The Hearing Impaired Child

Mr Dan Goldstein, Dan Goldstein

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781135799977
• Edition: 1
• Topic: Education
• Subtopic: Education General

The Hearing Impaired Child introduces the background issues of hearing impairment then discusses specific aspects. These include causes of hearing loss, speech and language, personality and emotional development, and careers. Appendices provide checklists for language acquisition and reading and writing skills, lists of useful addresses, a helpful glossary and references for further reading.

1
Introduction

Statutory considerations

This book is primarily intended to give non-specialist teachers an understanding of different types of hearing loss, how they are diagnosed and what teaching approaches are useful. The recommendations made take into account recent legislation and the imminent introduction of the national curriculum. It is important to bear in mind the fact that, ‘The Secretary of State believes that all pupils, including those with special educational needs, should have the opportunity to obtain the maximum benefit possible from it’. As ‘the 1981 Act placed LEAs under a duty to secure that, subject to conditions specified in Section 2(3), children with statements should be educated in ordinary schools’ (Draft Circular[–/89] Revision of Circular 1/83), there has been pressure for more disabled children to be in mainstream settings.

There is provision for disapplication of the National Curriculum in certain cases. From what has been published to date it would appear that the primary reasons for exempting children for up to six months is to allow for the effects of illness to be overcome or enough time to become proficient in English in the case of children for whom it is a second language. But as far as children with special educational needs are concerned teachers must anticipate teaching within the framework of the national curriculum, even though as the proposals for English point out, ‘some may hover around the level 1 attainments for the whole of their school careers’ (p. 59; 13.4).

Incidence of hearing impairment

Serious hearing loss occurs in about two per thousand of the population, the same sort of incidence as for other major disabilities. Apart from these cases it has been estimated that as many as 50 per cent of inner-city children under the age of seven may have transient hearing losses and up to 10 per cent a recurrent or persistent loss sufficient to affect educational progress. Given numbers of this order it is unlikely that a teacher will never be faced with a hearing impaired child. A loss of sufficient magnitude to make communication difficult is less likely to be encountered. When it is, it might be because parents insist on mainstream provision, a partially hearing unit is housed in the school and children from the partially hearing unit are integrated in mainstream classes for part of their timetable, or there is no local specialized provision of any kind and a boarding school is the only alternative to the neighbourhood school.

Qualifications required to teach hearing impaired children

At present special qualifications are mandatory to teach both ‘deaf’ and ‘blind’ children, so it is quite natural for a teacher without such qualifications to feel apprehensive when confronted with a child who has either one or possibly a combination of the two disabilities to some degree. It is possible for teachers without prior qualifications to teach hearing impaired children, but it should only be under the supervision of a qualified teacher and be accompanied by a recognized in-service training course leading to a specialist qualification. It is hoped that what follows will help the ordinary classroom teacher to understand more about hearing losses and of equal importance how they may teach more effectively. Any teacher with experience of hearing impaired children, including specialists, knows that there are limitations as to what can be achieved. The aim of this book is to encourage all teachers to assist hearing impaired children realize their fullest potential, while accepting it may not be possible for them to attain quite the same standards as children with normal hearing. Some idea of why this should be so is contained in Chapter 7 on language and emotional development.

Terms commonly used in reports

To set the scene for what is meant by hearing impairment a number of commonly used terms will be introduced. These, together with data presented in the other chapters will clarify information contained in reports included in the child’s records. Hearing impairment is an umbrella term, requiring more precise definition if it is to be meaningful in respect of a particular child. Basically there are four parameters: age of onset; cause; degree and type. The age of onset is important because impairment after speech and language have been acquired leads to less marked effects than when it is congenital or occurs very early in life. Hearing can of course be impaired or lost at any age. Present estimates of causes are that 60 per cent of severe and profound congenital hearing losses are due to otherwise fit and healthy parents both having a recessive gene which leads to deafness in their offspring. Apart from the hearing loss the children are usually healthy.

