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.

Language and Communication

My son is 11yrs old and is entering 4th grade he attends a private school that doesn’t offer any services. He was left back in kindergarten and third grade. He has moderate to severe hearing loss in both ears. He has a hearing advocate that supplies him with an fm system. However this year I was told he would have to sit in the back of the classroom because the fm system might distract the other children. I’m trying to explain to them that he needs to read the teachers lips. Is there anything I can do to help him or them to understand his hearing loss?

Question from G.B., New York. Posted August 24, 2012.
Response from Marc Marschark - NTID

First, let’s consider the most usual situation, in which your child is in a public school. Then, it is a matter that has to be taken up in an IEP meeting, to which you have a legal right. In developing a child’s IEP (Individualized Education Program) under the Individuals with Disabilities Education Act (IDEA), the IEP team must consider a child’s individual needs. Children with significant hearing losses, whether or not they utilize FM or similar assistive technologies, will benefit from being able to see the mouth of the teacher. (Hearing people as well as deaf people use “lipreading” in understanding spoken language.) This means, for example, not only sitting at or near the front of the classroom, but also ensuring that the teacher understands the needs of the child. As we have described in response to earlier questions on this site, IDEA guarantees a child with special needs a free and appropriate public education (FAPE) in the least restrictive environment. That means a public school is required to meet a child’s audiological, academic, and other needs as outlined in the IEP. If your son a public school, you could have a pediatric audiologist or speech-language therapist involved in the IEP meeting, as well as perhaps a school psychologist experienced in working with deaf children. If public schools are not open to this is part of their legal responsibility a parent can seek assistance from the state through a Due Process Complaint (in the State of New York http://www.p12.nysed.gov/specialed/publications/) or obtain legal advice.

Children who are placed in private schools by their parents receive a Services Plan, not an IEP.  Local Education Authorities (LEAs) must spend a certain amount of money to address the needs of such children. LEAs must consult with the private schools and the parents to determine what services it will provide. That’s what goes into the services plan. is no requirement for FAPE in this situation.  If the private school does not feel the consultation was sufficient it may file a complaint, but there is no right of due process for these students. (Of course, if the student is placed in the private school by the LEA, the school must follow IDEA.)

To give things an interesting twist, the Americans with Disabilities Act does apply in the case of private schools.  So, for example, if the parent wanted an FM system for their child the school would have to provide it unless it could show it was an undue burden.  The school would be required to provide effective communication under the ADA regardless of whether the child has an IEP.

Does anyone have any evidence that deaf children who have significant language delays but are otherwise able, do well by repeating a year in school and then staying with that cohort?

Question from A.W., England. Posted June 26, 2012.

General experience in many countries suggests that having children leave their cohort to catch up academically (by repeating a school year) works for some children. At least it does for those who demonstrate normal development and miss a significant amount of school time due,  for example, to the need for medical care or because the family has been abroad in a country with a school system not as well developed as the “home” one.

If the student has any disability, comes from another country, or is particularly well-established socially in their original cohort, the outcomes after being held back often are not so good. Then again,  if the parents and/or the student want it – the chances for success increase. Involuntarily holding a child back is more likely to hinder good development.

Unfortunately, there does not appear to be any research on this topic specifically with regard to deaf children and/or those with specific language delays, but there certainly needs to be! So, in Scandinavia, at least, I would only recommend repeating  agree if the student appears to have a documented, fair chance to catch up.

My 17 month old daughter will be having her second CI soon. Her therapist recommends that she only listen and NOT sign or use hervision. I want her to know how to sign as well as use her CI. I am trying to teach her as I learn. I have bought several books but i feel like I should learn from a person not a book/ dvd but I’m having trouble finding someone to teach me in my area. Do you know of anyone in my area that teaches sign language?

Question from C.W., Georgia. Posted June 22, 2012.

