Hearing and Vision Loss Exceptionality Report

Introduction
Both vision and hearing losses have a tremendous impact on how learners gather information,
communicate with others, develop social relationships, and retain meaningful and knowledgeable
experiences. The critical components of how vision and hearing losses can impact the way a
learner functions, communicates, travels, and acquires knowledge is largely determined by
factors such as age of onset, medical care, the degree of hearing or vision loss, and diagnosis
outlook. Hearing and vision loss has been divided into two categories:
(1) Adventitious: Loss occurred at a later time in the individuals development.
(2) Congenital: Loss occurs at birth or during students early developmental years
Below is a list of abilities that individuals have or acquire with hearing and vision loss, according
to Indiana State University:
- Those learners who have been blind or have low vision from birth and acquired their
hearing loss later in life will have a better understanding of sound, speech, and
environmental noise.
- Those learners who have been deaf or have a hearing impairment from birth and
acquired their vision loss later in life will usually have a better idea of boundaries in
space, visual imagery, colors, size, and concepts.
- Those learners who have been blind or have low vision and have been deaf or have a
hearing loss since birth will have the greatest challenges, since much of their learning
must through their near senses of touch, movement, or smell.

- Those learners who lost part or all of both their vision and hearing later in life usually
have some idea of visual and auditory imagery that they can rely on when learning new
concepts, communicating with others, and developing social relationships (Indiana State
University, 2014).
By understanding more about hearing and vision loss, we will be able to better help students with
these disabilities. We will be able to create programs and learning techniques to give them every
opportunity to learn the same material as their peers who do not have the same disabilities.

Definition and Prevalence

According to the Individuals with Disabilities Education Act, individuals who experience deafblindness, deafness, hearing impairment, or visual impairment, respectively, are defined as:
(2) Deaf-blindness means concomitant hearing and visual impairments, the combination
of which causes such severe communication and other developmental and educational needs that
they cannot be accommodated in special education programs solely for children with deafness or
children with blindness.
(3) Deafness means a hearing impairment that is so severe that the child is impaired in
processing linguistic information through hearing, with or without amplification that adversely
affects a child's educational performance.
(5) Hearing impairment means an impairment in hearing, whether permanent or
fluctuating, that adversely affects a child's educational performance but that is not included under
the definition of deafness in this section.

(13) Visual impairment including blindness means an impairment in vision that, even
with correction, adversely affects a child's educational performance. The term includes both
partial sight and blindness (U.S. Department of Education, 2004).
According to the American Speech-Language-Hearing Association on the prevalence and
incidence on hearing loss in children:
- The number of Americans with a hearing loss has evidentially doubled during the past
30 years. Data gleaned from Federal surveys illustrate the following trend of prevalence for
individuals aged three years or older: 13.2 million (1971), 14.2 million (1977), 20.3 million
(1991), and 24.2 million (1993) (1, 2). An independent researcher estimates that 28.6 million
Americans had an auditory disorder in 2000 (3). This estimate is reasonably well within
projections from the 19711993 trend line that evolved from Federal surveys.
- Children who are hard of hearing will find it much more difficult than children who
have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other
aspects of verbal communication.
- The number of children with disabilities, ages 621, served in the public schools under
the Individuals with Disabilities Education Act (IDEA) Part B in the 2000-01 school year was
5,775,722 (in the 50 states, DC, and Puerto Rico). Of these children, 70,767 (1.2%) received
services for hearing. However, the number of children with hearing loss and deafness is
undoubtedly higher, since many of these students may have other disabilities as well. Data by
disability are not reported by the Department of Education for ages birth to 5 years.
- Several studies indicate variance in the prevalence of newborns with congenital hearing
loss in the United States. The overall estimates are between 1 to 6 per 1,000 newborns. Most
children with congenital hearing loss have hearing impairment at birth and are potentially

identifiable by newborn and infant hearing screening. However, some congenital hearing loss
may not become evident until later in childhood.
- According to Blanchfield, et. al., as many as 738,000 individuals in the U.S. have severe
to profound hearing loss. Of these, almost 8% are under the age of 18.
- Among African-American, Cuban-American, Mexican-American, Puerto Rican, and
non-Hispanic White children, it is estimated that approximately 391,000 school-aged children in
the U.S. have unilateral hearing loss.
- According to Niskar and colleagues, approximately 14.9% of U.S. children have lowfrequency or high-frequency hearing loss of at least 16-dB hearing level in one or both ears.
- Profound, early-onset deafness is present in 411 per 10,000 children, and is attributable
to genetics in at least 50% of cases (American Speech-Language-Hearing Association, 2014).

