to influence au erations. Is quality and ex. de children into ive to assumed rguistic, perilin Thus, we use the mn indica- sential ome as the me: ent per se. Wh sch pro- What v flections uditory learning- ‘or example tions or perform ot observe com: hat we see is artial verations, itis dif ompletely. Inter n are more than ditory skills of tive and cortical ated; thus, behav ogy. Perhaps in pursuit of { observations of nts with hearing aring classroom 1991; Brackett, al to develop ap ‘grams to imple ment within that setting streaming and inclusion provide a portunity, without opportunit 5 (including on sment and in aboration) jervention as well as e ne opportunity is depreciated. Countless deaf students document the splintered we view that may be constructed in the abse language. Speech therapy 2 3 a week for 30 (fitting hear sehlear implants without ade elop listening, lan quate training to d guage, and speech in futility. Spec {integrated into a total curriculum fo age D/HH students. Without carefully aphed follow cross the not only fails to oF i choreog ronment, speech the istic im- provement, but it leaves the child with yet inothe ent of reality to integrate into a meaningful who regular education settings have been well described (Brackett, 1997). Educational intervention and habilitation for D/HH chil- dren may be a compromise between what is > optimize a child’s cognitive and ory abilities and what is reasonably lable through the ed ions vary from state to stat school system to school syster All options may not be available to all school-age stu- dents in all settings. If they we ate placement would be child may attend a residential day school for deaf children because there is nothing else available and not because thos: for that child, An- other child may receive only spe oF itinerant programming even tho re educational support is required, simply because such programming is the only available option in that ¢ chool system, For many deaf children is only one option reasonably avail able. That option may or may not coinci With the student’s Orchoices of parents. Stud Or smaller communities or in areas witho options are appropriate intensi ge Studer this lack of al ul alist includes acting adent’s receip bilitation spec vocate for th + Placement options (residential school, day school, public school resource, itinerant + Support services (speech therapy, lan- guage therapy, counseling, learning dis. abilities resource, or other resources if ad ditional disabilities are present). + Competencies of professionals (teacher + School philosophy (general attitudes to ward education, special education, and D/HH children), + Curricula (© tion of regular education sp: D/HH children, tional/learning materials + Access (technology, facil rial fable to heari Acoustics of the learn; ar education, modifica availability of instruc and mat sound tr Assessment The assessment process should be ction and definition of the interplay of ual student. A comprehensive assessment is, essential to implement eff tion and/or inst ts that constitute a complete description of th aunication, langua ed for learning in and out of school. 195-196) aptl children with hearing stics and needs cannot observes about testin oss, “Their charactei adeq approached through tradi- ment practices. Any attempt to impaired children, thefore, mandates a thorough understanding of the methodological and procedural elements necessary to maximize the validity of assess- ‘ment with this group.” The primary purpose of assessment of school-age students is to determine the na- ture and extent of the child’s strengths and weaknesses so that appropriate intervention and education can follow. Assessment i cludes formal testing, use of informal measures, dynamic assessment, and review of case history and current performance in school and other social settings. The reper- toire of formal tests, with specific guidelines to administer, score, and interpret results, is sparse with respect to inclusion of students with hearing loss in the standardization sam- ple. These tests are norm-referenced; that is, they have a normative group for comparing a student’s performance and yield several types of scores providing information about a student’s performance relative to other students. Unfortunately, this is comparison relative to hearing students. Informal testing may be less structured and is used to deter- mine present performance levels, student progress, and changes subsequent to direct instruction (McLoughlin and Lewis, 1990). Group and individual testing is common for hearing students, whereas individual testing will more likely be necessary for students with hearing loss. The five major purposes for assessment or administration of tests are: Screening. Placement. Program planning, Program evaluation Monitoring individual progress (Salvia and Ysseldyke, 1988), These purposes are valid for assessment of the performance of D/HH students across communicative, language, speech, and psychoeducational domains. Assessment is necessary to extract information regarding a child's educational and auditory habilita- tion. Ongoing assessment provides parents and professionals with a fund of new infor- mation to expand and alter the child’s pro- ‘gram to nurture development. 202 Section ie Audiologic Renobiitation: Chicken (GUIDELINES FOR ASSESSMENT RIGHTS Public Law 94-142 and the Individuals with Disabilities Education Act (IDEA) provide clear guidelines regarding assessment of in- dividuals with disabilities; these guidelines include the assessment of individuals with hearing loss. Assessment must be nondis- criminatory. To that end, assessment tools (tests) must be fiee from cultural or racial bias, be administered in the student's lan. guage, and not discriminate on the basis of the student’s disability. Assessment should be comprehensive and multidisciplinary and should focus on the student’s specific educa- tional needs. A single measure may not be the only basis for special educational placement, and no area of educational performance may be omitted. Whereas D/HH students may be eligible for educational services based solely on their hearing loss, they are entitled to a comprehensive evaluation that should in- clude vision, cognitive function, academic performance, communicative status, social/ emotional status, motor abilities, and health, The team of professionals evaluating the D/HH student’s performance should include at least one individual knowledgeable about hearing impairment, Assessment tools must be technically sound (valid and reliable) and administered by appropriately trained and experienced professionals. This may be a problematic area within public school sys- tems, Often the school psychologist and di- agnostic team responsible for administra- tion of intelligence and achievement tests have limited experience in testing students with significant hearing loss (Gibbins, 1989). The final aspect of assessment with respect to legislation involves rights: in- formed consent of parents, right to annual evaluation of progress, and reevaluation sy 3 years. Most importantly, no student will be placed in special education unless a comprehensive assessment including evalu- ation of educational needs has occurred (McLoughlin and Lewis, 1990). COMMUNICATION ASSESSMENT The assessment of a school-age student's communication performance should includeals with provide t of in- idelines is with nondis- at tools r racial t's lan: basis of should ary and > educa- atbe the cement, ree may may be d solely led to a ould ine cademic » social! i heath iting the include Te about ols must ble) and ned and ninistra- ont tests, students Gibbins, ent with zhts: in- 9 annual valuation > student unless a rgevalu- occurred student's dinclude language, speech, and sign language (if used) in a variety of school contexts. Ying (1990) describes the components of a com- munication evaluation as including: 1. Reception (replicate the real-life back ground noise expected in school settings in addition to usual audiometric testing in sound-treated environments). ‘Comprehension (include evaluation of the amount of contextual support required for understanding within various classroom settings). Production (acquire from spontaneous and elicited language samples). Intelligibility (evaluate across increas- ingly complex language contexts). Conversational competence (acquire from a diversity of conversational contexts). Written language (acquire for analysis along with interpersonal language samples). These areas are all critical for effective functioning in the academic mainstream, A criterion-referenced checklist that identifies the child’s communication function that can be used very easily and effectively in school settings is the Kendall Communicative Pro- ficiency Scale (in Thompson et al., 1987). The primary modalities used in communica- tion should be evaluated. These include sign language readiness and proficiency, speech, and/or simultaneous use of sign and speech. ASSESSMENT OF SIGN LANGUAGE PROFICIENCY Few specific measures are available to as- sess this component of a school-age D/HH student's functioning. However, a rating of readiness and/ot proficiency should be a part of the comprehensive evaluation for those students who use or may potentially use some form of sign language. A typical as- sessment includes measures of: 1. Manual dexterity and ability to form the hhand shapes required for signing. 