Instructional Strategies for Students who are Deaf and Hard of

Hearing (Updated September 2019)

Team members working with students who are deaf and hard of hearing need
to carefully consider each student’s unique needs and learning style, as well as
the demands of the task. The following strategies are offered to provide a
starting point for thinking about possible adaptations. It is important to
remember that all team members should have input into decisions regarding
instructional strategies for a student who is deaf or hard of hearing.
Possible effects of hearing loss on skill development in English
The task of learning to read is more difficult for children who cannot hear.
According to Traxler’s research in 2000, less than half of the 18-year old
students, who are deaf, leaving high school had reached a fifth grade level in
reading and writing skills (Traxler, 2000). Reading and writing may be
considered more critical for people who are deaf than for hearing people, since
they often rely on written means to communicate (e.g., emails, texts,
captioning).
It has been hypothesized that the low reading skills of deaf individuals result
from problems with phonological processing. Most hearing readers encode print
by sounding words out phonetically. Many children who are deaf and hard of
hearing, even with amplification, are not able to hear many of the speech
sounds. This encoding is important in reading, because it allows a person to hold
chunks of text in short-term memory long enough for higher-level processors to
assign meaning to it for overall comprehension.
90 - 95% of children who are deaf and hard of hearing have parents who are
hearing, and most often, are not fluent at signing. For children who depend on
visual communication, it may be more difficult for them to acquire language
from their environment incidentally (from overhearing/seeing conversations of
others in their environment, from TV, or other devices). Without this incidental
learning, a child who is deaf or hard of hearing may have limited knowledge of
the vocabulary and grammar that print represents, and even a limited general
knowledge of their world. Therefore, it is often more difficult for them to
predict or infer meaning. Multiple meaning words and idioms may present
particular challenges.
American Sign Language (ASL) has its own grammatical rules, and does not
follow the syntax or the word order of English. Children who are deaf and who
do not hear spoken English over and over during their daily routines may not
acquire use of English grammar and syntax naturally as hearing children do.
They may need to learn English grammar by memorizing the rules, a lofty task.
Some people may think that if a person who is deaf could just read a lot, they
would assimilate English syntax through repeated exposure. The problem is, if a
child doesn't hear English, and cannot assimilate the rules of the language
naturally, then reading English sentences is very difficult. If one is not able to
sound out the vocabulary phonetically and if sentence structure is confusing,
reading becomes a chore.
Ways to help students who are deaf and hard of hearing succeed in English
The following strategies are designed to promote access to English content for
students who are deaf and hard of hearing based on the Virginia Standards of
Learning. It is important to remember that each child has unique needs and that
decisions regarding instructional strategies should be based upon current and
accurate information about the child’s sensory functioning and on the student's
school-based team's input.
For those children who are deaf and hard of hearing and whose sensory devices
enable them to access and process speech as hearing children do, teaching
strategies may likely follow best practices used with hearing children. Sensory
devices (hearing aids, cochlear implants) and assistive listening devices (FM
systems, sound field systems) should be utilized according to the
recommendations of the audiologist and the IEP team to optimize auditory
reception of speech sounds.
Those children who are not receiving speech sounds adequately through
audition may need to learn to read using other strategies.
Educational programs that have a bilingual-bicultural (bi-bi) approach use
American Sign Language (ASL) to teach and introduce English as a second
language through print. Proponents of the bi-bi approach acknowledge the
importance of general world knowledge in the development of reading and
writing. They view ASL as the natural language for children who are deaf, and as
a critical tool that allows children to build and process knowledge of the world
around them. This promotes a metalinguistic awareness in the children of the
differences between ASL and printed English. As with most theories of literacy,
parent involvement is an essential aspect for bilingual education. If parents are
unable to sign fluently in ASL with their children to read stories, deaf mentors
may be brought in as models.
It is very important to remember that language precedes literacy. It is not
rational to expect a person to READ or WRITE words or about concepts that
they do not have knowledge of or cannot comprehend or express orally or
through sign language.
Instructional and Environmental Strategies:
For Students Using the Bilingual/Bicultural Method

 Let the child see the book, your face and signs simultaneously.
 Don’t be limited by the print - expand on pictures.
 Be dramatic - use props, exaggerate, use facial expression, eye gaze, body
shift to show different characters.
 Vary location of signing - on book, on child, etc.
 Read a story several times if a child asks.
 Act out the story together after reading it.
 Utilize the whole language philosophy.
 Use signed English, Cued Speech, and more fingerspelling to clarify
differences between ASL and printed English.
 Encourage students to translate between sign language and English, and
to make connections between all modes presented.

