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When a child has a hearing loss during the developmental
years, all areas of development can be affected significantly. A hearing
loss limits ease of acquisition of a communication system, which further
influences development of interactions with others, the ability to make
sense out of the world, and ease of acquiring academic skills. Early identification
of a hearing loss is critical to a child's academic and emotional adjustment.
What is a hearing loss, and how is it caused?
There are three major types of hearing losses. The first
is called a conductive loss. This occurs when something goes wrong with
the outer or middle ear, impeding sound waves from being conducted or
carried to the inner ear. The second type of loss is called a sensorineural
loss and occurs when damage to the inner ear or the auditory nerve impedes
the sound message from being sent to the brain. The third type is referred
to as a central auditory processing disorder because, although there is
no specific damage to the ear itself, the neural system involved in understanding
what is heard is impaired. Children with central auditory processing disorder
may have normal hearing as measured by an audiometer (device used to test
hearing levels), but they often have difficulty understanding what they
hear. A child may also have a combination of these forms of hearing loss
(Easterbrooks & Baker-Hawkins, 1994).
Many terms are used to refer to the population of individuals
who have difficulty hearing. The word "deaf" by federal definition
means a hearing loss which adversely affects educational performance and
which is so severe that the child is impaired in processing linguistic
(communication) information through hearing, with or without amplification
(hearing aids). The term "hard of hearing" means a hearing loss,
whether permanent or fluctuating, that adversely affects a child's educational
performance but which allows the child access to some degree of communication
with or without amplification (Individuals with Disabilities Education
Act, 1990). The term "Deaf" used with a capital D refers to
those individuals with hearing losses who identify themselves with the
Deaf Culture. These individuals view themselves as a population united
by a common heritage, a shared experience, a multi-generational history,
and a language, American Sign Language (ASL) (Padden & Humphries,
1988).
The term "hearing-impaired" is used inconsistently
around the country today. Some use it to mean all degrees of hearing loss
while others use it to refer to the hard-of-hearing population. The terms
"deaf mute" and "deaf and dumb" are antiquated. Not
only are they seen as outdated, they are also viewed as offensive.
How many people have hearing losses?
The National Center for Health Statistics (Adams &
Benson, 1992) estimated that more than 22.5 million Americans have some
degree of hearing loss. Of these individuals, 1,053,000 were under 18
years of age. This means that one of every six children has diminished
hearing to some degree at any given point in time (Berg, 1986). Schildroth
and Hotto (1994) reported results of demographic information on 48,300
children identified as having hearing losses. The students in their research
represented 60-65% of the number reported by the federal Office of Special
Education Programs (OSEP), U.S. Department of Education. The vast number
of individuals with hearing losses are hard of hearing or are older adults
who have lost their hearing.
What are the signs of a hearing loss, and how is it
diagnosed?
In very young children the signs of a hearing loss are
lack of attention or inconsistent attention, lack of vocal interactions
or reduced vocal interactions, and lack of or reduction in language development,
especially related to the quiet word endings such as -ed, -ing, and -s.
In school-aged children, the signs of a hearing loss are a high degree
of frustration with school and with others, low grades or a noticeable
drop in grades, or a change in patterns of paying attention (Davis, 1989).
In adults, the signs of a hearing loss are complaints that others are
mumbling or playing equipment such as the TV or radio too loudly.
How do people with hearing losses communicate?
The debate over the best way to teach a child with a
hearing loss to communicate has raged since the 1500s (Winefield, 1987).
Although this debate continues today, there is a growing number of individuals
who recognize that no one system of communication is right for all children.
The choice of a communication system must be made on an individual basis,
taking into consideration the characteristics of the child, the resources
available, and the commitment of an individual family to a communication
method. Additional ERIC digests explore each of these options in depth.
As an orientation, the following definitions are useful:
The Auditory-Verbal philosophy is a set of guiding principles
for early intervention that are used to support the development of residual
(remaining) hearing and speech and that focus on a strong development
of listening skills (see ERIC Digest E552 (ED414670)). The Auditory-Oral
philosophy is a set of principles that are used to develop spoken language
and listening skills at all ages and that may incorporate visual methods
of teaching these (see ERIC Digest E551). Cued Speech is a sound-based
system of hand cues that supplement speechreading. English-Based Sign
Systems are those systems that use signs from ASL plus invented signs
along with prefixes and suffixes to represent the English language in
signed form. The Bilingual-Bicultural philosophy stresses the importance
of early development of ASL, which has a grammar different from spoken
or signed English, as the deaf child's natural language, using ASL as
a bridge into English as a second language. Total Communication (see ERIC
Digest E559 (Ed414677)) refers to a philosophy of using the system most
needed by the child at any given time. Total Communication usually involves
simultaneous use of speech and sign and is the most commonly used form
of instruction (Schildroth & Hotto, 1993).
Other factors complicate the picture of which system
should be used to teach children who are deaf and hard of hearing to communicate.
Cochlear implants are computerized devices implanted into the cochlea
of individuals who are deaf, which influence the ability to develop speech
and listening skills (see Digest E554 (ED414672)). They are supported
by the various oral philosophies. Attendance at a residential school (see
ERIC Digest E558) is considered a key component in the success of a child
whose family has chosen the Bilingual-Bicultural approach to education.
The presence of additional learning disorders (see ERIC Digest E553 (ED414668))
may also affect a child's progress in any method or philosophy; therefore,
this challenging-to-test population must be assessed adequately (see ERIC
Digest E550 (ED414675)).
Where are children who are deaf or hard of hearing educated?
According to the annual report of the Center for Assessment
and Demographic Studies (CADS) at Gallaudet University (Schildroth &
Hotto, 1996), 21% of the students in the study attended residential schools,
8% attended day schools, and 70% attended their local schools. These figures
represent about 60-65% of the children reported on the federal child count,
and the assumption is often made that the additional students not in the
CADS study are being educated in local education agencies that are unaware
that they may participate in the CADS process. Whatever the reason, over
the past two decades, more and more children who are deaf or hard of hearing
are receiving instruction in general education environments (see ERIC
Digest E557).
What kind of technology is available for people who
are deaf or hard of hearing?
Today the options for support from technology
are exciting. A wide variety of hearing aids can be tailored to individual
patterns of loss. Students in classrooms may use a variety of assistive
listening devices that help them hear the teacher while filtering out
ambient noise. Telecommunication Devices for the Deaf (TDDs) are available
to provide people who are deaf with access to telephones (Compton, 1991).
Many states have relay services that work in conjunction with TDDs. Television
sets are now produced with built-in closed captioning capabilities, or
for older TVs, viewers may purchase captioners. A variety of alerting
devices are available which use visual means to alert individuals to doorbells,
telephones, a knock at the door, a baby's crying, oven timers, and smoke
detectors, among other sounds of daily life. Vibrating devices may be
used in place of an alarm clock. In addition, computer technology such
as fax machines, programs for teaching speech, real-time graphic display
devices for recording lectures, and a myriad of machines and programs
are affecting education and daily life to an ever-increasing degree.
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| References
Adams, P.F. & Benson, V. (1992). Current estimates
from the National Health Interview Survey, 1991. Vital and Health Statistics,
Series 10. National Center for Health Statistics.
Berg, F. (1986). Characteristics of the target population.
In F.Berg, J.C. Blair, J.H. Viehweg & A. Wilson-Vlotman (Eds.), Educational
audiology for the hard of hearing child. (pp. 157-180). New York: Grune
and Stratton.
Compton, C. (1991). Assistive devices: Doorways to independence. Washington,
DC: Gallaudet University.
Davis, D. (1989). Otitis media: Coping with the effects
in the classroom. Stanhope, NJ: Hear You Are, Inc.
Easterbrooks, S. & Baker-Hawkins, S. (1994). Deaf
and hard of hearing students educational services guidelines. Alexandria,
VA: National Association of State Directors of Special Education.
Individuals with Disabilities Education Act, PL 101-476.
(1990).
Schildroth, A. & Hotto, S. (1994). Annual survey of hearing impaired
children and youth: 1991-92 school year. American Annals of the Deaf,
138(2), 163-171.
Schildroth, A. & Hotto, S. (1996). Changes in student
program and characteristics, 1984-85 and 1994-95. American Annals of the
Deaf, 141(2), 68-71.
Padden, C. & Humphries, T. (1988). Deaf in America:
Voices from a culture. Cambridge, MA: Harvard University.
Winefield, R. (1987). Never the twain shall meet. Washington,
DC: Gallaudet University Press.
Many organizations promote the understanding and use
of the philosophies and technologies mentioned above, including:
Alexander Graham Bell Association for the Deaf
American Society for Deaf Children
Committee on Persons Who are Deaf/Hard of Hearing
Committee of the Division for Children with Communication
Disorders [DCCD] of the Council for Exceptional Children [CEC]
Convention of American Instructors of the Deaf
Conference of Educational Administrators Serving the
Deaf
National Association of the Deaf
National Cued Speech Association
SEE Center for the Advancement of Deaf Children
A more comprehensive listing of these agencies can be
found annually in each April edition of the American Annals of the Deaf.
Dr. Easterbrooks is Associate Professor of deaf education,
Georgia State University and chair, Committee on Persons who are Deaf/Hard
of Hearing, Division for Children's Communication Development (DCCD),
The Council for Exceptional Children.
ERIC Digests are in the public domain and may be freely
reproduced and disseminated. This publication was prepared with funding
from the Office of Educational Research and Improvement, U.S. Department
of Education, under contract no. RR93002005. The opinions expressed in
this report do not necessarily reflect the positions of policies of OERI
or the Department of Education.
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