Introduction

While formal deaf education began hundreds of years ago in specialized schools that educated deaf people together using sign language, a movement toward inclusive public school education during the past 50 years has resulted in the majority of deaf and hard-of-hearing students currently being educated in classrooms with hearing students that use spoken language. The experiences of deaf and hard-of-hearing students in these classrooms can be either inclusive or restrictive depending on the degree of accessibility and social integration. As we move forward, we must ask how the inclusion of deaf and hard-of-hearing children has been realized in practice and what evidence exists for its success.

The vast majority of Deaf and Hard of Hearing (DHH) children are born to hearing parents who may have little or no knowledge of deaf education and language development. Early language exposure has been related to proficiency in language and academic achievement, whether it is signed or spoken. Earlier studies showed that deaf students with deaf parents demonstrated greater language abilities and academic performance and that their language milestones were developmentally similar to hearing children, indicating that deaf children were capable of developing language at normal rates with accessible input. More recent studies have verified that DHH students with hearing parents also develop age-expected vocabulary skills when exposed to language (ASL) during infancy.

While early exposure to a signed language relates to greater language development, this may be relative to the quality and quantity of the sign language model(s), therefore deaf students who sign may arrive at school with a varying level of language proficiency. Advances in hearing aid/FM technology and cochlear implants have also changed the landscape for the language development and social communication of DHH students, but there is limited information on how assistive technology is integrated into classroom instruction and the impact of auditory devices on long-term outcomes relative to previous decades. Studies have shown, however, that students with a strong foundation in a first language, early age of identification/intervention, greater use of residual hearing, or later onset of hearing loss are more likely to have successful academic and social experiences.

The most successful placement for DHH students depends on which setting is accessible and appropriate for their language, communication, and social-emotional needs. Schools or districts that are unable to meet the needs of DHH students in the general classroom must either implement specialized programming or consider other placements.

(Silvestri and Hartman, 2022)

Types of Hearing Loss

Hearing loss and deafness can be either:

• acquired, meaning that the loss occurred after birth, due to illness or injury; or
• congenital, meaning that the hearing loss or deafness was present at birth.

Before we describe the types of hearing loss a person may have, it’s useful to know that sound is measured by:

• its loudness or intensity (measured in units called decibels, dB); and
• Its frequency or pitch (measured in units called hertz, Hz).

(Parent Information and Resources, 2015)

Hearing loss is generally categorized depending upon how well a person can hear the intensities or frequencies most strongly associated with speech. Impairments in hearing can occur in either or both areas, and may exist in only one ear or in both ears.  Hearing loss can be classified as mild (25 to 40 dB), moderate (41 to 55 dB), moderate-severe (56 to 70 dB), severe (71 to 90 dB), or profound (greater than 90 dB).  Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf. (Wikipedia, n.d. /Hearing loss)

There are four types of hearing loss, as follows (eHealthMD, 2013):

Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.

Sensorineural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves that supply it. These hearing losses can range from mild to profound. They often affect the person’s ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.

A mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear.

A central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain itself.

(Parent Information and Resources, 2015)

The terms hearing impaired or hard of hearing are usually reserved for people who have relative inability to hear sound in the speech frequencies. The severity of hearing loss is categorized according to the increase in intensity of sound above the usual level required for the listener to detect it.

Deafness is defined as a degree of loss such that a person cannot understand speech, even in the presence of amplification.  In profound deafness, even the highest intensity sounds produced by an audiometer (an instrument used to measure hearing by producing pure tone sounds through a range of frequencies) may not be detected. In total deafness, no sound at all, regardless of amplification or method of production, can be heard.  (Wikipedia, n.d. /Hearing loss)

Identification

Newborn hearing screening has led to increased numbers of children identified with hearing loss before they leave the hospital. This permits the implementation of specialized early intervention services. Without specialized early intervention services, children who are deaf or hard of hearing have been found to experience significant delays in their communication and language abilities, their social-emotional development, and, ultimately, the quality of their lives (Sass-Lehrer, 2011). Multiple correlational studies have indicated that children and families who receive early intervention services during the optimal period for the development of linguistic and cognitive abilities have better outcomes than children and families who began receiving services later (e.g., Calderon & Naidu, 1999; Kennedy, McCann, Campbell, Kimm, & Thorton, 2006; Moeller, 2000; Yoshinago-Itano, 2003a, 2003b; Yoshinago-Itano, Coulter, & Thomson, 2001; YoshinagaItano & Gravel, 2001; Yoshinago-Itano, Sedey, Coulter, & Mehl, 1998). In the United States, 6 months of age has been identified as the critical deadline for the establishment of intervention services (Joint Committee on Infant Hearing, 2007).

Early identification of hearing loss neither eradicates nor lessens the processes of grief and loss experienced by most hearing families (Vohr et al., 2008; Young & Tattersall, 2007). Consequently, specialized early intervention services provided by trained professionals focus on supporting families dealing with the stress of having a child who is deaf or hard of hearing, helping them make a choice about the communication method they will initially use with their child, and strengthening the families’ abilities to nurture their child’s development and overall well-being. Family-professional partnerships and program services, which are established based on the needs of the child and the priorities of the family, have typically included emotional support and information on a variety of topics such as hearing AT; communication options; and strategies for promoting language, speech, and auditory development (Sass-Lehrer, 2011). However, parents have reported that the Early Hearing Detection and Intervention (EHDI) system can be overwhelming, emotionally taxing, and difficult to navigate (Larson, Munoz, DesGeorges, Nelson, & Kennedy, 2012; Meadow-Orlans et al., 2003). Consequently, professionals must provide parents and guardians with information that is repeated over time and in different ways (e.g., discussion, notebooks, websites). Simultaneously, children’s language development, regardless of communication mode, should be regularly assessed to ensure that children are meeting language milestones and evaluate whether other interventions are needed (Meinzen-Derr, Wiley, & Choo, 2011).

