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.

Social, Emotional and Behavioral Development

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.
Response from Kimberly Peters - University of Western Washington

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 son is deaf and also has autism. Is there any research related to a dual disability? The current school system in our county is trying to remove his sign interpreter and replace with someone who signs of a toddler level, he is in middle school. Any information would be helpful.

Question from J.B., Florida. Posted October 3, 2016.

The Raising and Educating Deaf Children website (www.raisingandeducatingdeafchildren.org) recently posted a series of bulletins on deaf children and autism (see the July 2016 postings). There are several that should be useful for you. In addition to the information contained in the bulletins themselves and addresses of the authors, you will find free access to research articles from Oxford University Press.

We adopted our daughter when she was seven… no one had ever noticed that she was 95% deaf in her right ear. Now, as a beautiful 14-year-old we have noticed that while she is comfortable in public in our company, she gets overwhelmed in public. While shopping, she needs to stay very close to us, because I think, she doesn’t know how to filter out the sounds that are relevant to her situation. Consequentially, she is reluctant to attend events, activities, or shopping with kids her own age. This fall, she will be attending our local high school with 3,500 other students. Are there some exercises that we can practice to help her prepare for this? We live in a rural area with little or no programs available. She also has some other learning issues.

Question from L.B., California. Posted April 10, 2015.

Your observations of your daughter are astute, and kudos for being her advocate. Single-sided deafness (one normally hearing ear and one ear with significant or total loss of hearing) results primarily in difficulty localizing sounds and hearing in noise, skills that rely heavily on two ears. Public places are typically very noisy and have poor acoustics; therefore the shopping mall, the gym, and the birthday party all may present challenges for your daughter to understand what people are saying.

Though many children with single-sided deafness develop speech and language on track, we know that they are at increased risk for academic challenges, and many, like your daughter, experience frustration and negative social consequences. Speaking openly to your daughter about her hearing loss and encouraging her to advocate for herself will be of great value to her. There are also actions you can take to ensure she receives the best medical management and social and educational outcomes. The first step is obtaining an evaluation by an otolaryngologist (Ear, Nose, and Throat doctor) and a hearing assessment from a pediatric audiologist. It’s important to receive a diagnosis and explore potential causes of the hearing loss to determine if there are any associated conditions or risk for further hearing loss. There may be medical treatment for certain kinds of hearing loss. There are also several types of hearing technology that may be recommended for children with single-sided deafness, such as a bone-anchored hearing aid (BAHA), which is surgically placed in the bone behind the ear, or a contralateral routing of signal (CROS) hearing aid in which a microphone picks up sounds from the side of the deaf ear and sends them to hearing ear.

The next step is requesting an evaluation for special education services from the school system through an Individualized Education Program (IEP). That should include not only assessments of hearing but also the impact of the hearing loss on academics and social and emotional function. This is especially important if your daughter is exhibiting learning difficulties. Whether or not she is determined to qualify for special education services, the school is required by the Individuals with Disabilities Act to provide equal access to communication for your daughter, both in the classroom and at all school events. In cases of single-sided deafness this could mean, among other things, preferential seating, captioned media, and/or the use of an FM system where the teacher or speaker uses a microphone that transmits sounds directly to an ear piece worn by the student. It is critical that your daughter’s teachers be aware of and monitor her performance in class. Request contact with the school district’s educational audiologist, who will be your daughter’s ally.

Last, but not least, your daughter may benefit from counseling. Depending on her needs, she may be better served by either an aural rehabilitationist (speech-language therapist or audiologist) or a clinical psychologist or social worker, or both. Aural rehabilitation therapy focuses on developing listening skills, communication strategies, navigating hearing assistive technology, and self-advocacy, whereas counseling focuses more on social/emotional concerns.

For more information two great links are:

My son has AIED [Autoimmune Inner Ear Disease, a syndrome involving progressive hearing loss]. He began losing his hearing a little over two years ago at the age of 10. He currently has a profound to moderate sensorineural, bilateral loss. The loss is progressive. He obviously has acquired speech and language as a hearing child. What impact am I looking for as we go forward? Prior to the loss he tested at or above for reading levels, now his reading scores are below grade level. He still makes A’s and B’s in all subjects except math. He does struggle. He attends a small public school with no deaf education resources.

Question from L.W., Missouri. Posted March 3, 2015.

With any child with hearing loss, it is important to monitor different areas of development. The first is language. Based on your description, I am assuming he is using auditory/oral skills. You have indicated that his expressive (spoken) language is on target, but it is also important to monitor his receptive language skills. With the progressive nature of his hearing loss, does he still have good access to spoken language? This may impact his overall functioning, especially in school.

