Assessing the Academic Progress of Students with Hearing Loss
The Assessment of Mainstream Progress (AMP; Chute & Nevins, 2006) was developed specifically in response to the early mainstreaming of children with cochlear implants to determine a child's readiness for and progress in mainstream placement.
The rating form has two versions, one for preschool/kindergarten and one for elementary/high school. For a child in early intervention, mainstream readiness would be evaluated by the early intervention service provider. Over several days, the provider would observe behaviors to provide a basis for the rating. The AMP requires the service provider to rate a general percentage of time a particular behavior was observed. The following scale, modeled on a bell curve, was utilized: 0%–4%, 5%–25%, 26%–50%, 51%–75%, 76%–90%, 91%–100%. Children who are successful in the mainstream are often scored at 76% or greater on positively worded questions (Chute, 2002).
The pre-K/kindergarten version assesses a child's:
- General response to speech/music
- Attempts to communicate through speech/other modality
- Communication frustration
- Initiation of peer interaction
- Turn-taking skills
- Small group activity interaction
- Ability to follow classroom routines
- Play skills
The questionnaire for students in elementary and high school is completed by the classroom teacher and includes information about the educational setting, including physical configuration of the classroom and class size, and a description of all services the child receives. A six-point assessment scale is used to rate the child across various instructional and social domains. The teacher is asked to provide a class ranking of the child with a cochlear implant relative to his/her classmates.
The elementary/high school version assessesd the student's:
- General response to speech
- Response using speech/other modality
- Response to communication breakdown
- Spontaneous imitation ability
- Ability to follow instructions
- Attention during teacher-directed activity
- Level of participation in an activity
- Ability to comment (e.g., on-topic, off-topic, or enriching)
- Comprehension of instruction
- Ability to indicate lack of comprehension
- Recitation behavior
- Turn-taking skills
- Participation in group discussion
- Ability to follow classroom routine
- Willingness to take learning risks
—by Patricia M. Chute and Mary Ellen Nevins
Anderson, K. (2002). Early Listening Function. Hearing Review, 9(11), 24–26.
Anderson, K. (1989). Screening Instrument for targeting educational risk (SIFTER) in children with identified hearing loss. Tampa, FL: Educational Audiology Association.
Anderson, K. & Smaldino, J. (1998). Listening Inventory for Education. Tampa, FL: Educational Audiology Association.
Chute, P.M. (2002) Assessing Mainstream Performance in Children with Cochlear Implants, 7th International Symposium on Cochlear Implants in Children, Manchester England.
Chute, P.M., & Nevins, M.E. (2006). School professionals working with children with cochlear implants. San Diego, CA: Plural Publishing.
Francis, H.W., Koch, M.E., & Niparko, J. K. (1999). Trends in educational placement and cost-benefit considerations in children with cochlear implants. Archives of Otolaryngology Head Neck Surgery, 125(5), 499–505.
Geers, A.E., & Brenner, C. (2003). Background and educational characteristics of children implanted by five years of age. Ear and Hearing, 24(Suppl1) 2S–14S.
Nevins, M.E., & Chute, P.M. (1995). Success of children with cochlear implants in educational settings. Annals of Otology, Rhinology, Largynology, Suppl. 166, 100–102.
Nicholas, J.G., & Geers, A.E. (2006). Effects of early auditory experience on the spoken language of deaf children at 3 years of age. Ear and Hearing, 27(3), 286–298.
Spencer, L.J., Barker, B.A., & Tomblin, J.B. (2003). Exploring the language and literacy outcomes of pediatric cochlear implant users. Ear and Hearing, 24(3), 236–247.
A Comprehensive Audiologic Management Plan
by Linda Thibodeau
Management of a school-age child with hearing loss is a coordinated effort among the audiologist and others who serve the child, including the classroom teacher, speech-language pathologist, itinerant teacher of the hearing impaired, resource teacher, and parents. The educational management plan for students with hearing loss can be divided into three components—assessment, the TELEGRAM management program, and treatment plan—with technology as a key part of these components.
Assessment of hearing loss for educational purposes includes the basic audiometric protocol with speech recognition in quiet and noise, if possible. The results must be recorded onto the appropriate forms for determination of eligibility and services. Prior to initiating speech-language or academic assessments of students with hearing loss, a thorough electroacoustic analysis of their hearing aids is necessary. If the student wears a CI, a listening check via the listening earphone should be completed prior to behavioral evaluation of speech recognition. If the student uses a hearing aid, the gain and output of the instrument must be appropriate according to real ear measures and established amplification fitting protocols. Likewise, the CI program must be adequate so that the student is able to show improved speech recognition with the implant. The assessment also may include a classroom observation and completion of an FM questionnaire (see "Educational Audiology Web Sites").
Once the assessment is complete, a recommendation for educational placement, services, and assistive technology can be made and the TELEGRAM—a comprehensive management program—may be considered. The components of this plan, outlined below in order of the acronym letters, do not reflect actual priorities.
The second component to comprehensive management can be summarized by the acronym TELEGRAM, a word that symbolized an effective means of communication before the advent of cell phones and computers. Originally developed for use with adults (Thibodeau, 2004), TELEGRAM allows a clinician to summarize rehabilitative needs across key areas:
M–members of the family
The Pediatric TELEGRAM is a service model for children (Thibodeau, 2006); the current modification, the Educational TELEGRAM, provides a framework for the coordination of comprehensive services.
