31 Assessment of Deafblind Children

Deafblindness should not be seen simply as a combination of visual and hearing impairments but rather as a complex issue with cumulative needs that require special attention when a student has both types of impairment. These additional needs may not be present when dealing with only one sensory modality impairment.

Teams may question whether students with low vision or hearing differences qualify under the special education eligibility category of deafblindness. Remember that a student does not have to be entirely or legally blind and deaf to meet the eligibility requirements for deafblindness. A student with reduced sight and hearing may meet the criteria for deafblindness if the student has significant communication, developmental, and educational needs that require special education programs to address the vision and hearing needs (e.g., has needs beyond programs for students who are only deaf or programs for students who are solely blind) per the United States Individuals with Disabilities Education Act Section 300.8 Child with a disability (c) (13) (2004).

Teams must focus on students’ functional vision and hearing rather than measurements from medical reports. Even if a student appears to be coping fine, audiograms can be misleading and lead people to believe that the student can hear and understand effectively. When “high frequencies (above 1000Hz) are compromised, [the student may not have] access to high-frequency sounds [that] is what makes speech intelligible. Examples of high-frequency speech sounds are unvoiced s, f, th, k, and t, which not only provide us with the difference between words like ‘bat’ and ‘back’ but are also essential for plurals and tense markers. This is also even MORE critical for a youngster learning language. [In addition,] aided responses can provide a false representation of what an individual can hear. [Although] they hear the sounds provided in the sound field, it is not exactly what is required when attaching meaning to hearing words and language” (T. Kuerbis, personal communication, October 26, 2021). Being able to hear a sound does not necessarily equate to making sense of the sound.

The combination of limited access to visual and auditory environmental information for deafblind students results in fewer chances for incidental learning, which is the natural learning that occurs through observing and interacting with the everyday environment. Therefore, students with dual sensory impairments require hands-on, experiential learning opportunities to gain a meaningful understanding of new concepts. Youth who are deafblind may be actively engaged in educational settings or may have significant needs that impede the learning process.

Considering the wide range of strengths and needs among students with deafblindness, it can be difficult to identify the most suitable tools for evaluating all deafblind youth. The best tools for a particular case would depend on factors such as the student’s developmental or cognitive level and access to visual and auditory information with accommodations, assistive devices, and/or intervener support.

Consult with the Teacher of the Visually Impaired (TVI), Teacher of the Deaf (ToD), Teacher of the Deafblind (TDB), Speech Language Pathologist (SLP), and intervener throughout the evaluation process (i.e., during planning, testing, and interpreting evaluation results). Provide parents, caregivers, and family members opportunities to give input on how the student functions in various environments and with different people. In addition, consult with other evaluation team members who are involved. Orientation and Mobility (O&M) specialists, Occupational Therapists (OTs), Physical Therapists (PTs), Augmentative and Alternative Communication (AAC) specialists, Adapted Physical Education (APE) specialists, and Assistive Technology (AT) specialists are some of the possible additional evaluators who may support a deafblind student.

Collaborate closely with the TVI, ToD, and/or TDB to adequately accommodate the student’s hearing and vision needs to set up the environment optimally. Team members, such as the ToD, TDB, SLP, and intervener, must be consulted to clarify communication needs.

When direct assessments are conducted, at least one adult who knows the student well and understands their communication should be present if the examiner is not proficient in the examinee’s mode of communication. An intervener who has experience working with the examinee is an ideal option. Interveners are paraprofessionals who provide consistent one-to-one support to help deafblind students gain access to information and communication and facilitate the development of their social and emotional well-being. In educational environments, they are typically paraeducators who work under the direction of the classroom teacher and ToD or TDB. An intervener should be viewed differently from a typical instructional aide or paraprofessional and utilized during the evaluation to gather meaningful information.

Evaluating a student through an intervener who is using American Sign Language (ASL) highly impacts the results of your evaluation. American Sign Language has its own unique grammar and syntax, and interpreting changes how the instructions are given. You may end up accidentally testing the skills of the intervener more than the child. Include a validity statement in the report about giving the evaluation through an intervener who was interpreting for the child.

Day and colleagues (2015) provided guidance on using interpreters with the WISC-V for testing deaf or hard-of-hearing youth. Their considerations for the use of interpreters apply to deafblind children and their interveners as well.

Considerations to keep in mind include understanding the impact that an interpreter can have on the testing process and ensuring that interpretation does not inadvertently provide a correct response, simplify the task, or change the intended nature of the task. It is important to clarify whether the role of the interpreter is to interpret the child’s exact response, modify the response to accommodate for cultural differences, or fill in any gaps to clarify the response. (Day et al., 2015, p. 2)

Standardized assessments may not be appropriate to interpret quantitatively for deafblind students. No standardized assessments are valid and reliable for all deafblind individuals since significant variability exists within the deafblind population. In addition, the low incidence nature of deafblindness poses challenges in developing standardized assessments.

Test the limits with accommodations and/or modifications to better understand the student’s functioning while minimizing the impacts of the dual sensory loss on the student’s ability to show what they know. When the task demands are modified and subsequently changes the construct the test intended to measure, scores should not be reported. If standardized assessments are administered, qualitative interpretation of the results may be more appropriate than quantitative reporting. A dynamic, authentic assessment style is often recommended over a standardized method. For example, an examiner may start with standardized testing procedures and then test the limits with further inquiry or trials to explore how the student approaches a task or demonstrates their understanding with different levels of support. The examiner must consider the cause and validity of any assessment results (including rating scales) and be cautious when interpreting results. Determine if the results are representative of the student’s functioning or more of a reflection of needs and considerations for support stemming from deafblindness. Include statements regarding the validity of the results given the needed break from standardized procedures to facilitate the student’s engagement with testing. While the test scores might provide limited utility, the clinical insights gleaned from carefully observing the student’s process of working on tasks are valuable. Use the evaluation to determine what best promotes motivation, engagement, participation, and independence.

The article “Cognitive Assessment of Children Who Are Deafblind: Perspectives and Suggestions for Assessments” highlights the importance of using multi-method, multi-informant, ecological, and dynamic assessment approaches that include collaboration with family members and a multidisciplinary team (Nicholas, 2020). Consider the following questions from this article to guide the evaluation:

• “How information is best communicated to promote learning;
• How does perceptual-cognitive characteristics in the different modalities help promote the child’s multisensory learning;
• How does the child’s spatial ability in the visual or tactile modality affects his/her explorative activity, navigation, or mobility training (spatial cognition);
• How does the child stays focused and problem solve when a new or unfamiliar task is presented (attentional switching);
• How many repetitions of information does it take for the child to acquire new information (working memory);
• How does the child learn to remember specific personal episodes/experiences (autobiographical memory);
• How does the child’s ability to generate a plan affects his/her functions in everyday life (cognitive planning);
• How effectively does the child use feedback from the environment (cognitive flexibility);
• How does the child allow for change in perspectives in order to reach a goal (goal-oriented); and
• What is the child aware of when facing a task and processing the information related to it (metacognitive knowledge)” (Nicholas, 2020, pp. 4-5).

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