Audiology in the Classrooms: Getting Students Ready for “Back to School”
It’s that time of year again, September and the start of a new school year. For all students, this means a new grade, new teachers, some new classmates and sometimes even a new school. For students with hearing loss and their parents, though, come the additional uncertainties of worrying whether the teaching staff understand the challenges of hearing loss, are familiar and on-board with all of the recommendations in the student’s Individual Education Plan (IEP) and whether the teachers will be enthusiastic about using hearing technology for the first time. This month’s column will talk about some of the skills and plans needed across the grade levels for students to have their best chance for success at school.
Most Important for Every Student: Getting An Updated Audiological Assessment
Summer is the perfect time for parents to book audiological assessments to ensure that an up to date audiogram in in place, that there are no worrisome changes to hearing, that hearing technology is working properly and that earmolds fit well. For educational audiologists and teachers of the deaf/hard of hearing, having an updated audiological assessment is crucial both for planning, writing and updating IEPs, but sometimes also because a clinical report is required to access special services or funding (such as for Hearing Assistance Technology). Most clinical audiologists are extremely conscientious about sending reports to the school or to the Hearing Department, but it does happen that a secretary receives a report, files it in the student’s Ontario Student Record and does not think to notify the Hearing Department. Giving parents their own copy of the student’s report is an excellent strategy to ensure that even if a report has gone missing, the Hearing Department and school staff can access it.
It sometimes happens that a student arrives at a new school in September with a 4-year-old audiogram, earmolds that do not fit well anymore, and hearing aids which are not compatible with Hearing Assistance Technology. Unfortunately, it can take weeks (during one of the most crucial transitional times of the academic year) to sort everything out and put all of the necessary supports in place. This can also happen if students receive new hearing aids that are not compatible with the HAT that was purchased for them. Good communication between audiology clinics and schools is imperative. We all want students to hit the ground running in September, audiologically speaking.
It is also important to understand how the academic and listening demands change across the grade levels, necessitating different kinds of counselling and education for parents and students.
Primary Grades (Kindergarten to Grade 3)
The primary grades (particularly kindergarten) follow a curriculum which is developmental, exploratory and play-based in nature. With these more dynamic and authentic learning activities, however, generally come higher noise levels. The introduction of full-day kindergarten to Ontario, for example, has resulted in class sizes of up to 30 students (aged 3 to 5 years), and with one classroom teacher, one early childhood educator and usually one educational assistant. This means that young students (perhaps with oral language and/or articulation difficulties) are interacting with multiple adults and peers, under very difficult listening conditions, for a full school day. Parents and caregivers are often surprised by how exhausted and cranky their kindergarten-age students are when they get home, but considering the noise levels and listening demands of kindergarten, it makes sense. Building in quiet “down time” after school doing things that are not high-demand listening activities (such as colouring at the kitchen table, or riding their bike in the driveway) can be extremely helpful.
Grades one to three generally mean smaller class sizes and somewhat lower noise levels, but are still very dynamic and interactive places and “preferential seating” is a moving target, not a single chair. It can also be a time when a great deal of educational assessment happens, as additional learning challenges start to become evident, and as school staff explore strategies and educational placements that best meet the student’s learning needs; interacting with school professionals such as psychologists, occupational therapists or social workers might be a new and perhaps intimidating experience for parents.
The primary grades are generally the first time that parents encounter Hearing Assistance Technology. It can be very helpful for clinical audiologists to provide some advance information about the need for Hearing Assistance Technology, and to ensure that the student’s own hearing technology allows for a variety of HAT options, without necessarily indicating a particular brand or model. We need to be extremely flexible in considering HAT at the primary grades, since very young students are often not good reporters of sound quality, and managing 30 kindergarten students can leave classroom teachers with very little time to manage complicated HAT solutions.
Sometimes we implement a particular type of HAT for kindergarten using a system on loan, and then change to a different system in grade one or two, based on the changing needs of the student and the classroom learning environment. As well as adjusting to HAT, it is crucial for students (even at this young age) to begin to acquire hearing technology management skills such as taking out and replacing their own earmolds, and (for older students), changing their own batteries. Most educational audiologists and teachers of the deaf/hard of hearing can tell of the frustration of trying to fit a personal HAT system on a grade 2 child (necessitating taking the hearing aids off to put audio shoes and receivers on), only to find that the student is used to his/her mother putting the hearing aids in every morning and doesn’t know how to do this independently.