Specifically for your area, West Georgia College is likely a good place to find continuing education courses, including American Sign Language. More centrally, however, if your daughter is 17 months old, she should be in the Georgia PINES project (parent infant network). The PINES teacher would be able to help you both her learn signs. If she is not already in PINES, you can get more information at http://www.gapines.info/whatmodels.htm.  PINES also offers a deaf mentor project so you should have the opportunity to work with and learn from a deaf mentor.

I had an audiologist tell me that 99% of the time when you add sign support to an implanted student the language level/development drops. I respectfully disagreed – Your thoughts?

Question from R.S., California. Posted May 17, 2012.

Thoughts aside, there is no published evidence we know of to indicate that this is the case. You might recommend the following to the audiologist: Spencer, L. J., Gantz, B. J. & Knutson, J. F. (2004). Outcomes and achievement of students who grew up with access to cochlear implants. Laryngoscope, 114, 1576 –1581. They found that high school students with implants who also had sign language interpreters in the classroom were performing at a level comparable to their hearing peers, a result normally not obtained with longer-term use of implants by students without sign language support.

My almost 3-year-old daughter has a moderate to almost severe hearing loss in both ears (55-65 db). She uses ASL and also speaks while signing though her signing is more developed. She wears two hearing aids, since she was 1 year old. We use ASL at home (I am deaf myself) and also speak, at the same time. She is receiving services at a regional program and attends school a few times a month with other deaf children. This will soon increase to 2 mornings a week when she turns 3. We decided to add another school/Childcare, 2 mornings a week, that has all hearing students and the staff all knows a few signs while one staff knows more ASL though not fluent. That one staff isn’t always present. My concern is this: I believe she would benefit from more sign support either through an interpreter or a family friend (due to cost) to help serve as a bridge. She sometimes appears lost while looking around the classroom. She has had a difficult adjustment period though they have recently added more sign information and that has helped. Her regional teacher feels this school provides more auditory development for her, to hear and speak. There is a concern she may cling to whoever signs and not socialize much. I question whether anyone truly understands how much she catches with her aids. I wonder if it is best to provide extra sign support in the beginning and then taper off as needed when her abilities are clearly known. People have said she is only at the “other” school about 7 hours each week and all other times, she gets ASL. Will providing more sign support in this environment hinder her hearing / speaking abilities later?

Question from T.K., Oregon. Posted May 3, 2012.

The short answer to your question about whether or not sign language support will interfere with eventual spoken language development is an unqualified – NO.  There is no evidence that signing interferes with speech if speech is feasible for a child and supported by her auditory and oral-motor abilities.  How lucky for your daughter that she has fluent adult models for both ASL and English at home – and at the same time no less! The bigger issue seems to be what kinds of information your child has access to in the preschool class where less signing is available from the adults and virtually no signing is available from the children. Given your comment about her “difficult adjustment,” your child may benefit from more “scaffolding” for both social interaction and vocabulary learning in the new preschool setting. Providing more help in the beginning meets her immediate needs – always a good idea in the long run.  It would be unwise to suppose that she is able to function in one modality – hearing, at one school and another modality – vision, in the other.  Though she will almost certainly acquire two languages, she is one child with a singular need for optimal, that is to say dual, inputs in every linguistic encounted.

Satisfying social interaction is the most natural and powerful motivation for language learning.  If socializing is a goal – and it should be at age 3, then having supportive adults to help navigate interactions with age peers is a good idea. This help could come from an interpreter or family friend as you suggest, if their role is clearly defined and reinforced by the other adults in the classroom.  If learning language through listening and auditory skills are a goal, but the context is a preschool with hearing children who cannot sign, some kind of adult mediation is certainly warranted. Though always a risk when using interpreters, the signing adult need not be the sole source of either auditory or signed language input.  Perhaps activities could be devised wherein the signing adult teaches a hearing age peer to be a partner in listening games. Similarly, the signing adults could serve as on-the-spot tutors for the hearing children to learn signs for key words that support spoken language vocabulary in the course of play-based interactions.

