Deaf Hard of Hearing

Communication systems, environment, working with interpreters, and the cultural questions families navigate

Why this brief

Deaf and hard of hearing students span a wider range than most disability categories — students with mild unilateral hearing loss who attend general education with minimal support; bilingual ASL users in Deaf-centered programs; students with cochlear implants in mainstream classrooms with itinerant teacher support; students with progressive hearing loss; students who are deafblind. The team supporting any one of these students may include a Teacher of the Deaf (TOD), audiologist, educational interpreter, speech-language pathologist, classroom teacher, and paraprofessional. The work depends substantially on knowing the family's communication choices and the student's language profile.

This brief covers the basic distinction between cultural Deaf identity and audiological deafness, the major communication approaches and their implications, environmental design considerations, working with interpreters, common comorbidities and considerations, and the cultural and family decisions that shape the team's work. Deafblindness is treated separately in brief 07.13.

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| Language noteCapital-D "Deaf" refers to cultural Deaf identity — Deaf community membership, ASL use, Deaf cultural practices. Lowercase "deaf" refers to the audiological condition. "Hard of hearing" refers to less-than-total hearing loss. "Hearing-impaired" is generally rejected by the Deaf community in favor of "Deaf," "deaf," or "hard of hearing." Cross-ref brief 15.03 for the broader language frame; ask your specific family and student which terms they use. |

1\. The range of students under this label

Audiologically, hearing loss is described by degree (mild, moderate, severe, profound), configuration (which frequencies are affected), and laterality (one or both ears). Students with the same audiogram can have very different educational pictures depending on age of identification, technology, family communication choices, and access to language.

Functionally, students span:

Students with mild hearing loss in one ear, attending general education with environmental adjustments and minimal accommodation.

Students with moderate to severe hearing loss using hearing aids, in mainstream classrooms with itinerant teacher support.

Students with cochlear implants — surgical devices that bypass damaged hair cells in the inner ear — typically in mainstream classrooms; often acquire spoken language with intensive early intervention.

Students with severe to profound hearing loss using ASL as their primary language, in Deaf-centered programs (state schools for the Deaf, regional programs) or in mainstream classrooms with educational interpreters.

Students with progressive hearing loss — diagnoses where hearing changes over time, requiring evolving supports.

Students who are bilingual ASL/English users — for whom both languages are first languages.

Students with later-onset deafness (post-lingual) — lost hearing after acquiring spoken language.

Students who are Deaf+ — Deaf with additional disabilities (autism, intellectual disability, learning disabilities, physical disabilities).

The team's work and the para's role differ significantly across these. Read the IEP and talk to the family and TOD before assuming.

2\. Cultural Deaf identity vs. audiological deafness

This is one of the most important distinctions in DHH education and is often poorly understood by hearing teams.

2.1 The cultural-Deaf perspective

Deaf people, in the cultural sense, see themselves as members of a linguistic and cultural minority — the Deaf community — with its own language (ASL in the U.S., other sign languages elsewhere), history, art, literature, schools, sports, and norms. From this perspective, deafness is not a disability to be cured; it's a difference to be supported. The Deaf community has a long history of resisting framings that pathologize deafness.

2.2 The audiological / medical perspective

Deafness is a sensory condition with measurable hearing loss; intervention is typically aimed at maximizing access to sound (hearing aids, cochlear implants, auditory-oral therapy). Many medical professionals and many families operate primarily from this frame.

2.3 Most families navigate both

Many families of Deaf children are hearing themselves, and they navigate complex decisions: cochlear implantation or not, ASL or not, mainstream placement or Deaf-school placement, oral-only or bilingual approach. These are family decisions; school staff support them but don't make them. There are real disagreements between communities — for example, around early implantation — and the para's role is not to weigh in but to support the team's chosen path.

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| If you're new to this domainEngage the cultural-Deaf perspective seriously. The Deaf community has historically been talked over by hearing professionals about Deaf people's own lives. Read Deaf-led writing (NAD, Gallaudet, Deaf scholars) before assuming the medical frame is the only or right one. |

3\. Communication approaches

The student's primary communication approach drives most of the para's work. Common approaches:

3.1 ASL (American Sign Language)

A complete language with its own grammar and syntax, distinct from English. Native ASL users are bilingual or multilingual (ASL plus written English plus often spoken English). ASL is the primary language of the U.S. Deaf community.

3.2 English-based sign systems

Manually-coded English (MCE), Signing Exact English (SEE), Conceptually Accurate Signed English (CASE) — sign systems that follow English word order and grammar. Used in some educational programs. Linguistically not the same as ASL; Deaf community generally favors ASL.

3.3 Total Communication / Simultaneous Communication

Teaching and communicating using multiple modalities at once — speech, sign, fingerspelling, written. Common in some programs.

3.4 Auditory-Oral / Listening and Spoken Language (LSL)

Approach focused on developing spoken language through hearing technology (cochlear implants, hearing aids) and intensive auditory therapy. Common with early-implanted children. AG Bell Association is the largest organization promoting this approach.

