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There are several parts of the ear, including the outer, middle, and inner ear.

A hearing loss can happen when any part of the ear or auditory (hearing) system is not working in the usual way.

There are four types of hearing loss: conductive, sensorineural, mixed, and auditory neuropathy spectrum disorder

The degree of hearing loss can range from mild to profound.

Parts of the ear

Outer ear. The outer ear is made up of

The part we see on the sides of our heads, known as pinna.

The ear canal.

The eardrum, sometimes called the tympanic membrane, which separates the outer and middle ear.

Middle ear. The middle ear is made up of

The eardrum.

Three small bones called ossicles that send the movement of the eardrum to the inner ear.

Inner ear. The inner ear is made up of

The snail-shaped organ for hearing known as the cochlea.

The semicircular canals that help with balance.

The nerves that go to the brain.

Auditory (ear) nerve. This nerve sends sound information from the ear to the brain.

Auditory (hearing) system. The auditory pathway processes sound information as it travels from the ear to the brain so that our brain pathways are part of our hearing.

Four types of hearing loss

Conductive hearing loss. Hearing loss caused by something that stops sounds from getting through the outer or middle ear. This type of hearing loss can often be treated with medicine or surgery.

Sensorineural hearing loss. Hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works.

Mixed hearing loss. Hearing loss that includes both a conductive and a sensorineural hearing loss.

Degree of hearing loss

Mild hearing loss. A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.

Moderate hearing loss. A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.

Severe hearing loss. A person with severe hearing loss will hear no speech when a person is talking at a normal level and only some loud sounds.

Profound hearing loss. A person with a profound hearing loss will not hear any speech and only very loud sounds.

Hearing loss can also be described as:

Unilateral or bilateral. Hearing loss is in one ear (unilateral) or both ears (bilateral).

Pre-lingual or post-lingual. Hearing loss happened before a person learned to talk (pre-lingual) or after a person learned to talk (post-lingual).

Symmetrical or asymmetrical. Hearing loss is the same in both ears (symmetrical) or is different in each ear (asymmetrical).

Progressive or sudden. Hearing loss worsens over time (progressive) or happens quickly (sudden).

Fluctuating or stable. Hearing loss gets either better or worse over time (fluctuating) or stays the same over time (stable).

Congenital or acquired/delayed onset. Hearing loss is present at birth (congenital) or appears sometime later in life (acquired or delayed onset).

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Learn about parts of the ear, types of hearing loss, and degree of hearing loss.

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Hearing screening is a test to tell if people might have hearing loss. Hearing screening is easy and not painful. It usually only takes a few minutes.

If a baby or child does not pass a hearing screening, it's very important to get a full hearing test as soon as possible. This test is also called an audiology evaluation.

Recommended Early Hearing Detection and Intervention (EHDI) benchmarks include screening for hearing loss before 1 month of age, diagnostic evaluation before 3 months of age, and enrollment in early intervention before 6 months of age, known as the 1-3-6 benchmarks.

Why get a child screened or tested for hearing loss

Hearing loss can affect a child's ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you are a parent or caregiver and you suspect your child has hearing loss, trust your instincts and speak with your doctor.

When to get a child screened or tested for hearing loss

Babies

All babies should be screened for hearing loss no later than 1 month of age. It is best if they are screened before leaving the hospital after birth.

If a baby does not pass a hearing screening, it is very important to get a full hearing test as soon as possible, but no later than 3 months of age.

Older babies and children

If you think a child might have hearing loss, ask the doctor for a hearing test as soon as possible.

Children who are at risk for acquired, progressive, or delayed-onset hearing loss should have at least one hearing test by 2 to 2 1/2 years of age. Hearing loss that gets worse over time is known as progressive hearing loss. Hearing loss that develops after the baby is born is called delayed-onset or acquired hearing loss. Find out if a child may be at risk for hearing loss.

If a child does not pass a hearing screening, it is very important to get a full hearing test as soon as possible.

Types of tests

All children who do not pass a hearing screening should have a full hearing test. This test is also called an audiology evaluation. An audiologist, who is an expert trained to test hearing, will do the full hearing test. In addition, the audiologist will also ask questions about birth history, ear infection, and hearing loss in the family.

There are many kinds of tests an audiologist can do to find out if a person has a hearing loss, how much of a hearing loss there is, and what type it is. The hearing tests are easy and not painful.

Some of the tests the audiologist might use include:

Auditory Brainstem Response Test or Brainstem Auditory Evoked Response Test

Auditory Brainstem Response (ABR) or Brainstem Auditory Evoked Response (BAER) is a test that checks the brain's response to sound. Because this test does not rely on a person's response behavior, the person being tested can be sound asleep during the test.

