Hearing-impaired Children, Research Paper Example

When parents have a child with hearing impairment, they are presented with a variety of challenges regarding their child’s social, physical, and academic development.  Hearing impairment is defined as “the temporary or permanent loss of some hearing in one or both the years” (Alic, 2011.) Parents with such children are immediately placed in the position of becoming advocates for their children in order to get their needs, including special learning needs, met in an adequate way.  This paper will discuss various aspects of hearing impairments, the causes, treatment options, and rehabilitation methods and focus on the individualized educational plan, or IEP, goals that should be established for any children with hearing impairments, using as an example the plan for a 12 year old child.

In young children, there are basically three sorts of hearing impairment that can occur: conductive hearing loss, which is usually a temporary interference when receiving sound from the outer ear to the middle or inner ear; sensory neural hearing impairment, which is a lasting abnormality of the cochlear hair cells of the inner ear, the auditory nerves, or the auditory center of the brain; and finally, mixed hearing impairment, which is a combination of the above named impairments (Alic, 2011.) If the hearing impairments occur before a child learns to speak, it is termed “prelingual,” as opposed to post-lingual, or occurring after the child has begun to speak.  For children who are classified as having normal hearing, this is defined as the ability to hear sounds ranging from 0 to 25 decibels.  Children with hearing impairments are categorized in the following methods: mild, where a child can hear sounds from 26 to 40 decibels and where speech and having conversation is typically not affected, although distance sounds may be hard to hear; moderate impairments, in which a child can hear sounds from 41 to 70 decibels with the ability to form sounds and to hear normal conversation tones is affected; and severe impairment, in which a child may hear sounds from 71 to 90 decibels and requires a hearing aid in order to pick up conversations spoken at normal levels.  In profound hearing impairment, a child can merely hear sounds above 90 decibels and although a child can use a hearing aid which might help, he or she will not be able to speak with normal articulation.

Conductive hearing impairment is usually caused by otitis media, which is an infection of the middle ear common in children between the ages of six months and four years.  It is believed that about 20% of children have an episode of acute otitis media every year, and it affects boys and girls equally.  This occurs most commonly in children of parents who smoke.  Over the age of eight, this condition becomes less common.  Chronic secretory otitis media is the most common cause of temporary hearing impairment in children under the age of eight, and it is more common in males but rare in children over the age of eight (Alic, 2011.)

The most common congenital abnormality in American infants is deafness; nearly 12,000 American infants annually are born with some degree of hearing impairments.  Three out of every 1000 children begin life with significant hearing impairment, with about 65% of these children born completely deaf and an additional 12% losing complete hearing before the age of three.  In addition, 14% of children ages 6 to 19 in the United States have measurable hearing loss in one or both ears.  Even more disturbingly, hearing impairment caused by noise is increasing in the United States where it is not unusual for teenagers to become permanently hearing impaired because of the high-frequency decibel level of live music events and recorded music to which they expose themselves (Alic, 2011.)

A common cause of otitis media occurs when the eustachian tubes that connect the middle ear to the back of the mouth and equalize air pressure and drain fluid are too small and become easily blocked.  It can also result from respiratory infections such as a cold that causes inflammation to block a eustachian tube, causing a fluid accumulation in the middle ear that is vulnerable to bacterial and viral infections.  If such blockage continues, it can cause chronic secretory otitis media, or the most common cause of conductive hearing impairment in children.  The typical symptoms of acute otitis media include a painful earache and temporary hearing impairment; the symptoms of secretory otitis media usually have a gradual onset and fluctuate, becoming worse in the winter typically.  Symptoms of partial hearing loss from this condition may not become evident for some time and may result in the following symptoms: immature speech, behavioral problems caused by frustration at not being able to hear well, sitting close to the television or turning up the volume to a high level, and poor school performance.  At times, otitis media can be hereditary, running in families; in addition, another risk factor is second-hand smoke.  Conductive hearing impairment from middle ear infections may be connected with other medical conditions including asthma, allergic rhinitis, cleft palate, Down syndrome, and excessive build-up of earwax that interferes with sound waves reaching the ear drum.

Sensorineural hearing impairments are the result of abnormal development or disorders of the cochlea, the spiral cavity of the inner ear, abnormalities of the auditory nerve that sends electrical impulses from the inner ear to the brain, or maladies of the auditory center of the brain.  These conditions have a multitude of causes.  More than 70 known inherited disorders explain about one half of all severe sensorineural hearing impairments; despite that fact, however, more than 90% of children with congenital hearing impairment come from parents who have normal hearing.  Additionally, there are many problems connected with sensorineural hearing impairments such as craniofacial anomalies, Down syndrome, problems during or shortly after birth that will damage the inner ear or auditory nerve, low birth weight, incubator noise affecting premature infants, neonatal exposure to antibiotics, bacterial infections including meningitis during infancy, cytomegalovirus infection during childhood and accidents involving head injuries. (Alic, 2011.)

