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British Association of Teachers of the Deaf
MAGAZINE • March 2009 • ISSN 1336-0799 • www.BATOD.org.uk
Complex needs Bromley builds for the future VIEW – promoting support for visual impairment Communication choices following cochlear implantation
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Contents From your editor Complex needs Over recent years more and more I’m sorry, what was the question? 4 Teachers of the Deaf have found A Norfolk tale 7 themselves working with deaf In addition to deafness… 10 children with additional and increasingly complex needs. The At the weekends 12 survival of children who previously The Seashell commitment 14 would not have survived and the growing numbers of Patience rewarded 16 deaf children with complex needs in schools for the Sound teaching 17 deaf, other special schools and indeed in mainstream Finding the best curriculum 18 schools demand that Teachers of the Deaf widen their The Nottingham Special Branch 20 knowledge and skills in working with this very special Sensory integration 22 and heterogeneous group of children. Considering the options 24 This edition of the Magazine looks at a number of Getting personal 26 aspects of the subject, including children with ASD, A dual task 27 mental health issues, music, the curriculum in general The ABC of AAC 28 20 and PSHCE in particular, intervenors, support for parents and training teachers of children with MSI. Clearly, many General features of the articles pose more questions than they answer The Deafax Virtual Network 30 but we hope that they will stimulate further thought and A building ambition 31 exploration. As ever, we are very happy to hear from colleagues who have different or additional points of view Switching codes? 32 to those they read in the Magazine. Let me know if you Looking in, looking out 34 would like to write an article yourself on any aspect of Leading to linguistic independence 36 this subject for future editions. Happy Birthday, Louis 38 30
Every edition of the Magazine has a specific topic (and Regulars these can be seen in the Publications section of our Reviews 49 website) but articles and features on topics unrelated to ICT news 50 that theme are also very much welcomed so please submit your articles for consideration at any time. This and that 52 Abbreviations and acronyms 54 Finally, please consider whether you have anything Calendar – meetings and training 56 50 to offer to forthcoming Magazines (topics itemised below) – send your ideas to [email protected]. Association business Flying high 3 Forthcoming topics: A special teacher 39 May Inclusion – making a difference September Audiology Time for celebration? 40 November Mental health Reasons to join 41 January 2010 Assessment and value added Points of view 42 March Implementing Quality Standards BATOD was there representing you… 43 Representing you – NDCS 46 A comfortable fit 48 Change of address notification form 55
Magazine editor Subscription rates 2008/09 55 Officers of Nations and Regions inside back cover 39
Need to contact BATOD Cover picture about other matters? Kian Murphy and his mother Sam, courtesy of the Eastern Daily Press. Talk to National Secretary Paul Simpson email: [email protected] answerphone/fax 0845 6435181 batod_2.qxp 12/2/09 09:37 Page 12 batod_3.qxp 12/2/09 09:38 Page 1
Association business Flying high As BATOD continues to work to improve the channels of communication to all ToDs, Ann Underwood outlines some of the latest initiatives underway
ooking back at these columns over the past website pages are often visited we would still four issues shows that BATOD has been appreciate more responses to the questions that L making strides on behalf of its members – and we raise on the members’ noticeboard in the incidentally for other ToD colleagues too. Stressing members only section of the website. to colleagues the value of BATOD’s work at higher levels and how joining BATOD can help is everyone’s Maybe life is so busy that you can only take some responsibility. We want to represent all ToDs! information on a ‘need to know basis’? Perhaps information sent through official channels gets put BATOD does not work in isolation from its key on one side and forgotten about? Do you get an partners. Since SERSEN transformed into SESIP annual calculation of pay and were you one of a significant number of initiatives have been those last year who found that your protected status undertaken in close collaboration with BATOD, had disappeared? Peter Preston, our consultant, and SESIP has remained at the hub of sensory discovered that due to case law, some changes developments. Our President-elect, Gary Anderson, removed certain types of protection and thus the is working in close liaison with Lindsey Rousseau permanent protection payment in lieu of the ToD as Chair of the Task Group, and Paul Simpson allowance has now ceased to exist. represents BATOD on the working group considering data collection. David Couch, another NEC member, There have been many cries for help from small is chairing a group looking at mental health issues. services as their structure appears to be threatened Other BATOD members are contributing to the many by LA reorganisation. It has been agreed that a other working groups. This liaison adds strength to tick sheet of possible actions and ideas should be the work of BATOD and enables us to extend our produced as soon as possible to assist generally as collaborative working, increasing our involvement BATOD members build their case. A simple ‘Have with colleagues working with children with VI and MSI you done…?’ has already helped services to develop and ensuring that BATOD does not become isolated confidence and see the situation differently. within its own area of interest. The concept of regional and national groups has Discussions with the DCSF have borne some fruit been to provide support on a more local basis for and there will soon be an announcement about those individual ToDs who may feel isolated and funding to support the training of ToDs wishing to unable to travel to national meetings. Increasingly, acquire the Mandatory Qualification. The specific even regional travel, especially for evening or short mechanisms for this are still being considered. meetings, is becoming a logistical nightmare. Members in Norfolk and surrounding counties have Our discussions with NDCS, especially over the suggested that it might be possible to have a BATOD recent campaign ‘Must Do Better’, were published East region instead of being part of the ‘South’ in January’s Magazine – but following on from that or ‘Midland’. As ever there is an organisational there have been positive discussions with Brian Gale challenge which is being considered. Members in about other NDCS initiatives and BATOD’s views Eastern England are invited to contact me about this have been taken on board. These include a working ([email protected]) and the idea can be group to produce guidance related to phonics in the progressed further… ensuring that ToDs continue Literacy Strategy. to fly high.
When I made my inaugural speech at last year’s AGM in Wandsworth I stressed the need for us to use all the communication links available to ensure that those people leading BATOD forward on the NEC know what their colleagues across the membership are thinking. Paul Simpson keeps the documentation links up to date and easy for members to access. Although we know which
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Complex needs I’m sorry, what was the question? Wendy McCracken discusses the issues surrounding deaf children with additional or complex needs n thinking about additional or complex needs in intervention. While a number of professionals may deaf children and young people, every Teacher be involved in assessment, the aspect of deafness Iof the Deaf or learning support assistant (LSA) is and its impact on learning is a ToD’s expert area and likely to have a specific individual in mind. Inevitably should always be part of the wider assessment the challenges of heterogeneity, individual experience process. and expectations make this area difficult to tackle. Such challenges should not, however, be confused In practice with inaction or a reduced level of service. A range of areas need to be checked, confirmed and assessed. Audiological assessment of children A useful starting point may be to reflect on the impact who are developing atypically is complex. Many of a degree of hearing loss on any learner: reduced audiologists have received minimal training in this frequency discrimination, increased susceptibility to area and the test protocols, while providing an noise, a raised threshold and reduced dynamic range appropriate starting point, will need to be supported for hearing. It is logical to make the assumption that by information from those who are most familiar listening effort is considerably more demanding for with the child. Specialist skills, knowledge and anyone who has a hearing loss. So, what of the understanding of pre-verbal communication ideally impact on any child who has clearly identified needs place ToDs with this group of learners. in addition to deafness? A very clichéd phrase sums • Assess the individual child’s communication skills, up deafness and additional or complex needs: ‘not a check with the school on the communication policy simple addition of parts but a multiplier effect that and with the speech and language therapist (if there results in a more complex challenge’. is one attached to the school). The Pre-verbal Communication Schedule (developed by Chris Defining needs: a medical approach? Kiernan and Barbara Reid in 1985) can be a A classical approach is to consider medical factors useful starting point, as can the Early Support that may co-occur with deafness. These factors Developmental Journal (www.earlysupport.org.uk). encompass a huge range of need from profound and • Assess the learning environment – is it acoustically multiple learning needs to mild physical disability. friendly/hostile? Does the individual child have Advances in genetics mean that conditions previously access to FM amplification? If not, are there unnamed are being identified as specific disorders. sound pedagogical reasons for this? If the child The naming of a syndrome or condition can be was ‘simply’ deaf would he/she have access to an helpful also in identifying co-occurring conditions and FM system? in providing a broader set of information, both of • Check if any aspects of the child’s day are which are important in programmes of support. So in contra-indicated – loud percussive music may be looking at this area medically there are specific ideal but not for a child with hyperacusis. Peto syndromes and conditions that have a higher movement may be ideal for developing motor incidence of deafness than the typical population. A planning skills but if prone, children cannot lip-read few of these are described in the table opposite. or see sign. • Is the school communication policy offering For any syndrome or condition (such as cerebral extension and development of communication palsy) Contact a Family produces an invaluable skills? Increasingly, Makaton is being advocated and resource which lists factors associated, possible used in special schools. If a deaf child with complex additional effects and parent contact points. Every needs uses a system that is restricted to vocabulary service and school for the deaf would benefit rather than language then that is the upper limit considerably from owning the resource or buying in being offered for his or her development. Singalong to access the website. For parents where a child is is another approach using BSL signs and identified with a rare syndrome, knowing that there specifically aimed at individuals with learning are other families who can be contacted can be a disabilities. very important part of understanding a label and putting it in context. In some cases very simple In practice, the motor skills, sensory status, health, information can be useful. experience of learning and expectations of those around them will have a very significant effect on For any child, assessment of needs should precede these learners. They are vulnerable and limited to
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Group Prevalence Prevalence of Study Author deafness within group
Learning disabilities 4.2/1,000 Paucity of studies Abnormal pinna and Mazzoni et al, 1998 looking at LD in isolation hearing loss correlates Journal of International but figure of 50% in Down syndrome Disability Research Vol 38 (6) 549–560
Individuals with Down 0.92/1,000 60–80% Hearing loss in children Roizen et al, 1993 syndrome (DS) 90% of DS compared to with DS. Abnormal pinna Journal of Pediatrics 50% with LD non-DS and hearing loss Mazzoni et al, 1998 and 0% in controls; correlates in DS. Journal of International 50% (including 8.6 HI in children and Disability Research SNHL; 82% conductive; adolescents with DS. Vol 38 (6) 549–560 6.9% mixed) Early prebyacusis Buchanan, 1980
Cerebral palsy 1.4–2.4/1,000 4.5% hearing loss The frequency of other Robinson, 1973 Quadriplegia 22% handicaps with cerebral Developmental Medicine Hemiplegia 8% palsy and Clinical Neurology Diplegia 17% Dyskinetic 17% High risk factors of Wang et al, 2004 Mixed 21% cerebral palsy
Profound and multiple Unknown 55% require extensive The prevalence of Kiely M, 1987 learning disabilities support mental retardation Epidemiology Review 24% require intermittent support
Autism spectrum 9/1,000 mild mod 7.9% Autism and hearing loss Rosenhall et al, 1999 unilateral 1.6% Journal of Autism and profound 3.5% Developmental Disorders
the possibilities and opportunities offered to them by • Crossing midline to pick up a toy (children under professionals. 18 months should reach for an object with the hand closest to the object rather than using the opposite Identifying needs early hand and crossing over the midline). The Early Support programme was predicated on the • Fisting of the hands beyond four to six months of Government’s agenda of identifying needs early and age. seeking to ensure support was offered to families in a • Persistent primitive reflexes beyond four to six family-centred way that promoted optimum outcomes. months of age. With very early access to deaf children and their • Log roll (rather than segmental roll). families following the introduction of the Newborn • Muscle tone (low or high). Hearing Screening Programme (NHSP), ToDs need • Scissoring of the legs (when a child is picked up, to be aware of behaviours that suggest further the legs should be slightly apart rather than crossing investigation may be required. Such behaviours over each other). should not simply be a snapshot but rather a carefully monitored observation of repeated clusters of Clearly, if a baby or mother has been ill there may behaviour. be some delay. However, 95% of all children hit developmental milestones. If there are no other Example 1: factors that could account for low emotional tone • Mother recognises and responds to the baby’s cues. this concern should be discussed with the parents • By two months the baby smiles responsively. and, with their agreement, the child referred to • By four months the baby shows interest in people a paediatrician. NHSP potentially allows early and surroundings. identification of a range of needs, the effect of which, • By six months the baby should be tuned to with appropriate support, can be ameliorated. emotional tone, initiate interaction with a smile and show a range of emotional states. Social and emotional needs In a recent project the Royal School Manchester Example 2: (formerly Royal Schools for the Deaf), the University • Favouring one hand before 12 months of age (due of Salford and the University of Manchester ran some to weakness or difficulty using both hands). training on mental health for sensory services in
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North West England. This served to underline the are being directed not to provide services to special complexities that underpin the experiences of many schools. Some ToDs already offer significant support deaf children who in another social setting may be to very complex children and do so by applying their thriving. So a child may be experiencing significant skills and thinking ‘out of the box’. difficulty in learning and be deaf but not have a specific syndrome or identified special educational Increasingly, children with complex needs are need. For some children, the combination of factors receiving cochlear implants, raising the challenge of that were described were overwhelming simply to measuring outcomes and of reassessing needs. listen to and were recognised as presenting However, in contrast some children, particularly those significant challenges to any individual. Such factors with profound and multiple learning difficulties (PMLD) included: are not receiving adequate services. Lack of progress • Gradual loss of vision; parents unwilling to discuss is frequently ascribed to cognitive disability rather with child and refuse counselling for child. than poor audiology or lack of support. A number of • Mother at home unable to provide emotional parents attending an NDCS family weekend focusing support, father in prison, severe economic on additional needs reported that hearing aids are challenges, contact with wider family who are either being removed, kept in the box or not making any oversupportive or dictatorial. difference. The same parents were amazed to • In third foster home, abused at home prior to learn about high frequency hearing loss and FM fostering, four changes of class teacher in two amplification. years. • Large family, three deaf sons; mother, father and One parent was disappointed that after requesting other children live separately from three boys (one digital aids her son had failed to accept the aids. In 18 years old) and have only very limited means of discussion it became clear that the digital aids had communication with them. Father visits once a week been posted to the child’s home – no individualised with food and other provisions. No contact with fitting, no verification and, effectively, no service. One mother or other siblings. simply has to question whether a child who did not • Mother severely depressed, father alcoholic and have PMLD would be treated in such a way. abuses mother, who has failed to press charges on two occasions. In response to this damning story the NDCS funded a research project to consider parental experience of Any child in such settings would be at risk in respect services for deaf children with complex needs. This of their development and approach to learning. It is has received ethical approval and NDCS is actively particularly difficult for peripatetic teachers who may seeking parents to be involved. For an information have minimal contact with a deaf child and may be pack or any further information on this project unaware of the social/emotional challenges faced email [email protected] or by a specific child as they do not have access to [email protected]. This will confidential data. In such situations it is simple for include good practice and is not simply focusing on schools to ascribe negative behaviour and lack of ToDs but rather on all agencies that may be involved. progress to the child’s deafness. Similarly, class teachers may fall into the trap of assuming that the Inter-agency working is another key feature of ToD will take responsibility for the child and his or working with this group but that is another story. The her behaviour. A significant challenge is the lack role of social workers with these families and children, of educational psychologists and Children’s and the place of massage, the importance of a holistic Adolescent Health Care Services with a specialism, approach, the relevance of orthopaedic equipment in training or understanding of deafness. the choice of hearing aid microphones, the use of communication passports, sensory gardens and A positive way forward? much more could be usefully explored but that is also Every Child Matters (2004) and Every Disabled Child beyond the scope of this piece. Matters (2007) should help to ensure that all children who are deaf, whatever the degree of deafness and An excellent resource for practical ideas that provide the nature of additional or complex needs, have both credibility with colleagues in special settings and access to appropriate services. Given that any fun for the children is the magazine Information degree of deafness will impact on a child’s learning Exchange. For more information and a free magazine and social and emotional well-being, it should follow contact Sara at [email protected]. The telephone that all deaf children, including those in special number for Information Exchange is 07964 225568 or schools (other than schools for the deaf), at home fax 0845 127 5281. or in other specialist provision, should have access to the skills and expertise of a qualified ToD. It is Wendy McCracken is a senior lecturer in Deaf disturbing to hear that in some authorities HI services Education at the University of Manchester.
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A Norfolk tale Jenny Scorthorne, Rachel Sanders and Sam Wheeler consider the role of the intervenor working with multi-sensory impaired children from three different perspectives
• Sense intervenor training continues to be provided in Norfolk • school staff working with children with MSI receive ongoing training in deafblind awareness • Norfolk supports its intervenors through networking and by providing opportunities for intervenors to meet and share their experiences • a mentor is assigned to trained intervenors who opt for accreditation • intervenors are kept informed of forthcoming MSI-specific courses and conferences organised by Sense and other professional bodies • statements of special educational needs for children with MSI include provision for support from a trained/qualified intervenor.
The ‘hands on’ part of my work involves ensuring that: • I am able to work with children with MSI on a regular basis, in their homes, in pre-school settings and in schools s a qualified teacher of children with multi- • I work with intervenors to assess functional use of sensory impairment (MSI) I was asked, in March vision, hearing and communication A 2006, to take the lead in co-ordinating MSI and • I work collaboratively with my CSSS colleagues, intervenor training across Norfolk. An audit of children drawing on their expertise and experience, for with MSI was undertaken and special school staff and example the CSSS educational audiologist, and I parents of those children identified as having MSI undertake regular hearing assessments of children were invited to participate in our first round of training. with MSI.
The training was organised and delivered jointly Skilled intervention is crucial to the progress of all with Children’s Services Sensory Support (CSSS), children with MSI. One example of my work with Teachers of the Visually Impaired (ToVI), Teachers intervenors involves Rachel, who is a trained and of the Deaf (ToDs), a teacher of MSI, and Jenny highly experienced intervenor. We work together in Fletcher and Mary Foster from the charity Sense. school on a weekly basis with children with MSI. Rachel and I are fortunate in that we have been Our second round of training took place in October granted, by the school and by CSSS, two of the and November 2008, and this time participants most valuable resources in the education of children included a parent (Sam, whose story is told on page with MSI – time, and space in which to work. 8), classroom assistants working with children with MSI, respite carers and representatives from social Time allows us really to get to know the children, services. and to interpret and understand their communication modes. It allows the children to develop trust in the Sense intervenor training is now accredited with notion that they have a communication partner who Northampton University, as a result of which will listen to and understand them, no matter how participants from both rounds of training have long that may take. The availability of a room free enrolled and are currently working on their first from everyday visual and auditory ‘clutter’ in which assignments. On completion of the course, they will to work, communicate and encourage optimal use be recognised as qualified intervenors. of residual hearing and vision has made a real difference to the children with whom we work. Currently my work with intervenors in Norfolk is both strategic and ‘hands on’. The strategy involves Jenny Scorthorne is a teacher of MSI with the ensuring that: Children’s Services, Sensory Support, Norfolk.
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Sam’s story Kian was born a perfectly healthy boy in November and understand what is going to happen next. 2005 but just four days later he was admitted to The Sensory Support Service together with Sense hospital with a slight temperature. It was later also ran a five-day intervenor course and I was discovered that Kian was suffering from invited to join. I found the course very interesting pneumococcal meningitis. He was in hospital for and really enjoyed watching the DVDs of children six weeks and also endured an operation on his and adults who were using various different types of brain to remove the extra fluid and insert a Rickham communication. When I was first told that Kian was reservoir. Due to Kian’s fighting spirit he managed profoundly deaf and his vision area of the brain was to be home in time for Christmas. It was just before damaged, due to the fact that he was such a young his operation that we discovered that he had failed baby no one could tell me how bad this could be, his hearing test and had brain damage in the vision only that he would not have perfect vision or could and movement areas of his brain. be nearly blind. For quite a long time after hearing this news I was devastated, as I could not see how Kian is now three years old and is a happy little boy Kian would be able to communicate with two of his who still has that fighting spirit which makes him senses being affected as well as his movement very determined. He has been diagnosed as having problems. It was Sense and the Sensory Support a right-sided hemiplegia and athetoid cerebral Service which helped me to understand that there palsy, an anomalous visual impairment, mild optic were other ways of communication using touch disc pallor, nystagmous, squint, restricted eye and assisted sign language, so this gave me hope. movements to the left and eccentric fixation and a The intervenor course showed me this in practice. profound bilateral sensorineural hearing loss and developmental delay. I know that learning to communicate will be a long process; there is a way for Kian to be able to make Kian has three older brothers aged nine, eight and his choices and communicate his wants and needs five, all of whom have helped Kian to become the and give him a level of independence. My little cheeky, adventurous little boy that he is and he has boy attends Sheringham Woodfields School. His a lot of fun playing with them. In late 2008 Kian was intervenor is Rachel and he is visited by Jenny and chosen to front the national fundraising charity by Liz Reed-Beadle. Having been on the course Sense’s Christmas Appeal. Sense and the local I can now understand how an intervenor works Sensory Support Team have helped Kian and me a and can try and implement some of the things great deal in all aspects of his development. They that I learnt to make Kian’s life happier and more have assessed him regularly and introduced ideas fulfilling. I know I have the support of a good team and objects of reference to use so that Kian can try of people and I can ask questions at any time.