According to Lighthouse International, an Arlene R. Gordon Research Institute, the prevalence

of children and adults within the United States is as follows:
- Based on data from the 2004 National Health Interview Survey, approximately 19
million persons (8.8%) age 18 and over report having any trouble seeing, even when wearing
glasses or contact lenses.
- Based on data from the 1996 National Health Interview Survey, some degree of vision
impairment, defined as blindness in one or both eyes or any other reported trouble seeing, affects
8.3 million (3.1%) Americans of all ages.
- Approximately 3% of individuals age 6 and older, representing 7.9 million people, have
difficulty seeing words and letters in ordinary newspaper print even when wearing glasses or
contact lenses. This number increases to 12% among persons age 65 and older (3.9 million).

- It is estimated that there are more than 14 million people in the United States who have
low vision or a similar vision impairment.
- Based on data from the 2004 National Health Interview Survey, , 61 million Americans
are considered to be at high risk of serious vision loss if they have diabetes, or had a vision
problem, or are over the age of 65.
- About 12 million people have some degree of visual impairment that cannot be
corrected by glasses.
- An estimated 1.8 million individuals age 15 and older (0.8%) are unable to see words
and letters in ordinary print even when wearing glasses or contact lenses.
- Data collected from the National Health Interview Survey on Disability (1994-95)
indicate that approximately 1.3 million persons reported legal blindness (0.5%).
- An estimated 20% of legally blind individuals have light perception or less representing
an estimated 260,000 individuals.
- The following estimates are based on findings from The Lighthouse National Survey on
Vision Loss. Vision impairment is defined as follows, based on self-reports:
a. Inability to recognize a friend across the room, even when wearing glasses or
contact lenses; or
b. Inability to read regular newspaper print, even when wearing glasses or contact
lenses; or
c. Self-rated vision as poor or very poor even when wearing glasses or contact
lenses; or
d. Report of some other trouble seeing, even when wearing glasses or contact
lenses; or

e. Blindness in one or both eyes.

- One in six Americans (17%) age 45 years of age or older, representing 16.5 million
middle-aged and older adults, report some form of vision impairment even when wearing glasses
or contact lenses.
- The prevalence of vision impairment increases with age as indicated in the following
Estimates taken from various sources for research:
a. 15% of Americans ages 45-64 years report some form of vision impairment,
representing 9.3 million persons.
b. 17% of Americans ages 65-74 years and older report some form of vision
impairment, representing 3.1 million persons.
c. 26% of Americans age 75 years and older report some form of vision
impairment, representing 4.3 million persons.
d. Among persons age 65 and older, an estimated 21% report some form of vision
impairment, representing 7.3 million persons.
- Nationally, 5.1% of persons age 18-44 (5.6 million) report trouble seeing even when
wearing glasses or contact lenses.
- Among working age adults 21-64, an estimated 3.9 million report having difficulty
seeing words and letters in ordinary newsprint even when wearing glasses or contact lenses. Of
these 3.9 million working age adults, 800,000 are unable to see words and letters in ordinary
newsprint even when wearing glasses or contact lenses.
- An estimated 163,000 Americans ages 20-44, and 174,000 ages 45-64 are legally blind.

- According to the American Diabetes Association (n.d., a), diabetes is the leading cause
of blindness in persons ages 20-74. An estimated 12,000 to 24,000 people lose their sight each
year because of diabetes.
- Findings from the National Longitudinal Transition Study (NLTS) indicate that 57% of
youth with visual impairments had attended postsecondary schools in comparison to 68% of the
general population and only 27% of persons with disabilities overall.
- Based on a 1998 survey of college freshman, 1.1% of all full-time freshmen report
being "partially sighted" or "blind."
- Of college freshmen with any kind of disability, 13.3% report being "partially sighted"
or "blind" - a decline from 31.7% reported a decade ago and 22.0% just two years earlier.
- Based on data from the National Health Interview Survey, less than 1% (0.6%) of
persons under the age of 18 are visually impaired, defined as blindness in one or both eyes, or
have any trouble seeing even when wearing glasses, representing 448,000 children and youths.
- Based on data from the Survey of Income and Program Participation (Steinmetz, 2006),
189,000 children age 6-14 years of age (0.5%) have difficulty seeing words and letters in
ordinary newsprint even when wearing glasses or contact lenses. Of those, 42,000 have a severe
vision impairment (unable to see words and letters in ordinary newsprint), and 147,000 have a
non-severe vision impairment.
- In 1990, data on legal blindness indicated that approximately 2,600 children under 5
years of age and approximately 51,000 between the ages of 5-19 were legally blind.
- Among children under 5 years of age, prenatal Cataract is the leading cause of legal
blindness, accounting for 16% of all cases. This is followed by optic nerve atrophy (12% of all
cases) and Retinopathy of Prematurity (9% of all cases).