That your child is looking around confused, though distressing emotionally, is a good indicator that she knows that she does not know, and she is looking for a way in – an access modality. This sensitivity to needing language input is hard to teach, but something that her teachers can exploit every day.  Given that the limits of her auditory-only reception are uncertain for now, and that she is looking for input on the hands, she should be given routine access to concurrent, or at the very least sequential, signed and spoken English whenever ASL is not being used. Routine access means that the speech she cannot perceive is supported by signs on the spot and the signs she knows are associated with spoken English words that will eventually become the basis of her ability to develop text literacy i.e., reading and writing.


My daughter has a moderate/severe hearing loss. In school, she has a micro link FM system and a school aide. She has an IEP for this and recently was evaluated by a psychologist experienced with deaf and hard-of-hearing students who stated she would benefit from an oral interpreter. If I tell the school that I want an oral interpreter rather than the aide, do they have to honor this?

Question from R.S., Pennsylvania. Posted April 24, 2012.

It is very good news that your child was evaluated by a psychologist with experience with deaf and hard-of-hearing kids.  So often that does not happen!  So that is a good start.

With regard to your question, there are four steps in  IEP development:

1.  Evaluation of the child and identification of needs

2.  Development of annual goals to support the child in accessing and making progress in the general education curriculum

3.  Determination of services needed to achieve those goals

4.  Determination of placement.

When the psychologist says s/he believes the child would benefit from an oral interpreter, I take that to mean s/he is recommending this service under Step 3.  Each step builds on the one above.  IDEA requires that states “establish and maintain qualifications to ensure that personnel necessary to carry out [IDEA] are adequately prepared and trained . . .”  So if the child needs a services to access to communication in the classroom that service must be provided by someone who is adequately prepared and trained – for example a trained and qualified oral interpreter – not an aide.

I would recommend that you first find out what the school sees as the purpose of the aide.  To facilitate communication?  To serve as a tutor?  To make sure the child doesn’t wander off?  The role of each service provider should be made clear, and services should link to the child’s annual goals and access to the general education curriculum.  It is possible the aide serves some stated and needed role, but perhaps not.  An untrained aide cannot fill the role of an oral interpreter.

Bottom line – if an oral interpreter is necessary to assist the child in meeting her IEP goals, a qualified interpreter must be provided.  Based on the information provided, I would recommend that you ask for an IEP meeting and request that this service be listed on the IEP.  If it is on the IEP it must be provided (as you point out!).  If other members of the IEP team refuse to include it, they must provide the reasons why through a document called prior written notice http://idea.ed.gov/download/modelform2_Prior_Written_Notice.pdf.  If you are  not satisfied with the outcome, you may wish to exercise your due process rights at a higher level.

How is it that deaf and blind children learn to physologically communicate? In other words, how does one part of the brain compensate for another in the deaf and blind?

Question from S.M., North Carolina. Posted April 24, 2012.

The best answer to the question comes from Dr. Jude Nicholas of the Resource Center for the Deafblind and Haukeland University Hospital, Bergen, Norway. Dr. Nicholas has an excellent article on the Deafblind International Website  http://www.deafblindinternational.org/PDF/Active%20Touch%20Article.pdf

In short, the answer involves  the sense of touch ,including tactile sensation, tactile perception, and tactile cognition. Studies have demonstrated that individuals who are deafblind are more experienced in recognizing stimuli through active touch than are sighted-hearing individuals. This then leads to superior performance on tasks involving the tactile cognition tasks of tactile working memory and tactile memory. Individuals who are deafblind encode tactile spatial information more efficiently than do individuals who are sighted and hearing. Increased tactual experiences thus enables neuroplasticity or the reorganization of the nervous system.

