Children with hearing impairments

Deaf children are disabled to the extent that they cannot hear speech through the ear, even with some form of amplification. They are dependent on vision for language and communication. Hard-of-hearing children can hear speech through the ear, but they need some form of amplification to make it more understandable. Hard-of-hearing children far outnumber deaf children. Most of them can be enrolled in inclusive education programs, with some modifications to the classroom and to their ears. While 8 to 10 percent of school children have some loss of hearing, only about 1 percent qualify for special educational services for their hearing impairments.

The assessment of hearing impairments is usually ac­complished by identifying and measuring the decibel levels (loudness) of sounds, which the child can hear. These units can be generated on an audiometer. The child holds up a finger and points to the ear in which he or she hears a sound. An audiogram shows the results of an audiometric test. Children should be able to discern the pitch of sounds from 500 to 2,000 hertz, the range for spoken language. They normally can hear between 0-25 decibels (dB). A hearing loss from 26-40 dB is slight, loss from 41-55 dB is mild, loss from 56-70 dB is moderate, loss from 71-90 dB is severe, and a loss of more than 90 dB is deaf in each ear.

If an infant is born with a hearing impairment, he or she has a congenital hearing impairment. If the hearing loss is acquired later in life, it is an adventitious hearing impair­ment. If a hearing loss is present in both ears, it is bilateral. If it is present in only one ear, it is unilateral. If the loss of hearing occurs before a child learns language, it is prelinguistic. If it occurs after a child learns language it is postlinguistic. In terms of special adaptations required in education programs, the child with the former of each of these terms (congenital, bilateral, prelinguistic) usually needs more help. These forms of losses can occur in many combinations.

Two additional terms are very important in the assess­ment of hearing impairments: sensorineural hearing loss and conductive hearing loss. A sensorineural loss is usually more serious and requires more education adap­tations than a conductive loss. Sensorineural hearing impairments involve defects or disorders of the auditory nerve or portions of the inner ear. They are difficult or impossible (depending on the prpblem) to correct with surgery, medicine, or sound amplification. Conductive hearing impairments involve defects or disorders of the outer or middle ear. Depending on the problem, they are often correctable with surgery, medicine, or sound ampli­fication.

The causes of hearing impairments are not always easy to determine. In about 1/3 of all cases, the cause is unknown. Congenital losses may be inherited or caused by something during the mother's pregnancy and delivery, such as viral infections, drugs, prematurity, or low birth weight. Adventitious hearing losses may be due to injuries or diseases such as encephalitis, meningitis, or otitis media.

It is very important to assess hearing in infancy. PL 99-457 mandates comprehensive multidisciplinary ser­vices for infants and toddlers and their families. Once a hearing impairment is assessed, services should begin immediately. If the loss is conductive, the infant or toddler should be fitted with a sound amplification device (hearing aid). If the loss is sensorineural, the infant or toddler and the parents should begin learning sign language. Special educational services should also begin. Both receptive language (understanding what is said) and expressive language (speaking) are fostered with the earliest possi­ble intervention. Cognitive processes and socialization processes are also dependent on early comprehension of some form of language.

Children who are deaf or hearing impaired are fre­quently enrolled in regular education classes for elemen­tary, middle, and/or high school. Decisions about where to place them depend on many factors: age of onset of hearing loss, degree of hearing loss, language ability, cognitive factors, social factors, parental factors, and presence or absence of other educational disabilities. Individualized education programs must be annually up­dated. Sometimes the best environment (least restrictive) for a hearing impaired child is regular class for a portion of time and special class for another length of time. The nature of the child's problem determines the long- and short-term goals and the criteria for gauging the effective­ness of each special educational modification.

Teachers who have children who are hard of hearing in their classrooms should learn to read their audiograms, help them benefit from any residual hearing, and learn to use any kind of amplification system provided. These may include FM auditory training devices, microphones, or hearing aids. If a deaf child is enrolled in a regular education classroom, the teacher should make provisions for an interpreter, a notetaker, and/or captioned films and videos. If the child reads lips, the teacher must keep mouth movements visible. Speech reading (also called lipreading) is difficult for the child. The teacher should remember that the average speechreader only grasps about 5 percent of what is being said. If a computer is provided for the hearing impaired student, the teacher should be aware of software needs and appropriateness. Many deaf students are taught oral speech. It may be difficult to understand. A regular education teacher should work to comprehend it as much as possible. Since speech is important to the integration of deaf individuals to a hearing society, they are discouraged from using ges­tures, pointing, or written messages instead of speech.

Each child with a hearing loss should be motivated to do all he or she is capable of doing in both the educational and in the social activities of the school. The teacher has a major responsibility to help the nonhearing impaired peers understand the special needs of the child with a hearing loss. Teachers, peers, and all ancillary school personnel should encourage the child to participate to the fullest extent possible. The hearing impairment should not be allowed to become an excuse for nonparticipation. Children with hearing losses should be reinforced for their efforts but not praised for inaction. Understimulation and/ or pity are detrimental both to educational progress and to socialization and self-esteem.

The first article selected for this unit provides informa­tion about the uses of the frequency modulation (FM) auditory training device in a regular class. FM devices are increasingly being used by children with hearing losses in inclusive education classes. The second article provides information about the presence of an educational inter­preter in a regular classroom to assist children who are deaf. The interpreter may translate spoken language into sign language or may silently mouth the message in an oral form that is easier to speechread. The third selection addresses the controversy of providing special services to deaf and hard-of-hearing children who choose a private school over a public school education. The final article selected for this unit emphasizes the nonacademic les­sons that deaf and hard-of-hearing students need to learn: independence and responsible transitional behaviors for success in life.

Looking Ahead: Challenge Questions

What is a FM (frequency modulation) auditory training device? What must a classroom teacher know about wearing a microphone and checking the receiver worn by the student?

When an interpreter accompanies a deaf child to class, what should a teacher do? What role, if any, will the interpreter have with other students, other school person­nel, or parents?

Should tax dollars pay for an interpreter for a deaf student who attends a private school? Why, or why not?

What skills should be taught to adolescents with hear­ing impairments to help them make a successful transi­tion to adulthood?