Learners Who Are Deaf or Hard of Hearing

1. Learners Who Are Deaf or Hard of Hearing EDSP 6644 by Linda Jodock

2. Facts about Learners with Hearing Impairments • Most people who are deaf have some residual hearing. • Deafness poses more adjustment difficulties than does blindness due to inability to understand and speak oral language. • The phenomenon of a Deaf culture is natural; too much mainstreaming may diminish its influence. • Lipreading refers only to visuals arising from the lips’ movements. Speechreading is a more accurate term to describe the attention some hearing impaired give to facial cues and movements of the tongue and jaw. • Speechreading is extremely difficult to learn. Very few become proficient. • ASL is a true language with its own set of grammatical rules. • Some within the Deaf community have argued for the need for a critical mass of deaf students in order to have effective educational programs. Separate placements are a way of fostering Deaf culture. • Deaf children born to deaf parents fare better in academic and social areas due to their parents ability to communicate with them in ASL.

3. Definition and Classification • Division between deaf and hard of hearing • Two extreme points of • view between professionals: A physiological orientation versus an educational orientation Beethoven

4. The Physiological Viewpoint • Dependent on the measurable degree of impairment: those who can’t hear sounds above a certain intensity are “deaf”; others with hearing impairment are considered “hard of hearing”. • Hearing sensitivity is measured in “decibels”. Zero decibels is designated as the point at which the average person with normal hearing can detect the faintest sound. Each increasing number of decibels that a person cannot detect indicates a degree of hearing impairment. • The physiological point of view maintains that impairments of 90 dB or greater be classified as deaf. (This is about the loudness of a lawn mower.) • Those with lesser impairments are hard of hearing.

5. The Educational Viewpoint • The concern is for how much the hearing impairment is likely to affect the child’s ability to speak and develop language. • The close causal link between hearing impairment and delay in language development causes these professionals to categorize on the basis of spoken language abilities. • “Hearing impairment” covers a range from mild to profound and includes those who are deaf or hard of hearing.

6. Educationally Oriented Definitions • A deaf person is one whose hearing ability precludes successful processing of linguistic information through audition, with or without a hearing aid. • A person who is hard of hearing generally, with the use of a hearing aid, has residual hearing sufficient to enable successful processing of linguistic information through audition (Brill, MacNeil, &Newman, 1986, p.67, as cited in Hallahan, Kauffman, &Pullen).

7. Onset of Deafness • For educators, the close relationship between hearing impairment and language delay is crucial. An earlier onset means more difficulty for the child in developing the language of a hearing society. • A congenitally deaf child is born deaf. • An adventitiously deaf child acquires deafness sometime after birth. • Two other frequently used terms specifically refer to language acquisition: prelingual deafness – acquired at birth or prior to speech or language development; postlingual deafness – occurs after the development of speech and language. • There is a growing sentiment among the deaf community that deafness should not be considered a disability, but rather a cultural difference. These tend to refer to themselves as “Deaf”. • Those who refer to themselves as “deaf” with the lowercase usually try to maintain their contact with mainstream society and usually acquired their deafness later in life.

8. Prevalence • About 0.13 percent of the population from six to seventeen years old as identified by the US Department of Education is deaf. • It’s likely that students who are hard of hearing are far more prevalent. • Authorities suspect that many hard of hearing who could benefit from special education are not being served. • Twenty-five percent of deaf students in the US come from Hispanic homes. • Relatively large numbers come from other non-English-speaking immigrants. • Deafness makes native language acquisition difficult, let alone second language acquisition. Helen Keller

9. Anatomy and Physiology of the Ear

10. Anatomy and Physiology Three sections: • Outer ear – the auricle and the external auditory canal. The auricle protrudes from the side of the head. • Middle ear – the tympanic membrane (eardrum) is the boundary between the outer and middle ears. The middle ear is made up of three tiny bones (ossicles): malleus (hammer), incus (anvil), and stapes (stirrup). All are contained in an air filled-space. They conduct the vibrations of the eardrum to the oval window, the link between the inner and middle ear. • Inner ear – the size of a pea and a maze of passageways, it’s often called a “labyrinth”. Its two sections are the vestibular mechanism and the cochlea. a. The vestibular mechanism is responsible for the sense of balance. b. The cochlea, when stimulated by the movement of the oval window, begins to flow with fluid. The cochlear nerve is then stimulated, and an electrical impulse is sent to the brain, and sound is heard.