3.5 Bilingual-Bicultural (Bi-Bi)

Both ASL and English are taught; the student is bilingual. ASL is first language; English literacy is taught explicitly. Common in Deaf-centered programs.

3.6 Cued Speech

A sound-based system using handshapes near the mouth to disambiguate phonemes that look the same on the lips. Less common but in use in some programs.

3.7 Tactile sign and Pro-Tactile

Used by deafblind students. (Cross-ref 07.13.)

These approaches sometimes blend in real classrooms. The student's IEP and the family's communication plan specify which approach the team is using; the para's job is to align with that approach, not to substitute their own.

4\. Hearing technology

4.1 Hearing aids

Amplify sound. Available in many forms (behind-the-ear, in-the-ear, bone-anchored). Daily care matters — student should arrive with batteries; school may have spares; the audiologist or TOD typically owns adjustment.

4.2 Cochlear implants

Surgical devices with an external processor and an internal implanted receiver. Bypass damaged hair cells; deliver electrical signal directly to the auditory nerve. Most common in students implanted in early childhood. Components include the external processor (worn behind the ear), the magnet/headpiece, the cable, and the battery.

4.3 FM systems / Roger systems / DM systems

Personal listening systems that connect the teacher's microphone directly to the student's hearing aid or implant, reducing background noise. Critical in classroom settings. Common practice: the teacher (and sometimes the para) wears a small microphone; the system pairs with the student's hearing technology.

4.4 Care, troubleshooting, daily checks

The TOD or audiologist usually trains staff in daily care.

Daily check at arrival: device on, batteries good, settings correct, magnet in place (for CI users), nothing damaged.

Familiarize yourself with what "working" sounds and looks like for this student's specific device.

Have backup batteries available (kept by TOD or in nurse's office, depending on district).

Don't try to repair or adjust the device beyond what training authorized — it's expensive equipment that requires audiologist intervention for many issues.

Surface device problems immediately — a malfunctioning device means the student is not accessing instruction.

4.5 When the device is removed

Some students remove their devices voluntarily (taking a break from sound, swimming, contact sports, sleeping). Some students with autism and additional needs remove them more frequently. The plan should specify when and how. Don't replace the device repeatedly without checking with the team — there may be reasons the student wants it off.

5\. Working with educational interpreters

Many DHH students in mainstream settings are accompanied by educational interpreters who provide ASL interpretation of classroom instruction. The interpreter is a credentialed professional, not the student's adult helper.

5.1 What educational interpreters do

Interpret spoken English to ASL (or other modalities) for the student.

Interpret the student's ASL responses back to English for the teacher and class.

Sometimes interpret peer comments and group conversations.

Work alongside the team but maintain a specifically defined role.

5.2 What educational interpreters typically don't do

Tutor the student or provide instruction.

Discipline the student.

Assist with personal care.

Substitute for the para's role in non-interpretation contexts.

Make decisions about content delivery, accommodations, or behavior.

5.3 Working alongside an educational interpreter

Sit so that the interpreter is in the student's clear sightline. The teacher should be visible to the student too.

Don't talk to the interpreter; talk to the student. "Marcus, what do you think?" not "Tell him to share his answer."

Pause between sentences when speaking; interpretation has lag.

Use the student's name and direct attention before asking them a question.

Don't translate or sign yourself unless you're the student's primary signer and authorized to do so. Untrained signing alongside an interpreter creates confusion.

Don't position yourself between the interpreter and the student.

Coordinate with the interpreter on routines, transitions, and unusual events. They need a heads-up, just like other team members.

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| Educational interpreters are credentialedEIPA (Educational Interpreter Performance Assessment) is the most common credentialing in U.S. schools. RID (Registry of Interpreters for the Deaf) certifies broader professional interpreters. "Knowing some sign" is not equivalent to interpretation; districts that staff classrooms with under-credentialed interpreters are providing inadequate access. (Cross-ref 08.11 on working with interpreters generally.) |

6\. Environmental design

DHH students benefit from environmental conditions that maximize visual and auditory access. Practical considerations:

6.1 Visual access

Lighting — the speaker's face should be lit; no backlighting that puts the speaker in silhouette.

Sight lines — the student should have a clear view of the teacher, the interpreter (if present), and any visual content.

Seating — typically near the front, but not so far forward that they have to turn around to see peers.

Visual reinforcement — visual schedules, written agendas, captions on videos, written instructions in addition to spoken.

Notice when speakers are facing away — turn the student's chair, repeat what was said visibly.

6.2 Auditory access

Background noise — minimize where possible. HVAC, hallway noise, multiple voices at once all reduce comprehension.

Distance — closer to the speaker is generally better for hearing-aid and CI users.

Acoustic treatments — carpet, soft surfaces, sound-dampening reduce reverberation.

FM / Roger systems used as designed.

Speak clearly at normal pace; don't shout.

6.3 Captioning

Videos used in instruction must be captioned. Federal civil rights frameworks (ADA, Section 504) make this not optional.

