Children with Hearing Difficulties Special Education

Teaching Children with Hearing Difficulties: Evidenced-Based Practice
Early evaluation and detection for hearing difficulties forms the basis for timely intervention. This text emphasizes the need for early intervention as a way of maximizing the linguistic competence and literacy development of children with hearing difficulties. It covers the JCIH position statement and uses research evidence to demonstrate how early audiological intervention could help promote academic outcomes for children with hearing difficulties.
Reaction to the JCIH 2007 Position Statement
The JCIH position statement advocates for early evaluation and diagnosis of auditory problems for children with hearing loss. Early hearing loss detection and intervention helps to maximize the literacy development and linguistic competence of children with hearing difficulties, thus helping to enhance their academic and social outcomes. Studies have, in fact, shown that children whose hearing problems are diagnosed early (before 2 months of age) and intervention initiated have better functional, language, and speech outcomes than those whose problems are identified later in life (Cupples et al., 2013).
However, differently from what the position statement suggests; hearing problems may not always be diagnosed at this early age. For instance, the World Health Organization (WHO) estimates that 1.1 billion young people aged between 12 and 35 are at a risk of developing hearing loss due to exposure to noise (WHO, 2020). This calls for vigilance on auditory evaluation at all stages of life, including schools and workplaces. At the school level, early intervention calls for the presence of a full-time clinical audiologist to make continuous audiological evaluations on at-risk children, fit hearing aids, and measure children’s progress. However, all people working with children need to remain sensitive to symptoms of hearing loss, evaluation, and progress. Teachers can contribute to early detection and intervention by engaging in continuous education to increase their awareness on potential risk factors, evaluation techniques, and potential interventions. They need to engage in research to offer evidence-based advice to school authorities on the most appropriate assistive technologies for the children they serve.
Cupples, L., Ching, T., Crowe, K., Seeto, M., Leigh, G., Street, L., Day, J., Marnane, V., & Thomson, J. (2013). Outcomes of 3-Year-Old children with Hearing Loss and Different types of Additional Liabilities. The Journal of Deaf Studies and Deaf Education, 19(1), 20-39 (https://academic.oup.com/jdsde/article/19/1/20/394682)
In the above study, Cupples et al (2013) sought to investigate the functional, language, and speech outcomes of 119 three-year-old children with hearing loss and other disabilities, and assess how audiological evaluation early on in a child’s life influenced the same. The research findings provide crucial insights that instructors could adopt to improve academic outcomes for children with hearing difficulties. Outcome measures in the above study were assessed using formal assessments of language and speech development and subjective measures of functional auditory behavior as reported by clinicians and parents. All 199 participating children had been diagnosed with hearing loss ranging from mild to severe. Most of them were users of hearing aids, and slightly over one-quarter used bilateral or unilateral cochlear implants (CI). The researchers ran multiple regression analyses to determine the effect of three variables: the degree of hearing loss, maternal education, and age at the onset of audiological intervention (HA fitting and CI switch) on participants’ functional, language, and speech outcomes. The study findings showed a significant association between the age of audiological intervention, degree of hearing loss, and maternal education and all three outcome variables. Children whose hearing problems were discovered before six months and interventions began early enough reported better speech, functional, and language outcomes than those who were subjected to audiological intervention later on. Further, children whose mothers were more educated, those with a lower degree of hearing loss, and those with access to assistive hearing devices also reported better outcomes.
These findings underscore the need to promote early audiological evaluation and intervention. One crucial insight that teachers could obtain from the study findings is the need to increase access to audiological evaluation for at-risk children from an early stage to ensure that hearing difficulties are identified before they can cause significant hearing loss. Further, teachers need to be keen to provide assisting listening devices and hearing aids to facilitate positive learning for at-risk students since children with access to such aids have been shown to have better outcomes than those without (Cupples et al., 2013). Further, hearing loss has been shown to affect language abilities, depending on the sage of onset (Dobie & Hemel, 2004). As such, students who acquired their hearing loss at a very early age are likely to have literacy issues. In these cases, is may be beneficial for teachers to provide reading lists before the start of a course to provide guidance to key texts and facilitate such students’ abilities to learn (Dobie & Hemel, 2004). Finally, the study findings provide evidence to support the effect of proper family placement on the outcomes of students with hearing difficulties. Similarly, teachers ought to focus on placement when handling such learners. This includes seating such students towards the front of the class where the line of vision is unobstructed, particularly if they rely on visual cues, lip-reading, or hearing aids with limited range.
