CD 628: SPECIAL POPULATIONS By: Emily Laverty, Claire Magie,

DEAF/BLIND/DEAFBLIND and Olivia Withrow Spears

  Deaf-Blind: “Children with significant deficits in both hearing and
vision even though some may have useful residual vision and/or
hearing.”
 Deaf: “Refers to an individual whose hearing loss is so severe
that they cannot use their sense of audition as a primary means
of daily communication.”
DISORDER  Deafness: “As defined by IDEA, a hearing impairment that is so
severe that the child is impaired in processing linguistic
OVERVIEW information through hearing, with or without amplification, which
adversely affects a child’s educational performance.”

 (Welling & Ukstins, 2019)

DISORDER OVERVIEW CONT'D
Hard of Hearing: ”Preferred terminology for a person presenting with a hearing
loss who can derive benefit from hearing aids and uses aural/oral speech for
communication.”
Blindness: A state or condition of being unable to see due to either injury, disease,
or a congenital condition.

(Welling & Ukstins, 2019)

CAUSES & CORRELATIONS
Major Causes (2):
 Rubella Syndrome: “... A congenital condition that arises when
the mother contracts rubella, or German measles, during the
first months of pregnancy.”
 Deaf-blindness as a result of this syndrome has been greatly reduced due to an
increased spread of immunizations.
 Usher Syndrome: A rare genetic disorder

(Paul, Norbury, & Gosse, 2018)

CAUSES & CORRELATIONS CONT'D
Blindness:
 Prenatal, perinatal, and postnatal factors.
 Congenital cataract
 Infantile glaucoma
 Neuro-ophthalmic lesion
Deafness:
 Conduction, Sensorineural, Mixed
 Influenza
 Otitis Media
 Meningitis
 Chicken Pox

 (Welling & Ukstins, 2019)

 IMPORTANT FACTS
▪ Around 20%-40% of children diagnosed with a
permanent hearing loss have one or more additional
disabilities. (Cupples et al., 2018)
▪ Previous studies have shown an increase in
auditory/linguistic abilities following the implantation of a
cochlear device. (Cupples et al., 2018)

▪Around 14 million children in the world are estimated to

be blind. (Solebo, Teoh, & Rahi, 2017)
▪ Blindness has the potential to affect a child's later success
in education, employment, and earning potential. (Solebo,
Teoh, & Rahi, 2017)
VISUALLY IMPAIRED:
INCIDENCE/PREVALENCE
Box 1 Magnitude and causes of blindness in children
▪The epidemiology of blindness in children reflects socioeconomic development
▪The prevalence and magnitude ranges from about 3/10 000 children in
affluent societies (60 blind children per million total population) to 15/10 000
in the poorest communities (600 blind children per million total population)
▪75% of the world's blind children live in developing countries
▪Some 500 000 children become blind each year, most in developing countries
▪Blind children have a high death rate—the prevalence therefore markedly
underestimates the burden
(Gilbert, 2003)
 ▪May be attributed to disruptions in early visual
experiences, for example triadic joint attention, which
results in delays in acquisition of first words
and phrases.
VISUALLY
IMPAIRED: ▪ However, despite early delays, research indicates
that children with VIs develop age appropriate
LANGUAGE vocabularies and MLUs by their third birthday.
(Paul, Norbury, Gosse, pg. 114, 2018).

ACQUISITION
FUNCTIONAL EMOTIONAL DEVELOPMENT
Things to keep in mind...
1. Children who are visually impaired may struggle with self-regulation, engaging/relating, and
purposeful two-way communication.
2. Consider Capacity 1 (Self-Regulation): The FEDC website encourages parents to figure out their child's
sensory profile. It will be difficult for the VI child to find comfort and reassurance because they are missing
the sight of their mother's face and that relationship that is established during this time. This child likely
struggles to self-regulate enough to explore the world.
3. Capacity 2 (Engaging and Relating): The VI child may not experience mirroring mom's smiles and may
miss out on the anticipation, curiosity, and excitement the reappearance of their caregiver's face and
voice.
4. Capacity 3 (Two-Way Communication): The VI child may miss out on the following experiences that
occur during this developmental time period: smiling, vocalizing, putting a finger in caregiver's mouth,
taking a rattle from his mouth and putting it in the caregiver's, or touching or exploring the caregiver's hair.
(Interdisciplinary Council of Development and Learning, n.d.)
VISUALLY IMPAIRED: PRAGMATIC SKILLS
▪ Are vulnerable in children with Vis, and there is increasing evidence that many social communication in VI resemble those seen in sighted
children with ASD.

