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Children Who Are Deaf or Hard of Hearing

Chapter 10. Children Who Are Deaf or Hard of Hearing. Historical Overview. Samuel Heinicke Abbe de l’Epree Thomas Gallaudet Alexander Graham Bell Bob Holcomb American Sign Language (ASL).

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Children Who Are Deaf or Hard of Hearing

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  1. Chapter 10 Children Who Are Deaf or Hard of Hearing

  2. Historical Overview • Samuel Heinicke • Abbe de l’Epree • Thomas Gallaudet • Alexander Graham Bell • Bob Holcomb • American Sign Language (ASL)

  3. Hearing losses are defined in terms of (1) the degree of loss, (2) the age at which the loss occurs, and (3) the type of loss. The terms used with hearing loss are deafness—a hearing impairment that is severe enough that the child cannot process linguistic information through hearing, even when using amplification or hearing aids, and adversely affects the child’s educational performance (Council for Exceptional Children, 2006); Definitions

  4. Definitions • Hard of hearing—meaning all other categories of loss, and a loss of 27 to 70 dB (see Table 10.1) and central auditory processing disorders. • Central auditory processing disorder (CAPD is an auditory processing disorder characterized by difficulties with sound localization; auditory discrimination; understanding speech sounds against a noisy background; auditory sequencing, memory, and pattern recognition; sounding out words; and reading comprehension.

  5. The following chart shows the degree of impairment and the corresponding description. The loss is measured in decibels (dB), which is the intensity—power or pressure—of the sound. The frequency of the sound is the pitch and is measured in hertz (Hz). The human ear hears 16 Hz to 16,000 Hz and speech sounds are from 250 Hz to 4,000 Hz. See Table 10.1 in the text for more descriptions, causes, and sounds heard at different degrees of hearing loss.

  6. Degree of Impairment Description Up to 15 dB Normal 15-20 dB Slight 20-40 dB Mild 40-60 dB Moderate 60-80 dB Severe 81+ dB Profound Degree of Hearing Loss Note: Decibel loss refers to results from the better unaided ear averaged across the speech frequencies, source www.asha.org (February, 2008)

  7. Speech reception for children with varying degrees of hearing loss Profound loss: would hear nothing, not even that someone was talking. Severe loss (Volume would be as faint as a whisper): ---ee --i-- -i--, --ee –ow –ey -u-! Moderate loss (Volume would be faint but not as soft as a whisper) : ---ee --i-- mi--, --ee –ow –ey ru-! Marginal loss (Volume would be diminished more than with a severe cold) : ---ee bli-- mi--, --ee –ow –ey run! Mild loss(Volume is slightly diminished): --ree blin- mi--, --ee –ow they run! Normal hearing: Three blind mice, see how they run!

  8. The outer ear is comprised of the pinna, the temporal bone, and the auditory canal, or external auditory meatus. • The middle ear is composed of the tympanic membrane, or eardrum, and the three ear bones: the malleus, the incus, and the stapes. The stapes lies next to the oval window, called the gateway to the inner ear. • The inner ear contains the cochlea and the vestibular apparatus and the cochear, or auditory, nerve. Problems with hearing can be due to either the structure or function of the ear. http://www.ehow.com/video_4399799_parts-auditory-system.html

  9. Figure 10.2: Ear (Anatomy) From Freberg, L., (2006). Discovering biological psychology. 192. Used by permission of Houghton Miffl in Harcourt Publishing Company.

  10. Categories of Hearing Loss • Hearing losses can be classified into four categories: conductive losses, sensorineural losses, mixed losses, and central auditory processing losses. The first three types of hearing loss are considered to be due to problems with auditory acuity, or the ability to take in sounds and get these to the brain successfully. The fourth type of hearing loss is an auditory processing difficulty, which means that the individual can “hear” the sounds, but has problems understanding them

  11. A conductive hearing loss, usually within the 60- to 70-dB range, occurs when the intensity of sound reaching the inner ear is reduced and the sound does not fully reach the auditory nerve. These types of losses can be reduced through amplification, medical treatment, or surgery. • Sensorineural hearing losses are caused by defects within the inner ear. Hearing loss can result from problems in the outer ear as well as the inner ear. This condition is referred to as a mixed hearing loss.

