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Course: General Introduction to the Hearing Impairment (680)Level: M.!M."d in #pecial "ducation#emester: utumn$ %0&'

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-.& #" H" *IM/ 1,CI2, 2 H" H1M, ". 3H I# H""-1",C/ ,G" 2 H"I,G 2 ,2ML H1M, "4 (%0)ns5er:unctions o the "ar The two main functions of the ear are: assist with our balance, and hear the soundsaround us.Although it has been shown that otitis media will have an impact on both of theseareas, the main focus of this section is the impact that OM will have on the child’sability to hear. To help us understand the aect OM may have on our ability to hear,we rst need to be familiar with the structure of the ear and how it wor!s.

#tructure o the ear The ear consists of three areas: outer ear" middle ear, and inner ear. The middle ear is the area we are most interested in when loo!ing at the cause andeects of OM.2uter ear The outer ear consists of the pinna, the part you can easily see and feel, and the earcanal. The pinna helps to gather the sound waves around us. These sound wavestravel down the ear canal where they stri!e the ear drum. The ear drum separates theouter and middle ear.Middle ear#hen sound waves stri!e the ear drum they cause it to vibrate, which in turn causes

the three small bones in the middle ear to move. These three small bones arecollectively called the ossicles or easily !nown as the middle ear bones. The ossiclesconsist of the: malleus $hammer%" incus $anvil%, and stapes $stirrup%. The stirrup is connected to a tiny membrane on the inner ear called the oval window.Inner ear The oval window forms the entrance to the inner ear or cochlea. The cochlea is coiledand lled with &uid. 'f we magnify a section of the cochlea, we can see that the innercochlea is lined with tiny hair cells.Ho5 the parts o the ear 5or together#hen the bones in the middle ear move due to sound waves stri!ing the ear drum,the stirrup pushes rhythmically on the oval window. #hen the oval window moves it

causes the inner ear &uid to move and the hair cells to move bac!wards and forwards. The movement of &uid and hair cells can be li!ened to the wind in a eld of longgrass, as the wind blows, the grass sways bac!wards and forwards. This movementcauses electrical impulses to be sent to the brain, which are then converted into thesounds we hear. Anything which interferes with the (ourney of sound down the earcanal, past the ear drum or through the middle ear, will result in conductive hearingloss.ole 7 unction o the "ustachian tue

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 The )ustachian tube allows ventilation of fresh air into the middle ear and drainage of&uids from the middle ear. 'f we have a cold or &u, have large adenoids or tonsils, orare prone to allergies such as hay fever, the )ustachian tube may become in&amed,swollen or bloc!ed. This will reduce or stop the ventilation and drainage of the middleear. #hen this happens it could lead to one of the following three types of otitis

media: acute otitis" chronic otitis $sometime referred to as glue ear%, orchronic suppurative otitis $better !nown as runny ear%.

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*earing range describes the range of fre+uencies that can be heard by humans orother animals, though it can also refer to the range of levels. The human range iscommonly given as - to -,--- *, though there is considerable variation betweenindividuals, especially at high fre+uencies, and a gradual loss of sensitivity to higherfre+uencies with age is considered normal. /ensitivity also varies with fre+uency, asshown by e+ual0loudness contours. 1outine investigation for hearing loss usually

involves an audiogram which shows threshold levels relative to a normal.

/everal animal species are able to hear fre+uencies well beyond the human hearingrange. /ome dolphins and bats, for e2ample, can hear fre+uencies up to 3-- !*.)lephants can hear sounds at 34035h, while some whales can hear subsonic soundsas low as 6h $in water%.

9iliographic "ntresult(5!surrounding te;t)

#tandardi?: 455.

@)2periments have

shown that a healthyyoung person hears allsound fre+uencies fromappro2imately - to-,--- hert.@

-0-,--- *

@)ar@. Microsoft )ncarta )ncyclopedia. 7901OM. ---.

@The ma2imum rangeof human hearingincludes soundfre+uencies fromabout 3 to about3?,--- waves, or

cycles, per second.@

303?,--- *

Acoustics.

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nowledge. 56: ?.

hear vibrations rangingfrom 3 or 35 a secondto -,--- a second.@

-,--- *

7aldarelli, 9avid 9. and 1uth /.

7ampanella. )ar. #orld Doo! OnlineAmericas )dition. 5 May --C.

@The full range ofhuman hearinge2tends from - to-,--- hert.@

-0-,--- *

 The ear is an amaing body part because it enables humans and animals to hear whatgoes on around them. *earing is one of the ve senses of the body. The ears help thebody to pic! up sound waves and vibrations. /ound travels in waves through the air,the ground, and various other substances. /ound cannot be seen, but it can be felt byvibrations. The number of vibrations that are produced per second is called fre+uency. Fre+uencyvaries for each sound and is measured in hert. One hert is e+ual to one vibration

per second. A sound with a low fre+uency will have a low pitch, such as a humanGsheartbeat. A sound with a high fre+uency will have a high pitch, such as a dogwhistle. *umans cannot hear sounds of every fre+uency. The range of hearing for ahealthy young person is - to -,--- hert. The hearing range of humans gets worsewith age. ;eople lose the ability to hear sounds of high fre+uency as they get older. The highest fre+uency that a normal middle0aged adult can hear is only 3034 !ilohert. Also, the hearing range for men worsens more +uic!ly than the hearingrange for women. This means that women will have the ability to hear notes of higherpitch than men of the same age do.7hristopher 9GAmbrose 00 --C

9iliographic "ntr

esult

(5!surrounding te;t)

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@The human ear hasreceptors that candetect soundfre+uencies raging from35 vibrations to-,---vibrations per second.@

35H-,--- *

Berder, Francis 7. @The *uman )ar.@ )ncarta)ncyclopedia 9elu2e --4. 7901OM.

@The ma2imum range of human hearing includessound fre+uencies from3 to about 3?,---waves,or cycles, persecond.@

3H3?,--- *

;eter *amlin, /t. Olaf 7ollege. DasicAcoustics for )lectronic Musicians. 8anuary3>>>.

