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compliance with the standard as part of new construction specifi-
Madell et al., Pediatric Audiology: Diagnosis, Technology, and Management, 3rd Ed. (ISBN 978-1-62623-401-7),
copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
cations. The standard can be used to guide acoustic improvements
for students under IDEA. Many parents have worked with their
school team to include specific acoustical changes in their child’s
IEP. The standard can be helpful in knowing what is an appropriate
level of classroom noise and reverberation.
Title II also addresses public transportation, such as city buses
or rail transit. Both the service and the communication systems
that support the service (e.g., information kiosks, telephone information lines) are to be made accessible. In theory, this means that
voice announcements on transit systems should also be provided
in a text format.
Title III: Public Accommodations
Title III, public accommodations, covers businesses and nonprofit
organizations that oer services to the general public. Any entity
that normally conducts business with the public, including
restaurants, hotels, stores, movies, theaters, convention centers,
doctors’ oces, sports stadiums, fitness clubs, and private
schools, is subject to the ADA Title III provisions. One area where
there has been considerable eort by advocates is captioning at
the movies and at live theater oerings. Although movie theaters
are required to provide ALSs, including a means to link to the
telecoil of a hearing aid, movies were exempt in the original ADA
language from being required to show open-captioned movies.
Several court cases upheld advocates’ position that although
theaters are not required by the ADA to provide open captioning,
closed captioning is a needed and appropriate method of providing communications access. Many live theaters now provide one
or two open-captioned showings per run for a particular show.
Fig. 31.5 demonstrates one technology for providing closed
captioning in movie theaters and other places of entertainment.
An increasing number of movie theaters now oer a means of
accessing closed captions for nearly every film shown.
The definition of “places of public accommodation” continues
to evolve. A 2012 court case brought by the National Association
of the Deaf against Netix argued that providers of streaming
video entertainment on the Internet should provide captioning.
By consent decree of a federal court, Netix agreed to caption
100% of its videos.
The specifics of how the ADA is to be implemented are described
in detail in the revised Americans with Disabilities Act Standards
for Accessible Design, which were adopted in 2010 and took eect
March 15, 2012. The following changes17 in the regulations are of
interest to children and adults with hearing loss:
Technical standards for ALSs used in public places are required
•
to ensure consistency in the quality and strength of the audi-
tory signal.
Neckloop attachments must be provided to allow inductive
•
coupling between the ALS receiver and the telecoil in hearing
aids or cochlear implants.
Public telephones must have volume control with gain up to
•
20 dB.
The number of required TTYs in public places was increased.
•
16
31 Education and Access Laws for Children with Hearing Loss
Fig. 31.5 Rear Window is a closed captioning technology developed
by WGBH National Center for Accessible Media in Boston and used in
movie theaters around the country and at select attractions at Walt
Disney World and other theme parks. Rear Window displays reversed
captions on a light-emitting diode text display that is mounted in the
rear of the theater. Transparent acrylic panels that attach to the seat
in a theater reect the captions for people with hearing loss. (Photo by
Jerey Dunn for WGBH.)
Fire alarm alerts, audible and visual, shall be permanently
•
installed in a specific percentage of hotel rooms.
Section 504 and ADA general access provisions appear in Table
31.3.
31.5 Helping the Child Become Her
Own Best Advocate
One of the most important lessons we can teach our children
with hearing loss is that they must learn to be their own best
advocates. We should help them understand that the laws are
there to help them fully benefit from all life has to oer, and
the accommodations that we reviewed here—at school, in the
workplace, at the movies, when traveling, for telecommunications access—are basic rights in America. From an early age, we
should involve children in the IEP process. The IEP should not
be something that is done for the child; rather it should be a
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Table 31.3 General access laws pertaining to people with hearing loss
General Access Coverage Relevant federal agency Web resources
Section 504 of
the Rehabilitation
Act of 1973
(Nondiscrimination
under Federal Grants
and Programs)
ADA, 1990 Title I: Employment Title I: EEOC https://www.access-board.
Abbreviation: ADA, Americans with Disabilities Act
Requires that any federal agency, organization, or
program receiving federal funds not discriminate
based on disability. Nondiscrimination means that
such organizations must be fully accessible to people
with disabilities. Any grant, loan, or contract to an
entity or program—public or private—requires that
entity to follow the regulations of the act. Applies
to employers, hospitals, human service programs,
public schools, colleges, and universities—if they
receive federal funds.