- Blindness occurs mainly among children with birth weights below 1,000 grams (2 lbs, 3
oz) at rates of 5% to 6%.
- A study of children in schools for the blind in the United States revealed that 19% of
2553 children were cortically blind, and 12% had visual loss from optic atrophy or optic nerve
hypoplasia.
- According to state-reported data to the Office of Special Education Programs, 26,070
students ages 6-21 received vision services under Individuals with Disabilities Education Act
(IDEA) during the 1997-1998 school year.
- Among students who have disabilities, students with sensory impairments are the most
likely to graduate from secondary school with 73% of those with visual impairments doing so
(based on data from the 1993-1994 school year (Lighthouse International, 2014).

Classifications
According to the Centers for Disease Control and Prevention, hearing loss can be classified in
several ways, including type, severity, location, and treatment available. A hearing loss can
happen when any part of the ear or auditory (hearing) system is not working in the usual way.
Outer Ear
The outer ear is made up of:

the part we see on the sides of our heads, known as pinna

the ear canal

the eardrum, sometimes called the tympanic membrane, which separates the outer and
middle ear

Middle Ear
The middle ear is made up of:

the eardrum

three small bones called ossicles that send the movement of the eardrum to the inner ear

Inner Ear
The inner ear is made up of:

the snail shaped organ for hearing known as the cochlea

the semicircular canals that help with balance

the nerves that go to the brain

Auditory (ear) Nerve

This nerve sends sound information from the ear to the brain.
Auditory (Hearing) System
The auditory pathway processes sound information as it travels from the ear to the brain so that
our brain pathways are part of our hearing.
There are four types of hearing loss:

Conductive Hearing Loss: Hearing loss caused by something that stops sounds from
getting through the outer or middle ear. This type of hearing loss can often be treated with
medicine or surgery.

Sensorineural Hearing Loss: Hearing loss that occurs when there is a problem in the way
the inner ear or hearing nerve works.

Mixed Hearing Loss: Hearing loss that includes both a conductive and a sensorineural
hearing loss.

Auditory Neuropathy Spectrum Disorder: Hearing loss that occurs when sound enters the
ear normally, but because of damage to the inner ear/hearing nerve, sound isn't organized
in a way that the brain can understand.

The degree of hearing loss can range from mild to profound:

Mild Hearing Loss: A person with a mild hearing loss may hear some speech sounds but
soft sounds are hard to hear.

Moderate Hearing Loss: A person with a moderate hearing loss may hear almost no
speech when another person is talking at a normal level.

Severe Hearing Loss: A person with severe hearing loss will hear no speech when a
person is talking at a normal level and only some loud sounds.

Profound Hearing Loss: A person with a profound hearing loss will not hear any speech
and only very loud sounds.

Hearing loss can also be described as:

Unilateral or Bilateral: Hearing loss is in one ear (unilateral) or both ears (bilateral).

Pre-lingual or Post-lingual: Hearing loss happened before a person learned to talk (prelingual) or after a person learned to talk (post-lingual)

Symmetrical or Asymmetrical: Hearing loss is the same in both ears (symmetrical) or is

different in each ear (asymmetrical).

Progressive or Sudden: Hearing loss worsens over time (progressive) or happens quickly
(sudden).

Fluctuating or Stable: Hearing loss gets either better or worse over time (fluctuating) or
stays the same over time (stable).

Congenital or Acquired/Delayed Onset: Hearing loss is present at birth (congenital) or

appears sometime later in life (acquired or delayed onset) (Centers for Disease Control
and Prevention, 2014).