  12. Central auditory processing losses are usually associated with problems or changes in reception within the brain. These individuals may have difficulties with sound localization; auditory discrimination; understanding speech sounds against a noisy background; auditory sequencing, memory, and pattern recognition; sounding out words; and reading comprehension (ASHA, 2005; Salvia et al., 2007). (Please see Table 10.1.)

  13. Hearing Loss • Conductive Losses • Sensorineural Losses • Mixed Losses • Central Auditory Processing Losses

  14. Age of Onset of Hearing Loss • Congenital - present at birth • Acquired - occurs after birth • Pre-lingual deafness – before language acquired (no oral skills) • Post-lingual deafness – after basic language/speech skills acquired

  15. Deafness & Hearing Loss Prevalence 31.4 million persons in U.S. (about 10% general population) have some degree of hearing loss 70,767 children (ages 6-21) received special education in school under the category of “hearing impairment”. Represents 1.3% of all students with disabilities Better Hearing Institute, 2008

  16. Causes of Hearing Loss • Approximately 50 percent of hearing losses have genetic causes, and 50 percent are due to environmental causes. Sometimes genetic conditions are associated with other disabilities; examples are Down syndrome and cleft palate. • Seventy documented genetic syndromes exist, as well as many other single genetic causes of deafness and partial deafness. Environmental effects that begin before birth are associated with illness or infections (TORCHS). Noise pollution, infections after birth such as otitis media and meningitis, asphyxia during the birth process, and premature birth can also cause hearing loss.

  17. Congenital loss is a hearing loss or deafness that was present at birth.. Acquired hearing loss is a hearing loss or deafness that has occurred in either childhood or adulthood. • Prelinguistic deafness refers to hearing loss or deafness that occurs prior to acquired speech and language, and is usually associated with genetic or prenatal causes. Postlinguistic deafness refers to hearing loss that occurs after some language and speech have begun.

  18. Pure-tone audiometry, the most common means of determining hearing loss, can be used in children from age 3 and older. The audiometer presents pure tones in a range of sounds, measures of frequencies, and intensities. These are recorded on a graph called an audiogram, which determines the range and degree of hearing loss. Audiologists use behavioral observation audiometry to test hearing in children younger than 3 years of age. Play audiometry is conducted in pleasant environments with toys that move and make sounds.

  19. Auditory brainstem response (ABR) uses a small microphone to determine whether the hair cells in an infant’s ear respond to sound. If there is no response, further testing is advised (Green, 2000). • c. Bone Conductor Test • For children younger than 3 years of age, a bone conductor test can be administered. This test measures the movement of sound through the hearing system to the brain. The reception of sound in the brain, recorded on a graph as the brain’s response to vibrations, is compared against a chart of similar responses by those with hearing loss and used to determine the degree of hearing loss.

  20. Play Audiometry • Play audiometry tests are conducted in a pleasant environment with toys that move and make sounds. The toys are used to elicit responses, such as eye blinks and changes in respiration or heartbeat (slower heartbeats indicate attention). http://video.google.com/videoplay?docid=4322480960497088329# • http://www.ehow.com/video_4399800_hearing-test-demonstration.html

  21. Assessing a Hearing Loss • Pure-tone audiometry • Auditory brainstem response • Bone-conductor test • Play audiometry

  22. Problems arising without early intervention

  23. Characteristics • Cognitive Development • Language Development • Social and Personal Adjustment

  24. Cognitive Development • The majority of children with hearing loss possess normal intelligence. Because intelligence tests are mainly verbal, the assessment of cognitive abilities is somewhat skewed for children with hearing loss (Paul & Quigley, 1994). ). A child who has not heard the sounds of the language will not be able to decode print if he or she is taught in the usual method of matching speech sounds—phonemes—to print.

