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

Question from N.P., Alberta. Posted October 7, 2013.
Response from Christie Yoshinaga-Itano

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.

I am a deaf educator looking for a research based reading program to teach deaf students. I am currently being required to use programs created for hearing children with “modifications” for the deaf. There has to be a program someone has come up with created specifically for the deaf. I can modify all I want but if the program does not take into account the special language concerns, it turns into just “the best we can do” and I want more for my students. They can “work” the program but it has no meaning to them. Any suggestions ?

Question from D.C., Missouri. Posted October 1, 2013.

Many teachers today are required to use Evidence-Based Practices in teaching students. As most teachers have discovered, materials with an evidence base are few and far between. This is of great concern for those of us who teach DHH children. The fastest way to answer your question is to refer you to Easterbrooks and Beal-Alvarez (2013), Literacy instruction for students who are deaf and hard of hearing. New York: Oxford University Press. Pages 18 through 33 address what material is presently available and what to do if you cannot find a curriculum or set of materials that does not have an evidence base. Table 2 in chapter 1 lists several sets of materials that have a developing evidence base. However, no one package can meet all literacy needs of all students. When there is no material with an existing evidence base, we recommend that you examine the material to determine whether it includes features that we know lead to better outcomes. For example, we have clear evidence that visual supports to learning lead to better outcomes for DHH readers. When reviewing material, if it incorporates routine use of visual supports (which we call a “causal factor” because visual support causes better outcomes), then based on that feature of the material, you can argue that it has a developing evidence base. There are five causal factors that we know support better outcomes: a) higher-order thinking skills, b) teacher’s communication, c) visual supports, d) explicit instruction, and e) scaffolding. If the material is founded in at least two or three of these causal factors, then you can argue with your administrators that it is based in the evidence, even if there is no single research article on the product itself.

You will also want to watch what is happening with the National Research and Dissemination Center of Literacy and Deafness (CLAD; http://clad.gsu.edu). This research group is studying DHH children in sites around the nation and will be creating targeted literacy interventions over the next several years.

Hi. I’m 13 years old and I need some advice. I am not deaf my hearing reads 70-80 db. I’ve been advised to get a cochlear implant, but I prefer to stick with my hearing aids. I need you to tell me which is better in terms of sport,school,long term, and not letting your friends know. Thanks.

Question from D.S., United Kingdom. Posted September 15, 2013.

Hi. First of all, you are pretty amazing for thinking so hard about your options and for getting advice about a very big decision.  I admire your courage and wisdom at such a young age!

People who have had hearing aids are advised to get a cochlear implant if  their aided hearing abilities make it such that they are really struggling to hear words and sentences when they are using the best hearing aids in the best situations.  Sometimes a hearing loss is progressive, meaning it gets worse and worse and in this case a doctor my recommend a cochlear implant.  We think that by stimulating the hearing nerve using the cochlear implant soon after the hearing is lost, this can help the person maintain their memory of sounds so they can keep their hearing skills.

It is really hard to guess why you have been given this recommendation without knowing if it’s from your doctor, family, or friends.  You are right to ask a lot of questions at this point.  There is no clear answer of what is “better” in terms of sports.  With a CI, we tell people to avoid sports that can give a high risk of banging your head into something (like American football or hockey) but I have known people who participate in these sports who use CIs and they are very successful. Some of the new CIs allow you to get the CI a bit wet, and some even let you swim with a CI.

As far as school goes, a CI may help you with listening and understanding teachers other pupils in class.  You would need time to adjust to the new “sound sensation” of the CI, and this is something to consider.  In the long term, this IS a big adjustment and as I said it is a big decision.

I am really curious about your very last words of “not letting your friends know.”  Are you concerned that your friends will be upset if you choose a CI over a hearing aid…or the opposite?  Or are you concerned that your friends don’t understand about your hearing loss in the first place?  Might you feel comfortable explaining your choices to one good friend?  It can be really helpful to have someone to talk with.

At any rate, I really wish you the best with this very big decision.  I think you are doing the right thing to ask a lot of questions to a lot of professionals.  In the end this is your PERSONAL decision, and as long as you feel comfortable with what you decide, that is the right thing.

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

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

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

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

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

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


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

My grandaughter is aged four, has deaf parents, and high level BSL which is her first language. Her levels have been assessed as being approximately two years above her age in terms of her language acquisition.We are currently requesting that she is taught in a mainstream class with a high level interpreter in a bilingual setting but have been offered CSW’s with BSL level 2/3. Where can we find research/evidence to back up our request that she needs a highly skilled interpreter to go from one language to the other and therefore help her to acquire English as her second language, rather than a low level communication support worker which we have been told is all that a primary aged child needs?

Question from A.R., London. Posted August 21, 2013.

I am not aware of research that evaluates the merits of a Communication Support Worker (CSW) compared with a Sign Language Interpreter. Although the titles and job descriptions of each of these speak for themselves, and in theory at least, a CSW is appropriate for some deaf children, in practice, there are very few CSWs with sufficiently high levels of sign language to meet the needs of children such as your granddaughter. Then again, there are few high-level interpreters who work in school settings.