2. Receptive recognition and expressive performance of signs (Johnson, 1988). Chapter 7 » School-Age Students 203 Some schools for deaf students. such as Kendall Elementary and the Atlanta Area School for the Deaf have developed infor- ‘mal assessment tools for this purpose. Such tests as the Carolina Picture Vocabulary Test are useful receptive measures of picture sign recognition. Many language tests de- veloped specifically for D/HH students rec- ‘ommend in their directions the use of signed or spoken language in presenting the items to the student being evaluated. (CHARACTERISTICS OF SPEECH ‘The landmark study of speech characteris- tics of deaf and severely hearing-impaired students was conducted by Hudgins and Numbers (1942). Their findings indicated a pervasive impact of severe to profound hearing impairment on all aspects of speech production. Later investigations, including those conducted by Markides (Markides A. The speech of deaf and partally-hearing children with special reference to factors af- fecting intelligibility. Unpublished thesis, University of Manchester, 1967; 1980), were consistent with earlier studies and showed the following frequently reported errors Vowels 1. Vowel substitution, 2. Vowel neutralization (substitution of schwa for vowel). 3. Vowel prolongation, 4. Vowel diphthongization. 5. Diphthong errors (prolongation or neu- talization), Consonants 1, Consonant omission, 2. Consonant substitution. 3. Consonant distortion. Suprasegmental Intonation. . Phrasing. Pausing. Rate. Breath control. Stress204. Section i « Audiologic Rehabilitation 7. Loudness control. 8. Pitch control 9. Voice quality. Ling (1976, 1989) noted the consistency in speech errors in respiration, phonation. rate, prosody, and vowel and consonant production. It is Ling’s work that has formed the basis for current speech assess- ment and intervention with D/HH school age students. [ASSESSMENT OF SPEECH Assessment of speech can begin in infancy for children who are born deaf and should be continued throughout the student's academic career. After early evaluation of speech skills, many deaf students are pro- claimed “oral f and never receive quality speech instruction again. Speech has been the area that is most neglected in the rehabilitative process based on the as- sumption that minimal acoustic cues are available for speech development. Planni and conducting a speech development pro- gram with D/HH students requires und standing of speech acoustics and the spe- cific results of hearing evaluation. Although professionals frequently support total com- munication strategies, they often pay only lip service to speech development unless they are committed to oral education. This is truly a disservice to the deaf student be- cause any use of speech provides clues to ‘communicative partners for improved intel- bility. With systematic speech develop- ment programs, many deaf students are ca- pable of significant speech intelligibility ‘Additionally, knowledge of the phonologic system of English has been shown to facil- itate reading competence for both hearing (Lyon, 1994) and_hearing dents (Geers and Moog, 1994). Speech in- tervention is difficult. It requires incredible consistency and creativity and is misunder- stood by many professionals working with students with hearing toss, With the in- creased use of cochlear implants, even greater potential for speech development exists for deaf students. impaired stu Assessment of speech at any age shoul include evaluation of speech intelligibility (discourse, sentence, and word level), word production, syllable production, "single phone productions, and underlying prereq- tisites, Ling (1976, 1989) formulated an or- ranized, comprehensive program for speech assessment. The rationale for using the pro= cedure and specific directions are detailed within the Ling program (Ling, 1976, 1989; Stoker and Ling, 1992 ‘Assessment precursors to developing @ speech program include: 1, Examining the aided or cochlear implant audiogram Obtaining the best possible amplification or optimal listening devices for the child perception test results ecifics (for cochlear and programmin; implant students), Evaluating by usin; (ot Six-Sound) Test. Using audiometric and Ling Test res~ ponses to hypothesize what speech acous- tics are audible to the student. Performing phonetic evaluation to deter- mine the repertoire of sound production available to the student. Performing phonologic evaluation to de termine the word, phrase, sentence, and conversational production skills of the student. the Ling Five-Sound The first step is careful examination of the audiogram to hypothesize which c ponents of speech fall within the various octave bands paralleling the audiometric frequencies 125 to 8000 Hz. Analysis of the audiogram includes pure-tone frequency specific information, aided responses to pure tones and speech, immittance results, and word recognition. The professional's sensitivity to what is likely to be audible to a student is crucial in developing a speech program for that child. Ling (1989) de- Scribes the speech components associated with audiometric frequencies 125 to 8000 Hz. Ling also discusses the concept of the CLEAR zone (conversational level ele- ments in the acoustic range) of speech,should igibility D, word single prereq- an or- speech the pro- detailed 6, 1989; loping a implant lification he child. at results cochlear ‘e-Sound Test res- ch acous- to deter- ‘duction on to de- snce, and of the nation of ich com- 2 various diometric sis of the Frequency jonses. 0 e results, jonal’s audible to a speech 989) de- associated 5 to 8000 ept of the evel ele- f speech, which is critical to consider before begin- ning speech work. The child’s hearing levels and the effects of amplification on the various intensity levels of speech received dictate appropriate earmold selection to ‘make all significant components of speech detectable to the child (Ling, 1989, p. 69). The Ling Five-Sound test is conducted simply by using the “a, u, i, J, s” sounds, which represent the speech range acoustic information represented on the audiogram with the amplification used by the child. The Six-Sound Test adds the “m” sound. The test involves speaking the five or six sounds to the child, requesting a hand raise ‘or spoken imitation of each of the sounds at increasing distances (2, 4, and 8 feet) away from and out of the visual field of the child. This very simple test can be useful in validating the audiometric findings, in checking the hearing aid function, and in the carly identification of middle ear pathology. Additionally, it is useful as a hearing test for very young children or multidisabled children who may not re- spond to pure-tone or speech testing in the more formal situation. Use of this simple test provides information about specific phoneme audibility and the distance the speaker may be from the student while still being audible. The major stages of speech acquisition described by Ling (1976, 1989) occur at phonetic and phonologic levels. Evaluation of the student’s performance is conducted at each level. The phonetic level evaluated via the Phonetic Level Evaluation (Ling, 1976) includes: Vocalization freely and on demand. Suprasegmental patterns (intensity, pitch, duration), Voice control of all vowels and diph- thongs, Manner contrasts of consonants with all vowels. Place contrasts of consonants with all vowels, . Voicing contrasts of consonants with all vowels. Initial and final consonant blends. Chapter 7 « School Age Students 205 The phonologic evaluation uses. the Phonologic Level Evaluation (Ling, 1976) and includes analogous meaningful compo: nents: 1. Vocalization as a means of communica- tion. 2. Meaningful voice patterns. 3. Vowel use for word approximation. 4. Voice patterns used with word produe- tion. 5. Voice pattems for phrases. 6. Voice patterns for sentences. 7, Intelligible speech with natural voice patterns. Ling (1989) presents a hierarchy of speech acquisition that must be evaluated before speech program planning. After as- sessment, a speech development plan is im- plemented. Ling differentiates between in- formal learning facilitation, which focuses on speech play for more naturalistic devel- ‘opment of speech, and formal teaching with prompted production of specific speech tar- gets. Both emphases are discussed in “Inter- vention” in this chapter. Limited attention has been given to evaluating phonologic simplification processes of students with hearing loss, This is a linguistic approach based on the evaluation of whole words. D/HH stu- dents’ phonologic processes may be evalu- ated using processes developed for hearing students, such as the Assessment of Phono- logical Processes (Hodson, 1986) or the Khan-Lewis Phonological Analysis (Khan and Lewis, 1986), (CHARACTERISTICS OF LANGUAGE General language learning characteristics have been reported since earliest times; how- ver, itis only within the past 25 years that detailed descriptions of the language sys- tems of school-age students have been com- piled. The detailed longitudinal studies of the syntactic system performed by Quigley and associates provided a base for detailed de- scriptions of other language component use. Language research continues to be hampered206 Section I « Audiologie Rehabilitation: Chiidren by difficulties in research design, subjecthet- erogeneity, and small numbers (Laughton ‘and Jacobs, 1982). Because of communica- tion differences and difficulties, much previ- ‘ous research was conducted by analyzing written rather than interpersonal (spoken or signed) language use. More currently, efforts have been directed toward conversation and narratives (Kretschmer, 1997; Wood and ‘Wood, 1997), school discourse (Kretschmer. 