(Ferrell and Luckner, 2014)

It is important for teachers and audiologists to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is manual. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on implications of deafness within the family.

(Parent Information and Resources, 2015)

What Does the Itinerant Teacher of the Deaf/Hard of Hearing Do?

Follow the link above to learn more about the role of the Itinerant Teacher of the Deaf/Hard of Hearing. An itinerant teacher is a traveling teacher who supports students in different schools, districts and often cover a wide geographic range. These teachers are experts in areas specific to the needs of the student who is deaf or hard of hearing.

Characteristics and Impact on Learning

Hearing loss or deafness does not affect a person’s intellectual capacity or ability to learn. However, children who are hard of hearing or deaf generally require some form of special education services in order to receive an adequate education. Such services may include:

• regular speech, language, and auditory training from a specialist;
• amplification systems;
• services of an interpreter for those students who use sign language;
• favorable seating in the class to facilitate lip reading;
• captioned films/videos;
• assistance of a notetaker, who takes notes for the student with a hearing loss, so that the student can fully attend to instruction;
• instruction for the teacher and peers in alternate communication methods, such as sign language; and
  counseling.

Children who are hard of hearing will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication. For children who are deaf or have severe hearing losses, early, consistent, and conscious use of visible communication modes (such as sign language, fingerspelling, and Cued Speech) and/or amplification and aural/oral training can help reduce this language delay.

It is important for teachers and audiologists to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is manual. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on implications of deafness within the family.

(Parent Information and Resources, 2015)

Ferrell, K. A., Bruce, S., & Luckner, J. L. (2014). Evidence-based practices for students with sensory impairments – pgs 9-33  (There are no copyright restrictions on this document) Retrieved from http://ceedar.education.ufl.edu/wp-content/uploads/2014/09/IC-4_FINAL_03-30-15.pdf#page=64 

Evidence-Based Practices (EBPs) for Deaf and Hard of Hearing Students.

It is important to recognize that the population of students who are deaf or hard of hearing has been found to differ from the general student population as well as from other students with disabilities who receive IDEA services. In addition to typical factors that research has discovered influence the outcomes for hearing children and youth (e.g., intelligence, socioeconomic status of the family, ethnicity, community resources, quality of the K-12 educational program), an array of additional factors has also been found to affect the development of students who are deaf or hard of hearing. Examples include (a) degree of hearing loss; (b) type of hearing loss; (c) when hearing loss occurred; (d) when hearing loss was identified; (e) whether early intervention services were provided; (f) the quality and quantity of any early intervention services; (g) use/benefit from hearing assistive technology (AT; i.e., hearing aids, cochlear implants, frequency modulation [FM] systems, or communication boards); (h) home language of the family (i.e., American Sign Language [ASL], spoken English, and other spoken languages); (i) family attitude toward hearing loss; (j) any additional disabilities; (k) quality of home intervention and preschool services; (l) cultural identity (i.e., deaf, hearing, or hard of hearing and the interaction with other aspects such as race, ethnicity, language, and religion); (m) primary mode of communication preferred (i.e., spoken English, ASL, contact signing/Pidgin Sign English [PSE], Signing Exact English [SEE], or Cued Speech); and (n) where educational services are provided,

• a general education classroom with pull-out services from a teacher of students who are deaf or hard of hearing,
• a general education classroom with interpreter and/or notetaking services
• a general education classroom in which part of the day is spent in a resource room
• a self-contained classroom for students who are deaf or hard of hearing in a general education school,
• a general education classroom with students who are co-taught by a general education teacher and a teacher of students who are deaf or hard of hearing, or
• a special day or residential school program for students who are deaf or hard of hearing.

Given that the educational outcomes for students who are deaf or hard of hearing have been as varied as the population itself, the determination of appropriate services must be made on an individual basis, taking into consideration the factors noted above and the summary of the research literature that follows.

Administration

According to recent research, most professionals, including general education and special education administrators, are not deaf or hard of hearing and have limited experience or training in working with students who are deaf or hard of hearing (National Association of State Directors of Special Education [NASDSE], 2006; Szymanski, Lutz, Shahan, & Gala, 2013). As a result, professionals may not understand that hearing loss of any degree or type affects the quantity and the quality of interactions with others, which in turn may adversely impact language and academic, social, emotional, and career development.

To help make decisions that are in the best interests of students who are deaf or hard of hearing and their families, we have compiled the following recommendations based on the literature reviewed in this IC and requirements from the U.S. Department of Education:

• Know the potential impact of hearing loss and the effects on a child’s language, academic, cognitive, and social-emotional development as well as the impact on the family;
• Know the U.S. Department of Education’s guidance policy on education services for students who are deaf or hard of hearing;
• Learn about the cultural and linguistic needs of students who are deaf or hard of hearing;
• Understand the population demographics and the educational implications of service to the increasing numbers of students who are deaf or hard of hearing who come from diverse ethnic, linguistic, and racial backgrounds;
• Study the educational needs of students with hearing loss and additional disabilities;
• Actively recruit qualified individuals who are deaf or hard of hearing and individuals who are from diverse ethnic, cultural, and linguistic backgrounds to serve in professional and support capacities within programs for students who are deaf or hard of hearing;
• Have a system in place for monitoring students who are deaf or hard of hearing and delayed in developing communication and/or at risk for academic failure; and
• Conduct follow-up surveys and interviews to determine how well graduates are doing in higher education, employment, living, citizenship, family life, and personal well-being (Conference of Educational Administrators of Schools and Programs for the Deaf [CEASD], 2013; NASDSE, 2006; The National Agenda, 2005; Szymanski et al., 2013; U.S. Department of Education, 1992; U.S. Government Accountability Office, 2011).