The difference between the two roles is that a CSW is there to support communication, which is particularly necessary for deaf children with less well developed language. In these cases, the CSW may simplify the language used in class as needed in order to help the deaf child’s learning and language development. The CSW often goes beyond translation to provide additional explanations so that the child knows what to do or understands what s/he is meant to learn in class. In contrast, a sign language interpreter is there to translate directly from one language to another, normally without simplifying or modifying the language in any way. With an interpreter translating exactly what is said in class by the teacher and the other pupils, the deaf child has exactly the same access to information as any other child in the classroom. Importantly, the SLI will expose your granddaughter to all the complexities of classroom language that she needs to further develop her own language and this will also help her when she comes to learning to read English. A CSW with inadequate signing skills may oversimplify classroom language which can then limit language development. A final point of difference is that a CSW typically sits alongside the deaf child in class to support them whereas the interpreter stands next to the teacher. The advantage of the interpreter being positioned next to the teacher is that a deaf child has the possibility of watching both, thereby developing speechreading skills for improved understanding of spoken English.

There certainly is research to indicate that exposure to higher levels of language leads to better language development (e.g. Wood et al 1986) and also that higher language levels are associated with better literacy levels among deaf children – this is true for deaf children who communicate using spoken language (e.g. Daneman et al, 1995; Gravenstede & Roy, 2009) and those who use sign language (e.g. Strong & Prinz, 2000). Finally, there is also research that shows that better speechreading, particularly at a young age, is an important predictor of reading in deaf children (e.g. Harris & Moreno, 2006; Kyle & Harris 2010).

I am a mother of two profoundly Deaf children who have unilateral cochlear implants and have full access to NZSL as I am an interpreter and my husband is Deaf. My daughter, who is 3, has very strong spoken language skills and reasonably good sign language skills. I see her tendency is to use spoken language more dominantly. I want to know if there is any experience and research of educating children in both languages fluently and in what ways have been successful. I often use a form of sign-supported English when reading, but lately I notice she is not watching my signing. I have switched to separating the language and only using English or only using NZSL but when I just use NZSL she complains and wants me to use spoken English. I would love to have access to any literature in this area to help me navigate and teach 2 languages to my children.

Question from E.K., New Zealand. Posted August 16, 2013.

Unfortunately, there does not appear to be any research literature about this issue. What we know from observations and teacher reports concerning students in our bilingual programs is that this situation is not at all unusual among deaf 5- and 6-year-olds with cochlear implants. At first, they seem to start using fewer signs productively themselves, and later they ask hearing and Deaf teachers to switch on their voices when communicating with them. Why? We don’t know. Our speculation is that this reflects some kind of an evolutionarily-determined drive for multimodal perception. However, we also don’t know whether this is a temporary situation or whether the children “grow out of it.” There clearly is a need to collect more observations by parents and teachers as well as to conduct systematic research on the issue which may have long-term implications for academic outcomes, social-emotional functioning, and cognitive development.

Recommended reading:

Knoors, H. & Marschark, M. (in press). Teaching deaf learners: Psychological and developmental foundations. New York: Oxford University Press.

Watson, L., Hardie, T., Archbold, S., & Wheeler, A. (2008). Parents’ views on changing  communication after cochlear implantation. Journal of Deaf Studies and Deaf Education,   13, 104-116.

My niece is 27 years old. She graduated from her high school’s deaf and hard-of-hearing program at 21. She is profoundly deaf. She learned ASL when she came to live with us at 14. Prior to learning ASL she didn’t have a language base. She would like to attend RIT’s program for the deaf but we are a concerned with the requirements. It will be very difficult for her to take the SATs. As far as we understand the SAT is required. Any advice or suggestions that could be provided would be greatly appreciated.

Question from C.P., New York. Posted August 7, 2013.

There are several degree pathways at RIT (associate, associate + bachelor, bachelor at the undergraduate level), and admission criteria varies for each of RIT’s nine colleges.  NTID Admissions looks at many variables in facilitating an admission decision (SAT/ACT test scores, high school GPA, courses taken in high school, letter of recommendation, etc.).  In the test score sense, at minimum, the average accepted student into an associate degree program has a score of 15-16 on the ACT.  We accept students with lower and higher ACT scores into some of the associate degree program choices.  This link tells you what it will take to be admitted to a program of choice at all degree pathways: http://www.ntid.rit.edu/sites/default/files/colleges_admissions_requirements.pdf.

It is recommended, given your niece’s specific circumstances, to connect with Rick Postl, admissions counselor for New York, at Rick.Postl@rit.edu to begin a dialogue of options.  Admissions counselors for other states can be found at http://www.ntid.rit.edu/admissions/counselors.

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

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

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

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

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

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

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

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

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

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

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

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

My daughter is 15 and profoundly deaf. She is not oral and has fluent and excellent sign language skills. She has a cochlear implant but it doesn’t work for her – epileptic activity has damaged the area of her brain that processes sound. She began to sign at 11 months. Her mainstream high school has an integrated deaf facility and she is doing very well at school. It has become apparent that there is an issue with reading/writing/comprehending English – I want to find out what it is and how to help to overcome it. My daughter is very keen to improve as she has academic ambitions. I have made several enquiries but have not been able to find out who to consult. The usual avenues are not set up for testing through sign language.

Question from D.N., Australia. Posted July 17, 2013.

Your email emphasizes that contrary to what parents might believe, cochlear implants are not appropriate or necessarily useful for all deaf children. Most do benefit, but outcomes are quite variable (and often unpredictable) due to the large individual differences among deaf kids. As much as we would like to think so, there are no “silver bullets” in raising and educating deaf children. However, there are a variety of alternatives that can be helpful in situations like yours. In Victoria, contact the Victorian Deaf Education Institute in Melbourne at vdei@edumail.vic.gov.au. The Student Well-Being Division has the resources and contacts to assist you. In New South Wales, contact the Royal Institute for Deaf and Blind Children online@ridbc.org.au.