Alison King, MSP, CCC-SLP, LSLS Cert.AVT

Gain a better understanding of the unique role that medical and educational facilities have in assisting students who have a hearing loss Gain an understanding of hearing loss as a medical diagnosis Learning to recognize the unique speech and language characteristics of students who have a hearing loss based on communication methodologies Learn how to find other resources which may be beneficial for you as a professional to best serve your student’s needs

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In 2005, 91.5% of the nearly 4 million babies born in the US had their hearing screened prior to leaving the hospital (CDC). Early Hearing Detection and Intervention (EHDI) laws or voluntary hearing screening programs are in place in all 50 states and the District of Columbia (ASHA, n.d.). 1 month= All infants are screened for hearing loss prior to discharge from birthing/neonatal facilities, or within one month of birth. 3 months= All infants referred from the screening process complete diagnostic audiological evaluation. 6 months= All infants with diagnosed hearing loss receive appropriate interventions including amplification and Early Intervention.

Medical definition – clinical measure (arbitrary) used to determine eligibility for federal benefits Educational definition – considers the impact of hearing loss on educational performance

"Deafness" means a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects the child’s educational performance. 34 CFR § (c) (3) "Hearing Impairment" means an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but that is not included under the definition of deafness in this section. 34 CFR § (c) (5)

Virginia DOE Statistics 2010 Child Count Data There were 1,473 students between the ages of that had the label of Hearing Impairment and 25 who had the label of Deaf-Blindness. hild_count/

There were 357 students provided services in state operated programs. 111 students provided services at VSDB Staunton. –HI – 71 (under 5% of total population) –VI – 35 –DB – 5

Congenital – hearing loss is present at birth –Genetic –Prenatal infections (ex. CMV) Acquired – hearing loss after birth –Progressive hearing loss (hereditary) –Trauma (Turn down your earbuds!) –Ototoxic medications –Otitis Media (ear infections) Important to note that it is estimated that 90-95% of all children born with a hearing loss are both to parents with normal hearing. (White, 2006).

Conductive -Occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones of the middle ear. This type of hearing loss can often be corrected medically or surgically. Sensorineural - (SNHL) occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected. Mixed – Combination of both conductive and sensorineural

dB (decibels) – loudness level Hz (hertz) – frequency (pitch)

Degree of hearing lossHearing loss range (dB HL) Normal–10 to 15 Slight16 to 25 Mild26 to 40 Moderate41 to 55 Moderately severe56 to 70 Severe71 to 90 Profound91+

Hearing aids – Selected and programmed based on an individual’s loss (dB and frequency) Cochlear implants – Does NOT restore hearing! Used for sensorineural hearing loss or auditory neuropathy

How Cochlear Implants Work

ASL (American Sign Language) – bilingual approach which uses American Sign Language and English; ASL has it’s own distinct grammar and linguistic principles.

Auditory-Verbal- Emphasis of developing spoken language through listening

Auditory-Oral - An approach that teaches a child to use his/her remaining hearing through amplification and the use of speechreading/natural gestures/visual cues to aid the child’s understanding of language.

Cued Speech - An auditory-visual communication approach with the use of hand cues with the natural mouth movements of speech, specifying each sound (phoneme) of spoken language clearly wUQhttp:// wUQ

Simultaneous Communication- an educational philosophy that uses spoken language and sign language simultaneously. The sign is English-based. MeGSIixY4jchttp:// MeGSIixY4jc

Dependent communication methodology being used Have a clear understanding of where the child is with regards to auditory, speech, and language or sign development Sit on the side of the “better” ear Best practice = personal FM systems Best to say it again in the same way – child is still processing how you said it the first time Have child repeat back directions Have high expectations Never Assume!

The first seven years of life are critical for learning verbal language. Past those 7 years, it becomes much more difficult to acquire verbal language and the window of opportunity slowly closes neurologically (Lillard & Erisir, 2011). Demographic data suggests that 40% of all students with a hearing loss have a secondary disability (Wiley & Moeller, 2007). Due to UNHS, hearing loss is identified prior to many of these disabilities (i.e. autism, learning disabilities).

Yoshinago-Itano (2003) found that early identification of hearing loss and early amplification by either the use of hearing aids or cochlear implants have positive effects on the language, speech, and social-emotional development of children. As professionals, we must support parental choices!

Families have options. If they choose for their child to use sign, then they must learn sign at a faster rate than the child. The development of sign language does not equate exactly to the development of spoken language. Auditory skills are developmental and coincide with language and speech development.

Without access to sound, a child with a hearing loss will not develop articulation and vocal quality the same as their hearing peers – physiologically impossible. However, with early and appropriate amplification, a child with a hearing loss can develop articulation and voice commensurate to their hearing peers.

Personal FM systems – connects directly to the HA or CI Decreases the “distance” factor Provides the best opportunity for the child to hear and not miss important information from the teacher. Soundfield amplification – speakers in the classroom

Things to consider… –History –Communication modality –How long they have been hearing –Parental choices –LRE (?) It is all about LANGUAGE!

Early Identification –UNHS Early Amplification –Parental decision Early Intervention –Communication methodology can change over time based on the child/family needs –Language learning is the key!

Who decides what (or if) amplification should be used? Who decides what communication option should be used? When are these decisions made? What is the role of EI providers and Early Childhood Educators?

What are 3 important items that we need to take away from tonight?

AG Bell Association for the Deaf and Hard of Hearing National Cued Speech Association National Association of the Deaf VCU Cochlear Implant Program

American Speech-Language Hearing Assocaition. (n.d.). Early Hearing Detection and Interventon (EHDI). Retrieved from: Lillard, A. & Erisir, A. (2011). Old dogs learning new tricks: Neuroplasticity beyond the juvenile period. Developmental Review, 31 (4), Virginia Department of Health. (2003). Virginia early hearing detection and intervention Program 2003 annual report. Retrieved from: cuments/2012/publications/pdf/2003.pdf. White, K. R. (2006). Early intervention for children with permanent hearing loss: finishing the EDHI revolution. The Volta Review, 106, Wiley, S. & Moeller, M. (2007). Red flags for disabilities in children who are deaf/hard of hearing. The ASHA Leader. Retrieved from Yoshinaga-Itano, C. (2003). From seening to early identification and intervention: discoveringpredictors to successful outcomes for children with significant hearing loss. Journal of Deaf Studies and Deaf Education, 8(1),

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