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Observing to identify children who are deafblind

We cannot begin to assist a child, his/her family and educational team unless we identify that he/she has a combination of vision and hearing impairments. Sometimes this is easy to do, but more often, many children who are deafblind are not ’obvious’ at first glance. Definitely, no child who is deafblind can be thought of as ’typical.’

  1. Overview: The very term ’deafblind’ is misleading - but we continue to use it for want of a better word or combination of words (e.g., dual sensory impaired, deaf-and-blind, d/hh and blind/v.i. etc). There are very few children who are profoundly deaf and who have no usable vision. But when many people hear this term, that is what they think. And if a child wears spectacles and/or a hearing aid (or cochlear implant), the assumption is often that vision and/or hearing are corrected to ’normal’ or near normal!

    • Each child has a different level of vision and hearing, some with mild levels of sensory loss, some more severe. Some children have better vision than hearing; others, better hearing than vision.

    • Children who have mild sensory losses are often the ones that ’fall between the cracks’ because they may not qualify for the services of a vision specialist and/or a hearing specialist. Each mild sensory loss, looked at separately may not appear to be a barrier to learning, however, the combination of BOTH distance sensory losses, even mild losses, will usually impact a child.

    • We need to remember that if a child has a vision loss, hearing will usually compensate; and if there is a hearing loss, vision will compensate. When neither sense can adequately compensate for the other because they are BOTH affected, the child’s learning and day to day life, will be impacted.

    • Some children who have sensory losses appear to have more vision and/or hearing than they actually have because they accommodate so well. In fact, many children with sensory losses, especially children who are born with them, do not even know what they are not seeing or not hearing. They may think that everyone else sees and hears what they see and hear. So if asked ’Can you see the board?’, a child may say, ’Yes’ - because he does. What we may not realize is that he sees very little of what is actually ON the board! Again, the child may think that is what everyone in the class sees too.
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Simulation activities to experience how a "mild" dual loss of vision and hearing may feel.

  1. Brain-related Vision and Hearing Issues: Certain children may have eyes and ears that work well, but their eye-brain and ear-brain connections cause perceptual confusion. That is, they may not understand what they see or hear - or it takes them time to figure things out. There may be a lapse of time before they respond, and the response may not even be appropriate. These children may function as though they are deafblind. The conditions documented may be cortical visual impairment, auditory neuropathy (dyssynchrony), or (central) auditory processing disorder. Each of these conditions can exist in addition to vision issues related to the eye, and hearing issues related to the ear. In fact, sometimes they may be the only conditions that can be documented. Note: often, these brain-related vision and hearing issues may not be documented, especially in a child with multiple severe disabilities. This is why it is a good idea to conduct a FUNCTIONAL VISION and FUNCTIONAL HEARING ASSESSMENT for each child and document the information from those. A large part of functional assessments are based on good observational skills.
    Note: Orientation and Mobility instructors train their students to organize auditory information and may be able to help with observations relating to APD and a child’s listening skills.

Handout: Oregon Deafblind Project Child Registration Form. See sections on vision, hearing.

(Central) Auditory Processing Disorder (APD)

Auditory processing can be defined as "What we do with what we hear" (Katz, 1992 in Stecker, 1998). Musiek describes the integrity of auditory processing as ’ How well the ear talks to the brain and how well the brain understands what the ear tells it.’ Some examples of the skills this process provides include:

  • Identifying sounds, voices - knowing to what or whom they belong
  • Locating sounds -- Giving information on where a sound is coming from and which side
  • Discriminating between sounds
  • Recognizing sound patterns (e.g. tunes we know, the sound of a name, Dad’s truck pulling up)
  • Putting sounds in correct order (sequencing)
  • Knowing which sound is closer when there are numerous sounds simultaneously presented
  • Remembering sounds from the past and pairing or comparing them to sounds in the present

When these functions are affected, a child is said to have a (central) auditory processing disorder.

