My 4 year old son has been diagnosed with severe sensorineural hearing loss in both ears. He was not born this way; we believe he lost his hearing sometime between 2.5 and now. He was just diagnosed in June and he will be getting his first pair of hearing aids at the end of July. I’ve been told by his ENT and Audiologist that we need to make a decision about cochlear implants (CIs) very soon. My son had lots of vocabulary and speech sounds; he now is a little difficult to understand but communicates with family and friends. My question is where can I find good information about CIs and also why must I rush to make a decision?
It sounds as if your child’s loss predominantly occurred after he acquired verbal speech and auditory language, so his deafness is categorized as “post-lingual.” This means your son’s brain has a memory of what speech sounds like, even if that memory and how to reproduce it are fading a bit. That is one reason why implantation is recommended sooner rather than later – research has demonstrated that the shorter the lag between onset of the hearing loss and input from a cochlear implant, the better the child does. We believe that is because the auditory memory (part of that auditory path design) has had less time to “forget” the sounds of speech. There are lots of research articles that talk about keeping that time-frame short between onset of hearing loss and use of the CI, although outcomes are more variable than they might appear.
The signal from the hearing aid is amplified speech and other sounds, so your son will hear things at a louder level with his aids. The sounds will be distorted and some sounds may not be transmitted very well (sounds like /sssss/ and /shhhhhh/). His brain and his ears are connected by a path of nerves (the auditory path), and the signals that the ears receive must be interpreted by the brain. There is big difference between the signal provided by a hearing aid (loud speech) and the signal transmitted by the cochlear implant (kind of like Stephen Hawking’s electronic speech).
Without knowing more details as to the cause of the hearing loss, it is unclear whether there are specific reasons for recommending earlier implantation – some audiologists and ENTs simply believe that CIs are for almost every deaf children and the sooner the better. However, I can tell you that there are some conditions that can cause a bony growth to happen in the cochlea (which is the organ if hearing) and, if so, this growth begins after the hearing loss in a gradual and slow manner. If this occurs, the longer one waits, the more difficult it can be to insert the electrode of the cochlear implant.
There may be other reasons your healthcare providers are wanting you to make a decision, but you need to do your homework first. One of the predictors of children’s success with CIs, literally, is how much time their parents spend getting information on the subject. Here are two links that let you compare what the signals of a hearing aid sound like and the signals of a Cochlear Implant sound like
Here are some article review links:
[Ed. – For more, very objective information visit the UK’s Ear Foundation]
Over the years I have had many hard of hearing students deny their hearing losses and refuse to wear any amplification. I usually tell students that amplification needs should be discussed with their parents. I generally support whatever the parent wants to do.
One of my students’ parent wants to develop a contract for hearing aid and FM use next school year for her seventh grader. The prospective seventh grader will not acknowledge the hearing loss or any of its impact. At this point, I am truly concerned for the student’s well-being. My inclination is to teach clarification and compensatory skills while working to help the student come to some acceptance of the hearing loss.
What does research say about acceptance of hearing loss or amplification use in adolescence?
Your question about available research is difficult to answer – after all these years, we still only have anecdotes to inform us, and not even enough of these to work with. But we can take an educated guess at what this young person is thinking: “I have a problem but I want it to go away; all I want is be like everyone else so I will pretend I am.”
We do know quite a bit about acceptance in general, though: a mindset that first requires the hard work (and pain) of looking at a situation honestly. This young person may need to work with a counselor to “get there.” Additionally, while working on the strategies mentioned, perhaps you might ask her to chat about the concept of resilience. It’s often more comfortable to talk less about the issue at hand (amplification decisions) and instead discuss a bigger but semi-related topic, as in: “People are talking a lot about resilience these days, have you noticed? When adversity occurs, how do people rebound? What strengths do people draw upon to recover and move forward? Any examples come to mind?” Just generally about “people,” but most of us insert ourselves into the answers. All children need practice talking about their emotions. She is fortunate to have you in her life.
Are their any summer programs for hard of hearing children? My daughter is 7 years old and going into the 2nd grade in the fall. She has had a pretty good year, but is struggling with reading and spelling. Her low test scores in spelling have made her feel so badly about herself she is no longer interested in trying. I need to be able to find a way to encourage her to do better and try. What can I do? I hope to find a program for summer to keep her involved with learning.
Keeping your daughter interested and motivated in reading is important – Children who read more become better readers (and spellers).
To help keep her motivated, read books together, allowing her to take the lead at times in explaining what is happening in the story. Choose materials that within her range and on topics she is interested in (comic books and children’s magazines work well: simple language and interesting material).
You might be able to find an summer program through one of the schools for the deaf in your state, or you can contact GLAD (Greater Los Angeles Agency on Deafness), the NorCal Center on Deafness, which runs Camp Grizzly for KODAs, or the California chapter of Hands & Voices about locating or even starting one.