1997), ethnographic inquiry of communica- tion interactions (Maxwell, 1990; Messen- heimer-Young and Kretschmer, 1994), cul- tural aspects (Wilcox and Corwin, 1990), and sign language or sign systems for facil tation of language learning (Coryell and Holcomb, 1997). Additionally. there has been greater use of qualitative and/or single- subjects designs to study, in depth rather than cross-sectionally, the language devel- ‘opment of deaf children. ‘Table 7. briefly summarizes the lan- ‘guage development of deaf children from a modular perspective of pragmatic, seman- tic, and morphologic findings. Studies of pragmatic aspects have focused on interac tions between children and a small number of adults. Early communicative intents ap- pear to develop in a fashion similar to hear- ing children, although there may be less use of information-seeking, intentional behav- jor. Register changes for various conversa- tional partners appear to be intact at an early age and continue to be refined. Conversa- tional exchanges are not well developed in spoken language. Reception and expression of clarification or repair during conversa- tional interactions appear to reflect some differences as well. ‘Semantic development is characterized by well-documented vocabulary deficits that persist into adulthood. Students with hearing loss develop receptive and expres- sive English vocabulary later and ata slower rate than expected based on chronologic age. Later, they have fewer lexical items and continue to have difficulty with functional word meaning and content words. Some dis- agreement exists about whether there is delay in onset of semantic relations. Mor- phologic development suggests a similar se- quence of markers, with the exception of present progressive and plural markers for signed English. “The syntactic system has been studied in greater detail. The findings of Quigley and. associates (e.g., Russell et al., 1976: Quigley and Paul, 1984) suggest develop- ‘ment of the base syntactic structure rules by 10 years of age, although as many as 30 to 40% do not achieve full use of the determines or auxiliary systems by age 18. As contrasted, hearing students have fairly complete come prehension and production of the base struc= ture of language by 7 or 8 yeats of age. Deaf students continue to have difficulty with pas- sive structures (instead processing with subject + verb + object strategy), relative clauses, question forms, conjunctions, and complementation into early adulthood. Pronominalization and negation are acquired ina similar sequence to hearing students but ‘at a much slower rate. Similarities in devel- ‘opment of English after development of an- other language base give support to the En- glish as a Second Language (ESL) issue discussed earlier in this chapter. The rele- ‘vance here is not to point out differences be- tween hearing and deaf students, but rather to point to the school expectations for English competence that may challenge deaf school- age students. The significance of these find- ings illustrates the potential for mismatch be- tween the language systems used by deaf and hearing students and the language expecta~ tions of the school. More recent language studies of children who ate D/HE have inte- grated earlier work into the study of dis: course, narratives, conversation, and teacher instructional style. There is a greater focus on ‘ASL leaming, bilingualism, and bieultural- ism, whereas prior studies focused more of the acquisition of English. The effects of these language formats within the classroom context are relevant in assessment and intef- vention with students who have hearing loss. [ASSESSMENT OF LANGUAGE It is clear that the language leaning of students who are D/HH is characterized by disruptions in learning across pragmatic, Seception off narkers fa 1 studied i € Quis al., 1976) st develog are rules By} ny as 30/ig determine ‘contrasted aplete come base struc | of age. Deaf rctions, ag adulthood are acquitedy students Bitty ies in devel vment of aa tt to the Efia (ESL) issue r. The Fells ‘ferences Bem but rather + for Englishy deaf schoatl of these fins nismatch Bea iby deafanil age expects ent language (H have inte tudy of dis and teach vater focus Om id bicultaral ised more 0m ne effects he classroom ent and inte hearing. Chapter 7 « SchoobAge Students 207 J@ choractersics of dec children Deiotic gestures were the most commonly used and first acquired of two categories of gestures wed by hearing-impaired children (Feldman, 1975) HEarly communicative intents of hearing-impaired children exposed to oral language were similar fonormal-hearing (Curtis et al.. 1979) children Bo cation of intents to communicative mode were found (Greenberg, 1980) HHesing-impaired (signing) children showed less use of heuristic or informative intents (Pien, 1985) rsstional exchanges [Use atention-getting statements rat simple comments about topics to enter conversations (ioKirdy and Blank, 1982) PDD (Telecommunication Device for Deaf) topic establishment left up to the adult (Johnson and Barton, 1988) SDificulty in deciding when to enter a conversation (Brackett and Donnelly, 1982) fication lHesring- impaired children tend to repeat rather than revise (Donnelly and Brackett, 1982) Differences in responses to requests for clarification; use many nonlinguistic forms of i@brification requests (Laughton and Ray, 1982; Laughton, 1992) Bist changes Hesring-impaired children can adjust to various registers of parents by 13 months (Blemnerhassett, 1984) Preschool hearing-impaired children adapt registers to three different adult registers (Small, 19854) ‘impaired children had 0 to 9 words by 18 months compared with 20 to 0 words for bearing children; similar kinds of words; total communication (TC) children had more hulary than oral communication (OC) users (Schafer and Lynch, 1980) WMocabulary levels of deaf children are far below those of their hearing peers (Simmons, 1962 @oper and Rosenstein, 1966; DiFrancesca, 1972; Walter, 1978) 18 years, deaf children have fourth g vocabulary (DiFrancesca, 1972) BYounE deat children in homes with at le a ch sign was used regula Id vocabularies otal, 1984/1985) fchildren have fewer lexical items in vocabulary than hear ‘a great deal of Bifficulty with English function words (Odom et al, 1967) have deficient knowledge of content words (Walter, 1978) antic relations BY in onset of two-word uterances according to some investigators; others disapre; do have Be sess Gln Meadow an Fone, 1975, Sri nd Prting, 197) iy sciect words from appropriate syntactic categories but often choose inappropriate SewOrds within those categories (Bochner, 1982)208. Section |» Audiologic Rehabilitation: Children fabte 7.1 Language characteristics of deat children ‘Semantic structure heavily weighted toward or even restricted to factors concerned with concrete {judgments (Green and Shephard, 1975) ‘Word associations of deaf subjects resemble those of younger, hearing children (Koplin et al., 1967; Blanton, 1968) Exhibit differences in semantic organization of words associated with auditory imagery (Tweney etal., 1975) MORPHOLOGIC ‘Similar sequence to hearing with reverse development of *-ing” and “-s” (Gilman and Ratfin, 1975; Raffin et al, 1978) ‘Similar sequence to hearing with less differentiation in subject form class and slightly advanced ‘acquisition of structures leading to negative sentence structure Development of morpheme structure was significantly below that of their hearing peers at 8 years ‘of age but had leveled off by the seventh grade level, suggesting that the deaf students were ‘operating without optimal memory processes during the crucial educational years (Wilbur, 1987) “Feldman A. The development ofa lexcon by deaf children of hearing parents, orshere's mare to langage han mets the ear Unpublished doctoral dissertation, University of Pennsylvania, College Pak, i975 ‘small A. Negotiating conversation: interaction ofa hearing impaired child with her adult communication partners in language therapy. Unpublished doctoral disertaia, Univesity of Ccnnai, 1985, mantic, syntactic, and morphologic com- ponents when language (English language) is viewed from a modularity perspective. More recently, interactionist models of language acquisition and assessment have been discussed for children with hearing loss (Yoshinaga-Itano, 1997). Suggestions for intervention flow from the more current work in discourse and narratives—the major focus of school language use. ‘Assessment of D/HH students” language functioning is clearly within the purview of the speech-language pathologist, who must be knowledgeable about expected language acquisition during the school-age years for hearing students. (For excellent information about school-age language learning of hear- ing students, see Bemstein and Tiegerman, 1993; Ripich and Creaghead, 1994; Wallach and Butler, 1994; Nelson, 1998; Nippold, 1998) The language performance of deaf stu- dents has been an area of concer since the origins of their education many centuries ago. More recent assessment has centered around the use of naturalistic language sample analy- sis and the development of language tests where none existed previously. Analysis pro- cedures were detailed by Kretschmer and Kretschmer (1978, 1988, 1989) and others (Thompson et al., 1987). Although early as- sessment approaches paralleled the struc- tured or naturalistic approaches used for teaching, more recent attempts have moved toward integrated approaches (Yoshinaga- Itano, 1997; Kretschmer, 1997; Wood and Wood, 1997). Recent language assessment has seen more integration of pragmatic, se- mantic, syntactic, and morphologic systems of D/HH students. Additionally, a series of tests similar to those used for hearing stu- dents have emerged (Moog and Geers, 1980, 1985). These tools strip away context (ie., they are referred to as context stripping tools) and therefore must supplement rather than substitute for assessment in authentic con- texts. Assessment must occur in a context that is similar to the classroom contexts where the student uses language. A comprehensive assessment of language ‘must include multiple contexts in which the child uses language (including teacher lan- guage, the curriculum, the classroom dis- course, leaming formats) as well as a com- plete description of the student’s language system (discourse, narration, and pragmatic, semantic, morphologic, syntactic, phono- logic domains) and sign system used (if rele- vant). School inclusion children with hearing, Joss are similar to hearing students with lan- guage leaming disruptions in that they tend to‘concrete etal, (Tweney afin, dvanced 8 years vere vur, 1987) noe the eae sinlanguage the struc- used for ve moved ‘oshinaga- Wood and ‘sessment matic, e- ic systems 2 series of caring stu zers, 1980, antext (i, ping tools) vather than tentic con- ‘context a. contexts vf language \ which the zacher lan- stoom dis- as a com- language pragmatic, ic, phono- sed (if rele- vith hearing ts with lan- they tendto develop first as communicative language users, trying to satisfy basic intents; they then emerge into metalinguistic language users, using language to leam. Some D/HH students never move successfully into the metalin- guistic domain. The “pragmatics revolution” ofthe 1980s (Duchan, 1988) hada significant effect on language assessment. Much of what we know about language and how it is used hhas come from observing children using lan- guage in naturalistic settings. The teacher, speech-language pathologist, or audiologist ‘must understand normal language acquisition and school language expectations to assess the language use, content, and form of stu- dents with hearing loss. Some major assess- ment questions that should be posed are: 1, What is the student’s primary language (English, ASL, or a Pidgin form)? 