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CONDUCTIVE HEARING LOSS

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1 CONDUCTIVE HEARING LOSS
Do You Hear What I Hear? Living and Learning with Conductive Hearing Loss/Otitis Media Kit WA Department of Education Welcome participants then introduce yourself and give participants some background information about yourself. Give housekeeping details – location of toilets; morning tea and lunch time breaks; availability of kits; etc. Let participants know that the workshop will be interactive and will involve group activities. Also let them know your preference for timing of questions they may have (e.g. at anytime during the day OR at the end of each section).

2 Impact of Otitis Media is Multi-Factorial
Age at which the child experienced the first incidence of OM Number of incidences under the age of 12 months Access to good medical intervention Access to certain types of interactions within the family Access to audiology and speech pathology Child’s general health The impact OM has on children will be determined by a range of factors including the disposition of the child and his/her general health, plus external factors such as access to health and allied health services and home and school environments. Otitis Media in the first 12 to 18 months of life has much more serious consequences than OM in later childhood.

3 Oral Language is fundamental …
Speaking and listening provide the foundation for all language learning and underpin the successful development of reading and writing skills. Proficiency in speaking and listening contributes to children’s abilities to learn effectively in all learning areas. First Steps: Oral Language Developmental Continuum This is an assumption that underpins the section that follows and the strategies advocated in the kit. You may want to invite some discussion. Sometimes participants may question “speaking and listening provide the foundation for all …” in the light of AUSLAN (Australian Sign Language, the signing system frequently used by severely and profoundly deaf people). AUSLAN is recognised as a language in its own right and it has its own unique grammatical structure that differs from Standard Australian English (SAE). This means children whose first language is AUSLAN learn SAE as a second language. Not surprisingly, their hearing impairment and learning SAE as second language means that these children generally do not achieve learning outcomes comparable to their hearing peers.

4 Cultural Considerations
Language is the repository of the speakers’ cultural knowledge and reflects their world view. When we devalue a language we devalue everything contained within and reflected by it. The Western school system is set up to reflect a literate tradition. It assumes all children come to school knowing how to work with language in a de-contextualised manner. We need to be aware that children may come to school with rich language experiences from predominately oral traditions and cultures. Consider many Aboriginal children’s knowledge and understanding of their family, the relationships and responsibilities that exist between family members. The Aboriginal child’s family is highly likely to consist of parents, grandparents, brothers/sisters, uncle-fathers/aunty-mothers, cousin-brothers/cousin-sisters, etc. Ask a non-Aboriginal child about family and you get a very different picture. Another example is the word ‘home’, which for non-Aboriginal people conjures up a picture of the house in which we live. For Aboriginal people it is their country, unbounded by walls, and wherever family is. Literate Language (written and spoken) is formal and de-contextualised. It allows us to talk about: Experiences we’ve had but haven’t shared with the listener Places we’ve never been Times we’ve never lived through Issues and abstract ideas It is characterised by more specific vocabulary, complex sentences, clearer organisation and greater use of conjunctions. Aboriginal children (and other culturally and linguistically diverse groups) may not be familiar with Literate Language and will need to be taught this style. They come from an Oral Language tradition, which is informal and contextualised. Such language is used when we have shared the same experiences, know the same people and have a shared world view. e.g. “ ‘e’s gonna come ‘ere and ‘e’s gonna take that thing then e’s gonna go to aunty’s ‘ouse and they’ll take ‘im there.” In this example, we don’t know who ‘he’ is, what ‘that thing’ is, who aunty is, who ‘they’ are and where ‘there’ is. If we were part of this child’s family, part of this experience, we’d be very likely to understand it. For more information about culturally appropriate teaching/learning, the following resources may be useful: “Deadly Ways to Learn” Project resources including “Deadly Ideas”, “Deadly Yarns”, “Deadly Ways to Teach” video, “Talking Deadly” video. “Ways of Being; Ways of Talking” – videos and support materials “ABC of Two-Way Literacy and Learning” Aboriginal Education teams in district offices, Aboriginal Education, Training and Services Directorate in Central Office, ESL/ESD team in Central Office