Title II: State and local government and
transportation
Title III: Public facilities (private and nonprot
services open to the general public)
Title IV: Telephone relay (see Table 31.2)
Relevant federal agency http://www.section508.gov
Title II: Transportation
complaints to Federal
Transit Administration
Title II–IV: Access Board
(for guidelines and
standards), Department of
Justice (enforcement)
https://www.ada.gov/cguide.htm
gov/guidelines-and-standards/
buildings-and-sites
www.jan.wvu.edu/links/ADAtam1.html
http://www.ada.gov/cguide.htm
www.access-board.gov/Adaag/about/index.
htm
https://www.ada.gov/pcatoolkit/
chap1toolkit.htm
collaboration that allows the child to eventually become a full
participant. The child’s involvement can be something very
simple to start. For example, the child might serve punch to
the IEP team and discuss how his technology helps him. The
next year, he would be expected to contribute a bit more. As
time goes on, we want our children to transition into being full
partners in the IEP process, articulating their own needs and
helping formulate their goals. In some cases, we are seeing teens
run the meeting, which is highly desirable and will serve those
adolescents well as they begin their college careers or work life
in dierent settings without the support of their teams. This
does not happen overnight, so we need to begin the process
of teaching children to advocate for themselves while they are
still young. In so doing, we are instilling in our children the
understanding that laws are there to help address their needs.
However, to enjoy the benefits of our federal laws, we must (1)
know and understand our rights; (2) speak up about what we
need; and (3) know how to negotiate the system politely but
firmly. Whether we are talking about hiring the type of interpreter we want at school or ensuring that a facility is providing
an ALS, our children will benefit from our wide-ranging laws
only if they know how to advocate for themselves.
Many parents have diculty resisting the temptation to do
everything for their children. When the child has a disability,
the urge to do it for her is even more likely to take over. As the
child’s audiologist, you can make a positive contribution to your
patients’ success beyond the hearing loss by coaching families in
the importance of helping children develop their own advocacy
skills. Many resources are available to help you accomplish that.
Discussion Questions
1. Children with hearing loss are now being identied at birth
and tted early with technology that is considerably improved
from what was available 10, or even 5, years ago. Regardless
of their level of hearing loss, many children are learning language at a level equivalent to their hearing peers. What kinds
of issues does this create in terms of eligibility under various
disability laws, and what is your role in advising parents and
school professionals?
2. What are the dierences between legal intent and practice as
it applies to each of the three categories of laws reviewed in
the chapter?
3. How should we teach a child to advocate for herself, and at
what age should that process begin?
4. What if you do not agree with the school district’s decision
about placement and services for a patient? What is your role
vis-à-vis the child, her family, and the school-based personnel?
5. Does your role as a hearing health professional include or
exclude being an advocate for the child and her family? What
are the boundaries?
References
[1] Sorkin DL. Disability law and people with hearing loss: we’ve come a long way
(but we’re not there yet). The 2003 Libby Harricks Memorial Oration. The Deaf-
ness Forum of Australia. https://www.researchgate.net/publication/288023715_
Disability_law_and_people_with_hearing_loss_we%27ve_come_a_long_way_
but_we%27re_not_there_yet. Accessed January 4, 2018
[2] U.S. Department of Justice. ADA Best Practices Tool Kit for State and Local
Governments. http://www.ada.gov/pcatoolkit/chap1toolkit.htm 2008. Accessed
January 4, 2018
332
31 Education and Access Laws for Children with Hearing Loss
Madell et al., Pediatric Audiology: Diagnosis, Technology, and Management, 3rd Ed. (ISBN 978-1-62623-401-7),
copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
[3] Sutton v United Airlines, 527 U.S. 471 (1999)
[4] U.S. Department of Education. Raising the Achievement of Students with
Disabilities: New Ideas for IDEA. http://www2.ed.gov/admins/lead/speced/
ideafactsheet.html. August 2006. Accessed January 4, 2018
[5]
U.S. Department of Education. Assistance to States for the Education of Children
with Disabilities and Preschool Grants for Children with Disabilities, Final Rule.
71 FR 46539 https://www.federalregister.gov/documents/2006/08/14/06-6656/
assistance-to-states-for-the-education-of-children-with-disabilities-and-
preschool-grants-for 2006. Accessed January 4, 2018
[6] Tucker BP. IDEA Advocacy for Children Who Are Deaf or Hard of Hearing. San
Diego, CA: Singular; 1997
[7] Disability Rights California. Chapter 7: Least restrictive environment. In:
Disability Rights California, ed. Special Education Rights and Responsibilities (SERR). Sacramento, CA: DRC; 2011. http://www.disabilityrightsca.org/
pubs/504001Ch07.pdf. Accessed January 4, 2018
[8] Sorkin DL. FM technology: reimbursement and the law. In: Fabry DA, Johnson
CD, eds. ACCESS: Achieving Clear Communication, Employing Sound Solutions.
Proceedings of the First International Phonak FM Conference, Warrenville, IL;
2004:239–243. http://www.phonakpro.com/content/dam/phonak/b2b/Events/
conference_proceedings/1st_fm_conference_2003/2003proceedings_chapter25.
pdf. Accessed January 4, 2018
[9] Robinson P, Boyd P. Cochlear implantation in children with complex/additional
needs. Cochlear Implants Int 2013;14(Suppl 3):S1–S3
[10] Hands and Voices. Guide By Your Side. http://www.handsandvoices.org/gbys.
