Hearing and visual impairment

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Inclusion is about reducing barriers to learning and participation for all children. Particular consideration must be given to children with visual or hearing impairment and there are strategies and operational tactics which can assist in removing the barriers encountered by these children so that they can play a full, active and inclusive part in the available provision.

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• How Children Learn 1

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Some key thinking about hearing and visual impairment

Hearing impairment

Hearing impairment is measured in comparison with ‘normal’ hearing and is classified as one of four levels of severity:

• Mild.
• Moderate.
• Severe.
• Profound.

Within these classifications, each child will have a different profile of hearing loss. If it is the higher frequencies which are missing, this will affect the ability to recognise speech as most of the information in speech is carried by the consonant sounds, which are mainly high frequency.

The stage at which a hearing impairments takes hold in a child’s development is also very important. If the impairment occurs after the skills and concepts of language acquisition have taken place then the child, assuming there are no other delaying factors, will have developed speech and some measure of understanding. If it is congenital or from birth, then the child will need help to acquire language skills.

There are three approaches to encouraging language development in children with hearing impairment. (1) They all have their advocates and critics, the main issues being whether children should be encouraged to think of themselves as minority members of a hearing culture or identifying themselves as part of a deaf community. Some key approaches are as follows:

• Oralism: It is believed by some that all children, no matter how profoundly deaf, have some residual hearing which can be enhanced with some form of amplification. The children can then develop their speaking and listening skills alongside those with normal hearing. It would appear that there is likely to be some speech delay with this approach but that children will eventually be able to cope as part of a predominantly hearing society. (2)
• Total communication (TC): As well as developing language through an oral approach, the children are also taught sign language alongside which reinforces the structures of spoken language by the inclusion of grammatical signs and finger spelling. Visual clues such as lip-reading, facial expressions and gestures also feature in TC. (3)
• Bilingualism: Children are first taught a ‘natural’ sign language, such as British Sign Language (BSL). This reinforces their sense of identity and position within deaf culture. Only once they have internalised the sign language are they taught conventional language. (4)

It is important to recognise that language and communication are tied in very strongly with social and cultural identification. (5) When thinking about the above options, it is crucial to consider the first language of the child and their family. There are potential complications around encouraging English as a first language because it is spoken in a setting, if the home language is different.

Visual impairment

Webster and Roe promote the notion that:

‘[C]hildren with impaired vision cannot simply be considered in terms of the normal developmental milestones achieved by all other children, but with well-defined gaps in some areas of experience and maturation.’ (6)

Visual impairment is just one of the many individual factors that need to be taken into account (such as learning style, motivation and resilience) when considering the personal and social development of children. Depending on individual needs, a child may require more specialist support, such as through adaptations to the learning environment.

In each individual, visual impairment will influence other personality traits, social and personal skills in ways that are often unpredictable. For instance, confidence or determination may be affected, although this is not necessarily the case. However, any learning difficulties which a child encounters may not arise from such internal factors but may be as a result of issues to do with the provision or the way the environment is structured.

It could be significant at what stage in the child’s development the impairment takes hold. If it is after the skills and concepts of colour and shape and the visual aspects of spoken communication have developed then the child, assuming there are no other delaying factors, will have developed some measure of understanding of such visual concepts. If it is congenital or from birth, then the child will need more help to understand these concepts.

Complex Needs

It is quite possible that a child has a hearing or visual impairment as one attribute of wider or more complex needs. In this case careful diagnosis and monitoring is required and needs to be conducted within a framework that involves all the agencies that have an interest in the child, including the setting and the parents, so that there is consistency of care and shared knowledge of how the child’s needs are being met.

Strategies for managing hearing or visual impairment in young children

• Early diagnosis.
• Liaising carefully with other agencies, such as health and speech therapy.
• Close liaison with parents or carers to provide a consistent approach and keep them informed of progress.
• Staff training.
• Careful observation and listening by adults to determine what, if anything, is missing from the child’s repertoire of speaking and communication skills.
• Encouraging children to become confident in managing specialist equipment independently, such as hearing aids, glasses or magnifiers.

There is research evidence to suggest that the two factors which are most significant in determining language outcomes for five year olds with hearing impairments are early enrolment on intervention programmes and the involvement of families. (7) For early years settings, assuming there is not specialist expertise within the setting, this presupposes close liaison with external agencies, such as speech therapists.

Operational tactics with hearing impairment

• Reducing background noise in the setting.
• Working individually or in smaller groups.
• Getting the child’s visual attention and facing them before communicating.
• Having the same clear expectations of behaviour as with other children.
• Having regular breaks from listening activities.
• Teaching all the children songs and rhymes that they can sign (with, for example, Makaton).
• Possible use of a radio aid by the child, or the adult using a clip-on or facial microphone with sound then amplified throughout the room. (8)

Operational tactics with visual impairment

• Giving children time to interact with artefacts or make their way around.
• Working on communication skills such as listening, keyboard skills.
• Encouraging tactile and other sensory development.
• Assessing the appropriateness of activities, equipment and the environment from the perspective of the children
• Having the same clear expectations of behaviour as with other children.
• Developing mobility and orientation skills within the setting. (9)

Comment

It is a well-aired adage in education that what is good for special needs children is also good for all children. The strategies and tactics outlined above are part and parcel of good early years practice and their implementation could be expected within any setting, whether there are children with visual or hearing impairment or not. By providing a suitable environment and appropriate practices which support children’s individual needs, settings are also encouraging the other children and their families to understand the perspectives of children with impairments.

References

1. Lynas, W. (1994) Communication Options in the Education of Deaf Children. London, Whurr.
2. Stone, P. (1997) Educating Children Who Are Deaf or Hard of Hearing: Auditory-Oral. ERIC Clearinghouse on Disabilities and Gifted Education.
3. gtc (2011) Total Communication: Making a Consistent and Positive Difference [Internet]. Available from: <http://www.totalcommunication.org.uk/>.
4. Grosjean, F. (2008) Studying Bilinguals. Oxford, OUP.
5. Chamba, R. et al (1998) The Education of Asian Deaf Children. In: Gregory, S. et al (1998) Issues in Deaf Education. London, David Fulton.
6. Webster, A., Roe, J. (1998) Children with visual impairments: Social interaction, language and learning. London, Routledge.
7. Moeller, P. (2000) Early Intervention and Language Development in Children who are Deaf and Hard of Hearing Paediatrics [Internet] Available from: <http://www.pediatricsdigest.mobi/content/106/3/e43.full>.
8. Watson, L. et al (1999) Deaf and Hearing Impaired Pupils in Mainstream Schools. London, David Fulton.
9. Arter, C. et al (1999) Children with Visual Impairment in Mainstream Settings. London, David Fulton.

Where to find out more

Watson, L. (2003) Spotlight on Special Educational Needs: Hearing Impairment. 2nd ed. Tamworth, NASEN.

Mason H (2001) Spotlight on Special Educational Needs: Visual Impairment. 2nd ed. Tamworth, NASEN.

www.actiononhearingloss.org.uk

www.rnib.org.uk