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Return to a Process for Identifying Students with Deafblindness (Birth-22)

As a Teacher of the Visually Impaired, you are aware of the importance of hearing for a child with a visual impairment. The Functional Vision Evaluation and the Learning Media Assessment both consider how the child uses his/her hearing for learning. Here are some things that you should try to determine through parent and staff interviews and/or the student's records. (Adapted from the Checklist for Deafblind Census of Texas)

  1. Does the student have a documented auditory impairment meeting Texas eligibility requirements as cited in the Commissioner's Rules?
  2. Does the student have a documented unilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?
  3. Does the student have a documented bilateral hearing impairment (conductive, sensorineural, or mixed) of at least 15 dB?
  4. Does the student have a documented syndrome, disease or disorder associated with hearing loss?
    • Bacterial meningitis
    • Cytomegalovirus (CMV)
    • CHARGE
    • Usher Syndrome
    • Down Syndrome
    • Microcephaly
    • Rubella
  5. Does the student have a documented syndrome/disorder associated with a progressive hearing loss?
    • Cytomegalovirus (CMV)
    • Norrie Syndrome
    • Goldenhar Syndrome
    • Hurler Syndrome
  6. Does the student have a diagnosis of a central auditory processing disorder (CAPD) by a speech language pathologist or an audiologist? May also be called central auditory processing problem, central auditory processing dysfunction, auditory neuropathy. ORDoes the family or staff report the child having difficulty understanding what he is hearing?
  7. Is the student at risk for hearing loss? Factors to alert to include:
    • Documented chronic/persistent otitis media
    • Caregivers/professionals who know the child suspect impaired hearing based on:
      • significant and otherwise unanticipated delay in receptive and/or expressive speech-language skills or
      • Responses to full range of auditory stimuli in the environment is less than anticipated
      • Ototoxic medications such as those given for cancer, serious infections, etc.
      • Prematurity
      • Balance problems
      • Family history of hearing loss

Other risk factors include:

  • Drug or alcohol consumption during pregnancy
  • APGAR scores lower than 4 at one minute and below 6 at five minutes (APGAR scores measure newborn vital signs at birth)
  • Low birth weight (below 3.5 pounds)
  • Neonatal jaundice at birth requiring transfusion
  • Craniofacial anomalies
  • Visible malformations of the head, neck or ears including middle and/or inner ear structures
  • Family history of permanent or progressive hearing loss in childhood
  • Childhood injuries (especially skull fracture, sharp blow to the head or ears, loud noise exposure, and items accidentally inserted into ears resulting in damage)

Speech and language development are impacted greatly by hearing impairment. Even mild to moderate impairment can have dramatic consequences, especially if the child also has some type of vision loss. Below are typical milestones for a child with normal hearing according to the Alexander Graham Bell Association for the Deaf and Hearing Impaired. Be sure to visit their website at for more detailed information.

Average Speech and Hearing Behavior by Age Level

Birth-3 Months

  • Startled by loud sounds
  • Soothed by caretakers' voices

3-6 Months

  • Reacts to the sound of your voice
  • Turns eyes and head in the direction of the source of sounds
  • Enjoys rattles and noisy toys

7-10 Months

  • Responds to his/her own name
  • Understands "mama," "dada," "no," "bye bye" and other common words
  • Turns head toward familiar sounds, even when he/she cannot see what is happening: e.g., dog barking or paper rustling, familiar footsteps, telephone, person's voice

11-15 Months

  • Imitates and matches sounds with own speech production (though frequently unintelligible), especially in response to human voices or loud noises
  • Locates or points to familiar objects when asked
  • Understands words by making appropriate responses or behavior: "Where's the dog?" "Find the truck."

15-18 Months

  • Identifies things in response to questions, such as parts of the body
  • Uses a few single words; while not complete or perfectly pronounced, the words should be clearly meaningful
  • Follows simple spoken directions

2 Years

  • Understands yes/no questions
  • Uses everyday words heard at home or at daycare/school
  • Enjoys being read to and shown pictures in books; points out pictures upon request
  • Interested in radio/television as shown by word or action
  • Puts words together to make simple sentences, although they are not complete or grammatically correct: "Juice all gone" "Go bye-bye car"
  • Follows simple commands without visual clues from the speaker: "Bring me that ball." "Get your book and give it to Daddy."

2 ½ Years

  • Says or sings short rhymes and songs; enjoys music
  • Vocabulary approximately 270 words
  • Investigates noises or tells others when interesting sounds are heard: Car door slamming, Telephone ringing

3 Years

  • Understands and uses simple verbs, pronouns and adjectives: Go, come, run, sing, me, you, him, her, big, green, sweet
  • Locates the source of a sound automatically
  • Often uses complete sentences
  • Vocabulary approximately 1000 words

4 Years

  • Gives connected account of some recent experiences
  • Can carry out a sequence of two simple directions: "Find your shoe and bring it here." "Get the ball and throw it to the dog."

5 Years

  • Speech should be intelligible, although some sounds may still be mispronouncedsuch as the /s/ sound, particularly in blends with other consonants (e.g., "street", "sleep", "ask").
  • Neighbors and people outside the family can understand most of what your child says and her grammatical patterns should match theirs most of the time.
  • Child carries on conversations, although vocabulary may be limited
  • Pronouns should be used correctly: "I" instead of "me" "He" instead of "him"