State of Illinois Bruce Rauner, Governor

1
ILLINOIS SCHOOL FOR THE DEAF OUTREACH
FREE training and consultation for Illinois
children who are deaf or hard of hearing
ISD Outreach website www.bit.ly/ISDOutreach
Like us on Facebook! bit.ly/isdoutreach 217-479-4
393
State of Illinois Bruce Rauner,
Governor Dept. of Human Services Greg
Bassi, Acting Secretary Illinois School for the
Deaf Serena Preston, Supt.
www.bit.ly/ISDOutreach
www.illinoisdeaf.org
2
WORKING WITH STUDENTS with HEARING LOSS
and ADDITIONAL DISABILITIES
Deaf/Hard of Hearing Plus
3
PURPOSE To improve your knowledge of additional
needs or disabilities for students who are DHH,
in order to support student learning to meet the
rigorous academic standards and to improve social
development. This is research-based information.

• OBJECTIVES To gain understanding of
• -Learning challenges faced by students who are
  Deaf/Hard of Hearing and have other
  disabilities/issues
• -Strategies to support learners with hearing loss
  and additional needs
• -And to plan for sustained learning information
  that you can discuss or apply to your work with
  students or with your child.

4
Important thought

• An additional disability for learners
  with hearing loss presents unique needs, but
  remember
• there are always strengths, abilities, and
  potential for every child!

5
evolving interaction

SYNERGY
combined effect
6
Hearing Loss Factors

• Degree (mild-profound) and Type of hearing loss
  (sensori-neural, conductive, mixed, auditory
  neuropathy)
• Age of onset of hearing loss, progressive?
• Age of services
• Mode of Communication (for receptive
  understanding and expressive communication)
• Language level
• Use of hearing aid/cochlear implant

7
Non-Hearing Loss Factors

• Type and onset of the additional disability
• Severity of additional disability
• Presence of multiple other disabilities
• Onset of support and specialized services
• Personality strengths
• Coping strategies

8
Just how many Students are we
talking about?

• It is estimated that 20 to 40 of students who
  are deaf and hard or hearing have another
  disability.
• (Center for Assessment and Demographic Studies
  of the Gallaudet Research Institute collected
  statistics)

9
ISBE Disability Categories

• Autism
• Deaf-Blindness
• Deafness
• Emotional Disability
• Hearing Impairment
• Intellectual Disability
• Multiple Disabilities
• Orthopedic Impairment

• Other Health Impairment
• Specific Learning Disability
• Speech or Language Impairment
• Traumatic Brain Injury
• Visual Impairment

Sometimes the impact of the hearing loss in a
DHH student is masked, when there is another
disability present. Deaf Plus Dinah Beams,
M.A.,Hands Voices
10
Syndromes

• There are 400 multiple anomaly syndromes in which
  hearing loss is listed as a significant feature.
• Stickler syndrome
• Congenital cytomegalovirus (CMV)
• Usher syndrome
• Pendred syndrome
• CHARGE syndrome
• Waardenburg syndrome

11
What about materials and strategies?

• No one technique is appropriate for all children.
• Emphasis should be placed on what the student CAN
  do.

12

• Intellectual Disability

13
What is an Intellectual Disability?

• Below average general intellectual functioning
• and

Deficits in adaptive behavior
manifested during the developmental period
14
Adaptive Behavior
Personal Care Skills (eating, dressing,
toileting, self care)
Social and Communication Skills
(interacting/communicating with others and
language milestones)
Community Living Skills (time, money,
home/community skills)
Motor Skills
15
Honor Strengths

• While these students will have limitations in
  many adaptive behaviors, these limitations will
  co-exist alongside strengths in other areas
  within the individual.
• Independence and self-reliance should always be
  primary goals of all instructional strategies
  employed with students with intellectual
  disabilities.
• Project Ideal http//www.projectidealonline.org/v/
  intellectual-disabilities/

16
Teaching Strategies

• Visuals are a constant necessity
• Teach one concept or component at a time
• Teach one step at a time
• Be consistent
• Rephrase, rather than keep repeating
• Smaller groupings, individualized
• Multiple practice, in multiple places
• Prompts
• Praise

17

Visuals are a constant necessity What does this
say? What does this mean?
.

