DR. MUNIR AHMED

2. (RE) HABILITATION OF THE DEAF AND HARD OF HEARING(DHH) CHILDREN TO MEET THE MDGs - MAINSTREAMING DISABILITY DR. MUNIR AHMED

3. MAINSTREAMING OF DHH • A DHH child, who possess spoken language can Integrate effectively in our society, because our society communicates with spoken language • Acquisition of spoken language enables a deaf to become independent, participating and contributing member of our society • Advancement of electro-acoustic technology and auditory-verbal treatment plan can help the deaf to acquire spoken language • We all should join hand to prepare the Deaf for Inclusive Education in pre school age because critical age for language development is 0-3 years • Delayed detection of hearing loss is a worldwide problem. • To address this problem Joint Committee of Infant Hearing(JCIH) has issued position statements in 1998,2002 and 2007

4. THE POSITION STATEMENT The JCIH endorses early detection and intervention for infants with hearing loss • The goal of early detection of hearing loss and intervention is: • to maximize linguistic competence and literacy development for children who are deaf or hard of hearing • Without intervention, these children will fall behind their hearing peers; • in communication, cognition, reading, and social emotional development. Such delays may result in lower educational and employment levels in adulthood • To maximize the outcome for infants who are deaf or hard of hearing, • the hearing of all infants should be screened not later than one month of age • Those not passing screening should have a comprehensive audiologic evaluation not later than three months of age. • Infants with confirmed hearing loss should receive appropriate intervention • not later than6 months of age from professionals with expertise in deafness in infants and young children.

5. PROPOSED SCREENING PROTOCOL All infants who are at risk for hearing loss are to be screen out. A two stage screening process should be adopted: - Automated ABR for the initial screening. Failing should re screened using ABR. - Those passing ABR should return for re screen at the ages between 3-6 months Babies failing in ABR should be referred for complete audiologic evaluation to: - Determine the type and severity of the impairment; - Initiate a remedial program for the infants and family.

6. PROTOCOL FOR HEARING EVALUATION Regardless of age Case history /parents observation report Otoscopic inspection Tympanometry and Acoustic reflex 0-6 Months Auditory Brainstem Response (ABR) Caution: ABR should not stand alone for diagnostic purpose. Lack of response does not necessarily indicate an absent of useable hearing. Amplification and auditory learning are recommended as first option unless CT scan or MRI confirm absence of cochlea. 2. Behavioural testing, amplification and therapy

7. Contd-- 6 months - 30 months Behavioural Observation, Visual Reinforcement Audiometry Evaluation of auditory skills development. 30 months and above Conditioned play Audiometry 2. Speech Awareness Threshold 3. Pure Tone Audiometry

8. PRACTICE OF AUDITORY-VERBAL APPROACH • After fitting of appropriate Hearing aids, listening should be developed through Auditory-verbal approach • Auditory-verbal approach is a family centred approach, its success is hidden under the coaching of the family members, because • We need to develop a software of language among deaf with full participation of family, as nature develops this software among normal children within first five years of life, Which enable them to learn 28 words a day, when he celebrates his 5th birth day • Without this system a deaf cannot move even with hearing age; and we require that he catches his true age regarding language • Teaching words with visual clue are not appropriate for Language Development • One cannot teach 28 words a day without system and a normal child get this system in place within 5 years of age

9. Contd--- • This is the critical time for those who learnt words with Speech Reading. How one can expect that these words would continuously help them in school • One cannot push words into child’s vocabulary ,Software will help him to pull words from running speech, because • Learned language enables them to pull words from it when words are spoken • Child needs to be spoken at the level of language he understands and at slightly higher so he struggle to grow • They should have to break the code and must not longer depend on single words or simple sentences • Don’t think; Leaning words are not important, off course the enhancement of vocabulary is essential, but • one have to immerse the child in a language rich environment just at and just ahead but within reach of their own language abilities

10. PRINCIPLES AUDITORY-VERBAL APPROACH • An Auditory-verbal Therapist teaches children with hearing loss to listen and talk exclusively through listening and spoken language instruction. • Promote early diagnosis of hearing loss in infants, toddlers, and young children, followed by immediate audiologic assessment and use of appropriate state of the art hearing technology to ensure maximum benefits of auditory stimulation. • Promote immediate audiologic management and development of listening and spoken language for children as their primary mode of communication. • Create and maintain acoustically controlled environments that support listening and talking for the acquisition of spoken language throughout the child's daily activities. • Guide and coach parents to become effective facilitators of their child’s listening and spoken language development in all aspects of the child's life.

11. Contd-- • Provide effective teaching with families and children in settings such as homes, classrooms, therapy rooms, hospitals, or clinics. • Provide focused and individualized instruction to the child through lesson plans and classroom activities while maximizing listening and spoken language. • Collaborate with parents and professionals to develop goals, objectives, and strategies for achieving the natural developmental patterns of audition, speech, language, cognition, and communication. • Promote each child's ability to self-monitor spoken language through listening. • Use diagnostic assessments to develop individualized objectives, to monitor progress, and to evaluate the effectiveness of the teaching activities. • Promote education in regular classrooms with peers who have typical hearing, as early as possible, when the child has the skills to do so successfully.

12. ROLE OF THE AUDIOLOGIST AND SPEECH LANGUAGE PATHOLOGIST WITH DHH CHILDREN • In our country the role of the AVT is played by Audiologists and Speech language pathologists • They with full participation of parents should keep listening and language system intact by 1. Excellent management of child’s hearing loss • Frequent evaluation of auditory status • Keeping an eye on procedures adopted to catch true age • Provision of an environment full of rich meaningful and reward able language experience • To keep well versed with the above 1-4 evaluation and intervention procedures • Our audiologists and speech language pathologists must equip with knowledge and skill to practice paediatric audiology and auditory-verbal strategies who desire to work with DHH children • So our Hearing aids/cochlear implant users can get maximum benefits from these devices and can be mainstreamed to meet the MDGs- Mainstreaming disabilities

13. RECOMMENDATIONS • Establishment of full fledged Audiological and auditory (re) habilitation units in hospitals • Hearing screening should be carried out of every child who is at risk for deafness • Inclusion of pediatric audiology and auditory-verbal therapy courses in audiology, speech language pathology and teacher for the deaf programs • Provision of hearing aids and intervention through intensive auditory-verbal therapy at an early age on the recommendations of professionals • If residual hearing cannot be utilized with intensive auditory training then provision of cochlear implant on the recommendations of Audiologist and speech language pathologists

14. THANKYOU