Hearing and Vision Loss Exceptionality Report Introduction Hearing and vision impairment can have an impact on how

students gather and retain meaningful information, communicate with others, and social relations. Hearing and vision loss has been divided into two categories: (1) Adventitious a. Loss occurred at a later time in the individuals development. (2) Congenital a. Loss occurs at birth b. During students early developmental years (Indiana State University, n.d.) Below is a list of abilities that individuals have or acquire with hearing and vision loss, according to Indiana State University. Those learners who have been blind or have low vision from birth and acquired their hearing loss later in life will have a better understanding of sound, speech, and environmental noise. Those learners who have been deaf or have a hearing impairment from birth and acquired their vision loss later in life will usually have a better idea of boundaries in space, visual imagery, colors, size, and concepts. Those learners who have been blind or have low vision and have been deaf or have a hearing loss since birth will have the greatest challenges, since much of their learning must through their near senses of touch, movement, or smell.

Those learners who lost part or all of both their vision and hearing later in life usually have some idea of visual and auditory imagery that they can rely on when learning new concepts, communicating with others, and developing social relationships. (Indiana State University, n.d.). This report lists different classifications, characteristics, support services, and much more for individuals that are affected by either hearing or vision loss. Definition and Prevalence Deafness, hearing impairment, and visual impairment are defined in the Individuals with Disabilities Education Act (IDEA) as: (3) Deafness means a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification that adversely affects a child's educational performance. (5) Hearing impairment means impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance but that is not included under the definition of deafness in this section. (13) Visual impairment including blindness means an impairment in vision that, even with correction, adversely affects a child's educational performance. The term includes both partial sight and blindness (IDEA, 2004).

Hearing Loss: According to the textbook, an estimated twenty-eight million people in the United States suffer with hearing loss. Eleven million people have irreversible hearing loss; One million are completely deaf; Five percent are under the age of seventeen; Forty-three percent are over the age of sixty-five ; Men are more likely to than women to have hearing loss, and Caucasians are overrepresented (Hardman, Drew, & Egan, 2005, p. 322). According to Hardman, Drew, and Egan the prevalence of hearing loss decreases as family income and education increase (2005). Vision Loss: Approximately 1 in 3,000 U.S. children are considered legally blind; Three percent to the total population have significant vision loss; Roughly, five percent of U.S. children have serious eye disorder; The U.S. Department on of Education estimates that nearly 24,000 students with visual impairments receive specialized services; Accounts for 0.4 percent of students with disabilities (Hardman, Drew, & Egan, 2005, p. 340). Classifications Types of Hearing Loss Conductive Information Occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level or the ability to hear faint sounds. This type of hearing loss can often be corrected medically or surgically. Possible Causes Fluid in the middle ear from colds Ear infection (otitis media) Allergies (serous otitis media) Poor Eustachian tube function Perforated eardrum Benign tumors Impacted earwax (cerumen) Infection in the ear canal (external otitis) Swimmer's Ear (otitis ecxterna) Presence of a foreign body Absence or malformation of the outer ear, ear canal, or middle ear Illnesses

Sensorineural

Sensorineural hearing loss

(SNHL) occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss.

Drugs that are toxic to hearing Hearing loss that runs in the family (genetic or hereditary) Aging Head trauma Malformation of the inner ear Exposure to loud noise

SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or sound muffled. Sometimes a conductive Combination of above Mixed hearing loss hearing loss occurs in combination with a sensorineural hearing loss (SNHL). In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred to as a mixed hearing loss. (American Speech-Language-Hearing Association, n.d.) Classification Low visual acuity Definition Vision between 20/70 and 20/400 with the best possible correction, or a visual field of 20 degrees or less Visual acuity worse than 20/400 with the best possible correction, or a visual field of 10 degrees or less Visual acuity of 20/200 or worse with the best possible correction, or a visual field of 20 degrees or less. Visual acuity of 20/70 to 20/400 (inclusive)

Blindness

Legal blindness

Moderate visual impairments or low vision (Mandal, n.d.)

Characteristics Deaf or hard of hearing students may: be skilled lip readers, but many are not; only 30 to 40 percent of spoken English is distinguishable on the mouth and lips under the best of conditions

also have difficulties with speech, reading and writing skills, given the close relationship between language development and hearing use speech, lip reading, hearing aids and/or amplification systems to enhance oral communication be members of a distinct linguistic and cultural group; as a cultural group, they may have their own values, social norms and traditions use American Sign Language as their first language, with English as their second language (Johns Hopkins University, n.d.)

