Features
Deaf education: A primer

by Barbara Langham and Mari Hubig

“Imagine you are Remi, a 4-year-old girl who cannot hear well. You find it hard to understand the story the teacher is reading, so you stare out the window. Background noise from the dramatic play center drowns out what a child next to you is saying as you play with blocks. Outside you try to play with others, but you cannot understand them, so you climb onto the jungle gym to play by yourself.

Being deaf or hard of hearing (D/HH) affects the ability to communicate, develop language, and make friends. But as an early childhood educator, you can help children like Remi build a foundation for success in school and life.

What does deaf or hard of hearing mean?
The term deaf or hard of hearing (D/HH) is known among professionals by several names, including hearing impaired and auditory impaired. By federal regulation (3-4 CFR [Code of Federal Regulations] 300.8(c)(3)), 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 a child’s educational performance.” In other words, a child struggles to understand and express ideas and emotions using language when information comes only through hearing. In Texas, children who are D/HH are identified as having an auditory impairment based on the federal definition of deafness.

The term hearing loss, while widely used by health and education professionals, is generally not favored in the Deaf community because deaf children often never had intact hearing to begin with and thus had no hearing to lose. (Deaf with a capital “D” refers to the culture, and deaf with a small “d” refers to a person’s hearing status.) D/HH can be mild, moderate, moderately severe, severe, or profound.

A person’s hearing level can be charted on an audiogram, a graph that shows loudness and pitch with the focus on the sounds of a spoken language. While humans can hear sounds beyond what is shown on an audiogram, the graph itself looks at access to language through hearing

Loudness is represented in decibels (dB), (shown on the left of the chart on the next page). Loudness is usually show from around 0 dB to 120 dB. However, 0 dB does not mean there is no sound but rather a soft sound such as wind gently blowing through trees. Speech is usually around 50-60 dB, depending on the situation. A dB level of 100 includes semi trucks, chain saws, and motorcycles, and 120 dB would be a live rock band. It’s important to note that consistent exposure to sounds 80-85 dB and louder can permanently harm a person’s hearing.

The second measurement on an audiogram is pitch, which is represented in hertz (Hz). The pitch appears along the top of the audiogram running from left to right from 125 Hz to 8,000 Hz (as shown in the chart below). Spoken language is usually found between 250 Hz to 8,000 Hz. Examples would be a man’s deep voice at the low end, and a bird’s chirping at the high end.

Together, loudness (dB) and pitch (Hz) come together to create a picture of what a person can hear.

What causes D/HH in children?
One to three out of every 1,000 children in the United States is born deaf or hard of hearing. (Centers for Disease Control and Prevention 2010). It’s estimated that about half of all childhood deafness is due to heredity. This means that genes involved in the hearing process are passed on in a family.

But environmental factors such as infections during pregnancy, notably rubella and cytomegalovirus (CDC 2017), can play a major role. Birth factors such as prematurity, low birth weight, lack of oxygen, and jaundice can also contribute to D/HH. Certain medications, such as drugs used to treat meningitis, can damage the ear. These drugs are called ototoxic (oto—ear, and toxic—poisonous).

After birth, D/HH can occur as a result of the child’s having measles, mumps, chicken pox, cytomegalovirus, meningitis, and ear infections (American Speech-Language-Hearing Association n.d.).

As caregivers and teachers, we can urge pregnant mothers to obtain regular prenatal care to maintain health and use proper hygiene, especially frequent handwashing, to prevent infections. We can educate parents about how immunizations can prevent childhood diseases and encourage parents to seek medical attention for children’s earaches.

Why early detection is important
A child needs to learn the foundation for at least one language in the first three to five years of life. This foundation, ideally beginning at birth, can prevent delays in vocabulary, communication, and development of cognitive skills (Texas Department of State Health Services, “Texas Early Hearing Detection and Intervention” 2017).

Typically a baby’s hearing is screened before he or she leaves the hospital or birthing center. The screening requires no activity from the baby other than lying still (National Institute on Deafness and Other Communication Disorders 2017).

In addition, many schools provide hearing tests as part of required student health assessments. In Texas, for example, all children enrolled for the first time in any licensed child care center, licensed child care home, or in a public or private school must be screened or have a professional exam for possible hearing (and vision) problems (TDSHS, “Vision and Hearing Screening Requirements” 2017).