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Rachel’s work We also devise programmes for the sensory room I work in a special school for children with complex and hydro pool. needs called Sheringham Woodfields School, Norfolk. We take children from the age of 2–19 years old When I am in class working as an intervenor I have a and at present we are at our capacity of 90 children. couple of other staff who come and help me work with I have worked in this school for over four years, these children, so that they get to know them, bond coming straight out of college with my diploma in with them and learn their daily routines and structures. childcare and education into this job. I am now 22 If I am ever away or having to deal with something years old and working in the Foundation Stage/Key else and am not available, I feel confident that these Stage 1 class, where the children have a range of staff members can take over and keep up the routines needs from MSI to autism. and structures so that the children don’t get confused and upset about the changes. There are three children in the class with MSI, aged three, five and six years old. I work closely with Occasionally we will invite parents into our sessions them as their intervenor. I also oversee and help to to show them what we do. This gives them the support a newly trained intervenor for one of my opportunity to observe the progress that their former MSI children, aged seven, in Key Stage 2. children have made and to discuss activities or I have worked on and off with this child since I started certain daily routines and gain ideas to help their my job at Sheringham. This has enabled me to build children understand what’s happening to them. We up a great relationship with him, so it was very hard also give parents ideas on how to communicate with this year to say goodbye and let someone else take their children so that they understand what’s going my role as his intervenor. on; this generally helps the parents and children to bond even more closely. Since I completed my training as an intervenor over two years ago I have had the opportunity to work Without my training and the opportunity to work with alongside our MSI teacher, Jenny Scorthorne. Jenny Jenny the children would not have the skills that they has been coming into the school now for the last two have today. The set up that we have in our school is years to work with the four MSI children on a regular very good but without the dedication and support of weekly basis. To help the children develop the skills Jenny and the Foundation Stage teacher it would not Jenny was working on each week it was decided that happen. I feel that all MSI children should have I should take part in these sessions. This has also access to an intervenor and an MSI teacher on a enabled me to support Jenny, especially as the daily basis to enable them to acquire the appropriate children have high medical needs, and it has skills needed to cope with life and the world around improved my knowledge and professional them. It is a privilege to be able to work alongside development. Jenny and learn from her. It is amazing how far the children have developed since I have had my Jenny and I work with the children on communication, intervenor training and been working with Jenny. switch work, communication aids, body signing and on their hearing and visual skills. These all help the Working closely with the children and knowing that children to gain some independence in controlling every move and sound they make has got its own their environment and to communicate with the world meaning, and being able to understand what they around them. At the end of each session Jenny will mean, is an amazing experience. To watch them write up what we have done with the children and grow and develop their skills in communication, and either both of us or I will report back to the teachers watch their personalities grow and become more in the Foundation Stage and Key Stage 2 classes confident and less frustrated because they can what the children have been doing in their sessions. communicate their needs more effectively is We will also discuss if there are any new things that fantastic; no matter how small the steps may be, the children need to work on in class. If there are, we to these children and to me they are real steps will set aside a time in that week so that I can show and there are thousands of them. the two teachers or the new intervenor what they need to be doing. I am very proud to know that I am part of making their lives better and easier because I’m giving them We video our sessions to show the teachers and staff some independence, a chance to control parts of and we also use this for assessment and to show their environment, opportunities to communicate with parents the progress their children have made. I can the world around them and have the best possible then sit down with the teachers and plan programmes experiences and start in life. I go home feeling very and activities that the children should be working on, happy that I am making a difference to their lives and such as switch work, making choices between what their families’ lives. toys they want to play with, songs or work on communication, body signs and copying vocalisations. Rachel Sanders is a trained intervenor.
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In addition to deafness… A dual diagnosis of deafness and autism can be tricky if the symptoms of one mask the other. However, as Sandra Driver explains, it can be useful to compare and contrast the different characteristics of each condition
utistic spectrum disorder (ASD) is usually deafness, the child may not only be restricted in the diagnosed much later in deaf children than in use of language but may also show echopraxia A hearing children. Parents and professionals put (involuntary repetition of learnt phrases in speech or the lack of social development and unusual interests sign) rather than normal imitation. down to lack of hearing. As one parent says, ‘At first we thought we could blame everything on the deafness. In relation to vocalisations, children with ASD can have Obsessively turning lights on and off, spinning things, certain specific characteristics that may distinguish staring at fans – this was how he coped with the them from ‘deaf speech’. Rather than limited intonation silence, filling it with visual excitement.’ it may appear ‘odd’ (not English-like) with ‘irregular’ rhythm. Atypical squeals and growls and unusual The impact of a dual diagnosis is cumulative and syllable strings may also be present. Deaf children use devastating, so early identification of both disorders is a range of facial expressions, whereas children with essential in order to provide appropriate support and ASD are often reported to have a very ‘flat affect’ or learning when intervention is known to be most blank expression. effective. Children with deafness or ASD are very heterogeneous, but looking more closely at the Social interaction similarities and the differences between deaf children Similarities: Children with deafness or ASD can be and autistic children may help to lead to an earlier dual interested in visual stimuli, for example moving objects diagnosis. such as fans and lights.
What is ASD? Differences: Children with ASD may have a preference A diagnosis of ASD is given when there are difficulties for objects rather than people, whereas deaf children seen in all the following areas: without ASD will also have a strong interest in people’s • Communication and language development faces, showing social engagement. • Social interaction • Imagination (flexibility of thought). Hearing and deaf children, as early as two months old, start to develop primary intersubjectivity (sharing It is also common to see ritualistic behaviours and a moment with parents/carers) seen by mutual eye sensory sensitivities in children with ASD. gaze. Deaf babies do seek attention with eye gaze, vocalisation and whole body movements. Children with Three patterns of the onset of ASD have been ASD are unlikely to show primary intersubjectivity. They identified: are often remembered by carers to have been quiet • No period of typical development – ASD symptoms and easy babies. present from birth. • Developmental plateau – child begins to reach Children with ASD struggle to go on and develop true developmental milestones and then stops acquiring joint attention (secondary intersubjectivity). This is the new skills. ability attentively to follow the eye gaze or point of • Regression – child loses skills. another person and to engage in a shared experience. The child will also point to show something of interest Communication and language development to their communicative partner. This skill is apparent in Similarities: Delayed and restricted use of language hearing and deaf children with no additional difficulties, development is evident in some deaf children of typically at nine months old, but is either absent or hearing parents, in part due to limited access to spoken restricted in children with ASD. language. Children with ASD also have restricted use of language, using it as a means to an end. Flexibility of thought and imagination Protoimperative pointing (look at that and give it to me) Similarities: Pretend play fosters creativity and flexibility is more common, whereas protodeclarative pointing of thinking. Children with deafness or ASD may be (commenting and sharing of experiences with others) delayed or struggle to develop their play and in turn is less likely. Children with ASD also typically have their flexibility of thought, but for different reasons. delayed spoken language development. Hearing parents of deaf children may have difficulty scaffolding language with their deaf child, and children Differences: If ASD is present in addition to the with ASD have difficulty with social interaction to
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engage with the carer to learn from them. Deaf plateau or regression in the first three years of the children and children with ASD are therefore more child’s development, possibly indicative of ASD. likely to use real objects than substitute or imaginary objects and to be more repetitive in their play when Consider introducing questions into your initial case compared to a group of normally developing hearing history and ongoing review session which cover children. aspects of social interaction. ASD manifests itself differently at different ages and stages so it is important Psychologists refer to theory of mind as something to keep looking at these areas throughout the child’s that all people must develop in order to understand development. The Modified Checklist for Autism in the thoughts, feelings and beliefs of other people. Toddlers (D Robins, D Fein, M Barton, J Green, 2001) Research reports that deaf children of hearing and the Systematic Observation of Red Flags for ASD parents may be delayed by a couple of years in in Young Children (Wetherby and Woods, Florida State the development of theory of mind in comparison to University, 2004) both have a number of questions hearing children who start to develop this around the which could be asked and areas which can be observed age of four. Theory of mind develops normally in that might help to highlight concerns over and above deaf signing children of deaf signing parents, as they the deafness: have access to fluent language models in relation to • In babies look for evidence of primary conversations about feelings and thoughts of others. intersubjectivity. Theory of mind is also delayed or never acquired in • In older children, around nine months old, look for children with ASD and this is because the autistic joint attention developing (taking any general spectrum disorder leads to a fundamental breakdown developmental delay into account). Set up games in the ability to engage easily with others and perceive where you look across the room and point out the world from other people’s perspectives. something of interest. Does the child follow your eye gaze and your finger? Does he or she also point out Differences: Children with ASD are more likely to be things of interest? very repetitive in their play. As they get older they may • Is there any evidence of plateau or regression in rehearse or act out learnt play and language scripts children who have been making progress with sign or with no flexibility. They may also have a significant speech that cannot be accounted for by a change in preference for passive activities such as watching hearing status? television. • What is the vocal development like? Is it unusual for a deaf child? Behaviour • Look out for any unusual overreactions or Similarities: As a result of potential difficulties with the alternatively very passive behaviour in familiar or areas described above, children with either deafness unfamiliar environments. or ASD often have a preference for routines with the • Document eating and sleeping habits, likes and possibility of behavioural problems, particularly in deaf dislikes, as well play preferences. children of hearing parents. It is well documented that • Liaise with other professionals regarding their children with ASD exhibit behavioural and interpersonal observations to build up a picture of the child in difficulties. different environments.
Differences: Children with ASD are more ritualistic If you suspect ASD what should you do next? and repetitive in their behaviour than deaf children. Refer the child to your local specialist complex It is not uncommon for children with ASD to develop communication disorders team consisting of behaviours such as finger flicking, squeezing, pinching, paediatricians, psychologists, occupational therapists screaming, spinning round, spinning items and lining and speech and language therapists. It is often useful if things up. you offer to attend the appointment, as your experience of deafness will be of benefit to the team. Because their auditory access may be restricted, deaf children may have sensory sensitivities and If a diagnosis of ASD is made, in addition to the preferences for particular tastes, visual and tactile deafness, the ASD can be viewed as the primary stimuli. Children with ASD, however, may either deficit because it affects the fundamental skills for overreact in specific environments to textures, tastes learning of joint attention and social interaction. It and visual stimuli or alternatively may present as is vital that specialists in ASD, who can identify extremely passive and unresponsive to environmental appropriate teaching methods, are involved. Managing stimuli and people. the hearing loss without managing the ASD will not allow a child to maximise his or her learning potential. How do we change our practice? The roll out of the NHSP provides an opportunity to Sandra Driver is the Principal Speech and Language pick up any anomalies that may be indicative of ASD. Therapist of the Cochlear Implant Programme at Guy’s Alternatively ToDs can be documenting any sign of and St Thomas’ NHS Foundation Trust.
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At the weekends Pauline Walker highlights the NDCS family weekends where parents of deaf children with complex needs find unique support
follow-on event was called for, and so in 2002 we ran our first weekend for families of deaf children with complex needs in Newcastle, Northern Ireland. It was a great success, for all the same reasons as the other weekends: families sharing their knowledge, identifying similarities in their experiences and exchanging hugely helpful tips and advice with each other. As organisers we were aware that most of our knowledge was around deafness, and knowing it was an NDCS event, families accepted that this would be the main focus of the weekend. However, it became clear very early on that each of the families came to the event with a huge amount of expertise learnt from the needs of their individual child, and with eight or nine families in the group the challenge for hen the National Deaf Children’s Society session leaders was to encourage families to share launched its family weekends over 12 years their knowledge – it wasn’t hard to do! W ago, these were specifically targeted at families with newly identified deaf children. The Sometimes it can feel overwhelming for families fundamental ambition was to bring together families, when people say, ‘You are the experts when it comes ie parents, carers and siblings, to share experiences to your child’, but nowhere did it ring so true as at and knowledge and to begin to form a supportive these weekends. One of my vivid memories is of a peer group which would be there long after the young couple in their early twenties who had an weekend was over. The uniqueness of such events is eight-month-old baby with a tracheotomy, who was that they are primarily parent focused. The format is tube fed and needed 24-hour care as well as having kept very simple to allow plenty of opportunities for a significant hearing loss. In those few months they families to glean information from each other, but had developed the skills, knowledge and confidence there are also sessions with visiting professionals to care for their baby at home and to start to spread where they are able to ask all those questions they those skills to their wider family. When they shared may not have been able to ask in the busy world their story with the group, the weight on their outside the ‘weekend’ setting. The most common shoulders was obvious. Then a mother with a clearly evaluation comments we get from parents are, ‘It was boisterous three-year-old child spoke up to say that fantastic to realise we were not alone …. that other their family’s experience of the first year of their people were experiencing the same things as us … child’s life had been very similar. The young couple to realise we were doing OK.’ quite visibly relaxed, realising there were some other parent ‘experts’ close at hand to whom they could However, for families who come to the newly talk. They said, ‘It was great to share our identified weekends who have children with complex experiences with other parents who had a mutual needs, it may be the first time that they have focused understanding of our feelings and family needs.’ specifically on the deafness of their child. Until that point, for many families, the primary focus in their Many of the key issues for these families are the child’s life has been on other, possibly life-threatening, same as for most families with a deaf child, ie conditions, and to address the hearing loss as a communication, education, fear of the unknown, single issue is not always easy to do. It became clear but others are different. Interestingly, the subject that for these families an even more specific type of of respite care has rarely arisen at other family
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weekends, but for this group of families it is often ‘A fantastic session, pitched just right. It was great to a major issue, made all the more difficult because have access to someone so experienced in this field’ respite staff are not always familiar with working with (referring to the audiology session led by Patrick deaf children. Another issue includes frustration at Sheehan – see his article on page 24 of this having to attend numerous appointments at different Magazine). clinics and explain their child’s history afresh to each new professional. Also, many talk about difficulties in ‘Excellent to go on a course that covers both Down finding family-friendly places to take the children for syndrome and deafness, especially as deafness a day out where they can feel relaxed and not ‘stared usually takes second place. Communication is at’. However, as each of these topics is aired, other such a key skill that understanding it from the deaf families will come in with suggested solutions or perspective is vital. Learning from other parents – tips they have developed – for example, at some invaluable.’ weekends parents have started to develop lists of family-friendly places to visit and things to do in their The weekends for families with deaf children with localities. complex needs are developing all the time and if after reading this article you feel inspired to be The whole immediate family is encouraged to come involved yourself, for however small an amount of to the weekends and we work very closely with time, we would love to hear from you. Next year we professional childminders to ensure that the children plan to involve more professional volunteers than have an enjoyable experience as well. For many of ever to work with us on delivering these events. If the brothers and sisters it is a great experience to you want to know more please contact Iain Simpson, meet one another, and also to be having a good time NDCS Family Weekend Manager, by email at all thanks to their sibling! Some of the siblings have [email protected] or call 0191 270 8154. simply had to take on the role of young carers, and You can also find further information at for them it is often a relief to find that they are not www.ndcs.org.uk/ alone. Again, friendships form which may go on well into adulthood. Pauline Walker is Deputy Director, Families, at the NDCS. Another essential ingredient of a successful weekend is to include contributors who have an understanding of deaf children with complex needs, and over the years we have had some wonderful professionals involved with the events. We have been joined by representatives from voluntary organisations such as Contact a Family, Barnardo’s, Family Fund and the Down’s Syndrome Association, as well as by individual professionals who have worked, and are working, with us to develop an event which will be useful to all the families who attend. A particular mention should go to Wendy McCracken, who worked with us in running the early weekends and is now very supportive in helping us to develop our small but growing programme of weekends for families of deaf children with complex needs throughout the UK.
‘Deaf with complex needs’ can be applied to a hugely varied group of children, and it is a big challenge to both families and professionals to address all those needs at one weekend. Where we can, we are going to develop a small number of events which address deafness and a specific additional need. For example, we have already made a start by running a small number of weekends specifically for families with deaf children who have Down syndrome. Here are some parents’ comments from one such weekend: ‘I felt that I had a lot of shared experiences with everyone in the room, which was nice. Instead of feeling a bit different, I felt at home.’
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The Seashell commitment Despite the lack of specialist mental health services in the North West, Seashell Trust aims to provide a safe and caring environment for its students with severe and complex learning difficulties, as Alan Malin explains
eashell Trust – The Royal School Manchester who may experience mental health problems and and The Royal College Manchester (formerly the there is a clear written care pathway for students SRoyal School for the Deaf and Communication accessing the services which we provide. Disorders) – operates a mixed day and residential, co-educational, non-maintained special school and Mental health nurse practitioner (MHNP) independent specialist college. It caters for those I am an experienced, qualified registered mental students who have severe and complex learning nurse, educated at higher degree level. I am difficulties combined with significant communication responsible for facilitating high quality assessment difficulties, which include very limited or no oral and interventions for children and young people language. Its 86 students are among the most with severe communication and learning disabilities, complex and vulnerable in society, many accessing who sometimes have behaviours which challenge services 52 weeks of the year. Many also have Seashell Trust. I work as part of the collaborative, sensory impairment. multidisciplinary team using appropriate therapeutic models and will also work with families and key staff Our statement of purpose members to ensure that consistent management At Seashell, we aim to meet all our students’ emotional strategies are in place to promote positive mental and mental health needs by providing a high quality health. In addition, I am the lead contact for medical/psychiatric assessment service within a safe, implementation of the Mental Capacity Act, 2005 therapeutic environment. We are passionate about across Seashell Trust. providing the highest standards of mental health care to enable each student to achieve his or her maximum Visiting psychiatrists potential. We strive to ensure the emotional well-being Our mental health services are supported by two and mental health of all learners attending the school experienced consultant psychiatrists: Dr S Earnshaw or college. Our ultimate purpose is to adopt a whole- (CAMHS – Alder Hey Children’s Hospital) and Dr R school approach to work with our students, and their Turner (adult psychiatry – the National Centre for families and friends, to enable them to take control of Mental Health and Deafness/Alpha Hospital). The their lives. consultant psychiatrists review the care of each student, accessing the service on a monthly basis, A whole-school approach means thinking holistically, which includes the prescription of psychotropic looking at the whole context in which the students medication (where applicable) and also advising on function, including organisation, structures, procedures appropriate behaviour management strategies. and ethos, not just at individual students. The following are examples of the approaches taken. Healthcare support workers • Seashell effectively implements the Healthy Schools Our healthcare support workers offer direct support Programme and supports the emotional well-being of and assistance to the MHNP and psychiatrists in all its students. advising the staff teams within the organisation with • The young people with complex needs living at or regard to mental health care issues. attending Seashell are at the centre of planning for their current and future needs. A vision for the future • All staff receive in-service training in the promotion of At Seashell, we understand that good mental health is emotional well-being and the identification of the far more than the absence of any diagnosable mental emergence of any mental health problems. Additional illness. It includes a positive sense of well-being, and training has been provided in the specific areas of is related to self-esteem, self-actualisation and the depression, anxiety and crisis management. ability to form satisfying relationships with others. It is • We have strategies in place to involve and support about the ability to cope with adversity and it will be parents in meeting the needs of our most vulnerable affected by social, educational and economic students. circumstances. • Seashell guarantees the maintenance of good links with other institutions and bodies to ensure effective There are very few specialist severe learning disability multi-agency working. mental health service provisions especially for • The staff at Seashell know where to refer students children. An assumption was made that people with
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intellectual learning disability were not affected by resources because we have difficulty accessing mental health problems and that their well-being services free at the point of delivery. could be maintained by the services that cared for • Only 22.7% of the students accessing psychiatric them. Many studies have attempted to establish the services have input from external agencies prevalence of mental health problems among people (psychiatrist, community psychiatric nurse, mental with a learning disability, with varying conclusions. health social worker etc). 77.3% of those students The Count Us In Inquiry (Foundation for People with accessing psychiatric services only have input from Learning Disabilities, 2002) estimated that at any one the local level mental health services based at time 40% of young people with learning disabilities will Seashell Trust. be experiencing significant mental health problems. • There is limited access to suitably qualified learning disability psychiatrists in the North West. We are certain that individuals with complex needs • The students who access external psychiatric may have fragile mental health and that concept services have come from other areas of the UK underpins the whole-school/college development (Birmingham, Scunthorpe and Merseyside). plans. An examination of the risk factors of students • There are no primary CAMHS/LD workers in the at Seashell underlines the vulnerability of many of its area who can act as a gateway and ensure that individuals: students do not fall through the net and are • Bio-chemistry (physical illness, especially if chronic appropriately referred. and/or neurological) • The staff who work in local services are not trained • Genetics and family history in additional complex communication needs. • Predisposition • There are no specialist mental health and deafness • Damage to the brain CAMHS services in the North West. • Low IQ and learning disability (PMLD, SLD) • Students from Seashell who require in-patient • Developmental disorder and delay treatment in hospital are treated in mainstream • Communication difficulty (difficulty expressing services which have no formal training or experience emotions, or not having anyone to express them to) in the field of communication disorders or deafness. • Traumatic events in childhood/adulthood • The pathway from CAHMS/LD to adult mental health • Not having enough control over own life services is unclear. • Not having enough stimulating things to do in life • Seashell does not have the facilities to provide its • Social isolation students with secure psychiatric care when needed • Bullying and discrimination but sometimes finds itself acting in this capacity • Low expectations from others because of difficulty in referring to appropriate • Minimal academic achievement. services. • The visiting consultants do not have admitting rights Other risk factors identified include: into their own services for the students at Seashell. • Family breakdown • Neglect All these are issues which need to be explored at • Potential for abuse a strategic level. Although we have described the • Socio-economic disadvantage situation at Seashell to local and national level • Homelessness strategic commissioners, many of the issues are not • Significant adverse life events. specific to our students alone and therefore we are not considered a priority in developing services. At Seashell, we understand that if mental health problems in people with learning disabilities are not The lack of specialist mental health services for recognised and treated early, there is a detrimental children and young people with disability in the North effect on their ongoing quality of life and functioning. West remains a serious concern. We have had some This is reflected in government policy, and in our discussion with several private care providers with commitment to expand our mental health services. regards to the development and enhancement of However, despite the development of national level services at Seashell, although this is at an early stage. policy to ensure that the mental health needs of those with learning disabilities are not only addressed but With the recent economic downturn hitting the also met and understood, the students at Seashell are headlines, it seems unlikely that donors and consistently failed by the local and regional services. commissioners of services are likely to commit to the • All the students at Seashell are assessed as development of new services within our local area. vulnerable or at risk of mental health problems due With this in mind we strive to maintain a standard to a minimum of five or more of the risk factors of care that demonstrates our understanding and stated above. commitment to mental health at all times. • A total of 26% of the student population currently access psychiatric services of some description – Alan Malin RMN, BSc (Hons), DipHE is a mental mostly we buy these services in from our own health nurse practitioner.
