Understanding Deafness/Hearing People with normal hearing can’t fully appreciate the enormous importance of the auditory sense in human development and learning.
Definitions Medical-defines hearing loss on a continuum from mild to profound Educational-defines hearing loss on a child’s ability to use his hearing to understand speech and learn language and effects of educational performance
Category Labels Used by IDEA Hearing impairment Deaf Residual hearing Hard of hearing
Is Hearing a Disability? Deaf People Live, Proudly in Another Culture, But Not a Lesser One
How We Hear audition function auricle sound wave energy transferred vibration inner ear
The Nature of Sound Intensity Frequency Zero decibels Hertz
Characteristics of Deaf Students or Hard of Hearing Students Three qualifications:
English Literacy Disadvantage Not spontaneous Small vocabularies Omit ending words Differentiating questions from statements
Speaking Difficulty in all areas Significantly lower than peers As they age gap widens
Academic Achievement Most children with hearing loss have difficulty with all areas of academic achievement, especially reading and math.
Hearing loss may affect the child’s socialization and create social problems. In one study done in 40 deaf and hard of hearing children, 50 percent reported trouble with friendship and being accepted by peers. In the same study it was found that children with hearing loss were more likely to have behavioral difficulties in school and social situations. Missing a teacher’s language tone can affect the way the student responds, which can lead to behaviors which may come across as inattentive, off task, or rude.
Social Functioning Hearing problems also may lead to children feeling depressed, withdrawn, and isolated, according to one study. Another study done by Kluwin was performed in 1985 to determine what the most frequently related factor to deaf students who were perceived as disruptive in class. -----The factor found was reading ability. Students who were poor readers were the most apt to have behavior problems in school.
Social Functioning Research has not been too clear as to the extent to which hearing loss can affect social functioning. Attitudes of the community members in which the child is a part and their ability to mutually communicate can affect the way the child has success. It has also been found that deaf children with deaf parents may be more socially mature and have better communication systems than deaf children with hearing parents.---The cause of this is mutual communication that can be found between the deaf family. Most with deafness or hearing loss can live in harmony with their peers when COMMUNICATION is in place.
Prevalence 95 out of 1,000 people have CHRONIC hearing loss(American Speech-Language-Hearing Association) 28 million Americans experience some problem with processing and receiving auditory communication. The largest group was adults.---54% of people over 65 years old experience some problems with hearing. 83 out of 1,000 children in the U.S. have an educationally significant hearing loss. 9 out of 1,000 children experience profound hearing loss.
Related Conditions 25% of students who are deaf or have hearing problems have another disabling condition --learning disabilities 9% --mental retardation 8% --vision problems 4% --emotional or behavioral problems 4%
Types and Causes There are 2 main types: --Conductive hearing loss results from abnormalities or complications of the outer or middle ear. A buildup of excessive wax in the ear canal can cause this, as can a disease that leaves fluid or debris. Some children are born with incomplete auditory canals. ***Conductive hearing loss involves a problem with transmitting sound vibrations to the inner ear.
Types and Causes --Sensorineural hearing loss refers to damage to the auditory fibers or other mechanisms in the inner ear. --Surgery or medication cannot correct most of this type of hearing loss. **MIXED HEARING LOSS is when a person has a combination of conductive and sensorineural impairments.
Age of Onset Congenital—present at birth Aquired—appears after birth Prelingual—before spoken language Postlingual—after the development of spoken language Of the deaf and hard of hearing, 95% of students in special education have a prelingual hearing loss. This type requires more assistance with language acquisition and communication skills.
Causes of Congenital Hearing Loss Genetic Factors—more cases deal with genetic abnormalities rather than deaf parents passing a “deaf” gene to their children. Maternal Rubella—rubella has relatively mild symptoms usually, but can cause deafness when it affects a pregnant woman in her first trimester. Congenital Cytomegalovirus(CMV)—a common viral infection that 1% of infants have this virus in their saliva. Prematurity—early delivery and low birth weight are more common among children who are deaf rather than among the general population.
