Maximising Progress for hearing impaired students with additional language impairments
The CRIDE survey of 2015 reported that 21% of deaf children have additional SEN. These figures are similar to those from the Department for Education (DfE) School Census which show that, for pupils with deafness as a primary need, 26% have a secondary special educational need. The DfE identifies these additional needs to be commonly speech, language and communication difficulties. This presents a challenge for educators of hearing impaired children. Additional language impairment or processing disorders can be difficult to diagnose and present such a barrier to learning that delivering academic outcomes in line with the young person’s underlying non-verbal cognitive ability can be difficult to achieve.
This article, by our Head Teacher Ann Bradbury, hopes to offer colleagues working with deaf pupils with additional language difficulties some ideas about support programmes that are effective in achieving better educational and employability outcomes for these young people.
Case study 1: Joe
Joe came to St John’s in year 9. Joe is profoundly deaf and his hearing loss had been identified around his first birthday. He was fitted with hearing aids at 14 months and received a cochlear implant at 4 years, 4 months.
Joe had attended a mainstream secondary school with 1:1 support in 90% of lessons, only working independently in practical PE sessions. Joe was withdrawn from history, music, MFL and RE for tutoring in literacy and maths and had fortnightly visits from a speech and language therapist.
At the end of year 8, Joe’s reading age was significantly below 6 years 3 months on the Edinburgh Reading test. He knew the letters of the alphabet to ‘h’ but couldn’t sequence lower case letters beyond ‘e’. In both the BPVS and TROG assessments he scored below the first centile.
Joe’s liaison teacher for hearing impairment was increasingly concerned that,even with these very high levels of support, Joe’s educational trajectory indicated he would leave school with few or no formal qualifications and his high levels of anxiety and social isolation at school were also a concern. Further testing by a specialist speech therapist identified that Joe had additional language processing difficulties and weak auditory memory.
Joe’s parents were keen for a specialist placement and were becoming increasingly stressed as they considered how limited Joe’s employment prospects might be after year 11.
Joe’s curriculum at St John’s concentrated on intensive structured language teaching rather than maximum exposure to the language used in an instructional context by mainstream teachers. He had a daily individual language session for 30 minutes with a teacher of hearing impaired students who has additional training in dyslexia.
Joe was specifically taught the phonemes of English and, in each session, systematically practised the reading of letter patterns. For this kind of approach St John’s teachers have found the Active Literacy Kit, developed by Dyslexia Action, has a positive impact on reading and spelling in a short time. It can be used individually or in small groups and the timed activities are enjoyable for students who find that the systematic approach reduces their confusion and anxiety.
Although developing Joe’s reading skills at a word level was important, he also needed to improve the structure of his language at sentence level. For some years at St John’s we have used a shape coding system to support pupils’ writing. This concentrates on SVO sentences with a particular emphasis on teaching common regular and irregular verbs, ensuring they show subject-agreement and correct tense. Improving the accuracy of verb usage has a very strong effect in making pupils’ writing more easily understood.
As well as a specific literacy programme, Joe had two 20 minute individual sessions of speech therapy with a specialist therapist for hearing impaired pupils plus a weekly group therapy session. The focus included improving Joe’s understanding of non-literal language and developing a range of strategies to repair communication breakdown.
These interventions were reviewed half termly to evaluate Joe’s progress and continued throughout his secondary schooling and, with some adaptations, into the sixth form. In summary, Joe’s whole curriculum had a sharp linguistic focus. He revisited and overlearned skills and also importantly tried and tested his own hypotheses for reading and writing English without the prompting that had previously made him overly reliant on 1:1 support.
The most noticeable improvement over Joe’s first two years at St John’s was a much greater engagement with education and a growing confidence in his ability to make himself understood. Ironically, a significant contribution to this was made by the skills learned on his drama course which, at the time, was definitely not his favourite subject. At his previous school, Joe’s curriculum had been so narrow that he had had few opportunities to develop his problem solving or creative skills and, because of his hearing impairment, was withdrawn from group work and the opportunities that would have given him the best chance of improving his communication skills.
In both years 10 and 11 Joe had work experience and studied an Employability and Personal Development course. He became more assertive and felt confident enough to move into St John’s sixth form which links with an outstanding local FE college. Joe chose a L1 course in plastering followed by levels 1 and 2 in bench joinery, where his talents came to the fore. He continued to study maths and English, gaining GCSE grades D in maths and functional skills level 1 in English.