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Patience rewarded Janet Guest provides a personal view of working with children who have complex learning needs
hen meeting new people socially one of their first By working closely with questions is usually related to work. On telling class teachers, young Wpeople my profession I usually have at least one children are now wearing of the following responses: ‘You must be very patient’, ‘It their hearing aids more must be rewarding’ and ‘Do you do sign language?’ After consistently. At the hearing working with children with complex needs the answer to aid evaluation clinics, held all these questions is ‘Yes’! in designated rooms in the schools, audiological I have worked as a peripatetic Teacher of the Deaf targets are set for the with the Sensory Inclusion Service in Telford & Wrekin children. These targets are and Shropshire for 18 years. With a background in transferred to the annual mainstream secondary teaching and working with review reports, discussed at the annual review and secondary-aged young people with hearing subsequently transferred to IEPs. Often the target is impairments, I did not think of myself as being for the children to wear their hearing aids for longer particularly patient, but four years of working with periods both at home and school. The class teachers children with complex needs has taught me real have responded to this in numerous ways, including patience – patience in a hearing aid review clinic, compiling social stories with symbols and pictures for waiting for the slightest response from pupils, from the children to take home. Visual timetables with squeezing their class teacher’s hand on hearing the pictures of hearing aids for chosen lessons have also signal, to stilling, even just for a second. been successful. One young boy who has refused to wear his hearing aids all through school is now wearing I have always thought of my job as ToD as rewarding, one in school for longer and longer periods each day. but the changes we see to the lives of children with We have even carried out a hearing aid review in the complex learning difficulties are immensely satisfying. corridor for a Year 13 student who would only wear her In-class observation of a young girl with CHARGE aids to walk to the swimming pool! syndrome who had been very reluctant to wear post-aural aids showed that she was hearing her Multi-agency working is vital for these children to musical toys through bone conduction by putting the receive the best possible service. The audiologist from toys in her mouth. An assessment at Birmingham the Sensory Inclusion Service holds the hearing aid Children’s Hospital followed and the young girl is now evaluation clinics with the ToD and an audiologist from wearing a bone conduction aid on a sweatband and the Shropshire Hospital Trust. This audiologist runs responding to very quiet sounds. the audiological services for adults with learning disabilities and values the opportunity to meet future Other children and young people have since benefited patients. Audiologists from the service and I have from bone conduction aids on headbands, including visited residential schools for children with complex one young girl with Wolf-Hirschhorn syndrome who is learning difficulties in order to develop our skills in noticeably more awake and alert when wearing the audiological assessment. One of the young people on hearing aid. However, reports from bus escorts, class my caseload has a unilateral hearing loss. Discussion teacher and parents showed that the aids were being with the class teacher revealed that the girl was sitting switched off by the involuntary movements of the girl’s in her wheelchair with her ‘good’ ear pressed against head. Our technician was called in and the switches on the back of the chair, and examination revealed a build the hearing aid were cut down to prevent this from up of wax in the good ear. After this was removed and happening again. the wheelchair remodelled to encourage the girl’s head to rest in the other direction we were informed that she One young boy with Down syndrome wore a bone was now showing responses to her father’s voice. conduction aid on a band while waiting for his Baha assessment and operations. His family reported that Four years ago when starting work with children and he became one of the family again and even said young people with complex learning difficulties I was goodnight to the hearing aid at bedtime. apprehensive as to how best to perform my role. Now I feel very fortunate to be part of a team in each school All children and young people should experience the working with families to support this very special group best quality sound possible, and for the students in of children. special schools this is even more important. This can only be achieved if parents, class teachers and all Janet Guest is a Teacher of the Deaf who works for agencies involved in the schools work closely together. Telford & Wrekin and Shropshire Councils.
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Sound teaching Bring sound alive through music for the benefit of all deaf children, but particularly those with complex needs, urges Mark Withers
his feels not so much of a magazine article, to keep the work going and it subsides until the wheel more of a dare. I want to dare you to make your is reinvented with more input a couple of years down Tteaching easier, give your pupils a good time and the line. create an excellent learning environment. What I am asking you to do is… music. I hope that those of you who deliver wonderful music work will not feel too incensed by this article but that It may be that you failed in your attempt to give a you will feel moved to write to this publication and decent interpretation of the complete piano works of inspire us all with the innovative work that you are Beethoven or that you sing like a frog with a sore carrying out. For those of you who don’t get involved throat. That is irrelevant. What I am talking about is with music and are prepared to give it a go, here are giving the young people that you work with the chance three activities you could try to get some great work to create, enjoy and learn from their own music. You started: don’t need to be a musical genius to achieve this. • Use percussion instruments to have musical one-to-one conversations. Imitation, contrast, I know that you are very busy. That is why I have repetition. Anything goes. Expression will involve suggested that music can make your teaching easier. the face as much as the instrument. At times it will Over 30 years ago the Danish music therapist Claus involve the whole body. Simple and great. Bang pioneered work using music to develop speech • Play the guitar together. An acoustic guitar is a in deaf children. Music makes sound fun and fantastic vibro-tactile resource. An electric guitar is engaging. I have been involved in many sessions loud and age-appropriate for a teenager, and guitars where a deaf child has heard much more than they are cheap and very easy to get hold of. You may not ‘should’ simply because music takes them to an be able to play yourself but you can learn the basics exciting place that they want to be. Uniquely, music very easily. So much can be done with just three can be integrated with and enhance any area of chords. Use open tunings with children with complex curriculum learning. Mathematical patterning, topic needs to create a sound sensation. work… it is all there. Music also has remarkable • Open up the piano in your school hall, stick the right- effects on behaviour. hand pedal down and splash around on the black notes. Try sharing the pleasure with a child, maybe Above all, music is communication with sound. That is supporting their arm on the notes. Sounds great. what we need. Pianos are an amazing source of easily accessible, high quality sound. They are not just for pianists. I should back up this statement. In 1989 I started work as Director of Education for the Hallé Orchestra. The Do please try out some or all of these ideas. If you first letter that arrived on my desk was from a Teacher want professional support, you could approach your of the Deaf, Peter Annear, asking if we could get some local orchestra for help or contact: of our musicians involved with his programme – after • Creative Partnerships – a government-funded all, live musicians had to be more creative than scheme putting artists and schools together. a tape recorder. Peter had already found that deaf • The Beethoven Fund – a charity providing music children playing with sound had a much improved resources. auditory response than when they were passive • Music and the Deaf – long-established, experienced recipients. These responses were even more marked input. when we gave children full control of the sound that • Jessie’s Fund – a charity providing music projects was made through the use of our musicians. and training in music in special education, particularly relevant for children with complex needs. Since then, I have had the good fortune to be involved with deaf children in numerous settings. Mark Withers is a musician with many years’ The pattern that I have seen is alarmingly consistent. experience of working with children with complex Teachers of the Deaf respond to music as if the needs. He was for several years the musician in overhead light has been turned on. They see their residence at RSDC Margate. His current projects pupils achieving their goals through music and having include work with the London Symphony Orchestra fun at the same time. However, they often feel unable and Radio France.
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Finding the best curriculum Careful thought and much planning have gone in to the development of a curriculum for deaf students with complex needs at Exeter Royal Academy for Deaf Education. Lee Fulwood has the details
t has now been almost a couple of years since packaged is changing to reflect good practice across flexibility was introduced into the National the broader spectrum of additional need. All our ICurriculum. With that flexibility came a freedom students, for example, now have access to visual for schools and teachers to be more creative in timetables which, initially, were produced for our a way that would benefit their students. At the students with ASD. Shorter class periods, which Exeter Royal Academy for Deaf Education (ERADE) were also introduced to support students with teaching staff began to consider what a deaf ADHD and BESD, benefit all our students as visual curriculum should look like. Previously the National learners. We have found that in 40-minute single Curriculum was differentiated to meet the needs of lessons, more focus and better learning are achieved our students, but our curriculum was still, essentially, than in last year’s 50-minute and double lessons, the National Curriculum. Most members of staff were where students often felt ‘burnt out’. frustrated by a curriculum that was not mindful of our students’ difficulties with reading and writing We have also changed the organisation of the day so (compared to their mainstream peers) nor tailored to that we finish with assembly. Students who have had meet their preference for visual information and sign behavioural difficulties during the day have the language. Other concerns focused on the students’ opportunity to meet with staff after assembly to need for more time to be spent on experiential revisit and revise these behaviours and develop learning and accompanying language development. better coping strategies, leaving the student/staff Now we are beginning to construct a curriculum that relationship revitalised. The primary focus for is based on two pedagogical concepts we believe students with BESD is to provide them with respite should be consistently employed with deaf learners: from the systems and modes of working that experiential learning and relevance. they were unable to cope with, giving them the opportunities to build positive relationships with staff For Key Stage 3 students, we have developed and peers. Equally important is resignification – the themed learning, which embraces many subjects, opportunity to cast off negative self-images through specifically the humanities, art, food technology successfully achieving educational, behavioural and and the core subjects to bring about an integrated social targets. learning experience. We strive to provide experiential opportunities for learning as an effective means of Although we have adopted many ‘therapeutic processing and internalising information as well as community’-type approaches, with relationship making these experiences relevant to their situation building at the heart, a flexible, individualised so that they may become more active language curriculum is another key to the development of learners. All of our students, including those with self-esteem for our students. At Key Stage 4 we complex needs, have a tailored curriculum which have significantly enhanced the courses we are able upholds these principles. to offer our students. We continue to offer GCSEs, ELs and AQA unit awards, but we know that The changing population of students coming to our disengaged students, often with BESD and/or ADHD, school (the average student is secondary aged, benefit from more kinaesthetic courses, such as either having failed in a mainstream setting or, more Entry Level Jumpstart Motor Vehicle Maintenance, usually, a mainstream setting having failed them) Construction, Hair and Beauty and ASDAN Personal means we have to develop the ability to deal with Development Skills (Devon Youth Award). These are many aspects of mental health and other additional jointly provided by ERADE and the Learn to Work needs such as ASD, ADHD, OCD, BESD, programme, which is supported and delivered by a disengagement, non-compliance, learning and number of academic partners across Devon. Both physical disabilities. If we interpret ‘complex’ to Jumpstart and Hair and Beauty are delivered on mean ‘multiple’ needs therefore, the vast majority the ERADE site for a small combined group of our of our students have complex needs, and a few students and some mainstream students from partner are complex in terms of both breadth and depth of schools. Our students tell us they like ‘reverse need. As a result, our curriculum and the way it is inclusion’ – they are proud of their school and its
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facilities, benefit from being in a majority and are range from BSL and ‘BSL through play’ to Live therefore more confident and likely to engage when English and Cued English. Students with complex mainstream peers come to them. They regularly needs have additional programmes – students with make friends from local mainstream schools in this BESD may be offered social skills, students with way, and the hearing students in turn are more ASD may receive a curriculum based on social roles committed to learning basic sign language and and strategies, and students with MLD/SLD may be becoming aware of the needs of their deaf peers. offered ‘Hello Time’ (learning social conventions and becoming more confident about the rules for Other courses, such as NVQ Land Based Studies, functioning as a group). Entry Level Construction and ASDAN Youth Awards, are offered by mainstream providers and we support Some aspects of the KS3/Primary Strategy, such as our students who opt for these choices on those ‘Literacy Across the Curriculum’, have been a boon sites. We have found that all these courses not to our students. It’s easy to highlight where the only help to promote self-esteem because students curriculum fails them but we need to be constantly enjoy and succeed, but they also help to develop creating opportunities to catch them ‘doing good’. improved focus across the whole curriculum. For For example, for some, their best writing, reading some of our students, this individualised curriculum or speaking and listening may not be in a literacy has been the difference between re-engagement lesson, but another subject that better engages their with academic life and facing permanent exclusion. personal interests or captures their imagination.
For our students who have a depth of need, as well At the heart of our curriculum for students with as a breadth, such as SLD/MLD and deaf/blind complex needs is the quality of relationships with staff students, we offer the Equals schemes of work and peers and a well-rounded approach to education and Transition Challenge at KS4. All the students that promotes learners’ intellectual, personal, social have access to augmented communication and physical and language development. Our systems, including PECS signs and symbols, as teaching styles embody experiential and relevant communication is the cornerstone for successful education in order to scaffold learning and drive access to education. In addition, 20% of the language development and assessment. This curriculum is given over to social, personal, self-help approach catches our students at their best, doing and leisure skills. their best and being their best.
We have vertically streamed all of our students Lee Fulwood is Head of School at the Exeter Royal across the primary and secondary phases for Academy for Deaf Education. numeracy and literacy as a result of research with former gifted and talented students. They felt that class work often focused on the less able and failed to stretch their own abilities. Vertical streaming provides opportunities not only for our gifted and talented students but also for those with complex needs to be taught with like-minded peers. For example, some of our ASD students have good numeracy skills, but relatively poor literacy skills. They have opportunities to join groups that closely match their abilities in both these areas yet still learn in a way that focuses on their needs as autistic students. We feel it is often easier differentiating for learning styles than academic abilities.
As our whole curriculum has undergone change in trying to find the best ways to engage our students in their learning, we have also been looking at the curriculum for those with complex language needs. We now provide ‘access to language’ sessions three days a week, where students receive specific language and therapeutic input depending on their linguistic needs. These sessions are co-ordinated by our speech and language therapists, and students receive an individualised curriculum to help address their major barriers to learning. These sessions
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The Nottingham Special Branch Children with complex needs who have undergone cochlear implantation present a range of challenges for staff and parents. Chris Bones and Hazel Lloyd-Richmond describe how the Nottingham programme seeks to support them
he numbers of children with complex needs Outreach support programme coming to the Nottingham Cochlear Implant The Nottingham programme offers outreach support T Programme continues to rise. We have implanted to all the professionals working with children who almost 700 children in total and 10% of these have received a cochlear implant at Nottingham profoundly deaf children have three or more additional and also to those children who, for various reasons, difficulties. We began implanting children with complex have transferred into our programme. Implant centre needs in 1995 and as the age at which children Teachers of the Deaf support children by visiting them receive a cochlear implant gets younger, many of our on a termly basis during the first three years of implant children’s additional difficulties emerge after they have use and then less frequently depending on the needs received their implant. of the child. Visits are flexible and can be increased if it is felt appropriate to meet the needs of the child and Potential outcomes the family. We aim to visit the child and parents and For children with profound deafness and significant meet with the child’s local professionals, either in vision loss, a cochlear implant may give a sense of school, nursery or at the child’s home. distance which they would otherwise not possess. It can give them an awareness of carers around them Training needs when they are not in physical contact with them. This For many schools supporting children with complex can relieve their feelings of isolation and help them needs, our children may be the first to have a cochlear feel included in the family or class activity. Many of our implant and this will create training needs for the parents who have children with very complex needs school. report that their children are more involved in family life when they are wearing their processors. Parents We believe it is important that local professionals have have said that it is ‘like switching her on’ when the up-to-date information about the rapidly changing processor is activated in the morning. When the technology used in cochlear implantation and realistic processor is switched off or removed, these children expectations for this patient group. We provide INSET tend to withdraw into themselves and their stereotypic, presentations and give hands-on opportunities for all self-stimulating behaviours become more pronounced. professionals working with these children to learn more about the children’s cochlear implants and their Assessment process speech processors, including ‘troubleshooting’ and Children come to Nottingham for assessment for discussion of British Cochlear Implant Group (BCIG) cochlear implantation with a wide range of complex guidelines. Presentations are tailored to individual needs. Assessment can involve many professionals circumstances, with time for questions at the end. and we may need to liaise with several different School staff working with children on a daily basis hospitals and agencies to get a complete picture of need to have a clear understanding of the children’s the child. We take time to discuss with parents their processors, how they can be checked and what to do expectations of the likely benefits of implantation for if there is a problem, particularly as most of these their child, recognising that the outcomes for these children are unable to report that their processor is not children may be different from those of children working. without additional difficulties. We may put them in contact with another family whose child has similar Partnership working difficulties. Children with mobility issues may We aim to work in partnership with the local Teacher experience more difficulties in trying to keep the of the Deaf to support the staff working with the coil/headpiece in place when in a wheelchair or buggy. children in school. Being with their pupils on a daily We encourage parents to try a range of speech basis, they are able to recognise responses that may processors to ascertain the most suitable processor go unnoticed by other professionals who are less for their child’s particular circumstances and support familiar with the children. We assess the development them in their choice. of listening skills for all our children after implantation,
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she has heard and respond. Waiting appropriately, which may seem like a long time, is very rewarding when a child moves his/her arms, legs or uses his/her voice in anticipation of the climax of the song. The use of sound/singing/music cues which are included in the normal classroom routine can help implanted children to anticipate snack-time, home time and specific lessons. One boy, who has been implanted for two years, was recently observed putting his tongue out in response to the snack-time music. Singing can also be used to encourage vocalisations and vocal turn-taking.
