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Resource about Deafness. How it is recognized, tested and prevented.

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Hearing loss can affect a child's ability to develop speech, language, and social skills.

The earlier that children with hearing loss start getting services, the more likely they are to reach their full potential.

If you think that a child might have hearing loss, ask the child's doctor for a hearing screening as soon as possible. Don't wait!

What it is

A hearing loss can happen when any part of the ear is not working in the usual way. This includes the outer ear, middle ear, inner ear, hearing (acoustic) nerve, and auditory system.

Signs and symptoms

The signs and symptoms of hearing loss are different for each child. If you think that your child might have hearing loss, ask the child's doctor for a hearing screening as soon as possible. Don't wait!

Even if a child has passed a hearing screening before, it is important to look for the following signs.

Signs in babies

Does not startle at loud noises.

Does not turn to the source of a sound after 6 months of age.

Does not say single words, such as "dada" or "mama" by 1 year of age.

Turns head when he or she sees you but not if you only call out his or her name. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.

Seems to hear some sounds but not others.

Signs in children

Speech is delayed.

Speech is not clear.

Does not follow directions. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.

Often says, "Huh?"

Turns the TV or radio volume up too high.

Babies and children should reach milestones in how they play, learn, communicate, and act.‎

Causes

Hearing loss can happen any time during life-from before birth to adulthood.

The following are some of the things that can increase the chance a child will have hearing loss:

A genetic cause: About 1 out of 2 cases of hearing loss in babies is due to genetic causes. Some babies with a genetic cause for their hearing loss might have family members who also have a hearing loss. About 1 out of 3 babies with genetic hearing loss have a "syndrome." This means they have other conditions in addition to the hearing loss, such as Down syndrome or Usher syndrome.

1 out of 4 cases of hearing loss in babies is due to maternal infections during pregnancy, complications after birth, and head trauma. For example, the child:

Was exposed to infection, such as before birth.

Spent 5 days or more in a hospital neonatal intensive care unit (NICU) or had complications while in the NICU.

Needed a special procedure such as a blood transfusion to treat bad jaundice.

Has head, face or ears shaped or formed in a different way than usual.

Has a condition like a neurological disorder that may be associated with hearing loss.

Had an infection around the brain and spinal cord called meningitis.

Received a bad injury to the head that required a hospital stay.

Prevention

The following are tips for parents to help prevent hearing loss in their children:

Screening and diagnosis

Hearing screening can tell if a child might have hearing loss. Hearing screening is easy and is not painful. In fact, babies are often asleep while being screened. It takes a very short time-usually only a few minutes.

Babies

All babies should have a hearing screening no later than 1 month of age. Most babies have their hearing screened while still in the hospital after birth. If a baby does not pass a hearing screening, it's very important to get a full hearing test as soon as possible, ideally no later than 3 months of age.

Children

Children should have their hearing tested before they enter school or any time there is a concern about the child's hearing. Children who do not pass the hearing screening need to get a full hearing test as soon as possible.

Treatment

No single treatment or intervention is the answer for every person or family. Good treatment plans will include close monitoring, follow-ups, and any changes needed along the way. There are many different types of communication options for children with hearing loss and for their families. Some of these options include:

Learning other ways to communicate, such as sign language.

Technology to help with communication, such as hearing aids and cochlear implants.

Medicine and surgery to correct some types of hearing loss.

Family support services.

Get help!

If you think that your child might have hearing loss, ask the child's doctor for a hearing screening as soon as possible. Don't wait!

If your child does not pass a hearing screening, ask the child's doctor for a full hearing test as soon as possible.

If your child has hearing loss, talk to the child's doctor about treatment and intervention services.

Don't wait!‎

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This page helps parents and caregivers learn more about hearing loss in children.

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World Resource about Deafness

Includes the different stages in life where deafness can occur.

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Overview

Over 5% of the world's population - or 430 million people - require rehabilitation to address their disabling hearing loss (432 million adults and 34 million children). It is estimated that by 2050 over 700 million people - or 1 in every 10 people - will have disabling hearing loss.

'Disabling' hearing loss refers to hearing loss greater than 35 decibels (dB) in the better hearing ear. Nearly 80% of people with disabling hearing loss live in low- and middle-income countries. The prevalence of hearing loss increases with age, among those older than 60 years, over 25% are affected by disabling hearing loss.

Hearing loss and deafness

A person who is not able to hear as well as someone with normal hearing - hearing thresholds of 20 dB or better in both ears - is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears and leads to difficulty in hearing conversational speech or loud sounds.

'Hard of hearing' refers to people with hearing loss ranging from mild to severe. People who are hard of hearing usually communicate through spoken language and can benefit from hearing aids, cochlear implants, and other assistive devices as well as captioning.

'Deaf' people mostly have profound hearing loss, which implies very little or no hearing. They often use sign language for communication.

Causes of hearing loss and deafness

Although these factors can be encountered at different periods across the life span, individuals are most susceptible to their effects during critical periods in life.

Prenatal period

genetic factors including hereditary and non-hereditary hearing loss

intrauterine infections - such as rubella and cytomegalovirus infection.

Perinatal period

birth asphyxia (a lack of oxygen at the time of birth

hyperbilirubinemia (severe jaundice in the neonatal period)

low-birth weight

other perinatal morbidities and their management.

Childhood and adolescence

chronic ear infections (chronic suppurative otitis media)

collection of fluid in the ear (chronic nonsuppurativeotitis media)

meningitis and other infections.

Adulthood and older age

chronic diseases

smoking

otosclerosis

age-related sensorineural degeneration

sudden sensorineural hearing loss.

Factors across the life span

cerumen impaction (impacted ear wax)

trauma to the ear or head

loud noise/loud sounds

ototoxic medicines

work related ototoxic chemicals

nutritional deficiencies

viral infections and other ear conditions

delayed onset or progressive genetic hearing loss.

The impact of unaddressed hearing loss

When unaddressed, hearing loss impacts many aspects of life at individual level:

communication and speech

cognition

education and employment: In developing countries, children with hearing loss and deafness often do not receive schooling. Adults with hearing loss also have a much higher unemployment rate. Among those who are employed, a higher percentage of people with hearing loss are in the lower grades of employment compared with the general workforce.

social isolation, loneliness and stigma

impact on society and economy

effects on years lived with disability (YDLs) and disability adjusted life years (DALYs).