2. How does the student use language to communicate in a variety of contexts? 3. What strategies does the student use to earn language and to use language to learn? 4, What are the regularities in the child’s language performance? 5. What are the areas that need further de- velopment? Answers to the assessment questions may be obtained by: 1. Description of the student’s language sys- tem in multiple contexts (with particular emphasis on discourse and narration), 2. Description of the language contexts in which the student uses language (school). 3. Expansion of the sampled contexts with information gleaned via language tests (if necessary for school requirements). Many tests are available to sample parts of the language system of hearing students. Few tests exist that were designed specifi- cally for the D/HH student. A list of lan- Guage tests appropriate for D/HH students With indication of those developed specifi- cally for this population can be found in Laughton and Hasenstab (1993). Caution is Chapter 7 School-Age Students 209 recommended in the administration of tests, because of (1) the ample documentation of poor performance by D/HH students on all types of standardized tests, (2) the decontex- tualized nature of such tests (Laughton and Ray, 1982; Ray, 1989), and (3) the limited educational planning value of such tests.. To perform successfully on most tests, a student ‘must be metalinguistic (i.e., capable of ana- lyzing and reflecting on language). Factors to consider in test administration are: 1, Rate of stimuli input and response (timed, untimed). . Type of input and expected response. ‘Testing conditions (distractions—visual, auditory, linguistic. Directions that are clear, unambiguous, and language appropriate. . Context that is communicative or decon- textualized, The language assessment procedures de- scribed here are appropriate for students us- ing primarily oral or total communication in- struction, and there will be no specific differentiation. Coding of information for students using simultaneously signed and spoken language can follow the convention described by Johnson (1988), in which all of ‘the language and nonlinguistic information is recorded and the modality is indicated by S (speech), (sign), or C (combined). Recoding English language tests into ASL is problem- atic because two completely different lan- guages are involved. Naturalistic settings For many years, low structured observation has remained a favored method for the study of language of both hearing and hearing- impaired students. Low structured observa- tion occurs in natural social contexts with fa- miliar people. It is relaxed and allows the child more choice in selecting the topics. The assumption is that nonobtrusive sampling will yield the most representative language sample, unlike language tests or structured elicitation techniques (Lund and Duchan, 1983). This is especially relevant in light of210. Section Ii « Aucéologic Rehabilitation: Children research that shows that adults (teachers) can manage conversations to bring about more productive language productions from deaf children (Wood and Wood, 1984, 1997), Some structures such as requests may be more effectively elicited via structured elici- tation techniques when such a structure does not spontaneously occur in a low structured situation (Lund and Duchan, 1988). Curriculum-hased assessment (CBA) procedures provide a naturalistic approach for school setting assessments appropriate for school-age students with hearing loss. This method focuses on assessment of the school language contexts and the student’s language system before moving into inter- vention and literacy. The language of in- struction involves leaning to read, write, and talk about language as well as using lan- ‘guage to lear how to perform activities to eam about other information. CBA focuses on how oral and written skills required by ‘the curriculum contrast with the skills and strategies exhibited by the student (Nelson, 1989). The expected skills for future acqui- sition and modification in curricular expec- tations are a part of this type of evaluation so it leads directly to instruction, During lan- guage evaluation, the examiner is concerned with the child as a language user within the communication world. Historically, language assessment of D/HH students was accomplished rather in- formally by their teachers because few tests other than informal, teacher-constructed tests were available. However, during the 1980s, with the advent of a retum to lan- guage sampling in naturalistic settings and global analysis of the language used in a va- riety of settings by professionals working with hearing children, these formats became ‘more popular with students with hearing loss as well. Also, several language tests were de- veloped to address specifically the concerns about testing these children. Included among the tests developed are several tests similar to those in batteries for hearing children and several innovative models designed to ad- dress the needs of children with hearing loss specifically (Moog and Geers, 1980, 1985; deVilliers, 1988). Language sample procedures The practice of language or discourse sample analysis continues to be a popular way to pro- vide a picture of language functioning neces- sary for planning subsequent language inter- vention. Evaluation for school-age students hhas become more discourse-focused. The structures necessary in school are narratives (written, signed, or spoken), description, problem-solving, explanation, instruction- giving, and persuasion (Kretschmer, 1997). Lund and Duchan (1988) proposed a “child- centered pragmatics framework” for analyz- ing language samples. This process involves reorganization of semantic, morphologic and syntactic analysis into a pragmatic. focused perspective that includes sense- ‘making, functionalism, and fine-tuning, Sense-making describes the child’s sense of an event (event analysis) and reflects on the student’s understanding of common events rather than specific language know!- edge. Included in event analysis are scripts of action (e.g., events such as trips to the 00) and frames of discourse events (talking events such as conversations about a z00 trip). Analysis procedures could include: 1. Identifying the beginning and end of events, 2. Determining the child’s idea of an event frame, . Identifying the tightness of the frame. |. Determining the compatibility between partners. Identifying tums. successful contexts and Funetionalism interprets what communi- ators want to achieve via their communica- tion (‘e., their intentions). This analysis in- cludes: 1. Participant's agenda or what each wants to achieve. 2. Formulation of intents (speech acts). 3. Execution of intents and agenda, Fine-tuning involves the sensitivity of the communicative partners to each others’ ‘comprehension and includes:> sample ytopro- igneces- ge inter- students sed. The arratives scription, struction- 1, 1997). a“child- wr analyz~ involves phologic, ragmatic- sense- ing, Id’s sense d reflects common ge know!- are scripts ips to the ts (talking, out a 200 nelude: ad end of ofan event e frame. y between texts and ‘communi ommunica- analysis in- each wants thacts), ada, sitivity of each others” 1. Contingency analysis. 