For Any Child Who is Deaf or Hard of Hearing

 Use multimedia approaches for visual representation of lesson content.

Power point presentations and interactive white boards are preferable to
traditional chalkboards; as the teacher does not need to turn his/her back
to the students. This is especially important for students who rely on
speechreading, sign language, Cued Speech, and/or listening for receptive
communication.
 Offer systematic vocabulary instruction. The most effective approaches
emphasize numerous techniques, such as use of semantic maps, semantic
feature analyses, word maps, and classroom discussion of words.
Overexposure through repetition and varied formats is often essential.
 When using visuals, allow time for students to view the board, projected
image, or objects, then watch the explanation/instruction given by the
teacher or through the educational interpreter, and only then, allow
students to offer responses. A hearing person can view visuals and listen at
the same time. Students who are deaf and hard of hearing, especially
those who rely on visual communication through sign language, Cued
Speech or speechreading, must process information sequentially rather
than simultaneously. Students who use cochlear implant technology
require processing time as well.
 Pre-teach vocabulary for upcoming science, mathematics and social
science lessons in context. Collaboration with the speech-language
pathologist and/or resource teacher can be beneficial. Remember,
students who are deaf and hard of hearing typically do not learn words
incidentally; explicit instruction is necessary.
 Base instructional strategies on the individual’s receptive and expressive
communication strengths.
 Provide an enriched language environment that promotes a wide range of
meaningful experiences with opportunities for receptive, expressive
(through the air) and written language.
 Provide a peer or professional in the learning environment with whom the
student can interact and who can effectively provide, not only the
vocabulary to label objects, but also a language model for expressing
concepts and ideas, using the student’s primary mode of communication.
 Regardless of the communication modality used, make print an important
part of everyday routines, and emphasize the value of reading and writing
in varied, meaningful activities throughout the day.
 Partner with families. Maintain ongoing communication between the
home and teachers so that vocabulary and language concepts are
reflected and reinforced in as many different situations as possible. Make
families aware of the limitless opportunities in the home for language
enrichment during daily routines and determine whether the family
members are able to communicate effectively in the student’s chosen
mode.
 Prior to reading a selection, encourage class discussions so that students
may benefit from one another’s connections to the text, building students’
background knowledge of concepts and vocabulary.
 For students who sign, ensure that all involved are consistent in the signs
being used. Use conceptually based signs and avoid inventing signs for
new vocabulary. Be sure that students learn the conceptually accurate
signs for phrases and multiple meaning words and use them while reading.
While fingerspelling a word may indicate that a student may not know the
meaning, be sure to encourage and use recognized lexicalized signs
(recognized signs made from blending letters from the
manual/fingerspelled alphabet to form a fingerspelled sign. Example: the
ASL sign for “bus” is made by fingerspelling B-U-S).
 Guide students to formulate questions first; then answer their questions
through reading. This may help to improve their word recognition skills,
comprehension, analytical skills, and ability to draw inferences.
 Reinforce phonemic awareness through visuals (demonstrations, pictures,
and software programs) that show placement of articulators.
 Discuss in an IEP team meeting how phonemes will be introduced in a
consistent manner. Even students with the most profound hearing losses
may benefit from phonemic awareness enhanced with visual-gestural
strategies such as See-the-Sound Visual Phonics or Cued Speech.
 Incorporate speaking and/or signing, listening/receiving communication
visually, reading and writing activities consistently. Literacy involves all
four components.
 Teach students who use sign language to deliver classroom presentations
in sign. The student and the educational interpreter should practice
together prior to a presentation to ensure that the interpreter is familiar
with the material and is rendering an accurate representation of the
student’s work.
 Remember that language precedes literacy. Students will not understand
language expressed in print until they understand language presented
through listening and spoken language, sign language, and/or Cued
Speech, etc.
 Remember that no instructional strategy, however differentiated, will be
effective if the student does not comprehend a speaker’s communication
attempts.
 Provide an enriched learning environment that promotes a wide range of
meaningful experiences with opportunities for reading about and
discussion of historic events, past and present.
 Use more than one mode of presentation for abstract concepts. These
may include manipulatives (cubes, puppets, action figures), verbal (word
problems matching equations, role-playing, debates), pictorial (time lines),
and symbolic modes (graphic organizers). Encourage students to translate
between sign language and English and to make connections between all
modes presented. Pictures, drawing sets, and visualizing or pantomiming
of actions may be used to move from the concrete to more abstract
representations.
 Relate events in history with students’ personal experiences through a
dialogic process.
 Emphasize the role of individuals who are deaf and hard of hearing in
various events in history.
 Encourage students to process information at a deeper level through
questioning.
  Provide an enriched learning environment that promotes a wide range of
meaningful experiences with opportunities for exploration and problem
solving.
 Note that word problems may be especially difficult for some students
who are deaf and hard of hearing because of the literacy level needed to
comprehend the problem. Having the educational interpreter sign the
word problem may be an appropriate accommodation for some students.
 Introduce math word problems as informal stories with math facts
through dramatization, or use, interactive boards or overhead projection
with manipulatives; then translate the action into a math sentence.
Students can also use pictures, drawing sets, and visualizing or
pantomiming the action in a problem to move from the concrete to more
abstract representations of a word problem.