ABR focuses only on the function of the inner ear, the acoustic (hearing) nerve, and part of the brain pathways that are associated with hearing. For this test, electrodes are placed on the person's head (similar to electrodes placed around the heart when an electrocardiogram (EKG) is done), and brain wave activity in response to sound is recorded.

Otoacoustic Emissions

Otoacoustic Emissions (OAE) is a test that checks the inner ear response to sound. Because this test does not rely on a person's response behavior, the person being tested can be sound asleep during the test.

Behavioral Audiometry Evaluation

Behavioral Audiometry Evaluation will test how a person responds to sound overall. Behavioral Audiometry Evaluation tests the function of all parts of the ear. The person being tested must be awake and actively respond to sounds heard during the test.

Infants and toddlers are observed for changes in their behavior such as sucking a pacifier, quieting, or searching for the sound. They are rewarded for the correct response by getting to watch an animated toy (this is called Visual Reinforcement Audiometry). Sometimes older children are given a more play-like activity (this is called Conditioned Play Audiometry).

With the parents' permission, the audiologist will share the results with the child's primary care doctor and other experts, such as:

An ear, nose and throat doctor, also called an otolaryngologist

An eye doctor, also called an ophthalmologist

A professional trained in genetics, also called a clinical geneticist or a genetics counselor

For more information about hearing tests, visit the American Speech-Language-Hearing Association website.

Get help!

If a parent or anyone else who knows a child well thinks the child might have hearing loss, ask the doctor for a hearing screening as soon as possible. Don't wait!

If the child does not pass a hearing screening, ask the doctor for a full hearing test.

If the child is diagnosed with a hearing loss, talk to the doctor or audiologist about treatment and intervention services.

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Learn more about hearing screening and testing for children

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Treatment and intervention types

Intervention Services

Early Intervention (0-3 years)

Hearing loss can affect a child's ability to develop speech, language, and social skills. The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the child's communication (speech or sign language) and social skills will reach their full potential.

Early intervention program services help young children with hearing loss learn communication and other important skills. Research shows that early intervention services can greatly improve a child's development.

Babies who are diagnosed with hearing loss should begin to get intervention services as soon as possible, but no later than 6 months of age.

There are many services available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004). Services for children from birth through 36 months of age are called Early Intervention or Part C services. Even if your child has not been diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

Special Education (3-22 years)

Special education is instruction specifically designed to address the educational and related developmental needs of older children with disabilities, or those who are experiencing developmental delays. Services for these children are provided through the public school system. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.

Assistive Technology

Many people who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing person has is called "residual hearing." Technology does not "cure" hearing loss but may help a child with hearing loss to make the most of their residual hearing. For those parents who choose to have their child use technology, there are many options, including

Hearing aids

Cochlear or brainstem implants

Bone-anchored hearing aids

Other assistive devices

Hearing Aids

Hearing aids make sounds louder. They can be worn by people of any age, including infants. Babies with hearing loss may understand sounds better using hearing aids. This may give them the chance to learn speech skills at a young age.

There are many styles of hearing aids. They can help many types of hearing losses. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.

Cochlear and Auditory Brainstem Implants

A cochlear implant may help many children with severe to profound hearing loss-even very young children. It gives that child a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve.

Persons with severe to profound hearing loss due to an absent or very small hearing nerve or severely abnormal inner ear (cochlea), may not benefit from a hearing aid or cochlear implant. Instead an auditory brainstem implant may provide some hearing. An auditory brainstem implant directly stimulates the hearing pathways in the brainstem, bypassing the inner ear and hearing nerve.

Both cochlear and brainstem implants have two main parts. There are the parts that are placed inside the inner ear, the cochlea, or base of the brain, the brainstem during surgery; and the parts outside the ear that send sounds to the parts inside the ear.

Bone-Anchored Hearing Aids

This type of hearing aid can be considered when a child has either a conductive, mixed, or unilateral hearing loss and is specifically suitable for children who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids.

Other Assistive Devices

Besides hearing aids, there are other devices that help people with hearing loss. Examples of other assistive devices include

Frequency Modulation (FM) System. An FM system is a device that helps people with hearing loss hear in background noise. FM is the same type of signal used for radios. These systems send sound from a microphone used by someone speaking to a person wearing the receiver. FM is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system.

Captioning. Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don't have to buy anything special. Captions show the conversation spoken in soundtrack of a program on the bottom of the television screen.

Other devices. There are many other devices available for children with hearing loss. Some of these include

Text messaging

Telephone amplifiers

Flashing and vibrating alarms

Audio loop systems

Infrared listening devices

Portable sound amplifiers

TTY (Text Telephone or teletypewriter)

Medications and Surgery

Medications or surgery may also help make the most of a person's hearing. This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.