Causes of Acquired Hearing Loss Otitis Media—a temporary recurrent infection in the middle ear, also the most common medical diagnosis for children. 90% of children experience this infection at least once, and 1/3 of children under age 5 have recurrent episodes. If antibiodics are used, the infection will go away, but if not hearing loss is common. Meningitis—the leading cause of postlingual hearing loss. A bacterial or viral infection of the central nervous system that can destroy the sensitive acoustic part of the inner ear. Children with this condition usually have profound hearing loss.
Causes of Acquired Hearing Loss Meniere’s Disease– a rare disease that causes sudden and unpredictable attacks of vertigo, fluctuations in hearing, and ringing. Often occurs in the middle aged,but can also affect children under 10. Noise-Induced Hearing Loss—too much noise pollution (very loud sounds) can cause hearing loss.
Assessment of Infants The earlier the hearing loss is identified, the better. --early intervention --language and communication development Hearing loss often goes undetected in many children. All babies can make sounds, but until complex language development occurs, it is harder to find. **Figure 9.2 on page355 shows the expected auditory behaviors in young children. As of 1999 in most states, a hearing screening is mandatory for all newborns. --auditory brain stem response—sensors are placed on the scalp and measure electrical activity as the infant responds to the stimuli. --otoacoustic emission screening—a tiny microphone is placed in the baby’s ear to detect the “echoes” of hair cells in the cochlea as they vibrate to sound.
Pure-Tone Audiometry and Speech Audiometry Pure-tone audiometry is used to assess the hearing of older children and adults. An audiometer is an electronic device used that generates sounds at different levels of intensity and frequency. The child or adult raises their hand when sounds are heard. The results of the test are plotted on an audiogram. ***See the audiograms on Figure 9.3, page 358- 359. Speech audiometry tests a person’s detection and understanding of speech. A list of one and two syllable words is presented at different levels. If the person can understand half of the words, they are not considered hearing impaired.
Alternative Audiometric Techniques Play Audiometry—a child performs simple activities when they hear a signal. Operant Conditioning Audiometry—a child receives a token or candy when they push a lever in response to a sound. Behavior Observation Audiometry—an assessment procedure in which the child’s reactions to sounds are observed.
Degrees of Hearing Loss Slight Mild Moderate Severe Profound Some children hear at different degrees of clarity, and some children hear at different levels from day to day.
Hearing Aids Hearing aids are amplification devices that make sounds louder. Early hearing aids amplified sounds without discrimination, but now can be tailored to each child’s needs. Many different sizes and shapes exist, but all pick up sound, magnify sound’s energy, and delivers it louder to the middle ear. Hearing aids only make sounds louder, NOT CLEARER. The child wearing the device should wear it throughout the day. A noisy environment makes the hearing aid less effective.
Assistive Listening Devices Distance, noise, and reverberation are the major problems children with hearing loss will have in the classroom. This can be solved by using a group listening device. This is a radio link between the teacher and the child. The teacher wears a small microphone transmitter near the lips and the student will wear a receiver that doubles as a hearing aid. This device does not use wires because there is a radio frequency. This allows the teacher and student to move freely about the room. This listening situation is the same as the teacher and the student being only six inches away from each other at all times.
Cochlear Implants Cochlear implants are not like hearing aids because they do not amplify sound. They bypass the damaged hair cells and stimulate the auditory nerve directly. The implant have four basic parts: External microphone External speech processor Transmitter Receiver/stimulator Electrodes will collect the impulses from the stimulator and send them directly to the brain by the auditory nerve.
Cochlear Implant Surgery TT he actual surgery takes about 2-3 hours with an overnight stay. 44 weeks later the patient will return for stimulation of the device and tune-up sessions. AA bout 14,000 people in the U.S. have received these implants with half being children between the ages of 2 and 6. There is not an optimal age for implantation, but earlier implantation seems to have better outcomes.