School staff prepared Joe for his driving theory test and for the technical language required for his Construction Skills Certification Scheme (CSCS). He continued to flourish, passing his driving test and winning a Persimmons Homes award for the most outstanding college student on his joinery course.
Case study 2: Simon
Simon’s profound hearing loss was diagnosed at 8 months old, when he was fitted with hearing aids. These were followed by a cochlear implant at 3 years, 3 months. Whilst still very young, he was identified as having auditory neuropathy and oral dyspraxia.
Simon joined St John’s in the primary department after his parents and his cochlear implant team were concerned about his lack of progress in communication at another school.
His language skills were very delayed: his only social language was limited to hello, goodbye and the names of his family and he made no attempt to communicate with unfamiliar people. This latter characteristic meant that a diagnosis of atypical autism was considered in early childhood but later discounted.
However, Simon did have a strong visual memory and was very competitive. Assessments completed when he was older, using the WISC IV, found his non-verbal problem solving to be on the 95th centile, but his ability in understanding, thinking and reasoning with words was on the 1st percentile. Such a spiky profile meant that his curriculum needed to be based on embedding subject content within the simple linguistic structures he understood.
As conventional reading schemes were inappropriate, James’ primary teacher developed weekly texts based on events in school or at home and to which all the class contributed ideas. The starting point for sentences was the level of the children’s communication skills, extended in a structured way. Similarly, spelling lists were developed from relevant CVC words rather than including grammatical function words which the pupils did not fully understand at this stage.
This style of early language teaching is known as the maternal reflective method (MRM) as it mirrors the way caregivers reflect back and extend the language very young children produce. This approach tends to be used mainly in specialist settings but at St John’s we feel it could be used more widely. The training of teachers of the deaf involves detailed study of language development and their skills could be used to enhance literacy programmes in mainstream schools, where children like Simon need a very structured approach to developing language and are unable to filter and contextualise more complex language.
During his secondary education, Simon did not study a modern foreign language but instead had group reading lessons. These concentrated on further developing phoneme/grapheme integration, improving his vocabulary and comprehension skills, both literal and inferential, and also developing engagement with the text.
Simon had three individual speech therapy sessions per week and the work done was shared with his teachers both to improve his speech automaticity and overlearn linguistic structures.
At the start of year 7, Simon’s National Curriculum levels (pre 2014) were significantly below national expectations in all areas except number, ranging from P7 to NC level 1. However, during his secondary education, Simon’s language skills consolidated and improved so that his progress accelerated significantly between years 7 to 11. He gained GCSE qualifications or their equivalent in seven subjects, making outstanding progress from his starting point in year 7. He joined St John’s sixth form and passed his course in Performing Engineering Operations level 2, followed by a level 3 Diploma in Engineering. To complement his studies, Simon improved his GCSE science grade, and gained intermediate then advanced level maths. English remains a challenge and Simon is retaking his GCSE in order to achieve a grade 4 pass in the new grading system.
In terms of personal development, Simon has gone from strength to strength, doing regular work experience with a local engineering company and becoming an assistant supervisor on a heritage railway. His spoken communication improved to the extent that he also works part-time for a hospitality company. Last year, Simon was awarded college student of the year in Engineering and has begun his second year of a level 3 course. As his next step, he is considering a higher apprenticeship or a degree.
Experience at St John’s has shown us that there are a number of key factors in successfully supporting young people with hearing impairments and additional language difficulties. These include close monitoring of progress so difficulties are picked up at an early stage. It is also important that delays in acquiring language are not only ascribed to a hearing loss but pupils’ learning strengths and weaknesses are accurately identified. Whilst differential diagnosis may be difficult, it is certainly possible and will involve a range of specialists: speech and language therapists, teachers of hearing impaired children and educational psychologists.
Successful interventions are systematic, long term and are reviewed frequently by specialist teachers who can adapt provision when required. However, with the right level of resources and commitment, the long term outcomes, as shown by these case studies, can be very positive.
 Consortium for Research into Deaf Education
 British Picture Vocabulary Test
 Test of Reception of Grammar-2
 Wechsler Intelligence Scales for Children (IV) UK