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.

Early Intervention and Preschool

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.

My son was implanted at 2 years of age with a CI. He is now 3 years old. He was diagnosed with Auditory Neuropathy Spectrum Disorder and he is severely to profoundly deaf. They describe his disorder like a static radio most of the time it’s static but every once in a while he hears something but not enough to form speech or understand what a sound is. The CI was not a guarantee that it would work, but as my husband and I are both hearing and no one else in the family with hearing loss we figured we should give it a try. We have also been signing with him since he was 15 months old. Our son is now in school, and at his last IEP meeting we were told that they probably don’t have the funds for an interpreter or enough children to start a deaf class. I don’t know how to get my son the education he needs! I just don’t think it’s fair. He is very smart, very visual, and has an amazing memory. What can I do and how can I fight for my son’s education??

Question from C.D., Florida. Posted July 26, 2016.

You indicate that your son has auditory neuropathy and received a cochlear implant at age two. Some children with auditory neuropathy will benefit from cochlear implants, but most will need sign language for the very reason you described—auditory neuropathy produces static rather than a clear auditory signal, making it very difficult or impossible to access spoken language auditorily, even with a CI. It sounds like you have been doing everything right for your son by providing sign language since he was 15 months old.

I was sorry to hear that the school’s IEP team decided not to provide sign language for your son. Your son is entitled to a free appropriate public education (FAPE) under the Individuals with Disabilities Education Act (IDEA)—the federal law which governs every public school district in the U.S. For deaf students, the IDEA specifically states that communication needs, including the need for sign language, must be considered by the IEP team when making educational placement and services decisions. Furthermore, an IEP team may not use “lack of funds” as a reason not to provide interpreting or any other special services required for him to obtain FAPE.

The IDEA grants parents of children with documented special needs, including deafness, the right to appeal an IEP team decision. Every IEP team must, by law, provide parents with written procedures for appealing an IEP team decision. You should request the written procedures from your school district immediately and file an appeal according to the procedures described in that document.

In my experience, school districts often do not understand the communication needs of deaf children. However, you can and should advocate for your son through well-established legal procedures. In so doing, you will also be educating the school district – paving the way for future families with deafness—as well as for your son. I encourage you to be confident and persistent, because your son has the right to a free appropriate educational program, which in his case should include sign language.

I am a hearing, fluent ASL signer who is considering adopting a deaf child from a developing country. I have very limited information about his health history or hearing beyond the fact that the child “does not hear or speak at all.” The child’s estimated birth date is March 2012 and he has been living in an orphanage since being abandoned by his birth family for a couple(?) years. He is reported to imitate other children well and generally be content and happy. There does not seem to be any exposure to signed language and I assume zero early intervention or auditory assessments made. I am very aware of the importance of early language exposure. I can provide a signing environment probably from age 4.5 onward. I am wondering if you would see any benefit to his overall cognitive, social-emotional and academic development in also pursing a CI? Is it possible for a child to “catch up” from such a late start? I know that amongst older Deaf people this situation of coming to language late is not as unusual as it is today. My hope for my child would be that they would be able to become a critical thinker, I don’t place as much value on speech skills as I do on the possible boost to English literacy that might come from auditory input a CI could provide. I am an interpreter and I am trained as an elementary school teacher (though I don’t teach deaf kids) .

Question from C.H., British Columbia. Posted February 18, 2016.

The benefits that you seek from a CI are not usually achieved by children whose families have not invested significant resources into auditory-based instruction (speech perception and production) from the time of implant, throughout the school years. That investment entails placing a high value on acquiring spoken language and being willing and able to commit time and energy toward the process. On the flip side, however, there is no guarantee that investing a high level of desire and effort will have the payoff that you wish for your child.

Your child’s auditory brain areas will not be fully mature until his early teens. It remains open to learning, even learning language, although those areas may be allocated to visual processing without acoustic stimulation prior to about age 7. So, you are working with a long list of unknowns, inevitable in the situation of adoption, especially when a child is born in a developing country. For example, you believe your child to be deaf. It may very well be true that your child is deaf; or maybe not. Even a moderate conductive hearing loss could account for apparent lack of hearing (thereby, ruling out a CI); or there may be an anatomical abnormality of the outer or middle ear, possibly reversible; or auditory neuropathy affecting neural transmission of sound to the brain. Or something else.