Visual impairment is usually classified as either sight impaired or severely sight impaired.
These classifications are based on the results of the tests done by certified optometrists.
Sight impaired
Sight impairment, previously called partial sight, is usually defined as:

having poor visual acuity (3/60 to 6/60) but having a full field of vision, or

having a combination of slightly reduced visual acuity (up to 6/24) and a reduced field of
vision or having blurriness or cloudiness in your central vision, or

having relatively good visual acuity (up to 6/18) but a significantly reduced field of
vision

Severely sight impaired

The legal definition of severe sight impairment (which was previously called blindness) is
when a person is so blind that they cannot do any work for which eyesight is essential.
This usually falls into one of three categories:

having very poor visual acuity (less than 3/60), but having a full field of vision

having poor visual acuity (between 3/60 and 6/60) and a severe reduction within your
field of vision

having slightly reduced visual acuity (6/60 or better) and a significantly reduced field of
vision in your eyesight (NHS, 2013).

Characteristics
Hearing loss can happen at any time, and it can lead to delays in a child's ability to learn. Your
child's doctor should routinely ask about speech, language, and auditory developmental signs
like the ones below, but its a good idea for parents and other caregivers to be watchful. Contact
the doctor if you notice any of these red flags:
Warning signs: 12 to 18 months

Doesn't enjoy games like patty-cake

Doesn't recognize the names of familiar people, pets, and objects

Can't follow simple commands such as "come here"

Doesn't turn head in response to sounds coming from another room

Doesn't point to express a desire

Doesn't imitate simple words

Doesn't use at least two words

Doesn't respond to music

Doesn't babble

Doesn't point to simple body parts or look at familiar objects when asked

Warning signs: 19 to 24 months

Doesn't say more than five words

Can't point to at least two body parts when asked

Doesn't respond with "yes" or "no" to a question or command

Can't identify common objects such as "ball" or "cat"

Doesn't mix babble with some intelligible speech

Doesn't enjoy being read to

Doesn't understand "yes" and "no" questions ("Are you ready?")

Doesn't understand simple phrases ("under the table," "in the box")

Warning signs: 25 to 29 months

Doesn't respond to two-part commands such as "sit down and drink your milk"

Can't answer "what" and "who" questions

Can't form simple two-word sentences such as "I go"

Isn't interested in simple stories

Doesn't understand many action words ("run," "walk," "sit")

Warning signs: 30 to 36 months

Doesn't understand possessive terms such as "mine" and "yours"

Can't select things by size (such as "big" and "little")

Doesn't use any plurals or verbs

Doesn't ask "what" and "why" questions

Doesn't understand "not now" or "no more" (Baby Center, 2013).

Kids who have vision loss might have normal-looking eyes. Often, it will be something about
your childs behavior or the way he uses his eyes that makes you think there might be a problem
with the way he sees.
Most babies start to focus on faces and objects by 4-5 weeks of age. By about 6-8 weeks, most
babies will start smiling at the familiar faces and things they see. But if your baby has vision
impairment, you might notice she has trouble doing this.

Other signs that your baby might have a problem with his vision are if his:

eyes move quickly from side to side (nystagmus), jerk or wander randomly

eyes dont follow your face or an object, or he doesnt seem to make eye contact with
family and friends

eyes dont react to bright light being turned on in the room

pupils seem white or cloudy rather than black

eyes dont line up but look towards his nose or turn outwards.

An older child might also do a combination of things like:

hold things up close to her face

rub her eyes a lot

turn or tilt her head or cover one eye when looking at things up close

get tired after looking at things up close for example, reading, drawing or playing
handheld games

seem to see better during the day than at night

say she has tired eyes

seem to have misaligned eyes or a squint

seem clumsy for example, knock things over/trip (Raising Children Network, 2012).

Other signs of vision problems in children include

The child closes or covers one eye

The child squints the eyes or frowns

He or she complains that things are blurry or difficult to see

He or she has trouble reading or doing other close-focused work, or holds objects close

The child blinks more than usual or seems frustrated when doing close-up work

Eyes could be watery, and eyelids could look red-rimmed, swollen or crusted with
secretions (Mandal, 2012).
Diagnostic Assessments

Tests to diagnose hearing loss may include:

Physical exam. Your doctor will look in your ear for possible causes of your hearing
loss, such as earwax or inflammation from an infection. Your doctor will also look for
any structural causes of your hearing problems.

General screening tests. Your doctor may ask you to cover one ear at a time to see how
well you hear words spoken at various volumes and how you respond to other sounds.

Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds
when struck. Simple tests with tuning forks can help your doctor detect hearing loss. A
tuning fork evaluation may also reveal whether hearing loss is caused by damage to the
vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves
of your inner ear, or damage to both.

Audiometer tests. During these more-thorough tests conducted by an audiologist, you

wear earphones and hear sounds directed to one ear at a time. The audiologist presents a
range of sounds of various tones and asks you to indicate each time you hear the sound.
Each tone is repeated at faint levels to find out when you can barely hear. The audiologist
will also present various words to determine your hearing ability (Mayo Clinic, 2014).