2012. Accessed January 4, 2018
[11] Every Student Succeeds Act of 2015. P.L. 114–95. Signed into law December 10,
2015
[12] Federal Communications Commission. Hearing Aid Compatibility Order. 18 FCC
Red at 16780 Paragraph 65; 47 C.F.R. §20.19(c). 2003
[13] Federal Communications Commission. In the Matter of Section 68.4 of the
Commission’s Rules Governing Hearing Aid–Compatible Telephones, WT Docket
01-309, RM-8658. Report and Order. FCC 03-168. 2003. http://apps.fcc.gov/
edocs_public/attachmatch/FCC-03-168A1.pdf. Accessed January 4, 2018
[14] Federal Communications Commission. In the Matter of Improvements to Bench-
marks and Related Requirements Governing Hearing Aid Compatible Mobile
Handsets, WT Docket 15-285. Report and Order. FCC 16-103. 2016 https://apps.
fcc.gov/edocs_public/attachmatch/FCC-16-103A1.pdf. Accessed January 4, 2018
[15] Acoustical Society of America. ANSI/ASA S12.60–2010/Part 1 American National
Standard Acoustical Performance Criteria, Design Requirements, and Guidelines
for Schools. Part 1: permanent schools; Part 2: Relocatable Classroom Factors.
Melville, NY: Acoustical Society of America; 2010. http://acousticalsociety.org/
about_acoustics/acoustics_of_classrooms. Accessed January 4, 2018
[16] U.S. District Court for the State of Massachusetts, Western Division. National As-
sociation of the Deaf, Western Massachusetts Association of the Deaf and Hearing
Impaired, and Lee Nettles v. Netix, Inc., Civil Action No. 11–30168-MAP, consent
decree. 2012. http://dredf.org/captioning/netix-consent-decree-10-10-12.pdf.
Accessed January 4, 2018
[17] U.S. Access Board. ADA and ABA Accessibility Guidelines. 2010, amended 2014.
https://www.access-board.gov/guidelines-and-standards/buildings-and-sites/
about-the-ada-standards/background/ada-aba-accessibility-guidelines-2004.
Accessed January 4, 2018
Additional Readings
[18] Breslin M, Silvia Y. Disability Rights Law and Policy: International and National
Perspectives. Ardsley, NY: Transnational; 2002
[19] Strauss KP. A New Civil Right: Telecommunications Equality for Deaf and Hard of
Hearing Americans. Washington, DC: Gallaudet University; 2006
Resources and Helpful Web Sites
[20] Alexander Graham Bell Association for the Deaf and Hard of Hearing provides
books and other resources on education and advocacy for people with hearing
loss with a focus on children: http://www.agbell.org. Accessed January 4, 2018
[21] American Cochlear Implant Alliance is a nonprofit membership organization
of clinicians and scientists in the field of cochlear implantation as well as con-
sumer/parent advocates that organizes an annual clinical research symposium
and provides information for the general public on CIs, including connectivity
to other devices and advocacy to achieve full access: http://www.acialliance.org.
Accessed January 5, 2018
[22] Center for Parent Information and Resources provides information to parents of
children with disabilities on programs and services for young children under EI
and school-aged children including the six regional parent technical assistance
centers: http://www.parentcenterhub.org. Accessed January 5, 2018
[23] Hands and Voices is a parent organization that emphasizes unbiased advise-
ment on hearing and language options, information and support: http://www
.handsandvoices.org/. Accessed January 4, 2018
[24]
Hearing Loss Association of America is a consumer organization for people with
hearing loss of all ages that provides materials on technology, advocacy, access
laws, and telecommunications: http://www.hearingloss.org. Accessed January
5, 2018
[25] The Every Student Succeeds Act website provides detail on the legislation and
how it maintains the spirit of the No Child Left Behind law: http://www.ed.gov/
essa?src=rnn. Accessed January 5, 2018
[26] The U.S. Access Board has extensive online guidance materials on the ADA and
Section 504: https://www.access-board.gov/. Accessed January 4, 2018
[27] Wrightslaw is a website about special education law and advocacy with articles,
cases, and free resources on education law for attorneys and advocates. http://
www.wrightslaw.com. Accessed January 5, 2018
333
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copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
32 Screening, Assessment, and Management of Auditory Disorders in School-Aged Children
Madell et al., Pediatric Audiology: Diagnosis, Technology, and Management, 3rd Ed. (ISBN 978-1-62623-401-7),
copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
32 Screening, Assessment, and Management of Auditory
Disorders in School-Aged Children
Cheryl DeConde Johnson
Summary
This chapter addresses the pertinent components of delivering
audiology services in an educational setting. The chapter
begins with an overview of the U.S. Department of Education’s
regulatory requirements for audiology and support services for
children who are deaf or hard of hearing. These requirements
include basic services for children with disabilities requiring
specialized instruction as well as access services. Screening
protocols are described that pertain to the goals of identifying
late-onset hearing conditions. Strategies for identification of
noise-induced hearing loss are integrated with hearing loss prevention education. Assessment is focused on classroom listening
procedures for the student and the environment. Suggested
protocols for classroom observation, classroom participation,
self-assessment, and behavioral assessment are provided.
