Supporting Students with Hearing Loss in the Regular Education Classroom

1. Supporting Students with Hearing Loss in the Regular Education Classroom

2. We will discuss: • Hearing Loss • Type and Degree • Impact • Myths • The Goals of the AIU Deaf/Hard of Hearing Support Program • The Hearing Support Teacher • The Educational Audiologist • Classroom Accommodations • The Role of the Educational Interpreter

3. Audiology 101

5. Types of Hearing Loss • Conductive: • Involves the outer or middle ear • Temporary or permanent • Often able to be repaired or improved • Sensori-Neural • Involves the inner ear • Usually permanent • Causes a distortion of sound

6. Types of Hearing Loss Mixed Hearing Loss • A combination of conductive and sensori-neural losses • Part of the damage occurs in the outer or middle ear and part of it occurs in the middle ear Unilateral Hearing Loss • A hearing loss in one ear • Mild to profound • Children with UHL are at a higher risk for having academic, S/L, and social/emotional difficulties than their hearing peers • Children with UHL are ten times as likely to be held back at least one grade compared to children with normal hearing.

7. Degrees of Hearing Loss

9. p h g ch sh l a j mdb o r n ng e i AUDIOGRAM OF FAMILIAR SOUNDS FREQUENCY IN CYCLES PER SECOND (HZ) 125 250 500 1000 2000 4000 8000 0 10 z v f th 20 s 30 40 50 u HEARING LEVEL (dB HL) 60 70 80 90 100 110 120

10. The Speech Banana

11. Hearing Loss Simulations • http://www.betterhearing.org/sound/index.cfm • http://www.hear2learn.org/CICSsim/index.html • http://www.ndcs.org.uk/family_support/hearing_loss_simulation/index.html#contentblock1 • http://cuip.net/~gellenbaum/curriculumweb/activity2.html

12. Terminology • Use the term preferred by the person when referring to their hearing loss. • Most Deaf or hard of hearing people prefer “Deaf” or “hard of hearing” (usually depending on amount of residual hearing) • “Hearing Impaired” is seen by most Deaf and hard of hearing people as negative. Most Deaf people don’t consider themselves “impaired”. • Deaf refers to people who have little or no residual hearing and must access information visually (via ASL , speechreading, etc.) • “Big D” (Deaf): Culturally Deaf people • Hard of hearing refers to people who have some usable residual hearing and can access information aurally as well as visually. • DHH: Blanket term for “Deaf and hard of hearing”

13. The Impact of Hearing Loss • Depends on: • Congenital or Acquired • Prelingual or Postlingual • Degree of Hearing Loss • Type of Hearing Loss • Hearing or Deaf Parents • Early Intervention • Hearing Aids • Cochlear Implant • The Quality of Their Education

14. The Impact of Hearing Loss • Communication and Language • Lack of access to a visual language • Delayed diagnosis • Speech Audibility and Intelligibility • Incidental Learning • Academic Delays • Reading • Vocabulary • Social Isolation and Poor Self-Image

15. Communication and Language • Nine out of ten babies with hearing loss are born to hearing parents. • Delay in first language acquisition • The “critical period” for children to develop their speech and language skills -- from birth to the first two to three years of life • Universal Hearing Screening has improved the identification of children with hearing loss but there are still delays in identification and treatment of hearing loss.

16. Speech Audibility and Intelligibility • Children with hearing loss often can’t hear the higher frequency (quieter) speech sounds (“s”, “sh”, “f”, “t”, and “k” so their speech may be difficult to understand. • They may have difficulty monitoring their pitch and loudness because they may not hear their own voices.

17. Speech Audibility and Intelligibility • High-frequency sounds (“s,” “th,” “f,” “sh”) are very important for understanding speech because they involve consonant production and carry the meaning in many words. • Recognizing verb tense (“bounces” vs. “bounced”), pluralization (“book” vs. “books”), possession (“yours,” “John’s”), and contractions (“it’s,” “he’s,” “what’s”) is a difficult task for D/HH children

18. The Importance of Incidental Learning • Children with normal hearing often seem to passively absorb information from the environment . • As much as 90% percent of what a normally hearing individual learns is from overhearing conversations, with only ten percent from direct instruction. • A child with a hearing loss cannot casually overhear what people say and since a great amount of information that a child learns is not directed at him/her it stands to reason that s/he misses out on essential daily information. • Children who have a hearing loss will need to be taught directly many of the skills that other children learn incidentally.

