Deaf and Hard of Hearing
Hearing loss is common, and its incidence increases with age. For the most part hearing loss is mild and has no serious effect on the development of spoken language and communication. The number of children for whom hearing loss has implications for the classroom and for general communication is relatively small, and profound hearing loss, or deafness, constitutes a low-incidence condition. In general, two categories are used to describe hearing loss: hard of hearing and deaf, with no clear demarcation between the two. Roughly, hard of hearing children are characterized as having incomplete or limited access to the spoken word, either with or without augmented hearing. Deaf children have no functional access to the spoken word, either with or without augmented hearing. The hard of hearing category may be subdivided into two categories, mild and moderate, and deafness into another two, severe and profound. Numbers decrease with the severity of the hearing loss, with one school- age child in 2,000 exhibiting a profound hearing loss (Gallaudet Research Institute, 2005). Approximately 80,000 deaf and hard of hearing children in the United States have been identified as receiving education services (Mitchell, 2004).
The most significant development in assessment of hearing has been the spread of neonatal hearing screening. Close to 95% of newborn children are screened in the hospital. Until the implementation of neonatal screening, the average age of identification of hearing loss was 2 1/2 years. The two most common types of tests used are Automatic Auditory Brainstem Response (AABR) and Transient Evoked Otoacoustic Emissions (TEOAE) (Wrightstone, 2007). In the AABR test electrodes are placed on the forehead, mastoid, and nape of the neck of the infant, and the infant is fitted with a disposable earphone. The stimulus is a click or series of clicks. In the TEOAE test a microphone is placed in the external ear and a series of clicks tests the infant's response. In both cases, in order to reduce the number of false positives, a follow-up test is recommended for infants who do not pass the first screening.
Hearing testing, or audiometric assessment, can be accomplished in a variety of ways. Most frequently it is done by a trained audiologist using an audiometer, a device that emits tones at various frequencies and at different levels of loudness. The testing usually is conducted in a soundproof room. The person being tested wears a set of headphones or a headband and each ear is tested separately. The results are shown on an audiogram, a graph that represents hearing levels from low to high frequencies. The hearing is measured in units called decibels. Normal speech patterns are around 30 to 50 decibels. Hard of hearing individuals would have difficulty with much of spoken language and deaf individuals would have no access to it through audition.
Deaf and hard of hearing children, with some exceptions, reflect the general American school-age population. The exceptions are due to factors such as heredity, etiology, extent of hearing loss, and age of onset of a hearing loss.
For approximately half of American deaf and hard of hearing children, the hearing loss is caused by genetic factors (Moores, 2001).
Predominantly, genetic hearing loss is of a recessive nature, typically meaning that both parents, although they are able to hear, carry a gene for hearing loss. In a smaller number of cases, one parent may be deaf or hard of hearing and pass the gene along to the child in 50% of the cases. There are a small number of incidences of sex-linked hearing loss in which the hearing mother may pass the gene along to male children. This is possibly a partial explanation of why males constitute slightly more than half of the school age deaf and hard of hearing population. With a few exceptions, children with a genetic etiology do not possess disabilities; they are normal intellectually, physically, and emotionally.
Non-genetic factors play a decreasing but still important role. For generations, and perhaps for hundreds of years, worldwide maternal Rubella would double the number of deaf children born in particular periods of time. For large numbers of children, the results would include hearing loss, visual impairment, heart conditions, neurological disorders and physical frailness. The development of a Rubella vaccine has eliminated Rubella as a cause of hearing loss. Mother-child blood incompatibility is another cause of hearing loss that has been brought under control, at least in developed countries. Childhood meningitis, however, presents a somewhat different picture. In the past a very young child who contracted meningitis might die, whereas an older child might survive but with profound hearing loss. In the 21st century it is more likely that the older child would be cured without any hearing loss and the younger child survive but with multiple disabilities. Hearing loss may also occur as a consequence of premature birth, with the possibility of additional disabilities. Again, medical advances can lead to survival, but with concomitant conditions. Miller (2006) has argued that there are essentially two distinguishable categories of children with hearing loss: those who are normal intellectually and physically and those with overlays of disability.
There are some differences in the racial/ethnic make up of the school age deaf and hard of hearing population as compared to the hearing population. According to information compiled by the Gallaudet Research Institute (2005), 50% of the deaf and hard of hearing school-age population is classified as White, 15% as Black/African American, and 25% as Hispanic/Latino, with the remaining 10% being classified as Asian/Pacific, American Indian, Other, or Multi-ethnic. The disparity is with the Hispanic/Latino category. A larger percentage of Hispanic/Latino children are in programs for deaf and hard of hearing children than in the general school population. The reasons for this are not clear.