11. Identification of Hearing Impairment • Screening tests – An initiative by the American Academy of Pediatricians has resulted in 93% of newborns being screened for hearing (AAP, 2007). Some tests involve computers to measure otoacoustic emissions of the cochlea to test its functioning. • Many elementary schools have routine screening programs. • Individually measured tests rather than group tests and those performed in an audiologist’s office are the most accurate.

12. Pure-Tone Audiometry • This test is designed to establish the individual’s threshold for hearing at a variety of frequencies, measured in hertz (Hz) units. The pitch is higher with more vibrations per unit of time of a sound wave and lower with fewer vibrations. • Audiologists are concerned with measuring sensitivity to sounds ranging from 0 to about 110 dB. • The zero decibel level is frequently called the zero hearing-threshold level or audiometric zero. • Each increment in the decibel scale is based on ratios. Therefore, 20 dB is ten times more intense than 10 dB, and 30 dB is one hundred times more intense than 10 dB. (Normal conversation is at about 60 dB and a power lawn mower is at about 90 dB.) • The audiologist tests each ear separately in the range of 0 to 110 dB and 125-8,000 Hz until it’s established at what level of intensity (dB) can detect the tone at a number of frequencies. For each frequency, there is a level of hearing impairment. For example, a 50-dB hearing impairment at 500 Hz means that individual requires 50 dB to detect the 500 Hz sound whereas an average person would have heard it at 0 dB.

13. Speech Audiometry • Audiologists use speech audiometry to test individual’s detection and understanding of speech. • The speech reception threshold (SRT) is the decibel level at which one is able to understand speech. • Testing each ear separately with a list of two-syllable words, the dB level at which half of those words is understood is an often-used estimate of SRT.

14. Tests for the Young and Hard to Test • Play audiometry – examiner teaches the child to do various play activities when the signal is heard. • Tympanometry – a rubber-tipped probe is inserted into the ear canal, sealing it off. The effects of pressure and sound are measured to assess the inner ear’s function. • Evoked-response audiometry – measures changes in brain wave activity by using an electroencephalograph.

15. Causes • These are classified with respect to the type of impairment and its location. • Three major classifications: 1. conductive – transfer between middle and outer ear 2. sensoneurial – problems in the inner ear 3. mixed hearing impairment – a combination of the two.

16. Outer ear impairment • Atresia – a condition where the external auditory canal does not form. • External otitis – “swimmer’s ear” – an infection of the skin of the external auditory canal. • Tumors

17. Middle Ear Impairments • Usually, the mechanical action of the ossicles is interfered with in some way. These problems can be corrected with surgery or medical treatment. • Otitis media – infection of the middle ear caused by bacteria or virus. It’s linked to abnormal functioning of the eustachian tubes. It causes temporary conductive hearing impairment. Untreated, it can lead to rupture of the tympanic membrane.

18. Inner Ear Impairments • A person with this type of impairment may also have sound distortion, balance problems, and roaring or ringing in the ears. • Can be hereditary or acquired – genetic factors are the leading cause of deafness in children. • Over 400 different varieties of hereditary deafness have been identified. • Mutation in the connexin-26 gene is the most common (20%). • Acquired impairments: meningitis (2nd most frequent cause), prematurity, viral infections, anoxia at birth, prenatal infections of the mother (rubella, congenital syphilis, cytomegalovirus), Rh incompatibility, blows to the head, antibiotics’ side-effects, excessive noise levels. • The most frequent cause in newborns is cytomegalovirus (herpes).

19. Psychological and Behavioral Characteristics • Functionality in a language-oriented world is difficult. • The hearing impaired population is usually deficient in the language shared by most of the hearing society. However, they can become proficient in sign language. • Sign language – under the pioneering work of the linguist, William Stokoe, at Gallaudet University, ASL became recognized as a true language. Each sign consists of three parts: handshape, location, and movement. (1960, 1976) • Nonuniversality of sign language – French sign language (promoted by clergyman Michel de l’Eppe) is as foreign to an American deaf person as spoken French would be to a hearing American. • Sign languages evolve with usage – Nicaraguan Sign Language is an example. • Milestones in language development in sign language mirror the milestones in spoken language development – babbling, first words, and two-word phrases. • Neurologically, left cerebral hemisphere of the brain is the primary site responsible for both spoken language and for sign language. Louis Frisino: “Black Labrador Puppy”