19. Hearing Children

20. A Child with a Hearing Loss

21. Academic Delays • National research for students who are deaf or hard of hearing (e.g., Allen, 1986; CADS, 1991; Traxler, 2000) indicates that the average student with a hearing loss graduates from high school with reading comprehension skills at approximately the fourth grade level. •  Approximately 40% of deaf adults are unemployed and 90% are underemployed (National Deaf Education Project).

22. Why is Reading So Difficult? • Spoken Language is “hard wired” inside the human brain but it depends on a child’s ability to hear. • By the time a hearing child is 10 months of age, he or she has already learned how to recognize the speech sounds of the language spoken by caregivers. • Hearing children use their knowledge of their spoken language to facilitate the reading process (Goldin-Meadow & Mayberry, 2001).

23. Why is Reading so Difficult? • Children who are deaf or hard of hearing do not have easy access to the phonological code. • Additionally, natural sign languages such as American Sign Language (ASL) have their own vocabularies, morphologies, and syntaxes, which do not parallel those of spoken or printed English (Marschark & Harris,1996). . • Limited experiences and limited access to language leads to limited vocabulary.

24. Vocabulary is like Swiss Cheese…Full of Holes!

25. Social Isolation and Poor Self Image • Student’s with hearing loss often report feeling isolated, without friends and unhappy in school. • Students socialize most in school hallways or the cafeteria where listening is most difficult due to background noise. • They may be viewed as inappropriate or awkward due to lack or awareness of subtle conversational cues • They may miss fast-paced peer interactions • They may appear to daydream • They may have poor social skills • They may be more fatigued in class due to greater effort needed to listen and speechread • The may be left out of group work

26. MYTHS Hearing Aids are like glasses. =

28. Myth Everyone Can Speechread Read my lips…

29. WRONG! • Only 30% of the English language is visible on the lips. • Some sounds have same lip movements (e.g. mark, bark and park), even the most skilled speech reader may not accurately identify every word. • The phrase "where there's life, there's hope" looks identical to "where's the lavender soap" in most English dialects. • The ability to speechread depends on a child’s familiarity with the language.

30. Speechreading Can Help!

31. Goals of the AIU Hearing Support Program • Identify and assess students with hearing loss • Provide the students with the educational skills and accommodations needed to be successful in the least restrictive environment • Recommend and monitor assistive listening devices • Facilitate literacy, self-advocacy and independent living skills • Offer students appropriate access to the educational environment • Provide consultative services to school personnel and school districts

32. Hearing Support Teachers • Provide instruction and support for students in developing: • Auditory skills • Language skills • Literacy skills • Speechreading skills • Self advocacy skills • Hearing Aid/FM maintenance skills • Provide Academic Support when needed • Provide consultation to regular education teachers

33. Communication Plan • Teachers of the D/HH work with the IEP team to complete the Communication Plan as part of the IEP. • Identifies opportunities for direct communication and direct instruction in the student’s language and communication mode. • Provides an opportunity for the IEP team to discuss language and communication issues and ensure that the student is receiving appropriate communication supports.

34. Itinerant Teacher Needs • Quiet work space • Mailbox • Internet Access

35. Educational Audiologists • Provide consultation and recommendations for educational accommodations to maximize auditory access for students in the classroom. • Provide educationally relevant assessments of student auditory functioning, hearing, and listening levels • Participate in multi-disciplinary educational teams • Assist with the determination of eligibility and need for Deaf & Hard of Hearing Support Services. • Evaluate, fit, and monitor school provided individual assistive listening technology.

36. Assistive Technology • Personal Hearing Aids • FM Amplification Systems • Individual FM Systems • Sound field FM Systems • Closed Captioning • Special lights (Fire alarms)

37. Personal Hearing Aids • The behind the ear aid is held on the ear by a short hook. The hook carries the sound from the aid to a tube. The tube carries sound waves from the hook to the earmold.