Teachers of students who are deaf or hard of hearing provide services via a variety of models (e.g., direct service to students, collaboration with general educators, co-teaching, consulting with families) in an assortment of settings (e.g., general education classrooms, specialized schools for students who are deaf or hard of hearing, resource rooms, self-contained classrooms, homes) with children and youth ranging in age from 0 to 21. Professional guidelines have not specified the size of caseloads, but they have recommended that certified professionals who teach students who are deaf or hard of hearing be integral members of each student’s educational team.

Educational Assessment

Conducting educational assessments of students who are deaf or hard of hearing can be challenging for several reasons: (a) students who are deaf or hard of hearing sometimes master the academic content; however, their abilities to demonstrate their knowledge may be compromised because of communication, language, reading, and writing delays (Cawthon, 2009; Gilbertson & Ferre, 2008); (b) norm-referenced tests may cause problems for students who are deaf or hard of hearing because tests require reading ability for assessing skills other than reading, and test scores may reflect reading skill deficits rather than students’ content knowledge (Cawthon, 2009; Gilbertson, & Ferre, 2008; Luckner & Bowen, 2006); (c) it has been consistently reported that between 25% to 50% of students who are deaf or hard of hearing also have an additional disability (e.g., Blackorby & Knokey, 2006; D’Zamko & Hampton, 1985; Gallaudet Research Institute, 2011; Knoors & Vervloed, 2003) as well as the often-reported lack of language ability, attention problems, retention difficulties, and delayed academic skills, making it difficult to gather disability-specific data (Cawthon, 2007; Soukup & Feinstein, 2007); and (d) there have not been enough professionals who have the training and experience to assess students who are deaf or hard of hearing.

Another factor professionals should consider while conducting assessments with students who are deaf or hard of hearing is systematic error. Specifically, a systematic error can lead to inaccurate assessment results that produce poor decision-making. Three common examples of systematic error with students who are deaf or hard of hearing that can limit the validity of a test are,

1. the directions of an assessment are orally read to students who use signs as their primary mode of communication,
2. students who are deaf or hard of hearing and use signs are required to provide oral responses and
3. test items that are based on the ability to hear, such as matching words containing similar sounds, are included in the assessment (Gilbertson & Ferre, 2008; Luckner & Bowen, 2006; Wood & Dockrell, 2010)

Professionals working with students who use sign as their primary mode of communication and who are not fluent in that language or system themselves may require the services of an educational interpreter. Professionals should be certain that the educational interpreter is skilled in the sign language or system the student uses to communicate, familiar with the assessment process and instrument, and understands the importance of confidentiality (Gilbertson & Ferre, 2008; Maller & Braden, 2011; Wood & Dockrell, 2010). Finally, whenever possible, professionals should use a combination of procedures and instruments and avoid relying on a single test or assessment (Gilbertson & Ferre, 2008; Luckner & Bowen, 2006; Maller & Braden, 2011; Wood & Dockrell, 2010).

We consider the level of evidence for all assessment recommendations as limited because the research base is predominantly correlation studies and recommendations from the professional literature.

Assistive Technology

Students who are deaf or hard of hearing use an array of hearing AT to access sound. Not all of AT you see in the literature is covered under AT as determined in IDEA. Some AT may be purchased under Section 504 or ADA.

Examples include:

• Tactile communication devices;
• Personally worn, frequency-modulated (FM) amplification systems;
• Classroom amplification systems

Read article: Schools Purchasing Hearing Aids for Students

Professionals’ knowledge of the use and maintenance of the equipment is important to the academic success of this population of students (Punch & Hyde, 2011; Spencer, Marschark, & Spencer, 2011). In addition, with the interest in and success of cochlear implants, postimplant therapy has become an increasingly important area of expertise for teachers working with students who are deaf or hard of hearing.

Age at implant and consistency of device use are two factors shown to influence outcomes for individuals with cochlear implants (Connor & Zwolan, 2004; Geers, Brenner, & Tobey, 2011; Geers & Hayes, 2011; Geers & Sedey, 2011). However, studies have found that it is wrong to assume that once implanted, students can hear like the typical hearing person (Beadle at al., 2005; Geers et al., 2011; Hawker et al., 2008). Like other equipment, cochlear implants require training for the students and preparation for the teachers to help students effectively use them (Harkins & Bakke, 2011). Similarly, students with cochlear implants have been found to require ongoing support from professionals because they are likely to have listening difficulties in some social and educational contexts. As a result, some students have not had full access to school curricula or activities promoting social inclusion (Hyde, Punch, & Grimbeek, 2011; Punch & Hyde, 2011).

Studies have noted that making decisions about communication approaches and choosing which AT to use may be stressful for families (Archbold, Lutman, Gregory, O’Neill, & Nikolopoulos, 2002). Therefore, professionals should continue to advise with caution about the range of likely outcomes; they should also be aware that families are likely to be influenced by their hopes and aspirations for their children as much, if not more, than by the information they receive (Spahn, Richter, Burger, Lohle, & Wirsching, 2003). Consequently, information-sharing processes should be regularly repeated, extended, and evaluated through ongoing discussion and counseling (Archbold et al., 2002).

AT services may also include the use of sign language interpreters, tutors, and/or notetakers. Research has supported the benefits of having professionals teach students how to (a) use support services, (b) self-advocate about technology and support-service issues, and (c) troubleshoot technology problems (Punch & Hyde, 2011; Spencer et al., 2011). At the same time, it is important for service providers to respond with flexibility as the needs of students and parents change over time, especially when expected outcomes are not achieved and alternative strategies and approaches are necessary.