Practice varies considerably from area to area in terms of what information is made available to the class teacher. When the only reports on a child’s hearing difficulties are locked away with medical records, a peripatetic teacher of the hearing impaired may be able to supply the relevant facts—in the event of their not being made available by the school doctor or nurse. The term ‘hearing impaired’, already employed a number of times, is now used instead of deaf because even ‘deaf’ individuals can usually hear some sounds. Unfortunately the new term obscures the degree of loss. Various types of hearing impairment and hearing losses are described later.

Confusion can be caused because hearing loss and hearing impairment are often used interchangeably. When a loss is congenital the degree of hearing impairment should be specified. In practice reference is made to the size of the loss even though better levels of hearing have never existed. The point to remember is that what is said in reports refers to the situation at the time of the tests. With certain kinds of hearing loss, especially if they are amenable to treatment, there could be an improvement. In other cases a steady deterioration might ensue. The incidence of sudden loss is rare, but when it does occur the impact is quite shattering for the individual concerned.

The amount or degree of hearing loss ranges from profound, through moderate to mild. The profound or virtually total inability to hear is what most people think of as deaf. The advent of special services for the deaf on television has tended to reinforce this notion, suggesting that the principal form of communication for the deaf is through the use of signs and finger spelling. As it happens only a small percentage of all hearing impaired people rely wholly on these methods of communication. At the other end of the range mild hearing impairment is quite slight and likely to become familiar to most people as they get older. When hearing fails due to age a hearing aid can be useful. Just how useful may be gauged by the frequency and length of time it is worn. Many of the aids issued to elderly people languish unused in drawers, a fact explained away by reference to age, cantankerousness, an unwillingness to make an effort, or the loss of interest generally. Yet glasses, which are just as much of a nuisance are worn. The difference is glasses correct slight visual defects more or less completely. Hearing aids are not so precise in their function. This is dealt with in greater detail later. It has been mentioned at this point because the limitations of hearing aids, despite the enormous benefits they can confer, are still imperfect instruments. The wearing of them does not automatically solve all the hearing problems of users, a point that cannot be made too often.

A mild hearing loss is a bit of a nuisance to older people. Much of the time they do not have too great a problem, though they may tend to accuse others of mumbling. Noisy conditions present greater difficulties both for them and the greater losses about to be described. Moderate hearing losses entail missing much more of what is said and many everyday sounds are often not heard, for example the doorbell or the telephone. Once this degree of loss is encountered a hearing aid becomes a necessity, though in quiet surroundings, providing interlocutors speak up clearly, conversation can still be followed. Severe hearing loss removes the ability to make sense of what is heard unless some additional clues, such as lip reading, are used. A profound hearing loss is a major disability that affects the individual’s ability to communicate. It not only prevents those affected from hearing what is said it mars the quality of their own speech. This can make it somewhat difficult for those to whom they speak to understand. The vicious circle that ends in isolation starts at this point.

Origins of special education

The development of provisions to educate the hearing impaired has a long history, starting with the Romans, if not earlier. Renewed interest was shown in Europe in the 16th century and institutions were set up to educate the profoundly deaf. By and large they were taught separately by very specialized methods. An overview is given in Appendix A. The last century saw a further upsurge of interest in the education of the ‘deaf’ and ‘blind’, which led to the enactment of a statute making special qualifications for teachers of the deaf and the blind mandatory in Britain. Other European countries took similar measures. More special schools were set up. Many of these were residential and some such as the Royal School for the Deaf in Manchester and the Royal Victoria school for the Deaf in Margate still function. These catered for those whose hearing losses were evidently so great as to prevent them from learning speech and language normally through hearing. Some children with moderate hearing losses suffered the fate of being considered mentally defective or at a later date, educationally subnormal. ‘Moderate learning difficulty’ is the current terminology.