2. Interaction mode analysis (directive- ness/nurturance; motherese). ‘This type of procedure can be modified for classroom discourse and used effectively for students with hearing loss. The language sample analysis procedure provides examples of language functioning in several settings. The sampling procedure is helpful in observing the child's move from ‘one linguistic phase to another. Language samples from naturalistic or more structured school settings provide the data. Ongoing samples provide reliability data, that i whether any single sample is representative of the student’s language use and the impact of context variations. The number of utter- ances necessary for language sample analysis is relative to the language leaming level and context (Lund and Duchan, 1988). Whereas 50 utterances have traditionally been consid- ered to be appropriate, we know clinically that young hearing-impaired children may not generate 50 utterances within several set- tings. With older students the 50 utterances may be obtained easily, but more utterances will reflect flexibility (or lack of flexibility) as well as changes within the utterances contin- gent on pragmatic demands. For example, single-word utterances may be common when the examiner asks consecutive ques- tions of the child, but longer utterances may occur when a child is engaged in event de- scription or narratives (Wood and Wood, 1997). The specific utterances and the num- ber selected for the analysis should reveal the strengths of the language system. Further dis- cussion of language sample procedures is available from Lund and Duchan (1988). The most preferred language elicitation proc dures for preschool-age through adult are in- formal conversation followed by imperatives and “WH” questions (e.g., What? Where? Who?) for elementary and secondary school- age students (Atkins and Cartwright, 1982). ‘Children’s language is richer in content, syn- fax, and ideas when unstructured elicitation procedures are used; however, there are times When getting the conversation started neces- Sitates specific elicitation. Chapter 7 « Schoohge Students 277 Specific elicitation tasks variety of tasks have been critiqued for use in obtaining language samples. The authors have found the following to be effective: 1, Spontaneous interaction (free play or interaction, conversation) can be pro- ductive. With younger children, making puppets “‘talk,” identifying the charac- ters, and beginning action with dialogue have been helpful. With older students, discussion of school or age-related topics is generally more productive. There are many students who do not communicate freely with a stranger in this type of set- ting, so a teacher or peer may elicit a more representative sample. Elicited interaction may be necessary for students who are somewhat reluctant to communicate. Enticing the student to provide instruction in how to play a game often yields a rich language sample. Specific set-ups, such as role-playing with peers, can be productive as well. A creative example includes a situation in which students were directed to talk with each other about their favorite snack foods while they watched television, Their conversations were audiotaped us- ing an unobtrusive flat microphone taped to the comer of the table (Schober-Peter- son D. The conversational performance of low achieving and normally achieving third grade children. Unpublished doc- toral dissertation, University of Illinois, Champaign, Illinois, 1988). Other contexts include story-telling or use of a Viewmaster; the clinician directs the child to describe a frame and then tries to guess which one is being de- scribed. Requesting that the older school-age stu- dent give directions from where he or she is to their home or another location pro- vides a valuable sample. . Describing a movie not seen by the ex- aminer is also a good sampling strategy for older school-age students. . Deep testing for structures that do not appear in the sample can be done by patterning, sentence completion, inter-212. Section Audiologic Renabittation: Chikdren views, questions for information, retells, pretend situations, games, or even lan- guage test formats, The authors have found the following to be most helpful in eliciting a language sample. Make it real communication. Sabotage the environment if necessary ‘Avoid playing “20 Questions,” or single- word answers will be the product. Do not anticipate the child’s behavior, wants, of responses (ie., do not preempt the child). Ifpossible, let someone else interact with the child while the examiner makes notes and observes. Slow the pace, contribute to the conver- sation with narrative episodes includ- ing complex, embedded utterances rather than frequent repair, simple grammar, and numerous questions (Wood and Wood, 1997). ‘Audiotape and/or videotape the inter- action; even consider leaving the room briefly while the videotape continues. ‘Mean length of utterance (MLU), Brown's ‘Stage, and type-token ratio ‘A morphologic MLU is computed and serves as the entree to the analysis system. Procedures for computing MLU are avai able from Chapman (1981). Brown’s Stage is determined via both MLU and qualitative descriptors rather than MLU alone, which often inflates the Brown’s Stage determina- tion, For example, a child who has plateaued developmentally at Brown's Stage Il may have a higher MLU than the expected 2.0 to 2.5 with limited development of morpho- logic markers (pluralization, present pro- gressive) and determiners. Based on MLU alone, the child would qualify for Brown's Stage III but is clearly still at Brown’s Stage Tt qualitatively. A slight modification in morphologic acquisition has been observed with hearing-impaired students using See- ing Essential English (Raffin, 1976; Raffin et al., 1978). The difference observed was that plural and past tense were apparent be- fore the present progressive marker. Type-token ratio information is also helpful in adding to the total language func- tioning picture. Although this procedure has been criticized as a research instrument be- cause of variability related to sample size, it can provide helpful clinical data about the student's flexibility in use of lexical items and linguistic categories. For a further de- scription of this measure, see Miller, 1981 and Hess et al., 1986. Further analysis of language performance can be obtained through the use of some of the tests developed specifically for students with hearing loss or those modified for use by these students. PSYCHOEDUCATIONAL ASSESSMENT Psychoeducational assessment for children with hearing loss may be necessary to de- termine eligibility for services, to make appropriate decisions for placement, and to establish educational and (re)habilitative objectives. The area of psychoeducational assessment for school-age children with sig- nificant hearing loss has received less atten- tion than identification of their language and communicative function. Nevertheless, the psychoeducational domain reflects the im- pact of the hearing loss on learning within the environment in which these children are expected to compete. In some states, unlike the eligibility requirements for other dis- ability conditions requiring special educa- tion, the only requirements for students with hearing loss include audiometric evaluation, otologic evaluation, and minimal asses ment of basic academic skills, express and receptive communication abilities, and a statement about social/emotional adjust- ‘ment for developing the individualized edu- cation program. A psychological evaluation ‘using instruments appropriate for D/HH sta- dents is recommended but not required in some states (Georgia Department of Educa tion Regulations and Procedures, November 1, 1988). Speech and language evaluations ‘occur at least annually for D/HH students, ‘but comprehensive psychoeducational asessize, it bout the al items ‘ther de- er, 1981 ormance some of students 4 for use children ry to de- to make xt, and to bilitative ucational with sig- ess atten guage and eless, the s the im- ag within ildren are es, unlike other dis- al educa- {ents with valuation, al assess- expressive lities, and cal adjust lized edu- zvaluation D/HH stu- quired in of Educa- November valuations [ students, ational as- sessment may never occur during a_stu- dent’s school years. This state of affairs continues to present a major challenge for personnel charged with education planning. Horror stories of deaf individuals misla- beled as mentally retarded or emotionally disturbed continue even in these times. Ad- ditionally, many students with hearing loss remain underserved because of a lack of comprehensive assessment, Psychoeducational testing of school- age children often is divided arbitrarily into two areas: assessment of cognitive abilities and assessment of academic performance or achievement. Tests of cognitive ability the- oretically tap a child’s learning potential, learning style, and problem-solving strate- gies. Tests of academic performance are designed to determine how well a child per- forms in areas such as reading, math, gen- ral information, and other content subjects, Achievement represents the knowledge and experience that a child has accumulated. Cognitive areas represent the presumed Jeaming potential or capabilities of a child. Psychoeducational assessment of children with hearing loss The purposes for assessment of children who are D/HH are the same as for others: To provide baseline information and feedback about progress. . To identify the student's strengths and weaknesses. . To provide an appropriate educational program with modifications as needed. The major areas of assessment include cognitive, communicative, achievement, and social-emotional functioning (Heller, 1990), Communicative assessment has been discussed previously. Additional psychoed- Ucational assessment should minimally in- clude measures and behavior samples of: 1. Nonverbal and verbal cognitive func- tioning or learning abilities. 2. Achievement in reading, writing, math, and when possible other content aca- demic areas. Chapter 7» School-Age Students. 2/3 a, Reading—see Laughton (1988). b. Writing—see Conway (1988) 3. Information-processing performance. 