5 Impact of CHL on Speech and Language Development
Hearing children learn the basics of language passively, by hearing it. This avenue is not open to children with hearing losses. Creates a barrier for normal speech development and phonological processing Causes delays in the development of a child’s first language and any additional language, particularly when the hearing loss begins at a very young age: Poor vocabulary and semantic organisation Expressive and receptive language difficulties – language structure, word endings, grammar, word order etc. For Aboriginal children, diminished auditory experiences can affect opportunities for learning about culture, law, relationships, etc. (Clarke, 1992) Any interruption in a child’s ability to hear, even an intermittent interruption such as that typically experienced with CHL, will have a negative impact on speech and language development. This is particularly so if the interruptions occur in the first 12 to 18 months of life. This interruption will certainly impact on a child’s ability to access the curriculum at school but also on his/her ability to access cultural knowledge, which is critical in building an individual’s sense of identity and belonging. For more information about speech and language development and how it is impacted by the presence of CHL (or language disorder) contact the Speech and Language team, based at the Centre for Inclusive Education (Hale House), telephone Also check out the website: and:

6 Impact of CHL on Comprehension
‘Oral comprehension’ relates to the ability to understand the meaning of what is spoken. Comprehension is dependent upon context, previous knowledge and experience, sentence length, concepts and attention. (adapted from Health Department of WA Teacher Modules, 2000) A child with CHL or a history of CHL probably has: Difficulty with lengthy or complex instructions An underdeveloped vocabulary including concepts and descriptive terms (e.g. in Preprimary will not understand concepts such as location [over/under…] or size, and descriptive terms [colour, shape]) Difficulty with some questions (e.g. in Preprimary can’t understand ‘wh’ questions [who, what, when, where]) A child in Preprimary with CHL will probably not manage instructions with more than two parts.

7 Impact of CHL on Semantics
Semantics refers to the link between our thoughts and ideas and the vocabulary and concepts we use to express these thoughts. Semantic organisation describes how we organise incoming information in order to make sense of and later retrieve it. (adapted from Health Department of WA Teacher Modules, 2000 ; Holt & Spitz, 2000) In Preprimary, a child with CHL or a history of CHL probably: Has a vocabulary of less than 1500 words Speaks in sentences of < 3 to 5 words Doesn’t use language socially Is slow to learn words and concepts (due to ‘fuzzy’ representations) ‘Fuzzy’ representation refers to an inconsistent representation of words in a child’s brain meaning he/she will be unsure of their precise form. For example, “sun” may be heard as sun, un, fun, done, thumb, one, etc., and when asked to name a picture of the sun, the child may produce any one of these options. This means the child with CHL is uncertain of how words are correctly pronounced or what they might mean when said. This obviously has a considerable impact when written language is being introduced and children are being called upon to learn sound-symbol relationships. (See slide 47)

8 Impact of CHL on Semantics
Other indicators may be : Difficulty integrating new information with existing Limited conceptual understanding Under-developed receptive and expressive vocabulary Difficulty retrieving words Difficulty generating ideas related to a topic Conversational difficulties If teachers use brainstorming techniques when introducing a new topic or concept, children with CHL frequently have difficulty offering suggestions. However, using a thematic approach to teaching can be very beneficial because it helps children with their semantic organisation (likened to an internal filing cabinet and the ways in which we organise new and existing information in our brains).

9 Impact of CHL on Syntax Syntax or grammar refers to the way we organise words into sentences. Grammatical rules tell us which words should come before or after others, the word endings we should use and the way words combine to form sentences. (adapted from Health Department of WA Teacher Modules, 2000 ; Holt & Spitz, 2000 ; Owens 1992) Problems with forming linguistic categories such as plurals and tenses Grammatical errors and unusual word order Incomplete sentences Restricted use of describing words (adjectives/adverbs) and connectors (but, then, because, so …) Many languages do not mark plurals (i.e. adding ‘s’ to a word) or tenses (e.g. adding ‘ing’ or ‘ed’ to a verb) in the same way as English, so a child from a culturally and linguistically diverse background who is learning ESL/ESD will have to be taught about plural and tense markers. If this child also has CHL it will be more challenging because he/she is unlikely to hear ‘s’ anyway. It is a high frequency speech sound that is missed (refer back to the audiogram of familiar sounds and the speech banana).

10 Impact of CHL on Narrative (Oral Texts) Skills
Narratives/Oral texts encompass such genres as stories, reports, procedures, explanations, recounts and news telling. The common feature of these genres is the linguistic structures that are used to tell and retell a series of events in time order. (Adapted from Health Department of Western Australia Teacher Modules, 2000 ; Holt & Spitz, 2000) The Western-style narrative structure tends to be linear in nature and uses a distinct model that may be difficult to understand for Aboriginal and other CALD students. If a child has hearing problems they are likely to have additional problems with story grammar and descriptive vocabulary. Oral Texts are about half way between the continuum from Oral Language (informal and contextualised) to Literate Language (formal and decontextualised) – refer back to slide 40. Western-style narratives have a beginning, middle and end, and tend to follow a temporal (time) sequence. Aboriginal and other CALD (culturally and linguistically diverse) students may not be familiar with this style. For more information about Aboriginal story-telling styles and culturally appropriate teaching/learning, the following resources may be useful: “Deadly Ways to Learn” Project resources including “Deadly Ideas”, “Deadly Yarns”, “Deadly Ways to Teach” video, “Talking Deadly” video. “Ways of Being; Ways of Talking” – videos and support materials “ABC of Two-Way Literacy and Learning” Aboriginal Education teams in district offices, Aboriginal Education, Training and Services Directorate in Central Office, ESL/ESD team in Central Office

11 Impact of CHL on Phonological Processing
Phonological processing relates to the ability to use the sounds of a language to process oral and written language, which allows us to form phonological codes and access a word stored in our brain’s lexicon. Phonological awareness skills (explicit awareness of sound structure and ability to manipulate structure of words) are dependent on phonological processing skills. Need to hear words to learn words – to ‘map’ words to objects car? ar? bar? tar? … Absence of second sound in two-letter blend (eg frog, block) Absence of unstressed syllable(s) (banana, dinosaur, balloon) Poor discrimination and identification of sounds Being able to process sounds accurately underlies a number of different but related skills including speech, rhyme and literacy skills. If you’re not processing sounds accurately you will probably not hear that two words rhyme or start/end with the same sound, and you probably won’t be able to spell words accurately. So, accurate phonological processing skills are essential if a child is going to have success with phonological awareness tasks and with literacy skills in general. The processing of the sounds we hear can be described as occurring in three phases: How it is received (input) – and this is where it breaks down for children with CHL How it is stored (remembered and represented) How it is produced (output) When a teacher begins to introduce single sounds in a Year 1 classroom, children with ‘fuzzy’ representations (inconsistent and inaccurate representations) will frequently have difficulty. For example, a child may begin to form the notion that ‘ar’ is a a ‘curly c’ word when the teacher introduces this sound (see slide 43). This problem compounds as the phonological tasks become more complex and demanding. Children who speak Aboriginal English will hear words differently and this will manifest itself in their writing. For example, the word magnet is pronounced ‘maganet’ because Aboriginal English does not put two consonants together.

12 Impact of CHL on Phonological Processing
Australian English speech sounds with which ESL/ESD speakers frequently are not familiar: t, d, th a, e, ir, ai f, v, b, p, k, g o, o-e, oo/u, u-e s, z, sh, ch, j u, i-e, oi, ai ee, i, e, a o, oar, ar, oi, ir a, ar, u, ow (Adapted from Making the Jump, Catholic Education, Kimberley, 1997) Consider the similarities between these sounds (voice, placement of lips and tongue). If a child can’t hear a sound correctly he/she will have considerable difficulty learning to say it correctly, particularly if he/she is reliant on visual differentiation. This is the range of sounds or distinctions with which Aboriginal children may not be familiar. They will need to be trained to hear and produce these sounds. The presence of CHL will make this much more challenging.

