Hearing Loss: Terminology and Classification
Joint Committee of the American Speech-Language-Hearing Association and Council on Education of the Deaf
About this Document
The following technical report was developed by the Joint Committee of the American Speech-Language-Hearing Association (ASHA) and the Council on Education of the Deaf (CED). Joint Committee members responsible for the development of this document include (from ASHA) Joan Marttila, chair 1996–97; Linda Seestedt-Stanford, chair 1994–95; Evelyn Cherow, ex officio; Donald Goldberg; Dawna Lewis; Leslie Ann McMillion; Jane Seaton; Alicia Stewart; and Larry Higdon, vice president for professional practices in audiology and monitoring vice president; and (from CED) Kathee Christensen; Steve Nover; MarilynSass-Lehrer; and Patrick Stone. This document supersedes ASHA policy: Definitions of Communication Disorders and Variations: Hearing Disorders section.
The National Center for Health Statistics estimates that over 28 million Americans have a hearing loss (NIDCD, 1994). Although most of the individuals with hearing loss are adults, 1,224,000 are under 18 years of age (Adams & Marano, 1995). This population is heterogeneous with regard to type and degree of hearing loss, age at onset, use of amplification and other assistive technology, native language, family culture, preferences regarding mode of communication, and other factors that affect communication. Individuals with hearing loss rarely depend on a single system of communication.
Historically, definitions of hearing loss have classified persons into categories that did not describe the complex continuum of communication preferences and choices. Currently, several definitions and classification schemes exist for individuals with hearing loss: Some are based on audiometric data (Roeser, 1994); some are based on auditory processing of linguistic information (34 CFR 300.5); and some are based on visual processing of linguistic information such as signed languages, cued speech, or speechreading. Other definitions or schemes are based on identification with cultures or communities (NASDSE, 1994). Variations in the descriptions of individuals with hearing loss can be confusing and misleading. Historically, classification schemes have omitted the use and value of signed languages and the effect of assistive technology on communication.
Classification schemes have evolved to serve a variety of purposes. They have been used to refer individuals for additional evaluations (educational, medical, or psychological); to assess candidacy for sensory aids and other assistive technologies; to recommend language and communication modes; to choose educational program options and make placement decisions; to determine eligibility for entitlement under federal and state legislation and regulation (e.g., vocational rehabilitation services, candidacy for disability benefits, or access as defined by the Americans with Disabilities Act); to assess qualifications for worker's compensation benefits; and to develop self-help, social, and support groups.
The misuse of definitions, labels, and classification schemes may restrict the options available to an individual and his/her family/caregiver. Classification schemes also may influence expectations for development throughout an individual's lifespan. Quantitative descriptors based upon degree of hearing loss (e.g., mild to profound) may misrepresent an individual's communication functioning. In addition, definitions and labels have been developed from a deficit perspective. Terms such as hearing handicap emphasize the deficits of an individual's auditory system or communication ability. Some individuals with hearing loss strongly object to such terminology because it perpetuates the deficit model. 
The Joint Committee of ASHA and CED bases its position statement on the following assumptions:
Individuals who are deaf or hard of hearing constitute a heterogeneous population.
The relationship that exists between an individual's hearing level and that individual's ability to develop a language or languages in one or more communication modalities varies among individuals.
A variety of factors affect the communication function of individuals with hearing loss. These include, but are not limited to, the presence of concomitant disabilities related to vision, fine and gross motor functioning, and/or cognitive functioning.
Communication choices are influenced by such factors as the age of the individual when the hearing loss occurred, when the hearing loss was identified, the type of intervention/educational services available, and when those services were initiated.
Family, cultural values, and community support of individuals with hearing loss can have a strong impact on the individual. This can include but is not limited to access to language, communication approaches, and use of residual hearing and spoken or signed languages.
Individuals with hearing loss often interact differently depending on their work, education, community, and social environment. Communication is influenced by the presence or absence of and access to interpreters, appropriate technology, and communication partners.
In summary, the Joint Committee of ASHA and CED recommends that terminology to describe individuals with hearing loss reflect respect for personal and family/caregiver preference(s) and the complexity of the communication interchange as well as facilitate opportunities for personal, educational, social, and vocational development.
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Adams, P. F., & Marano, M. A. Current estimates from the National Health Interview Survey, 1995 (Vital and Health Statistics Series 10, 193). 1995. Hyattsville, MD: National Center for Health Statistics.
American Speech-Language-Hearing Association. (1993, March). Definitions of communication disorders and variations: Hearing disorders section. Asha, 35(Suppl. 10), 40–41.
American Speech-Language-Hearing Association. (1995). Report on audiologic screening. American Journal of Audiology, 4(2), 24–38.
National Association of State Directors of Special Education. (1994, October). Deaf and hard of hearing students: Educational service guidelines. Alexandria, VA: Author.
National Institute on Deafness and Other Communication Disorders (NIDCD). (1994). 1994 annual report of the NIDCD. Research and human communication. Bethesda, MD: National Institutes of Health.
Roeser, R. (1994). Audiometric and immittance measures: Princeples and interpretation. In R. Roeser & M. Downs (Eds.), Auditory disorders in school children: The law, identification, remediation. New York: Thieme Medical Publishers.
World Health Organization (WHO). (1980). International classification of impairments, disabilities, and handicaps: A manual of classification relating to consequences of disease (pp. 25–43). New York: Author.
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 The World Health Organization (WHO, 1980) continues to use the terms impairment, disability, and handicap. The Joint Committee recommends that these terms should be used only within contexts intended by the WHO (ASHA, 1995).
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