One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Most ear infections are managed with medication or careful monitoring. Infections that don't go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.

Another type of conductive hearing loss is caused by either the outer and or middle ear not forming correctly while the baby was growing in the mother's womb. Both the outer and middle ear need to work together in order for sound to be sent correctly to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem may be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.

Placing a cochlear implant, auditory brainstem implant, or bone-anchored hearing aid will also require a surgery.

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Treatment and Intervention for Hearing Loss

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Early intervention, special education, assistive hearing devices, medical and surgical

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Otitis Media
What is otitis media?
Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with the buildup of fluid. The fluid may or may not be infected.

Symptoms, severity, frequency, and length of the condition vary. At one extreme is a single short period of thin, clear, noninfected fluid without any pain or fever but with a slight decrease in hearing ability. At the other extreme are repeated bouts with infection, thick "glue-like" fluid and possible complications such as permanent hearing loss.

Fluctuating conductive hearing loss nearly always occurs with all types of otitis media. In fact it is the most common cause of hearing loss in young children.
How common is otitis media?
Otitis media is the most frequently diagnosed disease in infants and young children (1). Seventy-five percent of children experience at least one episode of otitis media by their third birthday. Almost one-half of these children will have three or more ear infections during their first 3 years of life (2). Health costs for otitis media in the United States have been reported to be $3 billion to $5 billion per year (3).
Why is otitis media so common in children?
The eustachian tube, a passage between the middle ear and the back of the throat, is smaller and more nearly horizontal in children than in adults. Therefore, it can be more easily blocked by conditions such as large adenoids and infections. Until the eustachian tube changes in size and angle as the child grows, children are more susceptible to otitis media.
How can otitis media cause a hearing loss?
Three tiny bones in the middle ear carry sound vibrations from the eardrum to the inner ear. When fluid is present, the vibrations are not transmitted efficiently and sound energy is lost. The result may be mild or even moderate hearing loss. Therefore, speech sounds are muffled or inaudible.

Generally, this type of hearing loss is conductive and is temporary. However when otitis media occurs over and over again, damage to the eardrum, the bones of the ear, or even the hearing nerve can occur and cause a permanent, sensorineural hearing loss.
Can hearing loss due to otitis media cause speech and language problems?
Children learn speech and language from listening to other people talk. The first few years of life are especially critical for this development.

If a hearing loss exists, a child does not get the full benefit of language learning experiences.

Otitis media without infection presents a special problem because symptoms of pain and fever are usually not present. Therefore, weeks and even months can go by before parents suspect a problem. During this time, the child may miss out on some of the information that can influence speech and language development.
How can I tell if my child might have otitis media?
Even if there is no pain or fever, there are other signs you can look for that may indicate chronic or recurring fluid in the ear:

Inattentiveness

Wanting the television or radio louder than usual

Misunderstanding directions

Listlessness

Unexplained irritability

Pulling or scratching at the ears

What should I do if I think that otitis media is causing a hearing, speech, or language problem?
A physician should handle the medical treatment. Ear infections require immediate attention, most likely from a pediatrician or otolaryngologist (ear doctor). If your child has frequently recurring infections and/or chronic fluid in the middle ear, two additional specialists should be consulted: an audiologist and a speech-language pathologist.

An audiologist's evaluation will assess the severity of any hearing loss, even in a very young or uncooperative child, and will indicate if a middle ear disorder is present.

A speech-language pathologist measures your child's specific speech and language skills and can recommend and/or provide remedial programs when they are needed.
Will my physician refer my child for these special evaluations?
As a parent, you are the best person to look for signs that suggest poor hearing. The American Academy of Pediatrics recognizes this when it states, "Any child whose parent expresses concern about whether the child hears should be considered for referral for behavioral audiometry without delay".

Parents should not be afraid to let their instincts guide them in requesting or independently arranging for further evaluation whenever they are concerned about their children' s health or development.

Congenital Causes

The term congenital hearing loss implies that the hearing loss is present at birth. It can include hereditary hearing loss or hearing loss due to other factors present either in utero (prenatal) or at the time of birth.

Genetic factors are thought to cause more than 50% of all incidents of congenital hearing loss in children (4). Genetic hearing loss may be autosomal dominant, autosomal recessive, or X-linked (related to the sex chromosome).

In autosomal dominant hearing loss , one parent who carries the dominant gene for hearing loss and typically has a hearing loss passes it on to the child. In this case there is at least a 50% probability that the child will also have a hearing loss. The probability is higher if both parents have the dominant gene (and typically both have a hearing loss) or if both grandparents on one side of the family have hearing loss due to genetic causes. Because at least one parent usually has a hearing loss, there is prior expectation that the child may have a hearing loss.