Among the unknowns is the child’s experience in utero and during birth; his early nutrition, diseases, and accidents; his genetic makeup; and whether he met nonverbal developmental milestones. There is no information about his speech motor skills. It would be informative to learn whether he attempts to communicate his needs (grunt, point, gesture, pull an adult to a relevant place). While he is said to be content and happy and imitates other children, does he engage in play with others? Does he recognize and comprehend symbols (for example, match pictures to objects)?

A CI is not a magic bullet. At the outset, with an uncertain history like your child’s, even CI candidacy may be difficult to ascertain. Following audiologic and development assessments, there is a requisite trial with a well-fit hearing aid. If a CI is obtained, benefit will be measured in small steps, focusing on gradual growth: whether the child accepts the new input, shows increased environmental sound awareness, turns to familiar voices, demonstrates changes in vocalizations. Many small steps precede the desired big gains. Catch-up, were it achievable, is very unlikely to be demonstrable early on. Your plan is to provide a signing environment, and speech appears to be of indeterminate value. Without a plan to provide consistent auditory (spoken) stimulation at home and at school, the CI will be significantly hampered in the facilitation of spoken language learning and positive effects on literacy and academic performance. Parents who consider a CI for their children often do so with the intention to get the most out of the tool. They speak to their child. They provide instruction that will help the child to speak. They stay the course through the school years.

Importantly, handle the transition from orphanage to home, first and foremost. Take time to tend to the emotional attachments with your child as much as you focus deliberately on his cognitive and academic development. Your child should feel safe and loved, without pressure to perform, as you establish communication through your relationship. Gently, consistently, reward all efforts to communicate. Initial stimulation should not be overwhelming. Your commitment to parenting will support your child’s learning. Be prepared to begin at the beginning, as if welcoming a new baby, with silly songs and first picture books.

Then, find the best pediatric audiologist in your region and make an appointment for a complete audiologic assessment. Follow up on all recommendations without delay. Filling in the unknowns will confirm your thinking one way or the other regarding speech and move you from a hypothetical answer to a personalized response on CI candidacy and estimates of CI benefit. If you choose a CI or a hearing aid, ensure consistent use and daily wear time. Minimize background noise in the house and at school. Focus the child on listening. Model spoken language and emphasize sound before vision. Use “listen cues” and wait time to establish listening attention. Then be expectant. And be patient. Keep in mind that hearing age will be more relevant than chronologic age.

I work as a teaching assistant in a primary school and work one to one with a deaf child aged 4. The main educational focus for this child is to develop their understanding and ability to use sign language however I’m not sure which way would be the best way to teach this?

I am able to use a basic level of sign language. The student has picked up some signs on their own like drink, toilet and food; however, this is a very slow process, does anyone have any tips?

Question from L.A., England. Posted December 23, 2014.

Your question which is massively important for the pupil with whom you are working. You clearly recognise that the situation you describe is not working, and you are absolutely right to voice your concern.

For this or any child to acquire a language, accessible, fluent language models are necessary, and consistent use is essential. That means that if sign language is the goal, the child will need to be surrounded by fluent and consistent language at school and at home. This may be a huge challenge for the whole family, but it’s an essential ingredient to long-term success. It would be helpful to have them look into NDCS family sign language curriculum.

It would appear from the description of your situation that both you and this child are being put in an untenable position. It is unreasonable for you to be given the responsibility to teach the child sign language: a highly-skilled sign language user trained to work with young children in an educational setting, ideally a native signer, is needed for the child’s future language, cognitive, and social-emotional development. With only a handful or words/signs at the age of four there should be a clear, focussed and frequently monitored language development programme in place for this pupil. If the child already has had extensive exposure to sign language, it also might be worthwhile requesting a cognitive evaluation just in case there are other factors at play.

The circumstances will of course be more complicated than you are able to express in a few short sentences, and it is important, therefore, that a much more detailed and extensive review of the situation is undertaken. In the first instance, you need to discuss this with the class teacher, SENCo and teacher of the deaf as soon as possible.