@The human ear canhear fre+uenciesranging from about -cps. to about -,---

-H-,--- *

http://www.aolsvc.worldbook.aol.com/wbol/wbAuth/jsp/wbArticle.jsp#h10.htmlhttp://www.stolaf.edu/depts/music/elmus/acoustcs.htmhttp://www.stolaf.edu/depts/music/elmus/acoustcs.htmhttp://www.aolsvc.worldbook.aol.com/wbol/wbAuth/jsp/wbArticle.jsp#h10.htmlhttp://www.stolaf.edu/depts/music/elmus/acoustcs.htmhttp://www.stolaf.edu/depts/music/elmus/acoustcs.htm

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cps $although anindividual might have aconsiderably smallerrange%.@

*arris, #ayne. /ound and /ilence. Termpro.Originally appeared in the MarchIApril 3>?>issue of 7ar /tereo 1eview magaine.

@The normal range ofhearing for a healthyyoung person is - to-,--- *" hearingdeteriorates with ageand with e2posure tounsafe volume levels.@

-H-,--- *

/ense. #i!ipedia. --4.

@*earing or audition isthe sense of soundperception and resultsfrom tiny hair bres in

the inner ear detectingthe motion ofatmospheric particleswithin $at best% a rangeof - to ---- *./ound can also bedetected as vibration bytactition. Bower andhigher fre+uencies thancan be heard aredetected this way only.@

-H-,--- *and higher

#hat is sound and fre+uencyJ /ound is a longitudinal mechanical wave of anyfre+uency. Fre+uency is the number of cycles, or complete vibration e2perienced ateach point per unit. Fre+uency is measured in hert. The hert, *, is the derived /'unit of fre+uency. The fre+uency of a sound wave determines its tone and pitch. Thefre+uency range of a young person is about - to -,--- hert. The human ear is capable of hearing many of the sounds produced in nature, butcertainly not all. /ome low fre+uencies li!e a heart beat of 3 or * can not be heard (ust li!e sonar sounds produced by dolphins which are too high. Any fre+uency that isbelow the human range is !nown as infrasound. 't is so low that it may be detected bya creature with big ears, such as an )lephant. 'n fact, recent research indicates that

elephants also communicate with infrasound. Kltrasound, on the other hand, is abovethe range of the human ear. Dats, whales, porpoises, and dolphins use ultrasound fornavigation. Most bats can detect fre+uencies as high as 3--,--- *L

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http://www.termpro.com/articles/hearing.htmlhttp://en.wikipedia.org/wiki/Sensehttp://www.termpro.com/articles/hearing.htmlhttp://en.wikipedia.org/wiki/Sense

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A common problem amid the parents that are raising autistic children is sociaisolation. #hether it be our friends leaving us after our child’s diagnosis or uspersonally isolating ourselves in order to simply cope with our child’s disorder. ;arentsare inclined to forget how important it is to be social, to interact with our peers. 'tseems that our own needs and emotions are often put on the bac! burner in order to

accommodate our family’s needs. 't also becomes progressively harder to maintain afriendship, even with those friends you thought would always be there.

he riendship "?ect

#hen your child is diagnosed with autism you lose friends. 't is an e2tremely hardreality to deny and an even harder situation to understand how you play a role in./ome parents feel li!e their friends (ust left them, and in some cases perhaps theydid. *owever, in a large number of cases, a big part of it is that you grew apart. Faceit, your life is completely dierent now. =ou thin! about 7DT appointments, 9therap, meltdo5ns, stimming, paraprofessionals, ;)7/ cards, and hoping you will

be blessed with more than hours sleep. =our friends, generally, have no in!ling ofwhat any of that means or what it’s li!e to be e2cited over sleeping 4 hours. =ou (ustdon’t understand each other’s’ lives anymore.

As the days go by ' bet you noticeInoticed how much it gets under your s!in when afriend tal!s about how smart their child is, how easily things come to them. After awhile you tend to not want to be around the person. Or those moments when a friendrudely as!s what is wrong with your child. #hether they meant to come o oensiveor not doesn’t lessen how it ultimately made you feel. 'nevitably you are going to startisolating yourself, especially in the@rst several ears. 't’s hard to tal! about yourchild’s disorder with friendsIfamily because, more than li!ely, the simplest thought of

your child’s autism brings you to tears. Eiven this how are you supposed to help afriend understandJ 'n turn your friends are going to start distancing themselvesbecause they do not get itN. There are those cases where the friend is tremendouslyignorant and they distance themselves simply because they don’t want to be aroundyour child or whatever other reason they may have. Try not to ta!e it personally.'gnorance is everywhere, you can’t educate the whole wide world0all you can do as aparent is try to help your little corner of it.

;arents also isolate themselves from their family, especially when their child is rstdiagnosed. 't is a well0!nown and tal!ed about fact within the autism community thatfamily members sometimes say the meanest things, meaner than the general public

dare say. The things that (ust ma!e you want to scream. Things that if said by astranger would no doubt lead to a stern educating.

 The worst part is that much of the time they act as though they have no clue they arebeing oensive. 't becomes easier to stay away than to listen things such as, =ou!now if ' was his parent he’d sure be dierent than he isLN 'ndubitably you’ll want toretort,

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*owever you wouldn’t say this in most cases. This issue has become so common thatthere is now a syndrome named for it. 't’s called Autism 'solation /yndrome.

utism Isolation #ndrome

Autism 'solation /yndrome, in a nut shell, is the way a parentIfamily copes with thestresses that are concomitant with raising an autistic child" whether emotional,physical, nancial, or social. 'n some instances the parent$s% isolate themselves fromsituations and from people. The three dened constituents are:

/ocial isolation )motional isolation ;hysical isolation

 There are several emotions that contribute to isolation. These emotions can bee2traordinarily deep in the beginning. The emotions that are most often identied

with parental isolation are:

Euilt /hame 9enial Boss of self  Erief  /adness )2haustion

According to an article by 1ebecca /perber, M./., MFT there are C stages to Autism

'solation /yndrome.

/tage 3: 'solation within your family /tage : ;hysical 'solation /tage C: /ocial 'solation

/tage 3 deals with not communicatingIventing your negative emotions with familymembers. The truth of it is that it simply grows to be too arduous to allow yourself tounderstand your emotions anymore.