Communication

About 95% of children who are deaf or hard of hearing are born to hearing parents who have little or no prior knowledge or experience with how to effectively communicate with a child who is deaf or hard of hearing (Mitchell & Karchmer, 2004). When parents do not make adaptations, such as moving into the child’s visual space, using hearing AT, or using sign, most children who are deaf or hard of hearing experience significant reductions in communicative interactions. This may cause delays in the development of language, which may adversely impact academic, social, emotional, and career development (e.g., Calderon & Greenberg, 2003; Mayberry, 2010).

To promote communication and language development, three general approaches have been commonly used:

(a) Oral methods—the use of hearing AT, such as cochlear implants and hearing aids, along with training to learn to use residual hearing and speech read;

(b) Manual methods—the use of ASL, a visual-gestural language that has its own grammar and syntax; and

(c) Simultaneous communication methods—signs are produced in the same order as spoken words and at the same time as the words are spoken.

Although there are proponents for each approach, to date, no approach has been demonstrated to be more effective than others. Some children using each approach have developed age-appropriate communication and language skills, and other children using the same approaches have not (Yoshinaga-Itano, 2003b). Also, many families change the communication approach they originally selected during the first few years of their child’s life (Meadow-Orlans, Mertens, & Sass-Lehrer, 2003; Stredler-Brown, 2010).

Correlational studies have suggested that the communication approach selected by families is not as important as (a) parental involvement (Calderon, 2000; DesJardin, 2006; Spencer, 2004); (b) children’s non-verbal cognitive abilities (Geers & Sedey, 2011); (c) the presence or absence of additional disabilities (Waltzman, Scalchunes, & Cohen, 2000); and (d) the quality of educational programming (Knoors & Hermans, 2010; Pianta et al., 2005) on the acquisition and development of communication and language skills. Similarly, survey research (e.g., C. W. Jackson, 2011; Meadow-Orlans et al., 2003) has indicated that parents want unbiased information about communication approaches as well as time and support from professionals and other parents of children who are deaf or hard of hearing in order to determine which communication approach to use with their children.

There is a limited but increasing body of research indicating that the quantity and quality of interactions with skilled language users during children’s optimal developmental phase for acquiring language affect the communication skill development of children who are deaf or hard of hearing.

Life Skills (aka Expanded Core Curriculum)

Professionals should conduct assessments to determine students’ current levels of performance and establish whether they need curricula that include an emphasis on life-skills instruction (e.g., safety, banking, cooking, purchasing skills; Luckner, 2012; Luft, 2012; Luft & Huff, 2011). General types of assessments have included formal testing and informal techniques such as observation, structured interviews, work sample analysis, and performance assessments (Cronin, Patton, & Wood, 2007). Research (Test et al., 2009) focusing on EBPs that predicts improved postschool outcomes for students with disabilities has found that four predictor categories are correlated with successful outcomes in the areas of education, employment, and independent living:

1. inclusion in general education
2. paid employment/work experience
3. self-care/independent living skills, an
4. student support from family members and friends.

Consequently, professionals should consider these predictors and the EBPs associated with them while planning programs for students who are deaf or hard of hearing.

As previously discussed, a high percentage of students who are deaf or hard of hearing also has an additional disability. The presence of disabilities in addition to hearing loss compounds the complexity of providing appropriate educational services. The additional disabilities make individuals’ special needs qualitatively different and often result in a variety of challenges across several domains such as communication, cognition, affective, social, behavior, and physical (Jones, Jones, & Ewing, 2006). Another portion of the population may not be identified with an additional disability but may exhibit limited communication and reading abilities as well as poor social and emotional skills (Wheeler-Scruggs, 2002, 2003). Consequently, a large percentage of individuals who are deaf or hard of hearing have been found to leave school and experience difficulty living independently or maintaining employment (Bowe, 2003; Dew, 1999; LFD Strategic Work Group, 2004). Therefore, in order to proactively meet the needs of students who are deaf or hard of hearing with additional disabilities and those who are not benefiting from a purely academic focus, professionals should gather assessment data and develop an educational plan that takes into consideration the knowledge and skills needed to live independently and put into place the types of supports these students will need when they exit their formal education programs.

Universal Design for Learning- UDL

Literacy

Many skills and experiences contribute to the acquisition of literacy (National Reading Panel [NRP], 2000). Two essential skills relevant to the challenges of students who are deaf or hard of hearing are language abilities and the ability to use spoken phonological knowledge for decoding printed words (Lederberg, Schick, & Spencer, 2013). Language skills are necessary for successful reading skill development. Research on early literacy with hearing children indicates that language skills are central to early and long-term literacy success (e.g., Biemiller, 1999; Se’ne’chal, Ouellette, & Rodney, 2006). However, many children who are deaf or hard of hearing begin formal schooling with little fluency in either a spoken or signed language or awareness of print and literacy concepts (Marschark & Wauters, 2008). Similarly, many children who are deaf or hard of hearing do not have easy access to the phonological code that allows them to map the spoken language they already know to the printed words on a page. Additionally, natural sign languages, such as ASL, have their own vocabularies, morphologies, and syntaxes that do not parallel those of spoken or printed English (Fischer & van der Hulst, 2011).

Given the diversity of the population of students who are deaf or hard of hearing, it is practical to consider interventions that are effective for two separate groups of individuals:

(a) students who are deaf or hard of hearing with functional hearing and

(b) students who are deaf or hard of hearing with limited functional hearing (Easterbrooks, 2010; Lederberg et al., 2013).

For students with functional hearing, interventions should be guided by the recommendations of the NRP (2000) for a balanced reading program, including phonemic awareness, phonics, fluency, vocabulary, and text comprehension (Luckner, Sebald, Cooney, Young, & Muir, 2005/2006; Schirmer & McGough, 2005). To help students who are deaf or hard of hearing gain access to phonological-related information, quasi-experimental research has suggested that visual phonics, a multisensory system of hand cues and corresponding written symbols that represents the phonemes of English, may be effective (e.g., A. Smith & Wang, 2010; Trezek & Malmgren, 2005; Trezek, Wang, Woods, Gampp, & Paul, 2007). For students who have limited functional hearing, it has been contended that knowledge of signs and their meanings can be associated with printed words and that finger spelling, which provides a visual representation of printed letters, can serve as a direct aid to decoding print (e.g., Bailes, 2001; Haptonstall-Nykaza & Schick, 2007; Padden & Ramsey, 1998; Strong & Prinz, 1997).

