Approximately 40% of children with hearing loss have an additional disability
6.3% Attention Deficit Disorder
8.2% Mental Retardation
1.9% Emotional Disturbance
1% Autism
6.9% Other
5.6% Not Reported
2004-2005 Regional and National Summary, Gallaudet Research Institute
PREDICTION: HOW WILL THESE CHILDREN LEARN TO COMMUNICATE?
How do we “predict” which children with hearing loss and additional disabilities will have good listening and spoken language outcomes? COGNITION… however, having good cognitive abilities is a predictor of language and literacy abilities in typically developing children, so perhaps the question we need to ask ourselves is: Are the child’s speech, language, and listening abilities commensurate with their overall cognitive profile? Is the child performing to the best of his or her abilities, regardless of how far from the norm they may be? A child should NOT be counted out of a listening and spoken language approach just because he or she has below-typical cognitive abilities.
INTERVENTION: WHAT TECHNIQUES SHOULD WE USE WITH THESE CHILDREN?
Unfortunately, there is very little about differentiated instruction in listening and spoken language for each additional disability area. Many of these children benefit from the same listening and spoken language techniques we use for children who are “just” deaf, with modifications based on their unique needs. For children with multiple disabilities, Listening and Spoken Language Specialists and other intervention professionals should use teamwork with professionals from other disability fields and professionals development/continuing education to further their knowledge of hearing loss as well as other challenges these children may face. Collaboration is crucial.
For some children with hearing loss and other disabilities, the child’s receptive (output) and expressive (input) modes of communication may be different. A child who does not have the anatomy to produce speech may use an alternative/augmentative communication device to express himself, but may be able to comprehend speech through listening. For some children with limited fine motor movement, especially in the hands, sign language may not be the best choice of expressive communication. Other children/families may use a variety of approaches. THIS post is my report of a presentation from this year’s AG Bell Convention, “AVT Model for Families Transitioning from Visual Language”, part of which discusses considerations for “Special Needs Signers” (scroll down, it’s the second session in the post).
BENEFITS: WHAT DO WE CONSIDER TO BE “SUCCESS”?
While open-set speech recognition in noise is the “gold standard” for many CI recipients, for severely impaired children, this may not be a realistic goal. Are CIs still beneficial or worthwhile? You’d better believe it. In fact, in a study of severely disabled children who had received cochlear implants, numerous benefits were demonstrated, including, “Moreover, most of the parents, when asked what they would choose if they had to make the decision for a CI for their child again, answered that they would choose a CI again” (Berrettini et al., 2008). This conclusion was supported by the interviews from parents that were reported in one of this year’s AG Bell Convention sessions, “The Auditory-Verbal Lives of Children with Multiple Challenges”, my report on this session can be seen HERE (scroll down, it’s the third session in the post).
THINGS TO CONSIDER
For children who are ventilator-dependent or require other equipment at all times, measuring accurate behavioral hearing thresholds may be complicated by the background noise of their “gear” – use NRT, ABR, OAE? Measure background noise and factor this into presentation level equations?
Progress may be slower due to missed rehabilitation appointments/school days for other medical complications, not necessarily due to innate child factors
Receptive vs. expressive communication modes – can the child hear and understand spoken language, but is physically unable to produce spoken language? AAC? Manual communication?
Is manual communication appropriate for a child with poor gross/fine motor skills? For children with low vision/blindness?
Facial nerve paralysis/stimulation issues during surgery/MAPping of children with abnormal anatomy?
Is the additional disability identified pre-implant (congenital or perinatally acquired) or later (i.e. when the child has difficulty learning to read ? dyslexia)
Who decides what is “benefit”? Who decides who can and cannot receive a cochlear implant? Cost? Who pays?
Are these children included in AO schools? If not, is it because the school truly cannot provide the necessary support services, or because it lowers outcome data?
So, that’s what I found… but it’s just the beginning! As medical technology improves, more and more children are being kept alive with multiple disabilities who may not have lived to make it into our clinics and classrooms decades ago. The population of children with hearing loss and additional disabilities is growing, and I believe that they (and their parents) deserve the same shot at a listening and spoken language outcome as their “vanilla deaf” peers. As professionals, we need to increase our skills and knowledge base to help them achieve this goal.
Elizabeth A. Rosenzweig 