The goal of early screening is to identify children with hearing issues and ensure that they get services to develop communication, social, and cognitive skills. Funding for early detection and intervention programs nationwide is provided by the Early Hearing Detection and Intervention (EHDI, pronounced “Eddie”) Act (Hearing Loss Association of America n.d.).

Children birth to 3 years who are assessed D/HH automatically qualify for services through the Early Childhood Intervention (ECI) program. ECI serves families who have children with disabilities and developmental delays and those at risk for developing delays.

“Parent-infant programs [for children who are D/HH] focus on language development, parent-child communication, social skills, and appropriate support for any residual hearing children might have, as well as testing and evaluation for hearing aids and cochlear implants,” according Dr. Marc Marschark, a professor at the Rochester Institute of Technology’s National Technical Institute for the Deaf (2007).

Hearing aids, which make sounds louder, have undergone significant technological advances in recent years and can be fitted for babies. In some instances, a cochlear implant may be helpful. This is a device in which tiny electrodes are surgically inserted into the cochlea that relay sound signals to the auditory nerve. It is important to remember that while listening technology can improve a child’s access to sounds and spoken language, there is no equipment or device that can restore or fix a child’s hearing level when loss is permanent.

Be alert to developmental milestones
Because children can lose hearing through infections, head injury, and loud noises, it’s wise to be alert to typical developmental milestones beginning with babies. If you observe an infant or toddler not meeting the milestones, refer the parents to ECI.

Birth to 6 months. The baby:
startles, moves, cries, or reacts in any way to unexpected loud noise,
awakens to loud noises,
freely imitates sound,
can be soothed by voice alone,
turns head in direction of a voice.

Six through 12 months. The baby:
points to familiar persons or objects when asked,
babbles to people and toys,
understands simple phrases such as “Bye-bye” by 12 months.

One through 2 years. The toddler:
accurately turns in the direction of a soft voice on the first call,
is alert to sounds in the environment,
locates where sounds are coming from,
begins to imitate and use simple words for familiar people and objects,
shows consistent growth in the understanding and use of words to communicate.

Communication methods
At every level of hearing status, learning to communicate is essential. Three main communication methods for D/HH children are in use:
Auditory-oral, or listening and spoken language. The child has hearing aids or cochlear implants and learns to communicate using whatever hearing exists (residual hearing) , spoken language, and speech reading (using what you see on the speaker’s lips as well as facial expression and natural gestures to understand conversation).
American Sign Language (ASL), considered by the Deaf community as the language of people who are Deaf. Typically ASL is taught in a bilingual/bicultural environment where the child learns ASL and English simultaneously, with English typically taught through print and fingerspelling. The child also becomes part of Deaf culture, a community of people with their own history, language, stories, and art.
Signed English, a system created to mirror spoken English on the hands. Many signed English systems use some ASL signs as well as signs created to show differences in vocabulary. These systems include signs for prefixes (such as un-, de-, and ex-) and suffixes (-ing, -ed, and –tion, for example). Signed English systems are often used in simultaneous communication, where instruction is presented in both speech and sign at the same time.

What are the options for public education?
According to the American Society for Deaf Children (2017), there is no one right way to educate a child who is D/HH. As caregivers and teachers, we can encourage parents to consult a wide variety of information sources and assist them in making an informed choice that is best for the child and the family.

For children from birth up to age 3, the family is the primary focus because they are responsible for the child’s well-being. If working with an ECI program in the community, the family participates in forming a team of specialists and writing an Individualized Family Service Plan (IFSP) outlining the family’s needs and services. The team includes a teacher for the deaf who brings support and information to the family specifically related to communication and language development.

Different team members coach families and caregivers on how to use daily activities to help children learn, socialize, communicate, and develop positive behavior.

As a child approaches age 3, more assessments are conducted to determine if the child meets federal and state definitions of deafness. In Texas, for example, the term is auditory impairment. Children who need continued services qualify for special education and will receive services in a setting that best meets their educational needs.

At age 3, the focus shifts to the child. Parents and team members write an Individualized Education plan (IEP) outlining the child’s education needs. At this stage, the family generally has three options for publicly funded education, depending on the hearing status and where the family lives. In Texas, for example, the three options are as follows:
1. The local school district, which may have D/HH teachers that work with children or which may contract for deaf education services.
2. The Regional Day School Program for the Deaf, either itinerant services in which a D/HH teacher travels among multiple schools, or daily deaf education services in which children from multiple school districts gather in a classroom on a centrally located school campus.
3. Texas School for the Deaf in Austin, which has a day program for Austin area students and a residential program for students (ages 6 through 21) from throughout the state.