The tests that are used to diagnose visual acuity and visual impairment include the Snellen test,
visual field test and so forth. By using these tests, we can better diagnose and understand the
reason behind the vision loss, helping the student adjust so that he or she can succeed in school.

Snellen test
The Snellen test is also known as the visual acuity test. Usually a chart called the Snellens chart
is used. It contains progressively shortening random letters and numbers and is placed 6 meters
away from the patient. The patient is asked to read the letters with each eye separately and both
together. Ability to read the letters at each size determines the visual acuity. After the test a score
is obtained. It is made up of two numbers. The first number represent how far away from the
chart the patient was when he or she was able to successfully read the letters on the chart. The
second number represents how far away a person with healthy vision should be able to read the
chart. Healthy vision scores 6/6. If the score is 6/60, it means that the patient can only read
something 6 meters away what a person with healthy eyesight can read 60 meters away.
- Being partially sighted, or sight impaired means if level of sight loss is moderate and
blindness, or severe sight impairment means when level of vision loss is so severe that a person
is unable to complete any activities that require eyesight.
- Partial sight or sight impairment is defined as 3/60 to 6/60 vision or having a
combination of moderate visual acuity (up to 6/24) and a reduced field of vision.
- Blindness is defined as having poor visual acuity (less than 3/60) but having a full field
of vision or having poor visual acuity (between 3/60 and 6/60) and a severe reduction in the
vision field or having average visual acuity (6/60 or above) and an severely reduced field.

Visual field test

Visual field is the range of vision that a person can see without tilting or turning ones head. This
measures the peripheral vision of the eyes. The test uses a device strapped over the patients
eyes. Lights are flashed on and off in the patients peripheral vision. He or she is then asked to
press a button every time they see a light. Any gap of field of vision is detected.
Tonometry test
This test uses specialized instruments to determine fluid pressure inside the eye to evaluate for
glaucoma.
Ocular Motility Assessment
This tests if there is squint of other problems in the movement of the eyeballs.
Other tests
Other tests like Visually-evoked potential (VEP), Electroretinogram (ERG), Electro-oculogram
(EOG) are sometimes used to test if signals from the eyes are travelling adequately to the brain.
These may help if the patient is very young and clinical examination is difficult or if there are
multiple handicaps that make diagnosis difficult (Mandal, 2012).

Eligibility Criteria
511 IAC 7-41-4 Deaf or hard of hearing
Sec. 4. (a) Deaf or hard of hearing, which may be referred to as a hearing impairment, means
the following:
(1) A disability that, with or without amplification, adversely affects the student's:
(A) ability to use hearing for developing language and learning;
(B) educational performance; and
(C) developmental progress.
(2) The hearing loss may be:
(A) permanent or fluctuating;
(B) mild to profound; or
(C) unilateral or bilateral.

(3) Students who are deaf or hard of hearing may use:

(A) spoken language;
(B) sign language; or
(C) a combination of spoken language and signed systems.
(b) Eligibility for special education as a student who is deaf or hard of hearing shall be
determined by the student's CCC. This determination shall be based on the multidisciplinary
team's educational evaluation report described in 511 IAC 7-40-5(e), which includes the
following:
(1) An assessment of the following:
(A) Current academic achievement as defined at 511 IAC 7-32-2.
(B) Functional skills or adaptive behavior across various environments from
multiple sources.
(C) Communication conducted in the:
(i) language or system utilized for the student's instruction; or
(ii) student's preferred mode of communication;
that assesses the student's receptive and expressive language skills.
(2) A social and developmental history that may include, but is not limited to, the
following:
(A) Communication skills.
(B) Social interaction skills.
(C) Motor skills.
(D) Responses to sensory experiences.
(E) Relevant family and environmental information.- 70 (3) A written report from an educational or clinical audiologist, otologist, or
otolaryngologist with information regarding the:
(A) etiology of the hearing loss; and
(B) student's potential requirement for amplification, if appropriate.
(4) Any other assessments and information, collected prior to referral or during the
educational evaluation, necessary to:
(A) determine eligibility for special education and related services; and
(B) inform the student's CCC of the student's special education and related
services needs (Indiana State Board of Education, 2010).
511 IAC 7-41-5 Deaf-blind
Sec. 5. (a) Deaf-blind, which may be referred to as dual sensory impaired, means a disability
that:
(1) is a concomitant hearing and vision loss or reduction in functional hearing and vision
capacity;
(2) causes significant communication and adaptive behavior deficits;
(3) adversely affects the student's educational performance; and