In autosomal recessive hearing loss , both parents who typically have normal hearing, carry a recessive gene. In this case the probability of the child having a hearing loss is 25%. Because both parents usually have normal hearing, and because no other family members have hearing loss, there is no prior expectation that the child may have a hearing loss.

In X-linked hearing loss, the mother carries the recessive trait for hearing loss on the sex chromosome and passes it on to males, but not to females.

There are some genetic syndromes,in which, hearing loss is one of the known characteristics. Some examples are Down syndrome (abnormality on a gene), Usher syndrome (autosomal recessive), Treacher Collins syndrome (autosomal dominant), Crouzon syndrome (autosomal dominant), and Alport syndrome (X-linked).

Other causes of congenital hearing loss that are not hereditary in nature include prenatal infections, illnesses, toxins consumed by the mother during pregnancy or other conditions occurring at the time of birth or shortly thereafter. These conditions typically cause sensorineural hearing loss ranging from mild to profound in degree. Examples include:

Intrauterine infections including rubella (German measles), cytomegalovirus, and herpes simplex virus

Complications associated with the Rh factor in the blood

Prematurity

Maternal diabetes

Toxemia during pregnancy

Lack of oxygen (anoxia)

Acquired Causes

Acquired hearing loss is a hearing loss which appears after birth, at any time in one's life, perhaps as a result of a disease, a condition, or an injury. The following are examples of conditions that can cause acquired hearing loss in children are:

Ear infections (otitis media) (link to specific section above)

Ototoxic (damaging to the auditory system) drugs

Meningitis

Measles

Encephalitis

Chicken pox

Influenza

Mumps

Head injury

Noise exposure

Finding Help
How can I find an audiologist or speech-language pathologist?
Search ASHA ProFind or contact the American Speech-Language-Hearing Association's Action Center, 2200 Research Boulevard #425, Rockville, Maryland 20850. Phone: 800-638-8255 or 301-296-5700.
Where can I find a pediatric audiology facility?
Search EHDI-PALS, a website with a national pediatric audiology facilities directory and great educational resources for families.

References

1. Dhooge, I.J. (2003). Risk factors for the development of otitis media. Current Allergy and Asthma Reports, 3: 321-325.

2. National Institute on Deafness and Other Communication Disorders. (2002). Otitis media (ear infection) (NIH Publication No. 974216). Bethesda, MD: Author.

3. Alsarraf, R., Jung, C.J., Perkins, J., Crowley, C. & Gates, G.A. (1998). Otitis media health status evaluation: A pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment. Annals of Otology, Rhinology and Laryngology, 107: 120-128.

4. Canalis, R.F., & Lambert, P.R. (2000). The ear: Comprehensive otology. Philadelphia: Lippincott Williams & Wilkins.

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Reasons for hearing loss in children are discussed including otitis media, congenital causes, and acquired causes.

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Note taking is the practice of capturing important pieces of information in a systematic way. It is not limited to the classroom. Note taking is an important accommodation in any situation requiring learning, including job sites and internships. Effective note taking is a skill that is acquired thro…

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Does Auto Captioning Effectively Accommodate Deaf People?

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What Is a 504 Plan?

A 504 plan is a way for schools to provide support for students with a disability so that they can learn in a regular classroom.

The name 504 plan comes from Section 504 of the Rehabilitation Act. This law prohibits discrimination against people with disabilities in programs or activities that receive federal funding (such as public schools or publicly funded private schools). This ensures that students with disabilities can get a free education that works for them.

Who Can Get a 504 Plan?

Students are eligible for 504 plans if they have a disability that limits daily life activities such as self-care, walking, seeing, breathing, hearing, speaking, or learning.

Students who need a 504 plan can include those with:

A student returning to school after a serious illness or injury also might get a 504 plan.

How Is a 504 Plan Made?

First, a parent, teacher or other school staff member, health care provider, or therapist asks the school to evaluate the student for a 504 plan. Every school handles 504 plans a little differently, but most have a 504 team that may include the principal, teachers, school nurse, guidance counselor, and psychologist. The team looks at a child's grades, test scores, medical records, and what teachers report about the student to decide if the student is eligible for a 504 plan.

If the 504 team decides that a student is eligible, they work with the parents to decide what kind of supports (called accommodations) the student needs to succeed. These are listed in the 504 plan.

What Does a 504 Plan Include?