I have a kindergarten who is in a mainstream school. We are currently getting a TOD for a hour a day, interpreter all day ans speech 3 days a week. She is testing above all of her hearing peers and are hopes are to keep it that way. We are currently using total communication and just recently had another hearing test. During this test the audiologist worked on her repeating her words which she is only getting 30% accurate. So are there any studies or research that say how we can help her. To us we know that she is using all of her skills and we are extremely proud of her.

Question from G.R., New Jersey. Posted April 6, 2012.

From your question, I am not sure what type (if any) listening device your child is using.  Hearing aids?  Cochlear Implant?  The other question I have is when was her hearing loss first suspected and/or confirmed.  The exciting things are that she is performing as well as (and it looks like even better than) her peers.  This index should bring you comfort that you are on the right path.  I am reading between the lines a bit, but your information that she is repeating words at 30% accuracy indicates that she working hard to derive information from the listening-only condition.  Again, I am assuming that the 30% number is representing that the test condition is “listening only.”  I wonder how she does with “auditory- plus vision” condition, that is, does her score improve when she can listen and speech-read?  If she has 50% accuracy when she is able to speech-read, we can assume she is using both vision and audition to understand speech that is spoken.  Without more information it is hard to give advice, but here is what I know.  We have research that indicates that there is a relationship between how well a deaf child uses sound cues and their eventual speech and reading scores.  Having said that, in looking at one study, I can tell you that for 72 children who had four years of Cochlear Implant listening experience, guess what their average score on a word repetition task was?  35%.  This tells us that your daughter is within the average range of deaf children for listening. My advice would be to target her ability to increase her word discrimination skills.  Work on her ability to listen to and identify a closed set of words (vocabulary lists from her school units).  Play listening games where you pronounce a word from a list and have her guess which word you said.  Do this  where she first watches you say the word, then when she is pretty accurate, stand behind her so she cannot see you and see if can understand the word.  Another task is to have her tell you if two words “sound alike”.  Let her watch you as you say two words that either rhyme (pick, kick)  or do not rhyme (walk, doctor).  When she is accurate at this task you can again make it harder by standing behind her as you pronounce the words.  As her listening skills improve, you can then have her listen to a word and repeat it.  Say “pink”  when she is accurate with that do a “switch up” Now say “pink” without the /p/ sound  (target:  ink).  These types of listening practice games will increase her phoneme (individual sound) awareness and ultimately yield a payoff for developing reading skills.

What are the language issues in deaf schoolchildren?

Question from K.M., Uganda. Posted March 19, 2012.

The biggest issue is that the majority of deaf children arrive in school lacking fluency in language (regardless of its modality). Parents, teachers, and other professionals also frequently do not realize that while spoken language and sign language might both be appropriate for educational purposes, they are not equivalent. Growing up with one or the other likely will be associated with educationally-relevant cognitive differences. Beyond these general points, there are so many issues associated with the lack of language fluency, literacy, and so on, that I need to refer you to other sources. Please be sure to look at one that does not have an inherent bias toward one language modality or the other such as Raising and Educating a Deaf Child (Marschark, M., 2007, Oxford University Press).

What is the difference between a sign skills coach and an interpreter?

Question from A.M., New York. Posted March 16, 2012.

The position of “Signing Skills Coach” originated from the one-on-one position referred to as a Skills Coach. A skills coach is an individual who works along side of a student/client and assists with the learning of a task/job.  For example, a skills coach might work with a developmentally disabled individual to learn the job of a dish washer.   A “Signing Skills Coach” is an individual who knows sign language and functions as  a skills coach with a student/client who is deaf, hard-of-hearing or in some circumstances hearing but can benefit from sign (e.g., some individuals with autism, Downs Syndrome, etc.).  The requirements are that the coach have intermediate to advanced signing skills and basic skills in consecutive interpreting.

A sign language interpreter is fluent in ASL (or other natural sign language) and all forms of signed English (or other spoken language). An interpreter would work between the hearing and deaf person but not teach the deaf person a skill.  Interpreters can work consecutively but tend to work simultaneously.