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CHAPTER 5
CHILDREN WITH HEARING IMPAIRMENTS

ORGANIZING KNOWLEDGE
Children with hearing impairments are at a great disadvantage in our educational
system. These children present special problems to educators because their hearing loss
interferences so greatly with the development of language and communication skills. This
chapter differentiates between the deaf and the hard of hearing child by explaining the
characteristics of each. It discusses some identification procedures, classification categories,
causes of hearing loss, and characteristics of hearing impaired children. It goes on to describe
the special educational adaptations that hearing impaired individuals need from preschool
through postsecondary education. The ongoing controversy over the merits of oral versus
manual methods of educating hearing impaired children is discussed, followed by recent
research into the most effective methods for developing language.

Focusing Questions
1. How do professionals define and classify individuals who are deaf or hard of hearing?
2. What is the prevalence of hearing impairment?
3. How do professionals identify hearing impairment?
4. What factors cause hearing impairment?
5. What are some psychological and behavioral characteristics of learners with hearing
impairments?
6. What are some educational considerations for learners with hearing impairments?
7. How do professionals assess the academic progress of students with hearing
impairments?
8. What are some things to consider with respect to early intervention for learners with
hearing impairments?


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Chapter Outline
1. Definition and Classification
2. Prevalence
3. Anatomy of the Ear
4. Identification of Hearing Impairment
5. Causes
6. Psychological and behavioral Characteristics
7. Educational Considerations
8. Assessment of Progress

1. Definition and Classification
Hearing impairment is a broad term that covers individuals with impairments ranging from mild
to profound, including those who are deaf or hard of hearing.
A deaf person is one whose hearing disability excludes successful processing of linguistic
information through audition, with or without hearing aid.
A person who is hard of hearing has residual hearing (with the use of a hearing aid) sufficient to
enable successful processing of linguistic information through audition.
Hearing sensitivity is measured in decibels (units of relative loudness of sounds). Zero decibels
(0 dB) is the point at which an average person with normal hearing can detect the faintest
sound. Each succeeding number of decibels that a person cannot detect indicates a certain
degree of hearing impairment. From physiological viewpoint, people are considered deaf if they
have hearing impairments of about 90 dB or greater. People with hearing impairments at lower
than 90 dB are categorized as hard of hearing. 90 dB is the approximate loudness of a lawn
mower.
The age of when hearing impairments begin concerns educators because there is a close
relationship between hearing impairment and language delay. The earlier hearing impairment
occurs in life, the more difficult the child will have developing the language of the hearing
society. In view of language development, professionals use different terms to classify hearing
impairments:
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 Congenitally deaf is a person who is born deaf. Deafness that is present at birth can be
caused by genetic factors, by injuries during fetal development, or by injuries occurring
at birth.
 Adventitiously deaf is a person who is born with normal hearing but become deaf
because of illness or accident.
In relation to language acquisition, professionals classify deafness into two categories:
 Prelingual deaf is a person who becomes deaf before speech and language develop.
 Postlingual deaf is a person who becomes deaf after speech and language develop.
In terms of hearing threshold levels, the classifications are:
Degree of hearing loss Hearing loss range (dB HL)
Normal –10 to 15
Slight 16 to 25
Mild 26 to 40
Moderate 41 to 55
Moderately severe 56 to 70
Severe 71 to 90
Profound 91+
Source: Clark, J. G. (1981). Uses and abuses of hearing loss classification. Asha, 23, 493–500.
(www.asha.org)

2. Prevalence
The U.S. Department of Education’s statistics in 2003 estimates that the public schools identify
about 0.13 percent of the population from six to seventeen years of age as deaf or hard of
hearing. Close to 25 percent of students who are deaf come from Hispanic-speaking homes.
There are relatively large numbers of other non-English-speaking immigrants who are deaf. This
creates significant challenges for the schools because deafness by itself makes spoken
language acquisition in the native language very difficult, let alone deafness plus attempting to
learn a second language.




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Thursday, September 07, 2006
Statistik OKU Malaysia 2004
Orang Kurang Upaya Yang Didaftarkan Oleh
Jabatan Kebajikan
Masyarakat (JKM) pada tahun 2004 mengikut
negeri di Malaysia.