I am not sure what kind (if any) of hearing technologies (hearing aids, cochlear implant, FM system, etc.) he is using, but unless he is using a signed-based language, making sure that he has good audibility is key. If audibility is a concern, providing information in a visual form may be beneficial. His educational needs should also be monitored. It sounds like he continues to do well in school and that is great! If you notice that he is starting to struggle, it is important to question why. Is he understanding what goes on in class? Could support services be provided to help him stay on target? It is important to work with his school to make sure his needs are met. I would work with them to see if he is eligible for an IEP or 504 plan (if he doesn’t already have one). Talk with his teachers, administrators, speech-language pathologists, deaf educators, etc. See if they can work to support his need for deaf education resources.

Finally, it sounds like your son may have had an stressful few years. Often overlooked, it is important to monitor the psychosocial impact of his hearing loss. Does he have a good understanding and acceptance of his hearing loss? Does he have a support system of friends, especially any with hearing loss? Feelings of isolation or questions/concerns about his hearing loss may impact his life. Working with a school psychologist may be beneficial. I hope these suggestions are helpful as you work to provide the best for your son!

We are constantly searching for appropriate assessment tools that address all the developmental areas of young children without penalizing the child because of the language acquisition differences. What do you suggest? We serve children ages 6 weeks through kindergarten with deaf, other communication disorders and hearing siblings all in the same classrooms.

Question from J.P., Oklahoma. Posted February 24, 2015.

This is a tough one, because communication delays and disorders potentially can affect all areas of development and/or give the appearance of doing so. I expected that most states would offer guidance in this respect…but have been disappointed. The New York State Department of Health does offer information ranging from dealing with the communication challenges per se to cultural issues and parent involvement in assessment. Both West Virginia’s and Minnesota’s Departments of Education offer listings of assessment tools for deaf and hard-of-hearing children that appear likely to be useful for a broad range of children.

A couple of book suggestions: In 2008, the Journal of Pediatric Psychology published a special issue on evidence-based assessment of children with various disorders. You could write to individual contributors to that issue who might seem pertinent. In the general area is Cohen and Spenciner’s Assessment of Children and Youth with Special Needs, 4th Edition. Specifically with regard to deaf and hard-of-hearing children is Edwards and Crocker’s Psychological Processes in Deaf Children with Complex Needs – An Evidence-Based Practical Guide.

I am a Teacher of the Deaf in a mainstream setting. I have a teenage student with a cochlear implant. She struggles with feelings of isolation and had a very bad experience at a school for the Deaf a few years ago. She desperately wants to have a friend that actually knows what she is going through but is unwilling to attend any Deaf teen events in the community due to the experience she had at the school for the Deaf. I believed she was bullied pretty severely for having a CI. I would love to help her find a friend that might be going through the same situation so she could videochat or even email. I am having difficulty finding other mainstreamed teens out in the world to with CIs to connect her with and wondered if you had any suggestions.

Question from E.B., New York. Posted February 16, 2015.

Some people at NTID have tried to get funding for a “video buddies” project that would allow students like yours to connect. Students who use different communication modalities, are different ages, have different interests could find friends around the country for video or text chats. Unfortunately, they have not yet found a foundation or organization willing to support the project. In the meantime, here are some possibilities:

Online forums
Hear US Teens https://www.facebook.com/hearusteenspage

There are several active cochlear implant groups on Facebook both brand-specific and general). A few are listed here:
Advanced Bionics www.hearingjourney.com
Connect to Mentor site http://apps.advancedbionics.com/CTM/US
Medel’s Patient Support Group implants@medelus.com
Cochlear Americas: http://www.cochlearcommunity.com/

A new series of captioned interviews with cochlear implant users has been posted on YouTube by an RIT student. The student hopes to educate others about cochlear implant technology and the experience of the users. he first two videos are intended to be educational and humorous.
CI Interview: Braden https://www.youtube.com/watch?v=7CFBOay2tyY
Cochlear Implant: Funny struggles https://www.youtube.com/watch?v=DujSeNPHB48

Leadership Opportunities For Teens http://www.listeningandspokenlanguage.org/LOFT/
Listening and Spoken Language Symposium http://listeningandspokenlanguage.org/
Biennial Northeast Cochlear Implant Conference http://listeningandspokenlanguage.org/

Empowering teens is also addressed with self-advocacy strategies. The document, Self-advocacy for Deaf and Hard of Hearing Students is posted at http://www.handsandvoices.org/needs/advocacy.htm.

My son is five years old. He is hearing impaired and has worn hearing aids since he was two. He is well-educated with ASL and so are we. He has the worst behavior problems at home if things don’t go his way; he starts throwing things, screaming, crying, and hitting anyone in his way. We don’t know what to do anymore. Please help.