Effects of hearing impairment in the classroom

Hearing impaired children’s slowness in learning is still being put down to a general lack of ability rather than the effects of hearing difficulties. I came across a case recently when I was asked to assess a child’s special educational needs. It was thought by her own teacher and the headteacher who had observed her, that she might be better off in a special school on account of her learning difficulties. Her mother and the Head of the school, both present during the assessment, were surprised by the quality of some of her answers. Indeed overall she showed herself to be well within the normal range of abilities. A quick and simple test (see page 120) showed she had a significant hearing loss. This was confirmed later under clinical conditions and since it was a curable condition, arrangements were made for surgical treatment. After the operation she was reported to be still slow. After years of not hearing properly it is inevitable that bringing her hearing to within normal limits would not effect a magical transformation. ‘But if she can now hear normally, why isn’t she responding normally?’ is a typical question, also asked when children are fitted with aids. Just because the brain is locked away in a bony skull does not make it different in essence from any other part of the body in terms of basic function. No one would expect to run a marathon without a lot of intensive training beforehand. The skills and stamina have to be built up over time. If it takes so long just to get comparatively simple muscles into shape, it is obviously going to take a lot longer when it comes to extremely complex intellectual functions.

Apart from children in the same position as the one just described, there are others whose lives have been transformed by the advent of hearing aids. By wearing them consistently many are able to cope in a normal school setting. In effect children with moderate to severe losses are enabled to learn in a way that was only true for those with quite mild losses—always provided optimal conditions are made available. About that more anon. Even so some children in this category need the extra support provided by a partially hearing unit, or at least some additional, specialized teaching input.

Issues

There are contentious educational issues which are peculiar to the hearing impaired, others apply with equal force to most disabilities. Some will only be mentioned in the introduction and not referred to again, leaving the remainder for more detailed discussion in later chapters. It will be appreciated that in a book of this size it is impossible to cover each and every area of importance in depth, so the aim is to give essential information and provide a feel for the issues involved. There is no typical hearing impaired child who can be described to personify the rest. As will become clear, hearing impaired children have to be considered very much more as individuals, taking due note of local influences.

Present educational provision for the hearing impaired

Pre-school

The way education is currently provided for the hearing impaired is a bone of contention. Before explaining why, the various specialists who are likely to come into contact with hearing impaired children will be listed. Who is available varies throughout the country. All local education authorities have a peripatetic service for the hearing impaired, staff by peripatetic teachers of the hearing impaired with an additional teaching qualification in respect of the hearing impaired. Prior to taking up such work the teachers will have had experience in one or more sort of specialized educational setting for the hearing impaired. Many have a Diploma in Audiology, so that in all two extra years of full-time training have been completed after initial qualification, usually with punctuation to gain more teaching experience as a specialist between times. Their first contact with a local hearing impaired child may be in an audiology clinic. Such clinics do not exist in all parts of the country. Some families have to make long treks to a specialist hospital department. In the event of a hearing loss being confirmed many further visits are bound to follow. These are very demanding, especially if a strict appointment system is not adhered to. Difficult journeys, followed by long waits can be very daunting, especially if there are other children in tow. In such circumstances, FTA (failed to attend) occasionally written on hospital records is not surprising. If it happens more than once or twice the parent is branded as uncooperative.

If there has been any reason to suspect a hearing loss or parents have been suspicious all is not well, the results obtained in an audiology clinic may simply confirm fears and expectations, quantifying the nature and degree of a hearing loss. Even when this is the case, it is still very traumatic for the parents. For parents for whom the revelation is wholly unexpected or denied, albeit subconsciously, their distress can be quite devastating initially. A child welcomed and regarded at birth as normal is exposed as invisibly damaged. So apart from the usual reactions to discovering an infant has a hearing loss there are additional stresses. On top of all this they have to cope with the various support agencies who become involved: ENT consultant; audiological physician; paediatrician; physiological measurement technician; peripatetic teacher of the hearing impaired; genetic counsellor; health visitor and social worker. The physiological measurement technician often carries out routine hearing tests and makes ear moulds, in addition to a wide range of other functions. At least five of these specialists will be involved if a hearing aid is issued, the whole lot in some cases.