 The nd and Crd /tages dig into topics such as losing yourself in your child’s isolation

and conse+uently not allowing a lot of physical contact yourself. 't becomes easier tobe numb. Also touching on the fact that our families are not li!e other families andhow that leads to fears associated with being in public with our child. As Ms. /perberput it, 'solation provides its own form of comfort, but not without profound loss.N

In Closing

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 There is no magic bulletN to cure the isolation we parents feel, (ust li!e there is nomagic bulletN to cure our children’s autism. #hile not all of the isolation is directlycaused by us, some of it is. The rst step in mending the problem is certainlyrecogniing that you contribute to it. 1each out for support, meet other parents, andsurround yourself with people that get itN. 't’s time to start healing the wounds that

began forming after your child was diagnosed.

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#hat children of divorce most want and need is to maintain healthy and strongrelationships with both of their parents, and to be shielded from their parentscon&icts. /ome parents, however, in an eort to bolster their parental identity, createan e2pectation that children choose sides. 'n more e2treme situations, they foster thechild’s re(ection of the other parent. 'n the most e2treme cases, children are

manipulated by one parent to hate the other, despite children’s innate desireto love and be loved by both their parents.

;arental alienation involves the programmingN of a child by one parent to denigratethe other targetedN parent, in an eort to undermine and interfere with the childGsrelationship with that parent, and is often a sign of a parent’s inability to separatefrom the couple con&ict and focus on the needs of the child. /uch denigration resultsin the child’s emotional re(ection of the targeted parent, and the loss of a capable andloving parent from the life of the child. ;sychiatrist 1ichard Eardner developed theconcept of @parental alienation syndrome@ - years ago, dening it as, @a disorderthat arises primarily in the conte2t of child custody disputes. 'ts primary manifestation

is the childGs campaign of denigration against a parent, a campaign that has no (ustication. 't results from the combination of a programming $brainwashing% parentGsindoctrinations and the childGs own contributions to the vilication of the targetparent.@ 7hildren’s views of the targeted parent are almost e2clusively negative, tothe point that the parent is demonied and seen as evil.

As Amy Da!er writes, parental alienation involves a set of strategies, including bad0mouthing the other parent, limiting contact with that parent, erasing the other parentfrom the life and mind of the child $forbidding discussion and pictures of the otherparent%, forcing the child to re(ect the other parent, creating the impression that theother parent is dangerous, forcing the child to choose between the parents by means

of threats of withdrawal of aection, and belittling and limiting contact with thee2tended family of the targeted parent. 'n my own research on non0custodial parentswho have become disengaged from their children’s lives $ru!, -33%, ' found thatmost lost contact involuntarily, many as a result of parental alienation. 7onstructivealternatives to adversarial methods of reconnecting with their children were rarelyavailable to these alienated parents.

https://www.psychologytoday.com/basics/divorcehttps://www.psychologytoday.com/basics/identityhttps://www.psychologytoday.com/basics/relationshipshttps://www.psychologytoday.com/basics/ethics-and-moralityhttps://www.psychologytoday.com/basics/divorcehttps://www.psychologytoday.com/basics/identityhttps://www.psychologytoday.com/basics/relationshipshttps://www.psychologytoday.com/basics/ethics-and-morality

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;arental alienation is more common than is often assumed: Fidler and Dala $-3-%report both an increasing incidence and increased (udicial ndings of parentaalienation" they report estimates of parental alienation in 3303P of divorcesinvolving children" Dernet et al $-3-% estimate that about 3P of children andadolescents in

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*atred is not an emotion that comes naturally to a child" it has to be taught. A parentwho would teach a child to hate or fear the other parent represents a grave andpersistent danger to the mental and emotional health of that child. Alienated childrenare no less damaged than other child victims of e2treme con&ict, such as childsoldiers and other abducted children, who identify with their tormentors to avoid pain

and maintain a relationship with them, however abusive that relationship may be.

-.A "B*LI, H" L,G1G" =""L2*M", 2 =" CHIL=", 2,","I,G I,2 H" #CH22L. (%0)ns5er:3hat is the di?erence et5een speech and language4 Banguage is the words, structures, thoughts and concepts we have in our minds./peech is one way in which we communicate our language to other people. #e canalso convey our language through sign language or through writing. 't is critical torecognise that any hearing loss a child has will impact on both language and speech

development, but language development is more important than speechdevelopment. This is because almost all learning depends on language. The betterlanguage a child has, the broader the range of their mental concepts and the morethey will be able to learn in school.Ho5 do children acDuire language47hildren are born with an inner capacity for language development.

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9eaf children cannot hear, or only hear parts of what people around them are saying.Often the only input a deaf child can understand is when people tal! or sign to themdirectly, one0to0one. 9eaf children cannot usually overhear conversations betweenother people or listen to the radio or television so they also miss out on lots ofincidental learning. This will limit their bac!ground !nowledge of dierent topics. The

input the deaf child receives will be much less than what a hearing child will receiveand which may lead to problems with communication and learning in school, e.g. theymay have heard a particular word only once or twice and only in one conte2t, whilethe hearing child may have heard it hundreds of times in many conte2ts.3hat actors a?ect a dea or hearing impaired childEs learning o language4 9eaf children vary widely in their ac+uisition of language. /ome of the factors include:ge o onset o the hearing loss 7hildren who are deaf before language develops will e2perience much more diQcultyac+uiring language than those whose hearing loss is ac+uired later. )ven if a hearingloss is ac+uired in early childhood, the eects on language development will be muchless than those who are deaf from birth or (ust after. The child losing hearing later has

had the chance to begin to understand about language and communication.=egree o hearing loss  The greater the hearing loss, the more eect it usually has on language development$unless the child is given +uality language input before they are 5 months old%.he Dualit o the language input The +uality of input is very important for language development. The better the+uality $provided the child can hear andIor see it%, the more consistent is theinformation the child can absorb about language. This all results in a greateropportunity for the child to develop good language s!ills.-uantit o language input The more communication the deaf child is engaged in or observes or listens to, the

more opportunity they will have for developing language s!ills. The deaf child needsto engage with a variety of spea!ers or signers for a large part of each day for optimalanguage development.*arentsE hearing status1esearch has shown that deaf children of deaf parents perform better in school thandeaf children of hearing parents. 9eaf parents !now how to naturally communicatewith their deaf children and they often have a positive attitude towards their childGshearing loss. *earing parents need to create opportunities for eectivecommunication with their deaf children, whether it be through )nglish or Auslan, toma!e sure their children are similarly advantaged."arl intervention

1esearch has shown that enrolment in an eective early intervention program is veryimportant for a childGs language development, providing options, language modelsand communication s!ills. 'deally, access to intervention by the age of si2 monthsgives deaf children the best opportunities for learning.ge o =iagnosis1esearch is showing that children who are diagnosed before they are si2 months ofage perform better than children diagnosed later on all areas of language learning.