Audiology management encompasses essential areas that
support students to function eectively in their school environment, including hearing and listening, communication, learning,
social, self-determination, and self-advocacy. This chapter ends
with a discussion of professional practices including workload
analysis and student-based outcome measures that result from
audiology services. The appendix contains a checklist developed
by the Educational Audiology Association that elaborates the
critical roles of educational audiologists, teachers of the deaf
and hard of hearing, and speech-language pathologists on the
school education team to promote language development and
communication access, essential for participation and learning
in today’s educational environments.
Keywords
Individuals with Disabilities Education Act (IDEA), Americans
with Disabilities Act (ADA), 504 plan, functional listening,
classroom communication participation, workload, outcome
measures
auditory decits and identifying appropriate accommodations, including the need for hearing assistance technologies.
Audiologic management of children in a school environment
•
encompasses the essential areas of hearing and listening,
communication, learning, social skills, self-determination,
and self-advocacy.
32.1 Foundations of Practice
The responsibilities of educational audiologists for school-based
audiology services are primarily dictated by the Individuals with
Disabilities Education Act (IDEA) and are therefore focused on
children who are eligible for special education and related support services. In addition, there is a growing number of children
with varying hearing levels in the education system who do not
meet the IDEA eligibility criteria but may receive accommodations through the Americans with Disabilities Act (ADA). This
latter group has become a special focus of educational audiologists, since these at-risk students are often under the radar of
classroom teachers and other special education providers.
Audiology services have been part of special education law
since 1975 with the passage of Public Law 94-142, The Education
of all Handicapped Children’s Act (now IDEA), which requires
public schools to provide a free and appropriate public education
(FAPE) as detailed in an individualized education program (IEP).
Reauthorizations have added additional requirements and clarifications over the years as well as name changes. This law was the
basis for the growth of educational audiology and continues to
serve us well.
Opportunities to broaden the impact of educational audiology
services have occurred under the ADA. Both laws are foundational
to our practice; therefore educational and pediatric audiologists
must know and understand these legal requirements and be
able to advocate for them. These laws serve as the basis for the
information that follows in this chapter. A detailed discussion of
all pertinent laws and regulations impacting children and youth
who are deaf or hard of hearing is located in Chapter 31.
Key Points
Audiology services have been part of special education law
•
since 1975; IDEA Part B, which pertains to children age 3 until
exit from high school, identies key components of these
services.
While newborn hearing screening is legislated in all 50 states,
•
hearing screening laws for school-aged children have varying
state requirements or may not exist at all.
Assessment respo nsibilities for educational audi ologists focus
•
on determining the educational implications of the child’s
32.1.1 Foundation One: IDEA
IDEA Part B, which pertains to children age 3 until exit from
high school, identifies key components of audiology services.
Pursuant to regulations under the act,1 state departments of
education and local education agencies determine how these
services are implemented. The following sections outline the key
areas specific to educational audiology.
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Audiology
Audiology is defined as the following set of responsibilities in 34
CFR §300.34(c)(1):
Identification of children with hearing loss
•
Determination of the range, nature, and degree of hearing loss,
•
including referral for medical or other professional attention
for the habilitation of hearing
Provision of habilitation activities, such as language habilita-
•
tion, auditory training, speech reading (lipreading), hearing
evaluation, and speech conservation
Creation and administration of programs for prevention of
•
hearing loss
Counseling and guidance of pupils, parents, and teachers
•
regarding hearing loss
Determination of the child’s need for group and individual
•
amplification, selecting and fitting an appropriate aid, and
evaluating the eectiveness of amplification
Assistive Technology Device
An assistive technology device is defined by 34 CFR §300.5 as
any item needed to increase, maintain, or improve the functional
capabilities of children with disabilities (exclusive of surgically
implanted medical devices).
For a child with a surgically implanted medical device who is
receiving special education and related services under this part, a
public agency is not responsible for the postsurgical maintenance,
programming, or replacement of the medical device that has been
surgically implanted.
Consideration of Special Factors
According to 34 CFR §300.324(a)(2)(iv)–(v), the IEP team for a
child who is deaf or hard of hearing must consider the full range
of the child’s language and communication needs, including
opportunities for direct communications with peers and professional personnel and direct instruction in the child’s language
and communication mode; the child’s academic level; and
whether assistive technology devices and services are required.
