Deafness

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Deafness Hearing Loss

• FRIEND CH 10,
• SPED 281
• Dr. Schneider

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LEARNING OBJECTIVES

• Definition of Deafness Hearing Loss
• Historical stepping stones
• Characteristics of deafness hearing loss
• Identification procedure for hearing loss
• Types of services for students who are hard of
  hearing or deaf
• Prevalence data
• Best Teaching strategies for students who are
  hard of hearing or deaf
• Perspectives of family members
• Issues affecting the field of Deaf Education

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Definition of Deafness Hearing Loss

• Terminology not very specific
• disability first deaf person
• person first person who is deaf
• person w/ hearing loss
• Deaf linguistic cultural minority
• The community of deaf individuals stresses that
  they have their culture and that nothing needs to
  be fixed about them
• hearing loss is measured according to an
  individual s ability to hear sounds that differ
  in pitch loudness
• this ability is being charted on an audiogram

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Definition of Deafness Hearing Loss Federal
Definition

• Hearing impairment permanent or fluctuating that
  adversely affects educational performance but is
  not included under deafness in this section
• Deafness hearing impairment so severe that the
  child is
• impaired in processing linguistic information w/
  or w/o amplification
• Impaired hearing adversely affects educational
  performance
• SINCE FEDERAL DEFINITION IS INCOMPLETE
• Additional info on definitions from National
  Center for Education Statistics (2002) with
  expansions

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Definition of Deafness Hearing Loss from
National Center for Education Statistics (2002)
with expansions

• Hearing impairment impairment in hearing,
  permanent or fluctuating, that adversely affects
  educational performance, in most severe case b/c
  child is impaired in processing linguistic
  information via hearing.
• Deafness hearing impairment so severe that it
  hearing linguistic information is impaired with
  or without amplification it adversely affects
  educational performance
• Hard of hearing hearing impairment that is
  permanent of fluctuating it adversely affects
  educational performance but is not included under
  definition of deaf

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Historical stepping stones

• (1) oral/aural method only
• oral/aural method speaking words using speech
  reading, amplification of sound
• Problem children severely hard of hearing had to
  learn to lip read BUT English is 75 impossible
  to lip-read!
• (2) sign language only
• (3) now both signed languages print pattern of
  English
• A) American Sign Language w/ finger spelling of
  proper nouns, names
• B) Simultaneous Communication
• using English word order finger spelling
  ASL parts new parts oral speech /reading
  manually coded English
• gtcurrent position do not just learn/teach one
  of these 3 communication strategies,
  learn/teach/use ALL 3

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Historical stepping stones

• (1) oral/aural method only
• oral/aural method speaking words using speech
  reading, amplification of sound
• Problem children severely hard of hearing had to
  learn to lip read BUT English is 75 impossible
  to lip-read!
• (2) sign language only
• (3) now both, even both sign languages
• A) American Sign Language w/ finger spelling of
  proper nouns, names
• B) Simultaneous Communication
• using English word order finger spelling
  ASL parts new parts oral speech /reading
  manually coded English
• gtcurrent position do not just learn/teach one
  of these 3 communication strategies,
  learn/teach/use ALL 3

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Historical stepping stones

• For more than a century, residential schools and
  a few day schools were the only ways to get
  educated as a deaf person or one hard of hearing.
• From 1975 on (P.L. 94-142, now IDEA), assured
  that majority of deaf individuals and hard of
  hearing attended general education classrooms.

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Causes of hearing loss

• A. Pre-lingual before individual has learned
  language.
• premature birth
• birth complications (e.g., lack of oxygen)
• heredity both being born deaf loosing hearing
  gradually leading to deafness can be hereditary
  congenital hearing loss
• 10 have deaf/hard of hearing parent
• 30 have deaf/hard of hearing relative
• maternal rubella or diabetis
• Toxema during pregnancy (w/ dangerously high
  blood pressure)
• Malformation of ear structure
• congenital cytomegalovirus (CMV)

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Causes of hearing loss

• B. Post-lingual after individual has learned
  lang.
• appr. 5 of deaf population
• Hereditary acquired or adventitious hearing
  loss
• brain trauma
• Repeated exposure to loud noise
• Drugs that can cause hearing loss
• high fever (e.g., meningitis)
• ottis media (most common) middle ear infections
• progressive degenerative genetic disease (usually
  does not affect school children)
• NOTE
• measles mumps are not a cause anymore (2000)

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Causes of hearing loss Types

• Conductive hearing loss
• Caused by an OUTER EAR or MIDDLE EAR PROBLEM
  thus sounds cannot get to inner ear listening
  technology can help
• Sensory-neural learning loss
• Caused by an INNER EAR PROBLEM or ALONG the
  PATHWAY to the BRAIN STEM (-gt cochlear
  implants)
• Mixed hearing loss
• When the hearing loss involves both a
  sensory-neural and the conductive hearing loss
• Bilateral or uni-lateral hearing loss
• Does it affect one ear only (UNI) or both (BI)?
• Fluctuating hearing loss
• Does it affect sometimes one ear and then the
  other
• Does it occur some days but not on others? (e.g.,
  tinnitus)