20. Intellectual Ability • Performance tests offer a fairer assessment of intelligence, particularly if they are offered in sign. • There is no measurable difference in IQ between hearing and deaf persons. Marlee Matlis

21. Academic Achievement • Reading ability, reliant on English language skills, is most affected. • Average hearing impaired student leaves school with a deficit of 5 years in reading (Kyle and Harris, 2006, as cited in Hallahan, Kauffman, & Pullen). • Those students with deaf parents have higher reading achievement and better language skills than those with hearing parents. • A supportive home environment is key to higher achievement.

22. Social Adjustment • Social development and personality development depend on communication just as in the hearing community. • Two important factors: inclusion hearing status of the parents • In inclusionary settings, research has shown that very little interaction occurs between the hearing peers and the deaf students. Some interventions using cooperative learning have been successful in increasing interactions. • Students who are deaf feel more emotionally secure if there are others who are deaf that they can communicate with. • A need for social interaction leads many to associate primarily with others who are deaf. • The Deaf Culture – a unifying influence of sign language is the first of six factors marking this community as a true culture: 1. Linguistic differentiation – many are bilingual in English and sign language. 2. Attitudinal deafness – self-perception as deaf although hearing impaired 3. Behavioral norms – more physical contact; frank discussions 4. Endogamous marriage – 90% ingroup marriage 5. Historical awareness of significant people and events pertaining to deafness. 6. Voluntary organizational networks – Goya’s Deaf Olympics, National Theatre of the Deaf “Old Men Eating Soup”

23. Erosion of Deaf Culture • There is a concern among those within the Deaf community that the increase in inclusion is eroding the cultural values of the Deaf culture. • Authorities recommend that schools involve members of the Deaf community in developing classes in Deaf history and culture. • Deaf Activism – the Gallaudet experience: 1. Deaf President Now Movement – From 1864 to the 1980’s, Gallaudet had never had a hearing president. When a second hearing president was announced in March of 1988, there followed 8 days of protest, resulting in the naming of a deaf president and a majority of deaf members on the board. 2. Unity for Gallaudet Movement – In 2006, Fernandes’ appointment as president was protested. Although she is deaf, she was considered too progressive, favoring inclusion of those with cochlear implants as well as those who had not grown up with sign language. She was replaced by Robert Davilla.

24. Deaf Activism • The cochlear implant – the procedure involves surgically implanting electronic elements behind the ear and in the inner ear. A small microphone picks up sound and sends it to a small computerized speech processor which sends coded signals to an external coil worn behind the ear. This coil sends the signals to electrodes implanted in the inner ear, and they are sent to the auditory nerve. • It’s recommended for those with profound sensorineural loss in both ears. In children, most implants occur between the ages of two and six. • The debate – the Deaf community views these implants as invasive both physically and culturally. • In order for the implants to be most effective, intensive oral instruction is recommended. Since many in the Deaf community favor manual (ASL) instruction over oral teaching methods, this is problematic. They are concerned that not enough exposure to sign language will occur for them to preserve their heritage. • Another scientific discovery which could help sustain Deaf culture involves the connexin-26 mutation. In vitro fertilization could ensure that only fertilized eggs containing this mutation would be implanted. • Some deaf couples have actually used artificial insemination by a donor who has a high probability of carrying genes causing deafness.

25. Oral Approaches • Auditory-Verbal Approach – • focus is exclusively on using audition to improve speech and language development. • assumes some residual hearing and relies heavily on amplification technology like hearing aids and cochlear implants. • heavy emphasis on speech training – many children with hearing impairments must be explicitly instructed in how to produce speech sounds. Granville Redmond: “California Poppy Field” c. 1926

26. Auditory-Oral Approach • Similar to the auditory-verbal approach, but also stresses the use of visual cues like speechreading and cued speech. • Speechreading’s goal is to teach children to attend to a variety of stimuli in addition to the movement of the lips, contextual stimuli like facial expressions and tongue and jaw movement. (Sometimes referred to as lipreading) • Cued speech is a way of augmenting speechreading by using hand shapes to represent certain specific sounds while speaking. There are 8 hand shapes for consonants and 4 for vowels.