’Children with Attention Deficit/Hyperactivity Disorder manifest behaviors strikingly similar to children with Auditory Processing Disorder’ (Keller and Tillery, 2002). Although some evidence suggests that APD and ADHD reflect a single developmental disorder, recent research studies have shown that APD and ADHD have distinctly different diagnostic profiles (Musiek & Chermak, 1997). Two behavioral phenomena are common to both conditions: 1) inattention and 2) distractibility. Whereas ADHD is described as an output disorder that involves the inability to control behavior, APD is considered to be an input disorder that impedes selective and divided auditory attention (Chermak, Hall & Musiek, 1998-1999 in Young, s.d.; Musiek & Chermak, 1997). Further, inattention and/or distractibility tend to be symptoms at the top of the list for ADHD and further down on the list for APD.

Information derived and adapted from: Building the Link between Hearing, Understanding and learning. APD in children (EduLink)

Auditory Neuropathy (AN) Resources

Auditory Neuropathy?
National Institute on Deafness and Other Communication Disorders (NIDCD)
AN is a hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired. It can affect people of all ages, from infancy through adulthood. People with AN may have normal hearing, or hearing loss ranging from mild to severe; they always have poor speech-perception abilities, meaning they have trouble understanding speech clearly. Often, speech perception is worse than would be predicted by the degree of hearing loss. For example, a person with AN may be able to hear sounds, but would still have difficulty recognizing spoken words. Sounds may fade in and out for these individuals and seem out of sync.

Auditory Neuropathy Information
(This site was designed and set up by the parent of a child with AN).
Auditory Neuropathy, referred to as AN, is a confusing diagnosis that has spared conflict among professionals in the field of audiology. Because AN is not a typical hearing loss it is misunderstood by many audiologists, speech language pathologists, and teachers of the deaf. Within this site, click on ’AN: A Simple Explanation’ in the contents ruler on the left of the site.

This site has computer simulations of AN (see #2. Acoustic Simulations of Auditory Neuropathy).

My Baby’s Hearing: Causes of Hearing Loss:
This site points out that cochlear implants may help with AN

Medical site on auditory neuropathy.

Auditory Neuropathy:
Wikipedia on Auditory Neuropathy

  1. Children with additional challenges: In addition to being deafblind, many children may have additional challenges, for example, with movement (orthopedic impairment), with thinking and problem solving (cognitive impairment), with other diagnosed conditions (autism, traumatic brain injury, other health impairments). So, two children who may have the same etiology/diagnosis (e.g., CHARGE syndrome, Cytomegalovirus or CMV) may be very different. In fact, the group of children who are deafblind is so varied and so complex that often individual children are identified as being multi-disabled or other health impaired (or another category), rather than deafblind/multi-disabled, deafblind/other health impaired and so on. Very few children have vision and hearing loss without other challenging conditions. Usher Syndrome is an example of this.

Handout: Oregon Deafblind Project Child Registration Form. See sections on etiologies, other disabilities

Handout: Functional Vision and Functional Hearing checklists/question forms

When observing this complex group of children, we need to remember that vision and hearing are our two most prominent senses and that these two senses help us learn 90% of what we learn. They are our "distance" senses - that is, we can acquire information without having to be in contact with things via these two senses. In effect, the world stretches out as far as our eyes and ears can see and hear! Imagine if we could not use these two senses, or if they were inefficient and/or produced distorted images or sounds! We would have to revert to depending on our other senses, which are "contact" senses. Essentially, this would make our world a MUCH smaller place, one that is virtually "within arms reach." This is a challenge, especially when reduced vision and hearing occur in addition to other conditions!

When a child who has vision and hearing disabilities also has additional challenges, we need to pay attention to the vision and hearing. If the child has a medical condition that is life-threatening and is in no position to learn, the situation would be different. However, children who are "medically fragile" and are not constantly being provided with medical interventions also have the innate desire to learn and to communicate with people around them. Their deafblindness will become a barrier to doing this unless people around them (including those providing medical care) realize that these children (a) are "deafblind" and (b) can and will learn - IF they are provided with appropriate strategies to access people and the world around them.

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Western Oregon University | The Research Institute | The Oregon Deafblind Project

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The Oregon Deafblind Project is funded through grant award # H326T130008, OSEP CFDA 84.326T, U.S. Department of Education, Office of Special Education (OSEP), OSEP Project Officer: Susan Weigert.

However, the contents of this site does not necessarily represent the policy of the US Department of Education, and no assumption of endorsement by the Federal government should be made.

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