4, Psychosocial characteristics In the past, psychological assessment of children with hearing loss was criticized for (1) failure to ensure that the child compre- hended the language and concepts used in psychological tests, (2) use of tests stan- dardized on hearing children only, and (3) use of evaluators with limited familiarity with the language and behaviors of students who are D/HH (Elliott et al, 1987). The reader is referred to reviews of appropriate tests for this population (Elliott et al., 1987; Simeonsson, 1987; Bradley-Johnson and Evans, 1991). These concerns continue to be of major interest to professionals within the discipline, because these students often fail to receive comprehensive assessment. Psychological testing is affected by situ- ational variables, measurement errors asso- ciated with test instruments, the personality ofthe evaluator and the student, and the het- erogeneity across individuals with hearing loss (Elliott et al., 1987), Differences among D/HH individuals that are critical and must be considered in assessment in- clude their language, culture, communica- tion mode, interpreter needs, comprehen- sion of the language used by the examiner, familiarity with test instruetions, and prior test-taking experiences. Testing assumes the ability to understand and communicate using the English language. Many psycho- logical and achievement tests use complex syntax, idiomatic expressions, and awk- ward sentences that are not in common us- age in informal spoken ot signed interper- sonal communication. Deaf individuals may not have the English competencies re- quired to deal with this type of language use. They may have experience with spoken English, signed English, ASL, or some modified version of each language. There- fore, they could be expected to be very dif- ferent in their comprehension of the lan- guage used in tests. Cultural differences are expected across deaf populations as well. Many psycholo-214. Section I» Aucioiogic Rehabiltation: Children, gists testing deaf students are unfamiliar with the diverse cultural aspects influencing testing of these students. These differences may include expectations of the assess- ment, appropriateness of discussing per- sonal matters, role interaction with hearing people, and how to deal with unclear com- ‘munication. Many deaf individuals require an inter- preter when the examiner is unable to sign for himself or herself. Few professionals evaluating deaf individuals are fluent in ASL or other English sign systems. There are no magic solutions when an interpreter is used, and questionable practices may occur. According to many psychometrists, conceptual signing used by most interpre- ters to get across the message may provide too many clues to the examinee. The inter~ preter used for psychological testing should be trained in psychology and testing as well as sign language (Suilivan and Vernon, 1979), Even when signing for himself or herself, the examiner must continuously ccheck to be sure the student has understood the language used The complexities of testing are not necessarily reduced during evaluation of auditory-oral students. Many are intelligible only to professionals trained to recognize the phonetic and phonologic speech charac- teristics of deaf students. Even when stu- dents are intelligible, their comprehension of spoken language cannot be assuumed to be intact. The typical psychological evaluator in public schools has had limited experience with deaf students using oral or simultane- ‘ous spoken and signed communication. The psychological tests most commonly used to evaluate students with hearing loss have not changed dramatically since the early 1970s (Levine, 1974; Gibbins, 1989) The WISC-R and WISC-III Performance Scales, the Leiter, the WAIS-R, and the Hiskey-Nebraska continue to be used most frequently. The only one of these tests that included children with hearing loss in the original standardization sample is the Hiskey-Nebraska, which was developed specifically for deaf students. Questions about the generalizability of this test were raised many years ago (Watson and Goldgay, 1985), The WISC-R and WISC-IIl do have hearing-impaired norms for the Performance Scale (Anderson and Sisco, 1977); however, they were developed after the fact rather than including these students in the original stan. dardization sample. The Nonverbal Scale of the Kaufman Assessment Battery for Chile dren (K-ABC) follows the above four tests in popularity for use with hearing-impaired stu. dents (Gibbins, 1989). Because of its ease of administration, motivation for children, and nonverbal subtest scoring, it became more popular during the 1990s Despite the clear statement in the original legislation, PL 94-142 requiring compe- tent evaluators to measure the psychological abilities of students with hearing loss, few professionals are trained or experienced with these children, Of particular concem is the typical school psychologist who per- forms testing of students who are D/HH within public schools. Gibbins (1989) ex. amined the practices of professionals pro- viding such services. The professionals de- scribed themselves as school psychologists, clinical psychologists, administrators, edu- cational diagnosticians, and learning spe- cialists. Eighty percent of the group indi- cated that their involvement with testing students who were D/HH was only part- time, with the majority of their time dedi- cated to the evaluation of hearing children (Gibbins, 1989). Improvement of the quality of psychological services is unlikely to oc- cur with school psychologists who have lim= ited experience and lack specialized training for testing this population and who work pri- marily in regular educational settings that serve these students in special classes or in the continuum of mainstream settings (Gib- bins, 1989), ‘A comprehensive assessment, although critical for educational planning, is not eas- ily accomplished with D/HH students, The interdependence of language and cognition presents difficulty in assessing cognitive function without using language (Orr et al» 1987). Performance tests minimize the use of language but generally require that in- structions be given using language. Beingldgar, vhave nance vever, wrthan I stan- sale of Chil ests in ed stu- zase of ‘n, and » more riginal “ompe- logical ss, few sienced reer is 10 per- D/H 89) ex: uls pro- nals de- ilogists, rs, edu ng. spe- ap indi- testing ly part xe dedi- children > quality y t0 00 ave lim- training vork pri- ngs that ses or in igs (Gib- although ‘not €a5- ants, The zogition cognitive Der et al, e the use > that in- xe. Being certain that students understand the task to be performed becomes complex. The Per- formance Scale of the WISC-R and WISC- Ill can be useful in providing an estimate of the student's general nonverbal problem- solving but provides little information about the individual's verbal abilities when the Verbal Scale of the test is not administered, as is often the case. Psychoeducational assessment of D/HH students must be accomplished within a con- text that provides meaningful information for educational planning. Most standardized testing is decontextualized, requiring the examinee to ignore the very guidelines they follow in interpersonal communication (Laughton and Ray, 1982; Ray, 1989). Stu- dents are removed from their usual sur- roundings and asked to interact with test stimuli in a structured manner that is diseon- nected from their world knowledge. Such assessments lack authenticity. Additionally, tests are often timed without direct notifica- tion to the student during the testing. These typical test conditions are likely to be unfa~ muliar to D/HH students who are less “test- wise” than many other school-age students (Ray, 1989). The examiner is cautioned in psychoeducational testing with students with hearing loss with respect to the use of: 1, Verbal tests that measure language rather than intelligence, psychosocial behavior, aptitude, or interest (Vernon, 1976; Zieziula, 1982). Modifications in administration of tests including pantomime (Graham and Sha- piro, 1963), visual aids (Reed, 1970), and practice items (Ray, 1976). Oral communication and hearing aids, considering the adverse effect of poor speech skills on understanding (Ross, 1990). Signed communication, considering the variable competencies of the student and the examiner. . Lack of validity of timed tests with timed responses (Zieziula, 1982). For hear- ing children, a timed test establishes an attention set that moves them efficiently through accurate responses (Veron, Chapter7 « SchoobAge Students 215 1976); students who are deaf typically try to finish quickly at the expense of ac- curacy. Such a difference in response to being timed is one of a multiplicity of subtle yet substantial performance fac- tors that inexperienced test administra- tors may fail to consider. Group testing, because of the attention to test directions and reading level re- quired for understanding directions (Sulli- van and Vernon, 1979; Levine, 1981; Zieziula, 1982). . Personality assessment that may tend to identify psychological subgroups in view of the language and communication, issues presented earlier. IMPLICATIONS The implications of early detection of hearing loss and optimal amplification or cochlear implants for students who are D/HH and who develop auditory skills al- lowing them to function primarily in an au- ditory environment are that these children then may experience the assessment and in- tervention services available to any hearing student with a disability. However, students whose speech is not highly intelligible to examiners with general special education backgrounds or whose primary language is conveyed through a signed format (English or ASL) may not receive the comprehen- sive assessment and subsequent interven- tion guaranteed by the legislation devel- oped for individuals with disabilities. ‘Although the primary focus of this chapter is directed to significantly hearing-impaired students, the reader is cautioned to be sure that all students with hearing loss, irrespec- tive of severity or relative success of the ha- bilitation, are entitled to a comprehensive assessment before development and initia- tion of their habilitative programs and peri odically through their school years. There- fore, many of the tests and procedures will be applicable to all school-age students who are D/HH. Despite successful rehabilita- tion, hearing loss is likely to interfere with communication in some interactions that216 Section ll» Audiologic Rehabilitation: Chidren occur daily, Thus, it is likely that all stu- dents with hearing loss will need some de- gree of intervention. Ongoing assessment provides parents and professionals with a fund of new information to expand and al- ter the child’s rehabilitative program to en- hance development. Intervention ‘The intervention phase of the rehabilitative process follows analysis of the contexts and the repertoire of tools available to the school-age student to apply to these con- texts. The long-term goal is that the child with hearing loss will