The Special Branch The Nottingham Cochlear Implant Programme, together with the Ear Foundation and Advanced Bionics, has established a new group aimed at these very complex children called The Special Branch. The group was started in response to the needs of our Nottingham patients and requests from their parents. The aims of the group are to enable: • interaction and communication through music • complex children and their families to meet • families to access support and advice from professionals. including those with very complex needs, giving due regard to their additional needs and the impact these The Special Branch meet on Saturday mornings using will have on their learning and responses to sound. the facilities at Ear Foundation House, with the help of It is very valuable to listen to reports of changes in Suzanne Harrigan. Chris Rocca and Cathy Bowker, behaviours exhibited by the children which indicate supported by Advanced Bionics, lead music sessions a developing awareness of sound and attention to with this group of cochlear implanted children. The sound. children, their siblings and parents all join in with the singing and music-making. During the session, there Multi-sensory impaired children is usually a story which is supported with music, We do not work directly with children who have puppets and objects which the children can handle to severe visual impairment in addition to their profound become engaged in the story. We have a core group deafness, but prefer to work through the child’s of families who attend this session, which is held intervenor. This involves discussing the child’s level every six weeks. The siblings have become friends of awareness, attention and listening skills prior to and it is an opportunity for the parents to meet other having a short session with the child where the families who have a child with similar needs to theirs. intervenor is in physical contact with the child doing Lunch is provided and it is a relaxed and informal time the activities suggested. Visits from our team are for everyone to chat about topics of mutual interest, relatively infrequent, because if these children have such as hydrotherapy or headrests on wheelchairs. too much direct contact with unfamiliar adults their ontological security can be challenged. The trust that We are keen that these sessions should support the has been built up over weeks between the child and targets which the children are working towards at the main carer/s is vital and a prerequisite for the home and school. These are discussed as the child to begin learning about the world. children arrive, before the session starts. For one child this may be eye-pointing and we will offer a Most of our children with complex needs do not have choice of two instruments for that child to choose severe visual impairment and we are able to interact from. Targets linked to vocalisation mean we will directly with them. We enjoy play activities which wait for vocalisations before passing an instrument involve sound toys and instruments. Singing is part of to the child. The development of anticipation through the sessions and children often give very pleasing listening is one of the main aims of these sessions. A responses to simple songs with actions. They are able large part of each session involves the children taking to listen to the rhythmic changes of pitch and, with turns to play instruments. The siblings are included in many repetitions, anticipate what’s coming next and all the activities, and parents and staff are required to join in. To use singing to optimum effect, it is important model what is expected! Everyone enjoys listening to know the time a child needs to process what he or and responding to the music activities.
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The progress observed in these children over time has made us appreciate how worthwhile the sessions are. The children are excited when they arrive and their attention spans have become longer as they follow the music and singing. They will focus on their playing of an instrument and some can anticipate their turn. Chris and Cathy bring instruments which are designed to be played by physically impaired children. To enable us to plan future sessions, our families completed a questionnaire after a year of meeting together which gave us valuable feedback. Comments include: ‘It is the only place we can go where he wants to join in’, ‘It is the only opportunity we have to meet other parents with their children’ and ‘It is totally enjoyable and he absolutely loves the music.’
Future plans We continue to develop our support for these children and are currently conducting a pilot study looking at a new assessment tool to monitor early auditory awareness in children with complex needs. We also review the outcomes from these children to help us determine likely benefits of implantation for future patients with complex needs.
Chris Bones and Hazel Lloyd-Richmond are Teachers of the Deaf with the Nottingham Cochlear Implant Programme. Sensory integration Dido Green explores the area of sensory processing as a potential problem compounding the difficulties of children with hearing impairments
r A Jean Ayres, an occupational therapist, has 3 Sensory-Based Motor Disorder (S-BMD) – explored the association between sensory problems integrating sensory input to plan and Dprocessing and the behaviour of children with co-ordinate postural and more complex motor plans specific learning difficulties, developmental, emotional and sequences. and other disabilities. She found that some children do not seem to process sensations efficiently to Although originally considered as a possible produce normal, organised learning, movement mechanism of more specific problems, sensory control and behaviour and she therefore considered, processing disorders have also been thought to and subsequently defined, the notion of a ‘sensory underpin some of the behaviour and learning integrative dysfunction’ to explain these problems. problems of many individuals with a broader range of Continuing with this line of research in 2007, LJ Miller developmental, sensory and neurological disorders. and colleagues proposed a consensus of terminology Individuals who have developmental disabilities and medical classification for three types of sensory may have major problems handling the variety of processing disorders: sensations we normally learn to take for granted. 1 Sensory Modulation Disorder (SMD) – when a Subsequently, they may find even common person has difficulty responding to sensory input with sensations confusing or frightening and have further behaviour that is appropriate and proportional to the difficulty comprehending and communicating what degree, nature or intensity of the sensory input. they experience. What is more difficult is teasing out 2 Sensory Discrimination Disorder (SDD) – sensory avoidance behaviours potentially indicating performance/skill is influenced by problems in an SMD from adverse reactions to social contact integrating/connecting sensory information to when exposed to inadvertent tactile, auditory or other co-ordinate skilled movement and behaviours. sensory stimuli. It is also difficult to tease out which
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behaviours might be a response to poor sensory Intervention using sensory integration (SI) methods discrimination or sensitivity as opposed to poor will be individualised but may be incorporated within cognitive understanding of how tools may be group sessions/activities. A child’s sensory processing manipulated or what links might occur between problems will be identified through assessment which different stimuli and subsequent events. may include standardised assessments and interview as well as observations and a report of skills and Behaviours and skills which may suggest poor behaviour across different tasks and environments. sensory processing that cannot be explained by The outcomes for SI therapy will address targets learning difficulties or other neurological and/or associated with poor sensory processing, such as sensory impairment include: hypersensitivity to sensory stimuli or poor balance or bilateral co-ordination (ensuring that a motor disorder SMD: sensory seeking or sensory avoidance has been ruled out as the cause of movement behaviours may reflect a disproportionate response problems). Intervention techniques focus on to sensory stimuli. enhancing sensory input to facilitate an adaptive and • Heightened distractibility and discomfort during appropriate behavioural response. Intervention may messy play or physical contact games or also include a ‘sensory diet’ if SMD is suspected. alternatively, the child may touch/stroke certain The ‘sensory diet’ concept comes from the work of textures excessively. P Wilbarger (1995) and is based on the idea that • Discomfort/irritability during personal care tasks each individual requires a certain amount of activity involving light touch such as teeth and nail care. and sensation to be as alert, adaptable and skillful as • Overly sensitive or apparently fearful of movement possible. The important thing about a sensory diet opportunities and therefore avoids swings, slides is to help the child feel calm, alert and organised and playground activities. Conversely may seek (demonstrating an appropriate degree of response these out for excessive periods of time. to sensory stimuli with respect to the context of the • Particularly distracted by daily habitual noises such environmental challenges) by using special activities as clothing accessories or utensils moving against scheduled through the day. SI therapy aims to crockery, which would be frustrating background capitalise on children’s inner drive for success and noise for someone with a hearing impairment. comfort in sensory experiences by encouraging • A preoccupation for certain noises such as running children to be actively involved in the exploration water or vacuum cleaner sounds or conversely of their environments in order to promote greater becoming distressed with particular background sensory organisation and replication of adaptive noises – for example, cries when hair dryer is behaviour. turned on or becomes upset by running water. Again, these are frustrating background noises for Sensory integration theory is a remediation approach someone with a hearing impairment, therefore the which addresses several of the problems exhibited response would be disproportionate to the level of by otherwise normal individuals. The theory is not the child’s sensory registration. intended to explain learning disabilities (cognitive problems), neuromotor deficits or sensory impairment. SDD: poor integration of sensory stimuli across However, individuals with deficits attributable to other modalities to execute a skilled response. areas, such as a hearing impairment, may have • Decreased orientation to differences between concomitant deficits in sensory integration. In this objects with associated difficulties in constructional instance, the application of sensory integration theory tasks. will be valid as part of an overall treatment plan. • Decreased manipulation of objects within the hand Careful observations may be helpful in detecting for development of fine manipulative skills. indicators that sensory integration may be one area • Holding objects too firmly or too lightly. of dysfunction. This does not imply that sensory • Difficulty orienting objects and/or self in space for integration is always the best approach – and indeed participation in games or social play. behaviour interventions may well help ameliorate • Difficulty recognising changes in facial expressions symptoms of a sensory modulation disorder as of playmates. effectively as SI therapy in the case of self-injurious behaviour. Importantly, should you suspect that S-BMD: problems integrating sensory input to plan sensory processing problems may exacerbate your and co-ordinate postural and more complex motor child’s difficulties in adaptive and skilled behaviour, plans and sequences. consult with your child’s therapist or medical • Problems executing complex tasks despite the professional. cognitive ability to follow instructions. • Difficulties sequencing task actions with fluency and Dido Green is a clinical expert occupational therapist good movement timing. in paediatric neurosciences at Guy’s and St Thomas’ • Poor targeting in reaching and aiming tasks. NHS Trust.
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Considering the options Patrick Sheehan and Julie Bradley explore the different methods for treating hearing loss in children with Down syndrome own syndrome (also known as trisomy 21) is the importance of frequent examinations with cleaning of the most common chromosome defect in humans. ears and aggressive treatment to minimise the risk of DThe collection of congenital abnormalities developing hearing loss. There can be great benefits for associated with Down syndrome is caused by the children with Down syndrome once their hearing loss is presence of an extra copy of chromosome 21 (three amplified. copies instead of two). Chromosome 21 is the smallest chromosome with the fewest number of genes. It is one Type of hearing loss of the few trisomies tolerated during the development of Conductive loss: the cause of the conductive loss is the human embryo. mainly associated with Eustachian tube dysfunction due to alterations in the skull base. However, excessive Many theories exist about the cause of the chromosome accumulation of wax can also cause obstruction of the abnormalities, but currently no one knows why this outer ear canal as it is often narrowed in children with occurs. The incidence is one in 750 births and is related Down syndrome. to the mother’s age at birth, so the older the mother the higher the incidence. Sensorineural loss: there is evidence to suggest this type of loss increases in later childhood, hence the child Middle ear problem in Down syndrome ends up with a mixed loss. Routine assessments should Glue ear is one of the most common conditions be performed throughout the patient’s life at regular involving the ear and has a particularly high incidence intervals to monitor sensorineural hearing loss. in children with Down syndrome. A mucoid secretion accumulates in the middle ear and stops the ossicles Treatment of hearing loss from vibrating freely, therefore reducing the hearing NICE, the National Institute for Clinical Excellence, levels. Children with Down syndrome tend to have has recently published guidelines for the surgical thicker ‘glue’, which is less likely to drain away due to management of otitis media with effusion (OME) the narrow Eustachian tubes, and more likely to become (www.nice.org.uk/nicemedia/pdf/CG60NICEguideline.pdf). infected. Studies estimate that up to 80% of children Within these guidelines there is a specific section on with Down syndrome will have a hearing loss usually in the management of OME in children with Down the 30–45dB range, but this can be more severe. syndrome. The guidelines stress the importance of a multidisciplinary approach and the benefit of testing Glue ear is often treated with the insertion of grommets children with Down syndrome in a centre with expertise (called pressure ventilation tubes or PETS in the USA). in testing children with learning difficulties. The insertion of grommets in the eardrum allows the ventilation of the middle ear, preventing glue from The most common treatment of hearing loss is the occurring. In the child with Down syndrome insertion conventional hearing aid in the very young, and of grommets can be more difficult as the ear canal is grommets in the older child. However, in those children narrow, there is also a higher incidence of infection with even a mild hearing loss (25–30dB loss), around the grommets and they are more often extruded consideration should be given to provision of a sound leading to the need for multiple insertions. amplification system in the nursery or classroom irrespective of provision of hearing aids or grommets. Middle ear infections (otitis media) are particularly A recent study of children with Down syndrome in a common in children with Down syndrome. This is due to classroom setting showed improved speech and the problem of poor drainage of the middle ear as the language development when the sound amplification Eustachian tubes are often narrower and the fact that system was supplied. children with Down syndrome are more susceptible to infections of all kinds. The treatment of middle ear For a few young children with Down syndrome infections usually involves antibiotics and, potentially, conventional hearing aids are not the best treatment as the use of grommets described above. the aids are often continually removed or lost. The Baha Softband™ may overcome this, giving them access to Importance of early intervention amplification. Similarly, in the older group there are As this patient group is already challenged in their some who are intolerant of hearing aids, cannot wear development of speech and language understanding, conventional hearing aids because of ear disease or it is of special importance that they are not further have had multiple insertions of grommets with little compromised if they develop a hearing loss. Studies of success. For these children the Baha system should hearing loss in children with Down syndrome stress the be considered.
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The Baha system provides several advantages in this specific population: NICE recommendations • Bypassing the conductive hearing loss. The care of children with Down syndrome who are • No problem fitting ear moulds: narrow ear canals are suspected of having OME should be undertaken by a multidisciplinary team with expertise in part of the syndrome and eliminating the need for an assessing these children. Hearing aids should ear mould is an advantage. normally be offered as an alternative to children • Leaving an open ear canal: Baha will leave the ear with Down syndrome and OME with hearing loss. canal open. This will allow the ear to dry out, reducing the further incidence of recurrent ear infections. Before ventilation tubes are offered as an alternative to hearing aids for treating OME in However, these advantages have to be weighed children with Down syndrome, the following factors against the fact that surgery is required to fit a Baha should be considered: system (not the Baha Softband™) and there is a need • Severity of hearing loss for daily cleansing of the site around a Baha. • Age of the child • Practicality of ventilation tube insertion Children with Down syndrome are at particular risk of • Risks associated with ventilation tubes some degree of hearing impairment due to a number of • Likelihood of early extrusion of ventilation tubes. physiological differences. The child needs amplification of the hearing loss in order to help with speech and whether the child needs support with an amplification language development. All the available options should system, has hearing aids or has had surgery to place be considered and discussed with the parents. grommets or a Baha system.
In conclusion, amplification of any hearing loss should Patrick Sheehan is a paediatric ENT surgeon and Julie be considered in children with Down syndrome. There Bradley is a senior audiologist at the ENT and Hearing are several options available and the Teacher of the Clinic for Children with Down syndrome at Manchester Deaf is integral in the overall management of the child, Children’s Hospital.
The Baha trial Over a period of three years we have been offering the Verification of the fittings has involved using use of Baha on a trial basis for children with Down aided/unaided thresholds, speech test material and syndrome who have conductive hearing loss. The feedback from parents and ToDs. children’s ages and level of loss have been variable. In the initial stages of the trial we assessed bone Overall we have experienced that the use of Baha in conduction thresholds and any children with a mild children with Down syndrome is a very viable option sensorineural loss were ruled out. Recently, some and has been very successful in a number of children. children with mild sensorineural have tried the aid, Alternatives suggested for those who rejected the providing the levels were within the range of Baha aids. Baha included fitting of post-aural aids and/or use of Throughout the trial period we have fitted 14 Baha Soundfield systems in school; however, these have compact hearing aids using a softband for three their own limitations. The main advantages of Baha months and, if post-aural hearing aids had not been over conventional aids include: tried previously, these were then fitted for a period of • The reduced need for frequent hearing assessments three months. to adjust the hearing aids. • The exclusion of ear mould problems. The results were compared and we asked the parents • Grommets can be used intermittently and the Baha to fill out diary sheets which included information about used in between times. hearing, practicality, reliability (ie a faulty device and • Assessment of hearing is often easier starting with general willingness of the child to put the aid on). The the Baha in place to condition a child to the test findings have been surprising, particularly with those procedure. whose parents were very reluctant about the trial. The improvement in hearing has been evident to everyone, It has been difficult to write the results up statistically for even for those children with as little as a 30dB hearing a number of reasons: loss. Also, the number of abused or neglected hearing • Numbers of children taking part in the trial are still low. aids has been low. Several children have gone on to • Test and assessment material is dependent on age have funding approved to own their own hearing aid and ability and is not comparable between children. and a few have been implanted with the abutment • Assessment of bone conduction thresholds is difficult fixture. For most of the children who rejected the aid, and sometimes relies on techniques, which means this was generally down to the aesthetics of the long appointment times and difficulties for parents softband, particularly for children with cranial sensitivity. who live out of the area.
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Complex needs
Getting personal Wendy Eadsforth, Christine Orpwood and Monica Malumphy raise the issue of personal, social and health education for young deaf people with complex needs
or our pupils and learners with complex learning youngsters to find the relief they need. However, in needs at the Royal School for Deaf Children, classroom situations these areas are not always F Margate, even the basic PHSE lesson relating available and toilets are not always deemed to feelings and emotions poses problems. When appropriate. adding to this the additional hearing impairment then communication becomes a real issue. What happens for the youngsters who are not able to use cushions and materials to find the relief they This article does not set out to provide answers to this need? Our nursing staff have been on courses run issue. It merely poses more questions, which we hope by our locally based learning disabled sexual health may open up debate, and seeks advice from other teams. It was advocated here that staff should ‘model’ schools and colleges who may face similar problems. and physically help youngsters in these cases. For us as an organisation this is an area we are very We are able to cover basic feelings such as clearly not willing to consider at present as we feel happiness, sadness and anger through role play, it makes students and staff vulnerable and open to drama and pictorial representation. More complex exploitation. emotions, such as frustration and jealousy, can be far harder to convey to this group of youngsters. Yet For our group of students and residents who are over frequently we find that these feelings are key to the 18 and clearly show signs of affection and wanting a emotional well-being of children, and certainly in relationship, the issues are far more complex. Some relation to sex education and adolescence. of this group often show very inappropriate but clear indications of wanting a sexual relationship. This Behaviour is frequently our only way of being able to poses questions as to whether the young people monitor menstruation and other personal issues, and really understand what sex is, what happens next consistency of staff who know their key students well and how to tell if it is consenting. Who needs to know is vital for this. Identification of these problems will – families, social workers and care managers? What lead to medical intervention and medication for pain if different groups of professionals or carers disagree? relief, but this does not address the underlying cause and how we help each individual to understand and In cases such as these a ‘Best Interest’ meeting will put them into the context of their lives. be called for key professionals who know the students or residents best. If necessary a formal assessment A wide range of pictures and, in many areas, models will need to be done under the Mental Capacity Act. are also available from catalogues. With these we Medical staff would then support in the area of sexual can demonstrate issues such as sanitary protection health to ensure safety for all involved. and breast, genital and testicular examinations to our pupils. These particular items support our work As yet this is unchartered waters for us, but again it both in PHSE and sex education lessons and also in raises issues that we have to consider, such as do we residential areas. Our medical centre and nursing staff provide shared rooms for adults who want to have are also crucial in our delivery and services offered in sexual relationships and are we morally able to do these areas. this?
Yet for particular groups of our youngsters this area We do not have clear and concise answers to all the of the PHSE and sex education programme can in questions. For us the key issue is that all our complex itself lead to the whole debate of privacy, safety and young people are different. It is the consistency of learning to understand what is appropriate. For our staff, using an in-depth knowledge and insight into adolescent young people the issue can be even communication systems and behaviours, which offers greater and the effects on behaviour can be extreme. the best support to our youngsters through these difficult times. The idea of giving individuals ‘time out’ is right, but where is the ideal place that offers privacy while Wendy Eadsforth is the Principal, Christine Orpwood not raising risks? In the residential area bedrooms is the Matron and Monica Malumphy is Head of provide this with few problems. Vibrating cushions Additional Special Needs at the Royal School for and different fabrics have been beneficial in aiding Deaf Children, Margate.
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Complex needs
A dual task Developing skills to teach learners with a dual sensory impairment is the goal of the deafblind programme at Birmingham University, as Liz Hodges reports
ost Teachers of the Deaf will have had some help participants develop relevant skills in observation contact with deaf pupils who also have a visual (including for those learners who make very small Mimpairment. Sometimes this visual impairment responses), in choice and use of assessment, in will be recognised and sometimes it won’t. Sometimes strategies for developing communication using it may be visual impairment that is recognised, and appropriate means, in planning teaching programmes, hearing impairment which is not. At least 5% of including for mobility skills – and much more. profoundly deaf children will have Usher syndrome, which means that they will gradually lose their vision Obviously there are fewer deafblind children than and their access to visual means of communication. It deaf children, so there are fewer students, although is not surprising that many ToDs feel ill-prepared when Birmingham is the only course which recruits nationally they meet such a pupil; ToDs have a repertoire of in deafblindness (there is also a course at Whitefield strategies and approaches which use vision and which schools/Kingston University in London). Teachers may not meet the needs of this group. For them, come from different backgrounds – deafness, visual lots of new questions arise; how should they choose impairment, learning difficulties and some from communication methods and develop communication specialist units for deafblind children. One of the great without vision? What additional learning areas should benefits of the programme is the ability of these groups dual sensory impaired children work in? What kinds of to interact, share their skills and knowledge and use provision will really meet their needs? each other’s expertise as a platform for their own development. New technology is a great way to help The programme in deafblindness at the University of distance learners come together, using e-discussion to Birmingham helps teachers to learn to deal with the allow everyone to contribute and learn from each other. many challenges of dual sensory impaired learners We have recently had online live discussions with (the programme explicitly includes deafblind learners teachers of deafblind children from Argentina and beyond school age). Fundamentally for ToDs it is not Canada (among others). just about ‘adding the visual bit’ to what they already know about hearing loss and deafness. Dual sensory In some ways, it’s a frustrating course. There is so impairment is much more than the addition of two much about which little is known, and not enough separate issues, deafness and visual impairment. research has been done. But this means that students (This is why the approach of a ToD working with a in their second year are frequently involved in cutting teacher of the visually impaired to educate a dual edge, original discovery as they work through their sensory impaired child is rarely very effective). While projects, investigating an area in which they are a deafblind child is deaf and also has a visual interested. Recent investigation has included using impairment, in addition to both of those, he or she is touch interactions to develop communication and deafblind – they have a loss of both senses with all the getting the most out of a cochlear implant for a young difficulties that causes. Everything, from assessment to child with multiple disabilities. The opportunity to communication methods, must be seen through the co-operate with people working in these areas lens of the dual sensory difficulties. Teachers with a contributes to everyone’s knowledge. Former Mandatory Qualification in deafblindness are equipped students are invited back to talk about their findings at least to be asking the right questions – even though and help to put them into practice. they may not always have the right answers, as the range of needs, from those of very young children with Students universally agree that it is hard work, but they profound and multiple learning difficulties, to older rarely complain about boredom. They say instead that learners taking accredited examination courses, is very this informs their practice and opens their minds. A wide. recent graduate who is also a ToD says, ‘I am teaching two new deafblind children and I am amazed how The programme in Birmingham focuses on deafblind much difference I feel in trying to meet their needs... learners, but as teachers qualify they often feel much It’s brilliant!’ better equipped to work with learners with hearing loss and physical disabilities, or hearing loss and learning Liz Hodges is the tutor for the programme in difficulties for example. By raising issues, asking deafblindness/MSI at the University of Birmingham questions, challenging assumptions and using and the advisory teacher for deafblind pupils in experience to inform learning, the programme aims to Hertfordshire.