Controversy There is great controversy over this topic. Some feel it is a form of genocide to the deaf culture. Luterman (1999) offers an explanation for the position that it is difficult for most hearing people to understand: “People who have never heard do not experience hearing impairment as a loss. This is why they can believe, much to the consternation of the hearing population, that deafness is a cultural difference rather than a deficit. It would be analogous, for example, to those who had ESP thinking that the rest of us were terribly handicapped in our communication abilities, while we who do not possess ESP and have never had it do not feel the least handicapped. The only way we would is if those who had ESP constantly reminded us of our deficiency and tried to “fix” us.”
Supports and Technologies That Supplement or Replace Sound There are five supports and technologies that students with a hearing impairment can use to increase communication. They are: 1.Interpreters 2.Speech-to-text translation 3.Television captioning 4.Text telephones 5.Alerting devices
Interpreters Definition of interpreting: signing the speech of a teacher or other speaker for a person who is deaf. It began as a profession in 1964 with the establishment of the Registry of Interpreters for the Deaf (RID), There are many states who trained interpreters must meet the standards of RID to be certifies by them. Initially the organization was used for deaf adults in situations such a legal or medical interactions. There are also educational interpreters (AKA educational transliterator). These people make it possible for students to successfully complete postsecondary programs. There is also a greater number in the elementary and secondary classrooms being seen. They perform jobs such as tutoring, assisting regular and special education teachers, keeping records, and supervising students with hearing loss.
Speech-to-text translations It is called computer aided speech-to-text translation (C-Print). The was created by the National Technical Institute for the deaf at the University of Rochester. How it works… Trained captionists type the teacher’s lecture and other student comments into a computer using shorthand. The computer uses special software to translate the code and the words will appear on the student’s screen about 3 seconds after the word is spoken. An example of the shorthand would be --- kfe for coffee The text will stay on the students screen for about 1 minute. These captionists eliminate redundancies, identify key points, and condense information in the fly, while trying to keep as close to the original as possible.
Television Captioning Most regular programming today has the availability of captioned text. This is printed text at the bottom of the screen that is similar to watching a film with subtitles. In 1993 a federal law required that all television sets sold in the U.S. be equipped with an internal device that allows users to position captions anywhere on the screen. Educational Setting: In the educational setting, it was found that deaf students comprehend more from scripts that were accompanied by video than by reading just scripts alone. This suggests that the visual stimulation can help the deaf viewers improve their comprehension. Lewis and Jackson suggest that television literacy might advance the reading skills of the deaf students by exposing them to English vocabulary and syntax.
Text telephones The telephone served as a barrier to deaf people in employment and social interaction for many years. They now have acoustic couplers to send immediate messages over conventional telephone lines in typed form. They can send a typed message over the telephone to anyone who also has a TT. The American with Disabilities Act said that TT’s should be available in public places. You can find them in : Airports Libraries All states have a relay service where an operator who will relay the messages so that they may communicate with a person on a conventional phone.
Alerting Devices Some individuals who are deaf use special devices to alert them of special sounds or events. These events can include: A doorbell An alarm-clock A fire alarm These devices are usually a sound or vibration sensitive switch connected to a flashing light or a vibrator. There are also alerting dogs that can sense these sounds.
Over the years, many philosophies, theories, and specialized methods have been used to teach children who are deaf. Many have been promoted and many have been denounced by all people. Table 9.1 gives the historical events that led up to this point. Pg.366-367 The primary function of all teachers of students with hearing loss is the development and use of language and communication skills. There are three approaches to teaching these students: Oral/aural approach Total communication Bilingual/bicultural approach It is said that the content of the subject is not as important as the chance for those students to use language expressively and receptively.
Oral/Aural Approaches Educational approaches with an oral/aural emphasis train students in producing and understanding speech in all aspects of their education. Prior to the 1970’s, oral/aural approaches were widely used in the U.S. Now only about ¼ of these educational programs identify themselves as solely oral/aural. Children in these programs will use several different means to develop residual hearing and to speak intelligibly. These are: Auditory Visual Tactile They use amplification, auditory training, speech reading, technological aids, and talking.