become an indepen- dent adult Short-term goals include: |. Well-adjusted parents; ‘A child with a good self-concept, Reduction of the impact of the auditory deficit through amplification, cochlear implants, and/or auditory learning; A child with cognitive skills commensu- rate with chronologic age; A child with language skills to meet com- municative and cognitive needs; A child with speech to expre: (Boothroyd, 1988); and/or A child with signs to express language (if this is the selected communication op- tion), language An effective rehabilitation management model includes these components: 1. Parental management: assisting parents in developing the skills to accept, teach, and advocate for their child. . Audiologic management: hearing test- ing, hearing aids and retesting, responsi bility for cochlear implants, hearing con- servation, Auditory management: establishing a program for development of auditory earning. Cognitive/linguistic management: devel- ‘oping a world schema with a symbolic system to represent the schema. Speech management: developing the auditory, motor, acoustic, phonetic, and phonologic aspects of spoken language. . Educational management: developing the leaming skills and modification of the learning contexts to facilitate leam- ing across the curriculum, Social and emotional management: de- veloping a perspective that enables active participation in the social environ- ‘ment with a healthy self-concept (Booth- royd, 1988: Brackett, 1997). Rather than differentiating the rehabilita- tive process from the education of D/HH students, the focus in intervention is to in- corporate both into an integrated model, The history of educating deaf students is rich but marked by controversy. Education for D/HH students in the United States pre= dates special education for other disability groups. The land grants for establishment of state universities also established schools for the deaf. Education of deaf students in the United States began in Hartford, Con- necticut, with the establishment of the ‘American Asylum for the Deaf and Dumb (later changed to the American School for the Deaf) in 1817. This program used the language of signs as the primary means of communication. Soon after, the establish- ment of the Clarke School for the Deaf in Northampton, Massachusetts, provided the option of an oral education for deaf stu- dents. To this date, disagreements continue regarding preferred methodology for com- munication and education of D/HH. stu- dents, These children and their families are not homogeneous; they have different needs and therefore require different plans for habilitation. Moores (1991) updated the school place- ‘ment revolution, documenting the changes in the school-age hearing-impaired popula~ tion from the 1980s to early 1990s. He noted that fewer students were deaf (had profound losses) and that logically more children were being taught via auditory! oral-only instruction (39% of the school- age population). Simultaneous instruction using signs and speech was used with 60% of the population, with all other modesic, and niage. loping tion of > learn: nt: de~ enables nviron- (Booth- rabilita f D/HH is to in- model, dents is ducation ates pre lisabili ment of schools adents in rd, Con- of the 1d Dumb zstablish- 2 Deaf in vided the deaf stu- continue for com- WHEL stu: ilies are different rent plans. ol plac e changes 2d popul 1990s. He deaf (had ally more auditory he school- instruction | with 60% her modes sued speech, other) used with % of the population. Moores further sum- marized the demographics, stating that “the population of children we are serving is be- coming less white and less black, less deaf, more oral and younger” (Moores, 1991, p. 307). This was, of course, reflected in edu: cational and rehabilitative practice. In 1986, the Executive Board of the Council on Education of the Deaf (CED) affirmed the principles central to PL 94-142 to pro- vide individualized instruction and services to D/HH students of school-age, noting that “no single method of instruction and/or ‘communication (oral or total communica- tion) or educational setting can best serve the needs of all such children” (Northcott, 1990, p. 3). The school placement trends continued through the late 1990s and into 2000, with the major impact of greater use of cochlear implants with younger children resulting in higher language achievers and ‘more oral communication educational sites being sought. A significant aspect of the school place- ment revolution was that the predomi- nance of children with hearing loss are schooled within the public day mainstream or inclusive settings. The students at resi- dential schools for the deaf continue to be the minority. Intervention at the beginning of the new century then must focus on the changes brought about through this place- ment revolution. Public school personnel must take very seriously their roles as case managers to implement all the commu- nicative, educational, and other services that children with hearing loss are entitled to for them to become contributing mem bers of the mainstream, multicultural ‘community Ross (1990, p. ix) describes the context for intervention for D/HH students that con- tinues to be relevant: “The core of any man- agement program of the mainstreamed Hiearing-impaired child must be the regular classroom. Itis the classroom teacher who is faced with the child for most of the school day.” The changing map from primarily Fesidential to primarily inclusive educa- tional contexts has brought both new c hooLAge Students 217 challenges and old dilemmas. The old dilemn- mas involved methodology (sign language or speech or combined instructional ap- proaches), lack of a research database, ap- propriate school placement, community of Deaf or deaf individuals, early identification, and intervention. The current challenges in- volve methodology, use of technology, mul- ticultural identity, language (ASL, English), individualization based on differences, and availability of educational services based on commonaities Alexander Graham Bell taught deaf stu- dents to see it, say it, write it, refine it, read it, and think it (1873). As Northcott (1990) notes, the master teachers, Fitzgerald (1949), Buell (1934), and Groht (1958), each added a significant dimension to the art and science of teaching students who are D/HH. Contemporary teachers and scholars such as Kretschmer and Kretschmer (1978, 1988, 1989), L.W. Kretschmer (1997), R.E. Kretschmer (1997), RR. Kretschmer (1997), Wood and Wood (1997), Yoshinga- Itano (1997), Moog and Geers (1980, 198: and Luetke-Stahlman and Luckner (1991) have interwoven the insights from the past with the findings of the present to facilitate more effectively the integration of D/HH students into the school community. ‘A primary purpose of intervention with .¢ D/HH students is to facilitate su full academic performance. Such success hinges on the ability to meet the requirements (comprehension and performance) for school language use. D/HH children must learn to move beyond the social and need fulfillment aspects of interpersonal communication into the realm of academic survival and enlight- enment through communication using both spoken and written English formats. In one form or another, the spoken or written En- glish language forms the foundation of the educational career forall students. Unless the linguistic rule systems are developed and used, the child will be unable to meet suc- cessfully the educational challenges of to- day's schools. Assessment by itself is ineom- plete. It should be seen as an initial step in an intervention program and an integral part of ongoing habilitation. To provide an optimalleaning environment for children with hear- ing loss, assessment and educational practice ust be bound intimately. All students need effective communica- tive language development and metalin- guistic instructional strategies to succeed in school. The role of the rehabilitative case manager is to define and locate for each child all the services he or she needs and to assist in integration of those services for the child’s benefit. Intervention in language, speech, sign language, and academic areas may be necessary. The key principle that guides intervention with school-age stu- dents with hearing loss is integration or in- terfacing of services. Speech and language therapy from the speech-language patholo- gist, language development from the teacher of the deaf, and academic instruction from the mainstream classroom teacher will be of limited value without aclearly defined effort by all to integrate these services. Armed with all of the assessment data discussed previously in this chapter, the team should construct a map of services, grounded in on- going assessment, that guides the student from the tenets of auditory leaning to the process of communication (be it a spoken or signed language) through experiential and semantic expansion, toward the ultimate goal of sufficient language facility for aca- demic success. The student is likely to need speech therapy and language therapy but may also need occupational, physical, or psychological therapy, counseling, and/or learning disabilities remediation. Just as curriculum-based assessment (CBA) has be- come a focus for identifying language needs for school-age students, comprehensive cur- riculum-based intervention that includes all aspects of school must be developed for the student who is D/HH to lear and realize his orher potential. Specific intervention in lan- guage (interpersonal and written), audition, speech, and academic areas becomes the do- main of the speech-language pathologist, re- habilitative audiologist, and educator of D/HH students in concert with classroom teachers. Each member of this team bears responsibility for effective integration of services and for the individual components of speech, language, and academics. A brief guide to each follows. ‘SPEECH