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Prevalence of hearing loss

• 16 out of every 1000 school children in the use
  has a significant hearing loss
• 8.6 of US population hearing loss (NIH, 2002)
• 1.3 children ? low incident disability
• 1.1 of all school children receive IDEA-based
  services
• 22 of those who are deaf also have 1 other
  disability
• 8 of those who are deaf also have 2 or more
  disabilities
• 90 of children who are hard of hearing or are
  deaf have hearing parents
• Insignificant differences between males/females
  and between ethnic groups

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Characteristics of deafness hearing loss

• The audiogram results identify the degree of
  hearing loss.
• no hearing loss (0-15 dB)
• slight hearing loss (16-25 dB)
• mild hearing loss (26-40 dB)
• moderate hearing loss (41-55 dB)
• moderate-severe hearing loss (56-70 dB)
• severe hearing loss (71-90dB)
• profound hearing loss (91 dB)

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Characteristics of deafness hearing loss

• Degrees of hearing loss
• no hearing loss (0-15 dB)
• No impact on communication
• slight hearing loss (16-25 dB)
• speech difficult to understand
• in noisy environment -gt could be classroom!
• mild hearing loss (26-40 dB)
• faint, distant speech difficult to understand,
  even in quiet environment
• classroom discussions definitely difficult to
  follow

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Characteristics of deafness hearing loss

• Degrees of hearing loss
• moderate hearing loss (41-55 dB)
• conversational speech understandable only when
  close by
• group activities in class hard to follow
• moderate-severe hearing loss (56-70 dB)
• only loud, clear conversational speech yes
• group situations very difficult
• speech intelligible but noticeably impaired

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Characteristics of deafness hearing loss

• Degrees of hearing loss
• severe hearing loss (71-90dB)
• conversational speech understandable only if
  loud, even then keywords may be difficult to hear
• environ. Sounds understandable but not always
  identified
• speech not always intelligible
• profound hearing loss (91 dB)
• Cannot understand conversational speech
• Can understand some loud environ. sounds
• speech difficult to understand or may not be
  developed at all

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Characteristics of deafness hearing loss

• (1) COMMUNICATION CHARACTERISTICS
• If reduced in early childhood gt emotional bonds
  not strong social-cultural elements of language
  not passed on
• (2) LEARNING CHARACTERISTICS
• quantity and quality of direct vicarious
  experiences in nature/outside reduced
• gt need for carefully constructed safe
  experiences
• Hard of hearing leads to different schemata about
  environment, life, language, logical sequences
• gt Reduced of social connections learning
  opportunities (see p. 377)

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Characteristics of deafness hearing loss

• (3) COGNITIVE CHARACTERISTICS
• those with disability as intelligent as those
  without those disabilities however, deficits in
  language perception and production may make them
  look cognitively defect
• appropriate teaching learning opportunities are
  key
• gt Proper non-verbal vs. verbal assessment is
  needed

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Characteristics of deafness hearing loss

• (4) ACADEMIC CHARACTERISTICS
• a) receptive and productive vocabulary limited
• b) pronunciation, articulation difficulties
• c) need for sign language as communication tool
• d) reliance on assistive listening devices
  (e.g., cochlear implants) other technology,
• e) reading A PROBLEM B/C ENGLISH PRINT is a
  second language their first language, oral
  language is signing that leaves them with a
  different picture about language structure than
  print requires research documents success for
  those who have family support

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Characteristics of deafness hearing loss

• (4) ACADEMIC CHARACTERISTICS
• f) writing A PROBLEM B/C it requires
  understanding English sentence structure, its
  vocabulary this is a second language task
  research has not many examples of success stories
  for writing BUT this may also be due to the
  teaching strategies used in the studies
• g) MATH higher performance levels than in
  reading and writing BUT any task that involves
  reading comprehension can lead to problems due to
  problems with second language ENGLISH IN PRINT

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Characteristics of deafness hearing loss

• (5) SOCIAL EMOTIONAL
• often secluded socially because of lack of
  social-emotional understanding between the
  hearing and the hearing impaired
  (miscommunication)
• gt behavior issues
• gt low self-esteem (higher among hard-of-hearing
  alone)
• in early development barriers between hearing
  parents and siblings child hard of hearing
• In school barriers between hearing teachers/peers
  child hard of hearing gt behavior issues
• miss out on oral social clues, idiomatic
  expressions, what is said between the lines
  through tone of voice

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Characteristics of deafness hearing loss

• (6) BEHAVIORAL CHARACTERISTICS
• If you cannot hear peoples reasoning for
  behavior and you have limited dialogue partners,
  you lag behind understanding behavior of those
  around you and the choices the make gt
  insecurity, anger, frustration, fear,
  disappointment gt behavior that does not fit in
  social setting gt USE PATHS project (p. 382)

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Identification procedure for hearing loss