Historically, there have been three interrelated major points of contention concerning the education of deaf and hard of hearing children and educational practices: Where should the children be taught, what should the children be taught, and how should the children be taught? (Moores & Martin, 2006). Complex sets of demographic changes, medical developments, societal expectations, and federal legislation have had major impacts on each of these questions.
Traditionally, deaf and hard of hearing children were taught either in residential school or in separate day-school programs in large cities. The situation began to change after World War II, due to the baby boom and population explosion. State legislatures were not willing to commit extra money for the construction of new residential facilities, and increasing numbers of deaf and hard of hearing children attended public schools, often in separate classes in schools with a majority of hearing children. The trend continued with the last major Rubella epidemic in the 1960s, at a time when the baby boom was over and there were empty rooms in the schools. The passage in 1975 of the Education of all Handicapped Children Act, which has undergone extensive amendment over time, including the Individuals with Disabilities Education Improvement Act Amendments (IDEA) of 2004, was the impetus for the acceleration of the movement of special education children to mainstream or integrated settings. The law requires a Free Appropriate Public Education (FAPE) for all disabled children, with each child receiving an Individualized Education Plan (IEP). Children are to be educated in the Least Restrictive Environment (LRE), and placement with non-disabled children is viewed as desirable. The concept of integration has been replaced with that of inclusion, by which modifications of instruction are expected to adapt to the needs of the child rather than placing the onus on the child. This is the expectation in theory, but it is not necessarily realized.
Amendments of IDEA lowered the age at which disabled children could be served until services are available at birth. For very young children there is an emphasis on serving the family as a whole system; instead of an individual education plan for the child, a family plan is developed. Coupled with universal neonatal screening there has been an increase of programs for children from birth to 3 years of age. Unfortunately, many states have not developed effective systems for follow-up once a hearing loss is identified, so there is often a lack of appropriate response.
Approximately half of deaf and hard of hearing children are placed in a regular classroom setting with hearing children, and may be served, depending on the IEP, by an itinerant teacher of the deaf or other professional. An estimated 40% of deaf and hard of hearing children in regular class settings receive sign interpreting services (Gallaudet Research Institute, 2005).
The question of what deaf and hard of hearing children should be taught has been influenced by changes in school placement and by federal legislation. The curricula for deaf and hard of hearing children used to emphasized speech training, speech recognition, and English, with relatively little attention devoted to content areas such as math, science, and social studies. However, as more and more children were educated in regular classrooms the regular education curriculum of the particular school district took precedence.
The enactment of the No Child Left Behind (NCLB) legislation in 2001 brought education of deaf and hard of hearing children into even more close alignment with regular education. Among other things, the law mandates that each state must establish high standards of learning for each grade and that the states develop rigorous, grade-level assessments to document student progress. Results are reported at school, school district, and state levels. Results are also reported at each level for all students and disaggregated by race/ethnicity, speakers of languages other than English, poverty (as demonstrated by free or reduced lunch eligibility), and disability. Annual goals are established for each category, and schools, school districts, and states must show annual yearly progress (AYP). Any achievement gaps among racial/ethnic, income, language, or disability groups must be closed so that by 2014 100% of American children will demonstrate academic proficiency, as measured by grade-level standardized state-administered tests. Only a small number of profoundly impaired children are exempt. All others, including deaf and hard of hearing students, must take the tests and, by 2014, have a 100% pass rate.
This poses an enormous challenge. Deaf and hard of hearing children in regular classrooms are already being exposed to the curricula of their home school districts, and most day and residential programs have adopted or adapted general education curricula. However, many, if not most, deaf and hard of hearing children start school, even after early intervention and preschool experiences, without the English skills and word knowledge that most children have acquired before the start of formal schooling. They are therefore unable to use English fluency as a tool to acquire academic knowledge and skills. For many deaf and hard of hearing children English is a barrier to learning that must be overcome. The curriculum must be modified to help deaf and hard of hearing children develop some of the skills that hearing children already have at the start of their education. Only a small percentage of high school-age deaf children achieve at grade level at the same level as their hearing peers (Moores & Martin, 2006) and the goal of 100 percent success in demonstrated academic proficiency will not be achieved by 2014.
The third issue, how to teach deaf children, deals with the oral-manual controversy, which has been raging for more than a century. In the first American schools for the deaf, which enrolled a substantial number of late deafened and hard of hearing students, instruction was through either a natural sign language, the precursor of American Sign Language (ASL), or through a system of signs modified by means of the American manual alphabet to represent English and presented in English word order. This method predated English-based signed systems that may be presented in coordination with spoken English. Oral-only education was introduced in the last third of the nineteenth century and quickly became dominant in the large city day schools and in some private residential schools. In the state residential schools a system evolved in which children up to around age 12 were taught orally and then tracked into either oral or manual classes (Winzer, 1993).