As previously noted, children with age-appropriate language skills have a distinct advantage in becoming literate. However, it is no longer assumed that language development must precede the emergence of literacy skills, but that literacy activities promote language development, and the two can be mutually supportive (e.g., Williams, 2004). Parent-child reading provides an excellent context for parents to communicate with their child and enhance language development. Research (e.g., Zevenbergen & Whitehurst, 2003) has demonstrated that parent-child reading is associated with many aspects of language growth of typically developing children as well as children with communication problems (e.g., Ezell, Justice, & Parsons, 2000). Longitudinal research (e.g., Crain-Thoreson & Dale, 1999) has demonstrated the relationship among experiences with shared picture book reading and later language skills. Several correlational studies and one intervention study suggest that interactions while reading books with students who are deaf or hard of hearing are also beneficial (e.g., Andrews & Taylor, 1987; Delk & Weidekamp, 2001; DesJardin, Ambrose, & Eisenberg, 2009; Fung, Chow, & McBride-Chang, 2005; Swanwick & Watson, 2005).

Summaries of research in the critical areas of comprehension, vocabulary, and fluency indicated that students with or without functional hearing benefit from.

• explicit instruction in strategies for comprehension
• teaching narrative structure or story grammar
• using modified directed-reading thinking activities
• activating students’ background knowledge prior to reading activities
• using high-interest, well-written reading materials that are not simplified grammatically or in vocabulary choice
• conversations to build vocabulary skills
• explicit instruction in sight words and morphemic analysis
• computer programs to develop vocabulary
• repeated readings to improve reading fluency

(e.g., Easterbrooks & Stephenson, 2006; Luckner & Cooke, 2010; Luckner & Handley, 2008; Luckner & Urbach, 2012; Schirmer & McGough, 2005).

Correlation research (e.g., Fagan, Pisoni, Horn, & Dillon, 2007; LaSasso & Davey, 1987) has suggested that a positive relationship between vocabulary and reading comprehension exists for students who are deaf or hard of hearing. Consequently, it is beneficial for professionals to identify ways to increase the vocabulary of students. Research has confirmed the benefits of teaching students high-frequency words (e.g., Easterbrooks, Lederberg, Miller, Bergeron, & Connor, 2008; Paul & Gustafson, 1991); introduction of key words using rich and explicit examples (e.g., de Villiers & Pomerantz, 1992); and instruction in inferential strategies to assist vocabulary development (e.g., Strassman, Kretschmer, & Bilsky, 1987). In addition, research has supported the use of repeated readings to improve students’ word recognition, reading rates, and comprehension (Ensor & Koller, 1997; Schirmer, Therrien, Schaffer, & Schirmer, 2009).

Mathematics

Research (e.g., Traxler, 2000) has indicated that the majority of students who are deaf or hard of hearing graduate from high school performing at a sixth-grade level in math procedures and a fifth-grade level at problem solving. Three factors have been associated with the performance of students who are deaf or hard of hearing. First, the language delay experienced by many students who are deaf or hard of hearing may limit their mathematics performance (e.g., Hyde, Zevenbergen, & Power, 2003; R. R. Kelly & Mousley, 2001). Conditionals and technical vocabulary may hinder their understanding of mathematical concepts and performance in problem solving (Pagliaro, 2010). Examples of conditionals are if/then statements; comparatives (e.g., less than); negatives; and abbreviations (e.g., lb.); an example of technical vocabulary is annual rate. Second, the low reading levels of many students who are deaf or hard of hearing may diminish their successes due to difficulty understanding the necessary computation based on word problems. Research has consistently demonstrated a strong correlation between reading proficiency and mathematics, regardless of the type of mathematics investigated (R. R. Kelly, Lang, & Pagliaro, 2003). Third, limited incidental learning opportunities and informal learning experiences may also negatively influence the mathematics performance of students who are deaf or hard of hearing (Kritzer, 2009).

Instruction should be guided by the Principles and Standards for School Mathematics established by the National Council of Teachers of Mathematics (NCTM, 2000) and the National Mathematics Advisory Panel (2008). However, research on mathematics instruction for students who are deaf or hard of hearing has shown an emphasis on memorization and drill-and-practice exercises/worksheets as well as on limited use of technology or investigation of open-ended problems (Pagliaro & Ansell, 2002, 2012; Pagliaro & Kritzer, 2005).

Students who are deaf or hard of hearing need more;

(a) experience solving and constructing story/word problem presented in various forms as the basis for mathematical thinking, communication, and higher order concepts;

b) explicit use and teaching of technical mathematics vocabulary; and

c) integration of mathematics concepts and thinking skills throughout the curriculum to promote problem solving, analysis, and explanation

(Pagliaro, 2010; Pagliaro & Kritzer, 2005).

Also, because many students who are deaf or hard of hearing have an additional disability (e.g., Blackorby & Knokey, 2006;  Gallaudet Research Institute, 2011) or are functioning significantly below their chronological ages (Bowe, 2003; Wheeler-Scruggs, 2002), some students will need functional mathematics instruction such as money value, budgeting, identifying units of liquid and dry measure, height and weight measurement, time management, temperature, graphic representations, and time related to scheduled events and calendars (Bowe, 2003; Wheeler-Scruggs, 2002).