(4) cannot be accommodated for by use of a program or service designed solely for
students who are:
(A) deaf or hard of hearing; or
(B) blind or have low vision.
(b) Students who are deaf-blind represent a heterogeneous group that includes the following:
(1) Students who are both deaf and blind with:
(A) measured acuities and intellectual and adaptive functioning; or
(B) estimated acuities and intellectual and adaptive functioning supported by a
description of pathology.
(2) Students with hearing and visual reductions of a mild to severe degree:
(A) with additional learning or language disabilities that adversely affect
educational performance; or
(B) who have been diagnosed with a chronic or degenerative pathology or a
disease that may potentially result in deaf-blindness.
(3) Students with generalized central nervous system dysfunction who:
(A) exhibit:
(i) auditory and visual impairments; or
(ii) deficits in auditory-visual functioning; and
(B) may demonstrate inconclusive or inconsistent responses:
(i) during hearing and vision assessments; or
(ii) to auditory and visual stimuli in the environment.
(c) A student who is solely deaf-blind is not considered to be a student who has multiple
disabilities as defined in section 9 of this rule.
(d) Eligibility for special education as a student who is deaf-blind shall be determined by the
student's CCC. This determination shall be based on the multidisciplinary team's educational
evaluation report described in 511 IAC 7-40-5(e), which includes the following:
(1) An assessment of the following:
(A) Current academic achievement as defined at 511 IAC 7-32-2.
(B) Functional skills or adaptive behavior across various environments from
multiple sources.
(C) Communication conducted in the:
(i) language or system utilized for the student's instruction; or
(ii) student's preferred mode of communication; that assesses the student's
receptive and expressive language skills.
(D) Functional vision.
(E) Functional literacy as described in 511 IAC 7-42-6(c)(5).
(2) A systematic observation of the student across various environments.
(3) A social and developmental history that may include, but is not limited to, the
following:
(A) Communication skills.
(B) Social interaction skills.

(C) Motor skills.

(D) Responses to sensory experiences.
(E) Relevant family and environmental information.- 71 (4) An assessment of motor skills, including travel skills.
(5) A written report from an optometrist or an ophthalmologist that includes the
following:
(A) Etiology and prognosis of the visual dysfunction.
(B) Secondary or accompanying visual conditions, such as nystagmus or
photophobia, if appropriate.
(C) Near/distance and corrected/uncorrected acuity measures for left, right, and
both eyes, as appropriate.
(D) Measures of visual fields for both eyes, if appropriate.
(E) Recommendations for use of aids, glasses, or lighting requirements, if
appropriate.
(6) A written report from an educational or clinical audiologist, otologist, or
otolaryngologist with information regarding the:
(A) etiology and prognosis of the hearing loss; and
(B) student's potential requirement for amplification, if appropriate.
(7) Any other assessments and information, collected prior to referral or during the
educational evaluation, necessary to:
(A) determine eligibility for special education and related services; and
(B) inform the student's CCC of the student's special education and related
services needs (Indiana State Board of Education, 2010).

Strategies, Interventions, and Adaptive Materials

This information is provided as a list of accommodations and classroom modifications for the
IEP or 504 Plan team to consider as they discuss what is needed to provide maximal access to the
general curriculum and meet the learning needs of the student with hearing loss. This is not an
exhaustive list. Students will vary in terms which of these items are necessary and appropriate to
support school progress commensurate with the students abilities. Educational settings vary in
the extent to which they provide accommodations and modifications to students with hearing
loss. It is important for the IEP or 504 planning team to include a professional with expertise in

the educational needs of students with hearing loss so that the unique access and learning needs
of the student with hearing loss are understood and can be appropriately accommodated.
Accommodations to Consider to Address the Access and Learning Needs of Students with
Hearing Loss:
Amplification Options:
___Personal hearing device (hearing aid, cochlear implant, tactile device)
___Personal FM system (hearing aid + FM)
___FM system/auditory trainer (without personal hearing aid)
___Walkman-style FM system
___Sound-field FM system
Assistive Devices:
___TDD
___TV captioned
Communication Accommodations:
___Specialized seating arrangements
___Obtain students attention prior to speaking
___Reduce auditory distractions (background noise)
___Reduce visual distractions
___Enhance speech reading conditions (avoid hands in front of face, mustaches
well-trimmed, no gum chewing)
___Present information in simple structured, sequential manner
___Clearly enunciate speech
___Allow extra time for processing information
___Repeat or rephrase information when necessary
___Frequently check for understanding
___Educational interpreter (ASL, signed English, cued speech, oral)
Physical Environment Accommodations:
___Noise reduction (carpet & other sound absorption materials)
___Specialized lighting
___Room design modifications