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3hat happens i a dea child does not acDuire good language eore theenter school4Many deaf children are still learning basic language s!ills when they arrive at school.*earing children arrive at school with a sophisticated language base and they use thislanguage as the springboard into literacy" they have an internalised language system

which is a foundation for the development of literacy s!ills. 9eaf children aretherefore at a disadvantage because they have to deal with learning both languageand literacy at the same time, eg, the child may not have in their vocabulary many of the words they are trying to read so they will nd it very diQcult to build an internalpicture of what they are reading.3hat are some common language diFculties aced dea and hard ohearing children4 9eaf children may have diQculties with:

• Bimited vocabulary

• )nglish grammar and synta2

• Erammatical mar!ers such as @0ed@, @0ing@, or @0er@

•  The paralinguistic mar!ers of language, such as turn ta!ing, control, as!ing forclarication, eye contact, greetings. 9eaf children may also misunderstand commone2pressions, such as @youGve got ants in your pants,@ idioms, such as @you let the catout of the bag@ and they may understand only in a literal way, such e2pression as @hefell on hard times@ or @open your mind.@ 9eaf children may also have diQculty inre+uesting information, as!ing and answering +uestions, see!ing clarication,greetings and repairing brea!downs in conversations. #hen +uestioned about theirunderstanding, they will often say that they have understood, as this is easier thanadmitting they did not understand.3ill dea children catch up to hearing children in language49eaf children may eventually catch up to their hearing peers if they are given fullyaccessible input, appropriate support and teaching. Other deaf children may alwayse2perience diQculties with language and therefore also with reading and writing. Thisis particularly the case for those who are diagnosed at a later age and those for whomthe +uality and +uantity of the language input has been poor. /ome deaf children ofdeaf parents are an e2ception. This has been attributed to these childrenGs parentshaving all the strategies and attitudes needed to successfully teach language to theirchildren. *owever, that is not always the case, and some of these children continue tounderachieve.Ho5 5ell do I need to sign to communicate 5ith a dea child4 )ven the use of !ey word signing can aid communication. *owever, if the deaf childdoes not understand spo!en language, !ey word signing may not be an eectivealternative. 7hildren need rich and comple2 language input in order to develop in ageappropriate ways. They need to be e2posed to more than (ust a simple learnerGslanguage.3hat are some strategies to use 5hen taling or signing 5ith dea children4

• )nsure the child is watching you before you spea!. =ou can get their attention byeither touching them lightly or moving your hand or some other ob(ect within theirvisual eld, but not too close to them.

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• eep eye contact with the child when tal!ing.

• *earing aids do not wor! well over a distance, so !eep about one metre between

yourself and the child.

• 9onGt eat, drin! or smo!e when tal!ing and !eep your hands away from your face. Trim your moustache or beard so it is not covering your mouth.

•  Dac!ground noise can create diQculties for deaf children and for those with ahearing loss in one ear. Also remember reverberation is a problem for hearing aidusers. De aware of the diQculties of listening in rooms where there is nothing toabsorb the sound, such as in bathrooms or gyms.

• Avoid shouting. /pea! naturally and if the child does not understand, say the same

thing in a dierent way which may be easier to lipread.

• Facial e2pressions and natural gestures will aid understanding, but donGt e2aggerate

e2pressions. #hen e2periencing diQculties in communicating remember thatpatience will be rewarded.

• 7ommunicating in the dar! and when you stand in front of a window is diQcult as

your face cannot be seen clearly.'f you use a new word or sign, be aware that the child may not understand and youmay need to provide additional e2planations. 1emember to continually e2pand yourchild’s vocabulary by using new words or signs.

 • Kse open ended +uestions to ma!e sure the child has understood, such as @how will

you get to the shopJ@ Many deaf children will nod their head regardless of whether ornot they have understood when they are as!ed if they understand.

• Eroup conversations, such as at the family dinner table, are particularly hard for achild with a hearing loss. Try and ma!e sure only one person spea!s at a time and cuethe deaf child into the changing topics of conversation.Ho5 can amilies improve dea children>s language sills4 

• Dy spending as much time as they can on tal!ing or signing with the deaf child. Kseevery opportunity they can to e2tend the deaf child’s language" play with the child,tal! or sign with the child, read boo!s with the child and wor! with the child’s teacherto develop strategies and games together.

• Dy visiting new places and providing the child with e2periences to tal! about later

together. The child can draw pictures or write about what happened. Tal! or signabout what will happen before the event, when it happens, and then after the event,tal! or sign about it together, draw pictures and write stories.

• ;hotos are a wonderful way to discuss events with the deaf child, and include photos

of specic people so that can names of these people, what they do, what they li!e ordon’t li!e can be discussed.

• The limit to activities which can be done with the deaf child is your imagination.

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9eaf education is the education of students with a variety of hearing levels whichaddresses their dierences and individual needs. This process involves individually0planned, systematically0monitored teaching methods, adaptive materials, accessiblesettings and other interventions designed to help students achieve a higher level ofself0suQciency and success in the school and community than they would achieve

with a typical classroom education. A number of countries focus on training teachersto teach deaf students with a variety of approaches and have organiations to aiddeaf students.

Identiing dea students

7hildren may be identied as candidates for deaf education from their audiogram ormedical history. *earing loss is generally described as slight, mild, moderate, severe,or profound, depending upon how well a person can hear the intensities offre+uencies.

 Individual ,eeds

9eaf education programs must be customied to each studentGs needs, and deafeducators provide a continuum of services to deaf students based on individuaneeds. 'n the Knited /tates, 7anada and the K, education professionals use theacronym '); when referring to a student’s individualied education plan.

Methods

/chools use a number of approaches to provide deaf0educational services to identiedstudents. These may be grouped into four categories, according to whether $and how

much% the deaf student has contact with non0deaf students $using

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eating meals with non0deaf students%" alternatively, deaf students may attenda special school.

