More than 80% of kids with hearing loss are educated in mainstream settings. For them to succeed, they need to be able to participate in every aspect of school activities. THEY NEED TO HEAR!!!!
Newborn hearing screening has resulted in really early identification. Kids with hearing loss are identified within weeks of birth. But we all know that early identification is not enough. Infants and babies need to be fit with technology IMMEDIATELY so that they do not miss a single moment of hearing. Audiologists are responsible for being certain infants and babies hear. Obviously that’s not all that needs to happen but if audiologists have not insured that babies and children hear, nothing else can happen. Once babies hear parents, teachers, therapists can take over and work towards developing the auditory brain and teaching children to listen, talk and read.
Then they go to school
Who determines what a child needs when she gets to school? Unfortunately, hearing loss is a hidden disability. Once kids are appropriately fit with technology (I admit not an easy feat) they can learn and when they are listening and talking then those who are not in the know, think they are fine. I cannot tell you how often I have heard from school personnel “he has hearing aids (or cochlear implant) now so his hearing loss is cured, right?” Of course that is not right. Once you have a hearing loss, you always have a hearing loss. Yes technology helps but it does not solve all problems.
ASHA reports that children with hearing loss are under identified as needing school support services. Only 1 in 100 children with IEP’s is found eligible for services due to hearing loss. They may receive speech-language services by a speech-language pathologist (who may have had only one course, or part of one course in grad school about working with kids with hearing loss) but those services are almost always provided in a separate office. Will that SLP see how the child with hearing loss is struggling in the classroom? If children have good language skills, they may not qualify for services in school. No matter how good language is, children with hearing loss are very likely to experience difficulty managing in a classroom. It is just too noisy.
No matter how good a child’s language is, s/he will likely benefit from classroom listening technology. In order to demonstrate the need for classroom listening systems, audiologists need to work with SLP’s to assess how a child is hearing and help convince the school to provide a remote microphone system.
Audiologists are the best people to educate school staff about the effects of hearing loss and how to help kids with hearing loss succeed. School staff needs to understand that hearing aids are not like eyeglasses. Hearing technology does provide normal hearing for children with hearing loss. Speech that is soft, (when the talker is more than 6 feet from the listener) or when there is competing noise (every school) will be difficult to understand. Children with hearing loss have to work a lot harder to manage in a classroom, making school but more difficult and results in more fatigue by the end of the day. Because of the extra effort to listen, children may be left with fewer cognitive resources to use for learning new material. Teachers need to understand that it is not a question of the child with hearing loss just “paying better attention”. They need more assistance to learn.
In November 2014, the Department of Education clarified that according to ADA, schools are required to ensure that communication for students with hearing loss is “as effective as communication for others” through the use of appropriate aids and services. How will this be accomplished?
The use of a remote microphone system can make a very significant difference in how a child with hearing loss hears in the classroom. When a teacher is wearing a microphone that is placed within 6 inches of her mouth, the child with hearing loss is receiving a signal that is much more clear with reduced effects of distance and noise. Great, the child will receive the information shared by the teacher. But is that all that a child needs to hear?
Listening to peers
We learn a great deal for all the people around us. Children learn from their peers. It is not just the correct answer, but the wrong answers and classroom discussion that helps us learn. So, ideally, every child with be wearing a microphone so that children with hearing loss, and if fact every child in the classroom will be able to hear what everyone says. That is not likely to happen any time soon. So what’s the solution? There are two possibilities. The teacher can repeat ALL COMMENTS made by any student (something they are not likely to be nuts about) or there can be a pass-around microphone that children use so that the child with hearing loss will hear all comments directly.
What can an audiologist do?
If only all school districts had educational audiologists. The educational audiologist would know the district and, over time, would have had the opportunity to educate staff about the effects of hearing loss and the needs of children with hearing loss. But, alas, as money becomes tighter, few districts have educational audiologists on staff.
Clinical audiologists will need to expand their roles to help meet these needs. What do we need to do? First, is technology doing what it needs to do? Are kids hearing well enough to ear well in the classroom? That means that kids need to have aided thresholds between 20 and 25 dB throughout the frequency range – including (or especially) in the high frequencies. Research by Moeller has demonstrated that 40% of children with hearing loss are not receiving sufficient benefit from their hearing aids. Recording aided thresholds on an audiogram that has the speech banana with the speech string bean on it (http://hearinghealthmatters.org/hearingandkids/2015/the-speech-string-bean) is a good way to demonstrate to the school (and parents) what a child is hearing and what she is missing. Testing speech perception at normal and soft conversational levels in quiet and in competing noise will also demonstrate how much a child is missing.
If we can demonstrate to classroom teachers what a child hears and what the child does not hear, school staff is more likely to embrace the use of a remote microphone system, to work to recognize when a child with hearing loss is missing something in classroom discussion and in working to improve performance.
Audiologists in clinical settings absolutely must expand their skills to work with schools if we are going to help our children succeed. Is it difficult. Yes. It is expanding our job and will require more time. But it is our job. We just need to do it.