The word deafness encompasses the state of not hearing. Prevalence estimates indicate that roughly 34 million adults representing approximately 17% of the United States report having a hearing loss. Within this group, the number of adults with severe to profound hearing loss ranges from 464,000 to 738,000, with approximately 54% being older than 65 years of age. Roughly 83 out of every 1,000 children have hearing loss.
Diagnosis Of Deafness
Deafness can be diagnosed very shortly after birth based on hearing screening in hospitals. Hearing loss can also occur suddenly, at any age, for a variety of medical reasons. Additionally, hearing loss can be progressive. In that situation, diagnosing deafness may take longer, depending on age. One factor that reinforces the delay in diagnosis is related to the difficulty in recognizing that a hearing loss may be present. For example, caregivers of toddlers may interpret the child’s behavior as stubborn without realizing the child may not hear. If caregivers express their concern about the delay in spoken language, doctors may tell them to be patient instead of referring them for an audiological (hearing) evaluation. Currently, diagnosis of deafness tends to happen between 12 and 33 months of age. With universal newborn hearing screening now mandated in most states, the use of electrophysiological methods that have been developed to screen infants for hearing loss is likely to significantly lower the age at which deafness is diagnosed.
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Hearing loss levels are categorized as mild, moderate, severe, and profound. Severe and profound deafness means that the available hearing level is insufficient to permit the understanding of speech through the ear alone, with or without hearing aids. Hard-of-hearing persons tend to have mild or moderate hearing losses that make it difficult but not impossible to understand speech, with or without hearing aids. The audiological evaluation takes loudness and pitch into account in diagnosing hearing loss. Loudness is measured in decibels (dB) across a range of frequencies that goes from low to high. Pitch is the subjective term for frequency. Examples of low pitch include men’s voices and vowels. Women’s voices and consonants are examples of high pitch. Audiologists often use the average of the responses obtained at three frequencies across the speech range to determine the level of hearing loss.
Early Intervention Programs
After diagnosis, early intervention programs facilitate the family’s ability to appropriately nurture and communicate with their deaf child from infancy onward. Families get basic information about deafness, auditory amplification devices, language development issues, communication approaches, techniques for providing stimulating and accessible environments, and educational options. Quality intervention programs are family centered in that they are sensitive to family variables and involve parent-child sessions during which caregivers have the opportunity to practice interaction strategies that will enhance the child’s communication and social development.
Recent research confirms the effectiveness of early enrollment in family intervention programs after early identification of hearing loss in optimizing the deaf child’s ability to communicate and meet developmentally appropriate social and educational milestones. Building on these findings, research is currently focusing on evaluation of the service delivery process by means of examining the interface of program components, the needs of the individual child, family variables including culture and parenting style, and service provider characteristics.
Language And Communication
Parents have to make decisions about language and communication issues. Language and communication are often incorrectly viewed as interchangeable. Language refers to conventionalized signs or sounds having understood meanings together with rules for manipulating expressions. In the case of deafness, language refers to spoken, read, or signed language (e.g., English, Spanish, American Sign Language [ASL], etc.). Communication refers to the process by which information is exchanged through a common system, whether spoken or signed. Deaf children can be exposed to spoken English, the spoken language of their home if different from English, signed English (signs matching English word order), cued speech (with handshapes on the face indicating the speech sounds of the language), and/or ASL. There has been a long history of conflict between supporters of spoken language for deaf persons and those who endorse the use of signed languages to facilitate optimal psychosocial development. Research with young children and their families indicates that the critical variable is not the communication modality but rather active family involvement. When service providers and families collaborate effectively in adjusting to the language and communication needs of the deaf child, this increases the chances of effective parent-child communication and in turn of achieving expected developmental milestones with minimal delay. It is important to recognize that deaf children rely most often on visual avenues for communication and language learning. Auditory training is essential if the focus is on spoken language and entails intensive time commitment. Family intervention programs as well as schools may emphasize spoken language, signed English, or ASL as a bridge to written English through bilingual approaches.
Parents also have to make decisions about auditory amplification, most notably between hearing aids and cochlear implants, if they want to encourage spoken language development in their deaf child. Digital hearing aids provide sound-processing strategies that can be programmed to fit the individual user. Cochlear implants require surgery to insert an electrode array within the inner ear structures, the purpose being to provide access to sound. For young deaf children, the process for learning to listen with any device tends to be lengthy because current technology does not match the cues offered by the optimally functioning ear. Current research on children with cochlear implants suggests increased potential for improvement in speech comprehension, although results are variable. However, emerging new technology continues to render earlier results obsolete, therefore requiring new research on the effectiveness of cochlear implants in facilitating the development of spoken language. In the case of individuals who become deaf after acquiring spoken language, research indicates that cochlear implants appear to be effective in facilitating speech comprehension.
Educating Deaf Children
Deaf children are educated in a variety of settings. Approximately 20% are in specialized schools for the deaf, with the rest (80%) in mainstreamed programs. Some of these children are in self-contained classes with deaf children only, some are fully mainstreamed with hearing peers, and others are partially mainstreamed and partially in a self-contained class. Placement decisions depend most often on what is available in the family’s geographic location. Almost all of the children in mainstream education require support services such as assistive listening devices, sign language or oral interpreters, communication access real-time transcription (CART) using computers, and tutoring. Deaf persons graduating from both specialized and mainstream settings on average do not achieve educational parity with their hearing peers. Their nonverbal intellectual functioning is similar to that of their normal hearing group, but limited exposure to linguistic and environmental stimuli in addition to the possible presence of additional disabilities depending on etiology make it difficult to catch up educationally. However, many deaf students have gone on to higher education and are successful in achieving career goals, primarily because involved families provided necessary support in addition to what the schools provided.
Research indicates that in the area of socialization, deaf children tend to socialize with deaf peers more often than they do with hearing peers, even in mainstream settings. The limited signing ability of hearing peers and the variable speech intelligibility of deaf peers makes socialization between the two groups more difficult. School social skills intervention programs with proven effectiveness have the potential to increase interaction when implemented consistently.
Perspectives On Deafness
To further understand deafness, it is necessary to note the presence of two basic perspectives of deafness. One is that of disability. The other perspective is sociolinguistic in nature and emphasizes deafness as part of the diversity spectrum.
The disability perspective is the one most individuals are familiar with. It focuses on deafness as a disability based on the biological function of the ear and the medical etiologies of hearing loss. Medical doctors are the ones who typically make initial recommendations when deafness is diagnosed, followed by audiologists. If medicine or surgery cannot eliminate the hearing loss, audiologists then recommend appropriate technology, including hearing aids, cochlear implants, and assistive listening devices, in order to enhance hearing ability. The goal is to overcome the isolating conditions of deafness by enabling the child or adult to hear and use spoken communication within the hearing family, school, and work environments.
The sociolinguistic perspective conceptualizes deafness as representing a linguistic and cultural minority. Specifically, the focus is not on the medical and disabling causes of deafness and auditory rehabilitation. Rather, the focus is on the use of ASL as a language that takes advantage of the deaf person’s natural reliance on vision to communicate with other people. The use of ASL is seen as connecting individuals with the culture of deaf people and thereby mitigating their isolation within hearing communities. Deafness becomes a bond that brings deaf people together.
In conclusion, deafness is far more than just not hearing. There are complex ramifications that affect the lives of people who are deaf.
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