The following are vision loss signs in children: Physical Signs o Crossed eyes, eyes that turn out, eyes that flutter from side to side or up and down, or eyes that do not seem to focus are physical signs that a child has vision problems. Other problems are less obvious. The American Academy of Pediatrics recommends that children have their eyes checked during regular well-baby visits throughout their first years. A child should have a routine eye exam every year beginning at age 5. Clumsiness o A child might have a vision problem if he appears to be overly clumsy. Poor vision might be the cause when a child is constantly running into things or falling down. He might have trouble realizing how close or far away objects really are. The eyes provide the information about surroundings and spatial position that is transmitted to the brain. Consequently, clumsiness can occur when the eyes misjudge a distance. Sometimes young children who do not walk well actually have problems with their vision. Behavior o Some children who have vision problems appear to have a short attention span. Other children might blink frequently or squint whenever they read or watch television. Often children are sensitive to bright light or might sit close to the television or hold books that they are reading close to their face. Likewise, younger children with visual impairments might hold toys very close to their face. Poor Eye-Hand Coordination o Poor eye and hand coordination can be another sign that a child has a vision problem; therefore parents should observe a young child as he plays. Older children who go to school might have difficulty with sporting activities or certain projects in class. Signs of poor eye-hand coordination might include difficulty throwing or catching a ball, tying shoes or copying schoolwork from the blackboard. Poor handwriting is often another sign of poor eye-hand coordination. Children who suffer from lazy eyes, crossed or wandering eyes can have problems with coordination, balance and depth perception, primarily because they learn to use only one eye at a time. Poor Academic Performance o Children who have trouble seeing often perform poorly at school. Frequently, problems with learning are actually related to poor vision and not to a learning disability. A child might not read well, or might use her finger to follow along

when she is reading so that she doesn't lose her place. Some children also have trouble remembering what they read. Children with vision problems can find it difficult to write as well or might have problems with math and other subjects. Schoolwork can be a challenge for a child who cannot keep a clear focus, deals with double vision or blurred print on pages. Unfortunately, not all vision problems are easily detectable. For children who have had vision problems from the start, their vision seems perfectly normal to them, so they don't usually complain. o Read more: http://www.livestrong.com/article/126096-characteristics-visuallyimpaired-child/#ixzz2iMjnLT6m (Keefer, 2011) Other signs include: o The child closes or covers one eye o The child squints the eyes or frowns o He or she complains that things are blurry or difficult to see o He or she has trouble reading or doing other close-focused work, or holds objects close to eyes o The child blinks more than usual or seems frustrated when doing close-up work (such as looking at books) o Eyes could be watery, and eyelids could look red-rimmed, swollen or crusted with secretions (Mandal, n.d.)

Diagnostic Assessments Hearing loss diagnosis tests may include:

General screening tests. Your doctor may ask you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds. Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss. A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves of your inner ear, or damage to both. Audiometer tests. During these more-thorough tests conducted by an audiologist, you wear earphones and hear sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and asks you to indicate each time you hear the sound. Each tone is repeated at faint levels to find out when you can barely hear. The audiologist will also present various words to determine your hearing ability (Mayo Clinic, 2011).

Vision loss diagnosis test may include: Snellen test o Usually a chart called the Snellens chart is used. It contains progressively shortening random letters and numbers and is placed 6 meters away from the patient. Visual field test

o Visual field is the range of vision that a person can see without tilting or turning ones head. This measures the peripheral vision of the eyes. o The test uses a device strapped over the patients eyes. Lights are flashed on and off in the patients peripheral vision. o He or she is then asked to press a button every time they see a light. Any gap of field of vision is detected. Tonometry test o This test uses specialized instruments to determine fluid pressure inside the eye to evaluate for glaucoma. Ocular Motility Assessment o This tests if there is squint of other problems in the movement of the eyeballs. Other tests o Other tests like Visually evoked potential (VEP), Electroretinogram (ERG), Electro-oculogram (EOG) are sometimes prescribed to test if the signals from the eye are travelling adequately to the brain. o These may help if the patient is very young and clinical examination is difficult or if there are multiple handicaps that make diagnosis difficult (Mandal, n.d.).

