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

What studies are you aware of that have followed children identified with hearing loss through newborn screening, were fitted with hearing aids or received cochlear implants, and had consistent educational interventions from early childhood on? Newborn hearing screening has not been around that long, but long enough that we are now seeing the impact early intervention and amplification can have on learning outcomes. I’ve been teaching a long time, and the educational outcomes I’ve observed of these children has been nothing short of amazing. Their performance certainly contradicts the research you cite regarding DHH students lagging behind hearing peers. Informally, I can tell you that our cochlear implant students as well as our hearing aid students who were identified early are performing so well on standardized measures that it is changing how I teach. These students no longer need individualized reading and writing instruction. Where once I was teaching literacy skills right up through high school to DHH-only students, now they don’t even need literacy support in elementary school. Students who were not amplified early still demonstrate outcomes that more closely mirror many of your research findings, and students with more than one disability area struggle more than those who only have hearing loss. But the early intervention, DHH only kids? Even the ones who were born with severe to profound hearing bilateral hearing loss are doing fantastically well academically. How much of the current research takes the early identification, early amplification, early intervention children into consideration?

Question from T.B., Minnesota. Posted May 7, 2018.
Response from Marc Marschark - NTID

You raise three very interesting points. There is no doubt that early newborn hearing screening, early family-centered intervention, early amplification (when appropriate), and ongoing support for young DHH children has led to “amazing” progress. As Marilyn Sass-Lehrer (Gallaudet University) and Greg Leigh (Renwick College/Royal Institute for Deaf and Blind Children) and I have pointed out, there is a surprising lack of long-term research on the impact of early intervention. One suspects that there are number of reasons for that gap in the literature, but a potential challenge of such research is that DHH children with more challenges (e.g., medical complications, greater hearing losses) are likely to receive more intensive early intervention compared to others who simply need it less. The extent and quality of intervention services are difficult to compare across individuals, even if they are evaluated within the same program.

More importantly, all of the factors you cite have led to well-documented advantages to achievement for young DHH children “in elementary school.” The problem is that DHH children who demonstrate age-appropriate academic abilities typically lose the support services that got them that far. In fact, neither early access to spoken language through cochlear implants nor sign language from deaf parents result in DHH learners having many of the skills and knowledge necessary for higher-level educational purposes beyond elementary school. As a result, national data (in the United States) and a variety of studies in several countries have indicated that by high school, those early advantages have largely evaporated, and DHH students with cochlear implants and those with deaf parents, on average, are no longer achieving at levels comparable to hearing peers (as they did during elementary school). The one study I know of that found high school students with cochlear implants performing at the same level as their hearing classmates involved students who had received typical support services for cochlear implant users but also benefited from sign language interpreters throughout the school years to ensure effective communication in the classroom. Recent studies involving DHH college students consistently have found no generalized advantage for either deaf children of deaf parents or cochlear implant users at that level. Such findings strongly argue for continuing support for DHH learners throughout the school years, regardless of their preferred mode of communication.

I am an itinerant TODHH. I am working to support a student who has bilateral CIs and just started using an Oral Communication Facilitator (OCF) within the last 12 months because oral language development had been a struggle. Currently, there is a struggle to find the balance of the role of the OCF with the student and multiple teachers that work with the student throughout the school day. Is there any type of document that explains the role of an OCF, and/or why a child with cochlear implants requires signing support to continue to help facilitate spoken language?

Question from J.J., Virginia. Posted December 14, 2017.

First of all, I commend the IEP team for recognizing that this student had language development delays and created a plan to remedy that delay. As we all know, plans often need adjusting as the student develops, teachers change, transition to a different building, and a host of other items arise. Multiple teachers throughout the school day can create communication challenges due to content, teaching styles, classroom settings, etc.

Oral Communication Facilitator, Language Facilitator, Communication Facilitator are all names for paraprofessionals who work with students by assisting, facilitating and guiding language and communication in the educational setting. It is the IEP team, which includes the student when appropriate, who should outline the specific roles and responsibilities of this one-on-one paraprofessional. There is no national standard on the roles and responsibilities of this paraprofessional. However, a quick search found some job descriptions.