  25. Because phonemic awareness, or the ability to use speech sounds, may be limited for children who are deaf or hard of hearing, alternative methods must be used to teach reading (McGough & Schirmer, 2005; Trezek & Wang, 2006). If reading and writing are approached in the traditional auditory way, a child who has not heard the sounds and structure of language will have difficulty decoding print. However, if the child is taught in a visual form (ASL), his or her chances greatly improve (Marschark, 2000).

  26. In summary, through improved teaching strategies, earlier intervention, new technology, and medical treatments (cochlear implants), children who are deaf or hard of hearing are making solid gains in learning to read. Please refer to the text for promising elements of reading instruction for children who are deaf or hard of hearing and discuss the techniques with class.

  27. Language Development • How do hearing losses affect a child’s language development, and what can be done to maximize communication potential? • Petito and Marentette (1991) suggest that infants are innately predisposed to learn language and do so by simulating the environment with babbling and/or babbling-like gestures. Children with hearing loss use gestures. It becomes essential for those who interact with these children to learn the meaning of these gestures.

  28. The ability to independently generate the rules of grammar (syntax and word order) tends to disappear after age 6 in most children. Therefore, if a child can be reached before age 6, that child has a greater chance of building on what he or she has learned. • The use of consistent, continual visual communication can greatly enhance the language development of any child with hearing loss (Solnit, Taylor, & Bednarczyk, 1992). The teacher’s and the parents’ ability to sign helps the child in language development. It also benefits the child’s social skills, peer interaction, and play.

  29. Social and Personal Adjustment: • Many children with hearing loss experience some difficulty in adjusting to a hearing-biased world. It is not surprising, then, that many seek communities of citizens who also have hearing losses (Guralnick, 2001). Early identification and intervention, increased parent training, technological aids, and sign-language interpreters can improve the social adjustment of children who are deaf.

  30. A curriculum called Promoting Alternative Thinking Strategies (PATHS) teaches self-esteem and interpersonal competencies and is useful for elementary-age children (Calderon & Greenberg, 2000). It should be noted that the Deaf community exists as a separate cultural group within our society (Moores, 2000), with ASL as their common language. Membership in the Deaf community is a part of the individual’s identity, and allegiance to the group is often strong.

  31. Adapting the Learning Environment • Students who are deaf or hard of hearing, like most other populations of students with special needs, are a heterogeneous population (Wachs, 2000). Because of this, each child will need an individualized educational program (IEP), and most will require services provided within all three tiers of the RTI model. • Early intervention is extremely important in developing the communication skills of children with hearing loss. Most early intervention strategies also focus on the parent, providing a homeschool intervention approach.

  32. Preschool and elementary educational settings demand that the teacher be skilled in working with a child with hearing loss (and preferably have some knowledge of ASL) to provide better visual instructional strategies. One area that must be addressed is reading instruction, specifically if phonics instruction (auditory in nature) is used as the primary means of teaching reading. • If secondary students are several grade levels behind their classmates, it is difficult to provide adequate services within the general education classroom. Wherever the child is taught, however, there is little that should impair the child’s learning if the teacher is willing to use more visual communication strategies.

  33. Adapting Curriculum • Research has shown that programs for students who are deaf or hard of hearing should concentrate on reading training, cognitive strategies, and accelerated training for students with high potential, and tutoring, and cooperative parent programs that encourage academic achievement at home.

  34. Children with prelinguistic hearing loss are often already identified before they come to school. However, some postlinguistic hearing losses and mild or moderate hearing losses do not appear until the child’s social environment is broadened through the school environment. If a teacher suspects a hearing loss, he or she can ask a series of questions for initial referral purposes: (1) Does the child appear to have a physical problem associated with the ears? (2) Does the child articulate sounds poorly and particularly omit consonant sounds? (3) When listening to sound recordings (radio, television, and music), does the student turn the volume up so high that others complain? (?

  35. 4) Does the student cock the head or turn toward the speaker in an apparent effort to hear better? (5) Does the student frequently request that what has just been said be repeated? (6) Is the student unresponsive or inattentive when spoken to in a normal voice? (7) Is the student reluctant to participate in oral activities

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