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Complex needs
The ABC of AAC Julie Marshall opens the door to the world of augmentative and alternative communication
n working with deaf children with complex needs palsy, but it is also useful to some individuals you may come across a range of communication with learning difficulties, autism and deafness Iaids that you are unfamiliar with or that you and for people with acquired conditions such as want to know more about. Conversely, you may communication difficulties following stroke, head support children who clearly need additional help in injury, motor neurone disease and multiple sclerosis. communicating their needs and accessing the world AAC may be useful for both temporary and long-term around them. Some ToDs will be very familiar with needs – for example, it may be used in intensive specific approaches; for others this may be a new care settings and with people suffering from area to think about. conditions such as Guillain-Barré syndrome. AAC may supplement or replace speech for people who What is AAC? have already acquired language and may act as AAC stands for augmentative and alternative a motivator for those who have not yet acquired communication. It refers to any form of language. communication which supplements or replaces speech. AAC is used by a wide range of people, What are the benefits of AAC? including both hearing and deaf. Some forms of Clearly, the benefits of AAC can be wide ranging. For augmentative and alternative communication, for those individuals who have had limited communicative example gestures, facial expression and writing, opportunities, AAC can provide them with motivation are used by the majority of people in a society. to communicate and prompt a realisation that they Other forms of AAC, such as computer-based can have some control over their environment. communication aids and symbol/picture-based For others, the use of AAC increases sociability, communication books, tend to be used only by those independence and self-esteem, supports language who have limited or no speech. Some AAC users who development (vocabulary, communicative functions, use sign may also be able to hear and understand grammar and so on), supports academic learning, speech. In the AAC field the communicative decision especially literacy, and facilitates employment, as well is rarely one of speech versus sign, but selection from as the obvious benefit of being able to state their a wide range of communication modes to meet as needs. many communicative needs as possible. Choices about AAC many change over time for an individual. Who supports people who need AAC? AAC assessment and implementation may be What types of AAC exist? supported by a number of people. Some speech AAC can be divided into aided and non-aided and language therapists specialise in AAC. Within approaches. Aided AAC includes both high- and educational provision for children with physical low/light-tech devices. High-tech devices include difficulties teachers, occupational therapists, support communication aids (sometimes called voice output workers and others may have expertise in aspects of communication aids or VOCAs) or speech generating AAC. devices (SGDs). Low-tech devices include eye-transfer frames (also called E-Tran frames), Communication Matters is the UK national picture/symbol/word books or boards, Talking Mats™, charitable organisation concerned with AAC: communication passports and objects of reference. www.communicationmatters.org.uk/ Specialist Non-aided approaches include gesture, sign assessment centres exist in England, Scotland and vocabularies, such as Makaton and Signalong, sign Wales. Details can be found on the Communication languages, such as BSL, facial expression, eye Matters website: www.communicationmatters.org.uk/ pointing, postural and body movement. Many people Resources/AAC_Centres/aac_centres.html/ who rely on AAC use more than one approach, dependent on the communication need, context, 1voice is a network of families and professionals communication partners and so on. An individual interested in AAC. It provides family support may not necessarily use the same forms of AAC weekends, a role-model project and a teenagers’ both receptively and expressively. project: www.1voice.info/
Who can benefit from AAC? Historically, for many people there have been Children and adults of all ages can benefit from difficulties in obtaining assessments and appropriate AAC. It is often beneficial for people with physical AAC systems, particularly for people who require disabilities which affect speech, such as cerebral expensive high-tech systems. The Bercow Review of
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Complex Needs
Speech, Language and Communication Needs (in Funding difficulties and expertise/resources to ensure England), which was published in July 2008, makes a that support for a person who needs AAC goes number of recommendations related to AAC and the beyond provision of the system remain challenging resulting action plan which was published in for some people. December 2008 also makes some specific recommendations relating to AAC: Family involvement is increasingly recognised as www.dcsf.gov.uk/slcnaction/ important and this may be challenging for some families, particularly as AAC implementation is likely Although there are some specific skills used in the to be long term and time consuming, potentially assessment for and implementation of AAC, many of placing a burden on families and services. these skills are routinely used by Teachers of the Deaf in much of their work. These include promoting The evidence base for intervention using AAC is the development of language skills, identifying growing but remains limited, partly due to small communicative functions used and needed, using proportion of the population who use AAC and the multi-modal communication, developing socially unique characteristics of each person who uses AAC appropriate communication, providing communicative (usually people with complex communication needs), opportunities and identifying and developing which make large group studies impractical. vocabulary sets appropriate to the range of contexts Additionally, challenges remain in ensuring that AAC in which an individual spends time. provision is appropriate whatever language/s the user is exposed to and that AAC provided is appropriate to Are there any disadvantages to AAC? the person’s culture. Sometimes parents of hearing children for whom AAC is recommended are concerned that it might Julie Marshall is a senior lecturer in speech and discourage their children from speaking. However, language therapy and a senior research fellow at research evidence strongly suggests that AAC Manchester Metropolitan University. provision does not discourage speech.
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The Deafax Virtual Network Graham Hocking has news of Deafax training packages encouraging innovative use of ICT
ver the past two years Deafax has been Project working with deaf students from six schools outcomes Oacross England, linking them together online The outcomes via the Internet. The students worked together on included the different projects chosen by them, as part of a development of programme funded by the Esmée Foundation. a mixture of hard and soft skills. Learning together online The hard skills The aim of the project was included discussing, debating, researching, creating to encourage young deaf and delivering presentations. Soft skills outcomes students to become more included not only reports from teachers of improved involved in their own communication skills and increased self-confidence learning plans through the but, most importantly, an increased interest in use of innovative ICT and students’ own learning plans. by helping them to develop virtual links between What next? schools through a virtual This project builds on network using webcams. Deafax’s 22 years of experience of using The project technology to facilitate The six secondary schools were in Fareham, Bristol, learning opportunities for London (two), Wolverhampton and Bradford. The deaf people. Traditionally schools received on-site initial training from Deafax Deafax has delivered face- on a variety of different technologies, both hardware to-face training to groups and software, including webcams, Internet of six or more, but we conferencing, digital cameras and PowerPoint. want to be able to support Following this initial training the schools were linked smaller groups of students or to offer one-to-one together and students worked with others from a sessions. This has led us to investigate the new different school. First, students were asked to opportunities provided by using long-distance brainstorm topics and ideas of things they were learning, both as a vehicle to deliver training and interested in, from mathematics and art to football as a way of linking schools to enable them to work and the local community. The students then together. Are you interested in linking up online with discussed, voted and selected five topics which the another school in 2009? Deafax has created three whole group agreed on. Once all six schools had packages to enable schools to take advantage of the picked their five topics the schools were matched outcomes learnt from this project: according to topic. Package 1 – one-day on-site initial training on different technologies, hardware and software, Each group including webcams, Internet conferencing and then wrote ten PowerPoint presentations. questions to Package 2 – join Deafax online network only – no ask the other on-site training. school, a live Package 3 – two days of full training, including link-up was on-site training on different technologies, arranged and hardware and software such as webcams, the students Internet conferencing and PowerPoint asked each presentations, plus two half-day supported other the link-ups. questions. They then researched to find the answers to the questions. If your school is interested in being part of the virtual Once all the answers had been found, the students network and would like more information about the created a presentation and again linked up with the different packages, please contact me, Graham other school and gave the presentation answering Hocking, at [email protected]. the initial questions. This process was repeated with a different school and topic each term. Graham Hocking is the Training Manager at Deafax.
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Feature A building ambition There are exciting new developments afoot for sensory impaired children in Bromley, as Di Blackmore reveals
s we all come to terms with a new financial also on our list and last but not least we needed to landscape I have been asked to write about a replace the KS1 and KS2 classrooms with specialist A ‘good news story’. Before the financial gloom teaching for deaf children. descended, the councillors of Bromley agreed that the accommodation for deaf children had seen better In many ways we are fortunate in Bromley as the days. The Teachers of the Deaf had, for 30 years, service has remained centrally funded. Four years been teaching in a hut which by 2007 had passed its ago the infant, junior and senior schools were invited sell by date. It was decided that to replace like with to have the budget for the specialist provisions for like would not take the service forward and so a new deaf children devolved into their schools. All three vision was developed and a £1.4 million new-build heads refused as they recognised that they did not for the Sensory Support Service was agreed. want the additional responsibility nor did they feel that they had the expertise required. A ‘revolving Bromley was a pilot authority for the Early Support door’ financial arrangement was agreed whereby the programme; therefore, the provision of a family- money is devolved into the schools and the service focused service from the time of diagnosis has been is bought back to provide the education for those established for some time. We have an excellent deaf children based in the specialist provision. The centre for families to come to if their child has practicalities of this arrangement mean that the complex needs. However, what we did not have service remains intact and is managed centrally. was a centre where families could come following The advantages of this model need little explanation a diagnosis of either deafness or visual impairment. I am sure; not least among them is that we are able Furthermore, we had no suitable provision for to plan strategically, manage specialist training and running any specialist pre-school services. We have the flexibility to use staff where they are wanted our own early years space so that we could needed at any given time – a must with low offer a toddler group for sensory impaired children incidence, as all readers of this article will know. and their families and pre-school provision for deaf children aged 0–5 years. We also wanted to develop The roof is nearly on and we are planning to open in specialist communication and language sessions for spring 2009. The children and staff are thinking of early years. In short, we wanted to be a children and names for the centre and much discussion has taken family centre for sensory impairment as well as place regarding the all-important colour schemes! offering specialist teaching for deaf children. We are nearly there and I am confident that when the dust has settled we will have created a building All this was in our minds as we worked with that supports our desire to provide a family-friendly architects to design a building that would meet all service. Watch this space! our requirements. We wanted the centre to operate a ‘hub and spoke’ model offering outreach across the Di Blackmore is Head of Sensory Support in borough to other children’s centres, bearing in mind Bromley. that locality services are difficult to manage for low incidence disability. Having established this model we set about creating a space that would provide a centre where parents could come to meet other Not a BATOD member? parents, access information and meet informally the range of professionals who support them. We wanted Membership fees help to provide this all the teams who form the Sensory Service to be Magazine and support the work carried based in the centre, including the peripatetic teams out on your behalf as a ToD. for HI and VI plus support staff. High on our list of must-haves was an early years centre so that we If you value this provision then join could offer a range of specialist pre-school activities, BATOD and ensure the work continues. with the children accessing their local provision while still being able to spend two or more mornings with Don't delay – join BATOD today us. A sensory room, speech and language rooms and a family room with the all-important kitchen were
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Switching codes? Alex Wheeler highlights some parental perspectives on changing communication skills following cochlear implantation
three-part study to look at the changes that Other parents hoped that their child would continue take place in mode of communication following to use sign alongside speech: ‘I want her to feel Aimplantation was recently carried out by the Ear confident in using sign in her mid to late teens.’ Foundation. Funded by the NDCS, the study was Some parents were keen to focus on the run by Sue Archbold and me at the Ear Foundation, development of spoken language as soon as in conjunction with Linda Watson from Birmingham possible: ‘One of the main reasons we went for a University and Tim Hardie, a parent of a deaf child cochlear implant was to give her a choice. There are with a cochlear implant. We were particularly two sides to this – recognise the fact that she is deaf interested to find out why change did (or did not) but give her the option of spoken language.’ take place and what influenced parents in their choice of communication mode. Communication after cochlear implantation Of the replies to the questionnaire, 84% indicated Retrospective data analysis that the child and family had changed their The children were divided into three groups by age communication approach following cochlear at implant (under three years/three to five years/five implantation. In 78% of cases the change was years and over). According to the implant centre towards spoken language and in the remainder the protocol, children were described as using sign if change was towards signed communication. Lack they were communicating and being educated of development of spoken language skills was through sign for all or part of each day; this included sometimes associated with children with additional BSL and SSE. Children were described as oral if difficulties, for example ASD. they were communicating at home and being educated at school through the use of spoken Parents’ comments suggested that they valued the language. contribution of signed communication and that the change towards greater use of spoken language Analysis showed that prior to implantation a very was child-led and driven by an increased ability to high proportion of children were using some form of hear through the cochlear implant. sign language, especially in the group of children implanted under the age of three (90%). Parents were asked which communication method they thought their child preferred; 70% felt that their When compared with the results at five years child preferred speech and 18% felt that their child post-implant, 83% of the group of children aged preferred to use sign language. under three years at implant were now described as using oral language. In contrast, over half the group In general, parents did not feel that the use of sign of children implanted at the age of five years and language had affected their child’s ability to learn to over were still using sign language as their main speak or vice versa. form of communication. This lends weight to the view that younger is better for cochlear implantation, When we asked parents how they chose which if the aim is the development of spoken language communication method to use 93% said they skills, as the results of this survey showed that wanted the most effective means of communication communication mode post-implant is statistically and 71% agreed that they wanted to use the related to age at implantation. Therefore, children communication mode that their child would find who are implanted at a younger age are more likely most useful in the future. to change from using sign to using spoken language. Parents were neutral in response to the statement ‘I was following the advice of my Teacher of the Responses to the questionnaire and interviews Deaf’. This could be interpreted in two ways: either Communication before cochlear implantation they listen to advice but follow their own inclinations, Most of the parents who were interviewed said that or the information given by local teachers is they used sign language or a mixture of sign and non-directive and they feel free to make their speech before their child had a cochlear implant. own choice. However, information garnered in the Parents differed in their attitudes towards the use of interviews suggested that some parents did have sign language. Some parents saw it as a useful tool issues with the advice offered by local professionals or bridge. – 75% of families reported some conflict over
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communication strategy with professionals working I miss signing.’ with them and two of these families moved house Interviewer: ‘What communication mode do you to live in a local authority with a communication expect to use after leaving school?’ philosophy that was closer to their own. ‘Talk, but I will still keep in touch with deaf friends.’
Implant centre staff were generally seen as more This and other research carried out by the Ear flexible and supportive, with only one parent Foundation has shown that there is a move by reporting an initial problem. All other comments young people who have developed spoken language regarding implant centre staff were either neutral or skills through their cochlear implant to use sign positive in relation to communication choice. Parents language again in adolescence as part of their consistently stated that they supported them in their exploration of their identity and relationship with choice of communication mode, while the conflict deaf friends. with local teachers or speech and language therapists arose from the offering of specific The Communication Journey direction regarding this. However, implant centre This whole ‘communication journey’ can be staff have the advantage of not having to engage summarised by the diagram below. with local politics or follow LA directives. The Communication Journey In the interviews, most local teachers seemed to be
advocating an approach which BEFORE IMPLANTATION CI AFTER IMPLANTATION varied with the needs of the child Development of spoken and which had the potential to language supported by change as the child developed. audition This was sometimes at variance Spoken language with the parents’ views on the Most effective established – readiness of professionals to be communication increased interest flexible in meeting their needs. in use of sign (SSE This may be accounted for in or BSL) part by the passage of time. Oral or sign or gesture or all Reduction of Sign/SSE Some of these parents were talking about events which were five or more years in the past, while teachers were probably reflecting on their After diagnosis of profound deafness and before current views and attitudes. the cochlear implant operation, parents choose the most effective communication. If a child receives a Both local and implant centre Teachers of the Deaf cochlear implant when young or quickly after were clear that where a child is using sign before hearing is lost, the extra hearing helps the child implantation, its use should not suddenly be gradually to learn to speak. This in turn means there abandoned but dropped gradually as the child’s is a change in communication method from using spoken language skills develop. One teacher talked primarily sign/gesture to the development of speech. about the development of ‘code switching’ where a This change happens gradually over time and young person may use sign with deaf peers and mostly follows the child as he or she develops speech with hearing people. This view was spoken language and drops the signs which he/she exemplified by a comment by one of the young no longer needs. Parents often make sure that there people interviewed: is a consistent focus on developing speech.
‘I sign to all my friends. I saw a lot of people signing However, many parents and children and young so I picked it up.’ people remain flexible in their attitude towards Interviewer: ‘Do you use sign only or sign and communication and the use of sign as a second voice?’ language. ‘If someone is a good signer I sign without my voice.’ With thanks to the families, cochlear implant staff Interviewer: ‘Which do you like to do best? Do you and local Teachers of the Deaf for their help with like to sign or talk or do both?’ this study. ‘I do both because if I sign it makes me feel kind of good when I do two languages. Sometimes I Alex Wheeler is a research consultant at the Ear miss talking but when I am talking with my family Foundation.
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Looking in, looking out On a short placement with Deafax, student Louise Mann had her eyes opened to some of the barriers that deaf people face
’m not a Teacher of the Deaf, neither do I pretend Tester: ‘Who makes the house?’ to be an expert on deafness. Before I started my Child: ‘Lots of men.’ Iplacement with Deafax, I was ignorant of the Tester: ‘How do the boys get into the house?’ world of deafness and the issues that having this Child: ‘They go in the door.’ disability can raise. After seven weeks, I began Tester: ‘How could the children’s friends guess they to develop an awareness of deafness and an were going into the house?’ appreciation for the obstacles that deaf individuals Child: (he associated this with another story). have to face. Having an insufficient awareness of deafness is where the problem lies; we all need The child had a good go at reading aloud and educating on deafness both here in the UK and on signing. However, the comprehension questions an international basis. Only then can we claim that clearly posed more of a problem for him. Generally everyone has equal rights. I think that he understood what was being asked, but he found it hard to relate the questions directly Through my work I have gained various impressions to the text. The actual answer to ‘Who makes the regarding the complexities of deafness and the house’, was the boy and his friend. The answer to acquisition of language. One of the highlights of my ‘How do the boys get in to the house?’, was that placement was accompanying a psychologist on they climbed up a rope. It is evident that in these several school visits. During this time, we completed instances he found it hard to recall the information British Ability Skills (BAS)/Neale Analysis of Reading in the text. Reasons for this could be that he was Ability (NARA) tests for the Leverhulme Project either distracted or that he took the meaning of the entitled ‘The significance of ICT for the reading, story far too literally; and his suggestions were very writing and communication skills of deaf people’. practical. For example, in the real world ‘lots of men’ These visits raised key differences between the way would make a tree house and most people would that hearing children and deaf children learn. enter a tree house through a door.
The most obvious differences related to reading Eager to research what I had observed, I consulted skills. The deaf children that we tested had much Marc Marschark’s book Psychological Development lower ability levels of reading. With regards to the of Deaf Children (published by Oxford University shapes/verbal similarities aspect of the test, the deaf Press US, 1997) which explained that some deaf children were just as able as the hearing children. children find it hard to grasp the literal meaning of As with any form of testing, it is important to text: consider the reasoning behind the results. ‘Not only do deaf children have smaller The deaf children’s downfall in the reading seemed vocabularies than hearing peers, but the classes to stem from the comprehension side of the testing. of words they do know are often different. Deaf Most of the children were able to read properly, but children generally are more likely to understand and they struggled to understand what they were reading use concrete nouns and familiar action verbs rather and what they were being asked. These issues than more abstract or general words with which they are of huge relevance to Teachers of the Deaf may have less experience, especially if they have and trainee teachers. Being able to read is an hearing parents... their vocabulary abilities tended to accomplishment in itself, but if a child is reading lag a year behind their own reading abilities.... Deaf without retrieving meaning from the text, then what children also perform better on vocabulary items is the point? Reading becomes functional, without that have only a single meaning. When words can an end result. A good example to use is a young have multiple meanings, and especially when those child’s list of responses to questions related to a meanings may not all be literal, deaf children story entitled ‘The Tree House’. perform poorly even when context is supplied.’