ACE AH CURB PAUL
Would a picture help you? Absolutely!




18

Visuals are a constant necessity A
picture does help!
.
ACE AH CURB PAUL




19

Visuals are a constant necessity A
picture does help!
.
ACE AH CURB PAUL


A soccer ball.
20

Visuals are a constant necessity.

.
EGG SIT SIGHING
A visual will help you.



21

Pictures do help
.

EGG SIT SIGHING



22

Pictures do help
.

EGG SIT SIGHING


Exit sign

23
More Teaching Strategies

• Real World Skills time and money concepts,
  functional reading
• Modifications to academics
• Picture supported learning
• Independent living skills, self-care and hygiene,
  community access, leisure activities, and
  vocational training.

24
There are many occasions for functional reading
experiences.

• Menus
• Labels
• Recipes
• Tags
• Instructions
• Directions for care
• Repair instructions
• Tickets
• E-mail
• Coupons
• Captions

• Schedules
• Games rules
• Clock
• Money, coins and bills
• List for store
• Receipts
• Calendar
• Job apps
• Maps
• Bills
• Weather reports

25

• CHOOSING MODIFICATIONS AND ACCOMMODATIONS

26
Modifications-

• Reduced/altered assignments, classwork
• Specialized or alternative curriculum
• Alternate book at students level
• Simplified vocabulary/concepts
• Picture supports
• Calculator
• Grading

27
Accommodations-

• Environmental changes- preferential seating front
  (near interpreter), flexible seating
• Peer Notetaker, Teacher notes/outlines,
  Interpreter signs test
• Using different paper, spell-checker,
  Highlighted text, Word banks
• Peer buddy, Frequent teacher check-backs
• Multiple choice, Verbal/Sign responses
• Shorten assignments, Extra time

28

• BEHAVIOR
• ISSUES

29
What might be the purpose of the behavior?

• Attention-getting
• Seeking Control
• Avoidance
• Sensory Regulation
• To Communicate to us

Behavior can be a way for the child to
communicate their wants and needs without
words. What is the behavior telling
us?
30
What triggers the behavior?

• For example
• Change in routine
• Expecting it to be hard to do
• Too stimulating, too many choices
• Not trusting the promisetoo hard to reach the
  reward

31
Remember We cant address EVERYTHING all at the
SAME time!!!!!!!!
Tell me what I am Doing Right. Praise me,
so I keep doing the right thing. Reward me
(with time, attention, sticker, star, story)
32
Behavior Tips

• ENVIRONMENTAL CHANGES
• Placing things in different areas of the room to
  allow for student movement
• Re-arranging desks/ nearby students
• Reminders on desk. Rule cards (positive rules)
• ADULT CHANGES
• Check back even when everything is going right.
• More frequent positive reinforcement/praise.
• Give the reason for the rule
• STUDENT CHANGES Substitute with a more
  socially
  acceptable behavior to meet students needs
• Choice boards, simple signal, break card

33

• SENSORY-INTEGRATION
• ISSUES

34
Sensory Integration

• We are constantly experiencing sights, sounds,
  touch and movement.
• How we process all of those sensations determines
  how well we function in our environment.
• For most of us, sensory integration occurs
  automatically.
• Poor sensory integration can impact
  participation, attention, etc.

