Living with Hearing Loss: At School

Transcription

1 Living with Hearing Loss: At School By Sam Trychin, Ph.D. and Janet Trychin, Au.D A Best Practices Manual for Teachers with Students who are Hard Of Hearing 1

2 Forward Classroom teachers can easily feel a bit overwhelmed by all the special children that are placed in their classrooms. It is no longer unusual for teachers to be expected to manage students who manifest attention deficit disorders, central auditory processing problems, learning disabilities, pervasive developmental disorders, and other esoteric diagnostic labels. These children present teachers with an on-going challenge, particularly since the genesis, description, and management of their problems are still rather uncertain. Educational trial and error, a lot of devotion and time, and a great deal of anxiety seems to be the teacher s lot when faced with these children. It s different with children who are hard of hearing (HOH). Of all the special children that regular classroom teachers are expected to educate, they probably have the best prognosis. With these children we know precisely why they manifest the communication and educational problems they do, i.e., inconsistent, incomplete, and inadequate auditory-verbal language experiences- and thus make possible the planning of an effective educational program. These children do not present us with either a cognitive or some vague central perceptual disorder. We know where their problem lies: in their ears and not in their brain. In brief, there s no mystery or uncertainty regarding either the genesis of their problem nor what we can do about it. As will be pointed out later in this monograph, it is important to keep in mind the quantitative nature of hearing loss. Most children with hearing loss cannot be classified as either deaf or normally hearing. The vast majority of them fall between these extremes, that is, they are HOH and not deaf. Furthermore, most of these children will be found in regular classrooms and not in special schools for the deaf. (The fact that many audiologically HOH children are found in special classrooms designed for deaf children is, for the most part, an indictment of their prior educational experiences.) The incidence figure for clearly HOH, those who wear or require amplification, is about 15 per 1000 and considered a low incidence disorder. These are the children that teachers generally know about and who they think of when the subject of HOH children arises. Even so, while this number is about 15 times greater than the figure for audiologically deaf children, and significant in its own right, some recent research demonstrates that this number underestimates the incidence of hearing problems in school age children. 2

3 In fact, there is some uncertainty on both ends of the HOH continuum. At the upper end, for those with more severe hearing losses, there are children for whom it is uncertain whether they should be classified as HOH or deaf. This is clearly an individual matter, and depends upon whether the children function primarily in an auditory or visual mode. In fact, there are relatively few children who fall into this gray area. There are more--a great many more--children who fall on the low end of the hearing loss continuum, and who gradually merge into those children with completely normal hearing. The incidence of hearing loss, in other words, increases as the degree decreases. In a very careful study published several years ago, researchers at Vanderbilt University tested over rd, 6th, and 9th grade children in Nashville (Bess, Dodd-Murphy, and Parker, 1998). Using fairly strict criteria (equal to or more than 20dB thresholds in at least one ear) they found an overall failure rate on their hearing test of 11.3 percent, or about one out of every 10 children. About half of those tested had some type of middle ear problem (ordinarily amenable to medical/surgical treatment) and failed for that reason. The hearing loss in the other half was of the sensorineural type, or not amenable to medical/surgical intervention. The investigators closely examined the educational performance and functional status of this group of children. What they found was that children with even these minimal hearing losses had more academic and psychosocial problems than those with perfectly normal hearing. Thirty-seven percent of these students repeated at least one grade (compared to two to eight percent for the other children) and showed significantly greater dysfunction in the dimensions of, behavior, energy, stress, social support, and selfesteem. And what is most significant, is that for the overwhelming majority, neither the teachers nor the children were aware of a hearing problem. What people saw, and what the children experienced, were the effects of the hearing loss, without conscious awareness of the primary cause of these effects. People often tend to assume that because a hearing loss is termed minimal, slight, mild, or moderate, that its impact accords with the general understanding of the label. Not so. In a very creative study, two researchers from the University of Wyoming (Haggard and Primus, 1999) examined this assumption. What they did was have parents of young children listen to audio simulations of audiologically classified slight, mild, and moderate hearing losses. In all cases the subjects judged the listening experience as evidence for a more severe hearing problem than that conveyed by the label, ranging from 3

