CONDUCTIVE HEARING LOSS

1. CONDUCTIVEHEARING LOSS Do You Hear What I Hear? Living and Learning with Conductive Hearing Loss/Otitis Media Kit WA Department of Education

2. Impact of Otitis Media is Multi-Factorial • Age at which the child experienced the first incidence of OM • Number of incidences under the age of 12 months • Access to good medical intervention • Access to certain types of interactions within the family • Access to audiology and speech pathology • Child’s general health

3. Oral Language is fundamental … Speaking and listening provide the foundation for all language learning and underpin the successful development of reading and writing skills. Proficiency in speaking and listening contributes to children’s abilities to learn effectively in all learning areas. First Steps: Oral Language Developmental Continuum

4. Cultural Considerations • Language is the repository of the speakers’ cultural knowledge and reflects their world view. When we devalue a language we devalue everything contained within and reflected by it. • The Western school system is set up to reflect a literate tradition. It assumes all children come to school knowing how to work with language in a de-contextualised manner. We need to be aware that children may come to school with rich language experiences from predominately oral traditions and cultures.

5. Impact of CHL on Speechand Language Development • Hearing children learn the basics of language passively, by hearing it. This avenue is not open to children with hearing losses. • Creates a barrier for normal speech development and phonological processing • Causes delays in the development of a child’s first language and any additional language, particularly when the hearing loss begins at a very young age: • Poor vocabulary and semantic organisation • Expressive and receptive language difficulties – language structure, word endings, grammar, word order etc. • For Aboriginal children, diminished auditory experiences can affect opportunitiesfor learning about culture, law, relationships, etc.(Clarke, 1992)

6. Impact of CHL on Comprehension ‘Oral comprehension’ relates to the ability to understand the meaning of what is spoken. Comprehension is dependent upon context, previous knowledge and experience, sentence length, concepts and attention. (adapted from Health Department of WA Teacher Modules, 2000) • A child with CHL or a history of CHL probably has: • Difficulty with lengthy or complex instructions • An underdeveloped vocabulary including concepts and descriptive terms (e.g. in Preprimary will not understand concepts such as location [over/under…] or size, and descriptive terms [colour, shape]) • Difficulty with some questions (e.g. in Preprimary can’t understand ‘wh’ questions [who, what, when, where])

7. Impact of CHL on Semantics Semantics refers to the link between our thoughts and ideas and the vocabulary and concepts we use to express these thoughts.Semantic organisation describes how we organise incoming information in order to make sense of and later retrieve it. (adapted from Health Department of WA Teacher Modules, 2000 ; Holt & Spitz, 2000) • In Preprimary, a child with CHL or a history of CHL probably: • Has a vocabulary of less than 1500 words • Speaks in sentences of < 3 to 5 words • Doesn’t use language socially • Is slow to learn words and concepts (due to ‘fuzzy’ representations)

8. Impact of CHL on Semantics • Other indicators may be : • Difficulty integrating new information with existing • Limited conceptual understanding • Under-developed receptive and expressive vocabulary • Difficulty retrieving words • Difficulty generating ideas related to a topic • Conversational difficulties

9. Impact of CHL on Syntax Syntax or grammar refers to the way we organise words into sentences. Grammatical rules tell us which words should come before or after others, the word endings we should use and the way words combine to form sentences. (adapted from Health Department of WA Teacher Modules, 2000 ; Holt & Spitz, 2000 ; Owens 1992) • Problems with forming linguistic categories such as plurals and tenses • Grammatical errors and unusual word order • Incomplete sentences • Restricted use of describing words (adjectives/adverbs) and connectors (but, then, because, so …)

10. Impact of CHL on Narrative(Oral Texts) Skills Narratives/Oral texts encompass such genres as stories, reports, procedures, explanations, recounts and news telling. The common feature of these genres is the linguistic structures that are used to tell and retell a series of events in time order. (Adapted from Health Department of Western Australia Teacher Modules, 2000 ; Holt & Spitz, 2000) The Western-style narrative structure tends to be linear in nature and uses a distinct model that may be difficult to understand for Aboriginal and other CALD students. If a child has hearing problems they are likely to have additional problems with story grammar and descriptive vocabulary.

11. Impact of CHL on Phonological Processing Phonological processing relates to the ability to use the sounds of a language to process oral and written language, which allows us to form phonological codes and access a word stored in our brain’s lexicon. Phonological awareness skills (explicit awareness of sound structure and ability to manipulate structure of words) are dependent on phonological processing skills. • Need to hear words to learn words – to ‘map’ words to objects • car? ar? bar? tar? … • Absence of second sound in two-letter blend (eg frog, block) • Absence of unstressed syllable(s) (banana, dinosaur, balloon) • Poor discrimination and identification of sounds

12. Impact of CHL on Phonological Processing Australian English speech sounds with which ESL/ESD speakers frequently are not familiar: Consider the similarities between these sounds (voice, placement of lips and tongue). If a child can’t hear a sound correctly he/she will have considerable difficulty learning to say it correctly, particularly if he/she is reliant on visual differentiation.

13. Impact of CHL on Metalinguistic Skills Metalinguistics refers to the ability to use language to think, talk about, reflect on and manipulate units of language. • Don’t know how to play with sounds and words, eg rhyming • Don’t know what a ‘word’ is so have difficulty understanding word boundaries and segmenting sentences into words: “Ontheweekend”, “smorning”

14. Impact of CHL on Metalinguistic Skills • Difficulty manipulating words within words (eg take ‘sun’ from sunshine); syllables in words (eg take ‘ing’ from doing); sounds in words (eg boat has 3 sounds: b / oa / t; take ‘c’ from coat); and blending sounds to make words (eg s – t – o – p) • Poor understanding that words are arbitrary symbols of a language system – words usually don’t contain any hint of their meaning • Problems working out how communication breaks down

16. Impact of CHL on Pragmatics Pragmatics relates to the use and functions of language for communication. Pragmatic awareness is the knowledge of conversational rules and includes both verbal and non-verbal aspects. (adapted from Holt & Spitz, 2000 ; Owens 1992) Children with a hearing difficulties may have problems with: • Entering into a group, requesting, responding and taking turns • Initiating conversations • Understanding subtle social rules • Accepting others points of view and others’ feelings • Monitoring the listener

17. Impact of Hearing Loss on Socialisation Children with hearing difficulties, however, are also likely to present with social and emotional challenges due to: • Their own frustration and/or the frustration of their peers • Avoidance • Just not “getting it” i.e. the subtleties and unwritten rules of social exchanges

18. Summary of Educational Impact of CHL • More than three infections under the age of 12 months is a significant risk factor • Even without a current ear infection children can still suffer the effects of a history of conductive hearing loss • Poor ability to discriminate sounds in words and to hear words in words; difficulty chunking words into individual parts; and relationship between own sound repertoire and written alphabet is tenuous • Language learning difficult; frequently have restricted content, vocabulary, language and confidence; prediction as a reading strategy is not functional except with simple or familiar texts • Poor foundation for literacy and without help will fall further behind every year • Socialisation difficulties and behaviour problems are likely • The most debilitating aspects of deafness are secondary to the hearing impairment itself