Eligibility Criteria Below is the eligibility criterion for hearing and vision exceptionalities from Article 7: 511 IAC 7-41-4 Deaf or hard of hearing Sec. 4. (a) "Deaf or hard of hearing", which may be referred to as a hearing impairment, means the following: (1) A disability that, with or without amplification, adversely affects the student's: (A) ability to use hearing for developing language and learning; (B) educational performance; and (C) developmental progress. (2) The hearing loss may be: (A) permanent or fluctuating; (B) mild to profound; or (C) unilateral or bilateral. (3) Students who are deaf or hard of hearing may use: (A) spoken language; (B) sign language; or (C) a combination of spoken language and signed systems. (b) Eligibility for special education as a student who is deaf or hard of hearing shall be determined by the student's CCC. This determination shall be based on the multidisciplinary team's educational evaluation report described in 511 IAC 7-40-5(e), which includes the following: (1) An assessment of the following: (A) Current academic achievement as defined at 511 IAC 7-32-2. (B) Functional skills or adaptive behavior across various environments from multiple sources.

(C) Communication conducted in the: (i) language or system utilized for the student's instruction; or (ii) student's preferred mode of communication; that assesses the student's receptive and expressive language skills. (2) A social and developmental history that may include, but is not limited to, the following: (A) Communication skills. (B) Social interaction skills. (C) Motor skills. (D) Responses to sensory experiences. (E) Relevant family and environmental information. (3) A written report from an educational or clinical audiologist, otologist, or otolaryngologist with information regarding the: (A) etiology of the hearing loss; and (B) student's potential requirement for amplification, if appropriate. (4) Any other assessments and information, collected prior to referral or during the educational evaluation, necessary to: (A) determine eligibility for special education and related services; and (B) inform the student's CCC of the student's special education and related services needs (Indiana State Board of Education, 2008, p. 79). 511 IAC 7-41-2 Blind or low vision Sec. 2. (a) "Blind or low vision", which may be referred to as a visual impairment, means a disability that even with best correction affects the student's ability to use vision for learning, which adversely affects the student's educational performance. The term: (1) includes a reduced ability or a complete inability to utilize the visual system to acquire information; and (2) may include or be limited to a reduction in field of vision. (b) Eligibility for special education as a student who is blind or has low vision shall be determined by the student's CCC. This determination shall be based on the multidisciplinary team's educational evaluation report described in 511 IAC 7-40-5(e), which includes the following: (1) An assessment of the following: (A) Current academic achievement as defined at 511 IAC 7-32-2. (B) Functional skills or adaptive behavior across various environments from multiple sources. (2) A social and developmental history that may include, but is not limited to, the following: (A) Communication skills. (B) Social interaction skills. (C) Motor skills. (D) Responses to sensory experiences. (E) Relevant family and environmental information. (3) An assessment of the following: (A) Functional vision. (B) Functional literacy as described in 511 IAC 7-42-6(c)(5). (4) A systematic observation of the student across various environments. (5) An assessment of motor skills, which may include travel skills.

(6) A written report from an optometrist or an ophthalmologist that includes the following: (A) Etiology and prognosis of the visual dysfunction. (B) Secondary or accompanying visual conditions, such as nystagmus or photophobia, if appropriate. (C) Near/distance and corrected/uncorrected acuity measures for left, right, and both eyes, as appropriate. (D) Measures of visual fields for both eyes, if appropriate. (E) Recommendations for use of aids, glasses, or lighting requirements, if appropriate. (7) Any other assessments and information, collected prior to referral or during the educational evaluation, necessary to: (A) determine eligibility for special education and related services; and (B) inform the student's CCC of the student's special education and related services needs (Indiana State Board of Education, 2008, p. 77-78).

Strategies, Interventions, and Adaptive Materials Hearing Loss Considerations and Instructional Strategies: American Sign Language (ASL) is not equivalent to English; it is a visual-spatial language having its own syntax and grammatical structure. Look directly at the student during a conversation, even when an interpreter is present, and speak in natural tones. Make sure you have the students attention before speaking. A light touch on the shoulder, wave or other visual signal will help. Recognize the processing time the interpreter takes to translate a message from its original language into another language; the student may need more time to receive information, ask questions and/or offer comments. Hearing Loss Accommodations (may include): Seating which allows a clear view of the instructor, the interpreter and the blackboard An unobstructed view of the speakers face and mouth Written supplement to oral instructions, assignments, and directions Providing handouts in advance so the student can watch the interpreter rather than read or copy new material at the same time Visual aids whenever possible, including captioned versions of videos and films Using a small spotlight to allow view of the interpreter while showing films and slides Repeating questions and comments from other students Note taker for class lectures so the student can watch the interpreter Test accommodations may include: access to word processor, use of interpreter for directions Providing unfamiliar vocabulary in written form, on the blackboard, or in a handout Use of e-mail, fax, or word processor for discussions with the instructor Visual warning system for building emergencies A real-time transcription requiring instructor to use a microphone. The text transcript is visible on a computer screen for student (Johns Hopkins University, n.d.)