The situation began to change in the 1960s because of dissatisfaction with results of oral-only early intervention programs. A philosophy called Total Communication quickly grew in popularity. Theoretically, it involved the use of any means of communication to meet individual needs: speech, ASL, English-based signing, writing, gesture, or speech-reading. It reality it usually involved English-based signing in coordination with speech, and was known as simultaneous communication (Sim Com). During the 1990s a movement developed to employ ASL as the main mode of classroom instruction, with an additional concentration on written English. The approach was labeled Bi-BI, or bilingual-bicultural. Early 21st-century data indicates that 50% of deaf and hard of hearing children are taught through oral-only communication, 40% through sign and speech, and 10% through sign-only communication (Gallaudet Research Institute, 2005).
There has been growing interest in multichannel cochlear implants for deaf and hard of hearing children. The surgical procedure involves removing part of the mastoid bone and inserting a permanent electrode array into the cochlear. The procedure has been more common in Australia (Lloyd & Uniake, 2007) and Western European countries such as Sweden (Preisler, 2007), where as many as 80% of young deaf and hard of hearing children have received implants. Implantation has increased in the United States and in some areas approaches 50% of the deaf and hard of hearing population. Cochlear implants are designed to bring a more clear representation of the spoken word to deaf and hard of hearing children. There have been anecdotal reports of dramatic improvements in hearing in some children, but systematic reports of the extent to which it helps children with different characteristics are not available.
In is important to keep in mind that the purposes of assessment for each child can include facilitating educational placement decisions, evaluating progress, determining educational approaches to be used, improving educational and intervention strategies, monitoring progress for individualized education plans, or family education plans (Miller, 2006). Although the situation is improving, attempts to provide meaningful and valid assessments for deaf and hard of hearing children have met with limited success. Miller points out that there is difficulty getting agreement in the field about which tests require “deaf norms” and which tests should use “hearing norms.” When separate norms are desired there is the additional question of who should be included in the normative sample—all deaf children, deaf children without disabilities, deaf and hard of hearing children, children with disabilities, and so forth.
Miller states that in establishing an assessment framework assessment specialists must keep in mind the normal course of development of a typical deaf or hard of hearing child who has no disabilities and who has been in a linguistically enriched environment from birth. Other deaf and hard of hearing children should be compared to this ideal prototype or model of development and measured in ways that can estimate their similarities to or differences from the ideal. The template of developmental norms for deaf and hard of hearing children should be the model for all deaf and hard of hearing children even if such children comprise a minority of the population under consideration. Some of the key variables to be considered include age of onset of the hearing loss, age of identification and beginning of educational services, home and school linguistic environment, presence or absence of disabling conditions, use of and benefit from auditory amplification, and consistency of the communication approach over the years.
Considering these variables, the assessment specialist should be able to identify those children with hearing loss only, those with disabilities who have received excellent programming from an early age, and those who have received little or inappropriate educational services. The need is for assessment specialists to redouble efforts to develop meaningful, relevant, and linguistically and culturally appropriate assessment batteries that make the most sense in practical terms for deaf and hard of hearing children and their families.
See also:Special Education
Gallaudet Research Institute. (2005). Report of data from the 2004–2005 annual survey of deaf and hard of hearing children and youth. Washington, DC: Gallaudet University.
Lloyd, K., & Uniake, M. (2007). Deaf Australians and the cochlear implant. In L. Komesaroff (Ed.), Surgical consent, bioethics and cochlear implantation (pp. 174–194). Washington, DC: Gallaudet University Press.
Miller, M. S. (2006). Individual assessment and educational planning. In D.F. Moores & D. S. Martin (Eds.), Deaf learners: Developments in curriculum and instruction (pp.161– 176). Washington, DC: Gallaudet University Press.
Mitchell, R. E. (2004). National profile of deaf and hard of hearing students in special education from weighted results. American Annals of the Deaf, 149, 336–349.
Moores, D. F. & D. S. Martin. (Eds.). (2006). Deaf learners: Developments in curriculum and instruction. Washington, DC: Gallaudet University Press.
Preisler, G. (2007). The psychosocial development of deaf children with cochlear implants. In L. Komensaroff (Ed.), Surgical consent: Bioethics and cochlear implantation (pp. 120– 136). Washington, DC: Gallaudet University Press.
Winzer, M. (1993). The history of special education: From isolation to integration. Washington, DC: Gallaudet University Press.
Wrightstone, A. S. (2007). Universal newborn hearing screening. American Family Physician, 76, 1349–1356.
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