I am an itinerant teacher of deaf and hard-of-hearing students. I have a 4th grade deaf student (severe sensorineural hearing loss) who has an interpreter but uses spoken language as well. She is reading on an early 2nd grade level. Has the literacy program LANGUAGE! been used with success to help hard of hearing students improve their reading skills?
Two of the counties in our area use this program, and teachers of the deaf have mixed feelings about it. Some love it, some don’t. Based on our knowledge of the students that they have in their programs, it seems to work well with children who have some available usable hearing and basic English proficiency, but the farther along the continuum of organized language to disorganized language (whether English or ASL) and the older the child is, the less effective the program has been.
The positives about the curriculum are that the lessons are systematic and explicit; the instruction can be individualized; the assessment is ongoing; and the lessons tie in reading, writing, and spoken language. From a deaf educator’s perspective, however, the curriculum seems to focus on phonological decoding rather than meaning, assuming that if the student can sound out the word then they would automatically know the word. There also are some activities that are difficult to access for students with hearing loss: identifying the stressed syllables in words, learning spelling through sound-spelling correspondence, etc. Teachers would need to think about having visual supports for their deaf/hard-of-hearing students, connecting practice activities to what they would be doing the next day (or even the next minute), and ensuring that students understand the point of the exercises (e.g., why it is important to be able to identify the stressed syllable or use the morpheme “un-“ to make new words). Overall, teachers likely cannot rely on the Language! curriculum alone, and would need to pull in other resources and deaf education strategies to have an effective English Language Arts class.
All the research that has been done with the curriculum has been completed with middle school and high school students (6th grade and older), although, the lowest level (Book A) is in the pre-primer to 2.5 readability range. There is no research we can find that has included students who were deaf or hard of hearing.
Our district audiologist wants to put all DHH students on personal FM and remove the class soundfields altogether. I find conflicting research on this. The DHH teachers don’t want to get rid of the class soundfield systems. Can you please confirm either the benefits or detriment of keeping the soundfield in place in addition to personal FMs?
By class soundfield system, I assume you mean a room equipped with two or more speakers that broadcast the desired signal into the desired space. The problem with these systems is that everyone in the room is exposed to the signal and, depending upon where the deaf or hard-of-hearing student is sitting, there could loss of signal strength over distance. Personal FM systems have the advantage of being set up specifically for the user, whether the individual is using a hearing aid (s), a cochlear implant, or both. The signal is clear, coming directly from the teacher to the student. The signal does not lose strength over classroom distance, and the teacher can use one microphone to connect to several students at the same time. Also, there is no “carry over” into adjoining classes as there might be with a sound field system (depending upon the decibel level of the signal). In my opinion, the FM is superior though more expensive. Two additional notes: (1) Students with milder hearing losses may do best with soundfield system while those with severe to profound losses are likely to do better with FM. (2) It is unclear why a person would remove an existing soundfield system unless maintenance is an issue.
My deaf son is in a public elementary school; they have helped him a lot. But, I think he needs a school that can “go a little deeper.” In reading, he needs to understand the words he’s learned. He sometimes acts like he’s afraid to open his brain. I encourage him, telling him he can do it, but I am not the greatest teacher. Can you offer advice? Would it help to ride the bus to school, giving him more language exposure?
You’d be surprised – I bet you are his greatest teacher. You recognize he needs more exposure to language in order to help his reading, and repeated exposure to new words in context and practice using new words in day-to-day situations is a great way to do this. You have the opportunity in every exchange with your child to provide slightly more complex language input than what he is currently expressing himself. There is great potential for language growth when new words and expressions are used in the real and meaningful day-to-day moments. My greatest piece of advice would simply be to communicate for understanding even more. See if you can increase (maybe even double) the number of exchanges happening between your son and family members or friends. Then when you sit down to read together (as often as possible while being fun), help him make those connections between the words on the page and the experiences you’ve shared. Riding the bus could help if he has a friend with whom he can engage in meaningful communication; at the same time, it may not help at all if he is not interacting with others and the language is just taking place around him.
Is there any evidence-based research regarding consistency with interpreters in a mainstream setting? If a student has the same interpreter for a number of years, does this in itself, negatively impact a student’s progress if the student’s use of the accommodations and interpreter is a positive one? My daughter, who is in a mainstream setting, has requested the same interpreter for the 3rd year. I do not see any problem with this; however, I was unsuccessful in finding supportive/non-supportive research, articles, etc. about this issue.
No one I have contacted has been able to cite research on this issue, so the simple answer to your question seems to be “no.” Stories shared over the years, though, have never yielded a negative about a deaf student having the same interpreter year after year….and even throughout the school years and into college. One male college student (still with his first, female, school interpreter) said that the early puberty years were a little strange at first, but he was glad he had not changed. High-quality educational interpreters are hard to find in many places. If your daughter has a good one and everyone is happy, there is no reason to change. Having a variety of sign language models likely would be beneficial for her language development. However, it seems best to have consistency in school terminology and support from someone who knows your daughters strengths as well as her needs. You can find her other language models in other settings.