4 difficult, handicapping, to severe. In other words, being told that a hearing loss of 20 to 50 db is a mild hearing loss is a world away from actually experiencing the auditory consequences of this degree of hearing loss (all day all the time). For a crude example of what this would entail, I encourage readers to insert earplugs in their ear canals and to try wearing them in some classroom for several hours. I ve tried this often enough with audiences of normally hearing people not to doubt the increased sensitivity to even a mild hearing loss that would result from this experience! In the following pages the author has provided valuable information regarding the identification and management of HOH children. In my opinion, the prerequisite for fully utilizing this information is a teacher s acceptance of the documented fact that a hearing loss, of whatever degree, is not a benign condition. While a hearing loss may be an invisible condition, its consequences, for a particular child, can be profound and very visible. It is just too easy to underestimate the possible consequences of even the slightest degree of hearing loss (which I would define as thresholds of 15 db or greater). It does not follow that because some child with hearing loss can easily communicate in a face-to-face situation that he/she will be able to function normally in a large and noisy classroom. Fortunately, as I pointed out above, with the knowledge that a child has a hearing loss comes power--because now we know what to do. And once we do what should be done, such children will tell us, by the way they function, that they are now really listening to us. Their performance can now better reflect their cognitive capacities rather than their damaged inner ear. And isn t this what teaching is all about? Mark Ross, Ph.D. Audiologist and Professor Emeritus, University of Connecticut 4

5 Preface The goal for every student is to achieve an education enabling them to function to their potential and become productive members of their community. In order to achieve this goal students need not only to develop personal discipline and to acquire information, but also to learn the social mores and skills practiced by other members of their community at large. Content is taught through a variety of media. The teacher lectures or facilitates discussion among class members. Students participate in workgroups that have a shared learning objective. Film, videotape, DVD s and slide presentations convey information about a variety of topics. Field trips and other outings provide students with varied educational experiences. Information is presented by public address announcements to classrooms. Much of the learning that occurs in educational settings is not directly taught, but is acquired incidentally through observing what others do. Certainly this is true of social behavior. Students observe other students interacting with each other, students interacting with faculty and staff, and faculty and staff interacting with each other. The school building is a rich source of readily available information about behavior that is and is not appropriate. All of this presupposes that students have the sensory abilities to understand what is being said and to make sense out of the behavior they are witnessing. When students have sensory modalities e.g., hearing or vision, that are not functioning properly, they are cut off from sources of information available to the other students with normal sensory capabilities. When sensory dysfunction is not recognized and/or not accommodated properly, such students are often at risk for functioning far below their potential. When this occurs early in their educational career, hard of hearing students are at risk for developing an, I can t. attitude. That attitude, together with the sensory deficit, may present an increasingly difficult challenge to educators as the student progresses through the grades. 5

6 Hearing loss is the invisible disability affecting many more children than has previously been recognized. Students with severe to profound hearing loss and those who rely on sign language for communication are often, but not always, identified, and efforts are made to accommodate them. Students with slight, minimal, mild, or moderate levels of hearing loss are often unidentified as having a sensory deficit. As indicated in the Forward section of this manual by Dr. Ross, any level of inability to hear and understand what is being said in educational environments presents serious disadvantages. Difficulty hearing and understanding should not be permitted to bar children from acquiring an education and functioning at the level of their abilities. It is our task as educators to learn to identify hearing loss in students who have it and structure the learning environment, teaching materials, and teaching methods to accommodate all children s hearing, normal or otherwise. The information presented in this book is intended as a guide for teacher s, most of whom will frequently have students who are hard of hearing in their classes. Angela Hawkins, Ed.D. Director of Special Support Services, Sweetwater Union High School District Chair, California Advisory Commission on Special Education 6