Response to Jonathan’s Provided Scenario
Jonathan was diagnosed with moderate-severe bilateral sensorineural hearing loss after a referral from the Newborn Hearing Screening. A CT scan shows Enlarged Vestibular Aqueducts, although the hearing loss diagnosis was delayed by multiple bouts of otitis media. The Auditory Brainstem Response (ABR) test is conducted if a child fails the newborn hearing screening test administered shortly after birth (American Psychological Association, 2010). It seeks to measure how the child’s nervous system responds to sounds. The audiologist will place four electrodes in front of the child’s head, connect the same to a computer, and monitor how the electrodes respond as sounds are made through the earphones. This response measures the extent of the child’s hearing loss. Jonathan’s moderate-to-severe diagnosis indicates a significantly poor response to sounds and hence, the presence of a serious hearing problem in both ears. One of the primary contributors to hearing loss in children is an enlarged vestibular aqueduct, a narrow canal that travels from the inner ear to the skull, and which is responsible for sending signals to the brain, thus creating a normal hearing and balance (American Psychological Association, 2010). The vestibular aqueduct may not adequately perform this function if it is abnormally enlarged (greater than a millimeter) (American Psychological Association, 2010). To diagnose this, the audiologist will conduct either a magnetic resonance imaging (MRI) or a computed tomography (CT) scan of the inner ear. Jonathan’s diagnosis indicates an enlarged vestibular aqueduct (EVA) (American Psychological Association, 2010). Enlarged vestibular aqueducts do not directly cause hearing loss. However, both the hearing loss and EVA could be a result of the multiple bouts of otitis media that the child experiences before 6 months (NIH, 2014).
The parents have chosen a Listening and Spoken Language approach for Jonathan. This requires them to understand the implications of the child’s hearing loss on his auditory, speech, and language skills. Voice and speech characteristics of children with hearing loss differ from those with normal hearing. The loss reduces their speech intelligibility, which impairs the tonal and production aspects of speech (Cole & Flexer, 2016). Jonathan is likely to have difficulty articulating consonants and vowels such as omissions, distortions, and substitutions (Dobie & Hemel, 2004). He may also be unable to differentiate between voiceless and voiced consonants such as ‘p’ and ‘b’ (Dobie & Hemel, 2004). This is often accompanied by a slowed rate of general speech sound awareness – he may be able to produce isolated, but may have difficulty combining the same in connected speech (Cole & Flexer, 2016).
His language skills are also likely to be affected. He will display a slow rate of vocabulary growth and grammatical development that may plateau prematurely (Dobie & Hemel, 2004). In this regard, he may have difficulty constructing long sentences and comprehending complex sentences such as those in the passive voice (Dobie & Hemel, 2004). His auditory skills are also likely to be affected (Easterbrooks & Astes, 2007). He may not hear quiet speech sounds such as ‘k’, ‘t’, ‘f’, ‘sh’, and ‘s’ and may thus not include the same in his speech (Dobie & Hemel, 2004). Further, he may not hear his own voices when he speaks and will often speak either too loudly or not loud enough, and may mumble due to poor inflection in some cases (Easterbrooks & Estes, 2007).
Conclusion
In conclusion, early evaluation and intervention offers promising avenues for teachers to promote the linguistic competence and literacy development of children with hearing difficulties, thus ensuring enhanced academic and social outcomes.
References
American Psychological Association (2010). Publication Manual (7th ed.). Washington, D.C.: American Psychological Association.
Cole, E. & Flexer, C. (2016). Children with Hearing Loss: Developing Listening and
Talking (4th ed.). San Diego, CA: Plural Publishing, Inc.
Cupples, L., Ching, T., Crowe, K., Seeto, M., Leigh, G., Street, L., Day, J., Marnane, V., & Thomson, J. (2013). Outcomes of 3-Year-Old children with Hearing Loss and Different types of Additional Liabilities. The Journal of Deaf Studies and Deaf Education, 19(1), 20-39.
Dobie, R. A., & Hemel, D. (Eds.). (2004). Hearing Loss: Determining Eligibility for Social Security Benefits. Washington, D.C.: National Academies Press.
Easterbrooks, S. & Estes, E. (2007). Helping Deaf and Hard of Hearing Students to Use
Spoken Language. Thousand Oaks, CA: Corwin Press.
NIH (2014). Enlarged Vestibular Aqueducts and Childhood Hearing Loss. National Institute on Deafness and Other Communication Disorders. Retrieved from https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/NIDCD-Enlarged-Vestibular-Aqueducts-and-Childhood-Hearing-Loss%20.pdf
WHO (2020). Deafness and Hearing Loss. World Health Organization (WHO). Retrieved from https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss