Today, Kristin Kelly (SLP at Heuser Hearing and Language Academy) shares some insight into assessing children with hearing loss. She says:
One of the joys and challenges of our profession is that we never know who is going to walk through our door. We are constantly charged with learning about new topics and we often encounter students who are the only one of their kind on our caseloads. I’d like to share some information that may help when assessing students with hearing loss since you may only have one on your caseload. Students with hearing loss present with a wide range of communication abilities from severely disabled to non-disabling. Some (but not all) of this information may apply to the student on your caseload.
My goal during standardized assessment is to determine (among many things) how a student can perform in the areas of communication being examined in ideal conditions. The impacts of noise, distance, inconsistent amplification and “real world” communication situations can be considered during the functional examination or other supporting evidence. If the testing plan lists “hearing aid(s)” or “cochlear implant(s)”, they must be worn during testing. If a student comes in with a dead battery or no amplification, I reschedule the testing.
a. Spoken Language. Many students with appropriate amplification use spoken language to communicate. Continue with standardized testing as you deem appropriate. Be aware of lip reading. Many students need a clear visual of your face for best performance. I note in my report if I think a student is lip reading but I don’t discourage it. I might address listening only skills during the functional exam by using a speech hoop. (A speech hoop is an embroidery hoop covered in audio speaker fabric so a student cannot read lips or facial expressions but has access to the auditory signal clearly. If you cover your mouth with your hand it distorts the auditory signal and they can still “read your cheeks”).
b. Total Communication. If a student uses true total communication with spoken English and Signed Exact English, standardized testing can be administered through the interpreter and scores should be considered valid. It would be wise to have a conversation with the teacher and the interpreter to clarify the use of SEE and ASL and how the test items need to be interpreted.
c. American Sign Language. If a student uses ASL as their mode of communication, standardized scores should not be reported. Since ASL has its own vocabulary, syntax and pragmatic rules, it should be treated like any other spoken foreign language.
2. Seating arrangements.
a. Sit on the side of better hearing.
b. Keep the protocol out of sight.
c. If there is one, work with the interpreter to determine the best seating arrangement.
3. Testing Behavior (ours…not theirs)
a. Students with hearing loss are typically VERY perceptive to visual cues. This includes looking at the correct response picture, facial expressions when they point to the right or wrong picture, small gestures used when giving the directions, etc. Be careful!
b. Processing time…allow extra before assuming that they do not understand
The gold standard of non-standardized assessment is the language sample. A language sample provides information about vocabulary, grammar/syntax, pragmatics, answering “wh” questions, comprehension, communication breakdown repairs, and articulation/voice/fluency in context. I always try to use a sample of 100 words or more but will use less if that is not possible for that particular student. I can even get my percentages for new goals from the language sample I used on the assessment if the sample is good enough. The reason I often shy away from more formal data probes is that kids with hearing loss are often therapized. They figure out what you are asking them to do on the first trial and then get the remaining 9/10 correct. They can often perform certain skills in isolation but do not show those skills “in real life”.
Another factor in assessing students with hearing loss is to consider their receptive language more in depth. This may include going to levels of listening before single word comprehension. The following is a quick list of questions that I ask myself or the parent during early childhood evaluations.
1. Detect environmental noises?
2. Turn to name being called?
3. Understand when music is on and when it goes off?
4. Understands some single words?
5. Can follow simple routine directions? (with/without gestures)
6. Understands a wide variety of words?
7. Can follow 2 step routine directions? (with/without gestures)
8. Imitates words? (how accurately)
9. Imitates phrases/sentences? How long?
10. Makes any discrimination errors (e.g. bat vs bag, eyes vs ice, goat vs boat)?
11. Has difficulty understanding you from a distance?
12. Has difficulty understanding you in noisy situations?
13. Has difficulty understanding you if he/she can’t see your face?
14. Can answer questions about something he/she heard? With picture support? Without picture support?
Other assessment considerations
1. Information from audiology
a. Current hearing status
b. Hearing age vs chronological age
c. Recent changes in hearing or in hearing technology
2. Child developmental history/Medical history
a. Cause of hearing loss
b. Risk factors for other learning difficulties or additional diagnoses
3. Parental input for modalities and amplification/Home support of recommended communication strategies
When in doubt, ask for help! We all have our areas that we are passionate about and this is mine. Give me the opportunity to “geek out” with you over these students! I hope this helps!