The primary goals of this role seem to be 1) assisting communication in the classroom by expanding, coaching and prompting and 2) working to foster increased student independence.
One resource is Students with Cochlear Implants: Guidelines for Educational Program Planning, jointly developed by Laurent Clerc National Deaf Education Center and the Deaf and Hard of Hearing Program of Boston Children’s Hospital. The documents are free and located at http://www3.gallaudet.edu/clerc-center/our-resources/publications/students-with-cochlear-implants.html.

Another resource is the Instructional Communication Access Checklist, one of the documents in the Placement and Readiness Checklists (PARC) at https://www.handsandvoices.org/pdf/PARC_2011_ReadinessChecklists.pdf. This is a tool the IEP team can use to gauge how a student accesses instruction using listening and spoken language, sign language, cues, or both sign and cues and how proficient the student is using that approach. One benefit of the tool is that it can emphasize skills that the student may need to have successful learning experiences in school.

Thank you for advocating for the communication and language needs of this student.

What is the best home schooling for deaf and hard-of-hearing children?

Question from L.M., West Virginia. Posted October 27, 2017.

As far as we can tell, there is no published research on the effectiveness of homeschooling for deaf and hard-of-hearing children in any age bracket. A quick Internet search using “homeschooling deaf” yielded over a dozen hits, some of which provided extensive information that you might find helpful.

Homeschooling appears to provide a number of advantages for deaf children, particularly with regard to ensuring effective access and communication (assuming, of course, that parents have established an effective mode of communication with their deaf child). As with any homeschooling, it is important to ensure that children have access to social interactions with peers, and local chapters of Hands & Voices or the American Society for Deaf Children might be helpful in that regard, as might a school/program for deaf children if there’s one in your area.

What does research tells us about the cascading effects of unilateral hearing loss in children in the classrooms? In other words, are children more likely to be diagnosed with ADHD (correctly or incorrectly), Executive Function Disorder (correctly or incorrectly)?

Question from T.M, Washington. Posted October 25, 2017.

Unilateral hearing loss (UHL) affects approximately 3 out of 1000 school age children; the left ear is more often affected than the right, and boys are more frequently affected with unilateral hearing loss than girls. The primary functional effects of unilateral hearing loss are poor ability to localize sound (determine the direction from which a sound is coming) and significantly reduced ability to understand speech in noise. The latter, while not always obvious in the classroom, can have profound effects on academic learning and psychosocial adjustment for children.

Although it is assumed by some that unilateral hearing loss does not result in clinically or educationally significant language and learning differences, the research shows that about 15-20% of children with unilateral hearing loss experience mild speech and/or language delays before three years of age. In addition, children with unilateral hearing loss are at extremely high risk for academic and psychosocial adjustment challenges. Children with unilateral hearing loss are ten times more likely to fail a grade than their peers with typical hearing, and more than half of children with unilateral hearing loss receive academic support services.

Social-emotional difficulties are also more common in children with unilateral hearing loss than in children with typical hearing. One study found that teachers described 20% of children with unilateral hearing loss as having behavior problems; another reported that teachers were more likely to describe children with UHL as uncooperative and inattentive. Teachers in a third study described children with UHL as daydreamers who were easily distracted and had difficulties in following instructions. This is consistent with research showing that children with unilateral hearing loss may demonstrate significantly poorer attention, class participation, communication, and behavior compared to typically hearing peers. Based on a parent-teacher behavior rating scale, 42% of children with unilateral hearing loss were rated as having behavior problems that included withdrawal and aggression. And 37% of children with UHL scored below an acceptable range in the areas of interpersonal and social adjustment.

My almost 12-year-old son was born profoundly deaf and has gotten great use from his bilateral cochlear implants since he was a toddler and is completely oral. For various reasons (hearing impairment, possible mild autism) he had challenges with his language development, frustration, etc., so his exposure to academics has been minimal. We taught him to read at home and he has demonstrated the ability to learn math, language arts, etc., He gets a tiny amount of instruction for academics each week but is now absolutely ready to tackle higher level work. We are at a loss as to how to bridge the gap between his current educational level of 2nd grade or so to allow him to be more integrated into his grade level classes. We want the school district to teach a modified curriculum to him and to provide intensive remediation, especially regarding vocabulary development, etc. Our district and the co-op that provides minimal hearing itinerant support do not seemed inclined to tackle this and may not know how to do it. My son is begging to be taught and we have to figure this out. Do you have any suggestions?