35
What can be done to support Sensory Integration?

• Attention to childs needs/ reaction. WHAT IS
  THE CHILD SEEKING?
• ACCOMODATIONS (move, stand)
• AWARENESS Goal--Student learning to be aware of
  state of being (need for calming or alerting,
  high/low) and what to do for self.
• SENSORY DIET
• PERHAPS Therapy in a sensory enriched
  environment
• Swinging, spinning, tactile, visual, auditory

36
What types of activities might be used by the OT?

• Lifting and pulling heavy things
• Swinging/rocking
• Scooter board
• Deep joint compression
• A weighted vest
• Rolling a big ball over the body

37
LIMITED ALERTNESS TO THE EDUCATIONAL ENVIRONMENT
Inattentive
Attentive to the unimportant

• ADHD
• ATTENTION ISSUES

HEIGHTENED SENSITIVITY TO ENVIRONMENTAL STIMULI
Hyperactive
Impulsive
38
ADHD

• Inattentive-Fails to give close attention to
  details or makes careless mistakes. Has
  difficulty sustaining attention.-Does not appear
  to listen.-Struggles to follow through on
  instructions.-Has difficulty with
  organization.-Avoids or dislikes tasks requiring
  a lot of thinking.-Loses things.-Is easily
  distracted.-Is forgetful with day to day
  activities.

39
ADHD

• Hyperactive-impulsive-Fidgets (with hands or
  feet) or squirms in chair.-Has difficulty
  remaining seated.-Runs about or climbs
  excessively in children -Difficulty
  engaging in activities quietly.-Acts as if
  driven by a motor
• -Talks excessively.-Blurts out answers before
  questions have been completed.-Difficulty
  waiting or taking turns.
• -Interrupts or intrudes upon others.
• Combined inattentive hyperactive-impulsive
  Combination of symptoms

40
Treatment, Strategies

• Education of the student, parent and teacher
  about ADHD
• Medication- if family seeks out this option
• Behavior supports- teaching children how to
  monitor their own behavior
• Social skills training
• Manipulatives (fidgets)/ movement allowed
• Agree on a small cue to help the student calm
• Minimize visual /auditory distractions

41
and what else?

• Minimize visual distraction where attention is
  required.
• Provide good listening environment for children
  with usable hearing.
• Agree on a small signal to help child remember to
  remain calm.
• Have child near you for ease of attention
  getting.
• Enlist parent help.
• Dont sweat the small stuff.

42

• AUTISM SPECTRUM DISORDER

verbal and nonverbal communication
and social interaction
43
Autism Spectrum
verbal and nonverbal communication
and social interaction

• Lacks or uses non-speech sounds
• Lacks early gestures (i.e. pointing)
• Is remote, disengaged
• Lacks interest in interaction / initiator only
• Insists on routine/prefers the familiar
• Perseverates on object/motion (i.e. spinning)
• Has limited range of interests and play
  strategies
• Has difficulty focusing on more than one sensory
  input

44
Helpful strategies

• Figure out their sensory needs
• Analyze repetitive behaviors for possible
  transfer
• Give time for transition
• Provide visual schedule, routine
• Develop and drill on communication strategies
  (choice of objects, pictures)
• Develop calming strategies
• Think of replacement behaviors
• Social Stories with pictures

45
Moving on
46

• STRATEGIES

47
STRATEGIES

• Extended time for tasks/tests
• Test item adaptations
• May need access to additional technology
• Visuals are important
• Preferential, flexible seating
• Opportunities for Success and positive
  reinforcement

48
STRATEGIES

• Structure helps (Unstructured time may be more
  challenging) Consistent routines help make the
  world more predictable.
• Break down task into smaller steps
• Allow more time and a multiple opportunities, to
  practice new skills for mastery. Practice the
  transfer of skills across school settings and
  real-life settings. Skills/behaviors may need to
  be retaught in different setting.
• Allow more Wait Time to process information and
  respond

49
STRATEGIES

• Schedules - give the student independence/control
  to know what happens next
• Schedules - classroom, individualized,
  interactive (posted schedule, desk schedule,
  carried schedule)
• Visual schedules with manipulatives/tangible
  objects, photos, symbols, drawings, words)
• Plan for upcoming Changes (mark on the
  schedule to indicate a change in routine, read a
  social story, visit new place in advance- school
  playground, or show pictures)

50
STRATEGIES

• Choice Boards (foods, toys, activities, actions)
• Video-modeling (with other models or self)
• First, then (language, charts, or pictures)
• Team approach to coordinate and integrate
  expertise. Teamwork can support the student,
  family, and staff.
•  
• Focus on Strengths and incremental steps of
  progress made

51
SUMMARY

• Alone we can do so little
• together we can do so
  much. -Helen Keller
• Every student has unique needs Its the synergy-
  the interaction and combined effect of the
  disabilities that is paramount to understanding
  the students individual needs.
• Teamwork can support the student, the family, and
  staff. Sharing resources, information, and
  insights provide a coordinated foundation.
• Look for what the students CAN do.