The educational audiologist should determine the best way for the child to communicate over the phone. Telephone communication is not typically part of educational services, but telephone features in hearing aids and cochlear implants offer improved telephone communication and facilitate coupling with classroom amplification systems. For example, a child may have a "microphone + t-coil" program that allows the child to use a neckloop for delivery of the FM signal.
The management of a child's educational needs may vary depending on the level of service provided. A child served through a regional day school program has convenient access to professionals who are trained to work specifically with children with hearing loss. Therefore, less coordination may be required because teachers or professionals trained to work with children with hearing loss may be aware of the child's specific needs or technology or have frequent contact due to the proximity of services. A regional day school program may employ an SLP and audiologist who would facilitate daily communication about technology or other accommodations.
When services are provided at the neighborhood school, professionals trained to serve students with hearing loss would likely provide periodic itinerant services, if needed. In this setting, the audiologist plays a greater role in the in-service training and subsequent follow-up with regular education personnel.
Many families are aware of admission, review, and dismissal (ARD) meetings and three-year re-evaluations required by the Individuals with Disabilities Education Act. However, families may be unaware that if a mainstreamed student is denied assistive technology through an Individualized Education Program (IEP), technology may be acquired through Section 504 of the Rehabilitation Act of 1973.
School-wide assemblies are provided for educational and entertainment purposes. During these events, assistive technology is often left in the classroom, and students are unable to understand a significant portion of the program. A student's FM transmitter can be interfaced with the public address system through the use of an audio cable and direct audio input connection on most transmitters. At a minimum, the FM transmitter microphone can be placed next to the microphone used by the main speaker.
Typical educational settings involve group instruction that pose communication challenges because of background noise and distance from the speaker. Therefore, the use of technology such as a personal FM system should be considered. The FM system should be selected and fit by an audiologist who follows guidelines established by the American Academy of Audiology (2009). The FM fitting should be verified electroacoustically and behaviorally to ensure the settings are optimal.
During classroom-based small-group activities, the student may be able to place the FM transmitter in the center of the group. Some FM transmitters offer an option of using an omnidirectional conference microphone that picks up conversation around a table.
In schools, recreation refers to extracurricular activities such as cheerleading, sports, choir, band, orchestra, and clubs. School-sponsored activities will need to be acoustically accessible. It is unacceptable for a student to be ineligible for the basketball team because he was 30 minutes late to the tryout because the time change was announced verbally in a crowded, noisy locker room.
Auditory perception of extracurricular activities can be particularly challenging because the distance from the speaker and background noise are even greater than in the classroom. Evaluation of the student's auditory perception in these settings is critical and assistive technology must be provided when needed.
Two main alarms are important: fire alarms and alarm clocks. Although schools are typically equipped with flashing smoke alarms, some rooms may lack visual alarms. For example, if a student is in theater tech class and works backstage during a production, would he or she notice the fire alarm signal in that location? The school building should be checked to determine the availability of flashing alarms. Although a student may hear the alarm with a hearing aid or cochlear implant, the visual alert is necessary if personal equipment malfunctions.
Members of the Family
The family must support the student's IEP. A student's hearing aids or CI should be functional and brought to school daily. If, however, a family is concerned that a hearing aid may get lost and doesn't allow it to be worn on the bus, the child receives an implicit message that hearing is important only in the classroom. Clinicians can help parents recognize the importance of technology by playing a hearing loss simulation, so that parents realize the sounds their child is missing, followed by a demonstration of the benefits of using FM technology in noisy situations.
The treatment plan is the final step in the comprehensive management of the school-age child with hearing loss. The necessary plans for each area of the TELEGRAM can be determined and reassessed at predetermined intervals. An IEP is developed based on the results of initial assessments and the TELEGRAM. The ultimate goal is for the child to receive the optimum auditory signal for all communication activities to enhance learning and retention in the educational setting.
Linda M. Thibodeau, PhD, CCC-A/SLP, is a professor at the University of Texas at Dallas. Her research involves evaluation of the speech perception of listeners with hearing loss and hearing assistance and has been funded by National Institutes of Health, Deafness Research Foundation, and National Organization for Hearing Research Foundation. Contact her at firstname.lastname@example.org.
Educational Audiology Web Sites
American Academy of Audiology. (2009) AAA Clinical Practice Guidelines: Remote Microphone Hearing Assistance Technologies for Children and Youth Birth-21 Years. http://www.audiology.org/resources/documentlibrary/Documents/HATGuideline.pdf [PDF]
Crandell, C.C., Holmes, A.E., Flexer, C., & Payne, M. (1998). Effects of soundfield FM amplification on the speech recognition of listeners with cochlear implants. Journal of Educational Audiology, 6, 21–27.
Schafer, E.C., & Thibodeau, L. M. (2006). Speech recognition in noise in children with bilateral cochlear implants while listening in bilateral, bimodal input, and FM-system arrangements. American Journal of Audiology, 15, 114–126.
Thibodeau, L. (2004). Maximizing Communication via Hearing Assistance Technology: Plotting beyond the Audiogram! Special Issue: Assistive Listening Devices. Hearing Journal, 57, 46–51.
Thibodeau, L. (2006) Hearing Aids and Cochlear Implants. In Luterman, D. Ed. Children with Hearing Loss. Sedona, ZA: Auricle Ink Publishers.
Thibodeau, L. (2006). Hearing Aids and Cochlear Implants. In Luterman, D. Ed. Children with Hearing Loss. Sedona, AZ: Auricle Ink Publishers.
U.S. Department of Education. (2007). Building the legacy: IDEA 2004. Retrieved October 29, 2007, from http://idea.ed.gov/.
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