Despite their carefully programmed hearing aids or cochlear implants, students with hearing loss often struggle to succeed in regular classrooms. Schools rarely have a full-time educational audiologist on staff to address the daily needs of each child with hearing loss. Most schools, do, however, employ a speech-language pathologist who is in regular contact with students and staff. For this reason, SLPs are well positioned—in collaboration with itinerant audiologists and deaf educators—to help meet daily needs of students with hearing loss in general education classrooms.
A six-step program—STAR-IT—will help SLPs highlight and meet needs of students with hearing loss through these simple actions:
1. Sound checks on a daily basis.
2. Troubleshooting malfunctioning hearing aids and cochlear implants (CIs).
3. Assistive technology in the classroom.
4. Recommending classroom modifications.
5. Information sharing among professionals.
6. Treatment goals to optimize classroom listening and performance.
The reauthorization of the Individuals With Disabilities Education Act (IDEA, 2004) states that each public agency must ensure the proper functioning of hearing aids and external CI sound processors worn by children at school. To assess hearing aid or sound processor functioning, SLPs may conduct behavioral listening checks with cooperative students or perform a more objective listening check with device-specific equipment. In behavioral listening checks for children with hearing aids or CIs, the child repeats auditory-only words or sounds from the Ling six-sound test (Ling, 1976). If a child is using bilateral hearing aids or CIs, or a combination of both, each device should be checked separately.
Younger children or students with special needs may require a more objective approach to determine device function. To check hearing aids, SLPs can use an inexpensive listening tube to monitor output of each hearing aid. Some CI sound processors have LED lights that indicate if the device is functioning properly or malfunctioning. Otherwise, verification of CI sound processor function will require device-specific equipment to confirm that the microphone is functioning properly or that the transmitting coil is sending a signal across the skin to the internal implant.
After completing a behavioral or objective listening check, the SLP may document proper device functioning by completing a simple monitoring chart that indicates the date and outcome of the check. The chart may also be used to document concerns or to communicate with the itinerant deaf educator or audiologist.
If a daily listening check identifies a problem with the device, the SLP may take several steps to troubleshoot the most common issues with a hearing aid or CI (see table [PDF]). The SLP will need basic instruction from the educational audiologist and an inexpensive hearing aid cleaning kit.
If the troubleshooting tips in the table do not resolve the problem, the SLP should document the troubleshooting attempt on the monitoring chart and contact the parent and audiologist. Ideally, a child who has a broken personal hearing aid (i.e., not purchased by the school) will be able to borrow a loaner hearing aid from the school district or the private audiologist.
Other than replacing or changing a rechargeable battery, troubleshooting a CI sound processor is more challenging than troubleshooting a hearing aid. With help from audiologists and parents, an SLP will be able to learn the controls and functions of one or two types of sound processors. Again, if the suggested steps don't fix the problem, the SLP should contact the parent and educational audiologist.
Most children with hearing loss, regardless of the degree, require hearing assistance technology (HAT), such as frequency modulation (FM) systems, to obtain speech recognition close to that of peers with normal hearing sensitivity (Ng, Meston, Scollie, & Seewald, 2011; Wolfe et al., 2011). Therefore, HAT may be used to improve the signal-to-noise ratio at the student's ear, which will ensure the least restrictive learning environment possible.
At this time, most published research supports the use of personal systems for children with hearing aids or CIs (Anderson, Goldstein, Colodzin, & Iglehart, 2005; Schafer & Kleineck, 2009). A personal system consists of a transmitter and microphone worn by the teacher and a receiver that plugs directly into the child's devices. Most educational and private audiologists will recommend and fit the miniaturized personal FM receivers because they may be adjusted and programmed to provide the most beneficial settings for each student. However, research from our laboratory submitted for publication suggests that contemporary neckloop FM receivers (as opposed to those that plug directly into the device) may also provide substantial improvements to speech recognition in noise relative to a CI alone.
The SLP may assist in the process of obtaining HAT by recommending or generating a referral to the appropriate school personnel (e.g., assistive technology team) for a HAT evaluation. Other school personnel may not recognize the classroom challenges of children with hearing loss or that academically successful children may still need HAT.
During the HAT evaluation, the SLP may offer valuable information on how an FM system will support goals and objectives in the child's Individualized Education Program (IEP). For example, articulation goals of many children with hearing aids include improved production of high-frequency consonants, and the use of an FM system may help to improve the audibility and production of these less intense speech sounds. After the FM system is added to the IEP, the SLP may share information at subsequent IEP meetings about changes in the child's classroom functioning, articulation, or listening behaviors that may relate to the use of the FM system.