Emotional Impact of Hearing Loss

Hearing impairment can negatively affect interpersonal communication,

intimate relationships, access to education, employment opportunities and
economic independence.

The emotional impacts of hearing loss can be far reaching. They can cause
feelings of distress, frustration, anger, embarrassment, inferiority, shame, loss
of identity, rejection, and loneliness (Bennett et al., 2021). People with hearing
loss tend to develop both helpful and unhelpful social behaviours in an attempt
to “cope” with the hearing loss and associated emotional distress in social
situations. These may include avoiding situations such as not attending social
events, or staying silent in group conversations (often referred to as “tuning
out”).

The breakdown of communication that is often experienced due to hearing loss

can affect an individual’s ability to socially engage. Consequently, untreated
hearing loss can lead to reduced social activity, social isolation, lower levels of
self-esteem, loneliness, and reduced quality of life.

Untreated hearing loss has also been associated with increased rates of anxiety,
depression, poor mental health and lower life expectancy.

Whilst hearing loss can affect all ages, it is considered to be one of the most
common causes of disability amongst the ageing population. It affects
approximately one third of adults over the age of 55 and three in every four
people aged over 70 years. Hearing loss is also associated with a number of
other health conditions. These include diabetes (Sommer, 2017), dementia
(Livingston, 2021) and heart disease (Tan, 2018). Research has yet to uncover
why these occur with hearing loss.

It is also known that hearing loss may occur along with vision impairment,
reduced dexterity, cognitive decline (Jayakody, 2020) and a greater risk of
falling. These may negatively impact the successful treatment of hearing loss.

Deaf and Hard of Hearing

According to Deafness Forum Australia, approximately one in six Australians

has a significant hearing loss. Within this population, most individuals have
some level of hearing impairment and only a small proportion of the group is
deaf. Types of hearing loss include sensorineural (nerve-related), conductive
(affecting the outer or middle ear) or a mixed hearing loss (mixture of both
types.) People who use Australian Sign Language (Auslan) often prefer to be
referred to as deaf rather than hard of hearing. They see this as a positive
identity rather than a negative label.

People who have a hearing loss are either pre-lingually deafened or post-
lingually deafened. People who are pre-lingually deafened have lost their
hearing before they acquired language. People who are post-lingually
deafened acquired their hearing loss after they acquired language. For each
group the impact of the hearing loss and the degree of deafness will vary.

Some people who are pre-lingually deafened use Auslan. Many received
cochlear implants early at birth. Some rely on spoken language. Many
communicate with a combination of spoken language and sign language.
Some have normal language and literacy development. Some may have
issues with literacy.  It varies greatly, so it is important to understand the
needs of each individual. All these factors need to be considered when
assessing the types of reasonable adjustments.

People who have a post-lingual hearing loss generally acquired their hearing
loss later in life. They may or may not benefit from listening devices. Some
may learn sign language as a means to diversify access to communication.  As
with people who are pre-lingually deafened, it is important to assess the
needs of each individual before implementing any reasonable adjustments.
This is because the requirements of each individual can be diverse.
Students with a hearing loss may require accommodations and assistive
devices to have the best access to education. Accommodations may be as
simple as preferential seating or as complex as wireless assistive listening
devices in the classroom. Some will require Auslan interpreters and live
remote captioning. Each learner with a hearing loss should be assessed
individually and accommodations should be implemented based on the
unique needs of each student.