WHO estimates that unaddressed hearing loss poses an annual global cost of US$ 980 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity, and societal costs. Of these costs, 57% are attributed to low- and middle-income countries.

Prevention

Many of the causes that lead to hearing loss can be avoided through public health strategies and clinical interventions implemented across the life course.

Prevention of hearing loss is essential throughout the life course, from prenatal and perinatal periods to older age. In children, nearly 60% of hearing loss is due to avoidable causes that can be prevented through implementation of public health measures. Likewise, most common causes of hearing loss in adults, such as exposure to loud sounds and ototoxic medicines, are preventable.

Effective strategies for reducing hearing loss at different stages of the life course include:

immunization;

good maternal and childcare practices;

genetic counselling;

identification and management of common ear conditions;

occupational hearing conservation programmes for noise and chemical exposure;

safe listening strategies for the reduction of exposure to loud sounds in recreational settings; and

rational use of medicines to prevent ototoxic hearing loss.

Identification and management

Early identification of hearing loss and ear diseases is key to effective management.

This requires systematic screening for detection of hearing loss and related ear diseases in those who are most at risk. This includes:

newborn babies and infants

pre-school and school-age children

people exposed to noise or chemicals at work

people receiving ototoxic medicines

older adults.

Hearing assessment and ear examination can be conducted in clinical and community settings. Tools such as the WHO "hearWHO" app and other technology-based solutions make it possible to screen for ear diseases and hearing loss with limited training and resources.

Once hearing loss is identified, it is essential that it is addressed as early as possible and in an appropriate manner, to mitigate any adverse impact.

Measures available to rehabilitate people with hearing loss include:

the use of hearing technologies, such as hearing aids, cochlear implants and middle ear implants;

the use of sign language and other means of sensory substitution,such as speech reading, use of print on palm or Tadoma, signed communication; and

rehabilitative therapy to enhance perceptive skills and develop communication and linguistic abilities.

The use of hearing assistive technology, and services such as frequency modulation and loop systems, alerting devices, telecommunication devices,captioning services and sign language interpretation, can further improve access to communication and education for people with hearing loss.

WHO response

WHO's work on ear and hearing care is to promote integrated people-centred ear and hearing care (IPC-EHHC).

WHO's work is guided by the recommendations of the WHO World report on hearing (2021) and the World Health Assembly resolution on prevention of deafness and hearing loss.

WHO's work includes:

guiding, assisting and supporting Member States to increase awareness on EHC issues;

facilitating data generation and dissemination of ear and hearing care related data and information;

providing technical resources and guidance to facilitate planning and health systems capacity building for ear and hearing care;

supporting heath workforce training in ear and hearing care;

promoting safe listening to reduce the risk of recreational noise-induced hearing loss through the WHO Make Listening Safe initiative;

observing and promoting World Hearing Day as an annual advocacy event;

building partnerships to develop strong hearing care programmes, including initiatives for affordable hearing aids, cochlear implants and services; and

advocating for ear and hearing care through the World Hearing Forum.

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Deafness and hearing loss fact sheet from WHO: providing key facts and information on causes, impact, prevention, identification, management and WHO response.

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All-in-one stop about Deafness, symptoms, resources, federal guidelines, and school support

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Disability Fact Sheet 3 (FS3)
Links updated, May 2015
In This Publication:
Caroline's Story

Caroline is six years old, with bright brown eyes and, at the moment, no front teeth, like so many other first graders. She also wears a hearing aid in each ear-and has done so since she was three, when she was diagnosed with a moderate hearing loss.

For Caroline's parents, there were many clues along the way. Caroline often didn't respond to her name if her back was turned. She didn't startle at noises that made other people jump. She liked the TV on loud. But it was the preschool she started attending when she was three that first put the clues together and suggested to Caroline's parents that they have her hearing checked. The most significant clue to the preschool was Caroline's unclear speech, especially the lack of consonants like "d" and "t" at the end of words.

So Caroline's parents took her to an audiologist, who collected a full medical history, examined the little girl's ears inside and out, ran a battery of hearing tests and other assessments, and eventually diagnosed that Caroline's inner ear (the cochlea) was damaged. The audiologist said she had sensorineural hearing loss.

Caroline was immediately fitted with hearing aids. She also began receiving special education and related services through the public school system. Now in the first grade, she regularly gets speech therapy and other services, and her speech has improved dramatically. So has her vocabulary and her attentiveness. She sits in the front row in class, an accommodation that helps her hear the teacher clearly. She's back on track, soaking up new information like a sponge, and eager for more.

About Hearing Loss in Children

Hearing is one of our five senses. Hearing gives us access to sounds in the world around us-people's voices, their words, a car horn blown in warning or as hello!

When a child has a hearing loss, it is cause for immediate attention. That's because language and communication skills develop most rapidly in childhood, especially before the age of 3. When hearing loss goes undetected, children are delayed in developing these skills ( March of Dimes, 2010).

Recognizing the importance of early detection, the Centers for Disease Control and Prevention (the CDC) recommends that every newborn be screened for hearing loss as early as possible, usually before they leave the hospital. Catching a hearing loss early means that treatment can start early as well and "help the child develop communication and language skills that will last a lifetime" ( CDC, 2013).

Types of Hearing Loss

Before we describe the types of hearing loss a person may have, it's useful to know that sound is measured by:

its loudness or intensity (measured in units called decibels, dB); and

its frequency or pitch (measured in units called hertz, Hz).

Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most strongly associated with speech. Impairments in hearing can occur in either or both areas, and may exist in only one ear or in both ears. Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf.

There are four types of hearing loss, as follows ( eHealthMD, 2013):

Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.

Sensorineural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves that supply it. These hearing losses can range from mild to profound. They often affect the person's ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.

A mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear.

A central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain itself.

How Common is Hearing Loss?