And here’s an addition of further readings from Christine Monikowski (NTID) who noted that many school districts have guidelines concerning time limits for interpreters working with a single student (typically 3 years)…to insure “professional boundaries” are adhered to:
Crosby, P. (1998, November/December). Looping in middle school: Why do it? Teaching Pre K-8, 29(3), 46-47.
Elliot, I. (1998, November/December). When two years are better than one. Teaching Pre K-8, 29(3), 38-41.
Nichols, J. D. (2002, September). The impact of looping and non-looping classroom environments on parental attitudes. Educational research quarterly, 26(1), 23-41
Is there any good research into the psychological impact on deaf children who are in mainstream education? I am a mature student and a parent of a deaf child in mainstream and am undertaking a research project into this topic with a view to eventually working with deaf children.
This seems like an easy question but, as with many things in deaf education, the answer is a bit complex. There is an “older” (1980s-1990s, ancient!) literature from the United States indicating that deaf children in mainstream settings were more likely to report feeling lonely and isolated than those in schools and programs for deaf students. While that may still be true in some cases, the fact that the vast majority of deaf children in many countries are now in mainstream classrooms means that the dynamic now is rather different.
For reasons that are unclear, there is very little research on the social-emotional/psychological impact of mainstream education on deaf children conducted in North America (but see research by Shirin Antia and her colleagues). Most of the work in that area is being conducted in Europe, with some in the UK, Hong Kong, and other countries. The recent Teaching Deaf Learners conference in Amsterdam had a number of presentations on the topic, and you can identify/contact the authors by looking at the program. A book based on the conference (Educating Deaf Students: Creating a Global Evidence Base) is due from Oxford University Press, but not until 2015. It will include reviews of work on various aspects of psychological functioning of deaf students in mainstream and special settings. In the meantime, an “advanced search” of the Journal of Deaf Studies and Deaf Education looking for “mainstream” in “title or abstract” will yield a variety of relevant articles. You can reach the authors through the site.
Our son was born deaf and has cochlear implants. He is now 6 years old and in regular classroom with assistive devices. He seems to have a real trouble focusing and some issues with getting angry, upset, crying at times and arguing with adults. We are wondering if there are things we can do to help him gain better control of his emotions and get better focus.
It’s very important to remember that using assistive listening devices can be extremely stressful and tiring. Cochlear implants have become very sophisticated and can be highly effective for many children and adults. But, many children and adults still need to work quite hard to make sense of the auditory input they are receiving and process all that information. School can be tiring, too. So, one first step is to look at the times and situations that are most difficult for the youngster—the situations that bring up the most tears, anger, and arguing. These may be times when he has been listening and working extra hard to hear and understand everything and everyone and is tired and worried that he hasn’t gotten it all.
Tracking the times and situations that are most difficult can also help teachers and parents to intervene before the child has reached that peak of frustration and can no longer regulate their emotions (leading to crying, arguing, and anger). Once a child has “gone over the edge,” so to speak and is very upset, adults can mostly just help them gain control again. That might mean getting away from the situation, waiting out the outburst, keeping them safe, etc. But, if adults are able to recognize the warning signs, then intervening before control has been lost is possible. Helping children learn to manage difficult times while they are still in control of their emotions can be done through conversations, modeling of appropriate behavior, offering alternative activities, and basic empathic statements. And always remember to show children things they can DO when upset, as opposed to telling them what they should not do. Not doing things is much harder than having an appropriate alternative.
How do I get public school to pay for an outside comprehensive evaluation for my 5 year old hard-of-hearing child. Her three-year IEP is coming up. The school does not have personnel trained on hearing loss to do the testing, but they argue that they have the right to do their own testing. Please advise.
In order for an appropriate IEP to be developed there must be evaluations conducted by the school district using licensed or approved staff. I would suggest that you put your request in writing and include that the fact that because the district does not employ staff trained to conduct such an evaluation for a child with a hearing loss an outside evaluation is needed. Remember that your child is entitled to an Independent Evaluation (known as an IEE ) and the district must comply. Include in your request the particular evaluations that you wish to be conducted outside the district.
As for payment, there are different avenues for you to consider. First, you may, but are not required to, share the cost with the district. This option would mean that you would have to share financial information with the district. Second, if you are income eligible, the district will cover the full cost of having the evaluation conducted. Third, you can agree to pay for it yourself.
While it is hard to imagine how a three-year review could be conducted without this information, I would recommend that you make clear in your request that in order for your child’s services to be developed, evaluations must be conducted by qualified staff and, as it is a three-year review, the evaluations must produce the needed information to develop the new IEP.
Parent rights for IEEs are detailed in the federal special education law known as The Individuals with Disabilities Education Act, and those rights along with your state provides for parents can be accessed on the Department of Education’s web site in the state where you live. Finally, if the initial evaluation conducted on your child included an evaluation by an audiologist and your child uses assistive listening equipment, it is not likely that an appropriate IEP can be developed without having this type of evaluation being conducted as well.