Science

Research has shown that the lags in reading comprehension, vocabulary, and experiential knowledge for many students who are deaf or hard of hearing negatively affect their knowledge of science concepts (Lang & Steely, 2003; Vosganoff, Paatsch, & Toe, 2011). Many science teachers use textbooks and multimedia, such as movies and television shows, for science instruction. Both the print in most science texts and the captions of science films and television shows are often too difficult for many students who are deaf or hard of hearing to understand (Lang, 2006). Also, many science teachers use lectures to disseminate content. Lectures can also prove difficult for students who are deaf or hard of hearing. Specifically, many students struggle to understand science concepts because they have not been exposed to the vocabulary of science (Easterbrooks & Stephenson, 2006), and about 60% of the words considered important in a science curriculum do not have sign representations (Lang et al., 2007). Consequently, research has suggested that students who are deaf or hard of hearing benefit from instruction from teachers who are well prepared in the content area of science and who are also able to effectively communicate with them (Easterbrooks & Stephenson, 2006). In addition, given the challenges of accessing science content via text or lecture, researchers have noted that students who are deaf or hard of hearing may benefit from instruction that includes,

• physical manipulation of objects
• use of graphic organizers
• highly pictorial or animated content with simplified English text
• additional practice on vocabulary

(e.g., Barman & Stockton, 2002; Diebold & Waldron, 1988; Easterbrooks & Stephenson, 2006; Elefant, 1980; Lang & Steely, 2003; Mertens, 1991).

The level of evidence for science recommendations is limited because the research base is predominantly correlation studies and professional literature.

Placement/Inclusion

Placement—where students receive educational services—is an issue that has generated continuing debate. Some professionals have expressed concern that the language, communication, and social needs of students who are deaf or hard of hearing are not being met in general education settings (e.g., CEASD, 2013). However, to date, there has been no research to support the assertion that placement in and of itself is an important factor. In contrast, a study comparing the educational consequences of different placements by Stinson and Kluwin (2003) reported that placement accounts for less than 5% of the differences in noted achievement. Therefore, it is more appropriate to focus on effective teaching—curriculum, instruction, assessment, classroom organization, and management—as the key components of the educational process for all students, including those who are deaf or hard of hearing.

Similarly, the ability of teachers to establish learning environments in which students are actively and productively engaged in learning has been shown to be a better predictor of student success than the mode of communication used by teachers (e.g., teachers who sign for themselves, use an interpreter, use simultaneous communication, use ASL without voice accompaniment) or whether teachers are deaf or hearing (Antia, Jones, Reed, & Kreimeyer, 2009; Marschark, Sapere, Convertino, & Pelz, 2008; Reed, Antia, & Kreimeyer, 2008). However, due to the heterogeneity of the population of students who are deaf or hard of hearing, professionals should be skilled in communicating with students who use different modes of communication (NASDSE, 2006).

Because placement is not synonymous with appropriate services, professionals must systematically monitor student progress. After collecting, analyzing, and sharing data about student functioning, the IEP team can make adjustments, if needed, in what is taught, how it is taught, and sometimes where it is taught based on how the student’s current functioning compares to other students (Antia, Sabers, & Stinson, 2007; Berndsen & Luckner, 2012; Karchmer & Allen, 1999; Powers, 2003; Reed et al., 2008). In addition, professionals trained in working with students who are deaf or hard of hearing should be able to adapt instruction and help other professionals adapt instruction for students who are deaf or hard of hearing (Antia et al., 2009; Antia, Stinson, & Gaustad, 2002; Luckner & Muir, 2001; Powers, 2003; Reed et al., 2008). Specifically, they should consult and collaborate with other professionals about strategies for promoting access to instruction and social interactions in all educational environments and to family members for the home and community (Antia et al., 2009; Antia et al., 2002; Kluwin, Stinson, & Colarossi, 2002; Luckner & Muir, 2001; Powers, 2003; Reed et al., 2008). Simultaneously, professionals trained in working with students who are deaf or hard of hearing should provide ongoing PD and support for other service providers who have not been trained to work with but provide services to students who are deaf or hard of hearing (Antia et al., 2002; Luckner, 1999; Nunes & Pretzlik, 2001; Powers; Reed et al., 2008). Finally, professionals should help students become involved in extracurricular activities in the school and the community (Luckner & Muir, 2001; Reed et al., 2008).

The heterogeneity of the population of students who are deaf or hard of hearing, as well as the variety and combination of placements for educational services, make it difficult to compare the effectiveness of one setting to others. Consequently, we consider the level of evidence for all recommendations on placement/inclusion as limited because they are based on correlation research and professional literature.

Social-Emotional Behavior (adaptive behavior)

Results of research on the impact of hearing loss on social, emotional, and behavioral development have been mixed (e.g., Andersson, Rydell, & Larsen, 2000; Antia, Jones, Luckner, Kreimeyer, & Reed, 2011; Coll, Cutler, Thobro, & Haas, 2009; Vogel-Walcutt, Schatschneider, & Bowers, 2011). Some students were found to show greater impulsivity, poorer emotional regulation, loneliness, and difficulty getting along with others. In contrast, many other students were found to have good communication skills, emotional understanding of self and others, friendships, and self-motivation (Calderon & Greenberg, 2003). Similarly, mixed results have been reported while trying to attribute differences to factors such as (a) degree of hearing loss, (b) mode of communication used by students, and (c) educational setting (Antia, Kreimeyer, Metz, & Spolsky, 2011).

Research (e.g., Austen, 2010; Barker et al., 2009) has suggested that compared to their hearing peers, children and youth who are deaf or hard of hearing exhibit higher rates of externalizing (e.g., aggression, violating social rules) and internalizing (e.g., anxiety, depression, social withdrawal) behavior problems. The language delays experienced by many students who are deaf or hard of hearing interfere with emotional and behavioral regulation. Language, which aids in internalizing social norms and the development of behavioral control, also plays an important role in executive function such as attention regulation, planning, problem solving, and response inhibition (Morgan & Lilenfield, 2000).