The 504 plan is based on each student's needs and strengths. Accommodations can include:

sitting in a certain place or with a certain desk or chair in the classroom

extra time on tests and assignments

use of speech-to-text (dictation) for writing

modified textbooks (such as one that can be read aloud to the student)

adjusted class schedules

verbal (out loud) testing

allowing visits to the nurse's office

occupational therapy or physical therapy

Many other accommodations are available. If a parent asks for one that the school can't provide, the school might offer another one that would help. Most accommodations in 504 plans don't change what the student learns - rather, they remove barriers to learning.

The 504 plan should be reviewed at least yearly to make sure the accommodations are up to date and work for the student's needs.

How Do 504 Plans and Individualized Education Programs (IEPs) Differ?

The main difference is that:

A 504 plan provides accommodations so a student can learn in a regular classroom.

An IEP is a plan for specialized learning (for example, for dyslexia) or special education. 504 plans don't usually change what the child learns but IEPs can.

There are other differences too, such as who is eligible, who creates the plan, and how changes are made to the plan.

Some students have both a 504 plan and an IEP. For example, a student with autism spectrum disorder may have an IEP for learning supports and a 504 plan for occupational therapy.

What Happens if Parents Don't Agree With the School About the 504 Plan?

Sometimes parents and the school disagree on whether a child should have a 504 plan and/or what should be in it. If this happens to you, start by setting up a meeting to talk to the school 504 team. Schools want their students to succeed and will work with parents.

If you still have concerns, you can ask for a mediation session with a mediator. A mediator is professionally trained to help with the discussion without taking either side. If the issue is not resolved in the mediation session, you can request a due process hearing. You may need to get a lawyer for the hearing. You can also make a written appeal to the school district or the U.S. Office for Civil Rights saying that the school violated 504 rights.

How Can Parents Help?

You are your child's most important teacher and advocate. Help your child by building a strong relationship with the 504 team. This way, you show that you value education and that you want to work together respectfully to help your child succeed at school.

It also helps to:

Understand the 504 plan. Know what the accommodations are and how they will be used.

Talk to the school about how your child is doing. Let them know if you think the accommodations are working.

If you think you need to add or change accommodations, talk to the 504 team about your concerns.

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Kids who have special needs in the classroom may be eligible for a government-supported learning plan.

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What's an IEP?

Students who need extra help and support in school may be eligible for special education services in the form of anindividualized education program (IEP). This program is offered free of charge to families of kids in public schools and outlines the goals and any support services that may be needed for a child to succeed in school.

The Individuals with Disabilities Education Act (IDEA) says that parents and guardians of students with disabilities or special health care needs are important members of their child's education team. They should work with educators to develop a plan that helps kids succeed in school.

Understanding how to get and use these services will help your child be as successful as possible in school.

Who Needs an IEP?

Students who are eligible for special education services need an IEP. While there are many reasons that students could be eligible, some common conditions include:

How Are Services Offered?

In most cases, the services and goals outlined in an IEP can be offered in a general school environment. This can be done in the regular classroom (for example, a reading teacher helps a small group of children who need extra help while the other kids in the class work with the regular teacher.) The small group serves students with similar needs who are brought together for help.

Every effort is made to help kids learn alongside their peers who do not have disabilities. But sometimes the level of support needed can't be met in a general classroom, so students are educated in a specialized learning classroom that is more appropriate for their needs. These classes have fewer students per teacher and allow for more one-on-one instruction. The teacher usually has training in helping kids with special educational needs. Students spend most of their day in a small group classroom and join the regular classes whenever possible - for example lunch, gym, or the arts.

What's the Referral and Evaluation Process?

The referral process begins when a teacher, parent, or doctor is concerned that a child may be having trouble in the classroom, and the teacher notifies the school counselor or psychologist.

The first step is to gather specific information about the student's progress or academic problems. This may be done through:

a conference with parents

a conference with the student

watching the student in class to assess performance (attention, behavior, work completion, tests, classwork, homework, etc.)

This information helps school officials decide the best next step. Sometimes new classroom strategies are all that's needed to help a child become more successful. If this doesn't work, the child will get an educational assessment, which can find a specific learning disability or other health impairment.

Note: The presence of a disability doesn't automatically guarantee a child will get services. To be eligible, the disability must affect how the child does at school. To decide on a child's eligibility, a team of professionals will consider their observations, as well as how the child does on standardized tests and daily work such as tests, quizzes, classwork, and homework.

Who's On the Team?

As a guardian, you can decide whether to have your child assessed. If you choose to do so, you'll be asked to sign a permission form that will detail who is involved in the process and the types of tests they use. These tests might include measures of specific school skills, such as reading and math or developmental skills, like speech and language.

The professionals on the evaluation team can include:

When the team finishes the assessment, a comprehensive evaluation report is developed. This report includes an educational classification and outlines the skills and support the child will need.