Each year in the United States, more than 12,000 babies are born with a hearing loss; often, the cause is unknown ( Centers for Disease Control and Prevention, 2010). Profound deafness occurs in 4-11 per 10,000 children; in at least 50% of these cases, the cause is genetic ( American Speech-Language-Hearing Association, n.d.). Through the Universal Newborn Hearing Screening program, many states now mandate that all newborns be screened for hearing loss within hours of birth ( National Center for Hearing Assessment & Management, n.d.).

Signs of a Hearing Loss or Deafness

Just as with Caroline, our first grader, there will be signs that a child may not be hearing normally. Parents may notice that their child:

does not respond consistently to sounds or to his or her own name;

asks for things to be repeated or often says "huh?"

is delayed in developing speech or has unclear speech;

turns the volume up loud on the TV and other electronic devices. (CDC, 2012)

Causes of Hearing Loss and Deafness

Hearing loss and deafness can be either:

acquired, meaning that the loss occurred after birth, due to illness or injury; or

congenital, meaning that the hearing loss or deafness was present at birth.

The most common cause of acquired hearing loss is exposure to noise ( Merck Manual's Online Medical Library, 2012). Other causes can include:

build up of fluid behind the eardrum;

ear infections (known as otitis media);

childhood diseases, such as mumps, measles, or chicken pox; and

head trauma.

Congenital causes of hearing loss and deafness include:

a family history of hearing loss or deafness;

infections during pregnancy (such as rubella);

complications during pregnancy (such as the Rh factor, maternal diabetes, or toxicity).

A child's hearing loss or deafness may also be a characteristic of another disability such as Down syndrome, Usher syndrome, Treacher Collins syndrome, Crouzon syndrome, and Alport syndrome ( American Speech-Language-Hearing Association, n.d.).

In all cases, early detection and treatment are very important to the child's development.

Is There Help Available?

Yes, there's a lot of help available, beginning with the free evaluation of the child. The nation's special education law, the Individuals with Disabilities Education Act (IDEA), requires that all children suspected of having a disability be evaluated without cost to their parents to determine if they do have a disability and, because of the disability, need special services under IDEA. Those special services are:

Early intervention | A system of services to support infants and toddlers with disabilities (before their 3rd birthday) and their families.

Special education and related services | Services available through the public school system for school-aged children, including preschoolers (ages 3-21).

To access early intervention: To identify the EI program in your neighborhood, visit the Early Childhood Technical Assistance Center, at: http://ectacenter.org/contact/ptccoord.asp

To access special education and related services: We recommend that you get in touch with your local public school system. Calling the elementary school in your neighborhood is an excellent place to start. The school should be able to tell you the next steps to having your child evaluated free of charge and, if found eligible, he or she can begin receiving services specially designed to address your child's needs.

There are also special services available to low-income children through the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program, the child health component of Medicaid. To learn more about the EPSDT program, visit: http://www.hrsa.gov/epsdt/

Definition in IDEA

It's helpful to know that, while the terms "hearing impairment" and "hearing loss" are often used to describe a wide range of hearing losses, including deafness, IDEA actually defines the two terms separately, as follows:

Hearing impairment is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance."

Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."

Thus, deafness is viewed as a condition that prevents an individual from receiving sound in all or most of its forms. In contrast, a child with a hearing loss can generally respond to auditory stimuli, including speech.

Educational Implications

Hearing loss or deafness does not affect a person's intellectual capacity or ability to learn. However, children who are hard of hearing or deaf generally require some form of special education services in order to receive an adequate education. Such services may include:

regular speech, language, and auditory training from a specialist;

amplification systems;

services of an interpreter for those students who use sign language;

favorable seating in the class to facilitate lip reading;

captioned films/videos;

assistance of a notetaker, who takes notes for the student with a hearing loss, so that the student can fully attend to instruction;

instruction for the teacher and peers in alternate communication methods, such as sign language; and
counseling.

Children who are hard of hearing will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication. For children who are deaf or have severe hearing losses, early, consistent, and conscious use of visible communication modes (such as sign language, fingerspelling, and Cued Speech) and/or amplification and aural/oral training can help reduce this language delay.

By age four or five, most children who are deaf are enrolled in school on a full-day basis and do special work on communication and language development. Parents work with school personnel to develop an individualized education program (IEP) that details the child's special needs and the services and supports that will be provided to meet those needs. IDEA requires that the IEP team address the communication needs of a child who is deaf or hard of hearing.

Read more about communication needs as one of IDEA's "special factors"
https://www.parentcenterhub.org/special-factors/#deaf
https://www.parentcenterhub.org/considering-hearingloss/
It is important for teachers and audiologists to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is manual. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on implications of deafness within the family.

People with hearing loss use oral or manual means of communication or a combination of the two. Oral communication includes speech, lip reading, and the use of residual hearing. Manual communication involves signs and fingerspelling. Total Communication, as a method of instruction, is a combination of the oral method plus signing and fingerspelling.

Using the Relay Service

Individuals with hearing loss, including those who are deaf, now have many helpful devices available to them. Text telephones (known as TTs, TTYs, or TDDs) enable persons to type phone messages over the telephone network.

The Telecommunications Relay Service (TRS) makes it possible for TT users to communicate with virtually anyone (and vice versa) via telephone through a communications assistant. Dial 711 to access all telecommunications relay services anywhere in the United States. The relay service is free.

Resources

In alphabetical order, here's a starter list of organizations providing info and guidance on deafness and hearing loss. Explore the sites below and the wealth of material they offer on types of hearing loss, newborn and early childhood screening, the EHDI program for early detection of hearing loss, guidance for parents, suggestions for educators working with children who are deaf or hard of hearing, and much more.