The peripatetic teacher of the hearing impaired gives guidance and support to the parents and/or any other regular caretaker in addition to advising on the use of any hearing aid issued. Examples of the suggestions made are set out in later chapters. The important practices that have to be observed are that if an aid is needed it is kept in good working order and it is worn consistently throughout the day. Activities to enhance awareness of as many environmental sounds as possible are used. Sound-making toys and a variety of musical instruments, especially the percussive ones, are employed in play situations into which elements of direction can be introduced. This stimulates a basic interaction between what is heard and what is done. It is at a lower level than obeying spoken instructions, but it has the same fundamental characteristic of linking hearing and doing. Naturally every opportunity is taken to draw attention to and encourage communication through spoken language.

School-age provision

A variety of educational establishments exist to make what is considered to be the best provision for hearing impaired children. In some instances children start in the nursery class of a special school as young as two years of age. Apart from day schools there are also residential schools catering for children with profound hearing losses. Of the latter type one is a grammar school, namely Mary Hare. Other schools, both day and residential, have pupils with the usual range of intelligence. Some of these have special units as well, for children with additional disabilities, e.g. The Royal Victoria School for the Deaf with its Deaf/Blind Unit, and another for children with behavioural and emotional difficulties. Some schools take partially hearing children, who can learn mainly through hearing. Day special schools usually only have profoundly hearing impaired children of normal intellectual ability. When other problems ‘arise arrangements are often made for them to transfer to a residential school. If a pre-school child goes to one of these full-time special schools the peripatetic teacher of the hearing impaired no longer has any dealings with the child since the teachers will all have comparable specialist qualifications. Contact continues with children who go to day nurseries and later to ordinary schools. The level of staffing in any given peripatetic service determines the amount of direct teaching given. When working for one authority as a peripatetic teacher of the hearing impaired I was able to see pre-school, nursery and infant children for about an hour, two or three times a week. With another, due to poorer staffing ratios, it was almost impossible to manage once a fortnight. So it is very unlikely any child in primary school will be taught on a regular basis. Once children are at secondary school the peripatetic teacher of the hearing impaired will do little more than check to see all members of staff are aware of the presence of a hearing impaired child, providing generalized guide-lines and saying who to contact for hearing aid maintenance.

In addition to special schools there are units. One London school has a unit for children with profound hearing losses. The children with normal hearing have become so expert at signing that they have completely undermined the whole purpose of integration since they omit to speak to the hearing impaired children when signing. Children with all their faculties are very adaptable and unconsciously alter the level at which they pitch their language when addressing those younger than themselves. In the setting cited, the hearing children, knowing what they say cannot be heard, do not make any unnecessary efforts, adapting their behaviour to suit the circumstances in a similar way. Apart from the children receiving special education there are large numbers with varying degrees of hearing loss scattered through day nurseries and schools. Most will only have mild or moderate losses, others quite severe ones. How successful they are depends on the usual range of factors: the innate ability of the child; the amount of help and support provided by the home; how much extra help is available within the school, etc. Each case must be judged according to individual circumstances. Blanket prescriptions should not be made on the basis of isolated cases.

Whatever educational provision is arranged for a hearing impaired child: special school; partially hearing unit; mainstream...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of Figures and Tables
• Acknowledgements
• Foreword
• 1: Introduction
• 2: Causes of Hearing Loss
• 3: Hearing Aids and Their Management
• 4: Speech and Language—General Issues
• 5: Speech and Language—The Specifics
• 6: Reading, Writing and Associated Activities
• 7: Personality and Emotional Development
• 8: Careers
• 9: Historical Perspectives
• Appendix I: Aide Memoire for Language Acquisition,Reading and Writing Skills
• Appendix II: List of Useful Addresses
• Glossary
• References and Further Reading