32.1.2 Foundation Two: ADA
Title II of the ADA applies to all children and youth in public
schools (as well as public higher education institutions) who
have a disability.
Pearl
Assistive Technology Service
Assistive technology services are defined by 34 CFR §300.6 as
services that directly assist a child with a disability in selecting,
acquiring, or using an assistive technology device, including:
Evaluating the child’s needs, including a functional evaluation
•
of the child in the child’s customary environment
Purchasing, leasing, or otherwise providing for the child’s
•
acquisition of assistive technology devices
Selecting, designing, fitting, customizing, adapting, applying,
•
maintaining, repairing, or replacing assistive technology
devices for the child
Coordinating and using other therapies, interventions, or
•
services with assistive technology devices
Training or technical assistance for the child or the child’s
•
family
Training or technical assistance for professionals, employers,
•
or other individuals who are substantially involved in the
child’s major life functions
Routine Checking of Hearing Aids and External
Components of Surgically Implanted Medical
Devices
According to 34 CFR §300.113, each public agency must ensure
that hearing aids and external components of surgically
implanted medical devices worn in school by children with
hearing impairments are functioning properly.
ADA diers from IDEA because ADA does not require an eligibility component that species the adverse eects of the person’s
disability.
The ADA defines a disability as “a physical or mental impairment that substantially limits one or more major life activities”
including “caring for oneself, performing manual tasks, seeing,
(
hearing, eating, sleeping, walking, standing, lifting, bending,
speaking, breathing, learning, reading, concentrating, thinking,
communicating, and working” and “a major bodily function”), “a
record of such impairment,” or “being regarded as having such an
impairment.”
Components of ADA include:
Determination for support must be made without consider-
•
ation for “mitigating measures,” e.g., use of hearing aids or
extensive studying to minimize the impact of the disability
cannot be used to deny services.
Regular or special education and related aids and services
•
must be provided that are designed to meet individual edu-
cational needs as adequately as the needs of persons without
disabilities are met (FAPE).
2[§12102]
Pearl
“Appropriate” means an education comparable to the education
provided to nondisabled students, as compared to IDEA, which
provides a “reasonable” education.
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copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
These services are described through an IEP if the child is also
•
eligible under IDEA, or through a 504 Plan for those who are not.
Eective communication under the ADA3 is actually a higher
•
standard than required under IDEA. It requires schools to
ensure that communication for students who are deaf or hard
of hearing is “as eective as communication for others” [ADA
Title II 28 CFR §35.160 (a)(1)], “aording an equal opportunity
to obtain the same result, to gain the same benefit, or to reach
the same level of achievement as that provided to others” [ADA
Title II 28 CFR §35.130 (b)(1)(iii)] and “to participate in and enjoy
the benefits of the district’s services, programs, and activities.”3
These requirements apply to all school-related communica-
tions. Eective communication may require auxiliary aids and
services. For students who are deaf or hard of hearing these
include qualified interpreters, note takers, real-time computer-aided transcription services, written materials, exchange of
written notes, telephone handset amplifiers, assistive listening
devices and systems, and open and closed captioning, accessible
electronic and information technology [see ADA Title II 28 CFR
§35.104 (1) for additional considerations]. Personal devices such
as hearing aids and cochlear implants are exempt from this
regulation (ADA Title II 28 CFR §35.135).
32.2 Screening and Identication
Screening and identification are often confused in practice. IDEA
requires identification procedures but does not mandate mass
hearing screening programs, which are instead state-legislated
practices. While newborn hearing screening is legislated in all 50
states, hearing screening laws for school-aged children have vary-
ing state requirements or may not exist at all. Identification practices in the schools are actually defined by “Child Find,” requiring
states to have policies and procedures for schools to ensure that all
children with disabilities who are in need of special education and
related services are identified, located, and evaluated, including
children suspected of having a disability even though they are
advancing from grade to grade (34 CFR §300.111).
As hearing specialists, audiologists have an important role
in hearing screening. According to the Educational Audiology
Association (EAA),4 audiologists should “coordinate hearing
screening programs for preschool and school-aged students
ensuring professional standards are followed and screening per-
sonnel are appropriately trained.” Even though hearing screening
programs are generally provided under school health services,
educational audiologists should collaborate at both state and
local levels with nursing professionals who have responsibility
for developing and implementing these programs. Educational
audiologists contribute their unique clinical and academic backgrounds to support school personnel, to provide expertise and
training, and to manage hearing screening programs.
32.2.1 Professional Guidelines
Audiologists involved with hearing screening must be familiar
with current professional practice standards and guidelines.
Guidelines for audiologic screening from the American Speech-
Language-Hearing Association (ASHA)6 and the Clinical Practice
Guidelines: Childhood Hearing Screening7 from the American
Academy of Audiology (AAA) provide guidance for screening
procedures including specific referral criteria recommendations
for each target age group. The American Academy of Pediatrics,8
the Joint Committee on Infant Hearing (JCIH),9 and the World
Health Organization10 each support hearing screening in children
and recommend various hearing identification procedures.