Although nearly half of congenital hearing problems have no known cause, prenatal risk factors for congenital hearing disturbance include rubella, or German measles, CMV, the most common viral infection in fetuses and a cause of congenital deafness, other infections such as toxoplasmosis, herpes and syphilis, and drug or alcohol use.  In newborns, there are quite obvious signs of congenital deafness such as lack of response to loud noises, lack of response to voices or noises when sleeping in a quiet room, the inability to calm down at the sound of mother’s voice, failure to make normal and typical baby sounds such as cooing by six weeks of age, failure to look for the source of a noise by 3 to 6 months of age, failure to play with noisy toys such a rattle by 4 to 8 months of age, and failure to babble by about six months of age.

Common signs that a young child may have a hearing impairment include lack of reaction to loud noises, failure to imitate sounds, lack of response to the child’s name during the first year of life, failure to speak or imitate simple words, take pleasure in games that include speech, or talk in two-word sentences during the second year, and failure to understand simple directions during the third year.  While it is always difficult for parents to acknowledge negative or troubling news about their child’s health, it is clearly most beneficial for the child to seek diagnostic evaluation as early as possible.  Delays in seeking such help could result in irreversible harm to the child’s potential for hearing, speech, language, and educational development.  There are a series of healthcare as well as rehab specialists that can be utilized to great advantage during the long-term treatment of a child’s hearings loss.  Some of these professionals include:

• An audiologist, who is likely to be the person who gives the initial diagnosis regarding the child’s hearing deficiencies. The audiologist typically conducts behavioral and objective testing to establish the degree and sort of hearing loss.  Ultimately, this specialist will make recommendations regarding appropriate amplification, following a medical consultation.  He or she will also fit the child with ear molds along with the hearing aids that will need to be adjusted as the child grows.  The audiologist might also be the person to provide information and referral to an early intervention program.  Finally, monitoring the changes in a child’s hearing impairment is also a function of the audiologist (Childrens’Hearing Loss, 2011.)
• Otologist, Otolaryngologist, or Pediatric Otolaryngologist (ENT Physician): After receiving the diagnosis of hearing impairment, parents will be referred to an ear, nose, and throat specialist, ideally one who specializes in pediatric ear and hearing problems. The physician’s role is to establish the specific nature of the problem that is responsible for the hearing loss, and will make a determination about whether the problem is medically or surgically treatable; if that is the situation, this doctor will also provide the necessary treatment., which may include procedures rather simple such as placement of the eardrum ventilation tubes or more complex surgical treatments.  In addition, the ENT specialist might also refer the child for additional diagnostic tests such as MRIs, X-Rays or CT scans to further specify the nature as well as the source of hearing impairment.  The doctor will also  refine hearing aid fitting, and make a determination about whether a Cochlear implant would be an appropriate treatment method and if so, would conduct this procedure.
• The Primary Care Physician, Pediatrician or Family Practitioner: if the child is not diagnosed with a hearing loss as a newborn but develops hearing loss later on in life, this is the doctor who should make the appropriate referrals to an ENT specialist and an audiologist to either rule out or diagnose hearing lost. This physician would also cooperate in the treatment of the ear infections if they are evident, and might also referred the family to a doctor whose specialty is genetics, to determine if the child’s hearing loss may be inherited.  This would be valuable to establish whether or not similar deficiencies might occur in other children within the family.
• Early Intervention Specialist: Typically, this is a professional that has an education background who could help locate resources in the community, clarify the roles of family members in early intervention and assist with answering questions regarding future educational placement. This person can also help the family cope with observations and concerns about the child and provide information and support regarding the child’s educational needs for the future.
• Speech /Language Pathologist: This is a professional who will evaluate the effect of a child’s hearing impairment on speech and language development, and keep track of his or her progress, paying particular attention to the child falling behind. If this occurs, the SLP may refer the child back to the audiologist to determine whether any changes have occurred in the child’s hearing.  This person will also help a child to learn proper speech production, articulation of speech sounds as well.  If a parent decides to choose oral communication for a child, the child may also be receiving treatment from an auditory-verbal therapist, who will help the child acquire the full range of speech sounds and direct the family to additional medical treatments.  The auditory-verbal therapist will also assist with the families familiarization with appropriate speech and language, auditory, and cognitive developmental milestones that one would experience when raising a child with hearing impairments (Childrens’Hearing Loss, 2011.)

