. Generally, however, even mild and unilateral hearing losses will affect spoken language comprehension, especially in noisy environments (like classrooms). It may be that your daughter has other skills that allow her to compensate in school, but standardized entrance tests tap a variety of  knowledge and abilities, not all of which necessarily are reflected in her school grades. (I am assuming that your daughter has not had difficulty understanding spoken instructions during the ACT test administration.)

It is wonderful that you (and presumably her daughter) aspire to higher ACT test scores, but you might want to recognize that students with almost any degree of hearing loss generally struggle academically as well as with standardized tests;  a composite score of 26 is quite good in that context. The Gallaudet University website, for example,  indicates that as of 2007-2008, deaf and hard-of-hearing students only have been required to have a composite score of only 14 to gain entrance.  Compared to deaf and hard-of-hearing students currently enrolled in baccalaureate programs at Rochester Institute of Technology , your daughter’s score put her in the top 50%.

I’ve seen and heard Marc Marschark say repeatedly that there is no evidence showing Cued Speech supports reading skills. He also writes “.In its more than 60 years of existence, it has never been found to facilitate the acquisition of reading skills by deaf children who are learning English.”

My question is has anyone ever bothered to do a proper unbiased research study on using cued speech with D/HH students to learn literacy?

Question from C.T., Washington. Posted December 27, 2013.

You’re almost correct. What he says is that there is no evidence to support cued speech facilitating the acquisition of literacy skills in deaf or hard-of-hearing children learning English. He readily acknowledges that there is a wealth of supportive evidence from children learning French. The difference appears to be that French (and Spanish and Italian) have very regular sound-to-spelling correspondence whereas English does not (see Alegria & Lechat, 2005).

Even if he can’t do the math (cued speech was developed in 1965-1966), Marschark explains that if, after more than 40 years,  there are no published studies supporting cued speech for English, the alternatives are that either (a) the research has not been done or (b) there has not been positive evidence. In fact, there has been a number of studies conducted aimed at supporting cued speech for deaf children in the United States, but apparently none have yielded sufficiently positive results and been “unbiased” enough to have been published in a peer-reviewed journal.

Cued English clearly facilitates speech reception and may support literacy subskills for some deaf or hard-of-hearing children, but English is simply too irregular for it to be of benefit more generally.

Recommended reading:  Alegria, J., & Lechat, J. (2005).  Phonological processing in deaf children: When lipreading and cues are incongruent.  Journal of Deaf Studies and Deaf Education, 10, 122-133.

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.

Which reading curriculum(la) do you recommend using with deaf/hh students? Do you support using cued speech with English speaking deaf/hh students?

Question from D.D., Arkansas. Posted December 9, 2013.

Thank you for providing the opportunity to remind visitors that this site tries to provide people with evidence-based information about raising and educating deaf children. Only in rare circumstances does the site offer opinions or preferences, and then we ensure that the person writing the response is clear about that.

I do not recommend any particular reading curriculum for deaf and hard-of-hearing students. I know of different schools and programsusing different curricula, and I’m not aware of any evidence that suggests that one is any better than the other. The issue is the extent to which the curriculum is appropriate for the student and matches their strengths and needs (and is delivered in a corresponding manner).

With regard to cued speech, I used to be a stronger proponent than I am now. Cued speech clearly supports the reception of spoken language by deaf and hard-of-hearing individuals. I infer, however, that your question relates to reading. There has never been any evidence that cued speech supports deaf children learning to read English.  The evidence demonstrating cued speech to support reading subskills comes from work involving French or Spanish, which are far more regular in their sound-to-spelling correspondence. Clearly, cued speech has its proponents, and some children succeed well with it. But the evidence for supporting the the reading of English is lacking, and has been for the more than 40 years since cued speech was created.

How does my child, who is hard of hearing, qualify for an IEP? Are such children automatically qualified because they have a “hearing loss,” or are there criteria that have to be met?

Question from T.R., San Diego. Posted November 15, 2013.

A  finding of eligibility for special education must be determined prior to the development of an IEP. The determination is made after an evaluation has been conducted by the education department where your child attends. The first step for you to do is to contact the educationl department and refer your child for an evaluation.

Once you have done that, a schedule will be prepared for the assessments to be conducted. When the process is completed, you will be invited to a team meeting to learn about the results. You can ask questions and will receive information about your and your child’s rights under the special education law known as  IDEA (the Individuals with Disabilities Education Act).

The presence of hearing loss does not ensure that an IEP will be developed. The evaluations must show how the hearing loss effects academic progress and the IEP is designed to provide the needed combination of services to support academic success. Included may be modifications to the classroom such as a sound field system or the introduction of an FM system for your child. These services may also be provided if there is not an IEP as part of an accommodation plan.

Contact the school and request a meeting to discuss a referral for an evaluation. Be prepared to share information and remember that the right to an evaluation is assured. The determination of an IEP will occur at the team meeting and you can object to all or some of the findings.

These steps will serve to provide you with a general direction. Without knowing the extent of the hearing loss or current performance is difficult to provide anymore information.