Question from E.C., Illinois. Posted October 24, 2017.

In general, academics depend on a student’s linguistic and information foundational base. For example, kids who have language skills around the 7 year level will likely be able to handle academics at around a 2nd grade. Having a good language/communication skills evaluation and a good cognitive assessment can often inform the educational team (including parents) about levels of instruction that would be appropriate to challenge – yet not overwhelm – learners. If that has not yet happened, you should request it of the school/district. With regard to your son being “completely oral,” chances are that consultation from a special educator(s) experienced with students on the spectrum may have valuable suggestions for an aural/oral learner. The “hearing itinerant” teacher can be expected to have experience and skill in working with a learner who accesses language and the curriculum with cochlear implants, but may not be that experienced in working with learners who have challenges like those of ASD. Does his school team have expertise from specialists in autism? If not, check with local itinerant teachers and/or school psychologists to find someone who does and be sure to ask for appropriate services to be put into his IEP.

Some DHH students who manifest features of autism learn best through visual means – charts, schedules, diagrams, dioramas, pictures, graphs, illustrations – and through print (written words and phrases and lists). Again, an experience itinerant teacher and/or school psychologist (experienced in working with deaf children) should be able to provide guidance.

I have a 15 year-old who has unilateral hearing loss and finally has an interpreter in her classes. I’d like to address ASL communication/language goals in her IEP. What test or tests do you recommend to identify the skill level for high school students? Her goal is to be fluent in ASL. Her college goals include attending RIT or Gallaudet. Because we are in a rural area and have limited access to qualified educators, I am figuring out a lot of these things on my own, including getting my daughter ASL instruction and figuring out the way to get her an interpreter in the classroom. My next question, is where can I get ideas on secondary language goals?

Question from A.L., Midwest, USA. Posted October 24, 2017.

Gallaudet University has just came out with an ASL Assessment. You can find more information about that from the Gallaudet VL2 website. Without knowing the rationale for fluency in ASL, it is difficult to answer your question fully. Is this because she is not able to communicate effectively with spoken language or is the goal to become bilingual? Depending on the goal, the school’s responsibility to provide supports for ASL would be very different. Typically, it would not be the school’s responsibility to provide SPED supports to ensure fluency in a second language if she is progressing academically/socially using spoken language. If she has a progressive loss or cannot access instruction through spoken language, then they would have a greater amount of responsibility in providing SPED services for ASL development.

We are a small state with a generic inclusion policy for all students with a disability, which means that deaf students must attend their local school and are supported by itinerant ToD and/or interpreters. Our numbers are small and decentralised so most deaf children attend schools where they are the only deaf child. I would like to influence the Education Department policy to allow deaf children the choice of enrolling ‘out of area’ to be educated in a setting with other deaf and hard-of-hearing students, but I need some research evidence to present to the Department before they will consider this. Can anyone please help with some research supporting the need for deaf children to have access to deaf peers and role models for their linguistic, social and emotional development?

Question from M.R., Australia. Posted August 3, 2017.

As much so we talk about the importance of “supporting the need for deaf children to have access to deaf peers and role models for their linguistic, social and emotional development,” the evidence is remarkably thin. What current evidence (as opposed to testimonials) there is comes primarily from co-enrollment programs, programs that include a critical mass of deaf students in inclusive classrooms that include both a general education teacher and a teacher of the deaf. You can find a description of co-enrollment and access couple of relevant articles through the Raising and Educating Deaf Children website. Two book chapters listed below specifically emphasize the benefits of being with a critical mass of deaf peers for linguistic and social-emotional development, respectively. At this point, however, we do not yet have much evidence to indicate strong effects of co-enrollment on academic achievement. More research is definitely needed.

Further reading:

Tang, G., Lam, S. & Yiu, K.-M. (2014). Language development of severe to profoundly deaf children studying in a sign bilingual and co-enrollment environment. In M. Marschark, G. Tang, & H. Knoors (Eds.), Bilingualism and bilingual deaf education (pp. 313–341). New York, NY: Oxford University Press.

Yiu, K.-M. & Tang, G. (2014). Social integration of deaf and hard-of-hearing children in a sign bilingual and co-enrollment environment. In M. Marschark, G. Tang, & H. Knoors (Eds.), Bilingualism and bilingual deaf education (pp. 342–367). New York, NY: Oxford University Press.

