Read the signs

By the time a hearing child is three it will have a vocabulary
of about 700 words. A deaf child of the same age – whose hearing
loss has not been detected – will know fewer than 25. And a quarter
of the estimated 840 babies born every year with a permanent
hearing loss are still undiagnosed by the age of three and a
half.
It is vital to diagnose deafness as soon as possible after birth,
because delay can have a ruinous impact on a deaf child’s ability
to learn language and communication skills, says the National Deaf
Children’s Society (NDCS).

Millie was hardly speaking at two and a half, but shouted a lot.
A community audiologist tested Millie but told her mother, Nicola,
that she was “just a naughty child”. Then in August 2003, a month
after her third birthday, a consultant’s tests showed she had
sensorineural hearing loss, moderate to severe in both ears, for
which she could get hearing aids.

Nicola was shocked by the diagnosis and angry that she had been
told so often that her daughter didn’t have a problem. Millie, now
four, is at a mainstream school with a hearing unit and Nicola
says: “Because she was diagnosed so late, she is quite far behind
the other children in language… I was hoping she’d have caught up
more by now, but she’s not.”

How many have deafness?

All told, there are an estimated 30,000 children and young
people in the UK with permanent deafness, ranging from moderate to
profound. Other children have mild deafness and some have deafness
that affects only one ear (unilateral deafness), while up to one in
five children experience temporary deafness caused by glue ear.
Some children are born deaf and others become deaf later on,
sometimes following an infectious disease. But few children are
totally deaf; most can hear some sounds at certain pitches and
volume.

Types of deafness

There are two main types of deafness:

Conductive deafness (the most common type), means the sounds
cannot pass through the outer and middle ear to the cochlea and
auditory nerve in the inner ear. This is often caused by fluid in
the middle ear (glue ear). It can either clear up spontaneously and
quickly, or can develop into a long-term condition needing surgery
or a hearing aid. Children under five are the largest group
affected by glue ear.

Sensorineural deafness usually means that the cochlea (inner
ear) is not processing the sound effectively. This can be the
result of: an inherited condition; an infectious disease such as
rubella, mumps, measles or meningitis; or a shortage of oxygen at
birth. Children can have a mixture of the conditions.

How to communicate?

Communication options depend on the individual child’s needs,
but the three main methods are:

Auditory-oral, using hearing aids, radio aids and cochlear
implants to amplify residual hearing to develop spoken language.
These can also include lip-reading, but not sign language or
finger-spelling.

Sign bilingualism, where the child learns to use two languages
at the same time: a sign language (using hand-shapes, facial
expressions, gestures and body language) and a spoken or written
language. Finger-spelling allocates a sign to each letter of the
alphabet and is used for signing names and places.

Total communication (TC) entails choosing the most appropriate
communication method for the child at any one time. Sign language
is used to support but not replace oral communication and the use
of residual hearing in developing speech and language skills.

How to identify deafness

If you have concerns about a child’s hearing, encourage the
parents to visit their GP and ask for a referral for further tests
if deafness is suspected.

Pointers to deafness include:

• Delay in learning to speak.
• Lack of clarity in speech, slurring of words, incorrect
  pronunciation.
• Intent focus on the face/lips.
• Reluctance to speak, eg nodding or shaking head rather than
  saying ‘yes’ or ‘no’.
• Temper tantrums.
• Incorrect verb tenses.
• Constantly asking for repetition.
• Continuing with an activity when everyone else has
  stopped.
• Making little or no contribution to group discussions.
• Shouting or talking too loudly.
• Speaking very softly.
• Frequently asking for help from peers.

And some practical advice for working with children with
deafness

• Position the child with their back to the window so they can
  see you.
• Make sure you have their attention before starting to
  talk.
• Speak clearly, naturally and at a normal rate – don’t
  shout.
• Face them when you are talking to them and keep a distance of
  between one and two metres for signing or lip-reading
  purposes.
• Try not to walk around while you are speaking.
• Repeat what other people say.
• Encourage parents to reinforce what you do at home.
• Statistics and information supplied by the NDCS

‘I had to pull myself together’ 

James and Damian live with their parents, Vicki and Owen. James,
now four, was eight months old when he was diagnosed as severely to
profoundly deaf. His mother, Vicki, says it was devastating. 
Having worked with children with communication problems, Vicki knew
fingerspelling and wanted him to be able to choose how he wanted to
communicate. By the age of two he had around 50 spoken words but
could sign 250, she says.

James’s pre-school arranged for a signer to be his one-to-one
communication worker. She taught all the other children and all the
other teachers have recently passed their BSL stage 1. “They do a
lot of signing at school now, and the kids have taken it home and
the parents are all wanting to learn it as well.” 

James now has a statement so he will have sign provision at
school. When James’s brother Damian was born 14 months ago, his
parents thought they were prepared, but it was still a shock when
they found he, too, was deaf. Says Vicki: “I had to pull myself
together and start again.” 

Damian was tested at two weeks, diagnosed with moderate deafness
and received his hearing aids when he was 10 weeks’ old. 

Says Vicki:  “We recently got married, after 16 years together,
and as a special treat the boys had glitter earmoulds.”She adds: “I
hope that I can encourage the boys to always speak up if they don’t
understand something so they don’t miss out on things… Owen and I
want them to have the best of both worlds.”

• All names have been changed
• Featured on the NDCS website: www.ndcs.org.uk