Alexander Graham Bell Association for the Deaf and Hard of Hearing | www.agbell.org

American Hearing Research Foundation | www.american-hearing.org

American Society for Deaf Children |1.800.942.2732 | www.deafchildren.org/

ASHA | American Speech-Language-Hearing Association | 1.800.638.8255 | www.asha.org/public/hearing/

Beginnings | For parents of children who are deaf or hard of hearing | http://www.ncbegin.org/index.php

Better Hearing Institute | 1.800.327.9355 | http://www.betterhearing.org

CDC | Centers for Disease Control and Prevention | 1.800.CDC.INFO
www.cdc.gov/ncbddd/dd/ddhi.htm

Deaf Children and Parents | http://www.deafchildrenandsigning.com/index.html

Deaf Culture Online | http://www.deaf-culture-online.com/index.html

Hands and Voices | http://www.handsandvoices.org/

Hearing Loss Association of America | http://www.hearingloss.org/

How's Your Hearing? | http://www.howsyourhearing.com/

Info to Go | Laurent Clerc National Deaf Education Center | 202.651.5051
http://clerccenter.gallaudet.edu/Clerc_Center/Information_and_Resources/Info_To_Go.html

Listen Up! | http://www.listen-up.org

Medline Plus | http://www.nlm.nih.gov/medlineplus/hearingdisordersanddeafness.html

National Association of the Deaf | http://www.nad.org

National Center for Hearing Assessment & Management | 435.797.3584 |
http://www.infanthearing.org/

NIDCD | National Institute | on Deafness and Other Communication Disorders | 1.800.241.1044
http://www.nidcd.nih.gov/health/hearing/

PEPNET | Regional postsecondary education centers to increase access to postsecondary education for persons who are deaf.
http://www.pepnet.org
Helpful Readings on Specific Subjects
Your Baby's Hearing and Communicative Development Checklist |
http://www.nidcd.nih.gov/health/hearing/pages/silence.aspx

To Parents of Deaf Children |
http://www.deaf-culture-online.com/parents-of-deaf-children.html

Early Intervention
http://www.infanthearing.org/earlyintervention/index.html

Assistive Technology for Hearing
http://www.asha.org/public/hearing/treatment/assist_tech.htm

Communications Considerations A-Z |
http://www.handsandvoices.org/comcon/index.html

Communication Plan for a Child Who is Deaf or Hard of Hearing
http://www.handsandvoices.org/pdf/communication_plan.pdf

Cochlear Implants | www.nidcd.nih.gov/health/hearing/coch.asp

How to set up closed captioning on Netflix, HBO, Hulu. Amazon Instant Video, and more
http://exstreamist.com/streaming-television-solutions-for-the-deaf-and-hard-of-hearing/

Resources for People Who Can't Afford Hearing Aids and Cochlear Implants
http://www.hearingexchange.com/articles/paulas-110601.htm

Strategies for Teachers
https://www.parentcenterhub.org/speced/#deaf

Tips for Teachers | http://deafness.about.com/od/schooling/a/inclassroom.htm

References

American Speech-Language-Hearing Association. (n.d.). Causes of hearing loss. Available online at: www.asha.org/public/hearing/disorders/causes.htm

American Speech-Language-Hearing Association. (n.d.). The prevalence and incidence of hearing loss in children. Available online at: http://www.asha.org/public/hearing/disorders/children.htm

Centers for Disease Control and Prevention. (2012). Facts. Available online at:
http://www.cdc.gov/ncbddd/hearingloss/facts.html

Centers for Disease Control and Prevention. (2013). Hearing loss in children. Available online at: http://www.cdc.gov/ncbddd/hearingloss/about.html

eHealthMD. (2013). Different types of hearing loss. Available online at:
http://ehealthmd.com/content/different-types-hearing-loss#axzz2zvvrz36Q

Merck Manual's Online Medical Library. (2012). Hearing loss. Available online at:
http://www.merckmanuals.com/home/ear_nose_and_throat_disorders/hearing_loss_and_deafness/hearing_loss.html

March of Dimes. (2010). Hearing impairment. Available online at:
http://www.marchofdimes.com/baby/hearing-impairment.aspx

Michigan Department of Community Health. (2004). A diagram of the ear. Available online at: www.michigan.gov/documents/mdch/DCH0519A_201145_7.pdf

National Center for Hearing Assessment & Management. (n.d.). Status of early hearing detection and intervention in the United States. Available online at: www.infanthearing.org/status/index.html

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Disability Fact Sheet 3 (FS3) Links updated, May 2015 In This Publication: Caroline is six years old, with bright brown eyes and, at the moment, no front teeth, like so many other first graders. She also wears a hearing aid in each ear-and has done so since she was three, when she was diagnosed with a moderate hearing loss.

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Breakdown of Deafness Disability

Includes the 4 levels of deafness and symptoms and preventions

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Deafness and hearing loss: Causes, symptoms, and treatments

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People with a hearing impairment, hearing loss, or deafness will have either a partial or a total inability to hear sound. Some will rely on lip reading to communicate. Here, we explain the difference between hearing loss and deafness, and the types, causes, and symptoms of both.

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Explains the main causes of deafness, symptoms, types, and diagnosis and treatment.

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Tips to help Deaf students in the classroom

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When a student who uses hearing aids or sign language shows up in your classroom, what is your first reaction? Is it anxiety because you don't know how to communicate with the new student? Is it panic over managing interactions between the deaf or hard-of-hearing student (hereafter, deaf) and your other students? Is it uneasiness at having an adult interpreter in the classroom? Is it anger at the addition of yet another student with special needs to your class load? In our work in schools, we've seen all of these responses. In this article, we want to show you some strategies that can turn such negative feelings into positive anticipation.

Two of us (Christina and Thangi) are faculty members and one (Joseph) is a PhD student at Gallaudet University, the world's only university for deaf individuals. From its earliest days, the university has navigated the concepts of disability and difference, dealing with some of the same questions that teachers in K-12 schools may face today. Should deaf students receive an oral education so that they can be "normalized" into hearing society-a society that views people who cannot speak or hear as less-than? Or should American Sign Language (ASL) be offered so that deaf students can learn through a language that's natural and accessible, and allows them to grow into their own identities? Can teaching be restructured so that deaf and hearing students learn as equal partners?

At Gallaudet, we approach our deaf students as individuals who do not have disabilities. They do not hear, and that is not an issue. The students just need to learn through nonauditory means. ASL is highly valued and is used in all classes and public events by default, but spoken English is also recognized and has its place.

On campus, spaces are designed for open, visual communication. ASL is the language of the classroom because it supports direct communication, and thus stronger relationships, between teachers and students. At Gallaudet, being deaf is not only the normal, everyday way of being; it is cherished. Deaf people share a culture and a language that places value on being deaf, recognizes shared experiences, and relishes deaf individuals' contributions to society.