Question from R.C., Florida. Posted November 11, 2014.

One of the first questions I would ask is regarding language. Often kids who have difficulty understanding or expressing themselves (verbally or in sign language) resort to behaviours to get their points across. Does your son have age-appropriate language acquisition? If his language is age-typical, then my next consideration is that these behaviours may be indicators of a mental health issue, and he should be assessed professionally by someone knowledgeable about deafness and mental health. Finally, it is not uncommon for children to act differently in different settings. Home is usually very unstructured compared to school and he may also be repeating the same behaviours there if he found them to be successful at home in the past (that is, getting his way). You might check with the school and see if he behaves differently there. If so, his teacher might be able to give you some advice. There may even be a school psychologist who can advise you.

Our five year old son has mild to moderate bilateral sensorineural hearing loss. He has had hearing aids since he was 2 1/2 years old. He is speaking very well due to all the support he has received from speech therapists and deaf educators over the past two years. When he was three we put him in two different half day programs for children with hearing loss. He seemed to flourish in those settings. However, he recently began Kindergarten at a school that specializes in D/HH children, but is mainly hearing students. He is one of two in his class who has hearing loss. We have begun to see behavioral issues that he did not have (or at least did not rise to this level) at his preschools. At one point he pushed a little boy and pulled his hair and spit on him. These behaviors are odd for him outside of the home. (He has a three year old brother who he sometimes hits). He has also began to act very odd when he leave certain places. For instance, last night we went to his open house at school and he was doing fine, but when we were getting ready to leave he began to lay on the ground and laugh and would not cooperate. He recently did this at a park as well. We also continue to have problems with him in the bus line, where he is hitting/pushing kids.

Since this is all new for us we are unsure what measures to take. He has a deaf educator who is in his classroom in the mornings and she has been very helpful. I should also mention that this summer we had a baby and moved to a bigger house, so he has had a lot of change. I appreciate any information that you might be able to offer.

Question from S.K., USA. Posted October 3, 2014.

I must start by saying that without spending time with your son and looking closely at everything in his life, it is impossible to explain what is happening with any level of confidence. What I can do is offer some thoughts on possible explanations given what you have described.

My first thought is that you’ve described a number of quite significant changes in his life. He is now in a different sort of school program, he has a new sibling in the family, and is living in a different house. Even with all the best preparation, that can be very hard to accept and adjust to. It also can leave a youngster feeling like life is not in his control. Some of the behaviors you’ve described seem to be connected to exerting control – pushing other kids out of his way, not transitioning out of an activity, and those sorts of things. This is one possible underlying theme.

I’m also struck by the change from being in a school program for kids with hearing loss to one where most of his peers are hearing, even though the program specializes in kids with a hearing loss. It’s wonderful that he has made such good progress with his aids and speech therapy, but it is critical to keep in mind that a youngster with a hearing loss living in a hearing environment expends a great deal of energy over the course of a day. Even the most skilled oral communicators will admit to being completely tired out at the end of the day. Constantly working to fill in the blanks in the sound stream of language can be exhausting. When children are stressed or simply very tired, their ability to cope with everyday stresses of playing with peers, learning, moving in and out of activities is diminished. While you described some problems at home, such as difficulties leaving the park, many of the issues appear to involve school in some way. This would suggest examining the challenges of the new school.

Some ways to address this include giving him as much reasonable decision making power as is possible, and giving lots of warning about transitions. If he feels many things have changed without his “input,” one way to help with that is to emphasize the things he can make decisions about, such as clothes to wear, games to play, and any of the normal choices 5-year-olds make in a day. For managing school stresses, perhaps some quiet times during the day when he need not worry about what his classmates are saying, or some structured time where the communication is adult mediated and made clear to all could be integrated.

If these issues do not resolve with reasonable understanding and support, it would be wise to involve the school counselor or school psychologist for help with further evaluation to understand more deeply what might be happening.

I’m a pediatric occupational therapist who only occasionally works with deaf children. I don’t have time (or a library) to read papers and books about deaf children. Is there something like Cliff’s Notes on deaf kids?

Question from R.P., Virginia. Posted July 16, 2014.

Yes, Virginia, there is a Santa Claus. (sorry!)

Raising and Educating Deaf Children is a new site offering objective, evidence-based information for policy-making and practice associated with raising and educating deaf children – with an eye to improving them. New eBulletins are posted quarterly; each includes sections on The Issue, What We Know, What We Don’t Know, and Implications about various topics, all written so as to be accessible to parents as well as professionals.  eBulletins include Further Readings with content offered free of charge by Oxford University Press.

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?

Question from S.K., Ohio. Posted June 17, 2014.

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.