 Visual Loss Considerations and Instructional Strategies: move about safely and independently, which is known as orientation and mobility; use assistive technologies designed for children with visual impairments; use what residual vision they have effectively and efficiently; and read and write in Braille, if determined appropriate by the IEP team of the child after a thorough evaluation.

Tips for parents: Learn as much as you can about your childs specific visual impairment. The more you know, the more you can help yourself and your child. Understand that your child is receiving small bits of information at a time, not all at once through vision. Help your child explore new things with his or her senses and build up a concept of the whole. For example, your child might need to be shown a banana, help you peel it, feel the banana without its skin, have a bite of it, and then help you mash it in her bowl to understand the qualities of bananas and that bananas can be eaten in different ways. (12) Encourage curiosity and explore new things and places often with your child. Give lots of opportunity to touch and investigate objects, ask questions, and hear explanations of what something is, where it comes from, and so on. Learn how to adapt your home, given the range and degree of your childs visual impairment. Help your son or daughter explore the house and learn to navigate it safely. Encourage your childs independence by letting him or her do things, rather than you doing them. Teach how to do a chore by using hands-on guidance, give lots of practice opportunities with feedback. Now, your child knows the skill, too. Work with the early interventionists or school staff (depending on your childs age) to build a solid individualized plan of services and supports that address your childs unique developmental and educational needs. Talk to other parents of children who have visual impairments similar to your childs. They can be a great source of support and insight in the challenges and joys of raising a child with vision problems. Many of the organizations weve listed in the Resources section have state or local chapters you can contact. You can also visit Parent to Parent, which specializes in teaming new parents up with veteran parents of children with similar disabilities. P2P is online at: http://www.p2pusa.org/p2pusa/sitepages/p2p-home.aspx Keep in touch with the professionals working with your child. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need. Find out how you can augment your childs learning at home (The National Dissemination Center for Children with Disabilities, 2012). Support/Services Providers Indiana Deafblind Services Project Blumberg Center; Indiana State University; College of Education, Rm 502 Terre Haute, IN 47809 Phone:

Fax: (812) 237-8089 http://www.indstate.edu/blumberg/db/deafblind.htm For more information, contact Lisa Poff, Program Coordinator at lpoff@indstate.edu The Project provides technical assistance, workshops, and support services to service providers and families of children with deafblindness. Project activities include: Site-based and Child Focused Consultations, a Technical Assistance Facilitator Training Project, Family Learning Weekends, a Parent/Professional Resource Library, an Usher Syndrome Screening Project, and a State-wide Census of Students, birth 21, who are deafblind. In addition, information is disseminated regarding dual sensory impairments and project activities through the project newsletter, Deafblind Focus, and other project products. Many topics are addressed in the technical assistance activities, workshops and support services. Some topics include: Communication Strategies, Curriculum Development, Instructional Strategies, Inclusion, Family Networks, Collaboration, Transition Planning, and Assistive Technology. http://www.fctd.info/organizations/12159 (The Family Center on Technology and Disability, n.d.). Resources Website: Hearing Loss Association of America http://www.hearingloss.org/ The Hearing Loss Association of America (HLAA) is the nations leading organization representing people with hearing loss. HLAA provides assistance and resources for people with hearing loss and their families to learn how to adjust to living with hearing loss. HLAA is working to eradicate the stigma associated with hearing loss and raise public awareness about the need for prevention, treatment, and regular hearing screenings throughout life (HLAA). Action for Blind People https://www.actionforblindpeople.org.uk/about-us/ This website offers visually impaired people a number of services, including help with finding a job, applying for benefits, housing issues, aids and adaptations, holiday breaks and information on local services. National Organization: American Association of the Deaf-Blind (AADB) www.aadb.org/ National consumer organization of, by, and for deaf-blind Americans. "Deaf-blind" is a broad term that describes people who have varying degrees and types of both vision and hearing loss together. Address: 814 Thayer Avenue, Suite 302, Silver Spring, Maryland 20910-4500 E-mail: info@aadb.org (301) 495-4403 (Voice) (301) 495-4402 (TTY)

