Unit 1: Need & Strategies for Early Intervention of Hearing Loss
1.1 Parent-infant programmes for children with HI: Overview, need, requirements and plan of action.
1.2 Pre-school training programmes: Overview, need, requirements and plan of action.
1.3 Individual Speech-Language Therapy Programmes: Overview, need, requirements and plan of action.
1.4 Impact of early intervention on school outcomes
1.5 Intervention of late identified children with hearing impairment: Challenges & Strategies
1.1 Parent-infant programmes for children with HI: Overview, need, requirements and plan of action.
Advances in hearing screening technology make it possible to
identify hearing-impaired infants at birth, enhancing the opportunity for early
intervention. To provide services for families of hearing-impaired infants, the
Parent Infant Program (PIP) was established. Enthusiasm for PIP emerged from
the concept that children advance to the best of their abilities when their
emerging speech, language and auditory skills are reinforced in a context of
acceptance and respect, and importantly, the most important learning
environment for a child during the early years, is the home.
During these early formative years, the child's
most important relationships are with their parents and other primary
care-givers, such as siblings, grandparents and other family members.
Consequently, the emphasis of PIP is a
home-based, family-centered, parent-guided, child-specific, natural approach to
learning. The parent infant program brings together children from infancy
through pre-school age, their parents, family and a variety of early
intervention professionals to work as a team and offer services to assist
families in communicating and bonding with their children in the child's
natural environment. Parents are encouraged to network with other parents. PIP
helps hearing impaired children and their parents develop potential in primary
areas and strives to nurture the child's development of language, literacy
skills, growth in world awareness, positive self-esteem, personal responsibility
and cultural pride.
Although there are improved and widespread
special schools for hearing impaired children available across India, the value
of an integrated educational program remains significant. The Indian
government's educational legislation emphasizes integration of the disabled
child into ''normal' schools through mainstreaming of children with various
disabilities, including hearing impairment. Consequently, to achieve successful
integration, pre-school education for hearing impaired children plays a key
role in establishing the foundation upon which further learning occurs.
The PIP was established to assist parents in developing strategies needed to nurture their child's language, speech, auditory, intellectual abilities, social and emotional growth throughout their education.
The emphasis of PIP is a home-based, family-centred, parent-guided, child-specific, natural approach to learning. The parent-infant program brings together children from infancy through preschool age, their parents, family and a variety of early intervention professionals to work as a team and offer services to assist families in communicating and bonding with their children in the child’s natural environment. Parents are encouraged to network with other parents. PIP helps hearing-impaired children and their parents develop potential in primary areas and strives to nurture the child’s development of language, literacy skills, and growth in world awareness, positive self-esteem, personal responsibility.
The Parent Infant Program strives to provide early intervention services and coordination including:
· Support for parents and families in their efforts to understand their child’s hearing loss.
· Information, training, modeling, and consultation for parents and family to allow for an increased understanding of their child’s unique needs.
· Networking opportunities for families to meet others who have children with hearing loss.
· Resources and instruction designed to prepare children with a hearing loss to reach their highest potential in preparation for further education.
Need
The Parent Infant Program offers parents and caregivers the skills and confidence they need to help their young children learn to listen and talk. Individualized sessions provided at home or in childcare settings are guided by teachers of the deaf and focus on auditory habilitation and speech/language development. The aims of parent infant programme are as follows:
1) To understand their child's deafness
Parents must understand the basic of hearing mechanism and hearing loss. The information regarding hearing loss includes type and degree of hearing loss. Children with sensory neural hearing loss will have more adverse effect on language development than the conductive hearing loss. Degree of hearing loss also plays important role. Sever to profound degree of hearing loss will have great difficulty in developing language than mild or moderate degree of hearing loss. Even children with unilateral hearing loss may have some problem in the early stage of their life.
2) To monitor growth in their child's listening, speech and language skill.