___Flashing fire alarm

Instructional Accommodations:
___Noise reduction (carpet & other sound absorption materials)
___Use of visual supplements (overheads, chalkboard, charts, vocabulary lists,
lecture outlines)
___Captioning or scripts for announcements, television, videos, or movies
___ Real-time speech to text translation (i.e., computer on desk)
___Buddy system for notes, extra explanations/directions
___Check for understanding of information
___Down time / break from listening
___Extra time to complete assignments
___Step-by-step directions
___Note taker
Curricular Modifications:
___Modify reading assignments (shorten length, adapt or eliminate phonics
assignments)
___Modify written assignments (shorten length, adjust evaluation criteria)
___Pre-tutor vocabulary
___Provide supplemental materials to reinforce concepts
___Provide extra practice
___Alternative curriculum
Evaluation Modifications:
___Reduce quantity of tests or test items
___Use alternative tests
___Provide reading assistance with tests
___Allow extra time
Other Considerations:
___Supplemental instruction (speech, language, pragmatic skills, auditory, speech
reading skills)
___Counseling
___Sign language instruction

___Transition / Vocational services

___Family support
___Deaf/Hard of Hearing role models
___Recreational/Social opportunities
___Financial assistance
___Monitor progress periodically with a hearing specialist (Anderson, 2012).

There are various tips and tactics to be used for a visually impaired student within a regular
education classroom. Texas School for the Blind and Visually Impaired shares these ideas:
- It's okay to say "look" and "see." Even fully sighted people use their other senses in the
context of looking at something. Visually impaired people might look at things in a different
way, but "seeing" is in the perception (rather than the eye) of the beholder.
- Audiovisual presentations and demonstrations are made accessible to severely visually
impaired students by providing verbal explanations. Read what is being written on the board
and/or describe what is pictured in the presentation. Allow the student time to handle tactually
adapted materials.
- Saying "over there" and pointing to something the student can't see are not useful with a
blind student. Instead, spatial directions must be given from the STUDENT'S perspective.
Remember that the student's left and right are opposite yours when you are facing the student.
- Seat or encourage the visually impaired student to come to the front of the classroom or
presentation area in order to be certain that s/he hears all instruction/explanation correctly.
- Braille materials take an exceptionally long time to order and/or prepare. Textbook
committee members should be aware of this and be certain that braille textbooks can be ordered
in January for the following fall so that they can be transcribed in time. Extra time may be

required for math and technical books, as Braille mathematical notation requires a unique
certification that many literary braille transcribers do not possess.
- Classroom handouts, especially those with pictures or diagrams, also require a great
deal of time to transcribe into braille and tactile formats or verbal descriptions. Classroom
teachers are wise to provide materials to be transcribed at least two weeks ahead of time,
preferably on disk, as some text can be transcribed using computer translation software.
- Expect the visually impaired student to complete the same assignments as the rest of the
class. Due to alternative media, assignments may take a visually impaired student longer to
complete. An average of double time for Braille or tape is a good rule of thumb. Due to time
constraints it may occasionally be necessary to reduce the number of examples to be completed
for classwork or homework (such as in math problems), as long as the student is able to
demonstrate that s/he understands the concepts and/or skills exhibited within each example.
Independence is of primary importance! Be patient. Observe the student, silently encouraging
independent problem-solving skills. Wait until the student asks for help and provide minimal
assistance only as needed to build self-confidence and independence.
- Avoid leaving doors and drawers ajar or chairs out from under tables and desks. Either
keep furniture consistent or inform and/or involve the student in rearranging.
- Address all students by name so that the visually impaired student can learn to associate
names with voices of classmates. Address the visually impaired student by name as well, so he or
she knows when he or she is being spoken to.
- Encourage the student's use of proper posture, eye contact as much as possible and
proper social etiquette. Discourage any inappropriate mannerisms to maximize the student's
physical and emotional health, as well as the student's social, educational and career potential.