Impact of Hearing Loss

The learning processes of students with a hearing loss  may be affected in the
following ways:

 Students who have been deafened in early childhood can be very

different to students who have lost hearing later in life in terms of
educational disadvantage. For example, their range of vocabulary may
be limited, which in turn may affect their level of English literacy.
 Deaf and hard of hearing students can sometimes prefer visual learning
strategies. This can be a challenge in an environment where much
essential information is delivered exclusively by word of mouth.
 Students with a hearing loss may need to use assistive technology to
participate in class. This assistive technology can be the laptop where
software such as Skype can be used to deliver Auslan interpreters or
captioning. For some it will be in the form of listening devices. For
others it will be a combination of technology that includes both
listening devices and computer based software.
 The impact of hearing loss can cause delays in receiving learning
material. Students who need information transcribed from tape must
sometimes wait for a significant period of time for this to happen. This
needs to be considered in terms of developing suitable timelines for the
completion of work for each student.
 Students with hearing loss may appear isolated in the learning
environment. The possibility for social contact and interaction with
other students is often limited, and this isolation or separateness may
have an impact on learning.
 Participation and interaction in tutorials may be limited. Students who
cannot hear the flow and nuances of rapid verbal exchange will be at a
disadvantage.
  Some students with hearing loss coming straight from the school
system have been familiar with a structured learning environment, and
may require a period of adjustment when entering into the post-
secondary learning environment. Communication difficulties and
adjustments may lead to a level of anxiety about performing in front of
others. This may affect participation in tutorials, particularly for
students whose speech development has been impacted by their
hearing loss.
Teaching Strategies

There is a range of inclusive teaching strategies that can assist all students to

learn but there are some specific strategies that are useful in teaching a
group that includes students with a hearing impairment:

 Encourage students with a hearing loss to seat themselves toward the

front of the lecture theatre where they will have an unobstructed line
of vision. This is particularly important if the student is using an
interpreter, lip-reading, relying on visual clues or using a hearing aid
which has a limited range. Be aware that some students may not be
comfortable with this suggestion or have alternate strategies. Respect
their choices.
 Use assistive listening devices such as induction loops if these are
available in the lecture theatre. Hearing aids may include
transmitter/receiver systems with a clip-on microphone for the lecturer.
If using such a microphone, it is not necessary to change your speaking
or teaching style.
 Ensure that any background noise is minimised.
 Repeat clearly any questions asked by students in the lecture or class
before giving a response.
 Do not speak when facing the blackboard. Be aware that moustaches,
beards, hands, books or microphones in front of your face can add to
the difficulties of lip-readers. Students who lip-read cannot function in
darkened rooms. You may need to adjust the lighting in your teaching
environment. If a sign interpreter is employed, follow the hints for
working with a sign interpreter.
 It is difficult for a student watching an interpreter to also take notes
from an overhead or blackboard. An interpreter is unable to translate
concurrently both your words and any information given on an
 overhead. It is important therefore that all information should also be
available as handouts.
 Provide written materials to supplement all lectures, tutorials and
laboratory sessions. Announcements made regarding class times,
activities, field work, industry visits etc, should be given in writing as
well as verbally.
 Allow students to record lectures or, preferably, make available copies
of your lecture notes. Flexible delivery of teaching materials via
electronic media is also particularly helpful for students who have
difficulty accessing information in the usual ways. For students with a
hearing loss, new technology - and the internet in particular - can be
used to bridge many gaps.
 Ensure that lists of the subject-specific jargon and technical terms
which students will need to acquire are made available early in the
course. If interpreters or captioning are being used as an adjustment,
make this list available to the professionals providing the service as
early as possible.
 Any videos or films used should, where possible, be captioned. When
this is not possible, you will need to consider alternative ways for
students with hearing impairment to access the information.
 In tutorials, assist students who lip-read by having the student sit
directly opposite you and ensure, if possible, that they can see all other
participants. Control the discussion so that only one person is speaking
at a time.
 Students with hearing loss, especially those with associated speech
issues, may prefer to have another student present their tutorial
papers.
 Language abilities are often affected by hearing loss, depending on the
age of onset. Students who acquired their hearing loss early in life may
have literacy issues. In some cases, providing reading lists well before
the start of a course for students with a hearing loss can be beneficial.
Consider tailoring these reading lists when necessary, and provide
guidance to key texts.
 Allow assignments or reviews to be completed on an in-depth study of a
few texts rather than a broad study of many.
 Using Auslan interpreters and live remote captioning may require some
adjustments in teaching styles, particularly the pace of the learning.
 Consult with the providers of the service early to identify any potential
changes.
 Where live remote captioning is provided, a transcript of the session
can usually be assessed within 24 hours. It is recommended that these
be emailed directly to the student as an accurate record of reference.
Assessment Strategies