Tester: ‘What would be the best name for that What is interesting about this information is that story?’ it also seems to relate to whole sentences/text. Child: (he looked for a name) ‘The Tree House.’ When the questions being asked have multiple
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meanings and answers, some deaf children will even familiar words. The lack of exposure, experience seek to answer very literally, even when the context and organised vocabulary puts them at a serious of the story is being applied. In the case of the child disadvantage to their hearing peers. being tested, he seemed to relate the majority of his answers to real life. Prue Goodwin’s view on engaging with text extends these ideas: ‘Understanding meanings beyond the Another impression that I gained from the BAS/NARA literal involves the following: picturing in the mind, tests was that some deaf children had difficulties with questioning, re-evaluating, inferring, predicting, the verbal similarities element of the test. There were anticipating, commenting, using personal 18 categories of similarities: fruit, colours, clothes, experience and using inter-textual knowledge.’ animals, games, utensils, trees, jobs, vegetables, shapes, measures/numbers, leaders, cold, furniture, It is intriguing to note that a deaf child is capable storage, metal, sweets and liquid. of most of these things, but most of these are aided by the ability to hear. Being able to categorise Children were given a series of examples such as semantically is at the core of language/learning. ‘banana, apple, orange’ and asked to name the With reduced abilities to share and question ideas group/category that these items were affiliated to. verbally, this will make comprehension hard for deaf For those that were more reliant on BSL or any children and leave gaps in their learning. Similarly, signs, our interpreter was unable to interpret some predicting and anticipating are difficult if meaning is of the words/categories as they didn’t have an lost linguistically and through the amount of time it equivalent BSL sign, for example sweets and might take to interpret the question. cutlery. These difficulties need to be considered, but it shouldn’t be perceived that the children were put An important point to note is that the interpreter at a disadvantage. Clearly the deafness needs to commented that if you could rephrase the question be taken into account but because of low incidence ‘Choose a colour’, then the children would be able it is very difficult to get robust norms for deaf to do this. Perhaps deaf children categorise students. In addition, since many deaf children are information differently? now integrated in mainstream education, it is not necessarily inappropriate for them to use ‘ordinary’ I would also like to mention some suitable literacy tests such as these. software for deaf children. I would recommend Clicker5 and Inclusive Writer as the most relevant Again, the following information from Marc in terms of literacy (reading and writing). The most Marschark’s book seeks to explain reasons for relevant for communication and all-round fun are these results: Kar2ouche (unique storyboards) and the software from 2simple (pictures, art and mathematics ‘A variety of early studies involving word-association opportunities). Textease Studio offers the greatest and word-sorting tasks demonstrated that young scope for working across the whole curriculum. Of deaf children evidence less extensive and less course, this software can only make a true impact if associatively organised vocabulary knowledge than ongoing ICT training and awareness are applied by hearing age-mates, as well as a lesser ability to ToDs, parents and support workers. organise words into semantic categories…. Aside from deaf children having relatively less breadth With regard to the BAS tests and the software in vocabulary knowledge as a function of exposure, reviews in particular, Deafax’s work is highly it is unclear whether even familiar vocabulary is significant. Its most relevant work, promoted recognised as quickly by deaf children as by by Professor Harold Silver (Evaluator), Helen hearing students. Deaf children typically perform Lansdown (CEO and English specialist) and Ken poorly on evaluations of vocabulary knowledge, Carter (Founder/Director of Research), focuses even when reading comprehension abilities are on the impact of the ever-changing ICT and new equated…. Lack of reading experience, among technologies used to improve deaf children’s other consequences, may well reduce the reading, writing and communication skills automaticity of word finding even when words (www.deafax.org). are relatively familiar.’ Louise Mann is a BA (Ed) student with an English This reference is also very interesting, as it seeks specialism, studying at the University of Reading. to explain why the younger deaf children found the She is in her fourth and final year and recently verbal similarities section of the test difficult. It also completed a seven-week placement with Deafax, helps to support the fact that the younger deaf finding its dedication to ‘transforming the quality of children in the schools found it hard to recognise life for deaf people’ inspirational.
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Leading to linguistic independence Morag Clark explores some of the auditory oral approaches being used successfully in countries across the world to enable young people to become independent in spoken language
It must be understood that the oral approach used today is very different from the old traditional oral approach. Dissatisfaction with the results of the old oral approach made many forward-looking programmes search for something different such as Cued Speech or Total Communication but, having changed, many were disappointed in the results of these too. They went on searching and when they identified young adults with severe and profound hearing losses who were linguistically independent in spoken language and were achieving their academic potential, these professionals asked for help to establish programmes that would allow the children with whom they worked to become the same. This is how I have become very involved in A hearing-impaired child and a child with normal hearing advisory work in many countries around the world. explore the computer together The approach used to lead these young people to dvances in hearing aid technology, audiology, linguistic independence is called the natural auditory medical science and psycholinguistics are oral approach – ‘natural’ because it recommends that A providing new, improved opportunities for young children with a hearing loss should be spoken children with a hearing loss. Early diagnosis allows to in the same way as children with normal hearing; for early amplification and that provides the potential ‘auditory’ because the maximum use of residual hearing for improved and earlier development of spoken is made from the earliest possible age; ‘oral’ because language. In turn this can lead to higher levels of nothing but normal spoken language is used with the literacy with resultant academic success, but it does children at all times and that is what they come to use. not always do so. Today’s digital hearing aids or cochlear implants will not Work as a consultant in programmes for children who themselves ensure that children with a hearing loss will are hearing-impaired in 12 countries shows that only a talk. Hearing is not the same as listening. Undoubtedly small proportion of them are benefiting from all that is hearing is powerful as it is the most effective modality available today. There is need for a sense of urgency to for the development of spoken language, but giving a look into why services vary so much from area to area child the possibility to hear does not guarantee that – even within the same country. listening automatically follows. Unfortunately, all over
It is understandable that in some third world countries the lack of progress is due to financial restrictions and it is good to find that in some cases professionals from developed countries are giving of their time and expertise to provide training and equipment in areas of these countries where local professionals are aware of their need for help.
It is worrying, however, that even in developed countries there are many programmes where children with a hearing loss are not benefiting from all that is possible today and that programmes in some of the third world countries are in advance of those in what Former pupils have the opportunity to return for audiological are considered to be the developed countries. support
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included programme in Singapore where the children with a hearing loss spent more time in the programme each day than those with normal hearing. This allowed them to be supported by their own teachers. This system has grown and covers the range from nursery to university entrance. It is now an excellent example of what can be done when children with a hearing loss have the same opportunity to listen and develop spoken language as those with normal hearing.
A very important part of the Singapore programme is observational parent guidance which is not dominated by a professional. Parents are observed interacting with A former pupil successful at the level 8 music exam now helps their child who is hearing-impaired. This makes big to conduct the percussion band demands on the professional who must develop the the world there are children who have been fitted with ability to analyse the interaction, praise all that is good in appropriate hearing aids but who are not listening it, select no more than one area that may be weak and because of the environment in which they are placed. offer suggestions on how to improve this. It is amazing to find that one of the most difficult things for some In 1988 I was invited to help the Japanese Oral School professionals is to accept is that sometimes only praise in Tokyo to drop Cued Speech because the children is necessary and that there are in fact no really weak were not using their hearing as they ought, on account points. Given freedom and encouragement many parents of watching for the cues. This has been a long learning are very creative. Such an approach to guidance helps experience for me. It took many years for staff and parents to become confident as well as competent. parents to realise how much the children watched instead of listened. Some of the adult behaviour had to As the included programme grew in Singapore there change too, because some automatically waited for the was the need to train more and more teachers. An children to look before speaking to them. It is really only approach was made to Nanyang University and a in the past five years that the school has become truly two-year, part-time course, leading to an Advanced auditory oral. Now children are listening well and using Diploma in the Natural Auditory Oral Approach, was fluent spoken language with natural voices as they set up and is now being run for a second time. It is follow the regular Japanese primary school syllabus, important that teachers have sufficient knowledge about some of them in regular schools. When making change the development of language of children with normal of this kind it is essential to monitor the progress hearing as well as a good understanding of basic regularly to ensure that the environment in which the audiological matters. children are learning concentrates on the maximum use of the children’s hearing and remains like that. There Over the years many programmes in other countries is a tendency for staff to incorporate parts of an old have sought help in different ways to learn how to turn system at a time when change is taking place and this their programmes into natural auditory oral ones or undoubtedly delays progress. simply to begin completely new programmes along these lines. Details of some of these will be given in the In the same year I was invited to spend time advising in next Magazine. the Canossian School in Singapore because they had changed from the old unsatisfactory oral method to Morag Clark is an international consultant in natural Total Communication. They then wanted to get rid of auditory oral education. the signs because the children were watching instead of listening and signing instead of speaking. As a result the quality of their voices was poor. Having always worked in completely auditory oral programmes it was a shock for me to see how difficult it was for a school to make this change.
It was decided not to change the children already signing and so a parallel auditory oral programme started with a few babies. They did not mix with the signing children and a regular nursery school for children with normal hearing was set up. As the babies with a hearing loss grew they were included in the regular nursery and this was the beginning of a large Parent guidance plays a most important role in the programme
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Happy Birthday, Louis Evelyn Westwood celebrates Louis Braille’s anniversary with a plea for all teachers of the sensory impaired to work together
ouis Braille was born on 4 January 1809, and are nonetheless the same, this year we celebrated his 200th birthday. But for example: L what has this got to do with you, you might • Conditions of service wonder? • Changing roles • Unknown future Many of you will be working in sensory services population. and will have colleagues who are part of the vision support side of your service, so for them the Please talk with your inventor of Braille will have a special significance. colleagues in the visual support services, share VIEW (Visual Impairment: Education and Welfare – your concerns and ideas. www.viewweb.org.uk) is the sister organisation to We need to work together BATOD, representing teachers of the visually to ensure that the needs of sensory impaired impaired on a range of committees and steering children continue to be represented. groups linked to issues relating to visual impairment (VI) at local and national level. Our aims, much like Evelyn Westwood is the Chairperson of VIEW. yours in BATOD, are to: • represent the views of our membership through training, support and surveys • raise the standards of the education of children and young people in schools and in further and higher education establishments • support developments in the field to benefit individuals with a visual impairment • support the development of mobility and orientation • support the qualification of piano tuners • share and disseminate information • establish links with other organisations, sharing information to benefit children and young people with a visual impairment.
A recent survey undertaken by the NFER/RNIB suggests that there are approximately 25,000 children with a visual impairment in Britain, and while the known number of VI children may be smaller than the number of HI children the issues we as services face
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A special teacher Celebrating the success of Anne Gough in last year’s Teaching Awards, Hilary Ward explains why she is such a worthy winner
nne Gough, whom I should also like to thank Anne for bringing some many of you will great publicity to the school, but most of all for being A know from the such a committed and inspiring teacher, for being presentations she has able to get inside the heads of the students and come up with such innovative individual programmes to given at BATOD and ensure their development and for sharing her skills other conferences, won with so many people. Thank you, Anne. the Special Needs Teacher of the Year Hilary Ward is the Chief Executive and Principal of Award at the Teaching Seashell Trust – The Royal School Manchester. Awards ceremony held in London in October 2008 – the first Teacher Anne Gough gives her view of the Deaf to do so. In October 2008 I received the Special Needs Teacher of the Year Award at the London Palladium Anne is qualified both as a ToD and a teacher of in front of 2,000 people. The event was televised children with multi-sensory impairment and she leads and shown the same evening on BBC2. This was a team of teachers and support assistants in the both a terrifying and exciting moment and one I will Sensory Department at Seashell – The Royal School never forget. It was on my return from the Easter Manchester (formerly the Royal School for the Deaf break that I first found out that a colleague from and Communication Disorders). Students in the school had nominated me for the award. I felt department have a range of complex needs and honoured that the people I worked with had such a include children with multi-sensory impairments, many high regard for me, but I was also embarrassed at of whom can be very vulnerable, to young people all the attention. The award has obviously meant with severe autism spectrum conditions, many of that there has been some very positive media whom can display behaviours which are very difficult coverage for the school; for me personally it has to manage. All students present unique challenges meant that the work we have done to promote and, for this reason, Anne moved towards planning the need for an individual approach towards the for them as individuals rather than as groups, with the education of children with sensory impairment and focus always on helping them to develop effective complex needs has been recognised. communication systems. All children are unique, but when a child has both Anne was initially nominated for the award by one her visual and hearing impairments as well as complex teaching staff – one of the many teachers Anne has physical and processing difficulties and very limited nurtured from being an excellent LSA, under her communication then one-to-one support and guidance, to taking teaching qualifications and opportunities to follow a programme designed to returning to The Royal School Manchester. The fact develop their residual hearing and vision are that so many have done this to become excellent essential. It is also vital to provide the right teachers is testament to Anne’s willingness to share environment to develop their communication and her expertise and mentor new staff to ensure the physical ability, life skills and independence. This needs of her students are met. Anne won the regional approach makes a difference not only to the lives of final against a strong shortlist and went forward for the children but also to their families as they benefit the national final, competing against candidates from from the advantages of having a child that they can 12 regions. A judging panel visited for both finals to begin to communicate with and a child that can see Anne’s work and to ask exacting questions of begin to cope, with support, out in the community. colleagues and parents. A different set of skills is developed by the teaching assistants working on the individual approach, and I should like to thank Wendy McCracken, who said the commitment and dedication shown by the staff that Anne was one of the best ToDs she had ever at The Royal School Manchester are outstanding. taught, and Gwen Carr, who was Head of the I feel honoured that this work has been recognised, Stockport Sensory Support Service and then Assistant not just for myself but for the team, as without their Director at NDCS and is now one of our governors excellent support this would not have been possible. and trustees, for their support for Anne’s nomination.
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Time for celebration? Ted Moore takes a look back over 100 years of the Mandatory Qualification for Teachers of the Deaf
he first schools for deaf children in Britain were diplomas, but, because the Board of Education founded on an independent and business basis regarded its Elementary Teachers’ Certificate as T in the latter part of the 18th Century, with more sufficient there were many Teachers of the Deaf following in the first half of the 1800s (for example, who were ‘unqualified’ in teaching deaf children. Edgbaston – 1814, Glasgow – 1819, Manchester – 1825, Brighton – 1842). Although in most cases Not to be deterred, the pace-setters first produced they were designed to make money, they also took an independent journal, known as The Teacher of the moral high ground of providing for the poor the Deaf, in 1903 (for which the cost of the first unfortunate ‘deaf and dumb children’ both issue of 350 copies was £5 10s!). They also decided educationally and spiritually. that to gain more recognition, and thereby improve the education of their charges, the three colleges The teaching methods employed within these ought to come together, form a joint examination schools seem to have been quite varied and often board and institute a single examination. This was closely guarded secrets. In the first part of the 19th agreed in 1907 but it wasn’t until two years later that Century the French system, derived from the work ‘the Board of Education acceded to the persistent of the Abbé de l’Epée (1712–89), was based on the demands (of the three colleges) and recognised the use of signs and was used in most of the institutions Diploma of the Joint College Examination Board as for the deaf. These institutions also made use of the the sole, necessary qualification for Teachers of the skills and knowledge of some of their past pupils, Deaf’ (McLoughlin 1985). and employed them as pupil teachers or assistant teachers. I do not know whether this was carried The Board of Education then laid down the out in recognition of the abilities of such people, ie regulation that teachers in schools for the deaf (and native sign language users, or because they were blind) ‘must obtain within two (now three) years of ‘cheap labour’ who would also follow the dicta of the their appointment an approved qualification’ head or owner without question. (Warnock Report, 1978).
In the late 18th Century Samuel Heinecke In the examination of July 1909 there were developed an ‘oral’ approach to deaf education, questions to answer under the following headings: which became known as the ‘German method’. History, The Methods of Teaching Language, This was taken up by Thomas Arnold and others in Articulation, Anatomy and Physiology and Principles England and ‘in 1870 the Association for the Oral of Education. I wonder how you would cope with the Instruction of the Deaf and Dumb was founded and following questions: in 1877 a training college established for teachers in the German method’ (McLoughlin 1987). Some six ‘In giving direct language instruction, to what extent years later the Society for Training Teachers of the would you, at the same time impart collateral Deaf and the diffusion of the German System was information, geographical, historical or general? set up and the following year it opened its own Give reasons for the course you would adopt.’ (From training college. However, ‘these were small private ‘The Methods of Teaching Language’.) concerns and the Institutions proceeded to teach their own hearing and deaf teachers largely without ‘How would you endeavour to overcome 1) a high reference to them’ (McLoughlin 1985). pitched, 2) a falsetto, 3) a disjointed, 4) a nasal utterance, and what measures would you take to Following the 1880 Congress of Milan some strong endeavour to lead to correct accent in words, and to and far-sighted characters in deaf education became proper modulation and emphasis in speech?’ (From determined to highlight the deficiencies in the ‘Articulation’.) education system towards deaf children. They sought to develop the idea of a professional body ‘What are the functions of the Nose?’ (From and to establish a College of Teachers of the Deaf ‘Anatomy and Physiology’.) and Dumb. This was in place by 1885 and instituted a diploma as a qualification for membership. There ‘What do you understand by the Will? How is it were therefore three colleges which offered related to Feelings, to the intellect? What motives
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can be made use of by the teacher in training the There has also been, on the plus side, the positive Will?’ (From ‘Principles of Education’.) outcome from the 1999–2000 review by the Teacher Training Agency (now the Training and Development But 100 years have passed, and despite the fact Agency or TDA) in which the current MQ courses that it seems to be an absolute necessity that deaf gained approval to continue to operate from children need to be taught by, or have access to, September 2001 for five years. This was then specialist teachers, the Mandatory Qualification extended for a further two years when new bids had (MQ), particularly in the last 20 years, has been to be submitted by the course providers. All courses under threat of extinction. The four-year Manchester have been approved and will commence from degree course ceased to exist in the 1980s as September 2009 under new specifications for a well as the one-year PGCE course, and currently further five years. there are difficulties in Scotland in ensuring that appropriate rigour is applied to courses there. NATD, NCTD, STD and BATOD, in conjunction with the course providers and NDCS, have battled over When I started teaching deaf children it was the years to ensure that teachers of deaf children generally accepted that peripatetic staff were have appropriate training. We should celebrate experienced practitioners who had learnt ‘their trade’ the fact that this has been achieved but we must in special schools and units. Nevertheless, it was also continue to guard closely the Mandatory still the case then that the qualification for these Qualification and ensure that there are continuous teachers was not mandatory, as the regulations only reviews of its standards and content. Only then will applied to schools. Despite concerted efforts by the deaf children get the education they need and course providers, NDCS and BATOD, this has not deserve. changed. Ted Moore is the former BATOD Consultant. However, some degree of success was achieved when the regulations involving school teachers’ References qualifications, including the MQ, were ‘re-enacted’ in McLoughlin, MG (1985), The Journal of the BATOD 2003 and the following information included: ‘The November 1985 Volume 9, No.6 regulations apply to teachers employed in schools and not specialist peripatetic HI/VI/MSI teachers McLoughlin, MG (1987), A History of The Education employed in LEA SEN support services. It would, of the Deaf in England, MG McLoughlin however, be our expectation that such teachers would have the relevant MQ.’ Other sources of information The Teacher of the Deaf, volumes 8 and 9, 1909 In addition, the regulation that stated that teachers and 1910 of ‘a craft, trade or domestic subject’ could be exempt from having to gain the MQ was removed, Lee, Raymond (Ed) (2004), A Beginner’s meaning that all ToDs in schools had to be Introduction to Deaf History, British Deaf History appropriately qualified. Society Reasons to join An extract from the editorial of the Teacher of the Deaf, January 1910
‘The National Association of Teachers of the beauties of the education of the deaf, can remain Deaf was founded to “further the cause of the outside the discussion of its interesting aspects. Education of the Deaf” and to “promote the It is almost as difficult to imagine the head of a Professional Interests of Teachers”. As these teacher who can stand apart from those who objects must inevitably compel the allegiance of are seeking to deal effectively with current every true teacher of the deaf, membership of the professional problems, which, whatever they may profession should necessarily mean membership be, have an important bearing upon the actual of the Association and this again should command work of our schools.’ the serious thought and endeavour of the teacher in the various phases of work undertaken by that Presumably from the Editors, Susanna E Hull and body. It is difficult, if not impossible, to understand AJ Story. the heart of a teacher who, having realised the
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Association business Points of view BATOD’s ToD email forum allows members to exchange views on a range of issues
ll BATOD members are encouraged to join the Music therapy electronic forum which is known as the ToD list. Has anyone any information on using music therapy AFull details of how to join can be found on our with deaf children – the benefits/activities used – or website by clicking on ‘The Association’ and ‘ToD can anyone direct me to useful references or email forum’. publications?