- Always treat the visually impaired student equally with other students. This includes
discipline and special privileges as well as involvement in extracurricular and leadership
opportunities.
- Give the visually impaired student as many opportunities to help others as to be helped
by others. Please don't presume that just because the student can't see and is using other learning
mediums that the student is incapable. Try to allow the student to use their strengths in the areas
they have to learn.
- All students, including those with visual impairments, learn at individual rates.
- As much as possible, treat the student as any other student and your example will
encourage classmates to do the same (Texas School for the Blind and Visually Impaired, 2010).

Support/Services Providers
These websites can help someone who deals with an hearing or vision impairment and loss find
resources within our state. They can help with some of the following needs:
- Local Resources
- Information
- Referrals
- Support Groups

Indiana Deaf-Blind Services Project

http://www.indstate.edu/blumberg/db/families.htm
Indiana Department of Education Special Education Resources
http://www.doe.in.gov/specialed/indiana-resource-network
Indiana University Deaf-Blind Equipment Distribution program
https://www.indstate.edu/blumberg/v2files/INDBEDP_brochure2.pdf

Resources
Website
Hearing Loss Association of America
http://www.hearingloss.org/content/helpful-website-links
Vision Loss: Resources for Vision Impairment
http://visionloss.org.au/
National Organization
Centers for Disease Control and Prevention
http://www.cdc.gov/ncbddd/hearingloss/index.html
http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/VisionLossFactSheet.pdf
State or Local Organization
Indiana State Blind and Visually Impaired Services
http://www.in.gov/fssa/ddrs/2638.htm
Informational Book for Parents
Your Child's Hearing Loss: What Parents Need to Know by Debby Waldman and Jackson Roush
Children With Visual Impairments: A Guide for Parents by M. Cay Holbrook
Childrens Book with Hearing/Vision Loss
A Button in Her Ear by Ada B. Litchfield (Author)
Sign Language: My First 100 Words by Michiyo Nelson

References
American Speech-Language-Hearing Association. (2014). The Prevalence and Incidence of Hearing Loss
in Children. Retrieved from American Speech-Language-Hearing Association:
http://www.asha.org/public/hearing/Prevalence-and-Incidence-of-Hearing-Loss-in-Children/
Anderson, D. K. (2012, August). Accommodations for Students with Hearing Loss. Retrieved from
Supporting Success for Students with Hearing Loss:
http://successforkidswithhearingloss.com/relationship-hl-listen-learn/accommodations
Baby Center. (2013). Warning Signs of a Hearing Problem in Children. Retrieved from Baby Center:
Expert Advice: http://www.babycenter.com/0_warning-signs-of-a-hearing-problem-in-children12-to-36-mont_12292.bc
Centers for Disease Control and Prevention. (2014, August 8). Hearing Loss in Children: Types of
Hearing Loss. Retrieved from Centers for Disease Control and Prevention:
http://www.cdc.gov/ncbddd/hearingloss/types.html
Indiana State Board of Education. (2010). Special Education Rules, Title 511, Article 7, Rules 32-47. 6970.
Indiana State University. (2014). Indiana Deaf-Blind Services Project. Retrieved from Blumberg Center
for Interdisciplinary Studies in Special Education:
http://www1.indstate.edu/blumberg/db/modules/deafblind-index4.htm
Lighthouse International. (2014). Prevalence of Vision Impairment. Retrieved from Lighthouse
International: http://www.lighthouse.org/research/statistics-on-vision-impairment/prevalence-ofvision-impairment/#national
Mandal, D. A. (2012, June 27). Diagnosis of Visual Impairment. Retrieved from News Medical:
http://www.news-medical.net/health/Diagnosis-of-visual-impairment.aspx
Mayo Clinic. (2014, September 5). Diseases and Conditions: Hearing Loss. Retrieved from Mayo Clinic:
http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/tests-diagnosis/con-20027684

NHS. (2013, October 10). Visual Impairment. Retrieved from NHS Choices:
http://www.nhs.uk/conditions/Visual-impairment/Pages/Introduction.aspx
Raising Children Network. (2012, June 25). Vision Impairment. Retrieved from RaisingChildren.Net:
http://raisingchildren.net.au/articles/vision_impairment.html
Texas School for the Blind and Visually Impaired. (2010, April 9). Classroom Strategies for Regular
Education Teachers who have Students with Visual Impairments. Retrieved from Texas School for
the Blind and Visually Impaired: http://www.tsbvi.edu/instructional-resources/1911-classroomstrategies-for-regular-education-teachers-who-have-students-with-visual-impairments
U.S. Department of Education. (2004). Section 300.8: Child with a Disability. Retrieved from Building
the Legacy: IDEA: http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,