I have a seven month old daughter just diagnosed with profound hearing loss. What are the main things I should be doing with her immediately (apart from starting sign language, which we did before she was officially diagnosed) to promote her language and literacy acquisition down the track?

Question from M.W., Switzerland. Posted November 16, 2014.

You are already doing the most important thing: asking questions. Next, but not unrelated, you should look into family-centered early intervention programs. Descriptions of these, the issues you need to be aware of, and the questions you should be asking can be found in two articles recently published and available from the Journal of Deaf Studies and Deaf Education. Click on “Read Highlighted Articles for FREE.”

Meanwhile, enjoy your daughter and engage in as much communication as possible by talking to her, signing to her, and through touch. Just remember to get her (visual) attention before communicating. You will do great!

Is there research to support why an additional year of preschool is considered appropriate for a child who is deaf and uses cochlear implants to develop language skills rather than moving on to kindergarten placement?

Question from A.H., Virginia. Posted March 4, 2014.

There does not appear to be any literature on this nor any general conclusions about what is or is not appropriate. It would definitely depend on the individual child and a full assessment of that child’s abilities.

Is there any research available which supports the decision to send hard-of-hearing children to preschool early? We have families sending their children to school during the spring semester (age 2 turning 3), as opposed to waiting for fall enrollment following the 3rd birthday.

Question from S.R., Iowa. Posted December 27, 2013.

I am not aware of any research that supports (or recommends delaying) the decision to send hard-of-hearing children to preschool when they initially turn 3 as opposed to waiting until the fall enrollment following their 3rd birthday.  Children eligible for special educational programming may transition to preschool when they are three years old.  The value of preschool education (e.g., child-centered programming that is center-based) for children who are hard of hearing varies child to child and depends upon many factors such as: 1) individual characteristics and needs of the child, 2) quality of the child’s home and/or other environments to promote language learning and overall development, and 3) quality of the preschool program. Programming may be full time or part-time and may be fully child-centered or include a family-child component. Family involvement in the transition from early intervention to preschool and the determination of services needed to support their child’s development is essential.

It is well-established that early identification and intervention (e.g., specialized support and collaborative family-centered services well-before one year of age) improve the overall outcomes for children who are deaf or hard of hearing.  The Joint Committee on Infant Hearing Position Statement of 2007 recommends that all children who are deaf or hard of hearing with permanent congenital bilateral or unilateral hearing loss, including those with permanent conductive or neural hearing conditions, receive early intervention programming. The Position Statement emphasizes that children with all types and ranges of hearing differences are at increased risk for delays in multiple areas of development.  Outcomes gained as a result of early intervention may be lost in subsequent years without continued and appropriate services.

Children who are hard of hearing are dependent upon the quality of the auditory environment for language development because they are likely to rely primarily on listening and speaking for communication.  Studies point to the importance of the quantity and quality of the language in the child’s environment as well as the child’s opportunities to engage in conversations as factors that influence language development.  There is evidence that suggests that children who are hard of hearing require even more exposure to language than children who are hearing to attain the same outcomes as their hearing peers. Quantity and quality of language input varies according to the adults with whom the child interacts on a daily basis. While some parents and caregivers provide rich, age-appropriate and meaningful language exposure others do not. Another variable is auditory access.  In order to obtain maximum benefit from the auditory input, the child’s hearing technology must provide good quality access to language, must be monitored to assure that it is functioning as designed, and must be used consistently.  The listening environment must also be conducive to maximize auditory access.

Both deaf and hard-of-hearing children benefit from a preschool program that includes professionals with the knowledge and skills to support specialized early learning opportunities and who attend to the individual needs of the child and the quality of the language environment.  Some children who have just turned three years old and are hard of hearing may do well at home or in another environment with consultative services from specialists who can provide family members and other caregivers with support to ensure that the language-learning environment is appropriate and accessible to the child.  Other children will be better off in a well-designed program with educators and other professionals with specialized skills. The measure of effectiveness of any learning environment, i.e., home, childcare program or preschool program, is child outcomes. Children who are hard of hearing should demonstrate the same outcomes as their normally hearing peers.  Monitoring of the child’s progress using appropriate and comprehensive measures should determine the effectiveness of the child’s learning environment and identify any additional supportive services needed.

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.

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.

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.

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.