I am a state-wide consultant for schools and early intervention programs. The mother of a 1st grade student called me asking for help with the school who has recommended that her child repeat 1st grade in the fall, because she “just needs one more year for things to click” (the child has cytomegalovirus). She uses an interpreter in school and has bilateral cochlear implants. She is a bilingual child, but in a mainstream class and a school thathas no deaf education specialist or anyone with experience working with this population. So their expertise is limited and their recommendations often not appropriate for educating a deaf child who is bilingual.

I am looking for research on retention and the impact this has and why this decision may or may not be the best for this child. I would love to hear from any expert who can guide me to resources I can share with the family and the school.

Question from K.L., Arkansas. Posted July 27, 2017.

There is no research to support either grade retention or “social promotion” as a beneficial intervention for students who are performing below grade or age-equivalent standards. When talking about grade retention specifically, the evidence suggests that grade retention is more detrimental than helpful to students. Students who are retained tend to have poorer self-esteem than their peers. They are also less likely to graduate from high school. This holds true for students with and without disabilities. Apparently the only study that has involved deaf students showed that if they had ever been held back a year, they performed more poorly on achievement tests in reading and mathematics in high school.

When students are retained, they often experience a short-term boost in their academic achievement (perhaps because the material is now familiar), but that boost does not maintain throughout their school years. Instead of grade retention or social promotion, the National Association of School Psychologist (NASP) recommends implementing evidence-based, culturally-responsive instructional interventions that are directly linked to the student’s needs (find their parent information document here). The invention instruction should be paired with progress monitoring in order to adjust instruction as the student’s needs change. Carefully-planned intervention instruction based on the child’s needs is a more appropriate plan of action than grade retention. NASP advises that if the team and parents decide that grade retention is appropriate, then simply repeating the grade is not enough. The student must also be provided the intervention instruction mentioned previously.

I want my daughter to go to a school with a full program for students with hearing loss. My child’s school is recommending a closer program to home that only offers ASL. My daughter had to repeat 9th grade because I believe she didn’t have the necessary accommodations. Is a school that offers ASL adequate? The other school has a team of audiologists, speech pathologists, career coaches for students with hearing loss.

Question from I.L., California. Posted July 25, 2017.

There are two aspects to your question. First, with regard to language, you do not say whether your daughter has spoken language skills or relies exclusively on sign language. If she has spoken language skills, you want a program that supports those skills (with audiologists, speech pathologists, technology, etc.) as well as any sign language skills she might have. In that case, a school that offers only ASL is not adequate. Second, any deaf or hard-of-hearing student, regardless of their preferred/stronger language modality, will benefit from career coaches and other support/advising services. Both these services and the language-related services you want for your daughter can be built into her Individualized Education Program (IEP). Recent research shows that ending interventions and support services available in elementary school can create real challenges for deaf or hard-of-hearing students if they are ended too early. Many if not most such students will need and benefit from continued support into the high school years. More services are always better then fewer services!

Have there been research studies on how best to develop early intervention supports in developing countires for young children who are deaf and their families?

Question from R.B., Somewhere USA. Posted March 16, 2017.

Not exactly. Most importantly, different countries and cultures have different needs. There is often an assumption on the part of us do-gooders that what works in Western countries is exportable. However, interventions, family support structures, and educational methods that fail to fit with the contexts into which they are being imported cannot be optimally effective, if they are effective at all. With regard to education, there is a forthcoming book from Oxford University Press on exactly this issue: Deaf Education Beyond the Western World- Context, Challenges and Prospects, but it is still close to a year from publication.

With regard to universal newborn hearing screening and early intervention, there is a book chapter that you might find informative: Leigh, G., Newall, J. P., & Newall, A. T. (2010). Newborn screening and earlier intervention with deaf children: Issues for the developing world. In M. Marschark & P. Spencer (Eds.), The Oxford Handbook of Deaf Studies, Language, and Education, Volume 2 (pp. 345-359). New York, NY: Oxford University Press.

“Research” into such issues would need be on a country-by-country (if not region-by-region) basis with regard to each content area of interest (e.g., early intervention, social-emotional functioning, education). You would need to search for such writings individually (by country and topic). There is unlikely to be any general research applying to developing countries that would be helpful.