The Parent infant program also provides auditory habilitation services to the child which include fitting of appropriate hearing aid, to show parents how to use the hearing aid, and auditory training to develop listening skill with the parents so that the child learns to respond through hearing and increases his/her receptive and expressive language. Baseline audiological and language data on the children also helps to monitor the growth of listening, speech, and language skill of the child.
3) To help the parents to coordinate their child with medical personnel, equipment dealers, and school systems.
The parents infant program is also designed to help parents to cordinate with medical personnel, mainly with Otorhinolaryngologist for any ear check up as and when required and with Paediatrician for general chek up. It also helps to cordinate with equipment dealer mainly with hearing aid dealer for after sale services of hearing instrument. Cordination with school system for mainstreaming of the child to normal schhool.
Requirements:
A team of professionals: Parent infant programs require involvement of a team of professionals along with the parents. These include an audiologist, speech and language therapist,primary care physician, Special educator etc. From special educators, audiologist, speech/language therapist, parents can learn to see that the hearing aids are functioning optimally,care and maintenance of the hearing aids, can learn how to call baby's attention to sounds and what they mean. Parents also can learn how to make speech as audible as possible, and how to encourage infant to listen to his or her own voice as well as parents Ensure hearing aids are used by the child. The professionals also advice parents to talk to the child most naturally preferably in a slightly slower manner ensuring that the child is looking at them, consciously label the things around the infant, converse on all the incidents and activities going around him. Team of professionals understand the emotions of parents therefore help them to make difficult decisions about their children's communication.
Appropriate listening situation: Parents can make their house a good listening environment. If possible one of the room can be made acoustically apprpriate for the heaing impaired infant where formal way of training can be done by the parents. Finding appropriate amplification is just the beginning, however. Because hearing aids and cochlear implants work differently than glasses, or ears with normal hearing, infant will need parents to guide those early listening experiences
Training materials: Training materials include toys and books, tools for listening training such as different noise makers and instruments generate different frequency tone.
Plan of action:
It is possible to identify hearing-impaired infants at birth with advances in hearing screening technology therefore enhancing the opportunity for early intervention. The Parent Infant Program (PIP) was established to provide services for families of hearingimpaired infants. It is assumed that children advance to the best of their abilities when their emerging speech, language and auditory skills are reinforced by parents during early years and there the enthusiasm for PIP emerged. The most important learning environment for a child during the early years, is the home.
During these early years, the child's most important relationships are with his or her parents and other primary care-givers, such as siblings, grandparents and other family members. Therefore, the emphasis of PIP is a home-based, family-centred, parent-guided; child-specific which is a more natural approach to learning. The parent infant program brings children from infancy through pre-school age, Parents, other family members and early intervention professional work as a team and offer services in communicating with their children in the child's natural environment. Parents are encouraged to network with other parents. Parent infant program helps hearing impaired children and their parents to develop potential in primary areas and nurture the child to develop language skills, better social and emotional skills, the ability to manage their own behaviour and mental health, a stronger foundation for learning at school, an easier transition into adulthood, better job prospects, healthier relationships and improved mental and physical health. Language development is vital as it is the basis of communication. It is the most important factor in the all-round development of a child. It is the basis of most learning, not only in the formal aspects of education, but also in the development of character, emotional state and social relationship of the children. The questions are 'who should develop language and how it should be taught to the children'.
In order to answer both these questions the simplest thing is to recollect how hearing babies have acquired language. The hearing baby acquired or learnt it from the parents and the family members around them through constant exposure and interaction. Parents unconsciously teach and reinforce the language. It is an established fact that the hearing impaired child also has the same innate capacity to learn language as a hearing child but the reason that he has not learnt it, is because he has not heard the language around him. Parents of a hearing impaired child may therefore interact and talk to him as naturally as they would do with hearing children. Action plans are designed based on short term and long term goals. Parents of a hearing impaired child should interact and talk to their child as naturally as they would do with hearing children.