Masih Ramai lagi OKU yang belum mendaftar
dengan JKM untuk mengambil kad kenal diri
OKU...
ogos1992.blogspot.com/2006/09/statistik-
oku-malaysia


Negeri Bilangan

Johor 17,040
Kedah 10,459
Kelantan 14,017
Melaka 5,530
Negeri Sembilan 6,834
Pahang 5,715
Perak 16,401
Perlis 3,065
Pulau Pinang 9,646
Selangor 19,073
Terengganu 9,486
WP Kuala Lumpur 13,295
WP Labuan 373
Sabah 10,049
Sarawak 9,634

JUMLAH 150,617



3. Anatomy of the Ear
The ear is divided into three connected sections: the outer, the middle, and the inner ear.
Hearing impairments are commonly classified according to their location in the hearing process
and the severity of the loss. The outer ear consists of the auricle and external auditory canal.
The middle ear consists of the eardrum and three tiny bones (ossicles): the malleus, incus and
stapes. The inner ear consists of the vestibular mechanism (monitors balance) and the cochlea.

The cochlea is considered as the most important organ for hearing. This snail-shaped organ
contains the parts necessary to convert the mechanical action of the middle ear into an
electrical signal in the inner ear that is transmitted to the brain. In the normally functioning ear,
sound causes the malleus, incus and stapes of the middle ear to move. When the stapes
moves, it pushes the oval window in and out, causing the fluid in the cochlea of the inner ear to
flow. The movement of the fluid in turn causes a complex chain of events in the cochlea,
ultimately resulting in excitation of the cochlear nerve. With stimulation of the cohlear nerve, an
electrical impulse is sent to the brain, and sound is heard.

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Diagram 1: Anatomy of the Ear (http://www.virtualmedicalcentre.com/anatomy/ear/29)


Diagram 2: Process of Hearing
(http://globalcarecompany.com/consumer/AnatomyOfEar.php)
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4. Identification of Hearing Impairment
There are four general types of hearing tests:
a. Screening tests are available for infants and school-age children. Some of the tests
involve computer technology to measure otoacoustic emissions (low-intensity sound
emitted by the cochlea when stimulated by auditory stimuli). These sounds provide a
measure of how well the cochlea is functioning. Routine screening programs done in
schools may detect children with possible hearing problems. These children need to be
referred to the audiologist’s clinic for extensive evaluation.

b. Pure-tone audiometry is designed to establish an individual’s threshold for hearing at a
variety of hearing frequencies. Frequency is measured in hertz (Hz) units and refers to
the number of vibrations per unit of time of a sound wave – the pitch is higher with more
vibrations, and lower with fewer vibrations. A person’s threshold for hearing is the level
at which he or she can first detect sound. It means how intense a sound must be before
the person detects it. The pure-tone audiometers present tones of varying intensities
(decibels), at varying frequencies (pitch).
A person with average-normal hearing is barely able to hear sounds at a sound-pressure
level of 0 dB. A leaf fluttering in the wind registers about 0 dB, normal conversations is
about 60 dB, a power landmower is about 90 dB. The audiologist will present to each ear
a variety of tones within the range of 0 to about 110 dB and 125-8,000 Hz until the
person establishes at what level of intensity he or she can detect the tone at a number of
frequencies.
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Diagram 3: Audiometry, Pure-Tone; Audiometry, Bekesy
(www.lookfordiagnosis.com)

c. Speech audiometry is used to test a person’s detection and understanding of speech.
The speech reception threshold (SRT) is the decibel level at which one is able to
understand speech. One way to measure the SRT is to present the person with a list of
two-syllable words, testing each ear separately. The dB level at which he or she can
understand half the words is often used as an estimate of SRT level.

d. Tests for young and Hard-to-Test Children techniques used by audiologists to test
hearing on very young children less than four years of age or for children with certain
disabilities. These children are not able to comprehend instructions or understand what
they are supposed to do. Using play audiometry, the examiner teaches the child to do
various activities whenever she or he hears a signal of pure tones or speech. The
activities are designed to be attractive to the young child such as picking up a block,
squeeze a toy or open a book. Using tympanometry, a rubber-tipped probe is inserted
in the ear, sealing the ear canal, and the effects of pressure and sound is then measured
to assess the functioning of the middle ear. The evoked-response audiometry
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measures changes in the brain wave activity by using electroencephalograph (EEG). It
can be used during sleep or the child can be sedated and thus not aware that he or she
is being tested.