27. Criticisms of the Oral Approach • Critics object to the deemphasis of sign language in this approach; they assert that most children with profound or severe hearing impairment are being denied access to a language to communicate. • Good speechreaders are rare due to several factors: 1. speakers produce many sounds with very little movement of the mouth 2. English has many homophenes – sounds that are visually identical (p, b, m) 3. variability among speakers 4. poor lighting 5. rapid speaking 6. talking with one’s head turned

28. Educational Considerations • For the educator, communication with the hard of hearing and those who are deaf is a major obstacle. • Oralism-manualism debate – Oralism involves teaching speech. Manualism advocates use of manual communication. It predominated until mid-nineteenth century, when oralism began to gain favor. • Currently, professionals recommend both – a total communication approach. • The Deaf community believes this is inadequate and advocates for a bicultural-bilingual approach; this promotes ASL as the first language and instruction in Deaf culture. Goya: Self Portrait

29. Total Communication • Simultaneous use of speech with one of the signing English systems, like fingerspelling- representing the letters of the English alphabet. • Criticism of this method has focused on the use of signing English rather than ASL. • The advantage is that signing English uses the same word order as spoken English, allowing one to speak and sign simultaneously. • ASL advocates believe this method is too slow and awkward and that word order is not the critical element in learning to use and comprehend English. They add that ASL evolved over several generations of users while signing English systems are relatively new.

30. Bicultural-Bilingual Approach • Many critics of total communication advocate this approach. • Several variations, but most contain three features: 1. ASL is considered the primary language and English is secondary. 2. People who are deaf play an important role in curriculum and program development. 3. The curriculum includes instruction in Deaf culture. • Studies have shown a relationship between ASL usage and academic performance in English. (Wilbur, 2000, as cited in Hallahan, Kauffman, & Pullen) • “…a range of approaches will probably best serve the needs of a range of deaf children.” (Schirmer, 2001, p.203, as cited in Hallahan, Kauffman, & Pullen) Douglas Tilden, sculptor

31. Technological Advances • Hearing Aids – FM systems can be connected to a wireless lapel microphone on the teacher. • Captioning – television, movie, and video. Federal law requires it. • Telephones – text phones. Federal government requires each state to provide a relay service to allow communication through an operator. • Video relay service – allows a sign language interpreter to serve as an intermediary between hearing and non-hearing communicators. • Computer-assisted instruction – visual displays of speech patterns can help the hearing impaired learn speech. C-print transcribes speech with reduced keystrokes to a computer in a lecture setting. The deaf student can receive a real time display and a printout. • Internet – electronic mail, world-wide web, information access, on-line classes. All are open to both the hearing and non-hearing world. Goya: “The Parasol”

32. Transition to Adulthood • Besides Gallaudet University and the National Technical Institute for the Deaf, many other postsecondary institutions offer programs for those with hearing impairments. • A common accommodation – sign language interpreters • Expanded transition programming, postsecondary education, and public awareness predict successful futures for the hearing impaired.

33. References • Beethoven, L. Image retrieved November 27, 2009 from buzzle.com • Ear anatomy image retrieved November 21, 2009 from www.bing.com/images/search?q=anatomy+ear&FORM=IGRE5 • Ferrigno, l. Image retrieved November 28, 2009 from About.com:Deafness • Frisino, L. “Black Labrador Puppy”. Retrieved November 29, 2009 from About.com:Deafness • Goya, F. “Self Portrait”, “Old Men Eating Soup”, and “The Parasol”. Retrieved November 27, 2009 from the Prado Museum on line. • Hallahan, D., Kauffman, J., & Pullen P. (2009). Exceptional Learners: An Introduction to Special Education. (11th ed.). Pp.339-369. Boston, MA: Pearson. • Keller, H. Image retrieved November 27, 2009 from About.com:Deafness • Matlin, M. and her translator, Jack Jason, all images retrieved November 27, 2009 from About.com:Deafness • Redmond, G. “California Poppy Field” (circa 1926). Retrieved November 29, 2009 from LACMA Collections on line. • Tilden, D. “The Young Acrobat” and “The California Volunteers’ Monument” retrieved November 27, 2009 from About.com:Deafnes • Waterford crystal bell image retrieved November 27, 2009 from www.bing.com/images/bells