Kid Confidential: Hearing Loss, Classroom Difficulties, and Accommodations

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(photo credit: sound waves via Bigstock)

Ah, the familiar sounds of rustling papers, fast paced walks from meeting to meeting room, and that all too common groan, a mixture of frustration and exhaustion in equal parts, remind me that it is that time of year in the schools.  It is “IEP season”.

In honor of the countless hours of reassessment, data collection, and paperwork completion you will be doing over the next few months, I thought I’d write a post to help out those of you who are once again, hitting the keyboards and staring at that blank section on your IEP.  You know the one I’m talking about.  You spend a lot of time thinking about it only after all the data and classroom observations are compiled.  You know it needs to be completed but after writing your student’s present level of performance, his goals and objects and of course his service time, who has the energy left to even think about classroom accommodations and modifications.  Well that is where I step in, at least for those of you who have students with hearing loss on your caseloads.

Last year at this time I had a few students with hearing loss managed with both hearing aids and cochlear implant (CI) on my caseload.  As a multidisciplinary team, we had to do some research to find appropriate accommodations and modifications for those students.  However, I recently read the book Children with Hearing Loss: Developing Listening and Talking Birth to Six, by Elizabeth Cole and Carol Flexer which provided some clinically useful information on the specific deficits a child with hearing loss might have in the classroom setting.  I wish I had read this last year while I was struggling with the multidisciplinary team to write an appropriate IEP.  But now that I found this information, I thought I would adapt parts of it and compile that information into a table for quick reference in the future.

The accommodations and modifications in the graphic below are suggestions of possibilities you may attempt to provide for your students.  This is by no means an exhaustive list nor would every student benefit from each suggestion.  Therefore, I recommend you use this list as a guide only while working collaboratively with your multidisciplinary team to determine appropriate accommodations and modifications for each student on an individual basis.

You will notice that the first accommodation for any hearing loss is the use of an FM system alone or in conjunction with auditory management (e.g. hearing aids, cochlear implant, other technology).  Research has shown the use of individual FM systems positively impact students with hearing loss of any severity level AND that classroom or sound field FM systems benefit ALL students.  One can’t help but wonder how different a student’s behavior would be in a classroom where the speech to noise ratio was in fact the recommended +15-20 dB rather than the typical +4 dB (Cole, Flexer 2007).  That is why the recommendation of an FM system is first as it is not only practical but very beneficial even for a child with very mild hearing loss.

Here are the levels of severity, classroom difficulties and possible accommodations and modifications for children with hearing loss.

You can download your copy of the above materials here.

I hope these materials help guide you and your multidisciplinary team when writing IEPs for your students with hearing loss.  Do you have additional modifications or accommodations you would add to this list?  Let us know by commenting below.

Thanks for stopping by and reading our second installment of Kid Confidential.  If you have any topics you would like us to discuss here, feel free to share.  You just might see your topic suggestion in one of the upcoming columns.  I’ll meet you back here on the second Thursday of next month.

Until then, remember, knowledge is power, so let’s keep learning!

References:

  • Cole, Elizabeth, and Carol Flexer. Classroom Accommodations for Students with Hearing Impairment. San Diego, CA: Plural Publishing, Inc., 2007. Print

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Maria Del Duca, MS, CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

For Children with Hearing Loss, Parents’ Desired Outcomes Should Drive Early Intervention & Use of Hearing Technology

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Photo by bjorn knetsch

Just this past week, a hallway conversation with a colleague underscored the frustration that parents and caregivers of children with hearing loss seem to encounter on an all-too-frequent basis. My colleague described a situation whereby some very diligent parents had chosen to pursue bilateral cochlear implantation for their 10-month old son with a profound bilateral sensorineural hearing loss. Even though they had gathered a mountain of information, received support from their pediatrician, approval from their insurance company, and spoke to countless other parents – some of whom had chosen cochlear implants for their children with hearing loss and others who had not – they found the most resistance from their early intervention providers. Not only were these professionals unsupportive, they provided grossly inaccurate information about cochlear implants and listening and spoken language outcomes. It was plainly obvious to these parents that they had obtained more knowledge than the “professionals” who were there to serve them. Unfortunately, this scenario is repeated too often throughout the United States.

Almost without exception, parents want their children to have more successful lives than themselves. Whether that success be academic, social, or career-related, parents want what is best for their children. Determining what is “best” is a complicated process. Parents must use their own familial experiences, cultural perspectives, belief systems, and knowledge to make decisions that will affect the developmental, communicative, and academic success of their children.

For parents of young children with hearing loss, research informs us that approximately 95% of these parents are hearing themselves and have little or no experience with deafness. Usually, their only exposure to deafness is what they’ve seen portrayed in the media or the occasional interaction with an older relative with an age-related hearing loss.

So, what are parents to do and how should they determine what is best for their infant or toddler who has been diagnosed with hearing loss? Once that diagnosis is confirmed, parents need access to information about communication options and expected outcomes, hearing technology, and the available services in the community. The child’s audiologist is a pivotal professional in this process as he or she should get this discussion started. The range of hearing technology, such as digital hearing aids, cochlear implants, and assistive listening devices should be thoroughly reviewed and prescribed. Then, the family should be referred to an early intervention program (usually a statewide system), and appropriate early intervention services should be initiated.

The type, frequency, and intensity of the early intervention services should be based on the parents’ desired outcomes for the child. That is, if the child’s parents have decided that they want their child to be eventually mainstreamed in a local public school with hearing peers and to communicate using spoken language, then early intervention services should be structured to support those desired outcomes. Too often – in too many states – parents are given a very limited menu of services that are available and simply told which services will be provided. Of course, when this occurs, it fails the test of having services that are individualized, and the services certainly are not driven by what the parents want for their child with hearing loss.

Ultimately, parents need to make informed decisions about what they consider is appropriate for their child. They need to gather information from multiple sources, speak to other families who have navigated the system, and make sure they are informed about their rights. Each state has its own unique way of doing things, including how federal laws are interpreted and services provided. With perseverance and due diligence, parents usually can structure services that are appropriate for their child. The key is to be persistent and to not give up until the services provided support those long-term, desired outcomes that are envisioned for the child!

(Note: This blog was adapted from an original posting by the author on the Better Hearing Institute’s Pediatrics Blog.)

 

K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT, is an Associate Professor in the School of Speech-Language Pathology and Audiology at The University of Akron. His primary areas of research include spoken language acquisition in children with hearing loss, strategies for enhancing parent engagement in the intervention process, Auditory-Verbal Therapy, and telepractice. He directs the Telepractice and eLearning Laboratory (TeLL), an initiative to evaluate clinical practices in the area of distance service delivery in Speech-Language Pathology.