13 Impact of CHL on Metalinguistic Skills
Metalinguistics refers to the ability to use language to think, talk about, reflect on and manipulate units of language. Don’t know how to play with sounds and words, eg rhyming Don’t know what a ‘word’ is so have difficulty understanding word boundaries and segmenting sentences into words: “Ontheweekend”, “smorning” If children are presented with the written words ‘car’, ‘cat’ and ‘hat’, have these words read to them and are asked to circle the two that rhyme, they may well use visual similarities (cat and hat) and respond with the correct answer. Using pictures is a more effective way of determining if children understand rhyme. “smorning” = this morning

14 Impact of CHL on Metalinguistic Skills
Difficulty manipulating words within words (eg take ‘sun’ from sunshine); syllables in words (eg take ‘ing’ from doing); sounds in words (eg boat has 3 sounds: b / oa / t; take ‘c’ from coat); and blending sounds to make words (eg s – t – o – p) Poor understanding that words are arbitrary symbols of a language system – words usually don’t contain any hint of their meaning Problems working out how communication breaks down Words are just arbitrary symbols of the language system - Words do not normally contain any hint of their meaning. The sound of the word chair does not suggest chairs, nor does the sound of dog suggest dogs. For example, the French word chien, Russian sobaka and Noongar dwert all refer to ‘dog’ even though they represent radically different sound symbols. Most of us have experienced that sensation of a ‘misunderstanding’ or a communication breakdown, and can figure out how it has happened and when, even if we don’t always want to take responsibility for it!! Children with metalinguistic problems will have difficulty working this out – they may think that what they mean when they say particular words and phrases is exactly the same as everyone else means when they say the same thing. A good example of this is the adolescent use of the word ‘wicked’ meaning great or fantastic, whereas the standard meaning of it is quite the opposite!

15 This is a slide for light relief
This is a slide for light relief. It serves to illustrate how sophisticated our knowledge of the English language has to be for us to find this amusing!

16 Impact of CHL on Pragmatics
Pragmatics relates to the use and functions of language for communication. Pragmatic awareness is the knowledge of conversational rules and includes both verbal and non-verbal aspects. (adapted from Holt & Spitz, 2000 ; Owens 1992) Children with a hearing difficulties may have problems with: Entering into a group, requesting, responding and taking turns Initiating conversations Understanding subtle social rules Accepting others points of view and others’ feelings Monitoring the listener Pragmatic skills are essential building blocks for successful social interactions. Pragmatics are culturally determined and it’s important to recognise that some of the pragmatics of Standard Australian English may not only be unfamiliar but also culturally inappropriate for Aboriginal (and other) students in their home environments, e.g. eye contact, how close you stand to people, etc. When a child is said to be having ‘social problems’ you’ll often find that the cause of these problems is that the child has not learned or doesn’t understand these pragmatic rules. If you teach them, the ‘social problems’ may well disappear! Children with CHL may have spent so much time just trying to understand the spoken language around them that they may not have picked up the pragmatic conventions.

17 Impact of Hearing Loss on Socialisation
Children with hearing difficulties, however, are also likely to present with social and emotional challenges due to: Their own frustration and/or the frustration of their peers Avoidance Just not “getting it” i.e. the subtleties and unwritten rules of social exchanges Peers may be frustrated by the acting out behaviours of a child with CHL, and/or the amount of teacher time the child takes, and/or the inability of the child to understand and follow the rules of activities and games, and/or the inappropriate social (pragmatic) skills of the child. Avoidance may be manifested in many ways, e.g. withdrawing, being quiet and shy, using strategies like frequent pencil sharpening and dropping work materials on the floor, or more overt and aggressive behaviours.

18 Summary of Educational Impact of CHL
More than three infections under the age of 12 months is a significant risk factor Even without a current ear infection children can still suffer the effects of a history of conductive hearing loss Poor ability to discriminate sounds in words and to hear words in words; difficulty chunking words into individual parts; and relationship between own sound repertoire and written alphabet is tenuous Language learning difficult; frequently have restricted content, vocabulary, language and confidence; prediction as a reading strategy is not functional except with simple or familiar texts Poor foundation for literacy and without help will fall further behind every year Socialisation difficulties and behaviour problems are likely The most debilitating aspects of deafness are secondary to the hearing impairment itself It is important to remind participants that even in a teenage student who has not experienced CHL for many years, the effects of that CHL are probably still impacting today.


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