(301) 495-4404 (Fax) AIM Buddy Name: AADBOffice Helen Keller National Center for Deaf-Blind Youths & Adults www.helenkeller.org/national/ Deaf-blind school that offers intensive and comprehensive rehabilitation training to youth and adults who are deaf-blind. Also provides field services and general information. Address: 1141 Middle Neck Road, Sands Point, NY 11050 E-mail: HKNCinfo@rcn.com (516) 944-8900 (Voice) (516) 944-8637 (TTY) (516) 944-7302 (Fax) State or Local Organization: Indiana Deaf-Blind Association Contact Information: Kacie Weldy 9901 Pendleton Pike, Tr. Lot 16 Indianapolis, IN 46236 Email: kcweldy@yahoo.com http://www.aadb.org/resources/db_organizations/indiana.html Informational Book for Parents: Hearing Loss: Waldman, D., & Roush, J. (2005). Your child's hearing loss: What parents need to know. New York: Perigee Books. Overview This indispensable resource includes: Causes of hearing loss Practical solutions for everyday problems Testing and assessment Technical advances in hearing aids, FM systems, and cochlear implants operate Current research and information from audiologists, otolaryngologists, geneticists, and other specialists The role of educators, physicians, speech-language pathologists, and specialists in early intervention Advocating for the hearing-impaired child's welfare in social and public environments Vision Loss: Chen, D., & Downing, J. (2006). Tactile strategies for children who have visual impairments and multiple disabilities: Promoting communication and learning skills. New York: AFB Press, American Foundation for the Blind. Overview

Young children who are visually impaired and have additional disabilities need to learn to use their sense of touch effectively to promote their growth, development, and ability to communicate. This manual provides teachers, early interventionists, and parents with critical information about alternative communication methods not based on the use of vision as well as countless practical strategies. Topics include assessing a child's skills, planning interventions, and selecting appropriate tactile strategies to meet the child's needs. Childrens Book on Disabilities: Hearing Loss: Litchfield, A. B., & Mill, E. (1976). A button in her ear. Chicago: A. Whitman. Overview A little girl relates how her hearing deficiency is detected and corrected with the use of a hearing aid. Vision Loss: Fraustino, L. R., & Andrews, B. (2000). The hickory chair. New York: Arthur Levine Books. Overview "Lilacs with a whiff of bleach." Gran's smell. That "rich molasses voice." Gran reading stories. By these things, Luis knows his grandmother. And he knows that she loves him. But when Gran passes away and leaves notes hidden in her things for each family member to find, Luis seems to be the only one forgotten. Could it be so? The answer comes generations later, when Luis himself is a grandfather, and his faith is only proved right. Truly, this is a story that uses all the senses to convey its loving message. A blind boy tells of his warm relationship with his grandmother and the gift she left for him after her death.

References American Speech-Language-Hearing Association (n.d.). Types of Hearing Loss. Retrieved October 15, 2013, from http://www.asha.org/public/hearing/disorders/types.htm The Family Center on Technology and Disability (n.d.). FCTD | Indiana Deafblind Services Project. Retrieved October 21, 2013, from http://www.fctd.info/organizations/12159 Hardman, M. L., Drew, C. J., & Egan, M. W. (2005). Human exceptionality: School, community, and family. 10e. Boston: Houghton Mifflin. IDEA (2004). IDEA - Building The Legacy of IDEA 2004. Retrieved October 5, 2013, from http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,

Indiana State Board of Education. (2010, February). Special education rules (Title 511, Article 7, Rules 32 47). Retrieved August 21, 2010 (use actual date you access online), from http://www.doe.in.gov/exceptional/speced/laws.html Indiana State University (n.d.). Indiana State University: Blumberg. Retrieved October 21, 2013, from http://www1.indstate.edu/blumberg/db/modules/deafblind-index4.htm Johns Hopkins University (n.d.). Deaf/Hard of Hearing. Retrieved October 10, 2013, from http://web.jhu.edu/disabilities/faculty/types_of_disabilities/deafness.html Keefer, A. (2011, May 9). Characteristics Of A Visually Impaired Child | LIVESTRONG.COM. Retrieved October 21, 2013, from http://www.livestrong.com/article/126096characteristics-visually-impaired-child/ Mandal, A. (n.d.). Diagnosis of visual impairment. Retrieved October 21, 2013, from http://www.news-medical.net/health/Diagnosis-of-visual-impairment.aspx Mandal, A. (n.d.). Types of visual impairment. Retrieved October 21, 2013, from http://www.news-medical.net/health/Types-of-visual-impairment.aspx Mayo Clinic (2011, August 23). Hearing loss: Tests and diagnosis - MayoClinic.com. Retrieved October 13, 2013, from http://www.mayoclinic.com/health/hearing-l oss/DS00172/DSECTION=tests-and-diagnosis The National Dissemination Center for Children with Disabilities (2012, November). Visual Impairment, Including Blindness National Dissemination Center for Children with Disabilities. Retrieved October 21, 2013, from http://nichcy.org/disability/specific/visualimpairment