7 Introduction It is important at the outset to distinguish between people who are hard of hearing and people who are deaf and to indicate that this book is focused on students who are hard of hearing and not on students who are deaf. People who are hard of hearing have some level of usable residual hearing that, when appropriate steps are taken, allows them to understand spoken speech. These are people whose primary language is English, Spanish, Japanese, or whatever happens to be their native tongue. They do not know or use sign language and the vast majority of them are not at all interested in learning, and do not need, sign language. It may help to think of students who are hard of hearing as being a subset of students who are normally hearing rather than thinking of them as being a subset of deaf students who rely on sign language for communication. Deaf and hard of hearing are two different populations. Students who are hard of hearing need help with increasing their understanding of spoken speech and with hearing environmental sounds. That help is in the form of appropriate communication behavior, environmental modification, and assistive technology. Again, this booklet is not intended for use with students whose hearing loss is beyond help by use of hearing aids and other assistive listening devices. It is not intended for use with students who use sign language as their primary means of communication. However, we do believe that students who have or are acquiring a cochlear implant and their families will also benefit from much of the information presented in this manual. For the relatively few students unable to hear speech sounds due to profound hearing loss, oral speech and language approaches such as that espoused by the A.G. Bell Association may be required. For others, learning some form of sign language might be more appropriate. 7

8 I want to take this opportunity to thank my dear friend Mark Ross for his encouragement and for the many years he has unceasingly devoted to improving the lives of people who are hard of hearing. He has long been at the forefront of efforts to improve the lives of children who are hard of hearing. I would also like to thank Dr. Angela Hawkins for providing me the opportunity to work with students who are hard of hearing and their family members and for her continued support of services for them. She is an extraordinary administrator whose heart and efforts are always focused on the special students she serves. I would like also to thank my wife, Janet, for her willingness to co-author this manual. I greatly appreciate her enthusiasm and perseverance in working directly with students who are hard of hearing, their family members and in ensuring that their mainstream classroom teachers were equipped to accommodate these children who are at high risk for being underserved.. Samuel Trychin, Ph.D. Psychologist and Consultant to the Sweetwater Union High School District 8

9 Identifying Hearing Loss Certain characteristics exhibited by students in classrooms are used as indicators of underlying problems that need to be addressed. Many of these indicators are also related to hearing loss which, if undetected or deemed unimportant, may result in a misdiagnosis of the root of the problem. For example, the hard of hearing student may be misdiagnosed as having an attention deficit disorder, low intelligence, or being emotionally disturbed, etc. Such misdiagnosis of the problem exhibited will result in an inappropriate remediation recommendation, e.g., medication, special classroom, or psychological counseling. The following general indicators can be related to hearing loss. General Indicators of Hearing Loss Inattention Functioning below academic ability Inappropriate behavior Lack of participation/unprepared Failure to follow instructions Disinterested Withdrawn/Excessively shy Confused Tense/Anxious High absenteeism Behavior problems/acting out Low self-esteem Depressed When any of these are present, look for the following specific signs that indicate the student may have hearing loss. 9

10 Specific Signs of Hearing Loss Frequently asking for repeat/saying, Huh? Frequently misunderstanding words (wash for watch) Inappropriate response to what is said Inability to understand in group situations Intently watching speaker s face or mouth Blaming people for not speaking clearly Turning head to one side to listen Showing strain around the eyes/furrowed brow Presenting a puzzled expression Speaking too softly or too loudly Avoiding social situations Pretending to understand (bluffing) Dominating conversations If several of these signs are present or hearing loss is otherwise obvious, e.g., the student is wearing hearing aids, refer the student for a hearing evaluation (see referral procedure, page 29). Many people, especially children, who have mild to moderate, and sometimes greater hearing loss are unaware that they have it. Even when aware of having a hearing loss, many people, especially older children and teens, are very reluctant to bring it to anyone s attention. They often go to great lengths to hide it. If they do own up to having a hearing loss there is often denial that it has any negative impact on their functioning. For these reasons, we cannot rely on self-reporting for identifying hearing loss in a great many instances. Classroom teachers are often in the best position to uncover previously unidentified hearing loss in their students. When a student is referred for a hearing evaluation, the teacher should request a copy of the student s audiogram. Once the audiogram is obtained, it can be used to assess the effect the hearing loss might be having on the student s academic performance, classroom behavior, and social/emotional status. The classroom teacher is in the best position to determine the impact the hearing loss may be having on the student s performance. For example, the teacher can best assess the amount of usual noise in the classroom, the amount of new vocabulary required, and the amount of student participation that occurs in their class. 10

11 Some students who have hearing loss perform very well academically. But, they do so by paying a heavy price physically and emotionally. Therefore, if students exhibit the signs of hearing loss previously listed, their hearing should be tested, even if their academic performance is good. There are intervention strategies (see pp 19-27) that will reduce their stress and possibly permit an even higher level of performance. 11