32.2.2 Screening Protocols and
Technology
Screening procedures that are dierentiated for specific populations can improve the program outcomes. Developmental
considerations for very young children, identification of otitis
media in young children, and identification of noise-induced
hearing loss in teens are examples of protocols that target problems that are common to these groups. Use of automated otoacoustic emissions (OAEs) to screen for hearing loss and middle
e
ar function has simplified identification of potential hearing
problems. Exciting advancements in wireless pure tone screening technology will ease background noise issues and increase
creening eciency through the use of automated protocols that
s
provide exible programming for various populations as well as
threshold options to 0 dB hearing level (HL) (Fig . 32.1).
Pearl
Ecient, cost-eective, and successful programs managed by
educational audiologists can ensure a screening process that cor-
rectly identies all children with auditory disorders and provide
appropriate referral, intervention, and management oversight.
Fi g . 32 .1 Creare’s newly developed wireless automated hearing test
system provides ambient noise attenuation sucient for threshold
5
testing outside the sound booth. (Photo courtesy of Creare, LLC.)
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copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
Child Find Screening
Once a child is referred from screening, the “identification”
responsibilities of the audiologist under IDEA formally begins.
Depending on the procedures, the audiologist may do some of the
follow-up testing at school or refer the student for an audiologic
assessment. There is one caveat regarding screening young chil-
dren considered at-risk. Child Find includes “screening” of young
children to identify any conditions that might be considered a
potential disability. Because these children are “at-risk,” they fall
into the “suspected” category for having a disability that needs
to be “identified” because it could result in special education and
related services. Although Child Find includes children to age 21,
most school Child Find screenings are focused on children birth
to age 5 and include physical and developmental measures. Often
screening of these at-risk children requires more sophisticated
procedures. Therefore, the educational audiologist, in addition
to helping develop and manage the hearing screening program,
may also perform these more specialized screenings.
Screening for Noise-Induced Hearing Loss and
Hearing Loss Prevention Education
Few states have requirements for hearing screening in teens,
yet this age group has the highest incidence of hearing loss due
to accumulated recreational noise exposure.
these students should be integrated with a noise exposure risk
checklist that targets students with a history of noise exposure,
followed by screening, and some type of hearing loss prevention
education.
responsibility areas of educational audiologists; integrating
these two programs is an ecient way to address this area. There
are several programs and resources that can be incorporated into
existing school health and science curricula, such as Dangerous
Decibels (http://dangerousdecibels.org), It’s a Noisy Planet,
Protect Their Hearing (https://www.noisyplanet.nidcd.nih.gov/
about/wise-ears-campaign-evaluation), AAA’s Turn it to the Left
(http://www.turnittotheleft.org/), and ASHA’s Listen to Your
Buds (http://www.asha.org/buds/), which can be incorporated
into existing school health and science curricula.
13,14,15
Hearing loss prevention education is one of the
1,12
Screening for
32.3 Assessment
Assessment has several purposes including:
Determining the presence of peripheral and central auditory
•
deficits
Defining the parameters of the auditory deficits, including
•
type and degree, and speech understanding abilities
Monitoring changes in auditory sensitivity
•
Determining the educational implications of the auditory deficits
•
Identifying appropriate accommodations, including the need
•
for hearing assistance technologies
Diagnostic procedures are covered extensively in other chapters
of this text. Therefore, this discussion will focus on procedures
used by educational audiologists to supplement clinical assessments to address communication and learning in the classroom.
These measures, often part of a Classroom Listening Assessment
16,17
(CLA),
determine how the child’s hearing status aects learning in the
classroom and participation in other school activities.
focus on speech in noise and other functional tests that
32.3.1 Classroom Listening Assessment
(CLA)
Emphasis on classroom listening has gained importance because
most childr en with auditory impai rments use audition and r eceive
the majority of their education in general education classrooms.
As a result, the audiologist must take a primary role in advocating
for the accommodations that are necessary for eective listening
for these children in school. Elements of classroom listening
include classroom and student considerations. In order to identify
individual listening needs and make relevant recommendations
for accommodations, a CLA is suggested. Specific components of
the CLA include observation, classroom acoustics measurements,
a functional listening evaluation, and a student self-assessment.
Pearl
The results of a CLA provide authentic evidence to implement
a plan that promotes eective classroom listening for children
with auditory decits.
Environment Assessment
The CLA begins with an observation of the classroom to consider
physical properties of the classroom design and setup (lighting,
seating arrangements, materials), how instruction is managed,
expectations for student participation, classroom acoustics, and
handling of student behavior.