Such Parent infant Programmes are available at a few centers in India. Some of the centres are:
|
A.Y.J.N.I.H.H. |
Maitri Infant Training Centre |
|
Vikas Vidyalay for the Deaf |
Balvidyalay School for Young Deaf
Children |
1.2 Pre-school training programmes: Overview, need, requirements and plan of action.
This goal is achieved through the following guiding principles:
The Preschool Program provides a continuum of services, including listening and spoken language and sign-based instruction depending on the learning needs of the child. The preschool aims to develop the child’s many ways of experiencing the world by providing a range of small and large group activities focused on early literacy, writing, drama, art, music, math, movement and exploration.
For children diagnosed and intervened at a very early stage and most importantly who have developed functional language could be included in regular pre–school programmes. However assistance from special teachers or resource teachers would be required so that the child develops good reading and writing skills and a continual language enhancement programme.
Segregated in a Special School
Children diagnosed late or those who have not developed adequate functional language are enrolled in Special pre–school programmes. In special schools, special teachers help children build a strong foundation of language which would ease out the formal education in primary and secondary school, again, either in an integrated setup or in a special school depending upon the child's achievements. Teachers in special schools develop conversational skills by using various techniques. Special pre–school curriculum to suit the needs of the children is devised and activities such as directed activity, story telling, guided play are contrived to develop receptive and expressive language in the pre–school hearing impaired children.
Special pre–school programmes are conducted at AY.J.N.I.H.H., Mumbai and its regional centres and at many of the special schools across the country. A model pre–school curriculum for Young Hearing Impaired Children is available at A.Y.J.N.I.H.H.
Requirements:
The pre-school should be equipped to enable communication as well as all-round development of children including assistive listening devices such as different class room amplification devices like group hearing aids, FM hearing aids; audio-visual aids like multimedia projector, 52" television; elaborate outdoor play equipment that facilitate therapeutic and academic training; and several computers along with wide range of educational CDs and software for developing multimedia educational materials. Following are the requirement for a successful preschool program.
Amplification devices: Children must use individual amplification devices whether hearing aids or cochlear implant. Children who can use at least some of their residual hearing will benefit from early chances to listen, provided by devices like hearing aids or cochlear implants. Using these devices children hear sounds louder and clearer. Parents need to make decision, what kind of hearing aid to select, and whether or not to consider a cochlear implant. Using of ear mould with the amplification devices is mandatory. Children also use different class room amplification devices in the class for their group activities.
A team of professionals: Pre-school training program for hearing impaired children requires involvement of a team of professionals along with the parents. These include an audiologist, speech and language therapist, primary care physician, Special educator etc. From special educators, audiologist, speech/language therapist, parents can learn to see that the hearing aids are functioning optimally, care and maintenance of the hearing aids. Parents also can learn how to make speech as audible as possible, and how to encourage children to listen to his or her own voice as well as parents ensure hearing aids are used by the child. The professionals also advice parents to talk to the child most naturally preferably in a slightly slower manner ensuring that the child is looking at them, consciously label the things around the infant, converse on all the incidents and activities going around him. Team of professionals understand the emotions of parents therefore help them to make difficult decisions about their children's communication.
Appropriate listening situation: The pre-school training set-up should have a good listening environment for the hearing impaired children. If possible all the rooms can be made acoustically appropriate for the hearing impaired children where formal way of training can be done. If induction loop systems are used as assistive listening device proper steps must be taken to avoid any spill over effect.
Training materials: Training materials include toys and books, tools for auditory training such as different noise makers and instruments generate different frequency tone. Audiovisual aids like multimedia projector, ; elaborate outdoor play equipment that facilitate therapeutic and academic training; and several computers along with wide range of educational CDs and software for developing multimedia educational materials.
Plan of action:
Class room activity
Pretend Play: Children who are deaf have normal intelligence and can study just like other children. However, in the initial years, they struggle with many issues including language and communication. Activities for the classroom are suggested to help a child build up language, communication and social skills. Pretend play is a normal part of child development. Most children pick up dolls, talk to them, and play with them. Children with sign language use signs instead of talking. Provide opportunities for the child to pretend play. Provide materials, time and space for a child to practice communication skills with dolls and imaginary friends. If the child is not doing it on their own, you may need to model it and involve the child till he or she learns.
