Because of the rapid changes in the world of hearing loss, parents of children with a hearing loss need a reliable guide to maneuver through the technological and educational pitfalls. This book reflects the new reality facing parents today: early detection, sophisticated amplification whether by hearing aid or implant, and integrated school placement. Chapter 1 on the emotions of hearing loss and chapter 2 on the impact of hearing loss on the family are not much impacted by the new realities. The diagnosis of hearing loss will still have a profound emotional impact in most families and the entire family system will be affected. These chapters represent my forty years of working closely with families of newly diagnosed hearing-impaired children. While the technology has changed and the outlook for the child with a hearing loss is so much brighter, the impact that the diagnosis has on the emotional response and on many of the family dynamics has not changed.

Since most hard-of-hearing children will currently be educated within an integrated school system, Chapter 3 provides information about the changes needed within the classroom to give a child with hearing loss maximum opportunity to succeed. Both school personnel and parents should be able to read this chapter with profit. It is written by Karen Anderson, PhD of the Florida Department of Health. Chapter 4 will provide you with information needed to negotiate the complex legislation supporting parental rights in the educational and diagnostic system. This chapter also provides information on resources. It is written by Cheryl DeConde Johnson, EdD, of the Colorado Department of Education. Chapter 5 on hearing aids and cochlear implants will provide you with up-to-date information on current amplification technology for the child. It is written by Linda Thibodeau, PhD of the University of Texas.

With the advent of the new century, technology has created an axial change in education of the child with a hearing loss. Cochlear implants and neonatal screening have catapulted the child with a hearing loss into the auditory/verbal camp. The auditory-verbal approach teaches a child to use available aural information without encouraging a visual orientation.

Children are taught to listen and in extreme instances are actively discouraged from “looking.” Because of both auditory-based therapy and the advancing technology, the difference between deaf and hard-of-hearing is rapidly blurring. Cochlear implants can now give many children (with a severe to profound loss) hearing that is in the mild to moderate category.

Previously we could not help these children with amplification because their loss was too severe. Coupled with early detection these “implanted” children function as hard-of-hearing. It is rapidly becoming feasible that deafness in a child will, in most cases, be a function of the choice of the parents or of poor clinical management.

We’re now able to detect hearing loss in infants at birth and provide sophisticated amplification in the form of digital hearing aids. If these are not sufficient then the child is fitted with a cochlear implant. The current service model in many communities bypasses segregated schools for children with hearing loss entirely. Referrals from diagnostic centers are increasing for auditory/verbal therapists working in early intervention centers. The ultimate goal is to mainstream hard-of-hearing children in regular public schools. Schools for children with hearing loss are becoming increasingly repositories for—

• the deaf child of deaf parents who choose not to implant their children;
• the multiply handicapped;
• and the disadvantaged child with a hearing loss.

Advantaged hard-of-hearing children no matter how severe their hearing loss are appearing in increasing numbers in public school programs. Many of these children have intelligible speech and grade-appropriate academic skills. It seems that if we can intelligently apply all that we currently know and use the available technology well, we have at hand all the necessary tools to mitigate the negative educational consequences of severe to profound hearing loss. This is an incredibly exciting time

The technologies are in some respects a double-edge sword—they provide the means to get the children into a school with normal hearing children where they can be competitive. These children, however, despite their good speech and language skills, still have a hearing loss and there will be many instances during a school day when they will not respond like a normal hearing child. Many of them are also the only such child within their school and they often experience social isolation. We all need community and if the orally successful child cannot find it within the school context, he or she will seek it elsewhere. We must give these children with hearing loss in integrated settings roots within their social context.

Professionals and parents need to work together to provide support groups and social outlets for children who are integrating with normal hearing children. This will allow them to know they are not the only one facing these challenges. Support from a child’s peer group can often be the most important influence.

What of the future? It looks incredibly bright. Binaural implants are already here and fully implanted devices are coming shortly. I think we’ll be implanting at increasingly younger ages and with children who are now classified as mildly to moderately hard-of-hearing. I think the surgery will be routine, as they are now doing on an outpatient basis in many surgical centers. It’s possible and even likely that implants will become the dominant form of amplification for people with hearing loss. I think there will still be small pockets of the culturally deaf who will be on the margins. Until we get the mainstreaming model fully operational we will go through periodic cycles whereby the deaf community and the romance of sign language is rediscovered by adolescents with hearing loss. I think some time in this century we will have a cure for sensorineural deafness. I have faith that stem cell research will ultimately be able to regrow damaged hair cells.

Despite all our current challenges, I think this is a wonderful time to have been professionally active in early childhood hearing loss. We professionals have seen us move from bleak prognosis to hopeful outcomes, from restricted vocational opportunities to almost unlimited ones, from poor academic skills to grade-appropriate, and from unintelligible speech to normal or near-normal speech intelligibility. I think congenitally hard-of-hearing children will have the choice of being included both within the cultural mainstream and the hard-of-hearing community. Hopefully, they will be able to move seamlessly between both worlds. The contributors and I feel privileged to have been a part of this true revolution and blessed to be living in such interesting times.