I have not updated my blog in several weeks because my life has been absorbed by my job and my new personal experience of being on the other side of the table going through my husband's cochlear implant process. This is the time of year I call "IEP Season" as there are several meetings every single week for about 3-4 months. It started in November with 7 meetings; December's count was 6; 13 in January; and 16 in February. So far there are 7 on the calendar for March. In between all those meetings, I attended the ASHA convention in Philadelphia, observed Thanksgiving and Christmas break, attended several appointments regarding my husband's cochlear implant, did not report to school for 4 full snow days and 4 half snow days, and there were other school closings due to federal holidays and a furlough day. On top of the meetings, I have completed speech/language assessments on 15 students as a part of their re-evaluation for their IEP. There were several weeks I was unable to complete any therapy sessions and I have spent many nights and weekends of my personal time writing reports, preparing for IEP meetings, and documenting what I have been doing. It's been exhausting! This season has been a little eye-opening for me compared to previous years.
As I mentioned before, I work in an elementary school with a Deaf and hard-of-hearing program. This year, my students range from kindergarten to 6th grade with a wide range of communication abilities. All the students have some sort of amplification whether it be a cochlear implant(s), behind-the-ear hearing aids, or a bone conduction hearing aid headband. In theory, as a speech-language pathologist who works with Deaf educators who have training on language development, my time with the students should focus on spoken language....speech articulation. When I first started working in the program, I noticed this to be quite difficult since the students all have severe language delays. Most are either unable to read or read severely behind grade level. I think the highest reader we have reads somewhere around the 2nd or 3rd grade level, but most are not at that level. All the work I do with the students must involve pictures for this reason. Some of the students have goals of producing certain sounds at the phrase or sentence level, but they do not have the language to create their own expressions containing target sounds and they are unable to read written sentences. This means that I must provide a model for each and every trial. How effective is that therapy? How much carryover or generalization is happening?
For this reason, the students not only get speech articulation goals on their IEPs, but most have receptive language and/or expressive language goals. I work with the students to help build vocabulary regarding categories, comparisons, answering questions, and during sessions where I emphasize Visual Phonics and all vocabulary for that session starts with the same sound, among other activities. In addition, this school year, I have taken the initiative to incorporate a grammar session into whole group sessions once weekly co-taught by the teacher for the Deaf and hard-of-hearing as I have noticed that all the students' writing skills are atrocious! If you can get them to spell words and put their thoughts on paper, most of the sentences contain words in random order with no function words, incorrect verb use, no punctuation, and the written productions may or may not be associated to the topic.
So, what I'm saying is that not only do the children struggle with speaking their thoughts orally, but all of them have language delays when they attempt to communicate those ideas in writing or through sign. Of all the students I work with, less than a handful lack the cognitive ability to learn communication skills that are age appropriate. Why is it that these children...all of these children have communication delays not to mention that not a single one of them is on grade-level for their academic content areas? With these children being identified at an earlier age, intervention starting at an earlier age, and with technology at the level it is today, who can explain this?
My personal thoughts are that we as a program have the priorities messed up! When students come to our program, a "selling point" to the parents is that their child will be exposed to spoken language AND sign language (if they join the total communication classes) simultaneously and that we have the resources to help the child learn to speak and be "normal". We will be pulling the child out of class to attend speech articulation sessions; in turn, the child will miss some part of the academic curriculum to attend these sessions. But the parents believe this is more important, so they approve. This pattern will result in delays in academic knowledge and skills, but that's worth the sacrifice to have the child speaking. On top of these delays, someone somewhere has convinced the parents that the child will learn to speak and lipread so learning sign language and using a visual mode of communication with the child would negatively affect that process. Either that, or no one has emphasized the importance of language to be able to speak and that even with amplification the child is still Deaf or hard-of-hearing and will not be able to pick up on language in the same manner as a hearing child. My personal question to the parents....what does it matter how beautifully a person can talk if they have nothing worth saying??
During the assessments I have done recently, there have been a few that have provided me with shocking results...two that really stick out. The first one was a student who is identified with "hearing impairment". For those of you that are not involved with the Deaf community, this is a very outdated term that is not preferred to be used. Others may call this student "hard-of-hearing", but for whatever reason, Maryland State Department of Education calls children with less than a profound hearing loss to be hearing impaired because they are not audiologically deaf. This student was identified "late" when he was in preschool then started in an auditory-oral classroom based on his "hearing impairment" status....meaning he wasn't "deaf enough" to be placed in the classroom that use a visual mode of communication. He stayed in this setting for kindergarten (twice), then the IEP team finally decided to try out the total communication class as he wasn't making significant progress. He is now in 2nd grade and I assessed his spoken language, ASL development, and several domains within receptive and expressive language. Across the board he is significantly delayed, functioning around the 3-4 year old level as a chronological 8 year old. Cognitive testing showed average to above average ability. Hmmm. Next, the other student is a Deaf girl in the 5th grade. She was born with bilateral profound hearing loss and received her cochlear implant when she was 2 years old. She has developed beautiful spoken language skills over the years, but with working with her I have noticed her grammar, written and spoken, to be awful and she is unable to answer basic 'wh' questions with appropriate responses. When she was younger, she received her education within a general education classroom with the use of FM, but she got so far behind that she now receives all instruction within self-contained classes with teachers for the Deaf and hard-of hearing. I gave her every test I could think of to try and find something where she performs within the average range for her age. At the IEP meeting where the results from all testing was presented to the parents, every single assessment (including cognitive) pointed to delays due to language skills. She is an 11 year old functioning at about the 5-6 year old level with regards to language skills. She is expected to complete 5th grade level curriculum with the language skills of a kindergartener and we wonder why she isn't passing state testing??
I attend somewhere around 70-80 IEP meetings each school year and every single one comes down to the same thing....the child is below grade level due to delays in language skills. With this information, why is it that speech skills are still so emphasized and language skills aren't? Our program comes up with money to pay for new ear molds and audiological testing when parents can't afford it, as well as the bank of loaner hearing aids we offer to students to guarantee they have amplification during school hours. But, what about money for sign language courses? Is it that the higher-ups don't understand the importance of language development or that it's not as socially acceptable to use signs as compared to speaking? Are we as a program audists? When I make suggestions about trying new things based on evidence from researchers or suggesting different strategies to the parents, I am told not my ideas don't coordinate with "our philosophy". Well, I got news for you...."our philosophy" isn't successful. Every single student has academic and communication delays. To me, that is the definition of failure. What have we achieved by doing this?
It's a lot to think about and digest. Am I really doing the right thing when the research shows otherwise? And from my own experience I see this isn't working. It's hard to swim upstream every day and see the the children are the ones who are suffering because of some philosophy that was set who knows when or whatever reason.
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