Diagram 4: A tympanometry Diagram 5: Evoked-Response
Audiometry
(riti04.cornwall.nhs.uk) (kesehatan.kompasiana.com)


5. Causes
Causes are discussed in terms of types of hearing impairment (conductive, sensorineural, and
mixed) as well as the location of the hearing impairment (outer, middle or inner ear).
Professionals classify causes of hearing impairment on the basis of the location of the problem
within the hearing mechanism. (1) A conductive hearing impairment refers to an interference
with the transfer of sound along the conductive pathway of the middle or outer ear. (2) A
sensorineural hearing impairment involves problems in the inner ear. (3) A mixed hearing
impairment is a combination of conductive and sensorineural hearing impairments.
Several conditions of the outer ear can cause a person to be hard of hearing. For example, in
some children, the external auditory canal does not form, resulting in a condition known as
atresia. Children may also develop external otitis (swimmer’s ear), an infection of the skin of the
external auditory canal. Tumors of the external auditory canal are another source of hearing
impairment.
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Most middle-ear hearing impairments occur because the mechanical action of the ossicles is
interfered with in some way. Most middle-ear hearing impairments are correctable with medical
or surgical treatment. The most common problem of the middle ear is otitis media – an infection
of the middle-ear space caused by viral or bacterial factors. It is linked with abnormal functioning
of the Eustachian tubes.
The most sever hearing impairments are associated with the inner ear, causing the person to
have additional problems such as sound distortion, balance problems and roaring or ringing in
the ears. Causes of inner-ear disorders can be hereditary or acquired. Over 400 different
varieties of hereditary deafness have been identified. Scientists have recently identified
mutation in the connexin-26 gene as the most common cause of congenial deafness,
accounting for about 20 percent of childhood deafness. Acquired hearing impairments can be
due to bacterial infections such as meningitis; premature birth; viral infections such as mumps
and measles; anoxia (deprivation of oxygen) at birth; prenatal infections of the mother such as
maternal rubella, congenital syphilis and cytomegalovirus; Rh incompatibility; blows to the head,
side effects of some antibiotics; and excessive noise levels.

6. Psychological and Behavioral Characteristics
Spoken Language and Speech Development By far the most severely affected areas of
development in the person with a hearing impairment are the comprehension and production of
the language used by most people of the hearing society in which they live. The distinction is
important because people who are hearing impaired can be expert in their own form of
language: sign language. Individuals with hearing impairment are at distinct disadvantage in
terms of language comprehension, language production and speech. Speech intelligibility is
linked to (1) degree of hearing impairment and (2) the age of onset of the hearing impairment.
Even after intensive speech therapy, it is rare for children with prelingual profound deafness to
develop intelligible speech. Infants who are able to hear their own sounds and those of adults
before becoming deaf have an advantage over those born deaf. Children who are deaf are
handicapped in learning to associate the sensations they feel when they move their jaws,
mouths, and tongues with the auditory sounds these movements produce. In addition, these
children have a difficult time hearing adult speech, which non-impaired children can hear and
imitate.
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Sign language Deaf children can easily learn sign language. However, historically, sign
language has suffered from several misconceptions including the belief that it is not a true
language. A linguist, Stokoe (see Box 1) claimed that similar to the phonemes of spoken
English, each sign in ASL consists of three parts: handshape, location and movement.
Research in several areas has proved that he was correct in asserting that sign language is a
true language.
