• )2clusion: A student unable to receive instruction in any school is e2cluded from

school. Most deaf students have historically been e2cluded from school, and e2clusionmay still occur where there is no legal mandate for special0education services $such

as developing countries%. 't may also occur when a student is in hospital orhousebound. )2cluded students may receive individual or group instruction, andstudents who have been suspended or e2pelled are not considered @e2cluded@ in thissense.9ilingualicultural education

'n this method deafness is seen as a cultural, not a medical, issue. 'n a bilingual0bicultural program deaf children are recommended to learn American /ignBanguage $A/B% as a rst language, followed by written $or spo!en% )nglish as asecond language. Dilingual0bicultural programs consider )nglish and A/B e+ualanguages, helping children develop age0appropriate &uency in both. The bilingual0

bicultural approach believes that since deaf children learn visually, rather than by ear,classes should be conducted in a visual language. American /ign Banguage andspo!en )nglish are not used simultaneously, to avoid harming the accuracy and&uency of both languages" instead, A/B is usually used. Many bilingual0biculturaschools have dormitories" students may either commute to school or stay in adormitory as part of a residential program, visiting their families on wee!ends,holidays and school vacations.

Auditory0oral and auditory0verbal education

 The auditory0oral and auditory0verbal methods, !nown collectively as listening and

spo!en language, are forms of oral education. These methods are based on the beliefthat a deaf child can learn to listen and spea! so that their family does not need tolearn sign language or cued speech. These methods, presented as communicationoptions, rely on parental involvement. 7hildren using this option may be placed in acontinuum of educational placement, including oral schools $such as the 7lar!e/chools for *earing and /peech%, classrooms for deaf students in public schools ormainstream classrooms with hearing students.

Mainstreaming and inclusion

Ksing this educational method, a deaf child attends public school in regular classes for

at least part of the school day. /tudents may receive accommodation, suchas itinerant teachers, interpreters, assistive technology, note0ta!ers and aides. Thebenets of inclusion include daily interaction with hearing students and theopportunity to live at home" drawbac!s include isolation and limited support.

 The curriculum for hearing impaired children is similar to that for ordinary children inthat it aims to provide the children with a general education in preparation for furtherstudies, future employment and adult life. The curriculum content for the mainstream

https://en.wikipedia.org/wiki/Special_education#Special_schoolshttps://en.wikipedia.org/wiki/Suspension_(punishment)https://en.wikipedia.org/wiki/Expulsion_(academia)https://en.wikipedia.org/wiki/American_Sign_Languagehttps://en.wikipedia.org/wiki/American_Sign_Languagehttps://en.wikipedia.org/wiki/Cued_speechhttps://en.wikipedia.org/wiki/Clarke_Schools_for_Hearing_and_Speechhttps://en.wikipedia.org/wiki/Clarke_Schools_for_Hearing_and_Speechhttps://en.wikipedia.org/wiki/Itinerant_teacherhttps://en.wikipedia.org/wiki/Interpretershttps://en.wikipedia.org/wiki/Assistive_technologyhttps://en.wikipedia.org/wiki/Paraprofessional_educatorhttps://cd.edb.gov.hk/la_03/chi/curr_guides/Hearing/eh-4.htm#whttps://en.wikipedia.org/wiki/Special_education#Special_schoolshttps://en.wikipedia.org/wiki/Suspension_(punishment)https://en.wikipedia.org/wiki/Expulsion_(academia)https://en.wikipedia.org/wiki/American_Sign_Languagehttps://en.wikipedia.org/wiki/American_Sign_Languagehttps://en.wikipedia.org/wiki/Cued_speechhttps://en.wikipedia.org/wiki/Clarke_Schools_for_Hearing_and_Speechhttps://en.wikipedia.org/wiki/Clarke_Schools_for_Hearing_and_Speechhttps://en.wikipedia.org/wiki/Itinerant_teacherhttps://en.wikipedia.org/wiki/Interpretershttps://en.wikipedia.org/wiki/Assistive_technologyhttps://en.wikipedia.org/wiki/Paraprofessional_educatorhttps://cd.edb.gov.hk/la_03/chi/curr_guides/Hearing/eh-4.htm#w

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education should therefore be appropriate for hearing impaired children as long asadaptations are made where re+uired. 'n addition to most of the sub(ects oered inordinary schools, special emphasis is put on /peech and Banguage, 7hineseBanguage, )nglish Banguage and Music. These sub(ects are considered to beparticularly important to hearing impaired children in that they help to improve their

communication competence re+uired in everyday life. These sub(ects have thereforebeen selected and will be discussed in this chapter. ;ossible adaptations to thecurriculum materials and related teaching approaches will also be suggested.

+.& #peech and Language

As natural ac+uisition of communication s!ills is hampered by hearing impairment tovarying degrees, it is necessary for the school to provide additional programmes tofacilitate the development of language and &uent speech in the children.

/ince hearing impaired children suer from dierent degrees of hearing impairment

and their speech and language abilities are dierent,individual /peech and Banguage sessions, tailored to meet their dierent learningneeds, are necessary. 't is best to arrange short, fre+uent sessions for the children tomeet the same teacher or speech therapist. The teaching session should best beconducted in a +uiet environment $preferably a sound0proof room%. Eroup /peech andBanguage sessions are also recommended as they help to generate interactionsbetween the children and the teacher and among the children themselves.

't is important for the teacher and the speech therapist designing and conductingthese sessions to be competent in /peech and Banguage teaching and to have asound !nowledge of childrenGs language development in their early childhood.

4.3.3 Bearning Areas

/peech and Banguage includes such learning areas asauditory learning,speech teaching,speech reading,language learning andsocial s!ills in communication.

 These various learning areas are elaborated as follows:

$3% uditor Learning

Auditory learning is a process in which hearing impaired children develop theirresidual hearing through guided listening practice. The teacher needs to give thechildren auditory e2ercises which involve the use of environmental sounds, music andspeech. Auditory learning re+uires a clear presentation of a systematically arranged,progressive se+uence of activities. These activities will ensure that, through the

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following stimuli employed, the children will ac+uire the s!ills of detection,identication, discrimination and comprehension:

$a% Dasic s!ills re+uired in detection include:

Auditory awareness 00 the awareness of the presence and absence of soundsAuditory attention 00 the ability to attend to soundsBocaliation 00 the awareness of the direction of soundsAuditory memory 00 the ability to recall a se+uence of sounds heard, e.g. a rhythmicpattern made by a musical instrument or by the human voice

$b% Dasic s!ills re+uired in identication, discrimination and comprehension include:

'dentication of the sources of sounds 00 e.g. a drum, a rattle, a telephone, animalnoise, the human voice $male and female% and other environmental noise.9ierentiation of the following

+ualities of sounds 00 duration $long and short sounds%, intensity $loud and softsounds%, and pitch $high and low sounds%.