Although widely perceived as serving only school-age children, the Texas School for the Deaf offers a parent-infant program for children birth to 3 years, in which specialists make home visits, and a toddler learning center for children 18 to 35 months, which operates on weekday mornings. The school also provides early childhood education classes Monday through Friday for children 3-5 years old.

In addition, the school operates an outreach program that serves approximately 7,000 D/HH students of all ages across the state enrolled in other programs. This outreach allows these students to take advantage of additional resources the school offers.

Beware of a few misconceptions
For many years, a popular notion in education was that D/HH students are the same as hearing students except that they cannot hear. Maybe not, according to recent research. Another misconception is that learning sign language hinders a child’s ability to speak.

“You can’t teach deaf kids as though they are hearing kids who can’t hear,” according to Marschark. “It’s not about ears and it’s not about speech versus sign language. It’s about finding their strengths and needs. The historical approach to deaf education simply doesn’t work well enough to get deaf students where they need to be” (Livadas 2013).

Teachers “need to understand deaf children learn differently, are more visual, and often process information differently than their hearing peers.” One difference, for example, is that hearing children learn incidentally from background noises, words spoken on TV, and conversations between other people. Deaf children also experience incidental learning, which may include watching others use ASL and, after they learn to read, watching closed captioning on TV.

Another difference is that children who are deaf have better visual-spatial memory but poorer sequential memory. For example, a D/HH child may be better able to remember the sequence of The Three Little Pigs if you offer visual supports such as objects representing the concepts in the book or laying out pictures on a table--the wolf blowing at the house of straw, then the house of sticks, and finally the house of bricks--and allow the child to manipulate the objects or pictures.

Other research on D/HH children has found the following (Livadas 2013):
Those who perform best academically usually are the ones whose parents have effectively communicated with them from an early age.
Early language skills—both American Sign Language and spoken language—correlate with reading ability, with no evidence that one is necessarily better than the other.
When entering public school, they often are lagging behind hearing children in their knowledge of the world, number concepts, and problem-solving skills, not just language.
They do not always learn, think, or know in the same ways as hearing children.

Another popular misconception is that sign language is a visual form of English. Actually, there are at least 300 different sign languages used around the world, and regions may have different dialects. ASL, used primarily in the United States, is a distinct language with its own grammar and syntax; it evolved from French sign language and homemade signs that families created to communicate with their children. It is a living language that grows and changes over time (National Association of the Deaf 2017).
In ASL, hand signs are not a form of pantomime and do not form pictures or symbols. It is a visual language. With signing, the brain processes linguistic information through the eyes. The shape, placement, and movement of the hands, as well as facial expressions and body movements all play important parts in conveying information.

Fingerspelling is an important part of ASL. “On the most simplistic level, fingerspelling can be defined as the use of handshapes to represent letters of the alphabet” (Baker 2010). While it can be used to spell our proper names and technical terms, it can also expand the ASL vocabulary through the use of abbreviations and compound words, for example. For children using signs, whether ASL or English, fingerspelling is an important part of their language development. Children need to be exposed to fingerspelling early so that it becomes a natural part of their signed communication.

Tips for working with children
Every child, hearing and D/HH alike, is a unique individual. Ideally, you will match the learning activities in your classroom to each child’s needs and focus on each child’s strengths. Some general tips:
Work cooperatively with parents, ECI specialists, and other professionals who work with D/HH children as outlined in the family’s IFSP or the child’s IEP.
Show the child love and affection, as you would with hearing children.
Make your communication as visual as possible, using facial expressions and body language that match your message. If you are happy, make sure your face shows it. If you say “No,” shake your head with a serious face.
Remember than language is essential to developing cognitive skills; it precedes reading and writing.
Regardless of the communication method used, make print an important part of everyday routines. Emphasize the value of reading and writing in varied and meaningful activities throughout the day.
Take time to listen to the child and try to understand what he or she is saying or signing.
Help the child learn words or signs for feelings like sad, happy, mad, afraid, and confused.
Make experience books with the child about what you do during the day. Take pictures with your camera, cut them from magazines, or draw them. Later use the books to talk about what you did.
Keep in mind that in learning a difference is not a defect.