Student considerations that inuence the observation include
age, audibility and listening performance, language and communication skills and opportunities, school performance, current
hearing technology use, motivation, self-esteem, and acceptance
of their hearing loss. Together, these elements interact to create a
complex profile of the variables that impact how classrooms are
designed to support classroom listening for learning, and how
well students are prepared and accommodated for listening and
learning in those environments. The Placement Checklist from
the Placement And Readiness Checklists (PARC)18 is designed for
structured classroom observation. Suggested observation protocols and their access links are located in Table 32.1.
The second step in analyzing the environment is measuring
classroom acoustics (this procedure is described fully in Chapter
23). Ambient noise levels, signal-to-noise ratios (SNR), and rever-
beration times are important for evaluating acoustic accessibility
as well as determining appropriate hearing assistance technology
(HAT) options. The noise and reverberation levels should comply
with ANSI s12.60-200219 standards for classrooms including SNRs
of at least +15 dB sound pressure level (SPL) for the target student.
In addition, critical distance estimations, based on the room size
338
32 Screening, Assessment, and Management of Auditory Disorders in School-Aged Children
Madell et al., Pediatric Audiology: Diagnosis, Technology, and Management, 3rd Ed. (ISBN 978-1-62623-401-7),
copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
Table 32.1 Suggested classroom listening protocols for classroom observation, self-assessment, and behavioral assessment
Protocol Authors Where to Get
Observation
Placement Checklist from Placement &
Readiness Checklists (PARC) for Children Who
Are Deaf and Hard of Hearing
Listening Inventory for Education—Teacher
Appraisal (LIFE-R)
Screening Instrument for Targeting
Educational Risk (SIFTER), Preschool SIFTER,
Secondary SIFTER
Children’s Auditory Processing Scale (CHAPS) Smoski et al 1998 http://www.successforkidswithhearingloss.com
Signicant Other Assessment of
Communication—Adolescent (SOAC-A)
Classroom Participation Questionnaire
(CPQ)—Revised
Listening Inventory for Education—Student
Appraisal (LIFE-R)
Self-Assessment of CommunicationAdolescent (SAC-A)
Functional Listening Evaluation (FLE) Johnson 2013; Johnson and Anderson 2013 http://www.adevantage.com/resources; recorded version
Ling Six-Sound Check Ling http://www.advancedbionics.com/content/dam/
Johnson et al 2011 http://www.adevantage.com/resources
Anderson et al 2011 http://www.successforkidswithhearingloss.com
Anderson et al 1989, 1996, 2004 http://www.successforkidswithhearingloss.com
Elkayam and English 2003 http://gozips.uakron.edu/~ke3/SOAC-A.pdf
Self-Assessment
Anita, Sabers, Stinson, 2007 http://www.adevantage.com/resources
Anderson et al 2011 http://www.successforkidswithhearingloss.com
Elkayam and English 2003 http://gozips.uakron.edu/~ke3/SAC-A.pdf
Behavioral Assessment
at http://www.successforkidswithhearingloss.com
advancedbionics/Documents/libraries/Tools-for-Toddlers/
tools-for-parents/The-Ling-Six-Sound-Check.pdf
and reverberation time, identify the maximum range between
the teacher or talker and the student for optimal audibility. The
Classroom Acoustical Screening Survey Worksheet from the AAA
clinical practice guidelines on classroom audio distribution systems (CADS)
for estimating critical distance. If ambient noise levels are high,
HAT options are usually limited to personal remote microphone
[RM] systems rather than CADS.
20[12]
guides these measurements and contains a chart
CLA: Student Assessment
Assessment of student listening performance includes objective
and subjective measures. Common tools for assessing classroom
listening are summarized in Table 32 .1 according to observation,
self-assessment, and behavioral categories. Utilizing at least one
tool from each area provides important perspectives from the
student and his/her teacher(s) to create a comprehensive profile.
Functional Listening Evaluation
A Functional Listening Evaluation (FLE)21 is a behavioral assessment that provides relevant information regarding how well a
tudent accesses spoken information in a variety of situations
s
common to the classroom. The purposes of the FLE are to:
Identify factors aecting classroom listening skills
•
Identify a student’s listening and comprehension ability under
•
various classroom listening conditions
Provide evidence for accommodations (HAT, acoustical treat-
•
ments, communication strategies) and supports (counseling,
HAT orientation and training, teacher inservice)
Improve teacher implementation of recommendations
•
Evaluate and validate the eects of accommodations and
•
supports on classroom listening
Reminder
Assistive Technology Services include “The evaluation of the
needs of a child with a disability, including a functional evaluation of the child in the child’s customary environment” (34 CFR
§300.6).
Classroom Communication Participation
Assessment of classroom listening and participation abilities
should always include the student’s perspective. Students’ per-
ceptions oer viewpoints that may dier from those of teachers,
parents, and peers; give the students a voice and stake in the
assessment process; and, equally as important, open the door to
counseling opportunities.
