16 Assessment in children who are Deaf or hard of hearing

Cautionary note: It is important to highlight that competency in assessment with children who are Deaf or who are hard of hearing involves much more than making adaptations to tests or choosing the right test. Specialized training in hearing loss is important to understand the impact of hearing on development, provide the appropriate adaptations, interpret results, and make appropriate diagnoses and recommendations. When working in this population, it is also important to have an understanding of Deaf culture and American Sign language. Given that the development of spoken language and reading can be expected to be different in children who are Deaf, there are special considerations in making diagnoses of a Language Disorder or Dyslexia. This chapter is designed to be a very preliminary introduction to hearing impairments for psychologists who are doing assessments with children who have multiple disabilities which includes hearing loss. Extensive resources for further learning are provided for those clinicians who are interested in developing competency in this area. A review of nonverbal tests of intelligence can be found in a separate chapter. Children in British Columbia, the Yukon, and the Northwest Territories with bilateral moderate to profound hearing loss may be referred by their medical doctor for multi-disciplinary assessments through the Sunny Hill Deaf and Hard of Hearing program. 

Hearing loss and the neuromotor population: Hearing loss is much more common in children with neuromotor and multiple, severe disabilities compared to the general population. Children with hearing loss may present with bilateral hearing loss or unilateral hearing loss. You may also see mild to profound loss.  Some children with neuromotor conditions may use a few “personal” signs to communicate. For those children, using an ASL interpreter is not necessarily appropriate. 

Mild and unilateral (one sided) hearing loss

When you are testing someone with mild or unilateral hearing loss, it is important to use a room without auditory distractions. Noises coming from outside the room will make it much more difficult for the child to hear.

When talking with the child, face them so that they can use visual cues as well as oral cues (look at your lips and facial expression). It is not necessary to sit to the side of a child with unilateral hearing loss. However, if you must sit to the side, sit on the side where they have better hearing.

Talk in a normal speaking voice, being alert to keeping up a normal volume. Be sure to pronounce words very clearly, especially the last sound in the word, which can sometimes get dropped. This is especially important on a task like list learning, where you read a list of words aloud. It would be normal for someone with mild hearing loss to mishear similar words (e.g., “eyes” for “ice”).

When looking at the group level, overall children with mild and unilateral hearing loss have more educational, social, and behavioural challenges than their peers.^[1] However, this is complicated by the various etiologies of hearing loss, which can themselves impact functioning. This may including premature birth, meningitis or infection.^[2]

Regardless of the etiology of the hearing loss, these children have to work harder than other children to listen. In the classroom, this can lead to fatigue or what looks like problems with attention or acting out.

Assessment with someone who is Speechreading (“lip reading”)^[3]

• Speak at a normal rate and with normal articulation.
• Keep your hands very still while talking.
• If you want to show something while talking, silently show first, then explain, and possibly show a second time.
• Never speak while not facing the person.

Assessment with an American Sign Language (ASL) interpreter

• If you are new to working with an ASL interpreter in an assessment setting, you should seek out consultation.
• When working with an ASL interpreter, allow more time for the assessment.
• Meet with an interpreter for 10-15 minutes before starting the assessment so you can talk about the process of the assessment. It is helpful to mention that you want to know the child’s level of language, therefore you want to know if they are using incorrect grammar, or if signs are signed incorrectly.
• Introduce the interpreter to the child and explain their role. Children may not be used to having interpreters.
• According to the professional code of sign language interpreters, they will interpret everything that occurs in the room (sounds, private conversations, phone calls).
• Generally, it is best to sit next to the sign language interpreter, opposite the child. Thus, the client can easily shift from looking at you to looking at the interpreter. Make sure there is no distracting background (e.g., venetian blinds) that could make it taxing to see the interpreter’s hands.
• Address the client directly, and maintain eye contact with the client rather than with the interpreter.
• In general, wait to begin speaking until the interpreter is finished signing.
• Do not give visual instructions (pointing, demonstrating) at the same time as you are talking (or the interpreter is signing).
• Allow a brief silent time for reading if you hand out written material. Wait until the Deaf person looks up before you start to speak again.
• The process of reading or writing printed English for someone who communicates via ASL is called transliteration. The interpreter who is assisting with transliteration is having to pair the printed English word with their vocabulary of ASL signs. You may wish to ask the interpreter if it is best for you to read the text aloud or have them read it themselves (e.g., on a consent form).

Specific testing tips for the child who uses ASL

• It is important to understand that ASL is another language. Sentence structure is Object/Subject/Verb commonly (In spoken English, Subject/Verb/Object is most common). Further, verbs are tough to translate into a single ASL sign. The verb is usually communicated together with the sign for the subject or the sign for the object. There are signs for most nouns, but specific signs are often fingerspelled (spelled letter by letter). Thus for spelling tests this is an important clarification –  some spoken words may be difficult to translate into a single sign.
• With a test of word reading, try to get children to provide a single sign if one exists (the interpreter can tell you).
• For paragraph reading, it is likely best to choose a test which allows for silent reading (e.g., WIAT) rather than reading aloud (e.g., GORT).
• When giving a measure of adaptive functioning, have parents think about child’s communication in ASL or spoken language. The child should get “credit” for accomplishing something using either sign or spoken language. However, as with spoken language, independence of behaviour is important. For example, if the child is prompted (reminded) to use the sign for “thank you”, that is not independent behaviour.