Junior Grades (Grades 4 to 6)
The difficulty of the transition from grade 3 to grade 4 often surprises parents; however, in terms of education, it is the transition between “learning to read”, to “reading to learn”. Teachers are no longer teaching students how to read by grade 4, although of course they continue to work on helping students improve their reading skills. The assumption is that students have all of the basic decoding and comprehension skills under their belts by grade 4 and therefore, that a teacher can give students something like a worksheet and have them complete it independently. Grade 4 is often where academic difficulties suddenly appear when actually, difficulties with language and early literacy have meant that the foundational skills for learning were not laid down in the earlier years. We need to be vigilant about continuing to monitor even students who appear to be doing well, so that we do not wait until academic difficulties have become a serious problem before intervening.
We also hope that students are continuing to develop HAT management and troubleshooting skills (for example, being responsible for charging the transmitter every night). We would expect them to be able to manage their own hearing technology independently by this age, including reporting to the teacher when something is not working. In the junior grades, students still have primarily one teacher for most subjects, so it is easier for this teacher to work on self-advocacy and self-management skills than in middle or high school, when students have many classroom teachers. In my own experience, it is very rare to encounter students who can read their own audiogram and understand what it means for them – this is something that educational audiologists and teachers of the deaf/hard of hearing often include as part of the IEP. It is crucial for students to understand their own hearing loss and their technology, but this sometimes gets overlooked because parents do not have the knowledge to explain audiograms and hearing loss and students may not feel comfortable asking their clinical audiologist to teach them during busy appointments.
Intermediate Grades (Grades 7 and 8)
In grades 7 and 8 (sometimes called middle school, senior elementary or junior high school), students begin to experience a rotary system for most subjects. While teachers continue to support students in developing self-advocacy and organizational skills, there are increasing expectations that students will manage an agenda, keep track of their assignments, and manage their own homework. This can be challenging for a student with hearing loss who also may have academic and/or language weaknesses.
One of the most challenging aspects of middle school, however, is managing Hearing Assistive Technology. For a student who has used a sound field amplification system in elementary school, this option is no longer practical for middle school and so we need to think about transitioning this student to a personal HAT system before middle school, not always a popular choice for students at this age. Even if students have been using personal HATs all along, the requirement to carry the transmitter from teacher to teacher all day is a new challenge, and not always something that students are eager to do.
Secondary Grades (Grades 9 to 12)
Grade 9 is a whole new world for all students, and for those with hearing loss, it brings the added challenge of up to 8 different teachers with 8 different voices, teaching styles and expectations. Secondary students are often extremely reluctant (and not infrequently, downright refuse) to continue using their Hearing Assistive Technology. While they often don’t object to the receiver portion (particularly if it is an integrated receiver or a loop receiver that can be worn under clothes), they object very much to having to carry the transmitter from class to class, deliver it to each teacher, then pick it up to take to the next class. There is often nowhere to charge the system; the solution is often to leave the system in the resource room overnight, but students often feel embarrassed to be seen visiting the “special ed” room. Social interactions and relationships become more and more important, and this can be an area of difficulty for students with hearing loss.
Colleges and universities will have an office which provides support services for students with disabilities but the type, level, and consistency of services can vary tremendously across institutions. Ideally, students entering college or university would have already contacted the office for persons with disabilities at their institution but if not, they need to do this ASAP. It is not uncommon for students to either assume that the support services they received in secondary school (an itinerant teacher, Hearing Assistance Technology, accommodations, etc.) will automatically follow them to postsecondary education OR assume that they will be fine without any supports and will go and find them later if needed. The volume of other students with disabilities also trying to access support services in October at mid-term time when they are drowning academically, makes it much more difficult to put accommodations in place quickly. Students need to locate and meet with the disabilities services office sooner rather than later, with a copy of a recent audiogram, as well as some general knowledge of what support services they are requesting. It is not unusual for the staff of the disability services office to automatically assume that any student with a hearing loss needs an ASL interpreter, and to be uninformed about more appropriate technology such as real time captioning or assistive listening devices.
Typically (in Ontario at least), the office either does not have any assistive devices to loan a student or, if they do, it is an old and out of date system. In Ontario, if students qualify for OSAP (Ontario Student Aid Program), they can access a bursary that provides funds with which they can purchase their own technology. For students who do not qualify for government funding for tuition, it can be much more difficult to access assistive devices, so starting early is always better. The process for accessing all services will be quicker if students have all of the necessary documentation and information at their fingertips, rather than having to track down records, or wait for an appointment.
We want the process of going back to school in September to be fun and exciting, a new adventure with new possibilities and we can increase the chances that this experience will be positive, rather than scary and intimidating, by working together and thinking ahead.