Three recent discussion threads will be of interest to If you are a BATOD member then you could look at readers: the issue of November 2004 (Creativity) as that has several music-based articles that you may wish to Signing in a darkened room follow up. If you no longer have the Magazine then Has anyone managed to crack the problem of you can purchase an electronic version – a CD of all supporting pupils in a class using a whiteboard with a the Magazines published between 1999 and 2008 – projector that then, if the board is to be seen clearly, for £35 by going to ‘Publications’ on the BATOD requires the lights to be off and any blinds drawn? website. Further research on the disk or in the I find myself attempting to sign in the near dark; my Magazine index on the BATOD website may be pupil certainly can’t see my face easily, never mind fruitful as well! the signs I’m using. I’m not sure what you are thinking of when you say Agree it is a big problem! This means that the deaf ‘therapy’. We have used music a great deal in our pupils are at a disadvantage and are not being work and it has fantastic impact but it I’m not sure offered equal access. Suggest you have a spot light that it could be described as therapy. Some of the on you – a small portable directional lamp should do activities are/have been as follows: it – but make sure it is a natural daylight bulb and not • Involvement in a production at the Lowry Theatre too glary, otherwise you`ll get headaches! It may also which mixed six deaf children with a large group of be worth staff considering background colour of board hearing children in a musical/ballet and had two with well-contrasted font colours. This may mean that public performances. the board is reasonably clear with lights on. • Involvement with Birmingham National Ballet in workshops based on their productions which the Try a small reading lamp, positioned on the floor, children then attend. pointing upwards towards your hands and face. • Attendance at Hallé orchestra workshops. • Buying in professionals to provide drumming A small reading lamp positioned on the floor would lessons for new arrivals in the country, guitar only create shadows whenever the interpreters move lessons for KS2 pupils (largely cochlear implant their hands over the face when signing, or shadows users), clarinet, cello and double base players for onto the wall behind creating ‘visual noise’ distractions. the under-three music group. It is not acceptable to make do and sign in the near • Attending Gamelan workshops – mixed age groups. dark – where is the equal access for the deaf person • Working with Opera North. if this happens? • Bringing in musicians to SLD/specialist schools.
The only problem with uplighting, if not carefully And much much more! positioned, is that it may cast your face in shadow and make you look like Mrs Dracula…. Light should Each time we do any of these things we are blown ideally be from above or at head/shoulder level. away by the positive spin-offs, such as listening behaviour in under-threes that we haven’t managed The teacher teaching the pupil needs to have basic to engage until then, rhythm development and, Deaf awareness training. It is important for you to ultimately, language development, for example in reinforce the importance of leaving some of the lights a child who appeared incapable of doing anything on so that the pupil can access you. There might be other than echo speech. We’ve also had children an instance when you and the pupil have to move spontaneously singing along to the guitar when places to ensure that the whiteboard can be they’ve never sung in their life before, greatly accessed by everyone, including your pupil and increased self-esteem and capacity to work as a yourself. It may be that a change of classroom is team, initiating and developing imaginative scenarios needed to make sure all the pupils in the class can for workshops with subsequent knock-on effects for access the lesson. writing stories, incredible and sustained written
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descriptions, sheer enjoyment and relaxation, parents www.njmt.no/bookreview_2006066.html – this is so proud they are in tears and discovering that some about Claus Bang. I attended one of his workshops. of the children are so good that they could develop the skill professionally. It’s an amazingly powerful tool. He can hear when he wants to I am after a pithy reply to the very annoying (and There is a company called Music and the Deaf based frustrating) statement: ‘He can hear when he wants to!’ in Yorkshire and if you click on the website, it will give I know all the long answers. I do loads of INSET. I just you more details: www.matd.org.uk/ need a one-liner that I can follow up more thoroughly.
I did a music degree and trained as a ToD. I used What about, ‘He may hear some sounds but he has to work with young children and our unit had the great difficulty discriminating speech’? privilege of having instruments donated from the Beethoven Fund (a charity for music for the deaf). I have previously pointed out that we all tune into our The links between speech, intonation and music are own name, and that a child with a hearing impairment very clear – I used to use the instruments for helping does this. young deaf children with intonation, conversation and control of their larynx. Please see the links below. Or if it’s worth listening to? I now work in FE, but am still excited about music with deaf people. The individual will hear when he is able to access www.nordoff-robbins.org.uk/musicTherapy/ourMusic speech and other sounds. I appreciate this has a TherapyServices/outreach/centalWest.html – different emphasis but may enable you to discuss it Nordoff-Robbins further.
www.24dr.com/reference/contact/group/beethoven.htm Try ‘Don’t we all!’ and then develop. It has helped with – The Beethoven Fund for the Deaf some people when you are totally frustrated.
BATOD was there representing you... Between the NEC meetings, members of BATOD attend various meetings that are of particular interest to Teachers of the Deaf. This list is not exhaustive. Your representatives at the meetings listed included: Gary Anderson, Babs Day, Sallie Diggory, Jen Nicholson, Paul Simpson, Debbie Staneva.
Date External participants Purpose of meeting Venue January 12 SESIP Reference group London 14 University of Birmingham Course consultative committee Birmingham 20 SESIP Working group London 21 SESIP Unpacking the Quality Standards event London 21 PAIG Steering Group Meeting Nottingham February various NDCS Working group on phonics and deaf children various 9 Pearson Key Stage 2 Maths SATs questions London 11 Ofqual Access consultation forum meeting London March 2 ASLI Contact meeting London 9 SESIP Working group London 9 SESIP Reference group London 11 NBRUH Opportunities for Translational Hearing Research NCSL, Nottingham 13 University of Oxford Brookes Course consultative committee Newbury 19 GTC Disabled task force meeting and seminar London 27 FEAPDA Pre-congress committee meeting Verona
Please inform the Secretary, Paul Simpson, if you know of any meetings where you feel representation on behalf of Teachers of the Deaf would be of benefit. Although there is no guarantee that BATOD would be able to attend every meeting, situations could be monitored and the interests of ToDs represented.
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Representing you – NDCS Paul Simpson reports on the latest meeting held with NDCS on 18 December 2008
1 Present: Jo Campion, Brian Gale, Paul Simpson. variety of ToD colleagues to discuss how to give We regretted the lack of representation from RNID. deaf children access to Letters and Sounds, the National Literacy Strategy in England. It is hoped 2 From the notes of the last meeting: that this will also be applicable in Wales, Scotland NDCS has been approached by Pearson to help and Northern Ireland. The aim is to complete a draft with developing KS2 mathematics tests. Brian will by the end of March 2009. send the letter to Paul. 6 The NDCS initiative on Quality Standards for The Government is considering asking schools to hearing support services will start following the include the impairment type of children on School SESIP meeting in January looking at the generic Action. There is concern that many deaf children QS. are not included in the official PLASC figures and that some unknown to services are included. 7 NDCS is considering a campaign concerning teacher entitlements and would welcome BATOD’s 3 Data and management information view. Paul is to put it to Steering Group in January. Brian and Ross Pullar, website manager for NDCS, It would look at the entitlement of classroom have suggested that CRIDE can use the NDCS teachers with deaf children in their class to support online survey facilities to support the CRIDE survey. and training. The specification will be sent when it is sent to others. There is concern that association with NDCS 8 NDCS is also considering a campaign on may reduce the return rate because managers in acoustics relating to new build and refurbishment; LAs may be suspicious of how NDCS would use the is BB93 being adhered to and does the standard information for campaigning purposes. need adapting? Paul counselled against
Brian is keen to see Sue Lewis’s comments on the proposed quick survey to be sent out by the NDCS (Paul to resend). Both the CRIDE and NDCS surveys attempt to get rough measures of support associated with different levels of hearing loss. The DCSF Pupil Progression project is intended to support schools to identify and target support for children who are not making satisfactory progress. It will also enable, at LA and national level, us to compare the percentage of children with SEN who have progressed two levels between Key Stages and the average for all children. This will enable us to assess whether additional support for children with SEN is adding value. Brian has asked the DCSF for information to show the percentage of deaf children progressing two levels between Key Stages and how this compares with all children.
4 Delegation of funding to schools is causing concern as there are reports in London of SENCOs stopping support to deaf children because they have to pay for it. Brian confirmed that NDCS would take up such issues with the LA if specific cases were brought to its attention. Other concerns in London include the fact that in some areas only 50% of children are being screened at birth.
5 National literacy strategy and phonics – Lillias Reary, a literacy expert, will be approaching a
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over-reliance on acoustics while still underlining 12 Paul explained that there had been a poor initial their crucial nature. He drew attention to the response to the TDA questionnaire asking LAs and explanatory paper appended to the SERSEN tribunal heads of service about their training needs for protocols. He suggested that contact be made ToDs. The questionnaire has been sent again with David Couch on this matter. There was brief and BATOD is strongly encouraging colleagues discussion about APD – NDCS now agrees that to complete it. NDCS regional directors will also this is not a matter for services for deaf children. encourage this. Paul undertook to send the TDA competences to Jo and Brian. They are in the 9 NDCS will contribute two articles to members’ area of the BATOD website – Jo pointed forthcoming BATOD Magazines – on the out that search engines do not highlight content in response to the Laming enquiry and on such members’ pages. prevalence rates. (May and September editions respectively). 13 NDCS wishes to continue to promote its Healthy Minds materials. 10 Brian said that he would be pleased to receive suggestions from BATOD members for the NDCS 14 We are still awaiting the final result from the magazine, particularly anything that highlighted NICE appeal on cochlear implants – we will good practice in working with parents. inform our members once it has been declared.
11 NDCS is developing a Best Practice website – 15 Future meeting dates were agreed: at the moment it only has information about Essex 15 June 2–4pm and its work on acoustics. NDCS would be pleased 24 September 2–4pm to receive contributions from BATOD members. 7 December 2–4pm.
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Association business A comfortable fit Red and yellow, even glitter and blue: what we need to know about ear moulds and tubing, according to Elaine Harris of the Audiology Committee
he ear mould and tubing are fundamental Condensation can collect due to a number of factors, components of the hearing aid. The ear mould’s sweating and weather conditions being common among T purpose is to anchor the hearing aid to the ear and them. When replacing any cracked or hardened tubing, to provide an efficient seal to prevent sound leakage it is important to remember that the length and diameter (feedback) from the ear canal. of the tubing alters the frequency characteristics. Current practice seems to be that ‘standard’ tubing is Pupils often have the misconception that the feedback requested by audiology departments and supplied by or whistle is caused by a faulty hearing aid and the manufacturer of the ear mould. The audiologist fits don’t realise that it is an ill-fitting ear mould which is the pupil’s aid and programmes it with this in place. responsible. It may be that the ear mould has not been After use, the pupil may have widened the bore cavity placed correctly into the ear canal and repositioning it with the pulling action to remove the ear mould, so to may cure the problem. The pulling of ear moulds from effect a tight seal the ToD may need to replace it with the ear by the tubing can, over time, create splits in soft thick-walled or double-walled tubing which has the moulds, again causing feedback. If damaged, the only same bore diameter as the standard tubing but a solution is to request new impressions to be taken to thicker casing to fill the additional space. procure new moulds. If the ear moulds are positioned too far down the ear canal, past the cartilaginous Tubing may also need to be replaced if wax has been section of the ear, they can cause discomfort. They may pushed into the tubing and in any way blocks or also block the ear canal, interfering with the passage reduces the sound passage. The equipment desired of sound if they push wax further into the ear cavity for retubing an ear mould may include: and impacting the wax, instead of allowing it to fall • Correct size tubing (can be precut for threading) out. These secretions are necessary as they serve to • Scissors (or scalpel, if brave enough) maintain a steady temperature near to the tympanic • Gloves membrane. • Antiseptic/antibacterial wipes • A threader Hearing aid users frequently need the size of their ear • A tube expander (if finances allow). moulds checked, especially in the early years while the child is growing, as feedback can be annoying and lead It is essential not to leave tubing protruding from the tip children to discard their aids, which can be detrimental of the ear mould as this can cause pain and discomfort. to early language acquisition. I am fortunate that my pupils are old enough to voice their opinions on whether the replacement has left them The type of material of the ear mould needs to be with a secure and comfortable fitting aid and, most considered as it can be a further cause of acoustic importantly, a better sound quality. feedback or allergic reactions. Today, ear moulds can be constructed from a variety of soft or hard materials: Elaine Harris is a VTHI in North Lanarkshire. silicone, acrylic and even titanium. The shape of the ear mould ranges from a full shell occluding the ear to a skeleton or open type insert which reduces the feeling of plugged ears and the annoyance of the wearer’s own voice. They come in an array of colours, incorporating glitter or cartoons, which gives pupils choice and personalises their aids.
The ear mould prescription may include ‘venting’ (parallel, Y type or external channel), which is another A puffer Glitter mould opening to the air and can be used to reduce the low frequencies produced by the hearing aid without affecting the high frequencies.
Routine checks must also include examining the tubing, as condensation can severely affect the sound being conveyed. Furthermore, wax can absorb this moisture and may swell causing further blockage of the sound passage. A puffer can be useful to clear the moisture. Full shell Standard/thick tubing
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Regulars Reviews
Title Pathways to Literacy DVD different chapter (and thus a different child and age Publication 2008 group) from the DVD. There is a synopsis, followed Publisher The Ewing Foundation by some background information and then discussion ISBN 978 0 9797287 3 0 points with a handy hint on when to show the DVD. Reviewer Corinda M Carnelley, Peripatetic ToD, You do have to load the DVD into the machine London Borough of Croydon yourself – but that’s about it! This is followed by discussion topics – headings followed by bullet points, This new DVD is a worthy addition to the Ewing for example, ‘What does this clip demonstrate?’ ‘With Foundation’s growing resource library. The pack the addition of an aide-memoire, responses might comprises three disks: two copies of the training DVD include…’ or ‘What are the advantages and (one with subtitles, one without) and a CD-ROM of disadvantages of these strategies?’ training notes. The overall package is intended for use in training people to extend the literacy skills of Discussion points are followed by activity suggestions, deaf children. The DVD provides real-life examples of and there are even website addresses pointing the deaf children developing literacy skills in a variety of leader in the direction of downloadable materials. This mainstream settings and covering a wide age range. is followed by further suggestions for trainers, and then a ‘Let’s be creative’ section. The resource is not intended for use with children or as a DVD to watch without any explanation. It This is a fantastic resource in that it covers all the is a resource to use as an INSET tool. On the information we know and love, but can’t and don’t accompanying CD-ROM there is a vast amount of always remember when delivering INSET. It’s all there information; in fact, it is hardly necessary to write for you and you can cherry-pick the bits you want and your own INSET ‘spiel’ at all! Each section covers a leave the bits you don’t. All in all, highly recommended.
Title Using Drama to Teach Personal, empathy and to learn how to Social and Emotional Skills manage feelings and develop Author Angie Wootten and Jacqui O’Hanlon social skills. What is refreshing is Published 2007 the recognition that, as a result of Publisher Lucky Duck Books delayed language, more visual Price £22.99 clues and detailed explanations ISBN 978 4129 1821 3 are required. It acknowledges Reviewer Carolyn Maguire, English and drama the importance of positioning to teacher at Ovingdean Hall School facilitate lip-reading or to watch signs. The book is also flexible in that the mode of communication If, like us, you struggle to combine meeting the needs can be spoken or signed. of hearing-impaired students (many with additional difficulties) with following national initiatives, this book I tried out Module 2 ‘I know how you feel’ with a Key could be what you have been waiting for. Stage 3 class in our weekly PSHCE lesson. Most of these students are very enthusiastic about drama and Written by an experienced Teacher of the Deaf and confident about discussing feelings and emotions. We an actress, who is an educationalist working with the deliberately did not use the drama studio so that the Royal Shakespeare Company, it provides practical students saw the activities as a vehicle for PSHCE suggestions and ideas for teaching PSHCE through rather than another drama lesson. The students drama. It is aimed at teachers involved with a broad responded well to the warm-up activities and liked the range of children, although it was written for and piloted different ways of being ‘mixed up’. They were familiar with deaf children on the premise that ‘good practice with ‘feelings sculptures’ but in the discussion that with deaf children is good practice for all’. followed they used an impressive range of emotional vocabulary. Core activities such as ‘I know how to The book contains six modules, providing three to five respond’ generated an excellent response. By the end lesson plans, including photocopiable resources on a of the module there seemed to be a greater level of CD. The clearly explained and well-structured lesson trust within the group. This was evident in their plans include warm-up games, drama exercises and contribution to the end activities, for example, discussion in order to develop self-awareness and ‘Something I like about being in this group is…’.
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Regulars
ICT news After a good browse around the BETT Show, Sharon Pointeer rests her weary feet and reflects on some of the best new products on offer
web-based resources and mobile computing. Visitors were spoilt for choice in these areas and decisions would have been difficult to make.
A number of things caught my eye which I will be able to write about in future ICT pages, but one of my favourites had to be the programmable dancers in the Yenka software from Crocodile Clips. No more learning to program using traffic lights; now pupils can issue commands like ‘spin’ and ‘cartwheel’ to watch their dancer perform on their screen. Best of all there is no need to buy anything; if a school registers then teachers and pupils can use the products at home free of charge. I feel some fun homework activities coming s I did not go to BETT last year I thought I ought on: www.yenka.com/ to go and see what was on offer this year which A would enhance use of ICT with hearing-impaired The other thing I wanted was a female version of children. Having spent over five hours walking the halls RoboSapien called a Femisapien. She has three main I came home, as usual, with aching feet and a bag full function modes. In attentive mode, Femisapien will of flyers and catalogues to browse at my leisure. My interact directly with the user; in learning mode, she main impression, and one shared by several veteran can be taught a sequence of movements up to 80 exhibitors I spoke to, was that there were not the huge steps long which she can then perform; in responsive number of product launches we used to see. Also, mode, Femisapien can interact with sounds and while some of the stalls boasted discounts for those perform comedy routines. She will also detect objects who ordered during the show or shortly afterwards, and stop when something blocks her path. No remote special offers were also sadly lacking – possibly due control is required for Femisapien – the user interacts to the current credit crunch. with her directly and she will respond to hand gestures, sound and touch: www.femisapien.info/ As this year marked the 25th BETT exhibition, I had been expecting to see more made of this anniversary, I was quite surprised to see John Popplestone of perhaps because I went to the very first one! The Connevans demonstrating its products at the show. larger stands in the grand hall downstairs were for the However, as there were a number of other exhibitors ‘big boys’ such as the hardware manufacturers and the showing Soundfield systems, it made sense for him to larger resource suppliers. Smaller software houses and be there. As I knew all about what Connevans offers, new innovative ideas were displayed in the smaller I passed the time of day and left him to talk to people national hall and around the upstairs galleries. I wanted who are not already customers, but it was nice to see to see everything, which was unrealistic both in terms a familiar face from the world of hearing impairment: of time and motivation, as there were over 700 www.connevans.com/ exhibitors. If only they would send out the excellent full show guide in advance it would be possible to read the exhibitor profiles and plan the visit more systematically. Typically I had received pre-show leaflets, but these tend to be targeted at what the organisers perceive are your interests, so I had an SEN and a leadership trail, neither of which I followed. I did try the online visit planner, but as my interests are so diverse I ended up with a map and list indicating that I needed to see almost all of the stands, which I already knew anyway.