You can review this report before an IEP is developed. If there is something that you don't agree with, work together with the team to come up with a plan that best meets your child's needs.

How Is an IEP Developed?

The next step is an IEP meeting with you and the team to decide what will go into the IEP. A regular teacher should also attend this meeting to offer suggestions for how the plan can help your child progress through the standard education curriculum.

At the meeting, the team will discuss your child's educational needs - as described in the evaluation report - and develop specific, measurable short-term and yearly goals for each of those needs. You can take an active role in developing the goals and determining which skills or areas will receive the most attention.

The cover page of the IEP outlines the support services your child will get and how often they will be provided (for example, occupational therapy twice a week). Support services might include:

Services might also include transportation, test help or modifications, participation in special programs, and the inclusion of transition planning beginning at age 14.

If the team recommends several services, the amount of time they take in the child's school schedule can seem overwhelming. To ease that load, a professional may talk with your child's teacher to come up with strategies that help but won't offer hands-on instruction. For example, an occupational therapist may suggest accommodations for a child with fine-motor problems that affect handwriting, and the classroom teacher would incorporate these suggestions into the handwriting lessons taught to the entire class.

Other services can be delivered right in the classroom, so the child's day isn't interrupted by therapy. The child who has trouble with handwriting might work one-on-one with an occupational therapist while everyone else practices their handwriting skills. When deciding how and where services are offered, the child's comfort and dignity should be a top priority.

Your child's IEP should be reviewed annually to update goals and make sure your child is getting the support that's needed. However, IEPs can be changed at any time on an as-needed basis. If you think your child needs more, fewer, or different services, you can request a meeting and bring the team together to discuss your concerns.

What Are My Legal Rights?

Guidelines (sometimes called procedural safeguards) outline your rights as a parent to control what happens to your child throughout the IEP process. For example, timelines ensure that the development of an IEP moves from referral to providing services as quickly as possible. When your child is referred, ask about this timeline and get a copy of your parents' rights.

The parents' rights also describe how you can proceed if you disagree with any part of the evaluation report or the IEP - mediation and hearings are some options. You can get information about low-cost or free legal representation from the school district or through early intervention programs.

Attorneys and paid advocates familiar with the IEP process will provide representation if you need it. You also may invite anyone who knows or works with your child whose input you feel would be helpful to join the IEP team. Federally supported programs in each state support parent-to-parent information and training activities for parents of children with special needs. The Parent Training and Information Projects conduct workshops, publish newsletters, and answer questions by phone or by mail about parent-to-parent activities.

What Else Should I Know?

Parents have the right to choose where their kids will be educated. This choice includes public or private elementary schools and secondary schools, including religious schools. It also includes charter schools and home schools.

But parents should know that the rights of children with disabilities who are placed in private elementary schools and secondary schools are not the same as children with disabilities who are enrolled in public schools.

Two major differences that parents, teachers, school staff, private school representatives, and kids need to know about are:

1. Children with disabilities who are placed by their parents in private schools may not get the same services they would get in a public school.

2. Not all kids with disabilities placed by their parents in private schools will get services.

The IEP process is complex, but it's also an effective way to address how your child learns. If you have concerns, be sure to ask about the evaluation findings or the goals recommended by your child's IEP team. You know your child best and should play a central role in creating a learning plan tailored to their specific needs.

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individuals with disabilities education act

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Some kids may be eligible for individualized education programs in public schools, free of charge. Understanding how to access these services can help you be an effective advocate for your child.

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What Teachers Should Know

Hearing loss can affect a child mildly or in a very profound way. Profound hearing loss may mean that a child is "deaf." Kids are born with hearing loss or can lose their hearing through injuries, infections, or long exposure to loud noises.

Signs that a child has hearing loss include:

having limited or unclear speech

not following directions or paying attention

hearing only parts of a conversation; asking for information to be repeated

not being able to hear everyday sounds, like a school bell or morning announcements

learning problems

Hearing loss can be temporary. But when it's not, there are technologies, therapies, and other treatments to help. Devices like hearing aids and cochlear implants can improve a child's ability to hear. Learning sign language or speech reading can also make it easier to communicate.

What Teachers Can Do

Educators, audiologists (experts who diagnose and treat hearing problems), speech therapists, parents, and students with hearing loss can work together to create an educational plan. This may include setting up an individualized education program (IEP) or 504 plan to help kids reach their full potential. Plans may include a classroom aide or interpreter to assist with communication and more. As a child grows, this plan will change.

To support students in your classroom:

Make seating changes. Kids with hearing loss may need to sit closer to the front of the class to speech read (read lips) or hear more clearly. Also consider arranging chairs in your classroom in a U-shape or circle so that students with hearing loss can better interact with classmates.