The SLP may coordinate and monitor the child's use of the FM system through actions similar to those for hearing aids and CIs. To maintain daily use and function of an FM system, the SLP should charge batteries overnight, conduct behavioral listening checks by presenting speech to the transmitter microphone, conduct objective listening checks if necessary, document use and proper function of the FM system, and contact the audiologist for additional batteries, troubleshooting, or device repair.
An SLP can recommend classroom and teaching modifications to support the needs of children with hearing aids or CIs; these modifications can be added to the child's IEP or 504 plan, when applicable. Children with hearing loss should always be seated near the front of the classroom, away from noise-producing equipment (projectors, computers, air vents), doors, and windows.
During and following instruction, the teacher may confirm the child's comprehension of the message with a secret hand signal. The teacher may also enhance comprehension of spoken messages by providing the child with written instructions, announcements, and assignments.
Because it is difficult for a child to take notes during instruction and to focus on helpful speechreading cues from the teacher, a designated student note-taker could provide a copy of the notes to the child with hearing loss. Alternatively, some children use Computer Assisted Real-Time Transcription to obtain notes following instruction. Classroom movies and videos should include captions.
SLPs can also encourage teachers to use techniques to control ambient noise levels (for information on classroom acoustics, visit ASHA's government relations webpage and ASHA's tips for creating good listening environments in classrooms). Management techniques include the use of silent actions, such as a hand signal to quiet the room (hand goes up, mouths are closed), teacher-controlled noise meters on a chart (noise-o-meter to indicate noise levels), or flashing room lights.
To engage students in monitoring the noise level, teachers can use a simple stoplight sound-level meter to warn children that noise levels are too high. These types of devices are often used in kindergarten classrooms, large cafeterias, or intensive care units at hospitals.
To improve the physical acoustics of a classroom, the teacher or school administrators may add carpeting or rugs to hard floor surfaces, drapes or corkboard to walls, and latex-free soft tips to chair and desk legs.
Children with hearing loss will be most successful when the professionals who serve them collaborate to share goals and objectives, academic content, and concerns about the child. However, appropriate consent or release-of-records forms are required for communication among all professionals, including the school SLP, private SLP, general education teacher, special education personnel, educational audiologist, private audiologist, and deaf education teacher.
If the child receives private and school speech-language treatment, sharing IEP goals between professionals provides continuity across treatment sessions and the potential for more rapid growth. In addition, the general education teacher, school SLP, and deaf education teacher can work together to pre-teach and re-teach important concepts to children. It is imperative that school-based professionals report any changes in the child's response to sound to private SLPs and audiologists, especially if the child has a CI. A malfunctioning CI could result in profound deafness.
Each student should have individualized listening, speech, and language goals. In addition to typical language and articulation goals identified using standardized tests and language samples, goals related to classroom vocabulary also may be appropriate. Pre-teaching vocabulary for upcoming lessons may ease the difficulty of listening in the classroom. Re-teaching or reinforcing these concepts following their introduction in the classroom will also help the child.
Goals that address the child's ability to advocate for his or her own needs also are important. Self-advocacy is critical to a child's success in a mainstream environment, as those who are not confident in seeking clarification will not be able to function optimally in the classroom, indicate when they just do not understand what is being asked of them, or report when their HAT, hearing aids, or CIs are malfunctioning.
Depending on the child's level of functioning, formal goals may need to include listening skills. Information related to listening skill development is available from several resources, such as The Cottage Acquisition Scales of Listening, Language, and Speech (Wilkes, 2001) or Cochlear Implant Auditory Guidebook (Sindrey, 1997). It is important for the SLP to evaluate whether the child's difficulties are listening- or language-based (i.e., does the child understand the concept but miss the question due to a listening problem?).
By following STAR-IT, SLPs give children with hearing loss the opportunity to reach their maximum potential. The model aims to achieve optimal audibility of speech signals from the teacher, improve classroom acoustics, enhance collaboration among professionals, and develop treatment goals to enhance the child's classroom comprehension and listening potential.
We should not wait for a child with hearing loss to fail before providing supports. Many children with hearing loss have high academic potential and need only to be given amplification, HAT, and environmental and school-based support to succeed.