As a result of language development delays; limited opportunities for incidental learning; and the unfamiliarity of parents, families, and caregivers who are deaf or hard of hearing, it is prudent for professionals to proactively think about promoting the healthy growth and development of social, emotional, and behavioral knowledge and skills. For children ages 0 to 3, involving families in comprehensive early intervention programs can foster healthy attachments and communication skills that facilitate their children’s development (Calderon, 2000; Hintermair, 2008; Luckner & Velaski, 2004). It is important to help elementary-age students develop the language and understanding of (a) emotional self-awareness, (b) emotional self-regulation, (c) motivation, (d) empathy, and (e) social skills (Goleman, 2006). Research has demonstrated the effectiveness of social-skills training (e.g., Antia, Kreimeyer, & Eldredge, 1994; Ducharme & Holborn, 1997; Schloss & Smith, 1990; Schloss, Smith, & Schloss, 1984). Similarly, Providing Alternative THinking Strategies (PATHS), a school-based curriculum for promoting alternative thinking strategies, has been demonstrated to help students who are deaf or hard of hearing to effectively develop and maintain self-control, increase their ability to communicate about feelings, and improve their problem-solving abilities (Kusche & Greenberg, 1993).

Adolescence is a critical time for the formation of identity and social relationships. Correlation research (e.g., Luckner & Muir, 2001; Reed et al., 2008) has suggested that participation in after-school and/or community activities provides adolescents with opportunities for socialization, shared experiences, achievement, and distinction. Through their involvement with activities such as sports, drama, drawing, computers, photography, and chess, students can learn to master skills that will help them throughout their lives. Active participation in after-school and/or community activities helps students to develop their leadership and decision-making abilities as well as organizational, time management, and interpersonal communication skills.

Given the previously mentioned risk factors and potential academic delays, it is important for professionals to conduct formal and informal assessments of students’ social-emotional and behavioral functioning in order to intervene in a timely manner. In addition to observation and the use of standardized behavior rating scales, professionals can use the Classroom Participation Questionnaire (CPQ; Antia et al., 2007) and Placement and Readiness Checklists for Students Who Are Deaf and Hard of Hearing (PARC; Johnson & Seaton, 2012) to collect data about how students are functioning.

Transition

Research findings on the educational and employment outcomes for individuals who are deaf or hard of hearing have been mixed. In the past 10 years, graduation rates with regular high school diplomas have increased from 58% to 68% for students who are deaf or hard of hearing (U.S. Department of Education, 2009). As a result, these individuals have enrolled in postsecondary education programs at a high rate (i.e., 67%) that is similar to their hearing peers (Wagner, Newman, Cameto, & Levine, 2005a). However, for a variety of reasons, about 75% of these students have left school without either a 2- or 4-year degree (Lang, 2002; Marschark & Hauser, 2008; Stinson & Walter, 1997).

In the area of employment, some individuals who are deaf or hard of hearing have achieved great success. Professionals who are deaf or hard of hearing have been represented in almost every line of work (Foster & MacLeod, 2003). However, research (e.g., Boutin & Wilson, 2009b; Capella, 2003; Mowry, 1988) has indicated that workers who are deaf or hard of hearing are more likely to work in non-professional jobs (e.g., food processing, printing, welding) and earn less than the general hearing labor force. In addition, studies have found that many low-functioning individuals who are deaf or hard of hearing do not work (Bowe, 2003; Wheeler-Scruggs, 2002). The Social Security Administration (2013) reported for 2012 that 64,950 individuals in the United States who are deaf or hard of hearing collect Supplemental Security Income (SSI).

To prepare students who are deaf or hard of hearing to successfully transition to postsecondary education programs and/or the workforce, professionals should provide them with information about careers and facilitate the development of self-determination and self-advocacy skills (Bowe, 2003; Brolin & Loyd, 2004; Sitlington, Neubert, Begun, Lombard, & Leconte, 2007). Additionally, professionals should involve students in the development of IEP and transition goals and should have students participate in IEP meetings (Velaski, 1999).

Professionals should also use formal and informal assessments to gather information from students, families, and other professionals about students’ current levels of functioning and future aspirations. Using these data, professionals can use a backward planning process to create a vision of what is most important for a students’ future success and determine actions that must be undertaken and in what order. Once a plan has been established, the information can be translated into a course of study that integrates the necessary knowledge, skills, and transition goals into the IEP and then implemented with coordination across individuals, organizations, agencies, and settings (Luckner, 2002, 2012).

Studies have shown that many students who are deaf or hard of hearing demonstrate limited knowledge or skills in the areas of independent living (e.g., budgeting, bill paying, contractual agreements, cooking and nutrition, family planning) and employment (e.g., organization, time management, collaboration, planning; Bonds, 2003; Bowe, 2003; Luckner, 2002, 2012; Luft, 2012; Luft & Huff, 2011; Punch, Hyde, & Creed, 2004). Consequently, professionals should provide instruction in these critical areas during high school and work with vocational rehabilitation (VR) counselors to help individuals who are deaf or hard of hearing prepare for adult life (Boutin, 2009; Bowe, 2003; Punch et al., 2004). Research by Boutin and Wilson (2009a) has indicated that three factors—job placement, provision of AT devices, and job-search assistance—are the primary VR services that contribute to clients finding and maintaining employment.

Professionals should also help students who plan to attend postsecondary institutions succeed. Correlation research has found that the English, Natural Science, and Mathematics subscores of the American College Test (ACT) predicted the academic success of college students who are deaf or hard of hearing for the year studied. The English subscore accounted for more than 80% of the variance. Neither audiological variables related to degree of hearing loss nor communicative variables related to spoken language or ASL skills were predictive factors (Convertino, Marschark, Sapere, Sarchet, & Zupan, 2009).