Minimize background noise when possible. This may mean finding quiet areas for a student to work.

Use an FM system. This device helps a child with hearing loss or listening problems hear their teachers better in a noisy classroom. To use the system, a teacher wears a microphone/transmitter and the student wears the receiver, which amplifies sound.

Face students when you speak. Most students with hearing loss can speech read to some extent. To help them, face them when you talk, talk slowly and clearly, and don't yell. As long as they have their devices on, you can speak in a normal tone.

Use lots of pictures, graphics, and text labels. Many students with hearing trouble are visual learners.

Use technology to make learning easier. This includes having real-time captioning on any videos used in the classroom and using voice-recognition software on computers. For more ideas, ask the student's family, the audiologist, or special education teacher.

Have a plan for missed instruction, assignments, and testing. Students with a hearing difficulty may miss class time to go to doctor visits. Know how the student will make up for missed time.

Talk about and celebrate differences. Students with hearing loss want to be accepted like everyone else. But sometimes they're targeted by others who see them as "different." Talk about and celebrate differences, and focus on the interests that kids share. Be mindful of bullying, and keep a zero-tolerance policy for that behavior.

Encourage participation in classroom activities, physical education, and extracurricular activities.

By addressing special needs and offering support when needed, you can help students with hearing loss learn as best as possible.

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Hearing loss can affect a child mildly or in a very profound way. Profound hearing loss may mean that a child is "deaf." Kids are born with hearing loss or can lose their hearing through injuries, infections, or long exposure to loud noises.

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In most cases, children with hearing loss require some accommodations in the classroom to maximize success at school. While there is no "one size fits all" IEP for children with hearing loss and many factors to consider when discussing classroom accommodations, here are nine common accommodations for children who are deaf/hard of hearing.

Reduce background noise

Environmental sounds that students with typical hearing can generally tune out, such as the hum of a furnace or the noise of traffic passing by an open window, can significantly impede the sound of a teacher or fellow student who is speaking. To the extent possible, effort should be made to reduce these background sounds in order to make the signal more audible. Some examples include closing doors and windows and using sound-absorbing materials on floors and walls. For more on managing classroom acoustics, check out this blog post by my friend Deanna at Listening Fun!

Provide Preferential Seating

Students with hearing loss should be seated in the most ideal location in the classroom for them, in order to improve their ability to hear and/or view an interpreter. Always consider whether or not the student hears better with one ear over the other, and be sure that the better-hearing ear has the best access to the desired signal. Not only does the teacher's position in the classroom need to be considered, but also the location of lesson materials and how other students are situated in the classroom.

Ensure Student Can See Your Face

Many students with hearing loss may use speech reading as well as the teacher's eye gaze, gestures, and facial expressions to increase their understanding of what is being said aloud. Teachers and other professionals should be sure to face the class when speaking in a well-lit room. They should avoid covering their mouth with their hands or standing against a backlight, in order to improve understanding for students with hearing loss.

Children with hearing loss often require multiple, direct exposures to new vocabulary and concepts in order to retain them. Because they do not often learn incidentally as their peers with typical hearing do, multiple opportunities for explicit instruction are usually needed for them to learn new information. Communicating with a student's speech-language pathologist or itinerant teacher of the deaf about what's being taught in the classroom will allow these professionals to integrate general education coursework into their service time with the child and supplement learning of key concepts.

Get Attention Before Speaking

Because children with hearing loss are much less likely to identify when a person at a distance has started speaking, always be sure that students with hearing loss are aware that you're talking before providing instruction. If addressing an entire class, a teacher may flash the lights a few times or verbally ask for attention and wait to ensure that all students are looking before providing information. When trying to get the attention of just a student with hearing loss, a teacher may lightly tap their shoulder, say their name, or give a small wave.

Supplement with Visuals

Information that is presented auditorily should be supplemented with visuals. Depending on the child, this could include any combination of the following: using gestures, displaying key concepts or word maps on a whiteboard, supplying typed notes or vocabulary lists, allowing another student to share notes, captioning videos, or providing access to sign language.

Repeat/Rephrase Information

In addition to providing supplemental visuals, students with hearing loss may often need multiple opportunities to hear information. By providing repetition, the student gets another opportunity to hear words that may have been missed, as well as hear material explained in another way using different vocabulary and/or grammatical structures which may provide needed clarification.