'mitation of sounds 00 the ability to repeat a sound heard, e.g. by beating a rhythmicpattern on a drum or by saying a phoneme, a syllable, a word, a phrase or a sentenceheard.

1esponse to sounds 00 the ability to react appropriately to dierent sounds, especiallyto the spo!en language, by carrying out a command, answering a +uestion or re0telling a short story heard. 

#peech eaching$a%

/peech teaching is closely lin!ed to auditory learning. 'f the natural learningapproach fails, a more structured one should be used. A cumulative, se+uentialprogramme is recommended. The teacher should help the children learn speechrst in the auditory mode. The visual mode or even the tactile mode, if re+uired,can also be enlisted. Dut, whatever mode is used, he should still emphasie theimportance of the auditory mode.

$b%

At a phonetic level, the teacher needs to ensure that the children can producespeech with appropriate suprasegmental elements $duration, intensity and pitch%and the phonemes $vowels, diphthongs, consonants and blendsv %.

$c

%

At a phonological level, attention has to be given to morphology, semantics and

synta2. The transfer of s!ills from the phonetic to the phonological level re+uirescareful planning on the part of the teacher. Desides, the teacher needs to ensurethat the children are given suQcient motivation, practice and reinforcement.

#peech eading

/peech reading should be learnt as a supplement to listening. 't should not beregarded as a separate s!ill. To prepare the children for real0life situations, speech

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reading and listening s!ills should be practised both in the presence and absence ofbac!ground noise.

Language Learning

't is important for hearing impaired children to be given suQcient opportunities formeaningful verbal interactions both in real life and in contrived situations. 'ndeveloping daily conversational s!ills in the children, the teacher can consider thefollowing suggestions:

$a% using +uestions to develop answering s!ills

$b% using open0ended +uestions to develop narrative s!ills

$c% using action phrases or pictures to develop se+uencing s!ills

$d% using pictures or activities to develop descriptive s!ills

$e% using activities to develop +uestioning s!ills

$% /ocial /!ills in 7ommunication

/ome of the social s!ills are: initiating a conversation, maintaining eye contact withthe spea!er, ta!ing turns, as!ing for an e2planation when necessary, ending aconversation, etc. These social s!ills can be developed in contrived situations.

4.3. 1ecord0eeping and Assessment

1ecords of the childrenGs personal information should be !ept. The information shouldinclude their medical history, causes and onset of deafness, previous speech andlanguage learning and attainment, hearing age $the age when a child rst uses ahearing aid%, hearing aid usage, etc.

Dased on the information, a programme can be designed in progressive stages toensure the transfer of learnt communication andproblem0solving s!ills from the classroom to everyday life situations.

)valuation of /peech and Banguage programmes may ta!e many forms. ;eriodic

assessment, formal or informal, may be used to detect the childrenGs levels ofattainment and provide a basis for designing remedial programmes in /peech andBanguage learning.

+.% Chinese Language

As a complement to /peech and Banguage learning to improve the childrenGscommunication competence, 7hinese Banguage is an area to be emphasied. The

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teaching of this sub(ect includes Te2t Teaching, 7omposition, 9ictation and 1eading.Apart from the guidelines laid down in the 797 /yllabus for 7hinese, which theteacher is advised to familiarie himself with, the following are some suggestions onpossible adaptations to the curriculum materials and teaching approaches speciallyrelevant to the learning diQculties and needs of hearing impaired children.

4..3 Te2t Teaching The learning materials selected should mainly be those written in a vernacular styleand those, in which the content is related to the everyday life e2periences, interestsand practical needs of the children. Materials on practical writing should also beincluded. 9ue to their language decit, some children may progress at a slower pacethan ordinary children. The teacher therefore need not be too concerned aboutcovering every single chapter in the te2tboo!. 'n fact, sometimes instead of the wholechapter, selected paragraphs can be taught.Comprehension

3. Attention should be given to comprehension of the te2t as a whole before

detailed study of individual paragraphs should be made.. The teacher should avoid adopting the one0way communication mode inteaching. *e should encourage discussions in the class. The children will thenhave more opportunities to listen, to thin! and to e2press themselves so thatthey can better understand the te2t.

C. The teacher should encourage the children to e2press themselves in phrases orcomplete sentences as appropriate and help them master some of thebasicgrammar of the language.

4. 9uring the lesson, the teacher needs to write on the blac!board, whenevernecessary, to help the children with their diQculties in speech reading andcomprehension.

eading loud

1eading by the teacher for demonstration and then reading aloud by the whole class,small groups or individual children for practice are good for language learning. Theteacher may need to correct the childrenGs speech at the appropriate moment.*owever, he has to ma!e sure that this is not over0emphasied, otherwise this willundermine the childrenGs condence.

$C% *hrase ";planation and #entence Construction

$3% 't is advisable to teach those phrases which are generally used in the childrenGseveryday life instead of teaching all of them in depth, otherwise too much timewill be spent on one chapter and the general progress will be aected.

$% As the childrenGs receptive ability of language may aect their power ofcomprehension, the teacher should illustrate a word or a phrase with e2amplesdrawn from the childrenGs everyday life. *e may start with the simplere2pressions so that the children can learn and understand them with lessdiQculty. Abstract concepts should be e2plained with the help of concrete

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e2amples.

$C% 'n teaching pronouns, !inship terms and ways to address people, role play is aneective approach.

$4% 7onstant revision of sentence patterns will help to reinforce language learning,which is particularly re+uired for hearing impaired children.

$% )2ercises in sentence construction are also of particular importance to thesechildren. They indicate to the teacher whether or not the children can use a wordor a phrase correctly.

$5% At the initial stage, in order to encourage the children to write, the teacher canuse sample sentences to guide them in writing correct sentences.

$6% 1eading aloud and recitation of good sentences are useful for learning sentencesand e2pressions.

+.%.% Composition

$3%

 The teacher needs to discuss with the children and help them organie theirthoughts before they set about writing.

$%

 The teacher should watch out for the childrenGs common errors, some of whichare:wrong word se+uence, omission of words, confusion of the sub(ect with theob(ect, etc.