• AUDIOLOGICAL EVALUATION
• Case history (family history, interview, medical
  data ottis media middle ear infection)
• Physical evaluation (outer ear, inner ear ear
  canal, eardrum, middle ear function
• Audiometric analysis with audiogram to measure
  pure tone
• OTHER ASSESSMENTS (to rule out co-occurring
  disabilities)
• Vision
• Overall health
• Achievement tests (literacy, math skills)
• Intelligence test

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Identification procedure for hearing loss

• ELIGIBILITY CHRITERIA (OFTEN CONSIDERED)
• Inability to recognize most spoken words
  occurring at conversational level in a quiet room
  without the use of assistive devices
• Significant receptive and/or productive language
  delay
• Impairment of speech articulation, voice or
  fluency
• Significant discrepancy between verbal and
  nonverbal performance on an intelligence test
• Significant delay in reading skills because of
  language deficits or overall lower than expected
  academic performance
• Inattention or serious behavior issues due to
  hearing loss

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Identification procedure for hearing loss

• infant screening 2x during first 6 months
• after that audiologist conducts
• behavioral audiological evaluation
• conclusions drawn based on
• childs behavioral response
• audiometer generates pure tones
• test hearing range
• select, fit hearing aids
• evaluate other listening devices

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Identification procedure for hearing loss

• responses up to age 3
• more frequent sucking
• more frequent eye blinking
• head turning
• stop of play to listen to sound
• responses older children
• raise finger for as long as they
• hear sound, then lower it

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Types of services for students who are hard of
hearing or deaf

• 15 in special schools for the hard of
  hearing-deaf gt significant hearing loss
• 25 in public schools but for more than 60 in
  special classes (resource)
• 20 in general ed classes for 20 of time at
  least
• 40 in general ed classes for more than 80 of
  time INCLUDSION

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Best Teaching strategies

• A. Technological Devices
• hearing aids only amplify sound gt most
  beneficial in quiet environment
• cochlear implants electronic device that
  compensates for absent hair cells in the cochlea
  gtIt directly stimulates the nerve fibers
• Assistive Learning devices
• an FM radio system that is tuned in for sound
  frequencies only audible for the person who wears
  microphone gt must be passed on during group work
  from student to student

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Best Teaching strategies

• For students hard of hearing inclusion best
• in inclusion setting
• encourage peers to learn sign language (
  yourself)
• check that all notes taken by student and/or note
  taker are complete
• group student with peers who are understanding
  caring
• foster conversation using
• augmenting instruction
• total communication
• cued speech
• oral/aural strategies
• For students who are deaf inclusion not
  necessarily best educational choice

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Best Teaching strategies

• In general up the ladder of experiential
  learning from concrete to abstract Emphasize
  visual cues and teaching strategies
• Sign finger spelling
• Speech reading watching mouth face movement of
  speaker
• Technology TV, overheads, elmos, pointers, video
  relay services, telecommunication relay service,
• Materials pictures, illustrations, slides,
  charts, film clips w/ captions, graphics,
  artifacts
• Culture sensitive signs for daily routines

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Best Teaching strategies

• Emphasize value of reading!
• Enhances vocabulary students cannot not hear well
  or at all
• Enhances understanding of grammatical logic and
  glue systems of the language that is hard to
  hear or inaudible
• Enhances background knowledge about the hearing
  world if certain experiences are re-modeled for
  them

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Best Teaching strategies

• How are sign language and American Sign Language
  different from one another?
• How does Central Auditory Processing Disorder
  differ from being hard of hearing?

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Perspectives of family members

• For hearing parents, it is difficult to
  understand the world of the hearing impaired
• Often diagnosis occurs late because it is a low
  incidence disability
• Requires commitment of entire family to assure
  social-emotional integration of hearing impaired
  individual
• Important for success are a) perseverance, b)
  emphasis on reading, c) early identification, d)
  family support, e) involvement in extracurricular
  activities
• Motto do not let deafness hold you back

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Issues affecting the field of Deaf Education

• Universal new-born hearing screening
• Now possible to identify hearing loss by 6 months
  of age, before not until age 2 (EHDI)
• Increase use of cochlear implants
• The device stimulates the hearing nerve in the
  inner ear so that messages can be transferred to
  the brain requires wearing a small piece behind
  your ear
• Designed for those with severe to profound
  hearing loss
• Bilingual-bicultural approach for educating
  individuals hard of hearing or deaf
• Teaching ASL as the primary language and English
  is the second language English is then taught by
  learning how to read and write in the same print
  system as the non-hearing impaired peers

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websites

• www.deafchildren.org/home/home.html
• http//p3.csun.edu
• http//center.uncg.edu (infant- toddler info)
• www.babyhearing.org (early identification)
• www.deaflinx.com (factual info to foster
  deaf-friendly world)
• www.deafed.net (info about preparation of new
  teachers)
• http//clerccenter.gallaudet.edu (National Deaf
  Education Center w/ materials strategies for
  teachers)
• www.agbell.org (international organization
  addressing hearing loss deaf issues
• www.NCLID.unco.edu (National Center on Low
  Incidence Disabilities)