As educators, the three of us have all taught and worked in a wide variety of K-12 and higher education classrooms with deaf students. Collectively, we have experience in residential schools for the deaf, center-based programs for deaf students, and general-education settings that serve deaf students and hearing students together. We aim to educate both adults and students on the concept of Deaf-Gain, which reframes the idea of losing hearing into one of gaining deafness and recognizes the contributions that deaf people make to society (Bauman & Murray, 2009).

It's not easy; we face many barriers. For example, when participating in an outdoor education program with her 6th graders, Christina was told that she was the only teacher who would be required to sleep in a cabin with her students because her students were deaf. When she pushed back, the team leader resisted, despite being offered alternatives that provided the deaf students with access to communication but did not single them out. Eventually, a solution was worked out, but it came with a warning that it would only be acceptable if the parents were informed that there would be no teacher in the cabin with their deaf children. This team leader perceived the deaf children as deficient instead of as whole human beings who simply needed minor modifications to enjoy the same experience as their peers.

Rather than viewing deaf students as needing intervention, we need to recognize the benefits diverse students bring to the classroom. To illustrate, as an elementary school principal at the American School for the Deaf, Thangi arranged a partnership between kindergartners at her school and a neighboring Montessori school. The deaf students were exposed to the enriching experience of the Montessori curriculum, while the hearing students were exposed to the richness of ASL. They learned how to communicate visually in ways that did not disrupt the flow of the classroom.

Joseph was formerly an English-language arts instructor in an ASL and English bilingual secondary school that enrolled both deaf and hearing students. He and his team often had to reframe the perception of what it means to be deaf, explore strategies that worked for all students in a cohort, and incorporate Universal Design for Learning (UDL) principles into instruction.

UDL helps us approach planning by looking at all of our students as individuals with unique learning profiles. The UDL framework allows educators to shrug off the "this-disability-equals-this-accommodation" formula and review what students need to participate in a particular unit, lesson, or activity. It enables us to design learning in a way that does not limit students by stereotypes or pre-existing expectations. In this context, here are a few strategies that support the learning needs of not only students who are deaf but also of their hearing counterparts.

Closed captioning is an obvious strategy for educators who work with deaf students, but it also benefits students who are not deaf. Closed captioning provides deaf students with access to the words that are being spoken as well as important sounds that are part of a video. And hearing students, particularly English language learners, can benefit from seeing the written words while listening to what is being said, thus strengthening the connection between spoken and written words.

Closed captioning supports the language and literacy development of all students. This is typical of many UDL strategies-materials and procedures that improve accessibility for a particular subgroup actually benefit a broader group. Here are tips for using closed captioning successfully:

▪ Always check the video for the closed captioning symbol, and know how to turn the captions on before class starts.

▪ Change the color and size of captions whenever possible to make them accessible to students with visual differences.

▪ Filter searches on YouTube to show only closed-captioned videos, or use Amara (http://amara.org/en/videos/watch) to search for a list of videos with accurate captions.

▪ Be aware of the difference between automatic captions, which are often unintelligible, and closed captions, which are typed and reviewed.

▪ Sign up for the Described and Captioned Media Program (http://www.dcmp.org) to locate free, accessible videos.

▪ Review the video product yourself, with captions, to ensure accuracy.

Deaf students access information and the world through visual and tactile means. Providing visual cues and information is a fundamental part of deaf education, one that also benefits hearing students.

One of Christina's most powerful learning experiences occurred during a professional development workshop. The facilitator was making a case for supporting students who had just arrived in the United States and who were expected to learn content even though they did not know English. The facilitator showed a video of an instructor teaching in Farsi, and then asked the workshop participants questions about the topic of the lesson. No one in the workshop could answer the questions. The facilitator then showed the same lesson conducted in Farsi, but with the use of pictures and objects that provided context; this time, participants could answer most of the questions about the lesson. The power of using visuals to support learning for all students was made clear in this workshop-even to a veteran educator of deaf students.

We've found that anything that is language-based, whether oral or in print, can be supported with pictures, demonstrations, or graphics. Start small by identifying a slide or two in your next presentation that could use a makeover and representing that information in a visually appealing way. For example, when teaching complex verb tenses, use photos to illustrate actions. In social studies, use graphs or pictures to highlight concepts. It's worth the payoff in student learning.

Educators should also take time to think about how they present and organize visuals so they can do so in ways that benefit diverse classrooms. Some instructors speak while showing visual images. This can be confusing for deaf students, who must split their attention, looking at the interpreter or lipreading the teacher and examining the image at the same time (Mather & Clark, 2012). It can also confuse some hearing students, especially when they're beginning to learn new concepts. If you plan lessons to give students time to view visuals before you discuss them, students are likely to be more engaged with the lesson.

Here are a few more strategies you can implement to make the classroom more visual:

▪ Use gestures, props, or role plays to illustrate processes or ideas.

▪ Add pictorial or graphic representations to text content.

▪ Create videos to show how ideas connect.

▪ Provide graphic organizers or mind maps.

▪ Color code concepts and ideas.

▪ Be aware of visual needs as well; if colorblindness is an issue for any of your students, use bold, italics, white space, and other types of style formatting to differentiate text.

▪ Incorporate project-based learning activities that enable students to interact with artifacts and primary-source documents at their own pace.

Support for students' social development, which is important in all schools, has long been one of the strengths of state schools for the deaf. Students who are deaf are different from other minority groups in that they constitute a very small part of the population (less than 1 percent) and they often cannot even identify with their family members, who are usually hearing. Schools for the deaf provide linguistic and social access for students who are deaf by providing a critical mass of deaf students. Center-based programs can serve a similar purpose.

However, 80-85 percent of students who are identified as deaf or hard-of-hearing receive their education in their neighborhood school (U.S. Department of Education, 2015). In American Sign Language, the standard sign for "mainstream" is both hands in a five-handshape (all five fingers extended) overlapping. But this sign has recently changed so that one hand has only one finger extended, symbolizing the loneliness that the mainstreaming experience can generate.