Box 1: The Pioneer of Sign Language (en.wikipedia.org/wiki/William_Stokoe)


William C. Stokoe, Jr. (pron.: /ˈstoʊkiː/ STOH-kee; New Hampshire, July 21, 1919 – Chevy
Chase, Maryland, April 4, 2000) was a scholar who researched American Sign Language
(ASL) extensively while he worked at Gallaudet University. He coined the term cherology, the
equivalent of phonology for sign language. However, sign language linguists, of which he may
have been the first, now generally use the term "phonology" for signed languages.
Stokoe graduated from Cornell University in Ithaca, NY in 1941, from where in 1946 he
earned his Ph.D. in English, specifically medieval literature.

From there, he became an
instructor of English at Wells College in Aurora, NY.
From 1955 to 1970 he served as a professor and chairman of the English department at
Gallaudet University. He published Sign Language Structure (1960) and co-authored A
Dictionary of American Sign Language on Linguistic Principles (1965). The latter was the first
place the term American Sign Language was ever formally used. He also started the academic
journal Sign Language Studies in 1972, which he edited until 1996. Stokoe's final book,
Language in Hand, was published in 2001, after his death.
Though the relationship between Stokoe and Gallaudet was not always one of complete
support (Gallaudet closed his Linguistics Research Laboratory, wherein he carried out the
studies that would lead him to declare ASL a fully formed and legitimate language, in 1984),
the university awarded him an honorary doctorate in 1988.
Through the publication of his work, he was instrumental in changing the perception of ASL
from that of a broken or simplified version of English to that of a complex and thriving natural
language in its own right with an independent syntax and grammar as functional and powerful
as any found in the oral languages of the world. Because he raised the prestige of ASL in
academic and educational circles, he is considered a hero in the Deaf community.
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Intellectual Ability For many years, professionals believed that the spoken language of
individuals who are deaf was a sign that they also had intellectual deficiencies. Any intelligence
testing of people who are hearing impaired must take their spoken language deficiency into
account (e.g. English or Bahasa Malaysia). Performance tests, rather than verbal tests,
especially if they are administered in sign, offer a much fairer assessment of the IQ of a person
with a hearing impairment. When these tests are used, there is no difference in IQ between
those who are deaf and those who are hearing.
Academic Achievement Unfortunately, most children who are deaf have large deficits in
academic achievement. Reading ability, which relies heavily on spoken language skills and is
probably the most important area of academic achievement, is most affected. For example, the
average student in USA who is hearing impaired leaves school with a deficit of at least five
years in reading. Several studies have demonstrated that children who are deaf who have
parents who are deaf have higher reading achievement and better language skills than do those
who have hearing parents. This may be due to the fact that deaf parents might be able to
communicate better with their children through the use of ASL, providing the children with
needed support. In addition, children who have parents who are deaf are more likely to be
proficient in ASL, and ASL can aid these children in learning written English and reading. A
supportive home environment is associated with higher academic achievement in students who
are deaf. Families that are more involved in their children’s education, seek knowledge about
their child’s condition to provide guidance, have high expectations for achievement, don’t try to
overprotect their child, and participate along with their child in the Deaf community are likely to
have higher-achieving children.

Social Adjustment Social development and personality development in the hearing population
depend heavily on communication, and the situation is no different for those who are deaf. The
hearing person has little difficulty finding people with whom to communicate. The deaf person,
however, can face problems in finding others with whom he or she can converse. Studies have
shown that many students who are deaf are at risk of loneliness. Two factors influence the
possible isolation of students who are deaf: inclusion and hearing status of parents. In
inclusionary setting, very little interaction typically occurs between students who are deaf and
those who are not. Students who are deaf feel more emotionally secure if they have other
students who are deaf with whom they can communicate, which is most often does not happen.
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In terms of the second factor, some experts believe that the child who is deaf and has hearing
parents runs a greater risk of being unhappy that the child who has parents who also are deaf.
This is because, many hearing parents don’t become proficient in sign language and are unable
to communicate with their children easily.