Classroom Responsibilities: In the classroom, children who are deaf should also be given some responsibilities. Responsibilities can be as simple as making sure the board is clean before they leave, or opening the windows in the morning. These responsibilities help the child feel important and valued and helps build up their confidence to work independently.
Story Time: Story time is a great way to develop language skill in children with hearing impairment. Activities should use short stories with pictures and few words per page. Read the words, and explain them during the story. Get the children to sign some of the words used in the story with you. Also, use the story to talk about other things related to the same topic. Even if you have an integrated classroom, the other children will enjoy learning and practicing signs at story time. Allow children to look at books that you have read to them at their own pace.
Music: Children who cannot hear miss out on learning to appreciate and enjoy music. However, you can make this possible by helping them understand vibration. Use drums and other vibrating instruments in your classroom for activities. Allow children to play with instruments and feel the vibrations. You can also play a drum while allowing the child to feel the rhythm with one hand, and follow the rhythm with the other hand on another drum.
Paired Activities: Children who cannot hear find it difficult to work with others, especially other children who can hear. Pair up a child who is deaf with another child to do an activity together. The activity can be a craft activity, or even going to the garden and getting some materials for the lesson. Start with more structured activities that require only the sharing of materials, and slowly involve the child in more unstructured activities that require planning and communication. All of these various activities will help a deaf child develop necessary communication skills.
1.3 Individual Speech-Language Therapy Programmes: Overview, need, requirements and plan of action.
Speech therapy is the treatment of speech/language production, voice production, swallowing function, cognitive-linguistic skills, and/or general communication abilities that have been impaired as a result of a disease, injury, developmental delay or surgical procedure. The purpose of speech therapy is to provide necessary services for the diagnosis and treatment of impairments, functional limitations, disabilities or changes in speech/language production, voice production, swallowing function, cognitive-linguistic skills, general communication deficits, and compensatory communication abilities. Speech therapy is medically necessary to help restore functional speech, swallowing and language following the onset of their impairment.
Individual speech and language therapy program helps in the identification, screening, assessment, and rehabilitation of individuals with hearing loss. Speech and language therapists have the specialist skills and training to address communication effectiveness, disorders, differences, and delays that result from a variety of factors, including those that may be related to hearing loss. They provide individualised assessment, diagnosis and intervention to the child and also help the parents to make the choices regarding communication mode and habilitation approach. Individual speech and language therapy program accelerate language development in order to reduce and/or eventually close the gap between the child's chronological age and language age. Individual speech and language therapy program helps to make the choice of mode of communication of the child such as auditory-verbal communication, Aural oral communication, cued speech, sign language or total communication. It helps parents to select hearing devices (analog hearing aids, digital aids, bone anchored hearing aids, cochlear implants) suitable for their children and teaches parents how to maintain and troubleshoot their child's hearing device(s) in order to get the best sound possible. Individual speech and language therapy program provides family-centred therapy that focuses on the child's learning needs and potential which helps the child to develop Skills and sub-skills for learning speech and language.
Need:
Children with hearing loss needs speech and language therapy because of the adverse effect of auditory deprivation on communication. Therefore an early intervention on speech, language development is important because of critical period for language learning and brain reorganisation. Children learn the following aspects of speech through the Individual speech and language therapy program.
1) Vocalization and its meaningful use
2) To improve the usage of meaningful vocalization more spontaneously. 3) Proper use of intensity and pitch in vocalization.
4) To improve on speech imitation skill.
5) Proper use of respiration and tongue. 6) Maximum use of residual hearing for production of Speech.
7) To teach the child to use visual and tactile clues for learning language.
8) Proper articulation of vowels and consonant sound in syllables, words and sentence level.
9) Spontaneous use of language at phonetic level. 10) Satisfactory use of language for effective communication.