Educators who use this approach acknowledge the difficulty for the teacher, the parents, and even the students. The students are the ones who have the most difficult time with it, but the reward is great and thought to be worth the effort. Most of these students will learn speech well enough to communicate effectively with hearing people. The best results are when the child experiences this program and is also integrated into the classroom for most of the day. Oral/Aural Approach continued
Auditory Learning Adults: Listening is 45% of our daily communication. Children: Listening is close to 60% of their daily communication. Many children with hearing loss have more auditory potential than they use. Their residual hearing can be improved by communication and daily experiences. All children, regardless of their communication preference, should receive training to help them improve their listening skills. How should this type of training occur??? It should begin by teaching young children awareness of sound. Parents can direct their child’s attention to sounds in their home (ex: doorbell, running water) They can then focus on the localization of sound. The next step is the discrimination of sounds.
Auditory learning continued The main focus of auditory learning is to learn to listen and to learn by listening instead of just listening to hear. There are four levels of auditory listening : Detecting Discriminating Identifying The comprehension of meaningful sounds (highest level of listening skills) Some teachers will conduct these sessions using only hearing. In all actuality though, the child will gain useful information from vision and the other senses. So all senses should be developed and used.
Speech Reading Definition: Understanding a spoken message by observing the speaker’s face. Children with any type of hearing loss and regardless of what type of communication they use will use vision to help them understand speech. Children can pay attention to the speaker’s lips and can derive words and important clues. Speech reading is very difficult and has many limitations. Some words appear the same through pronunciation. (ex: mat, bat, pat) Visual clues may be blocked by a hand, pencil, gum, or mustache. Some speakers do not move their lips at all when they speak. It is very tiring to watch lips for extended periods of time. Distance is always a factor when reading lips.
Speech Reading continued Walker (1986) estimates that even the best speech readers detect only about 25% of what is being said through visual clues alone. Shanny Mow (1973), a teacher who is deaf, graphically describes the frustrations of speech reading. “Like the whorls on his fingertips, each person’s lips are different and move in a peculiar way of their own. When young, you build confidence when you guess correctly “ball”, “fish”, and “shoe” on your teachers lips. This confidence doesn’t last. As soon as you discover that there are more than four words in the dictionary, it evaporates. Seventy percent of the words when appearing on the lips are no more than blurs. Lip reading is a precarious and cruel art which rewards a few who have mastered it and tortures the many who have tried and failed.”
Speech Reading continued Even though there are many problems with speech, reading it is still a valuable tool for a deaf or hard of hearing person. There are computer-assisted video instruction that have been developed by Bloomberg University. These can improve their speech reading skills by letting them practice speech reading themselves and others.
Cued Speech Cued speech is a method of supplementing oral communication. It gives a visual representation of spoken language by adding cues, in the form of hand signals near the chin, to assist in identifying syllabic and phonetic features of speech that cannot be distinguished through speech reading. These hand signals: Are used in conjunction with speech. They are not signs or alphabet letters and cannot be used alone. Eight hand shaped identify consonant sounds and four locations identify vowel sounds. A hand shape used with a location gives a visual identification of the syllable. Cornett (1974) feels that this is good for young children because it clarifies the pattern of spoken English and does not disrupt the pattern of natural speech.
Deafness: The Dilema by Bonnie Tucker pg 362-363 Some deaf people claim the right to personal diversity. They do not want to fix their hearing if that option ever came about. Some believe that it is their own ethnicity. At the same time they will demand to have interpreters, TTY’s, telephone relay services, specially funded educational programs, and close captioning, at no cost to themselves. It is argued that they have the right to not fix their “deafness”, but they should not expect society to pay for the resulting cost of that choice. Bonnie says, “ You can’t have your cake and eat it too”. What do you think???
Total Communication Also known as simultaneous communication, or simcom Educational programs with an emphasis on total communication support diversity in forms of communication to teach English to students with hearing loss.