$C%

*earing impaired children may have diQculties in abstract thin!ing. At an earlystage, they should be as!ed to write on sub(ects related to their everyday life insimple forms such as diary, dialogue (ournal and various !inds of practicalwriting.

+.%.A =ictation

9ictation is also important to hearing impaired children. 't provides practice inlistening, comprehension and speech, which can be achieved through oral activities. The teacher needs to choose a suitable passage for dictation according to thelanguage abilities of the children. The format of dictation includes oral dictation andrecitative dictation. 'n oral dictation, the teacher should ma!e sure that the childrendo not memorie the passage beforehand. *e should read at a natural pace so thatthe children can be aware of the natural &ow of the language.

+.%.+ eading

1eading is again of particular importance to hearing impaired children. 't helps toenrich their receptive language. Therefore good reading habits need to be developedin the children. *owever, the following has to be noted:

$3% The teacher needs to nd out the childrenGs language abilities and ma!e surethat the materials selected are suitable for them.

$% The content of the reading materials selected should best be related to the

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+.A.A eaching #trategies

 The choice of te2tboo!s and supplementary materials should be made according tothe abilities of the children. The content of these materials should be related to thechildrenGs interests and e2periences.

 The introduction of language items must be monitored with care:

$3%

there must not be too many items at a time since overloading can causeapprehension and confusion"

$%

there should be clear gradation so that the children can move comfortablyfrom the easy to the diQcult, the simple to the comple2, and the basic toe2tended use"

$C%

all vocabulary items should be related to the childrenGs daily life"

$4%

all language items should be used in immediate situations when they aretaught, such as tas!s and pro(ects"

$%

an appropriate amount of drilling is often necessary for hearing impairedchildren, though this is not encouraged in ordinary schools.

9ictation should primarily be seen as a form of e2ercise to give the children practicein spelling, and, with &e2ible use of the dictation format, also practice in the correctuse of grammatical features and sentence structures. 't provides training to improvethe childrenGs auditory comprehension and reading s!ills. And when it is used forvarious te2t0types, it also provides an eective means of introducing the features ofeach te2t0type.

)2tensive reading is important to the cognitive aspect of language development. 'tdoes not re+uire listening s!ills and enables the children to develop their individual!nowledge and language framewor!s through meaningful e2periences. The childrenshould be encouraged to read abundantly for the ac+uisition of both information andpleasure. The teacher can help them to achieve this by providing them with a broadrange of reading materials, including picture boo!s, and a self0evaluation record cardfor simple reading pro(ects.

Eroup wor! is always eective when the children are given interesting tas!s in whichthey can ta!e dierent roles and use group eort to produce something that anindividual cannot. A good number and variety of tas!s that enable each child to ta!eturns to play the dierent roles helps the children to form meaningful languageconcepts and ac+uire s!ills for eective communication. To enable hearing impairedchildren to complete group wor!, signs and symbols, wor!sheets, forms and+uestionnaires, role cards and game boards can be used.

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+.+ MusicMusic has assumed increasing importance to hearing impaired children over the yearsfor its use to improve their communication competence. This sub(ect is thereforediscussed in the Euide. Through audition orvibration, hearing impaired children can perceive music. They can be trained to listen

to various sound sources with their residual hearing. Music helps to develop auraawareness in hearing impaired children. 'n connection with other sub(ects in thecurriculum, it also helps to improve their language s!ills, particularly verbacommunication s!ills.

+.+.& #uggested Musical ctivities

3. uditor Learning

 Through learning musical elements such as rhythm, pitch, metre, melodicdirection, register, etc. and identifying environmental sounds li!e those of the

weather, animals, machines, the traQc, etc., particularly the human voice, thechildren can develop their sensitivity to sounds" !eep in touch with the environmentand dierentiate the nature, +ualities and directions of sounds.

. #inging

/inging should be a ma(or activity in a music lesson. /inging helps the children todevelop breath control, intonation and a sense of rhythm.

C. =ance and Movement

9ance and movement can be taught with the help of songs or music. 9ance helps thechildren to establish a good self0image, e2press their feelings, co0ordinate theirmovements, and interact with others non0verbally.

4. Music ppreciation

Music appreciation can arouse the childrenGs awareness of music and their interest init. This can be conducted in music lessons, assemblies and during lunch time.

. Instrument *laing

;ercussion, !eyboard, string and wind instruments can be used, according to thedegree of hearing loss and the ability of individual children.

5. Music Games and Mimes

7hildren understand music through en(oyable e2periences in games and mimes These games can be played in singing, movement, listening, or instrument playing9rama, action songs and activities related to everyday life can be included.

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-.' 3H/ I# *"#CH22L C21,#"LI,G IM*2, 2 =" CHIL=",4"B*LI, 3IH"BM*L"#. (%0)ns5er:

All children need full access to all communication in their homes, community, andspecial settings. For young children who are deaf or hard of hearing $9**%, this needis magnied by the /wiss cheeseN eect that emanates from their hearing loss. Thatis, without careful planning, children at best hearIsee bits and pieces of words andphrases" at worst, they hearIsee very little that is meaningful to them. As a result ofthese inconsistencies, their receptive and e2pressive language may be full of holes,li!e /wiss cheese. /ince young children’s language s!ills are not fully developed, theyare unable to ll in words and other information that are not heardIseen, missed orare left out. Thus, targeted and purposeful intervention is re+uired to providee2periences that build language and a !nowledge foundation.Banguage access includes two critical elements" rst, developing the language s!ills

to understand and process everything going on around the child, and second, havingfull access to all communication in these various environments, again so that therecan be full participation in learning and conversation in the same way as their hearingpeers.)very eort must be made to avoid any gap between a child’s age and their languageand other developmental levels. The e2pectation for children who have had earlyidentication and appropriate early intervention services is for normal or near0normalanguage and cognitive development. This developmental tra(ectory must continue atthe same rate as typical hearing children to avoid gaps that leave children behind. These gaps start an adverse cycle that impacts comprehension, attention, genera!nowledge, behavior and ultimately academic performance. #hen transitioning from

early intervention programs that are parentIfamily focused to preschool settings thatare child focused, there are several considerations for parents and the preschooprofessionals to discuss when developing the ');. /ome of these are:

• 7hild 1eadiness H what type of an environment is the child ready to benet fromJ

o First, ma!e sure that a thorough assessment has been completed so that current

s!ills, strengths and wea!nesses, are clear. This should minimally include: an in0depth language assessment loo!ing at all aspects of language and speech

development a cognitive assessment

for children who utilie their hearing, an auditory assessment $hearing and listening

s!ills in +uiet and in noise% a social0behavioral assessment to address attention, condence, and social s!ills

o 'f language s!ills and cognitive development are normal or near normal they should

be ready for a typical preschool setting so long as the supports are in place that willassure their s!ills are supported so that their growth tra(ectory continues.

o 'f language s!ills are delayed, they still need access to the language of their typical

peers. *owever, they will need more direct instruction from a deaf educator with early

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childhood e2pertise who can assure targeted e2periences to build s!ills that arebehind.

o 'f at all possible, placement in a preschool program that serves children with a variety

of disabilities $often referred to as non0categorical% should be avoided. 7hildren whoare deaf and hard of hearing have the same learning potential as their typical hearing

peers and therefore need to be in stimulating environments that will foster theirdevelopment and readily promote communication with typical peers $who may behearing or 9** using oral andIor or sign%.

• )nvironment 1eadiness H is the preschool environment being considered for

placement ready and able to support a preschooler who is deaf or hard of hearingJ#hat should you loo! forJ

o  The physical environment Hcommunication access can be compromised by poor

classroom acoustics, inade+uate lighting, teachers who have diQculty pro(ecting theirvoices, children with little voices, and other classroom noise sources such as shtan!s, pencil sharpeners, overhead pro(ectors, and ventilations systems.

o 7ommunication accommodations H #hether children listen, tal! or sign, they need full

access to everything going on around them. #hat provisions are in place to assure fulaccessJ

For preschool children using sign language, a sign language interpreter in the

traditional role of sign0interpreting what the teacher or spea!er is saying is generallynot appropriate. 7hildren at this age learn and communicate best directly. Boo! for adeaf education teacher who is procient in sign language or a sign languageinterpreter who understands how to deliver and mediate language under the directionof the classroom teacher. These professionals may also be called language facilitators

For children who communicate primarily through listening and spea!ing, ma!e sure

the teacher understands the importance of communication pro2imity, facing the child,and repetition when necessary. Eenerally preschool teachers are pros at language

e2perience and enrichment. 8ust be sure the 9** child is able to fully participate. Alanguage facilitator may be necessary for children with signicant language delayswho need e2tra modeling and practice to develop those s!ills.

*earing assistance technology $*AT% can be critical for 9** children to hear the

teacher, other spea!ers, and especially the little voices of their peers. Appropriate*AT options should be e2plored with the educational audiologist who must also t therecommended device. Training for the classroom sta and support to monitor that it isfunctioning appropriate is critical.

o Eeneral learning and instructional style

 The teacher should be a good language model, communicate e2pressively, and use

multiple strategies, especially visual ones, to deliver ideas as well as for children todemonstrate what they learned  The teacher and school should be &e2ible and willing to wor! with children and their

families to provide and advocate for what is needed to assure !ids receive what theyneed to meet their individual goals

• Fre+uent and consistent monitoring of performance to assure that the learning

tra(ectory illustrates one for one growth $e.g., one month’s growth in one month, oneyear’s growth in one year%

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• *igh performance e2pectations from everyone0 parents, teachers, and serviceproviders, that these children can achieve the same as their peers without hearingloss.

• 's my child eligile for specialied services at schoolJ

o 7hildren with a hearing disabilityN may be eligible for special education support, but

hearing loss alone is not a +ualifying conditionRthe child must also need specialiedinstruction.

o 'f a 9** child is identied early and has benetted from eective early intervention,

there may be no adverse eectN of hearing loss that would +ualify for speciaeducation support at school. ;arents should become !nowledgeable about theirchild’s uni+ue needs and what it ta!es to meet them, and whether or not specialeducation services are appropriate. Knderstanding special education as well asparental rights, applicable laws and regulations related to a 9** child’s education isessential.

• #hat is the accountailit system in the schoolJ #ho is the special educationdirectorJ #hat is the chain of commandJ #hat is the role of the schoo

administratorJ #ho has day to day responsibility for the servicesJ #hat is their levelof !nowledge and e2perience with 9** studentsJ

o Administrators should demonstrate that they are committed to supporting families

and their children and be willing to advocate for their access needs and specialiedservices.

• *ow is the perormance of 9** children assessed, monitored and ad(ustedJ

o 'n addition to pre0academic and academic areas, schools should consider non0

academic areas such as speech, listening, social, and self0advocacy s!ills. ;rogressshould be monitored fre+uently $that may mean wee!ly for many s!ills% and servicead(ustments made when progress e2pectations are not met. ;arents should be !ept

informed of all progress monitoring results and any service ad(ustments that aremade. ;ractices used in school should be based on research evidenced0basedpractices or consensus best practices for 9** children and youth.

o 'n addition to individual student data, group performance data for 9** students

should be analyed, and monitored within the school, school district, orcooperativeIregional program including performance on state and district0wideassessments.

• *ow are parents included in the preschool programJ

o  There should be opportunities for training, specically designed to help address the

child’s goals under parent counseling and training as well as trainings that teachersand other sta attend. Many preschools also oer a home component with the

teacher ma!ing periodic home visits.o ;arent groups, specically for parents of 9** children, are another important avenue

for families to share their e2periences, learn from one another, and plan speciaactivities for their children and families.

• #hat are the options for services and programmingJ *ow are educational placementdecisions madeJ *ow are communication considerations under special educationlawIthe '9)A discussed and incorporated into the student’s 'ndividual )ducation ;lan$');%J #hat related services are available $e.g., audiology, counseling

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interpretingIcaptioning, parent, training and counseling, speech0language%J #hatspecialied instruction is available $e.g., self0advocacy training, listening s!ill training,deaf culture, transition preparation%J

o  There should be a continuum of services and placement options that are discussed for

each child. ;lacement decisions should never be made on what is available. The ');

team may need to be creative to design the right program for your child.o ;re0academic performance should be one of the primary factors to determine

placement and services. *owever, non0academic factors are also important. Otherconsiderations include access to other 9** peers, opportunities for participation ine2tra0curricular activities, and the need for specialied instruction and supportservices.