Requirements:
Amplification devices: Children must be fitted with individual amplification devices whether hearing aids or cochlear implant based on their degree of hearing loss. Children with their residual hearing and amplification devices will be benefitted from early chances to listen. Using these devices children hear sounds louder and clearer. Parents need to make decision, what kind of hearing aid to select, and whether or not to consider a cochlear implant. Using of ear mould with the amplification devices is mandatory.
Appropriate listening situation: Individual speech and language therapy program should have a good listening environment for the hearing impaired children. If possible the room can be made acoustically appropriate for the hearing impaired children where therapy program can be done.
Training materials: Training materials include toys and books, tools for auditory training such as different noise makers and instruments generate different frequency tone. Audio- visual aids like multimedia projector, ; elaborate outdoor play equipment that facilitate therapeutic and academic training.
Plan of action:
· In the recent times, there has been increasing support of intervention occurring within the child's and family's functional and meaningful routines and experiences dispersed throughout the day rather than in tightly planned and executed activities. This shift away from traditional, clinical models for services for young children and their families is aligned with the federal mandate to provide services in natural environments and is responsive to the success of parent-implemented interventions. The use of routines and everyday activities as a context for embedded instruction involves (a) identifying the sources of learning opportunities occurring regularly in family and community life; (b) selecting, with the parents and caregivers, desired participation and desired communication by the child in the routines; (c) mapping motivating aspects and the child's interests within the routines; and (d) identifying facilitative techniques that will be used to maximize the learning opportunity.
· Organization of the ever-expanding research base on effective intervention approaches and strategies in early intervention is challenging for a variety of reasons. The focus of intervention may be the parent or caregiver, the child, the dyadic interaction, the environment, or combinations of these factors. The agent of the intervention may be the SLP, another team member, a family member or peer, or varying combinations. The intervention may be in small or large groups, individual or massed, or distributed opportunities throughout the day. Much of the empirical data collected to date have been on preschoolers rather than infants and toddlers, and the quality and preponderance of the evidence are lacking for some intervention practices. However, there are intervention approaches and strategies for the SLP and team to consider that have some evidence to support their use by professionals and parents in both home and community settings for young children with a variety of disabilities.
· Strategies with promising evidence fall into one of three groups: responsive interaction, directive interaction, and blended. Responsive approaches include following the child's lead, responding to the child's verbal and nonverbal initiations with natural consequences, providing meaningful feedback, and expanding the child's utterances with models slightly in advance of the child's current ability within typical and developmentally appropriate routines and activities. Responsive interaction approaches derive from observational learning theory and typically include models of the target communication behavior without an obligation for the child to respond. Among others, specific techniques include expansions, extensions, recasts, self-talk, parallel talk, and build-ups and breakdowns. Directive interaction strategies include a compendium of teaching strategies that include behavioral principles and the systematic use of logically occurring antecedents and consequences within the teaching paradigm. Blended approaches, subsumed under the rubric of naturalistic, contemporary behavioral, blended, combination, or hybrid intervention approaches, have evolved from the observation that didtactic strategies, while effective in developing new behaviors in structured settings, frequently fail to generalize to more functional and interactive environments. The emphasis on teaching in natural environments using strategies derived from basic behavioral teaching procedures has been broadened to include strategies for modeling language and responding to children's communication that derive from a social interactionist perspective rooted in studies of mother-child interaction. The core instructional strategies are often identical to those used in direct teaching (e.g., prompting, reinforcement, time delay, shaping, fading) but also may include strategies that come from a social interactionist perspective (e.g., modeling without prompting imitation, expansions, recasts, responsive communication). Naturalistic language interventions may be used as the primary intervention, as an adjunct to direct teaching, or as a generalization promotion strategy.
· Monitoring intervention. Because young children often change very rapidly, and families respond differently to their children at various periods in development, systematic plans for periodic assessment of progress are needed. The three broad purposes of monitoring are to (a) validate the conclusions from the initial evaluation/assessment, (b) develop a record of progress over time, and (c) determine whether and how to modify or revise intervention plans. Thus, the evaluation/assessment and intervention processes can be viewed as a continuous cycle of service delivery. Monitoring includes attention to both the child's IFSP as well as broader aspects of the child's development and behaviors, such as participation in routines, play, social interactions, and problem behaviors, to determine appropriate goals in these areas. For children in early care and education programs, attending to their levels of engagement in activities can help determine whether changes are needed in their classroom environment.