Because the costs of providing the necessary assistance, equipment, and other resources needed for maximizing the potential of a child with hearing impairment, it would be vital to contact The Hearing Loss Association of America, a vast organization that provides financial assistance as well as personal assistive technology for people with hearing impairment.  This tremendous clearinghouse of information can refer parents to the needed resources in their local communities, including support groups and concrete resources and equipment (Support, Financial, Financial Assistance for Hearing Aids and Personal Assistive Technology.)

who have hearing impairments may be plagued by one of several constraints, including impaired language development that can affect understanding of written material, test questions, speaking, writing, and the potential to understand abstract concepts; rely and son visual cues; hesitation to ask for help or to have things repeated because of being stigmatized; misinterpretation of requirements; challenges participating in group discussions or activities; difficulty participating independently in class without an interpreter; in minimized comprehension for individuals that use hearing aids because of environmental noise (Florida State University, n.d.)

Assigning an interpreter to a student can greatly assist hearing impairment by commuting playing with the student through verbatim translation into signs or interpretations.  The interpreter interprets everything that is repeated in the class and vocalizes everything that the student says.  Typically, an interpreter sits in the front of the classroom close to the teacher, facing the student.  Because signing requires tremendous concentration, it is often necessary for the interpreter to take a break in particular in the instances when a class is very long (Wright, 1997).

Once a student has been identified as hearing impaired, certain accommodations should be rate and into the students IEP, such as note taking assistance, front row seating, sign language interpreter if needed, visual aids, visual warning systems for emergencies, auditory trainers, testing adaptations such as extended time on tests and exams, oral exams, and the quiet setting in which to take the exam (The Children’s Hospital of Philadelphia,n.d.).

When developing the IEP, the report should contain a summary of the child’s current status of educational performance.  For example, if your 12 year old daughter has reading problems, the IEP should present reading scores, or if the child has problems in math, the document should contain math test scores.  Most importantly, the IEP should include measurable yearly goals, including both long-and short-term objectives.  These goals should be directly connected to your child’s needs that are a direct outcome of his or her disability and should allow the child to be involved in planning and participating in the overall curriculum.  These goals should concentrate on both reducing and even eliminating the child’s problems.  They should state clear ways for the parent and the teacher is to concretely measure the child’s progress or lack of (Wright, 1997).

The following goals will be implemented into the educational program for Susan, a 12 year old girl with severe hearing impairment who communicates through signing, and has an interpreter with her in class at all times:

1. Susan will participate twice a week in a small group of girls during recess, with her interpreter, by having her teacher selected a group of students who want to discuss that morning’s English class and the book that they have been reading during that time. The teacher will select two or three girls and encourage them to include and understand Susan’s disability, helping them to learn patience in waiting for the interpreter to both make comments and ask questions, and then wait for her to respond by signing through the interpreter.  This goal will accomplish helping Susan feel more confident in contributing to conversations with her peers, and in turn will help them have increased understanding about her disability.  The goal is for her to establish some friendly relationships with the other girls.
2. Susan will improve her grades in math and English by one full grade from a C to a B by taking her tests with extended time and in quiet space either before or after the regular test is taken. Her interpreter will accompany her in any test-taking.
3. Susan will attend and participate in IEP meetings with her interpreter, where she will be asked to bring up any problems, worries, or concerns that she has with her academic program, in an effort to reinforce her confidence in speaking up to ask for help.
4. Susan’s parents will participate in the IEP meetings and develop a system of rewards for her successes in participating in her group meetings as well as raising her grades, a reward system that is based on points earned and redeemed for fun activities with the family.
5. Susan’s family will continue to refine their signing skills in an effort to include Susan in family discussions and activities, to normalize their interactions as a family.

References

Alic, M. (2011). Hearing Impairment. Retrieved February 8, 2011, from www.answers.com: http://www.answers.com/topic/hearing-impairment-1

Children’s Hearing Loss. (2011). Retrieved February 8, 2011, from American Academy of Otolaryngology: http://www.entnet.org/HealthInformation/childHearingLoss.cfm

Florida Atlantic University. (n.d.). Accommodating Students With Hearing Impairments. Retrieved February 8, 2011, from Hearing Impaired: http://www.nhj.k12.in.us/nhj/specialservices/HI.htm

Stonecypher, L. (2010, April 12). Teaching Hearing Impaired Children. Retrieved February 8, 2011, from Bright Hub: http://www.brighthub.com/education/special/articles/28616.aspx

Support, Financial, Financial Assistance For Hearing Aids And Personal Assistive Technology. (n.d.). Retrieved February 8, 2011, from Hearing Loss Association of America: http://www.hearingloss.org/support/financial.asp

The Children’s Hospital of Philadelphia. (n.d.). Your Child’s IEP. Retrieved February 8, 2011, from Raising Deaf Kids: http://www.raisingdeafkids.org/learning/rights/iep.php

Wright, P. D. (1997). Retrieved February 8, 2011, from Your Child’s IEP: Practical And Legal Guidance For Parents: http://user.cybrzn.com/kenyonck/add/iep_guidance.html