Always consider alternative forms of assessment where necessary. Standards

are not expected to be lowered to accommodate students with a disability
but rather are required to give them a reasonable opportunity to
demonstrate what they have learnt. Once you have a clear picture of how
the disability impacts on learning, you can consider alternative assessment
strategies:  

 When their range of literacy is an issue, students may require the use of
a thesaurus or dictionary during exams. A personal computer with
spelling and grammar functions may be required.
 Provide alternatives to those assignments which are based on
interviews or questionnaires, and be flexible with assignment deadlines,
particularly if students have had to wait for transcripts of learning
sessions.
 Provide extra time in examinations, particularly extra time for reading
questions. Some students will prefer to have questions and instructions
‘signed’ to them.
INSTRUCTIONAL STRATEGIES
 Use captions
All students benefit from captions and especially those who are Deaf or
hearing-impaired, plus those with English as a second language. To
cater for these students it is important to use only captioned multimedia
such as TV, online video and DVDs. Captions provide vital access to
multimedia content. Media Access Australia’s CAP THAT!(link is
external) initiative was created to focus on the importance and use of
captions in the classroom, and still provides relevant advice and
downloadable resources.
 Make use of available technology
Many classrooms are now equipped with technologies such as
interactive whiteboards (IWBs) and soundfield amplification systems. If
you have access to these technologies or anything similar, ensure that
 you’ve been briefed on how to best use them to complement your
teaching. A simple Google search will confirm just how much choice is
out there.
 Use visual stimulus
Students who have a hearing impairment require visual cues/ support in
their learning to assist their understanding of content. And of course, so
do children who have English as a second language. Teachers can use
visual stimuli such as providing lesson outlines, main points and any
directions on IWB or display boards to help these students.
 Consider classroom arrangement
There are always variables as to where a student who has a hearing
impairment should sit in the classroom. Ensure that these students are in
a position where your face (and ideally the faces of other students if they
are participating in class discussion) are clearly visible, and where the
sound of your voice is least obstructed.
 Keep unnecessary noise to a minimum
Students who have a hearing impairment find it very difficult to
concentrate when there is background noise. Blocking out some or all of
this noise through closing doors or windows can be a simple and
effective measure. Remember that even if your student or students use
assistive hearing technology, they do not hear in the same way that their
peers do. They will benefit from having unnecessary background noise to
a minimum.
Successful communication requires the efforts of all people involved in a
+conversation. Even when the person with hearing loss utilizes hearing aids
and active listening strategies, it is crucial that others involved in the
communication process consistently use good communication strategies,
including the following:

 Face the hearing-impaired person directly, on the same level and in

good light whenever possible. Position yourself so that the light is
shining on the speaker's face, not in the eyes of the listener.
 Do not talk from another room. Not being able to see each other when
talking is a common reason people have difficulty understanding what
is said.
 Speak clearly, slowly, distinctly, but naturally, without shouting or
exaggerating mouth movements. Shouting distorts the sound of speech
and may make speech reading more difficult.
 Say the person's name before beginning a conversation. This gives the
listener a chance to focus attention and reduces the chance of missing
words at the beginning of the conversation.
 Avoid talking too rapidly or using sentences that are too complex. Slow
down a little, pause between sentences or phrases, and wait to make
sure you have been understood before going on.
 Keep your hands away from your face while talking. If you are eating,
chewing, smoking, etc. while talking, your speech will be more difficult
to understand. Beards and moustaches can also interfere with the
ability of the hearing impaired to speech read.
 If the hearing-impaired listener hears better in one ear than the other,
try to make a point of remembering which ear is better so that you will
know where to position yourself.
 Be aware of possible distortion of sounds for the hearing-impaired
person. They may hear your voice, but still may have difficulty
understanding some words.
 Most hearing-impaired people have greater difficulty understanding
speech when there is background noise. Try to minimize extraneous
noise when talking.
 Some people with hearing loss are very sensitive to loud sounds. This
reduced tolerance for loud sounds is not uncommon. Avoid situations
where there will be loud sounds when possible.
 If the hearing-impaired person has difficulty understanding a particular
phrase or word, try to find a different way of saying the same thing,
rather than repeating the original words over and over.
 Acquaint the listener with the general topic of the conversation. Avoid
sudden changes of topic. If the subject is changed, tell the hearing
impaired person what you are talking about now. In a group setting,
repeat questions or key facts before continuing with the discussion.
 If you are giving specific information – such as time, place or phone
numbers – to someone who is hearing impaired, have them repeat the
specifics back to you. Many numbers and words sound alike.
 Whenever possible, provide pertinent information in writing, such as
directions, schedules, work assignments, etc.
  Recognize that everyone, especially the hard-of-hearing, has a harder
time hearing and understanding when ill or tired.
 Pay attention to the listener. A puzzled look may indicate
misunderstanding. Tactfully ask the hearing-impaired person if they
understood you, or ask leading questions so you know your message
got across.
 Take turns speaking and avoid interrupting other speakers.
 Enroll in aural rehabilitation classes with your hearing-impaired spouse
or friend.