1.4 Impact of early intervention on school outcomes
Early intervention (EI) is a system of professional services provided to children from birth until about five years of age who are disabled, have delayed development or are at risk of delayed development. To help children with disabilities, it is essential to focus on the earliest years of development, since this is a critically important time for early learning which powerfully affects the child’s future life course. Along with medical and rehabilitation services (where ever required), the children are actively engaged in an instructional program many times a week, throughout the year. It involves planned professional intervention organized around relatively brief periods of time for the very young children so that they may receive sufficient adult attention. The Early Intervention Program offers a variety of therapeutic and support services to eligible infants and toddlers with disabilities and their families, including:
§ Family education and counselling, home visits, and parent support groups
§ Special education
§ Speech pathology and audiology
§ Occupational therapy
§ Physical therapy
§ Psychological services
§ Medical services
§ Nutrition services
§ Social work services
§ Assistive technology devices and services
Understanding the Benefits of Early Intervention:
1. Early Intervention helps your child make the most of learning through play
Purposeful play is a child’s work and essential to brain development, particularly during their first three years. If your child appears to be experiencing developmental challenges, getting support early and understanding exactly how services can help is essential. Opportunities for play with a caregiver or Early Intervention specialist can facilitate the development of the skills needed for problem solving, self-control, socialization and communication.
2. Early Intervention may reduce the need for specialized instructional support during a child’s school years
Early Intervention can be effective in helping a majority of children make progress toward achieving age appropriate developmental milestones. Children receiving Early Intervention support may show potential for increased academic readiness and to better be able to interact with their peers.
3. Early Intervention occurs where your child is most comfortable and becomes part of their routine
The therapists will meet with your family in a natural environment such as your home, or day care. Children are most comfortable in familiar environments, and as a result Early Intervention activities become part of your daily routine. Your child will progress by repetition and incorporation of strategies into meal time, play time, and bed time.
4. Early Intervention services are provided at NO COST to families
The value of Early Intervention in addressing developmental delays has been recognized. As a result, through available funding, Early Intervention services are able to be provided to families at no cost.
5. Early Intervention empowers families to help their child reach their true potential
As a parent, you are your child’s primary teacher. Through Early Intervention services, you will be empowered with the tools necessary to help your child through their developmental challenges, so that they may reach their full potential.
Child functional outcome in the two randomized groups was similar. Process evaluation revealed that some physiotherapeutic actions were associated with child mobility and parental educational approach at follow-up: e.g., training and instructing were associated with worse mobility.
Children with hearing impairments are at risk for serious difficulties acquiring and developing literacy skills. Among children with severe to profound hearing impairment, low literacy rates have frequently been reported in the literature. Numerous studies with children who are deaf show that literacy development and proficiency has been challenging for this population (Spencer et al., 2003). Literacy difficulties can impact the child's academic, social and emotional success. When hearing children learn to read, most are competent language users and map their existing phonological, syntactic, semantic and discourse skills onto the newly acquired task of reading. The deaf child approaches the reading task with an incomplete spoken language system and, because reading is a speech based system, this significantly increases the difficulty of the task. As a result, this may facilitate and improve development of speech perception skills in children with hearing impairment (Watson, 2002).
1.5 Intervention of late identified children with hearing impairment: Challenges & Strategies
Verbal language perception, development, and usage is strongly related to the auditory sense. Therefore, the presence of hearing loss – even to a mild extent – has a negative effect on speech–language development in hearing-impaired children, and delays acquisition of linguistic, social, academic, and sensory abilities. Further, as speech and language development are prerequisites for cognitive development, an auditory defect may affect and impair the hearing-impaired child’s cognitive ability. Verbal language is a humanized skill which is acquired gradually during a defined step-by step process. Language is acquired through daily life interactions without any training in normal-hearing children. Hearing loss hampers this process and causes language disorder. Therefore, normal language acquisition in the hearing-impaired child requires special training based on the degree of hearing loss.
