Educational Audiology Exam

LRE: Least restricted environment: as much involvement in the general education classroom to join their peers without limiting their educational goals and progress.

• Language-rich environment with the best placement for DHH children

FAPE (Free Appropriate Public Education): any child has access to education without parents having to pay, under IDEA

EA: Educational audiologist

Defines what an EA does (via IDEA):

• identify, determine range/nature, and degree of HL

• provision of habilitative activities (speech-reading/lip-reading, speech conservation, auditory training, etc.)

• creation of prevention of HL programs and counseling children, parents, and teachers

• determine need for amplification, select and fit, and evaluate the effectiveness of amplification.

LEA: Local education agency

• Public school district, charter, Part C provider (birth-2 years)

IEP: Individualized education plan via IDEA

• Receives funding

• Present levels (strengths/weaknesses, results of evaluations), special factors (communication plan), annual goals, accommodations/modifications, transition plan, service delivery, placement in LRE, meeting minutes

• Direct Services: Minutes of direct contact with the student, which are documented and delivered on a scheduled basis

  • Holistic Approach: incorporates aspects from analytic, synthetic, and pragmatic approaches = improvement of overall communication skills, psychosocial aspects of HL, education of SO

• Hierarchy of Auditory Skills

  • Detection

    • Listening walks

  • Discrimination

    • games with 2 different sounds

    • long vs short, loud vs quiet

  • Identification

    • treasure hunt for single-word items

    • multiple vs single syllable

  • Comprehension

    • talking, introducing new ideas

• Indirect Services: more consultative, spontaneous, on-call, or by request

40% of DHH individuals have a co-morbid diagnosis

Special Factors:

Communication Plan: for DHH students to ensure the child receives education in their native language

• determine appropriate accommodations

• Language factors (Spanish, ASL, AAC)

• All education options (placement-LRE)

504 Plan

• assessed without mitigating measures (that level the playing field like amplification)

• revisited every year but re-evaluated every 3 years

• general education teachers/classroom

• major life activities

IFSP: Individualized family service plan

• Part C (Early Intervention) of IDEA

• Teaching models, focus on routines related to the child’s disability

• 45 days from date of referral to evaluation and determination

Present Levels: strengths and weaknesses, health, communication, motor, cognitive

• Goals, Minutes, Transition

Reviewed every 6 months for annual reassessment

IDEA: individuals with disabilities education act

• requires the existence of a disability that adversely affects educational performance, necessitating special education and related services

  • Related service: EA, ToSDHH, SLP, OT, PT, SPED

ADA: americans with disabilities act

• prohibits discrimination in any state or local government entity

• equal access for all individuals within these entities who may be experiencing difficulties connected to broader definitions of disabilities, including students under the IDEA

• what 504 falls under from the Rehabilitation Act of 1972

RTI (response to intervention): identify students who are making inadequate progress and provide them with evidence-based support for learning and/or behavior needs in the general education classroom

• A framework before the initiation of a special education referral to ensure that the learning problem is not a result of a lack of appropriate instruction.

• Levels of intervention used before IEP

Tier I: Core Universal Interventions (All students)

• General classroom communication accommodations

  • Frequent check-ins for understanding

• HL prevention education and staff awareness

• Classroom audio distribution system

Tier II: Targeted Group Interventions

• Testing/exam accommodation and modifications

• Note-taking support

• RM HATs

• Priority seating

Tier III: Intensive Individualized Interventions (All students require special education with an IEP)

Including Tier I and 2 interventions plus….

• individualized instruction and accommodations

• Expanded core curriculum: addresses areas that are either not typically taught or require specific and direct instruction. The tool is designed to assist with program development in: extracurriculars, advocacy, career education, audiology, functional skills, technology, etc.