UCSF Health medical specialists have reviewed this information. It is for

educational purposes only and is not intended to replace the advice of your
doctor or other health care provider. We encourage you to discuss any
questions or concerns you may have with your provider.

About Hearing and Development

Hearing sounds and words helps children learn to talk and understand. A child with hearing loss misses out
on these sounds. This can cause problems with speaking, reading, school success, and social skills. It is
important to have your child tested if you think he has trouble hearing. Getting help early is key.
Hearing loss in children can lead to:

 Delayed speech and language skills

 Learning problems in school
 Feeling bad about himself
 Having trouble making friends

Learn more about problems that children with hearing loss may have below.

Words
Children with hearing loss do not learn words as fast as those who have normal hearing. They may:

 Learn concrete words like cat, jump, five, and red. However, they may have trouble with abstract words
like before, equal to, and shy. They may not use words like the, an, are, and a.
 Have trouble knowing the different meanings of a word. Think about the word bat. It can mean a flying
animal or what we use to play baseball. A child with hearing loss may not understand these meanings.
 Fall farther behind children with normal hearing as they get older. Children with hearing loss do not catch up
without help.

Sentences
Children with hearing loss may have trouble understanding and using sentences. They may:

 Understand and use shorter sentences than children with normal hearing.
 Have problems with more complex sentences. They may not use clauses in their sentences. An example of a
clause is "When I get home, I will eat dinner." They may not use passive voice. An example of this is "The
ball was thrown by Mary."
 Have trouble hearing word endings, like -s or -ed. They may not understand or use plural words, like cats.
They may not use past tense, like walked. And possessives, like Bob's, can be hard to hear or use.
Speech
Children with hearing loss cannot hear sounds well. They may have problems speaking clearly. They may:

 Not use sounds like s, sh, f, t, or k. These are quiet sounds that are hard to hear.
 Not hear their own voices when they speak. They may be too loud or too soft. They may speak in a high pitch.
People may think they mumble or sound different.

School Success
Children with hearing loss have trouble in school. Reading and math may be the hardest for them. Some
facts about hearing loss and school success include:

 Children with mild to moderate hearing loss may fall one to four grade levels behind without help.
 Children with more severe hearing loss may not learn past the third- or fourth-grade level. School support will
help them do better.
 Children with hearing loss do not do as well as children with normal hearing. The gap between them grows
over time.
 Children with hearing loss will do better in school if they get help early. This includes support at home from
parents and families.

Social Skills
Hearing loss can make it harder to talk with others. Children may not want to talk or play with other kids.
Children with hearing loss may:

 Feel alone and like they have no friends.

 Be unhappy in school.

What You Can Do

The most important thing you can do is to have your child's hearing tested. With early help, your child may
speak or use sign language as well as children who hear. An audiologist can test your child's hearing. He or
she can talk to you about the best way to treat your child's hearing loss. This may include medical treatment,
hearing aids, or speech and language therapy.
To find an audiologist near you, visit ProFind.

How Does Hearing Loss Affect Communication?

Hearing loss can affect a child’s development of speech and language skills. When a child has difficulty
hearing, the areas of the brain used for communication may not develop appropriately. This makes
understanding and talking very difficult.

When hearing loss is identified early and managed appropriately, the child can become an effective
communicator. This process involves caregivers and professionals working together.