Pre-lingual hearing loss has a negative effect on all fields of language acquisition, but the influence on phonology, morphology, advanced vocabulary, and syntax is most profound. Because of the dramatic decreased hearing sensitivity in moderately severe or severe hearing loss, delay of speech and language development in hearing-impaired children is not unexpected. Since full compensation of auditory defects is not possible solely by acoustic amplification, lip/speech reading and even sign language training in some cases is needed for normal cognitive development in hearing-impaired children. The first 36 months of childhood are the most critical periods in terms of language acquisition, and language development is never again as rapid after this period. Reception and perception of acoustic stimuli are essential prerequisites for pre-lingual activities. Therefore, early hearing-loss identification accompanied by appropriate intervention is essential for normal language acquisition in hearing-impaired children.
Identification of hearing loss and early appropriate intervention before the age of 6 months can increase the possibility of normal speech and language development in hearing-impaired children. The appropriate intervention program must include family consultation, hearing aid description/fitting, auditory training, language learning, and educational strategies based on the needs and abilities of the baby or child.
Although hearing impairment has detrimental consequences, deep-rooted cultural beliefs can predispose some parents or care givers to stubbornly refuse to opt for clinical treatment or rehabilitation. Hearing impairment is 1 of the 4 major disabilities recognized by WHO and early hearing detection and intervention are required for speech and language development in children with hearing impairment.
Delays in identification of hearing impairment can result in speech and language, social, emotional, cognitive, educational, and occupational delays. Hence, hearing screening should be conducted by 1 month of age, diagnostic tests by 3 months, and appropriate intervention by 6 months. Transient evoked otoacoustic emissions and auditory brain response are commonly used for hearing screening, and brainstem evoked response audiometry and auditory steady state response are reserved for routine clinical testing.
Hearing is sometimes called the social sense because it has a fundamental role in interacting and relating with people and the social environment. Therefore, adaptable solutions are required for individuals with hearing impairment to improve hearing-related health and wellbeing. The extent of hearing impairment from moderate to profound has been highlighted in previous studies in which children were prone to make pragmatically inappropriate responses because they lacked the ability to comprehend environmentally available auditory cues and were victim to extreme literalness.
Socializing is a core component of human activity, and educating children with hearing impairment should also focus on this vital aspect of life. Hence, timeous suspicion of hearing impairment, with prompt diagnosis and early intervention, positively affects socialization, including active involvement in festivities and religious activities. A 2002 review reported that children with hearing impairment are socially immature compared with children with normal hearing. Children with hearing impairment tend to interact more with other children with hearing impairment rather than those with normal hearing, and their self-esteem is not linked to mainstreaming.
Professional failures can result in delayed diagnosis and fitting of amplification devices, in spite of suspecting hearing loss in the first 3 years of life. Lack of knowledge regarding the critical age of speech and language development and lack of rehabilitation facilities contribute to the delay in identification and rehabilitation of hearing impairment. Therefore, it is essential to improve awareness among mothers, as primary care givers in Asian communities, of the importance of timely identification and intervention of hearing impairment.
Parents can be led to believe that their child does not have hearing impairment if the child has been subjected to a perfunctory testing regime that does not accord with internationally accepted norms of detection by neonatal hearing screening. For example, at age 2 days, some paediatricians resort to manual testing of children’s hearing by clapping or clicking their fingers. This can yield a false and a misleading result, even for parents who suspect hearing impairment. Such children are deprived of the appropriate neonatal hearing screening, which invariably causes delay in rehabilitation and management of hearing impairment. Instead of the stepwise involvement of various professionals, the hearing impairment goes unnoticed. Subsequently, after the parents’ suspicion is heightened, the child is brought to the clinical or hospital and subjected to the requisite screening and hearing impairment is detected.