▪ Pragmatic Impairments Include

1. Extensive and inappropriate use of questions

2. Limited use of communicative gestures

3. Extensive use of imitative speech

4. Repetitions

5. Verbal routines

▪ Less likely to capitalize in nonverbal communicative cues to understanding internal states of their conversational partners, meaning they
may struggle with theory of mind, however little evidence has supported this theory

▪ IMPORTANT: Maternal verbal behaviors was significantly correlated with children’s social- communicative competence, suggesting a key
role for caregivers in scaffolding social communication.

(Paul, Norbury, Gosse, pg. 114, 2018).

 1. Limited amount of information, but it
isn’t much different than how we assess
children who have their sight.

VISUALLY
IMPAIRED: 2. Criterion referenced and/or informal
assessment is likely the most appropriate
ASSESSMENT
3. Will have to modify assessment tools
(PAUL, NORBURY, GOSSE, PG. 114, 2018). making the objects used more tactile in
nature; Braille may need to be
incorporated somehow as well.
ROLE OF THE SLP: SOCIAL
COMMUNICATION
1. Likely involves facilitating early social communicative exchanges
between children with VI and their parents.
2. May need to help parents recognize and explicitly comment on and
reinforce non-verbal communication behaviors they themselves emit or
observe through their child
3. Help families find different ways to establish joint attention and use
these opportunities to have rich linguistic environments.
(Paul, Norbury, Gosse, pg. 114, 2018).
VISUALLY IMPAIRED: INTERVENTION
Methods of Facilitating Language and Social Communication

1. Provide labels and descriptions of the objects the child handles and what he or she can do with these objects.

2. Ask both open-ended and more directive questions

3. Provide more qualitative information not only about the child’s actions but also other things going on in the
environment

4. Model and encourage the child to engage in pretend play

5. Engage in shared book reading activities

(Paul, Norbury, Gosse, pg. 114, 2018).

 1. Books and/or other materials will need to be adapted to make
it more meaningful
2. Books may need to be made with heavy cardboard and
fastened together with rings
3. Can be made interesting to the child by placing different
textures and shapes of materials on each page to explore
4. Need to gain experience in orienting the book in a comfortable
position and turning the pages from left to right

INTERVENTION: 5. Also need to learn directions such as top, bottom, right, and left,
which will help the child locate specific shapes or textures which
are attached in various positions on the page.

EMERGING LITERACY 6. Help build concrete relationships through touch and using all the
other senses. Children who are VI may not be as motivated to
explore their world so play could be a challenge.
7. TOUCHING though is the key to building
linguistic relationships. They need more experience
with real objects and more opportunities to understand the
relationship between word-names and objects
8. Keep in mind the child will have limited mobility throughout their
environment which limits their experiences
(Harley, Sanford, & Truan, 1997).
DEAFNESS IN CHILDREN:
INCIDENCE/PREVALENCE
- 1 to 3 per 1,000 children born have hearing loss (Permanent Child
Hearing Loss, n.d.)
- The number could increase later due to illness, trauma, or gradual
loss in children
-Although there are not known recorded numbers of how many
children with hearing loss require speech-language intervention, it is
safe to say that most would have challenges in language
development due to input complications without some type of
intervention.
 Type and severity degree
Affects what medical interventions are available

Medical Intervention
Age of diagnosis, age of medical intervention,

DEAFNESS AND duration and consistency of device usage

LINGUISTIC FACTORS Cognition

Other Factors:
Maternal education, child sex, and other existing
medical conditions that may impact language
development and outcome

(Paul, Norbury, & Gosse, 2018)

ROLE OF THE SLP
An SLP DOES:
-Provide "education about risk factors associated with noise-induced hearing loss and
preventative measures that may help decrease the risk" (American Speech-Language-Hearing
Association, 2016)
-Conduct hearing screenings and refer accordingly
-Provide speech, language, communication, and listening intervention for those impacted by
hearing loss, deafness, or auditory processing disorder
An SLP does NOT:
-Diagnose hearing loss or deafness
-Adjust or educate on hearing aids, amplification options, or cochlear implants

(American Speech-Language-Hearing Association, 2016)

COMMUNICATION OPTIONS FOR THE DEAF
-Listening and Spoken Language
 - For infants and young children for language development
 - Teaches to listen and talk with hearing technology: hearing aids, FM systems, or cochlear implants
 -Very specialized, not always available, parent and caregiver support is required for success
 -Goal is to attend regular classroom