7. Educational Considerations
Controversy in terms of how best to educate learners who are deaf is referred to as oralism-
manualism debate. Oralism favors teaching people who are deaf to speak; manualism prefers
the use of some kind of manual communication. Currently, most professionals recommend both
oral and manual methods in what is referred to as total communication approach. However,
within the Deaf community, they advocate for a bicultural-bilingual approach that promotes
American Sign Language as a first language, English as a second language, and promotes the
teaching of Deaf culture.
Oral Approaches
The auditory-verbal approach assumes that most children with hearing impairment have some
residual hearing that can be used to their benefit. Thus, it promotes usage of audition to improve
speech and language development at earliest age possible with heavy emphasis on
amplification technology such as hearing aids and cochlear implants.
The auditory-oral approach stresses the use of visual cues such as speechreading and cued
speech. Speechreading is a method involves teaching children to use visual information from a
number of sources to understand what is being said to them. This is more than lipreading where
children use only visual cues arising from the movement of the mouth in speaking.
Speechreading considers contextual stimuli; facial expressions; and speech sounds (cues
related to the degree of jaw opening and lip shaping). Cued speech is a way to enhance
speechreading. The individual uses hand shapes to represent specific sounds while speaking,
to differentiate between sounds that look alike on the lips. Cued speech is not used widely in the
United States.


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Total Communication Approach
American Sign Language (ASL) ASL is used by many deaf in the United States, thus its use
promotes assimilation into the Deaf Community. ASL is a visual language, and speechreading
or listening skills are not needed to learn ASL fluently. Because of its visual nature, ASL is very
graphic, and understanding of concepts can be promoted more easily. It has developed over
time through usage by deaf individuals and is a free-flowing, natural language. ASL is a
language complete in itself. It is not usually written or spoken, but can be translated, just like
French or German, to English and vice versa. ASL has it's own syntax and grammar. It does
count as a language credit at University level, because it is a separate language.

Letters of the American Sign Language
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Fingerspelling Fingerspelling is a method of spelling words using hand movements.
Fingerspelling is used in sign language to spell out names of people and places for which there
is not a sign. Fingerspelling can also be used to spell words for signs that the signer does not
know the sign for, or to clarify a sign that is not known by the person reading the signer.
Fingerspelling signs are often also incorporated into other signs.
Spell: WELCOME

www.fingerspellingalphabet.com
Pidgin Signed English(PSE) or Signed English PSE is probably the most widely used
communication modality in the United States among deaf and hearing persons who work with
them. Many teachers use PSE or Signed English. The vocabulary is drawn from ASL but follows
English word order. Words that do not carry information (e.g. to, the, am, etc.) are often
dropped, as are the word endings of English (e.g. -ed, -s, -ment, etc.). This means that the
signer can easily speak while signing, since it is possible to keep pace with spoken English. It is
simpler to learn than ASL or SEE, since one does not need to include all English endings, nor
does one to master the structure or idioms of ASL.
Signing Exact English SEE is based upon signs drawn from ASL and expanded with words,
prefixes, tenses, and endings to give a clear and complete visual presentation of English. The
ASL sign for the concept of "pretty, lovely, beauty, beautiful" and other such synonyms is
retained for beauty, initialized with P for pretty, L for lovely, and the suffix -ful is added for
beautiful. The child thus has an opportunity to develop an expanded vocabulary. The learning of
this English based sign system may be more comfortable for English-speaking parents.
Maximum use of residual hearing and speechreading is encouraged since the signs match the
elements of spoken English. SEE encourages the incorporation of ASL features to show
intonation visually. SEE does require more signing time that PSE, because of the word endings
and prefixes, etc. Overconcentration on signing every word may lead to "colorless" signing
(www.listen-up.org/sign2.htm).
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The Bicultural-Bilingual Approach
Three features of this approach are:
1. ASL is considered the primary language, and English is considered the secondary
language.
2. People who are deaf play an important role in the development of the program and its
curriculum.
3. The curriculum includes instruction in Deaf culture.
Technological Advances
The American National Association of the Deaf explains several advances that help the hearing-
impaired community to hear (www.nad.org/issues/technology):
Assistive Listening Systems (ALSs) are sometimes called Assistive Listening Devices
(ALDs). Essentially they are amplifiers that bring sound directly into the ear. They separate the
sounds, particularly speech, that a person wants to hear from background noise. They improve
what is known as the “speech to noise ratio.” ALSs help address listening challenges in three
ways: minimizing background noise; reducing the effect of distance between the sound source
and the deaf or hard of hearing person; and overriding poor acoustics such as echo. People
use ALSs in places of entertainment, employment, and education, as well as for home/personal
use. ALSs utilize FM, infrared, or inductive loop technologies. All three technologies are
considered good. Each one has advantages and disadvantages. Each ALS has at least three
components: a microphone, a transmission technology, and a device for receiving the signal
and bringing the sound to the ear. This is important to understand in order to troubleshoot
problems systematically and to improve a system’s effectiveness.