Self-assessments and questionnaires work well for students
who are able to read and respond. For younger students, the questions or prompts can be read to obtain their input, but the student
must be encouraged to respond honestly even if it identifies
communication challenges with the teacher or in the classroom.
For all students, sucient time must be allotted to complete
the assessment and for the audiologist to review the student’s
responses and discuss the issues that might be raised as well as
a collaborative discussion of possible solutions to address them.
Avoid asking students to reveal information about themselves
339
IV Educational and Clinical Management of Hearing Loss in Children
Madell et al., Pediatric Audiology: Diagnosis, Technology, and Management, 3rd Ed. (ISBN 978-1-62623-401-7),
copyright © 2019 Thieme Medical Publishers. All rights reserved. Usage subject to terms and conditions of license.
Table 32.2 Management areas aligned with IDEA services
Management Areas IDEA Services
Hearing and listening skills 34 CFR §300.34(c)(1)(iii): Provision of habilitation activities, such as language habilitation, auditory training,
Communication and instructional access 34 CFR §300.34(c)(1)(vi): Determination of the child’s need for group and individual amplication, selecting
Social skills
Self-determination and self-advocacy
Parent and teacher support
speech reading, (lipreading), hearing evaluation, and speech conservation
and tting an appropriate aid, and evaluating the eectiveness of amplication
34 CFR §300.113(a): Duty of each public agency to ensure that hearing aids worn in school by children
with hearing impairments, including deafness, are functioning properly including external components of
surgically implanted medical devices
34 CFR §300.5–6: Assistive technology devices and assistive technology services
34 CFR §300.34(c)(1)(v): Counseling and guidance of pupils, parents, and teachers regarding hearing loss
without suciently acknowledging their comments and giving
opportunities for discussion.
The suggested protocols under self-assessment in Table 32.1
are options to address student perspectives.
32.3.2 Communicating Assessment
Results
Results from assessments are only as helpful as how well they
are articulated and understood by those who will be parenting,
teaching, and supporting students. Recommendations are eective only when they are implemented with fidelity, that is, as
intended by the person who wrote them. Therefore, reports must
be written with the reader in mind, without abbreviations and
other audiologic lingo. A discussion with those who receive the
reports may also be necessary to address questions and to help
with implementation of recommendations. Tools such as Countthe-Dot audiograms and hearing loss, hearing aid/cochlear
implant, and HAT simulations may assist with understanding.
32.4 Management
The topic of audiology management encompasses essential areas
that support students to function eectively in their school
environment, including hearing and listening, communication,
learning, social, self-determination, and self-advocacy. As illustrated in Table 32.2, these areas are aligned with IDEA services
and need to be incorporated within each student’s IFSP or IEP.
Students requiring only accommodations are generally served
under 504/ADA. Accommodations must be described in their
504 Plans.
The following discussion will focus primarily on the professional practices that are necessary to manage school-based
audiology services and programs.
32.4.1 Professional Practices
The first requirement for eectively managing services and
programs for students who are deaf or hard of hearing is to be
familiar with federal and state laws. Advocacy for students,
parents, and the services they require is dependent upon this
knowledge and the audiologist’s ability to navigate and leverage
the requirements of these laws.
Interprofessional collaboration and teamwork is a benefit
of school-based audiology practice. The team of professionals
within schools includes speech-language pathologists, school
psychologists and counselors, deaf educators, learning disability
specialists, other special instructional providers, and school
nurses. Eective collaboration requires that these professionals
work as a team, understanding and respecting each other’s expertise and roles, collaborating on student assessment and planning,
and ad
vocating for appropriate services.
Some lines between roles of educational audiologists and
teachers of the deaf and hard of hearing (TODHHs) have blurred.
Because most students receive their education in the general
education classroom, TODHHs frequently function as teacher
consultants to general education teachers and other sta, providing more indirect support than direct instruction, although
they often preview new material and review material taught in
the classroom with the student to assist in learning. In this role,
teachers are often asked to manage student HAT, sometimes
including fitting remote microphone devices, which is working
outside of their scope of practice. The EAA’s published guidance22
regarding recommended roles of educational audiologists and
TODHHs clarifies primary practice responsibilities pertaining to
assessment and management of students who are deaf or hard of
hearing. This document, reproduced in Appendix 32.1, is a useful
tool to guide discussions regarding these roles.
32.4.2 Workload Analysis
A workload analysis is an important component of program
evaluation and improvement planning. The analysis provides
quantitative information about how the audiologist’s time is
organized, which can be useful when comparing how time spent
fits with the priorities of the program. It also provides evidence
when documenting the need for additional full-time equiva-
lents (FTE) or other sta support for the program. To create a
form for the analysis, list all major activities that are performed
throughout the school year in the categories of direct services,
indirect services, and administrative duties. Track hours weekly
for each activity to illustrate how time is spent as well as how
it varies by month, a function of changing priorities throughout
the school year.
340
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