• team meetings, expanded training and consultation

Classroom Acoustics

• 35 dBA is the ambient noise level for unoccupied classrooms and RT of 0.5 sec

5 Acoustic Factors

1. background noise

2. SNR

   1. Children with HL require +20 to 30 dB SNR (more than ELL kids)

   2. Typical classrooms have +5 to -7 dB SNR

   3. Recommended +15 dB SNR

   4. Unoccupied ambient noise= 35 dBA

   5. Occupied classroom 55-60 dB

3. RT

   1. target: 0.6-0.7 sec, but reality is 0.4-1.4 sec

   2. A square room, more occupancy, smaller room/ceiling size, soft surfaces, and carpet reduce RT

   3. Speech Transmission Index: includes RT and background noise in how well a person can hear via combining the level of the talker’s voice at various distances and locations within a classroom

      1. The higher the number: 0.76-1.0 (excellent: listening environment)

      2. Opposite of RT

   4. Bad RT negatively affects speech intelligibility

4. Speaker-listener distance and directionality

   1. Incidental learning with an omnidirectional hearing aid

5. interaction amongst the 4 above variables

Universal design/benefit with more daylight in a classroom increases test scores, and also benefits of better visual cues for DHH students

Hearing Screening:

• K, 1, 3, 5, at 20 dB HL at 1, 2, and 4 kHz

• Once in middle school and twice in high school (ie. 7, 9, 11)

  • at 20 dB HL at 1, 2, 4, and 6 k Hz

• Recommend otoscopy, DPOAEs, PTAs, and Tymps (if not passed AUD, always with K and 1)

• 500 Hz is often not screened because of upward spread of masking makes it difficult to understand in background noise (low hums of outlets and 35 dB A of unoccupied classrooms)

• 8% will not pass initial screening and of that 8%, 6% will not pass follow-up screening

Sensitivity: the ability of the screening procedure to IDENTIFY the TARGET population ACCURATELY (hit rate)

• true positive/(true positive + false negative)

Specificity: the ability of the procedure to NOT IDENTIFY/PASS those who DO NOT have the DISORDER

• true negative/(true negative+false positive)

Why are major life activities important?

• Impacting caring for one’s self, performing manual tasks, concentrating, speaking, hearing, communicating, walking, sleeping

Overarching differences between HAT and when you would choose which

EduMic: Oticon and Cochlear CIs

• Pro: cheap, lightweight, can connect to multiple students

• Con: Cannot change the volume on mic

MiniMic2+: Cochlear CIs

• Pro: small, lightweight, cheap, pair to many devices

• Con: sound is poor, not designed for classroom

Roger: Phonak and AB

• Pro: adaptive sound, connects to most devices, easy to use

• Con: expensive, bulky, can be confusing to connect

Personal HAT system:

• Pro: reduce background noise, improve clarity (no distance factor), reduced fatigue

• Con: costly, easy to lose and break, changes as HAs change

Soundfield HAT system:

• Pro: benefits all students, most inexpensive, good parent participation

• Con: residual distance, increased RT, benefit only in the classroom

ASSESSMENTS AND PROTOCOLS

Proxy-Assessments: SIFTER, TEACH/PEACH

• SIFTER: screening instrument targeted at educational risk in the way they perform in class academically, with attention, communication, class participation, and behavior.

Self-Assessments: Quality of life, LIFE-R, CPQ, Vanderbilt Fatigue Scale

• Vanderbilt Fatigue scale of occurrence of listed statements/experiences can be self or proxy

• Classroom participation questionnaire about communication preferences and how you communicate in class

Listening fatigue

• Symptoms: slumped or slouching, irritability, ignore/not paying attention, requires more repetition in school, difficulty concentrating and following directions, headaches

Informational guidance

Phase I: understanding basic parameters, implications of the hearing condition

Phase II: information about communication, programs, and education

• F2F support, Deaf mentors, PIP

Education, technologies, and accommodations

Personal Adjustment Counseling: developing positive attitudes, self-determination, and addressing feelings, beliefs, and behaviors.

• cope with the emotional and psychological impact of HL

DIFFERENCES BETWEEN EAs and CAs:

HAT Systems

Troubleshooting

Transmitter: (HAT system)

• power/batteries

• Check the microphone (inserted into the jack)

Receiver: (Boot/Roger 21 or hearing device)

• power/batteries

• headphones (inserted into the jack)

• switch out to different headphones

• Verify if the boot is completely inserted

Case Studies:

Ways to encourage autonomy with the use of HAT:

1. Participation/socialization

2. Reward System

3. Give and Take: aim for 1 class/subject

4. Asking questions of why not

   1. Introducing conversations

Utah Law for DHH