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Hearing Aids There are three main types of
hearing aids: worn behind the ear, worn in
the ear, and worn farther down in the canal
of the ear. Generally hearing aids make
sounds louder, not clearer. So if a person’s
hearing is distorted, a hearing aid will
merely amplify the distorted sound.

Hearing aid-fitting


Cochlear Implants The most basic aspect
of the cochlear implant is to help the user
perceive sound, i.e., the sensation of sound
that is transmitted past the damaged
cochlea to the brain. In this strictly
sensorineural manner, the implant
works: the sensation of sound is delivered
to the brain. The stated goal of the implant
is for it to function as a tool to enable deaf
children to develop language based on
spoken communication.


Ear with cochlear implant
(www.newsworks.org)
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Cochlear implants do not eliminate deafness. An implant is not a “cure” and an implanted
individual is still deaf. Cochlear implants may destroy what remaining hearing an individual
may have. Therefore, if the deaf or hard of hearing child or adult later prefers to use an
external hearing aid, that choice may be removed.
Unlike post-lingually deafened children or adults who have had prior experience with sound
comprehension, a pre-lingually deafened child or adult does not have the auditory foundation
that makes learning a spoken language easy. The situation for those progressively deafened
or suddenly deafened later in life is different. Although the implant’s signals to the brain are
less refined than those provided by an intact cochlea, an individual who is accustomed to
receiving signals about sound can fill in certain gaps from memory. While the implant may
work quite well for post-lingually deafened individuals, this result just cannot be generalized to
pre-lingually deafened children for whom spoken language development is an arduous
process, requiring long-term commitment by parents, educators, and support service
providers, with no guarantee that the desired goal will be achieved.
Many more technological devices invented for the deaf community include telephone
adaptations such as text telephone and video relay services; computer-assisted instruction usch
as DVDs, CD-ROMs and C-Print; and the internet with numerous websites, newsgroups,
electronic mails and many more.

New piece of technology for
people with hearing disorders
www.gizmowatch.com


www.start-american-sign-lan...


Music for the deaf.
Deafnewstoday.blogspot.com

news.bbc.co.uk



Entertainment Access
Technology: The Deaf Sony
Glasses | Gadgets World


Video Relay Service
globalaccessibilitynews.com
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8. Assessment of Progress
Progress Monitoring Curriculum-based measurement (CBM) can be implemented as a means of
monitoring students’ with hearing impairments academic progress. CBM can be appropriate
method for measuring reading fluency and comprehension for students who use sign language.
To measure a student’s reading fluency, the examiner asks the student to read a passage for a
three-minute time period using sign language. The reading rate is then determined by
calculating the number of correct words signed per minute. To measure comprehension, the
student retells the passage and the examiner determines the number of correct idea units
retold.
Outcome Measures Research supports the development of phonics-based reading skills for
students who are deaf or hard of hearing. Important outcome skills include word identification,
pseudoword reading, and reading comprehension using the Wechsler Individual Achievement
test-II. Students responded to instructions using signs, fingerspelling, vocalization and visual
phonics cues. There are a few standardized tests for the deaf or hard of hearing including The
Test of Early reading Ability-Deaf and hard of Hearing (TERA-D/HH); and the Standford
Achievement Test, Ninth edition.
One of the most common accommodations for standardized assessments involves the use of
sign language both for the delivery of administrator directions/instructions and student
responses.
Conclusion
Families of children who are deaf who have hearing parents might be in greater need of early
intervention programming than families in which the parents are deaf. Because it is difficult for
hearing parents to become fluent in sign language, native signers are a part of some
intervention programs.