Intervention for children with hearing impairment:
A few easy steps can be taken to ensure the classroom is suitable for hearing impaired students. When possible, turn off equipment that creates background noises, such as fans and projectors, when not in use.
When a student who is hard of hearing or deaf is placed within a general education classroom, seating arrangements are crucial. Providing a student with a “preferred” seat in the classroom can allow for more interaction with the teacher and peers. If the student is sitting in the front of the classroom with all the other students behind them, it may be easier to follow the conversation when the teacher is talking, but more difficult when other students are speaking. Students relying on speech reading would need to turn around when a classmate begins to talk.
When using preferred seating, the student should be able to see not only the teacher clearly but the classmates as well. One form of preferred seating is the set up the seats in the classroom in a “U” shape. This would allow the students to be able to see each other clearly, as well as see the teacher (Tvingstedt, 1995). Another way of setting up the classroom would be in groups. This would mean organizing the desks into small groups of about four or five students. If the room is structured into groups, the students would be able to see most people clearly, and they could easily turn to see the rest of the class (Tacchi, 2005). The teacher might also ask the student where he/she would like to sit. This would allow the students to choose a seat from which they feel they can communicate and learn to the best of their ability (Keller, 2004). The student should be allowed to change to another location in the room as flexibly as possible for better viewing of the teacher and peers (Waldron, 2005). Through the use of preferred seating, a teacher can set up the classroom to allow all students equal access to the conversations and curriculum.
1. Look directly at the student and face him or her when communicating or teaching.
2. Say the student’s name or signal their attention in some way before speaking.
3. Assign the student a desk near the front of the classroom, or where you plan to deliver most of your lectures.
4. Speak naturally and clearly. Remember speaking louder won’t help.
5. Do not exaggerate your lip movements, but slowing down a little may help some students.
6. Use facial expressions, gestures and body language to help convey your message, but don’t overdo it.
7. Some communication may be difficult for the hard of hearing student to understand. Explicitly teach idioms and explain jokes and sarcasm.
8. Young hearing impaired children often lag in the development of social graces. Consider teaching specific social skills such as joining in to games or conversation, maintaining conversations, and staying on topic.
9. Male teachers should keep moustaches well groomed.
10. Sign Interpreters and Notetakers:
Students who are hearing impaired or deaf may have either a note-taker or a sign interpreter in the classroom to assist in their learning. It is very important that the teacher and the child’s support staff member work together to help the child gain full access the curriculum. The interpreter’s role in the classroom must be clearly defined prior to entering the classroom, so that situations do not arise out of misunderstanding. The teacher and interpreter should discuss the following areas to insure that the student will receive the most benefit from the services provided:
The teacher and the interpreter can assure student success in the classroom through constant communication and monitoring of the student’s progress
1. Adjust teaching methods to accommodate your visual learner’s needs by writing all homework assignments, class instructions and procedural changes on the board.
2. Arrange desks in a circular pattern if possible so hearing impaired students can see other students. This is especially important if they need to read lips.
3. Provide students with an outline of the daily lesson and printed copies of the notes, allowing them to focus on discussions and questions while you are teaching. Students can then be more engaged in learning and can easily review the notes at a later time. Since vision becomes a hearing impaired student’s primary means for receiving information, utilize visual aids whenever you can. Consider using posters, charts, flash cards, pictures, manipulatives, graphic organizers, artifacts or any visual items to illustrate concepts. Try to use captioned videos in class.
4. Follow all established guidelines within the student’s IEP (Individualized Education Plan), regarding classroom adaptations and aids for hearing impaired students. Don’t be afraid to contact your school district if you need help.
It is critical for teachers to monitor the progress and understanding of all students, but especially so for those with special needs. Teachers must be sensitive to the needs of hearing impaired students and follow the IEP as closely as possible.
Teaching hearing impaired students doesn’t have to be difficult, as long as you are flexible. When you incorporate these strategies into your teaching practice, chances are that you’ll find a number of students who benefit from your efforts.