Teachers in neighborhood schools who have deaf students in their classes must find a way to support these students' social development and engagement. That's no easy feat when you consider the common tendency of children to reject peers who are different, the challenges of communication, and the issue of having an adult interpreter present. This last item can be particularly tricky when students enter puberty and tend to reject adult intervention. Having an interpreter around may be a social liability; other students may feel uncomfortable with this adult interlocutor and therefore reject the deaf student's participation in social groups.

But teachers can overcome these challenges with a bit of elbow grease, planning, and use of multiple means of engagement, the UDL principle that emphasizes bringing students' lives and interests into instruction. Specific strategies for engaging students socially include the following:

▪ Provide examples of famous or influential deaf people in each content area as frequently as possible-for example, Beethoven (music), Thomas Edison (inventor), Vinton Cerf (commonly known as the "father of the Internet"), Annie Jump Cannon (astronomer), Marlee Matlin (actress), Connie Briscoe (author), and Dorothy Miles (poet).

▪ Teach students a variety of prosocial ways to interact with one another. Incorporate ASL signs into instruction, and teach hearing students the signs to communicate simple interactions like agreement or greeting. Enable students who are deaf to use text or chat programs, or a shared Google document, to connect in group discussions. Creating environments where all students can communicate more easily gives them equity in the classroom.

▪ Use a variety of grouping strategies to give students opportunities to work in smaller groups as well as larger groups.

▪ Create communication norms to allow for full participation in the classroom. For example, have one person speak at a time, have the speaker stand at the front of the room, ensure that the speaker is not moving and is facing the deaf student, and allow time for attention to move between speakers.

When we change the stereotypical narrative that casts deaf students as having a disability and move to a narrative that views them as learners with differences, we gain insight into strategies that benefit all students. This process is enacted daily on the campus of Gallaudet University and in many residential schools for the deaf around the world. The basic premise of Universal Design for Learning is that instructional materials and processes that give one student more access to learning in fact benefit all students-either directly, in terms of content, or indirectly, in terms of modelling equity. The strategies shared here will not only increase student achievement, but also help students thrive by giving them classrooms that recognize and value the differences they bring.

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Supporting Deaf Students-And All Students

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These strategies can help students thrive by recognizing and valuing the differences they bring to the classroom.

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12 Ways to help Teachers make the classroom and better learning environment for students that are Deaf or Hard-of-Hearing

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For more information about accessibility solutions, . We'd love for you to test drive Ava in class!

Image Description: Teacher is wearing a mask and holding a book out to a student who is seated and wearing a mask. Other students are sitting at their desks nearby with masks on and looking towards the teacher.

Now that the COVID-19 vaccines are spreading throughout the US, many schools are starting to plan to head back into the physical classroom.

Many are excited for the return to "normalcy," but for some students, in-person classroom attendance means additional barriers to communications, especially for students who are Deaf or hard-of-hearing. How can we support these students with special needs?

Whether you're a teacher, accessibility manager, or even a concerned parent, if you are supporting Deaf or hard-of-hearing students, this is for you!

How to Accommodate Deaf Students in the Classroom

Image Description: Teacher is facing the classroom holding up a light bulb. There are four students sitting behind white desks looking towards the teacher attentively. In the background, there are book shelves and plants.

We sat down with Grace, who works in education as an Assistive Technology Specialist. In her role, she is responsible for making sure that classrooms are accessible for students with access needs. We asked her to share her best practices for communication access in the classroom. Here's what she said:

1. Ensure comfortable lighting

Lighting that is too dark makes it hard to see and lighting that is too bright (like harsh florescent lighting) can be taxing on the eyes. Comfortably lit areas with natural light are best. (Also, make sure whoever is speaking doesn't have shadows on their face or glare coming from behind them.)

2. Reduce visual noise

Image Description: In a classroom, children are sitting at their desks, which are arranged in a semi-circle. All students can see each other and are chatting with one another.

Students who are Deaf and hard-of-hearing folx often use their eyes to listen. Just as background noise can make it hard to hear what someone is saying, visual busyness (patterns, clutter, flashing or moving graphics, etc.) can make it hard for someone to visually focus on signs, lipreading, or facial expressions. Wearing shirts without patterns and keeping the classroom uncluttered help.

3. Sit people in a semi-circle arrangement where everyone can see everything

Image Description: In the foreground, a man and woman are talking face-to-face in front of a table and chairs. They have strong eye contact and the man is using his hands to describe something. In the background, a man is standing while on his phone. Two other people have their backs turned to adjust some post-its on a corkboard.

Since Deaf and hard-of-hearing students often listen with their eyes, it's important to arrange all participants so that everyone can see everyone at the same time. Generally, creating a semi-circle or circular seating arrangement allows for this.

4. Only address people from in front and when you have their attention

If the conversation happens from behind or to the side, a Deaf or hard-of-hearing student might not catch what is said because they might not be able to hear well in that direction. Getting a student's attention before you communicate with them - and making sure you are in front of them in clear view - maximizes their ability to understand what you are saying.

5. Use visual supports to explain concepts

Because Deaf and hard-of-hearing students largely engage with the world visually, using visual supports such as pictures, graphs, models, and gestures help enhance comprehension.

6. Provide notes and resources

Deaf and hard-of-hearing students generally use their eyes to listen, so it's hard to look down and take notes without missing what someone is saying in the front of the room.

Providing silent mini-breaks in the lecture for students to write notes, providing notes beforehand, and providing a transcript afterward are all ways to let students both listen to the full lecture and take notes.

Ava provides the option to save transcripts after a captioning session. Learn more about using Ava for live captions and notes!

7. Address the student, not the interpreter

Sometimes students will use interpreters in educational settings. Remember that the interpreter is merely providing a voice but the student is the actual person talking. Looking and talking directly at the student when communicating and addressing them shows respect.

8. Use the student's preferred means of communication

Every Deaf and hard-of-hearing student is unique. Ask them what their preferred method of communication is and follow that path. As a teacher, you have the unique opportunity to advocate for your students. If the school doesn't provide any accommodations for their communication style, you have the power to make that happen.

Ava provides advocacy services to assist teachers and accessibility specialists who are trying to support their students. Contact our Advocacy Team for more information.