Check for Understanding

Check-in with a student with hearing loss to ensure understanding. Since students will generally answer "yes" when asked if they understood something, use other methods to assess comprehension, such as:

asking the student what they heard

drawing an illustration of the information

formulating their own comprehension questions or summary

utilizing a subtle gesture to signal to their teacher that they did not understand something during a class lecture

Support Hearing Technology

Teachers and other professionals in the school that work with the child should become familiar with the child's hearing aid(s), cochlear implant(s), and/or FM system so that day-to-day troubleshooting is possible. Especially for younger children, school personnel must be knowledgeable in daily assessment of hearing technology, so that there are not long periods of time during the school day when the devices are not providing adequate input. Additionally, school staff should appropriately utilize FM systems and sound field systems in order to maximize their benefit.

Whether you're a parent or school professional, I hope this list gives you some things to consider for your students with hearing loss. Download the mini-poster shown above to help support your students and their families and teachers, and share the link to this post with anyone else that you think could benefit!

If you're looking for more information, check out this post on supporting self-advocacy goals with your DHH caseload!

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Classroom Accommodations for Children with Hearing Loss

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In most cases, children with hearing loss require some accommodations in the classroom to maximize success at school. While there is no "one size fits all" IEP for children with hearing loss and many factors to consider when discussing classroom accommodations, here are nine common accommodations for children who are deaf/hard of hearing.

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DRC works as an advocate for D/deaf, hard of hearing, latened deaf, deaf-blind to request and ensure the provision of appropriate accommodations for effective communication. For those who believe they may have been denied access to effective communication under the ADA, Rehabilitation Act, or other federal or state laws. We can provide consultation and information regarding the complaint process and other avenues of recourse.

For more information on the ADA and Accommodations for Deaf and Hard of Hearing Persons in medical settings, download this booklet:
Education Pamphlet to Medical offices regarding ADA and interpreter services 2013
Community Education:

DRC provides education about deafness to the eight (8) counties we serve (Bay, Calhoun, Franklin, Gulf, Holmes, Jackson, Liberty, and Washington) through outreach presentations available upon request. We also have a Business Partnership Program to provide educational materials to businesses and other organizations about using the Florida Relay Service (711) to communicate with hard of hearing and deaf individuals on the phone. Our ongoing effort to create community awareness about persons who are hard of hearing or deaf is accomplished through presentations to civic clubs, neighborhood and professional associations, businesses, churches, and schools. We also participate in health fairs and community expos.

Interpreting Services:

Through the provision of DRC's qualified and/or certified sign language interpreters, D/deaf consumers are provided effective communication during medical appointments, mental health counseling, government agency meetings and other public services. For this service, please print and fill out the DRC Interpreter Request Form. The form can then be mailed, emailed to outreach@drcpc.org or faxed to Elizabeth, our Deaf Services coordinator. In the future if there is sufficient area interest, we would like to offer workshops for local sign language interpreters so that they can improve their expressive and receptive interpreting skills. DRC maintains a DVD and book loan library for area interpreters. Topics include Idioms, signing to children, medical terminology, improving expressive and receptive skills, and finger spelling practice.
Interpreter Service Application
ADA Effective Communication - Title III in ASL:

Family Services:

DRC recognizes the need to provide a variety of support services to D/deaf individuals and families with D/deaf or hard of hearing family members, and to empower D/deaf or hard of hearing clients who need assistance in overcoming any communication barrier and accessing community resources. This is accomplished through information exchange and referral to appropriate service providers throughout the Central Panhandle of Florida. DRC is considered by many as a central source of information on deafness, sign language, communication systems, interpreting, and adaptive and accessibility equipment for deaf and hard of hearing individuals.

Job Assistance:

In order to assist D/deaf and hard of hearing individuals who are unemployed or underemployed, our offices have partnered with and have a close working relationship with Vocational Rehabilitation, Goodwill, CareerSource, and other employment related businesses/agencies to provide assistance towards adequate employment to D/deaf and hard of hearing people. DRC office provides printed material related to finding and maintaining employment from our loan library. DRC offers sensitivity training to employers who have D/deaf and hard of hearing individuals on staff.

Local & Regional Deaf Groups on Social Media:

Resources

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DRC works as an advocate for D/deaf, hard of hearing, latened deaf, deaf-blind to request and ensure the provision of appropriate accommodations for effective communication. For those who believe they may have been denied access to effective communication under the ADA, Rehabilitation Act, or other federal or state laws.

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Studer Family Children's Hospital Pediatric Rehabilitation - Panama City Beach

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Studer Family Children's Hospital Pediatric Rehabilitation - Panama City Beach in Florida provides speech, occupational and physical therapy.

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Pediatric audiologists at Studer Family Children's Hospital in Northwest Florida deliver care for babies and children with hearing loss.

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Children's Home Society of Florida | We Do Good

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Proudly Serving:

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(850) 747-5411

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Providing Services and Accommodations for Deaf and Hard of Hearing Students in a Mainstream Setting