Most hearing losses are identified through a screening at birth. Some children are not diagnosed until later,
when speech or language skills are not progressing. Earlier identification and management of hearing loss
results in better outcomes for the child.

We also know that parents and caregivers are essential in the diagnosis and intervention process.
What Can Cause a Hearing Loss?

Hearing loss can be a result of numerous factors or events. These include:

 Genetic factors
 Chromosomal differences
 Anatomical differences
 Syndromes
 Prenatal drug or alcohol use
 Medication used in serious medical situations
 Prematurity
 Illness or injury

Hearing loss can also be unexplained.

What Factors Influence Speech and Language Development for a Child with Hearing Loss?

All children are different in how they develop. There are developmental stages that most children follow.
Hearing loss can affect how communication develops in many ways. These include:

 Age at identification of the hearing loss

 Family involvement and support
 Type and degree of hearing loss
 Age of amplification
 Consistency of device use
 Type of treatment (early intervention, direct therapy, school-based therapy)
 Cognitive and motor skill level
 Other medical conditions

What Are Speech and Language Challenges for Children with Hearing Loss?

Children with hearing loss may have difficulty with:

 Hearing and understanding sounds around them

 Making speech sounds
 Learning new words
 Putting together sentences
 Using correct grammar
 Effectively expressing themselves
 Understanding speech from other people
 Following directions in quiet and noisy places
 Paying attention and controlling behavior
 Following conversations with multiple people
 Making friends and interacting with peers. This can be caused by difficulty understanding games, rules, and
directions.
 Listening and learning in the classroom
 Learning to read

What Can We Do to Help the Child and Caregivers Succeed?

Treatment for a child with hearing loss starts with a partnership. Children with hearing loss make the most
progress when caregivers and professionals work together. They also make progress when caregivers work
with the child at home.
The child should have a speech-language evaluation to see how the hearing loss is impacting their
development. Speech and language therapy may be needed. The speech-language pathologist and family
will work together in therapy. The focus of therapy will be to develop communication skills.

The speech-language pathologist will likely add listening games into the session. Listening skills are
important for progress in therapy. The use of strategies with your child at home will help speech, language,
and listening skills develop.

Why Are Caregivers So Important in Their Child’s Success?

We know that bringing your child to therapy won’t “fix” their speech or language difficulties. We actively
engage caregivers to partner with us in therapy. As caregivers, please:

 Actively participate in therapy with your child. Parents and caregivers are the child’s best supports and
teachers.
 Ask questions if something is unclear. The speech-language pathologist will take time to talk about your
questions.
 Use speech and language strategies learned in your session with your child every day.
 Keep noise to a minimum. This will help your child hear important information clearly.
 Make sure you have your child’s attention before talking with them. Make sure they heard you by watching
their actions and responses.
 Read books daily to help build your child’s vocabulary and language.