9. Design your class with Universal Design for Learning concepts and provide multiple means of representation, expression, and engagement

The Universal Design for Learning (UDL) philosophy proposes that education and the classroom experience should be as accessible as possible for everyone - students of different language and cultural backgrounds, introverts, extroverts, students with disabilities, older students, and everyone in between.

Following UDL principles will help you create a classroom that works for everyone, including Deaf and hard-of-hearing students. In particular, the UDL tenets of providing options for perception and options for expression and communication will allow Deaf and hard-of-hearing students to work from their strengths and get the most out of the classroom experience.

10. Create a classroom culture of respect

It's hard to learn if you don't feel safe. Safety starts by creating a classroom culture that respects and values all students, including Deaf and hard-of-hearing students. Practicing Deaf etiquette and discussing accommodations in a friendly, professional, and confidential way are great steps in the right direction.

11. Keep open lines of communication with the student

It's important to keep an open line of communication with your student so that you both can check in with each other to see how the strategies you are using are going.

12. Ensure that students are included

A lot of the learning that happens in school is incidental learning that happens outside of the lecture itself. Often Deaf and hard-of-hearing students miss opportunities for incidental learning because they cannot participate in the talk that happens before and after classes.

Make sure students are aware of important announcements and events. Encourage a school culture of inclusion by providing tools and resources for peers to communicate more easily.

As we re-enter the classroom, it's so important that we take extra efforts to accommodate our Deaf and hard-of-hearing students so that they get the same access as everyone else. How do you practice accessibility and inclusion for your students? Share with us in the comments below!

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12 Ways to Make Classrooms Accessible for Deaf & Hard-of-Hearing Students

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For more information about accessibility solutions, . We'd love for you to test drive Ava in class! Now that the COVID-19 vaccines are spreading throughout the US, many schools are starting to plan to head back into the physical classroom.

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Instructional Strategies to help teachers better teach students who are Deaf

Includes: technology, literacy, body placement and more!

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Instructional Strategies for Students who are Deaf and Hard of Hearing

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The mission of Virginia’s Training and Technical Assistance Centers (T/TAC) is to improve educational opportunities and contribute to the success of children and youth with disabilities (birth - 22 years). The Centers provide quality training and technical assistance in response to local, regional, and state needs. T/TAC services increase the capacity of schools, school personnel, service providers, and families to meet the needs of children and youth.

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Ways to help teachers better accommodate students who are deaf.

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RSV is a highly contagious illness that infects nearly every child at least once before they are two years old. Until recently, there was no good prevention plan for parents to put into action. Now, everything has changed.

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At Nationwide Children's Hospital, our vision remains unchanged. We aspire to create the best outcomes for children everywhere. This means families come to Nationwide Children's from around the globe knowing they will get the highest quality care. When your child needs a hospital, everything matters.

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State by State links for resources in your area.

Phone service, Video relay, and non-profit information

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Resources for the Deaf & Hard of Hearing Community

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There are many resources and organizations that serve the deaf and hard of hearing community. Different & Able has compiled a list of resources, phone services, and nonprofits that work with individuals who are deaf or hard of hearing.

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Links to point those who are deaf in the right direction for help. Includes: phone numbers for regional ADA coordinators, how to get hearing aids, and more

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Deaf and Hard of Hearing Clients | Florida DCF

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The following links are available to clients who are deaf or hard of hearing. The resources available within the linked pages include videos that provide information on services available, contacts for Regional ADA coordinators, telephone numbers, and other resources.

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Volunteers with ties to the Deaf and Hard-of-Hearing community willing to assist anyone in need. Find the chapter near you to speak to a representative.

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The Hearing Loss Association of Florida, Inc. - A Voluntary Non-Profit Organization

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To see if there is a Florida HLAA Local Chapter or Support Group in your area, browse through the list of Chapters below. If there aren't any chapters in your area, contact the National Chapter Coordinator about today!
HLAA Florida Association fulfills its mission because of the dedication of its corps of volunteers at the state and local levels across Florida. HLAA (FL) volunteers are people with hearing loss, their families and friends, and those in the professional community. Our volunteers, in turn, are rewarded with the experience of making a clear and dramatic impact on the lives of people with hearing loss. We hope your shared experiences enriches your lives as it has our organization and those we serve.

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Find A Florida Support Chapter - The Hearing Loss Association of Florida, Inc. - A Voluntary Non-Profit Organization

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Local Florida Chapters Chapters are local or area-wide organizations offering regularly-scheduled meetings and programs. Chapters offer emotional support, camaraderie, tips and techniques for living with hearing loss, technical information about hearing assistive technology, in a hearing-friendly place. They offer the inter-personal connection that simply cannot be replicated online.

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The Coordinating Council is a resource for deaf and hard of hearing Floridians who need assistance with everyday needs including employment, education and access to services.

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Welcome to the Florida Coordinating Council for the Deaf and Hard of Hearing website, (FCCDHH)

Florida Coordinating Council for the Deaf and Hard of Hearing, hereafter referred to as the "Coordinating Council" is mandated by Section 413.271 Florida Statutes to serve as an advisory and coordinating body which recommends policies that address the needs of Florida's deaf, hard of hearing, late-deafened and deaf-blind (hereafter referred to collectively as "hearing loss") community.

The Coordinating Council is a resource for deaf and hard of hearing Floridians who need assistance with everyday needs including employment, education and access to services. The Coordinating Council is dedicated to assisting the nearly 3 million Floridians affected by hearing loss through providing technical assistance and resources to individuals, governmental agencies, private and public organizations.

The Coordinating Council's technical assistance allows both public and private entities to better and more efficiently serve persons with hearing loss and their families. This information can also help those entities avoid costly and unnecessary litigation resulting from violations of the Americans with Disabilities Act (ADA) and other laws and statutes that provide for protection of civil rights.

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florida coordinating council for the deaf and hard of hearing

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Florida Coordinating Council for the Deaf and Hard of Hearing

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Florida Coordinating Council for the Deaf and Hard of Hearing, hereafter referred to as the "Coordinating Council" is mandated by Section 413.271 Florida Statutes to serve as an advisory and coordinating body which recommends policies that address the needs of Florida's deaf, hard of hearing, late-deafened and deaf-blind (hereafter referred to collectively as "hearing loss") community.

