Evaluating Deaf Individuals with Additional Disabilities

1. Evaluating Deaf Individuals with Additional Disabilities Donna Morere, Ph.D. Gallaudet University

2. Vulnerability to Other Risk Factors • Some etiologies of deafness increase the risk of other conditions. • These etiologies include: • maternal rubella meningitis • Cytomegalovirus CHARGE Syndrome • Prematurity Rh incompatibility • About 40% of deaf children have a diagnosed additional condition.

3. Conditions ADHD & disorders of executive functioning Learning Disabilities (LD) Primary Language Disorders (PLD) Intellectual Disabilities (formerly MR) Vision limitation Motor impairments PDD, Autism Other medical conditions Psychiatric conditions

4. Assessment for ADHD, LD, etc. • Areas to be tested: • Intellectual functioning (addressed elsewhere) • Linguistic ability • Visuospatial & visuomotor functioning • Executive functioning • Memory functioning • Academic achievement • Adaptive functioning • Psychosocial/emotional functioning

5. Linguistic Ability • Linguistic ability should be measured in all modalities used by the person. • ASL or sign skills may be based on interviews and informal testing. • English skills may be tested in print • Individuals who use oral skills should have some estimate of these skills – including receptive skills and speech intelligibility – measured. • Tests may be from batteries or comprehensive language tests

6. Visuospatial& VisuomotorFunctioning • Important for all deaf individuals • Especially important for signing deaf individuals • Limitations can produce secondary language deficits. • May affect both receptive and expressive language. • If concerns, multiple measures should be used to evaluate all areas of functioning.

7. Executive Functioning • Manager of cognitive resources such as: • Attention - focus, maintain, shift • Problem Solving, planning, organization • Working Memory • Cognitive flexibility and adapting to change • Self monitoring and control - emotional & impulse • Initiating, or “getting started” • Response to feedback • Learning from experience • Wide ranging evaluation is important

8. Memory Functioning • Batteries • Test of Memory and Learning, Second Edition (TOMAL-2) • Wechsler Memory Scale – Fourth Edition (WMS-IV) • Both visual and linguistic memory should be reflected. • Both new learning and retention of previous learning should be considered.

9. Academic Achievement • Achievement Batteries • Woodcock-Johnson III Tests of Achievement (WJ-III) • Wide Range Achievement Test 4 (WRAT4) • Wechsler Individual Achievement Test–Third Edition (WIAT–III) • PIAT-R – older norms, but most subtests do not require spoken/signed responses. • Reading • Compare performance to both standard norms and D/HOH samples as well as own abilities. • Most word identification tasks require speech • Signed responses do not represent the same task

10. Academic Achievement • Writing • Typically comparable to reading • May use English words with ASL-like grammar • Math • Calculation may be preserved, although language or educational limitations may cause delays • Applied problems affected by English skills. • Content areas • Typically test in English print. • Scores affected by both content and vocabulary limits.

11. Adaptive Functioning • Rating scales typically used • ABAS-2 • Scales of Independent Behavior - Revised (SIB-R) • Vineland Adaptive Behavior Scales • AAMR Adaptive Behavior Scales (ABS) • Inventory for Client and Agency Planning (ICAP) • Respondents • Parents & carevigers • Teachers • Self (older respondents)

12. Psychosocial/Emotional Functioning • Rating Scales • BASC-2 and other child/adolescent scales • Whenever possible get multiple respondents • Self rating affected by reading & deafness related issues. • Refer to data in manual related to D/HOH sample. • MMPI-2 and other adult scales • Problematic due to both reading/language and culture/experience) • Direct assessments also have significant issues • Rorschach significantly affected by language • Drawing tasks poorly validated

13. Attention Deficit Hyperactivity Disorder (ADHD) • Prevalence • Appears to be greater than in the general population • Often co-occurs with LD and other issues. • Special issues in assessment • Affects other areas of testing and may require accommodations, such as redirection to tasks. • Special impacts on deaf clients • Deaf individuals have to pay attention to receive language.

14. Learning Disabilities • Difficult to diagnose in D/HOH children • Delays often assumed to be secondary to deafness • Especially language related learning disabilities • Some schools do not dually diagnose deaf & LD • Can involve math, reading, writing, or other specific areas of academic functioning • Comprehensive testing of all areas • In-depth testing of identified areas of need

15. Nonverbal Learning Disability • Controversial diagnosis with a pattern of weaknesses with implications for deaf clients • Problem areas: • Visual and spatial information. • Social skills • Executive functioning • Motor skills deficits • Interpreting non-linguistic aspects of communication (facial expression, posture, etc.) • Hearing individuals do well on basic verbal skills, but deaf signers may have secondary language impacts.

16. Nonverbal Learning Disability • Individuals with NLD • score poorly on non-verbal measures despite adequate cognitive skills in daily life. • Problem testing intelligence in deaf child • have expressive and receptive difficulty with • pragmatics (social aspects of language) • Connotation vs. denotation • Turn taking, etc. • “emotional expression” and understanding it in others • Flat presentation, don’t understand emotional cues

17. Primary Language Disorders • PLD is exacerbated by deafness. • Diagnosis is complicated • Information on language access history is critical. • Language testing is limited and must often be adapted from standard English • Language performance must be compared to expectations based on language access. • Comparison to standard hearing norms leads to false positive • Excessively low expectations lead to false negatives

18. Other Disabilities • Psychiatric • ASL mistaken for “word salad” • Interactions between deafness and other disabilities – effects on performance • E.g., motor or vision issues • Further limits validity of standard instruments • Complicates interpretation • Expands areas of expertise needed by evaluator.

19. Recommendations • The most important part of the report • Should be practical and “doable” • Should be relevant to the needs of both the individual and the specific disability • E.g., extended time for ADHD may be less beneficial than additional breaks to re-focus • Accommodations vs. interventions • Using recommendations to help the client.