INTERVENTION As Northcott (1990) observed, the 1978 leg- islation dealing with human rights identified speaking and listening along with reading, mathematics, and written communication as rights to which each child (including the students who are deaf) in the U.S. public schools is entitled. Legislation continues to support the right to comprehensive speech and language assessment and intervention services for all school-age students with hearing loss, Facilitating intelligible speech produe~ tion has been a goal since the beginning of education of D/HH students. Success has not always been realized with significantly hearing-impaired students. However, dedi- cation to speech development and consistent strategies based on current technology have not always been a part of the speech devel- ‘opment program. Some degree of residual hearing, amplified early, has been a consis- tent prerequisite for intelligible speech de- velopment. Although speech development strategies were laid out in detail in Haycock’s (1972) primer on speech methods for the deaf, it was later with the development of Ling’s (1976, 1989) methodology (Stoker and Ling, 1992) that we began to see the specifics of audio- logic testing information and appropriate amplification selection brought together with known speech acoustic information to become manageable for interventionist. Speech-language pathologists recognize that speech development with D/HH children is far from synonymous with traditional articue lation therapy used with hearing students, al- though the newer theories of phonologie processes became more relevant to speech development with all of these students. Intervention in speech commences at the level of breakdown identified through speech assessment (phonetic and phono- logic). Ling (1976, 1989) described the pho- netic intervention model as consisting of @ hierarchy, beginning with the developmentof suprasegmentals (intensity, duration, and frequency), continuing through vowel and diphthong development, and moving to con- sonant and consonant cluster development. The phonologic aspect of intervention con- tinues the process in development of words, sentences, and longer chunks of meaningful language. The phonetic and phonologic intervention is implemented by informal learning or formal teaching strategies, de- pending on the age of the child and on how ong the hearing impairment has affected the child’s leaming (Ling, 1989; Stoker and Ling, 1992), A well iaid out curriculum is available for developing the phonetic com- ponent through formal teaching, including: . Production of speech sounds. Combination of consonants and vowels into syllables. Production of syllables rapidly and auto- ‘matically. Alteration of syllable pairs automati- cally. As soon as a child is able to produce syl- lables automatically, itis appropriate to add the semantic or meaning component to the Production. This is followed by develop- ment of words and longer spoken contexts or the phonologic component of speech development, All speech-language patholo- ists responsible for students with hearing loss should have the Ling materials avail- able for use. Curricula such as the Clarke School for the Deaf Speech Development Curriculum (1995) details the sequence of spoken language development. Treatment approaches based on elimina- tion of phonologic simplification process: Should also be a part of speech intervention. (See Edwards and Shriberg, 1983; Hodson and Paden, 1991; Bemthal and Bankson, 1998.) Specific speech intervention pro Srams have been developed for students who have had cochlear implants, but the Ling ™ethodology continues to be the foundation of many of these programs. The differences are likely to be that with the new processed Speech (“hearing system”) provided by the ochlear implant, children may not follow Chapter 7 « School Age Students 219 exactly the hierarchy proposed by Ling in vowel and consonant development. Admin- istration of the entire Phonetic Level Evalu- ation may be necessary, and targets selected for intervention may be more varied. It is, likely that most other procedures and strate- gies proposed by Ling will maintain. More instances of “sound preferences” have been observed with children who have cochlear implants; the children become enchanted with a specific sound, rehearse it, and overuse it. The benefits of an auditory-verbal approach (Pollack et al., 1997), a methodol- ogy that has been most successful with chil- dren with residual hearing, are becoming more well-known in the successful applica- tion with students with cochlear implants. The development of specific intervention programs and the application of auditory ap- proaches for children with cochlear implants are also underway (Tye-Murray, 1992), LANGUAGE INTERVENTION Historically, language development/teach- ing of students who are D/HH has had a rich, colorful past, with remnants of the fabric shaping current teaching methodology. The analytie/synthetic methodologies have been reinterpreted into the structured/naturalistic contexts for language learning. The counter part to the Groht and Fitzgerald teaching ap- Proaches evolved into a metalinguistic/ ragmatie/semantic focus. Current models of language intervention draw heavily on the child language acquisition literature of hearing children, Intervention in language follows a similar sequence as language intervention with h ing students. After a comprehensive analysis, the language goals across all domains are de- veloped and implemented within the school context. For more detailed discussion of school language intervention objectives and strategies, the reader is directed to the fol- lowing references for school-age language intervention with hearing students: Bloom and Lahey, 1978; Ripich and Spinelli, 1985; Simon, 1985a,b; Lahey, 1988; Wallach and Miller, 1988; Nelson, 1989, 1998; Bemstein and Tiegerman, 1993; Ripich and Creaghead,220. Section « Audiologic Rehabilitation: Chitiren 1994; Wallach and Butler, 1994; Paul, 1995; Nippold, 1998. The following references are excellent resources for language interven- tion with D/HH students: Kretschmer and Kretschmer, 1978, 1988, 1989; Texas De- velopmental Language Centered Curricu- lum for Hearing-Impaired Children, 1978; Quigley and Kretschmer, 1982; McAnally et al., 1987; Kretschmer, 1989, 1997: Paul and Quigley, 1990; and Luetke-Stahiman and Luckner, 1991. Selection of language targets and strategies should be based on the tanguage needs identified through each stu- dent’s language assessment. The process is one of determining developmental level, de- termining school expectations, and then de- signing intervention that matches the student's capabilities with the school expec- tations. EDUCATIONAL INTERVENTION ‘The array of educational interventions avail- able to the student who is D/HH, such as note-takers, captioning, and interpreters, is discussed elsewhere in this text. However, ‘an area of concern that bears mention here follow-up to the discussion of psychoeduca- tional assessment is the issue of educational intervention with respect to reading, math, spelling, and the basic skills required for earning the content of school subjects. Cus- tom has dictated that the teacher of the stu- dent who is D/HH teach all content areas that cannot be learned readily in the mainstream setting The inclusion model has seen the teacher of D/HHT students collaborate in the classroom with the regular education teacher. The need for collaboration and/or consultation with other professionals, such as reading or learning disabilities specialists, should not be overlooked in the intervention phase of the process. Although not always experienced with D/HH students, these pro- fessionals have much to offer in program planning and implementation. ADDITIONAL LEARNING DIFFICULTIES ‘There will be instances with multidisabled D/HH students in which the need for learn- ing disabilities services is as great or greater than the need for services for hearing loss. The simultaneous occurrence of additional disabling conditions within the D/HH pop- ulation presents an additional complication to the task of rehabilitating and educating these children. All the major etiologies of deafness (e.g., prematurity, meningitis, Rh incompatibility, rubella, cytomegalovirus) and inherited deafness may be associated with other disabling conditions (Moores, 1987, 1991; Vemon and Andrews, 1990), Because of additional conditions, as many as 25% of D/HH students are considered to have multidisabilities. There is disagree- ment over the definitions, precluding spe- cific incidence counts; however, mental retardation, visual impairments, as well as learning and behavioral disabilities fre- quently occur with hearing loss, making educational planning a complex venture (Moores, 1987). The current operational plan in special education for hearing stu- dents is to group these students within a “mildly disabled” rubric, although protests from some teachers suggest there are differ- ences in learning styles among these chil dren. The “learning disabled hearing im- paired student” (Laughton, 1989, p. 70) has been discussed with no consensus about the characteristics demonstrated by children with this phenomenon, Many children with hearing loss present additional challenges to professionals engaged in assessment and in- tervention, requiring multidimensional, in- terdisciplinary teams working in unison to provide the services necessary. Identifica- tion, assessment, and the development of in~ tervention programs for such children are underway (Powers and Elliott, 1990; Eliott and Powers, 1992; Laughton, 1992). A Look Into the Future ‘A significant revolution in education of D/HH students occurred in the shift from the residential school as primary service provider to the local school system with strong parental involvement. The effects of this shift are seen as we enter the new cen tury. Increased responsibilities have shifted