Reassure parents
Be aware that hearing parents may struggle emotionally when they first learn their child is deaf or hard of hearing. A nurse or doctor may have used words associated with disease, such as something’s wrong, failed the test, and diagnosed, which can cause anxiety. As caregivers and teachers, we can reassure parents that their child has many opportunities for learning, making friends, going to college, and having a rewarding career.

Resources
For more information about the genetics of deafness, see the online booklet, Understanding the Genetics of Deafness, A Guide for Patients and Families, http://projects.iq.harvard.edu/files/centerforhereditarydeafness/files/understanding_the_genetics_of_deafness.pdf.

For information about state laws on newborn hearing screening, see www.infanthearing.org/legislative/mandates.html.

For information on laws impacting D/HH students, see Gallaudet University Laurent Clerc National Deaf Education Center, www3.gallaudet.edu/clerc-center/info-to-go/legislation/laws-impacting-students.html.

For more information about the Texas School for the Deaf, see www.tsd.state.tx.us/.

For a list of Texas programs serving D/HH students, see www.esc11.net/cms/lib3/TX21000259/Centricity/Domain/118/Statewide%20DHH%20Directory.pdf.

For more information on assisting parents to learn more about a baby’s hearing in Spanish or English, see babyhearing.org, provided by Boys Town National Research Hospital with support from the National Institute for Deafness and Communication Disorders, www.babyhearing.org/HearingAmplification/index.asp.

For a video on calming parents upon learning their baby is D/HH, see ASLized.org, http://aslized.org/journal/ei/.

For photos of the fingerspelling alphabet, see Signing Savvy, www.signingsavvy.com/browse-fingerspelling.php/.

For videos of signs to use with babies, including signs for feelings, see Signing Savvy, www.signingsavvy.com/wordlist/babysigns.

For tips on working with school-age children, see TTAC Online, a resource from the state of Virginia, https://ttaconline.org/instructional-strategies-students-deaf-hard-of-hearing.

References
American Society for Deaf Children. 2017. Parents and Families, http://deafchildren.org/knowledge-center/parents-and-families/.
American Speech-Hearing-Language Association. n.d. Hearing Loss After Birth (Acquired Hearing Loss), www.asha.org/public/hearing/Acquired-Hearing-Loss/.
Baker, Sharon. July 2010. The Importance of Fingerspelling for Reading, National Science Foundation, http://vl2.gallaudet.edu/files/7813/9216/6278/research-brief-1-the-importance-of-fingerspelling-for-reading.pdf.
Centers for Disease Control and Prevention. March 22, 2017. Hearing Loss in Children: Data and Statistics, www.cdc.gov/ncbddd/hearingloss/data.html.
Centers for Disease Control and Prevention. March 5, 2010. Identifying Infants with Hearing Loss—United States, 1999-2007, www.cdc.gov/mmwr/preview/mmwrhtml/mm5908a2.htm.
Livadas, Greg. Fall 2013. Deaf Education: A New Philosophy, American Society for Deaf Education, http://deafchildren.org/wp-content/uploads/2014/03/DeafEducation2013.pdf.
Hearing Loss Association of America. n.d. Early Detection and Intervention Act (EHDI), www.hearingloss.org/advocacy/know-your-rights/ehdi.
Marschark, M. 2007. Raising and Education a Deaf Child, 2nd Ed. Oxford, N.Y.: Oxford University Press.
National Association of the Deaf. 2017. What is American Sign Language?, www.nad.org/resources/american-sign-language/what-is-american-sign-language/.
National Institute on Deafness and Other Communication Disorders. March 6, 2017. It’s Important to Have Your Baby’s Hearing Screened ,https://www.nidcd.nih.gov/health/what-do-if-your-babys-screening-reveals-possible-hearing-problem.
Texas Department of State Health Services. March 1, 2017. Vision and Hearing Screening Requirements, www.dshs.texas.gov/vhs/require.shtm.
Texas Department of State Health Services. May 25, 2017. Texas Early Hearing Detection and Intervention, www.dshs.texas.gov/tehdi/.

About the authors
Barbara Langham is an editor of Texas Child Care Quarterly. Mari Hubig is the birth-3 outreach specialist at the Educational Resource Center on Deafness at the Texas School for the Deaf.