-Cued Speech/Language
- Combines mouth movements of speech into eight cues (hand shapes)
-The cues distinguish between sounds rather than actual words.
- Child must be able to learn some through amplified hearing, but cannot solely rely on it

-Sign Language (Evaluating

- Signs/ hand gestures follow a linguistic code for both words and grammatical structure Communications
Options for Your Child,
-Total Communication Method n.d.)
 - Free-for-all: combines all types of methods to communicate.
 -I.e. finger spelling, individual signs, gestures, writing, signing and speaking simultaneously
DEAFNESS AND LITERACY
- Often literacy skills for students who are deaf or have hearing loss
are significantly below average. Why?
- Early life may have focused closely on amplification and oral
language, there was less exposure to literacy
- Typical Approach: phonics, phonemic awareness by detecting
sound differences leading to grapheme-phoneme correspondence

- Suggestion for Literacy Development:

-Combine reading instruction with finger-spelling and/or explicit
instruction in morphological consistencies in print
(Paul, Norbury, & Gosse, 2018)
DEAF/BLIND INTERVENTION TECHNIQUES
Unaided Techniques:
 Signaling: Simple body signals, such as coordinated rocking with reciprocal cues to start and stop.
 Gestures: Conventional gestures, such as hi, bye, or head nods.
 Adapted Signs: Cues used to signal an upcoming action so that the child may anticipate events, such as
rubbing the child’s cheek with a washcloth to signal bath time.
 Finger Spelling: Finger spelling can be shaped to produce signs, and the child can be encouraged to
feel the clinician’s hand shape to perceive signs. At first, gross approximations can be accepted and
then gradually shaped to more conventional signing.
 Speech: Children with residual hearing may be taught speech, but other modes of communication can
coexist with speech instruction.
 Print/Braille: Children with significant residual vision can be introduced to print when level of
functioning appears appropriate. Braille may be appropriate for those who can make fine tactile
discriminations.

 (Paul, Norbury, & Gosse, 2018)

DEAF/BLIND INTERVENTION TECHNIQUES
Aided Techniques:
 Opticon: This device changes print to a tactile representation and may assist higher functioning deaf-
blind students who rely on Braille for academic instruction.
 Teletouch: This device allows sighted people to type messages on a standard keyboard so that each
letter is reproduced as Braille.
 Communication Boards: Pictures of symbols can be labeled with Braille or more concrete tactile cues
and used for both receptive and expressive communication.
 Typing and Writing: Computers and dedicated electronic augmentation devices can be used and
coupled with speech synthesis software to allow an individual’s message to be written out and spoken.

 (Paul, Norbury, & Gosse, 2018)

 References
American Speech-Language-Hearing Association. (2016). Scope of Practice in Speech-
Language Pathology. doi:10.1044/policy.sp2016-00343
Cupples, L., Ching, T. Y. C., Leigh, G., Martin, L., Gunnourie, M., Button, L., . . . Van Buynder, P.
(2018). Language development in deaf or hard-of-hearing children with additional disabilities:
Type matters. Journal of Intellectual Disability Research, 62(6), 532-543.
doi:10.1111/jir.12493
Evaluating Communications Options for Your Child. (n.d.). Retrieved July 20, 2020, from
https://www.agbell.org/Families/Communication-Options
Harley, R. K., Sanford, L. D., & Truan, M. B. (1997). COMMUNICATION SKILLS FOR VISUALLY
IMPAIRED LEARNERS : Braille, Print, and Listening Skills for Students Who Are Visually Impaired.
Charles C Thomas.
Interdisciplinary Council of Development and Learning. (n.d.) Functional emotional
developmental capacities. Retrieved from https://www.icdl.com/dir/fedcs
Paul, R., Norbury, C., & Gosse, C. (2018). Language disorders from infancy through adolescence.
St. Louis, Missouri: Elsevier.
Permanent Childhood Hearing Loss. (n.d.). Retrieved July 20, 2020, from
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934680
 REFERENCES (CONT.)
Solebo, A. L., Teoh, L., & Rahi, J. (2017). Epidemiology of blindness in
children. Archives of Disease in Childhood, 102(9), 853.
Welling, D. R., Ukstins, C. A. (2019). Fundamentals of audiology for speech-
language pathologists. Burlington, Massachusetts: Jones and Bartlett Learning.