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For Parents of Newly Identified Deaf or Hard of Hearing Children

Links and resources to help you on your journey

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Getting Started
If you are reading this you probably recently have found out your child is deaf or hard of hearing. The news may have come as a shock - maybe you never met a deaf person before. Or maybe it came as a relief - perhaps noticed your child wasn't responding to your voice but were not sure why. In any case, you are looking for answers and support. Here are some tips to consider as you gather information and make decisions for your child and family.

Language and communication. The ability to express and understand language and to be able to communicate is essential to our lives. It is what makes us human and allows us to learn and grow. Your child can develop language and communication and reach his/ her potential. Some families choose to use sign language with their child as well as speak, others choose spoken language only. Regardless of how you communicate, your child should have as much access to the language as possible. Pay attention to how s/he responds and whether s/he reaches her language milestones on time.

Speech and language. Language is a linguistic system of symbols that can be expressed several different ways, including through speech. Speech is not the same thing as language. Many deaf and hard of hearing children and adults have a complete language foundation although they may not have the ability to speak. The ability to speak has nothing to do with a person's intelligence. Further, the ability to speak does not interfere with the learning of sign language, and the ability to sign does not interfere with the learning of speech. Communicate with your child as richly as possible, to the best of your ability.

Early intervention. Ensure your child is enrolled in an early intervention program in your area. For most children, early intervention is necessary to develop age appropriate language skills. (See Early Intervention Services.)

Assistive technology. Most deaf and hard of hearing children benefit from hearing aids, so try to have your child fitted with hearing aids soon. Try to work with an audiologist with experience with young children to find the most appropriate hearing aid for your child. Some families also use additional assistive listening systems. Families also use visual alerting systems in the home, such as a flashing light connected to the doorbell, to give their child information about what is happening in their environment.

Learn from other parents. Meeting other parents of deaf or hard of hearing children will provide support and information that only another parent can provide. Ask your early intervention program to connect you with parent groups or individual parents within your community.

Learn from deaf and hard of hearing adults. Many deaf and hard of hearing individuals are happy to answer your questions about raising a child with hearing loss and give you practical suggestions for communication at home. Ask your early intervention program about a Deaf Mentor program, groups, and events in your area.

No decision needs to be forever. There will be many twists and turns throughout the life of your child and family. Be flexible enough to stay with approaches that work and to modify those that don't. Take your cues from your child. Observing your child's development will help guide you on this sometimes difficult, yet rewarding path.

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Getting Started If you are reading this you probably recently have found out your child is deaf or hard of hearing. The news may have come as a shock - maybe you never met a deaf person before. Or maybe it came as a relief - perhaps noticed your child wasn't responding to your voice but were not sure why.

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Activities, scholarships, and more for parents of children who are deaf.

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There is no one right way.

Every child and family is different. Values, experiences, opinions, and resources vary from family to family. What works in one situation may not work in another. There are a number of ways to be successful raising a deaf or hard of hearing child. No one plan or formula will work for everyone. You must do what you believe is right for your child and family. ASDC is comprised of a board of parents of deaf children as well as deaf adults and we have compiled for you the ASDC Information book. Our gift to you will provide you with our combined expertise in one place.

Get to know other parents of deaf and hard of hearing children

All parents want what is best for their child. Meeting other parents and learning about their experiences can help you find out about options, resources and can serve as a means of support.

Get to know deaf and hard of hearing role models

Spending time with deaf and hard of hearing role models can help you understand what it means to be deaf. Your deaf or hard of hearing child can achieve the same academic, social, and personal fulfillment as hearing children. Did you know that most deaf and hard of hearing adults grew up in a hearing family? Their experience, information, and perspective can help you as you navigate your families journey.

Recommended Reading

Increasing Literacy Skills with Your Deaf Infant It is never too early to communicate with your child, especially if they are deaf or hard of hearing. The Infant and Toddler Program If your infant or toddler has been identified with a hearing loss, they may be eligible for services under the Infant and Toddlers Program of the Individuals with Disabilities Education Act (IDEA). Picking Educational Programs Often parents want to know what the best program is, or whether a particular program is better than another one.

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Parents and Families - American Society for Deaf Children

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Every child and family is different. Values, experiences, opinions, and resources vary from family to family. What works in one situation may not work in another. There are a number of ways to be successful raising a deaf or hard of hearing child. No one plan or formula will work for everyone.

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Linked with resources for parents. This includes emotional support, guidance, testing, and so much more

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Just in Time Resources for Families/ Children Who Are Deaf/ Hard of Hearing | NCHAM

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‘Just in Time’ Resources to Support Families of Children Who Are Deaf or Hard of Hearing

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Filled with links for different resources to get your child ready for school!

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Resources Overview Toolkits Back to School Guides Find guides, templates, overviews, publications, videos and more. Our resources are developed by experts, covering a variety of topics to support evidence-based practices in postsecondary outcomes for deaf individuals. Video description Starting a new school year, while exciting, can also be uncertain.

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TV shows and movies that bring awareness to the Deaf community.

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17 Powerful TV Shows with Deaf Characters | tvshowpilot.com

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Here we’re listing the best TV shows that feature deaf characters who are portrayed not as disadvantaged but as regular people living their lives.

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Different Schools all over the world geared towards teaching the Deaf

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List of schools for the deaf - Wikipedia

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This is a list of schools for the deaf, organized by country.

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This free, choose-your-own adventure game for deaf teens is designed to be both educational and fun. You’ll navigate challenging situations, make choices that shape your future, and pick up important skills for success in high school and beyond.

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Deafverse is a choose-your-own-adventure online game created just for deaf teenagers, where they can learn important skills for success in high school and beyond. Players get to make their own choices, stand up for themselves, and build confidence and skills they can use in real life.

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Games that are geared towards Deaf children

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8 Activities and Games for Deaf Children | Its Psychology

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Here we present a list of games and activities for deaf children that you can do in the educational field and even at home to improve their autonomy and understanding of the world around them. Sometimes, it is difficult to know the type of exercise we can do with children who have some type of deafness. However, it […]