38. FM Amplification Systems • Individual FM • May attach to hearing aid • Teacher wears wireless microphone • Sound field FM • Teacher wears wireless microphone • FM signal is transmitted to speakers that are placed on the walls near the student, or on the student’s desk

39. FM receiver attaches to hearing aid. Easy Listener for students without hearing aids Bag of Sound A small speaker that is placed on student’s desk Portable Soundfield System Soundfield System mounted to the classroom walls.

40. How FM Systems Can Help • Because hearing aids amplify all of the sounds that reach the microphone, noisy environments are difficult for a hearing aid wearer. • Real life example : Tape recording a lecture or class. • The mic picks up all the noises around you. • You have to concentrate to be able to hear the main speaker. • This is sort of what happens to those wearing hearing aids.

41. The teacher wears a microphone within 6 inches of his/her mouth. • Amplifies the speaker’s voice and reduces the background noise. The child is still able to hear what's going on around them and is able to hear language from other children nearby who may be serving as language role-models.  • On some individual systems, the FM can be set so that it amplifies the speaker’s voice and eliminates all background noise.This is much clearer and easier to understand, but you lose the benefits of being able to hear sounds other than that coming from the primary speaker. For some children, this is the preferred result. 

42. Cochlear Implants A surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing http://www.ndcs.org.uk/family_support/hearing_loss_simulation/cochlear_implant.html

43. ClassroomAdaptations:Reduction in Background Noise • Inside the classroom: • Heating, ventilating and air conditioning system (HVAC) • Students talking • Desks and chairs sliding on hard surfaced floors • Shuffling books and papers • Pencil sharpeners • Audio-visual equipment (overhead projectors,etc.) • Computers • Aquarium pumps • Lighting (ballasts in florescent lights) • Soft background music • Fans

44. Classroom Accommodations:Reduction in Background Noise • Outside of the Classroom: • Interference from adjacent classrooms(especially in “loft” or open classroom schools) • Corridor and hallway traffic • Sounds emanating from cafeterias, playgrounds, gymnasiums, music class, and band • Highway traffic • Construction equipment • Lawn mowers, blowers and other landscape maintenance noise

45. Classroom Accommodations:Reduction in Background Noise Possible Solutions: • Carpeting and window covering • Soundproof panels or cork • Tennis balls on legs of chairs and desks • Pads on the bottom of the legs of chairs and desks • Seating away from objects that generate noise • Seating away from door (hall noise) or windows (street noise, AC, fans) • FM Systems

46. Classroom Accommodations:Preferential Seating • Seating where student can clearly see your face • May not always be front and center! • Have the better ear toward your instructional area • Do not stand with your back to the window or light source • Always face the class when speaking • Use an overhead projector when possible • Don’t talk when writing on the board

47. Communication Tips for the Classroom Teacher • Speak naturally at normal volume and rate. Exaggeration and over emphasis of speech will hinder the student’s ability to speechread and auditorily process language. • Get the attention of the student before addressing him/her (call the child’s name or tap his/her shoulder). • Make sure the speaker’s face is visible to the student . . trim large mustaches, avoid covering the mouth or chewing on pencils, etc. • Remember that a child with a hearing loss can’t speechread when looking at a paper. Allow the student time to look at new material before speaking.

48. Communication Tips for the Classroom Teacher • Do not talk while walking around the room or turn towards the white/chalk board while giving instructions. (An overhead projector can be effective teaching tool if the fan noise doesn’t overwhelm the D/HH student). • Since D/HH students have difficulty following conversations that move around the room, identify who is speaking and repeat peer comments during class discussions. • Place yourself facing a source of light for better speechreading. • Understand that it takes more effort for these students to listen and speechread and the student may be fatigued by the end of the day

49. Communication Tips for the Classroom Teacher • Restate rather than simply repeat information when the student is having difficulty understanding after one repetition. • Write instructions and information such as new vocabulary words, assignments, announcements, simple outlines for the lesson, and key words or phrases as the lesson progresses. • Check for understanding. Ask the student questions that require him/her to repeat content rather than respond with yes or no answers.

50. Communication Tips for the Classroom Teacher • Provide the student with a written copy of the daily announcements. • When homework is corrected within the classroom, give the student the answer sheet to correct his/her work. • Repeat any announcements given over the PA system.  • Use Closed Captioned Videos! Do not require the student to take notes or be tested on contents.