D/HH Plus: Supporting
the Whole Child


By Dinah Beams, Colorado School for the Deaf and the Blind
CO Hands & Voices Board Member

As I read the article “Plus Means Positive” by Christine Moody in the Spring 2011 edition of The Hands & Voices Communicator, Iwas moved, inspired, encouraged, and motivated as a professional working with families with young children who are deaf/hard of hearing and have other challenges. 

“It is of little help to parents or professionals to use an assessment that merely points out what a child cannot do. “
The term “deaf plus” is a reference to the child’s hearing loss combined with other conditions. The need is great; according to the Gallaudet Research Institute (November 2008) school districts reported that approximately 40% of the students nationwide have a condition in addition to deafness. These issues are varied including: vision, developmental delay, specific learning disability, motor issues, ADD/ADHD, cognitive, emotional, and autism spectrum disorders. One area of development impacts another which often makes it difficult to tease out exactly what is happening for the child and how learning is being impacted. For example, speech perception skills may be further impacted by cognitive delays or sign development may be impacted by motor issues. It may be a challenge to measure auditory skills with behavioral testing due to motor or vision issues.  Expressive language development may be impacted by motor or cognitive skills. In other words, nothing stands alone!

All issues are not diagnosed at the same time; some issues impacting a child’s progress and learning may not yet be diagnosed, but this in no way diminishes their impact. The presence of hearing loss may make it more difficult to diagnosis other disabilities.  Conversely, other conditions might mask the hearing loss, particularly if these other conditions are also associated with communication and language delays. Less severe challenges are often diagnosed later, with attention being focused early on those that are more obvious. 

Often it is difficult to secure the accurate assessment data that is needed to set appropriate goals for a child because the assessment instruments commonly used may not be appropriate for this population. It is of little help to parents or professionals to use an assessment that merely points out what a child cannot do. In order to set appropriate goals, we must have an accurate way to measure a child’s current progress and skill set.   If expectations are too low we will not see the progress desired. Conversely if expectations are too high, it will contribute to a sense of failure and frustration, and the child’s progress may not be recognized or honored. We must always acknowledge the skills a child has and build on those skills. Several years ago a mother of a three year old girl said to me, “You are the first professional who has said anything positive about my child.” This was a heartbreaking statement as this beautiful little girl, although significantly impacted, had many wonderful communication skills that had not been recognized and supported by the professionals working with her. “Deaf Plus” was definitely an accurate description for this little person.       

Often, as parents or professionals, we are working on the right skill in the wrong way.  The child may not be motivated to learn because we are not approaching things in an interesting way. Find out what motivates your child and go with it! Recently I was with a little girl whose motor therapist had been working on a particular skill for many months.  This child was not making progress with this skill. During a hospital stay, her aunt brought her I-Pod to the hospital. This little one was so intrigued with this technology that she quickly began to use her fine motor skills in new ways. Mom bought her an I-Pod for her birthday and within two weeks she had mastered, and moved beyond, the skills her motor therapist had been working on for months.  I was amazed at everything this child could do with the I-Pod. She had even learned to use it to initiate conversation by quickly pulling up different pictures to clue others in on what she wanted to talk about. The right activity can be a powerful motivator!

Collaborative teaming by professionals working with a child who is d/hh plus is crucial.

Each of the professionals brings expertise in a particular area to the table, but unless they work together the outcomes will likely be less than desired. Years ago one mother of a young boy who had combined vision and hearing loss with cognitive and motor delays reminded me of this truth when she said, “It seems everyone only looks at their piece of my son.” Professionals need to be willing to learn from each other as they value the importance of viewing the whole child. Professionals can co-treat or do joint visits in order to learn from each other. Perhaps a child needs to be positioned differently (the motor therapist has this knowledge) in order to be supported for learning. If a child has vision issues, knowledge of his visual field (learned from the Teacher of the Visually Impaired) is critical to meeting his communication needs. The possible examples of the way these issues impact each other go on and on. There needs to be an understanding of how the different special needs of the child combine to impact communication, play, social, and self-help skills.

Every child communicates; it is our responsibility as professionals and family members to determine how a child is communicating, to honor that communication, and to build on it.  Approach each child with his uniqueness in mind, affirming the skills he possesses and supporting his acquisition of new skills. Be prepared to let the child teach and lead you.  And be ready to be surprised!

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