Total Communciation Practitioners of total communication claim that signing and fingerspelling accompanied with speech make it possible for children to use either one or both types of communication. Most widely used method of instruction in schools for the deaf
Manually Coded English Teachers speak as they sign Teachers follow form and structure of spoken English as closely as possible Intention of the English-based sign systems is to facilitate the development of reading, writing, and other language skills
Manually Coded English Signing Essential English (SEE I) Signing Exact English (SEE II) Signed English Manually coded English borrows many signs and incorporates some of the features of American Sign Language Manually Coded English SEE I SEE II Signed English Signing Exact English
ingerspelling Manual alphabet Consists of 26 distinct hand positions (one for each English letter) Used to spell out proper names for which no signs exist Let’s play a game!!
American Sign Language Language of the Deaf culture in the United States and Canada A visual-spatial language in which the shape, location, and movement pattern of the hands; the intensity of motions; and the signer’s facial expressions all communicate meaning and content.
American Sign Language Has it’s own rules of phonology, morphology, syntax, semantics, and pragmatics Does not correspond to spoken or written English Some signs are iconic Most signs have little or no iconicity
Bilingual-Bilingual Approach 1990’s – Deaf community began calling for the use of ASL as the language of instruction. –Believe that ASL provides a natural pathway to linguistic competence and that English is better learned in the context of a bilingual-bilingual (bi-bi) approach after the child has mastered his native or first language (ASL)
Bi-Bi Approach –Proponents of this model view deafness as a cultural and linguistic difference, not a disability, and recognize ASL as the deaf child’s natural language –Goal to bi-bi education approach is to help deaf students become bilingual adults who are competent in their first language, ASL, and can read and write with competence in their second language, English.
Bi-Bi Approach Bilingualeducation L1 L1 literacy skills L2 The basic theoretical argument for bilingual education is that students who have a solid foundation in their native language (L1) will be able to use their literacy-related L1 skills as a springboard for learning the majority second language (L2).
Bi-Bi Approach Some related support for the bi-bi approach can be found in research finding a correlation between early exposure to and development of fluency in ASL and increased competence and English literacy.
U.S. Department of Education (2004) 82% attend public schools 45% regular classrooms 19% resource rooms for part of the day 22% separate classrooms 7% attend special schools
Educational Placement Alternatives Braden, Maller, and Paquin (1993) report that the performance IQs of children with hearing loss who were educated in residential schools increased over a 3- to 4-year period but that the scores of similar students in regular school day programs did not.
Educational Placement Alternatives Bat-Chava (2000) notes where a child who is deaf is educated also influences the likelihood of his or her cultural identity. Also, students are more likely to view hearing loss as a disability in schools where oral English is the language of instruction. Schools that use ASL in the language instruction view the deafness as a culture.
Educational Placement Alternatives Deaf or hard of hearing students must be provided with all speech and other auditory information by an educational interpreter. A skilled interpreter in the classroom, however, is no guarantee that students with a hearing loss will receive receive and participate in accurate communication.
Educational Placement Alternatives Stinson and Liu (1999) recommends the following for students with hearing loss: –Take responsibility and believe the outcome will be successful –Use communication skills for participating in the regular classroom –In small-group learning activities, carry out a specific task and share the information with the group
Postsecondary Education The percentage of students with hearing loss who attend postsecondary educational programs has risen dramatically in the past 20 years. 40% of all students with hearing loss go on to receive higher education
Current Issues and Future Trends Oral-aural and total communication will likely be used An increasing percentage of the deaf children served in special schools and self-contained classrooms will be taught with the bi-bi approach, where ASL is the language of instruction
Current Issues and Future Trends In the past, fundamental disagreement focused on the extent to which deaf children should express language through speech and perceive the communication of others through speechreading and residual hearing. The focal point today, however, is the language modality – auditory or visual – best suits a child’s acquisition of an initial language.
Current Issues and Future Trends Mahshie (1995) recommends letting the child choose his or her first language: –In environments where the Deaf child encounters both spoken and signed language separately – as whole language – during the course of natural interactions, it has become apparent to both parents and professionals that the child will be the guide regarding his or her predisposition toward a more oral or more visual language. In this win-win situation, the choice of a first language is clearly the child’s (p.73).