ncidental learning might be defined as what a person learns through informal communicative interactions with
others in public and educational settings. For children who can hear, incidental learning constitutes a major
portion of their social development and world knowledge. However, for the deaf child, even though surrounded
by this type of learning, it is often not accessible.
There is extreme naivety on the part of parents and many school administrators and teachers concerning the
educational problems linked to communication access that is often denied to children who are deaf. The
absence of access to incidental learning may well precipitate the continuing struggle that the deaf child
encounters academically.
Accepting the fact that the hearing child receives the bulk of his educational, informational, and learning
experience outside of the classroom, this conclusion is not valid for the deaf child who does not hear or only
receives partial information through impartial hearing, unless a number of vital conditions are met, understood,
and planned for. It is evident that incidental learning is far more important than is realized by many people,
including the architects
of federal laws that call for an appropriate education in the least restrictive environment. In fact, the lack of any
degree of focus on the out-of-the-classroom environment may be the missing link in deaf education.
To fully comprehend the crucial need for access to incidental learning, one must investigate the learning
environment of the hearing child apart from the time spent in formal schooling. The child who can hear reaches a
fairly sophisticated understanding of English syntax, use of idioms, and a full blown vocabulary before they ever
set enter a school or formal classroom. During these early pre-kindergarten years the hearing child begins to
understand counting, elements of set theory, and other mathematical concepts. They learn a great deal of
history and geography from television, radio, and peer and adult conversations. They internalize facts and
understandings about social codes and attitudes, health habits, and rules of games. Hearing children, provided
there is adequate communication, tend to learn more by example than by precept, more from the world as it is
than through admonition, lecturing, or demonstration. In short, they have access to this information because they
can hear.
The hearing child’s total education is readily accessible 24/7. Innumerable teachers, such as the mass media,
the home, the street, novels and other literature, self-instructional materials, and what he/she learns from their
peer group influence it. Hearing children are able to use their language foundation that is fortified with incidental
learning opportunities to expand their education and to extend their learning horizons both in and out of school.
They are able to expand their worldview and knowledge. It is, after all, the community that performs the major
role of education, not the schools.
For the deaf or hard of hearing child, one will logically ask, “Where is the community?” Where and how is this
vital incidental language and access provided? Sadly, the community is often a physical presence, but a mental
blankness. Deafness is invisible, so people rarely see beyond the surface. This is where parents, administrators,
and teachers often demonstrate their naivety.
It is instructive for the parent, school administrator, and teachers to question the accessibility of the deaf child to
incidental learning that occurs every day within the public school classroom. Does the deaf child have access to
the language of incidental learning that occurs at the library or media center, during recess, at lunchtime, during
formal classes, independent artwork and laboratory classes, after-school activities such as intramurals and
varsity athletics, student body government functions and meetings, in extracurricular clubs such as debate,
foreign languages, drama, chess, etc.? Far too often, the child is a wallflower, a member of the crowd, present
and yet absent, a child with latent leadership abilities undeveloped and left dormant.
The opportunities for the hearing child to acquire knowledge and expand their world thorough access to
incidental learning are rampant. For the deaf child in public school settings, this is often not the case. Even
though federal laws have been enacted to provide a least restrictive environment and an appropriate education,
the implementation of these laws have often not addressed incidental learning. Deaf children are often unable to
access incidental learning when they cannot do the following:
• Hear the teacher
• Hear their classmates in front of, behind, and all around them
• Hear and participate in class discussions
• Hear the educational film presented in class
• Hear the principal over the public address system
• Hear the visiting speaker invited to class
• Hear the guide on a field trip
• Hear the peer interactions happening between classes
• Hear the friendly exchanges during recess
• Hear the news and gossip that happens at lunchtime
• Hear the countless happenings that occur as if by osmosis that others are absorbing
Certainly, a partial solution to the deaf child’s dilemma of acquiring incidental learning is a family that has opted
to use visual communication so that the child will have better access to language and will be able to better make
sense of their community/environment. Another solution is to provide the deaf child with an educational
environment that offers a variety of peer contacts and adults who know and use appropriate communication
modes, including use in and out of class of captioned films, videophones, and other visual technological
advancements. While these positives will not cover the full range of missing elements in the access of incidental
learning, they will go a long way in assisting the deaf child during his/her early, crucial years to build the
foundations upon which he/she can further their education and use it as a springboard to move confidently into
the greater world beyond childhood. Perhaps the most important solution is for the parents, administrators, and
teachers is to understand the simple fact that the deaf child does not hear, and the problems outlined above can
be remediated by assuring that the child’s educational placement be in a residential school or a day-class
program where the child can experience easy and accessible communication that naturally embraces access to
incidental learning.
If parents opt to not choose a residential program or a day-class program for their child’s education and instead
choose a mainstreamed or self-contained program in a public hearing school, the following suggestions might be
considered to assure access to incidental learning;
The research suggests that teachers and administrators in educational settings should understand the
significance of incidental learning. Teachers should find ways to integrate incidental learning with structured
learning, exposing deaf and hard of hearing students to as much of the incidental learning that hearing students
are able to access. A good example would be to allocate classroom time for discussions on informal topics, such
as where students like to socialize and why, favorite books, or what happened at the dinner table last night.
Teachers can share information of their own as well, and then relate it to what they are teaching in their formal
classroom settings.
The teachers can also set up a role play situation where hearing students portray a deaf or hard of hearing
student in a crowd of hearing students or vice versa with the goal being to help each student understand the
other’s perspective. Students, teacher, and other school staff should see that making an effort to include deaf or
hard of hearing students in informal interactions will make a difference.
Incidental learning is a crucial part of the development of social skills, cognitive skills, and self esteem. Without
it, deaf and hard of hearing students are potentially missing out on something as simple as daily gossip or as
imperative as having access to social norms or educational topics that could impact their overall social and
academic development. When it comes to incidental learning, the key is access.