Conclusion

We live in a sound-oriented society. Extensive amounts of information are deliberately and incidentally conveyed through verbal interactions with others. Through these interactions, children and youth

• refine their communication skills
• acquire language
• obtain information (i.e., background and domain knowledge) about the world
• learn concepts
• become literate
• develop social skills
• participate in the daily activities of life.

Hearing loss of any type or degree tends to alter the quality of sound (i.e., softer, distorted, or non-existent) that travels to the inner ear and brain stem, which then has the potential to change interaction patterns with others and adversely impact development that may lead to language, literacy, social, and academic delays.

Determining and establishing the most appropriate educational environment for each student who is deaf or hard of hearing require a series of difficult decisions such as the following examples:

• What services are needed?
•  Where should the services be provided?
• Which professionals will provide the services?
• Which primary mode of communication will be used?
• Which AT options, like FM systems, interpreters, and notetakers, will be needed?
• What should be the focus of the curriculum?
• Which adaptations will be beneficial?
• How will progress be monitored?

Because placement is not synonymous with appropriate services, professionals must examine the learning environments of students who are deaf or hard of hearing. To meet the communication, academic, and social needs of these students, students’ progress must be systematically monitored using assessments that compare students’ learning rates and levels of performance to expected benchmarks so that timely adjustments can be made. These data allow professionals to develop a comprehensive continuum of supports and services and adjust the intensity and nature of the interventions when students are not making appropriate progress. This helps ensure students achieve targeted, standards-based learning goals within set time frames.

(Ferrell, Bruce & Luckner, 2014, Deaf/HH)

Watch the Video: Dispelling Myths of Language Acquisition for children who are deaf and hard of hearing. (5:44 minutes)

Myths

1. ASL is not an essential component of language learning for deaf and hard of hearing children. False
2. Listening technologies are the solution, with cochlear implants and hearing aids viewed as making a deaf child “hearing” . False
3. The timing of developmental milestones for ASL is a much longer window than spoken English, therefore it is acceptable to delay a child’s opportunity to learn ASL. False

Watch the video to learn why these are myths and the truth about ASL and English.

[ClercCenter]. (2017).  Inauguration Event: Dispelling Myths of Language Acquisition {video file]. From https://youtu.be/uXYNfJCG1PY

Caroline’s Story

Caroline is six years old, with bright brown eyes and, at the moment, no front teeth, like so many other first graders. She also wears a hearing aid in each ear—and has done so since she was three, when she was diagnosed with a moderate hearing loss.

For Caroline’s parents, there were many clues along the way. Caroline often didn’t respond to her name if her back was turned. She didn’t startle at noises that made other people jump. She liked the TV on loud. But it was the preschool she started attending when she was three that first put the clues together and suggested to Caroline’s parents that they have her hearing checked. The most significant clue to the preschool was Caroline’s unclear speech, especially the lack of consonants like “d” and “t” at the end of words.

So Caroline’s parents took her to an audiologist, who collected a full medical history, examined the little girl’s ears inside and out, ran a battery of hearing tests and other assessments, and eventually diagnosed that Caroline’s inner ear (the cochlea) was damaged. The audiologist said she had sensorineural hearing loss.

Caroline was immediately fitted with hearing aids. She also began receiving special education and related services through the public school system. Now in the first grade, she regularly gets speech therapy and other services, and her speech has improved dramatically. So has her vocabulary and her attentiveness. She sits in the front row in class, an accommodation that helps her hear the teacher clearly. She’s back on track, soaking up new information like a sponge and eager for more.  (Parent Information and Resources, 2015)

Deaf Culture

International Symbol for Deafness

Supplemental/Optional Resources

New Hampshire Deaf and Hard of Hearing Education Initiative Project (2016). Educational Service Guidelines for Students who are Deaf and Hard of Hearing. from : http://nhfv.org/wp-content/uploads/2013/07/DHH-Guidelines-revised-Dec-2016-.pdf

References

Ferrell, K. A., Bruce, S., & Luckner, J. L. (2014). Evidence-based practices for students with sensory impairments (Document No. IC-4). Retrieved from University of Florida, Collaboration for Effective Educator, Development, Accountability, and Reform Center website: http://ceedar.education.ufl.edu/tools/innovation-configurations/ Deaf or Hard of Hearing- pages 9-33  (There are no copyright restrictions on this document) Retrieved from http://ceedar.education.ufl.edu/wp-content/uploads/2014/09/IC-4_FINAL_03-30-15.pdf#page=64 

Itinerant Online, (2021) What Does the Itinerant Teacher Do, Anyway, from https://www.theonlineitinerant.com/blog/what-does-an-itinerant-teacher-do-anyway 

Parent Information and Resources Center, (2015), Deafness and Hearing Loss, Retrieved 4.1.19 from https://www.parentcenterhub.org/hearingloss/#def public domain.

Silvestri, J.A.; Hartman, M.C. Inclusion and Deaf and Hard of Hearing Students: Finding Asylum in the LRE. Educ. Sci. 2022, 12, 773. https://doi.org/10.3390/ educsci12110773. This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

Trinity University (n.d.) Hearing Loss, From   Trinity University (n.d.) Vision Impairment  Chapters, From https://www.trinity.edu/sites/students-vision-hearing-loss/hl

WATI, (2009), Assessing Students’ Needs for Assistive Technology, Chapter 13: Assistive Technology for Students who are Deaf or Hard of Hearing

Wikipedia, (n.d.) Hearing Loss. From https://en.wikipedia.org/wiki/Hearing_loss

Image Source

International Symbol for Deafness from Wikimedia Commons. https://commons.wikimedia.org/wiki/File:International_Symbol_for_Deafness.jpg

Updated 7.3.24