There were a number of recurring themes in evidence, including text messaging parents to provide information quickly, Internet filtering and security, online and
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Soundbeam converts physical movements into sound up receptive language difficulties. Teachers of the so that anyone can make music. This technology has Deaf, particularly those in the visiting teacher service, been in extensive use for many years with pupils with probably need to be aware of this software, even if severe learning difficulties; however, electronic and they are not using it themselves: www.speechlink.info/ digital technology is key to giving pupils access to live music-making and multimedia performance. Soundbeam can be used for contemporary composition and group music-making in an innovative and interactive way. It can be used from pre-school upwards and children can produce creative and satisfying music without the need for formal instrumental lessons. The system uses sensors to convert movements of hands, arms, legs, feet or the whole body into sounds based on the direction and speed of movement. The equipment can be interfaced to instruments directly or through a computer. The company also sells vibroacoustic products which allow the vibrations of sound and music to be experienced physically. The products were originally developed to enable hearing-impaired people to feel sound, but they are also used very successfully in vibroacoustic therapy: www.soundbeam.co.uk/ WriteOnline from Crick Software is aimed at ages nine ClaroRead Plus is a multi-sensory to adult. The idea is that it provides anytime, anywhere software solution for supporting pupils word processing facilities. Pupils are used to carrying who struggle with reading and writing. out tasks on any computer, so an online writing tool The software is designed to integrate feels natural to them. They just log in to the website, with other software such as Microsoft click the ‘Launch WriteOnline’ button and they’re ready Word and Dragon Naturally Speaking to start writing. Everyone gets their personal online to provide text-to-speech, with human folders as part of the WriteOnline subscription, and voices, and speech-to-text facilities. However, it was they can save documents there or to their own the other features which made the product stand out, computer. User preferences are automatically stored such as the provision of coloured overlays for pupils for online, so the program starts up as they want it with dyslexia, the predictive word processor facilities every time, on any computer. It is suitable for pupils and the inclusion of a concept mapping tool. Another who are struggling with writing and includes a aspect which could be very useful to deaf children is predictive system and Clicker-style wordbars. Teachers homophone highlighting, so where two words sound can use the document analysis tools to build up a alike, definitions can be looked up and many of these picture of the pupils’ literacy development needs and are supported by images to aid selection of the correct target teaching based on this information: word: www.clarosoftware.com/ www.cricksoft.com/
Kath Balcombe has been teaching pupils with dyslexia If you use an interactive whiteboard and find that there for the past 18 years. As KBER she was demonstrating are some disadvantages, then a plasma screen may the resources she has developed to help pupils be the answer. Reported disadvantages of interactive develop their writing skills. These included a set of whiteboards include problems with pupils’ shadows, precursive fonts and Handwriting for Windows, which grainy images and glare, the health and safety issues allows the user to produce worksheets and other of pupils looking into the projector beam and the image documents in simulated handwriting with the correct projecting across the user’s face making lip-reading letter shapes and joins: www.kber.co.uk/ difficult. These can all be overcome with the Inclusive Interactive Plasma Screen from Inclusive Technology. SpeechLink is primarily designed to help teachers and The screen can also be mounted on an electrically teaching assistants to work alongside speech and powered, height-adjustable stand which can be wall language therapists in assessing four to eight year olds mounted or portable, so can be used with a range and implementing speech sound programs. I wasn’t of pupil and teacher heights easily without any convinced that this was applicable to hearing-impaired complicated adjustments: www.inclusive.co.uk/ pupils, but I did wonder if pupils included in mainstream might be assessed using this system as part of a If you would like to contribute anything to these school or authority initiative. There is a parallel pages, please contact Sharon Pointeer at Language Link program which is designed to pick [email protected].
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Young artists at New audiology good Mary Hare practice guide The Department of Health has produced a document entitled Transforming Services for Children with Hearing Difficulty and their Families: A Good Practice Guide. It offers practical advice on setting up local audiology networks made up of a wide range of professionals, healthcare providers and families of deaf children.
In welcoming this publication, Brian Gale, NDCS Director of Policy and Campaigns, pointed out that in 2007 the Government published a national framework for audiology services which completely ignored the needs of deaf children. This omission and the concerns expressed to the organisation by many parents with deaf children about the standard of audiology Mary Hare School for the Deaf in Newbury is one services led NDCS to lobby government of ten schools from across the South East of ministers to look at how these services could England to be selected for SEGRO’s Young Artists be improved. Clearly, access to appropriate programme for 2009. audiology services is vitally important for deaf children’s development and educational Schools throughout the region were invited to achievement. apply for a place in the scheme and, at a launch event held at Slough Trading Estate, the ten NDCS stated that, if implemented, the guidance winning applications were unveiled. will reduce the unacceptable variation in the quality of service between different primary care Now in its second year, the initiative is designed to trusts, ensure that as much care as possible can create exciting opportunities for school children to be delivered close to the child’s home, provide rapid access to specialist expertise if needed work closely with their teachers and practising and reduce waiting times. artists in order to inspire and develop their talent for art.
Mary Hare School for the Deaf will get to Text a taxi experience working with artist Jennifer Lapsley during the spring term, and will produce artwork Leeds Society for Deaf and Blind People and Premier Cars of Leeds have launched a themed around the ‘world of work’. The artwork one-of-a-kind ‘Text-a-Taxi’ service exclusively can be produced in any format, including digital designed for speech and hearing-impaired people. media, but must be suitable for display in a business setting. Booking a taxi is probably something we all take for granted; however, this can be an impossible task for Each of the schools will then have their work the speech and hearing-impaired community. The exhibited at a prestigious London venue in June. service is intended for those who find it difficult or A select few will also have their work purchased by impossible to call the usual taxi hotline. Customers SEGRO and displayed throughout the company’s can simply send a text message to the exclusive European offices. SMS number. Visit www.leedsdeafandblind.org.uk for more information.
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Medical charity funding and Funding for parent awareness involvement Research published recently by the Association of Medical As part of the Aiming High for Disabled Research Charities (AMRC) shows a worrying lack of Children programme in England, the awareness of the work of medical research charities. A Government has committed £5 million over the survey of more than 2,000 British adults has revealed next three years to support parent involvement huge gaps in knowledge about these charities, even in the planning and strategic development of though these now top the list of charitable causes to which local services for disabled children. Secretary we give money. of State Ed Balls welcomes the work done by Deafness and deafness-related conditions affect one in Brian Lamb for his inquiry into improving seven of the UK population – nine million people – yet the parental confidence in services for children charity Deafness Research UK estimates that less than with SEN. He has given the green light for £2 per person affected is spent on medical research into pilot projects in eight areas to look at how deafness each year. This is less than the cost of a pint of confidence can be increased. The projects beer! in North Tyneside, Durham, Blackburn with Darwen, Wolverhampton, Oxfordshire, Vivienne Michael, Chief Executive of Deafness Research Newham, Portsmouth and Kent will look at UK, says, ‘The survey reveals a worrying lack of public a range of approaches including: awareness about the extent to which medical research and • the development of the ‘Team around the better health care in this country relies on the research Child’ approach charities. The funding for deafness research is woefully • improvements in parental engagement in the inadequate. According to Charities Aid Foundation figures, school-based stages of assessment and deafness is one of the least supported causes in the UK; provision, with better information for parents we urgently need to alert people to the devastating impact • closer involvement of parents in the of deafness, the potential that exists to find medical cures decision-making process. and the fact that this relies enormously on public support.’
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Abbreviations and acronyms used in this Magazine
AAC Alternative and Augmentative Communication NBRUH National Biomedical Research Unit in Hearing ADHD Attention Deficit Hyperactivity Disorder NCSL National College for School Leadership AGM Annual General Meeting NCTD National College of Teachers of the Deaf APD Auditory Processing Disorder NDCS National Deaf Children’s Society AQA Awarding Body NEC National Executive Council ASD Autistic Spectrum Disorder NFER National Foundation for Educational Research ASDAN Award Scheme Development and Accreditation Network NHSP Newborn Hearing Screening Programme ASLI Association of Sign Language Interpreters NICE National Institute for Clinical Excellence BA (Ed) Bachelor of Art (Education) NVQ National Vocational Qualification Baha Bone-Anchored Hearing Aid OCD Obsessive Compulsive Disorder BAS British Ability Scales Ofqual Office of the Qualifications and Examinations Regulator BATOD British Association of Teachers of the Deaf Ofsted Office for Standards in Education – inspectorate BBC British Broadcasting Corporation OME Otitis Media with Effusion BCIG British Cochlear Implant Group PAIG Paediatric Audiology Interest Group BESD Behavioural, Emotional and Social Difficulty PECS Picture Exchange Communication System BETT British Education and Training Technology PETS Pressure Ventilation Tubes BSA British Society of Audiology PhD Doctor of Philosophy BSc Bachelor of Science PHSE Personal, Health and Social Education BSL British Sign Language PLASC Pupil Level Annual School Census CAMHS Child and Adolescent Mental Health Services PMLD Profound and Multiple Learning Difficulties CD Compact Disk PSHCE Personal, Social, Health and Citizenship Education CD-ROM Compact Disk Read Only Memory QCA Qualifications and Curriculum Authority CEO Chief Executive Officer QS Quality Standards CRIDE Consortium for Research in Deaf Education RMN Registered Mental Nurse CSSS Children’s Services Sensory Support (Norfolk in this Magazine) RNIB Royal National Institute of Blind People CSW Communication Support Worker RNID Royal National Institute for Deaf People dB Decibel RNTNE Royal National Throat, Nose and Ear (Hospital) DCSF Department for Children, Schools and Families RSDC Royal School for Deaf Children DipHE Diploma of Higher Education SAT Standard Assessment Task/Test DS Down syndrome S-BMD Sensory-Based Motor Disorder DVD Digital Versatile Disk SDD Sensory Discrimination Disorder EL Entry Level SEGRO Slough Estates Group – a provider of Flexible Business ENT Ear, Nose and Throat Space in Europe ERADE Exeter Royal Academy for Deaf Education SEN Special Educational Needs E-Tran Eye Transfer SENCO Special Educational Needs Co-ordinator FE Further Education SERSEN South East Regional SEN (Partnership) FEAPDA Fédération Européenne d’Associations de Professeurs de SESIP South East Sensory Impaired Partnership Déficients Auditifs (European Federation of Associations SGD Speech Generating Device of Teachers of the Deaf) SI Sensory Impaired/Sensory Integration FM Frequency Modulation (radio) SLD Severe Learning Difficulties GCSE General Certificate of Secondary Education SMD Sensory Modulation Disorder GTC(E) General Teaching Council (England) SNHL Sensorineural Hearing Loss HI Hearing-Impaired or Hearing Impairment SPD Sensory Processing Difficulties ICT Information and Communication Technology SSE Sign Supported English IEP Individual Education Plan STASS South Tyneside Assessment of Syntactic Structures INSET In-Service Education and Training STD Society of Teachers of the Deaf IQ Intelligence Quotient TBA To Be Announced KBER Kath Balcombe Educational Resources TDA Training and Development Agency (for schools) KS Key Stage ToD Teacher of the Deaf LA Local Authority ToVI Teacher of the Visually Impaired LD Learning Disability UK United Kingdom LEA Local Education Authority USA United States of America LSA Learning Support Assistant VI Visually Impaired/Impairment MFL Modern Foreign Languages VIEW Visual Impairment: Education and Welfare MHNP Mental Health Nurse Practitioner VOCA Voice Output Communication Aid MLD Mild/Moderate Learning DIfficulty VTHI Visiting Teacher of the Hearing-Impaired MQ Mandatory Qualification MSI Multi-Sensory Impaired/Impairment If you have found an acronym in the Magazine that isn’t explained NARA Neale Analysis of Reading Ability in this list, then use www.acronymfinder.com to help you to work NATD National Association of Teachers of the Deaf it out.
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Association business Membership subscription rates 2008–2009 due 1 August Annual Quarterly Cheque Direct Debit Direct Debit Full members in employment £ 60.00 £ 15.80 £ 65.00 Associate members in employment £ 60.00 £ 15.80 £ 65.00 Full members taking a career break £ 30.00 £ 7.90 £ 32.50 Associate members – unwaged £ 30.00 £ 7.90 £ 32.50 Retired members £ 30.00 £ 7.90 £ 32.50 Special members £ 22.00
Members are reminded that membership of the Association is only open to individuals. There is no category for Service or School membership. We are aware that some members have their subscription paid for them and that some have their mailing to their work address, but please remember, only the named individual is the member and no other person at that address can claim any benefits of membership. This subscription can be claimed against income tax. You do not normally need a receipt for this; just put it on your income tax form. A list of previous subscription details can be found on the BATOD website. Follow: The Association, BATOD membership, back-subscriptions information. Full membership is open to those teachers who have successfully completed training as a Teacher of the Deaf. As a Full member you will receive the Association Journal 'Deafness & Education International' four times a year and the Association Magazine, five times a year. You will have a discounted admission to any BATOD-run event and you will be entitled to vote at any meetings called. Associate membership is open to anyone else who is interested in the education of deaf pupils: teachers, speech & language therapists, those in training as a Teacher of the Deaf, parents, social workers, etc. Associate members have the same privileges as full members except they have no voting rights. Special membership is open to those working with deaf pupils in a support position, LSAs, CSWs, TAs, etc. As a Special member you will receive the Association Magazine five times a year and be entitled to members' rates at events, but you will have no voting rights. Members may seek Retired status on retiring from paid employment. If members return to work it is at their discretion to inform the Membership Secretary of their changed circumstances. For those retired members who no longer wish to receive the Journal there is a concession to pay a reduced subscription. Please contact the Membership Secretary. Current Full and Associate members who are entitled to a reduced subscription should notify the Membership Secretary of their circumstances by 30 June for the following year's membership, to enable the necessary paperwork to be completed. Members with a change in circumstance or personal details should inform the Membership Secretary as soon as possible. Our financial year runs from August to July. Cheque payers will be sent a reminder about payment in June. Direct debits will be altered automatically for payments in August and beyond. Only the named individual is the member and no other person at that address can claim any benefits of membership. Any enquiries should be made to: email: [email protected] BATOD Membership Secretary 112 Deas Avenue, Dingwall, Ross-shire IV15 9RJ All members are reminded that the Membership Secretary MUST be notified of any change of address to ensure that labels are changed and Magazines and Journals reach the new address.
Name changed to: Address changed to:
Post code Post code: Telephone: Membership number Email:
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Meetings and training Calendar
This page is an extract from the Calendar to be found on the BATOD website. Please note that it is not exhaustive. Items noted on this Calendar may have been advertised within the Magazine or the information reported by telephone. BATOD is not necessarily the organising body. Please contact the organising body (column 2) for details of conferences, not the Editor of this Magazine.
Date Organisation Meeting topic Venue March 24 Mary Hare Training Services Transitions for deaf children and young people Newbury 26 Sign Bilingual Consortium Curriculum developments in sign bilingual schools Frank Barnes School, and services Camden 31 NHSP Training and Consultancy Effective Audiological Assessment and Management for Deaf Children with Complex Needs Manchester April 1 Mary Hare Training Services An Introduction to Counselling Newbury 6–8 Cued Speech Association UK Easter at Exeter – Improvers and Advanced classes Exeter 6–9 Cued Speech Association UK Easter at Exeter – Foundation Course Exeter 9 Cued Speech Association UK Level 1 and 2 exams Exeter 21–22 Mary Hare Training Services BSA Course in Industrial Audiometry – subject to BSA accreditation Newbury 23 Mary Hare Training Services Promoting Deaf Children's Access to MFL Newbury 28 Scottish Sensory Centre Using film more effectively in the teaching and Moray House, assessing of deaf pupils (ICT workshops) Edinburgh EH8 8AQ 30 Mary Hare Training Services One-day intermediate course in Photoshop Newbury May 6–8 Mary Hare Training Services BSA accredited course: Hearing assessment in general practice, schools and health clinics Newbury 8–9 BATOD NEC Steering Group Association business TBA 9 City Lit Centre for Deaf People Pain-free signing: how to reduce the risk to your limbs City Lit, London WC2B 4BA 11 Mary Hare Training Services STASS Newbury 12–13 Mary Hare Training Services ACE – Using the Assessment of Comprehension and Expression with Deaf Children Newbury 14–15 Mary Hare Training Services Using the Reynell Developmental Scales with Deaf Children Newbury 16–17 City Lit Centre for Deaf People Note-taker training course City Lit, London WC2B 4BA 19 Ear Foundation Troubleshooting Cochlear Implants: Including FM Systems RNTNE Hospital, London 20 Mary Hare Training Services BSA accredited course: Otoscopy and Impression Taking Newbury 20 BATOD Midland What caused the hearing loss? – raising awareness of aetiology and the implications for the child Leicester LE3 9NR 31 Scottish Sensory Centre Enabling young deaf people to become confident individuals Moray House, (promoting resilience) Edinburgh EH8 8AQ June 1 Mary Hare Training Services Troubleshooting Cochlear Implants: Including FM Systems Newbury 8 Mary Hare Training Services Working with Hearing-Impaired Children Newbury 11 Mary Hare Training Services Working with Families in Homes and Early Years Settings Newbury 12–13 BATOD NEC Association business – regional emphasis TBA 12–13 Manchester University Deaf Education Fit for the Future: Innovation, Manchester Conference Research and Practice Centre 20 City Lit Centre for Deaf People BSL to English: advanced voiceover skills for CSWs City Lit, London WC2B 4BA 23 Mary Hare Training Services BSA accredited course: Certificate in Otoscopy and Impression Taking (Paediatrics) Newbury 24 Department of Education, NDCS Family-School Partnership: Promoting Deaf Harris Manchester College, University of Oxford and NDCS Children's Education 10am to 4pm Oxford OX1 3TD 26–27 BATOD NEC Steering Group Association business TBA
The Calendar on the BATOD website is edited as soon as we know about meetings. Additional information about courses and registration forms may also be linked to the calendar entries.
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Association business Officers of Nations and Regions BATOD contacts and Magazine Distribution
Northern Ireland Chairperson: Wendy Martin, 15 Ballyholme Esplanade, Bangor, County Down BT20 5LZ Secretary: Heather Lammey, 4 The Oaks, Newtownards, County Down BT23 8GZ Treasurer: Antonette Burns, 39 Wynchurch Avenue, Rosetta, Belfast BT6 0JP Scotland Chairperson: Moira Callan, 1 Cove Gardens, Cove Bay, Aberdeen AB12 3QR Secretary: Carole Torrance, Kerrann, 110 Causewayhead Road, Stirling FK9 5HJ Treasurer: Anne Pack, 63 High Beveridgewell, Dunfermline, Fife KY12 9ER Wales Chairperson: Marian Williams, 2 Woodview Terrace, Bryncoch, Neath SA10 7EQ Secretary: Marian Williams, 2 Woodview Terrace, Bryncoch, Neath SA10 7EQ Treasurer: Rhian Gibbins, Rhianfa, 24c Forest Hill, Aberdulais, Neath SA10 8HD Midland Chairperson: Pauline Wells, 9 Plantagenet Way, Ashby de la Zouch, Leicestershire LE65 1LE Secretary: Ursula Walker, 207 Bentley’s Lane, Walsall WS2 8SP Treasurer: Robert Miller, 13 Derby Close, The Meadows, Broughton Astley, Leicestershire LE9 6BE North Chairperson: Elaine Rayner, 25 Frosterley Drive, Great Lumley, Chester-le-Street, County Durham DH3 4SJ Secretary: Trish Cope, 23 North Drive, High Leigh, Knutsford, Cheshire A16 6WX Treasurer: Mary Fortune, 30 Alexandra Road, Stockton Heath, Warrington WA4 2UT South Chairperson: Mary Ensor, 9 Landrock Road, Crouch End, London N8 9H Secretary: post vacant Treasurer: Donald Allen, Freewaters Cottage, Freewaters Close, Ickleford, Hitchin, Hertfordshire SG5 3TQ South West Chairperson: Wanda Garner, 10 Ashleigh Road, Exmouth EX8 2JY Secretary: post vacant Treasurer: post vacant
Articles, information and contributions for the Submissions to the Journal Association Magazine should be sent to: ‘Deafness and Education International’ should be sent to: BATOD Secretary Dr Linda Watson Mr Paul Simpson School of Education tel/fax 0845 6435181 University of Birmingham email [email protected] Birmingham B15 2TT
...as should Association information and general email [email protected] queries.
Advertisements for the Association Magazine DISCLAIMER should be sent to: The Editors and the Association do not necessarily Mr Arnold Underwood endorse items or the contents of advertisements BATOD Publishing and published in the Magazine and cannot accept Advertising 41 The Orchard responsibility for any inaccuracies. Leven, Beverley Please note that items from this Magazine may not East Yorkshire be reproduced without the consent of BATOD and HU17 5QA the source must be acknowledged. tel/fax 01964 544243 Photocopying items may breach copyright. email [email protected]
BATOD Magazine distribution from: Royal Schools for the Deaf, Stanley Road, Cheadle Hulme, Cheshire SK8 6RQ Association Magazine ISSN 1366-0799 Published by The British Association of Teachers of the Deaf, 41 The Orchard, Leven, Beverley HU17 5QA Printed by The Nuffield Press Ltd, 21 Nuffield Way, Ashville Trading Estate, Abingdon, Oxon OX14 1RL Magazine Project Manager: Kath Mackrill batod_obc.qxp 12/2/09 10:16 Page 12