52

• Thank you for your time
• and attention.

53
Resources

• A-Z Index of Birth Defects, Blood Disorders
  Disabilities (follow the links for disability
  specific information) www.cdc.gov/ncbddd/sitemap
  .html
• www.aussiedeafkids.org.au/additional-needs-introdu
  ction
• Center for Disease Control (follow the links for
  disability specific information)
• www.cdc.gov
• www.cdc.gov/ncbddd/autism/facts.html

54
Resources

• Center on the Social and Emotional Foundations
  for Early Learning (follow links for free info,
  strategies, modules)
• http//csefel.vanderbilt.edu/index.html
• http//csefel.vanderbilt.edu/resources/strategies.
  htmlscriptedstories
• http//csefel.vanderbilt.edu/resources/family.html
  
• Sample Behavior Support http//csefel.vanderbilt.
  edu/modules-archive/module3b/handouts/jackson/4.pd
  f
• Summaries of Effective Practices for Supporting
  Children's Social-Emotional Development and
  Preventing Challenging Behaviors.
• http//csefel.vanderbilt.edu/resources/what_works.
  html

55
Resources

• Curriculum modification Making standards
  accessible for deaf students with disabilities by
  Holly McBride and Matthew Goedecke, Odyssey
  Spring 2012
• Diagnostic and Statistical Manual of Mental
  Disorders, Fifth Edition, (DSM-5), the American
  Psychiatric Association 2013
• Deaf Plus, Dinah Beams, M.A. Hands Voices,
  http//handsandvoices.org/comcon/articles/deafplus
  .htm
• Hands and Voices www.handsandvoices.org/
• How Does Your Engine Run? by Mary Sue Williams
  and Sherry Shellenberger Therapy Works, 1996.

56
Resources

• Including Deaf and Hard-of-Hearing Students With
  Co-occurring Disabilities in the Accommodations
  Discussion, R. H.T. Leppo, S.W. Cawthon and M. P.
  Bond,Journal of Deaf Studies and Deaf Education,
  Vol.19, Issue 2
• ISBE Disability www.isbe.net/spec-ed/html/disabili
  ty-areas.htm
• Memory skills of Deaf Learners Implications and
  applications. American Annals of the Deaf 156
  (4), Hamilton, H. (2011)
• Psychological Assessment of Children with
  Additional Disabilities (STUDY) Psychological
  Assessment of Children with Multiple Handicaps
  Who Have Hearing Loss by Robert Schum, Ph.D.,
  A.G. Bell

57
Resources

• Raisingchildren.net.au (follow links for
  disabilities)
• http//raisingchildren.net.au/learning_about_asd/l
  earning_about_autism.html
• http//raisingchildren.net.au/articles/autism_spec
  trum_disorder_encouraging_behaviour.html
• Tips and Ideas for Making Visuals to Support
  Young Children with Challenging Behavior (visual
  schedule, choice charts, first/then board,
  etc.)http//csefel.vanderbilt.edu/modules/module3b
  /handout2.pdf
• When Deafness and Autism Co-exist in Children,
  Odyssey-2008-vol9 issue1 https//www.gallaudet.edu
  /Documents/Clerc/Odyssey-2008-v9i1.pdf

58
Training and services at no cost
Contact

• Outreach Staff
• Toll Free
• Fax
• e-mail
• Like us on Facebook! Go to www.bit.ly/isdoutreach
  

• [phone]
• [phone]
• [phone]
• Curt.Kuhn_at_Illinois.gov

Illinois School for the Deaf 125
Webster Jacksonville, Illinois 62650