Everyone who works with children with hearing loss knows that, even with all the great technology that is available today, kids still need help. Because the technology is so good, school staff members sometimes think that kids do not need any help. I have had school staff tell me that now that a child has a cochlear implant he is no longer disabled. Well, he is certainly much better than he was before he received an implant, but it is really important to understand that he is still not normal hearing.
What does a child with the best technology miss?
That depends on the technology. It is important NOT to ASSUME anything about what a child hears. We can only know what a child hears by testing. Real-ear does not tell us what is reaching the child’s brain; it only tells us what is reaching the eardrum. (And from the point of view of listening, it is a really long way from the eardrum to the brain.) Cochlear implant programming tells us how much electrical stimulation is being presented – not what the child is able to hear. We need to be sure that the child is hearing through the frequency range and can hear soft speech. In order to know if a child is hearing well enough we need to test. (Speech Perception: The Basics)
Hearing in the classroom
Even if a child is hearing well, a child with hearing loss is listening through a damaged auditory system. We know that a child with hearing loss needs four times the repetition to learn. So we know that in a classroom situation, a child with hearing loss will need to hear everything multiple times to get the message. What does this tell us about how a child is learning? It tells us that we need to be sure a child has the information he needs to follow classroom discussion. To me this means that a child needs preview and review by a person who has academic skills. Usually this is a teacher of children with hearing loss. It may be a speech-language pathologist who provides the service, and this can work well for young children, but may not be optimal for older children where academic material is more difficult. The SLP will also be responsible for teaching all speech and language skills so, if the SLP is responsible for preview and review, more time needs to be allotted to service provision.
Looking at test results
When reviewing evaluations it is important to look at all subtests. People frequently look at the total score and, if a child seems to be doing well, they make a determination that no services are needed. However, it is very valuable to look at all subtests and see areas in which a child is either below average or scores more poorly than in other areas. For example, if a child is within normal limits on the overall test but is performing poorly on auditory memory tests, it indicates that she will need therapy to address auditory memory skills even if her overall score is good.
Comparing test results with other kids in the class
It is important to compare kids with other kids in the same school, not just with kids in the standardized test pool. This is especially important for child in high achieving school districts. Kids need to compete with the kids around them. So we need to pay attention to how kids are performing and work hard to keep them there. As long as we pay good attention we will succeed in helping kids be the best they can be.