Live captioning (CART) is sometimes available for older students, especially in postsecondary.

Real-time captioning during announcements, assemblies, and emergencies.

7\. Academic and language considerations

7.1 Reading and writing in English

Many Deaf students develop English literacy more slowly than hearing peers, especially when ASL is the primary language and English is a second language acquired primarily through reading rather than listening. Reading instruction often needs more explicit teaching of phonological structure and English-specific syntax than typical curricula provide.

7.2 Vocabulary

DHH students often have smaller English vocabularies than hearing peers; this is not a cognitive issue but a language-access issue. Pre-teaching vocabulary, using dual-language anchor charts (ASL+English), and explicit vocabulary instruction help.

7.3 Background knowledge

Hearing students absorb a great deal of background knowledge incidentally through ambient conversation, radio, peer chatter. DHH students often miss this. Strong programs build background knowledge explicitly.

7.4 Math

Mathematics is sometimes a relative strength for DHH students because the visual and conceptual aspects don't depend on auditory access. Word problems and language-heavy math content require the same scaffolding as any language-heavy content.

7.5 Social access

Many DHH students in mainstream classrooms experience social isolation — peer chatter is hard to access; jokes don't land in time; group dynamics happen in spoken English. The para and the team should attend to social access alongside academic. (Cross-ref 04.18 on peer-mediated strategies.)

8\. The Deaf+ student

Some DHH students have additional disabilities — autism, intellectual disability, specific learning disabilities, ADHD, physical disabilities, mental health conditions. These students are sometimes called "Deaf+" in the field. Their educational picture is layered and often requires expertise from multiple specialty areas.

Particular considerations:

Identification can be complicated. Some symptoms of additional disabilities (delayed language, social communication differences, attention concerns) overlap with what's expected from inadequate language access; the team needs to disentangle.

Communication systems may be more complex — combining ASL, AAC, gestures, signs, and other modalities.

Mental health support is often needed and often missing — the field has fewer Deaf-fluent mental health providers than students need.

Family stress is real — multiple specialty appointments, multiple service providers, navigating both Deaf community and disability community resources.

9\. Family and community considerations

Families of Deaf children navigate complex terrain that the para should be aware of:

Hearing parents of Deaf children — about 90% of Deaf children are born to hearing parents. The communication-modality decisions these families make shape the student's life. The decisions can be in flux.

Deaf parents of Deaf children — often (not always) come to the school relationship with strong views about Deaf culture, ASL, and the school's communication approach.

Deaf parents of hearing children (CODAs — Children of Deaf Adults) — different family configuration; bilingual home.

Cultural background interactions — Deaf experience varies significantly across racial, ethnic, and immigrant communities.

Cochlear implant decisions — sometimes contentious within and across communities.

Educational placement decisions — Deaf school vs. mainstream — can be a decade-long family conversation.

Listen. The family knows their child's history and language environment far better than the school does at the start. Don't bring assumptions about which approach is right.

10\. Equity considerations

Underdiagnosis — Deaf students of color, students from low-income families, and students whose families have limited English may be diagnosed later, with less audiological follow-up, and with less access to specialty services.

Provider language fluency — there are not enough Deaf-fluent professionals (TODs, mental health providers, audiologists, interpreters) for the population. Districts often understaff.

Mainstream placement is sometimes the default even when a student would do better in a Deaf-centered program. The IEP team's placement conversation must consider full continuum.

Captioning compliance is uneven; many students experience video instruction without captions.

Intersection with race — Black Deaf students experience compounded disparities; their voices in the educator workforce and on advisory bodies are underrepresented.

11\. Common pitfalls

Treating cultural Deaf identity as a deficit framing.

Speaking to the interpreter rather than the student.

Assuming "some sign" qualifies you to interpret.

Letting the device or interpreter become the entire support, ignoring environmental and instructional design.

Skipping captioning on videos used in instruction.

Background noise and lighting decisions made without considering the DHH student.

Treating language gaps as cognitive deficits.

Not building social access alongside academic access.

Imposing a communication approach the family hasn't chosen.

Not flagging device problems immediately.

Treating Deaf+ students as Deaf-only or as additional-disability-only rather than as students with multiple integrated needs.

12\. Resources

Major organizations

National Association of the Deaf (NAD) — nad.org — National civil rights organization for Deaf and hard of hearing people.

Gallaudet University — Clerc Center — clerccenter.gallaudet.edu — National research and resource center for Deaf education.

Hands & Voices — handsandvoices.org — Family-driven non-profit; supports families regardless of communication choice.

AG Bell Association — agbell.org — Advocates for Listening and Spoken Language approach.

American Society for Deaf Children — deafchildren.org — Family support organization.

Educational and professional

Council on Education of the Deaf (CED) — councilondeafed.org — Teacher of the Deaf credentialing organization.

Registry of Interpreters for the Deaf (RID) — rid.org

Educational Interpreter Performance Assessment (EIPA) — classroominterpreting.org

Deaf Education Resources — Boys Town National Research Hospital — boystownhospital.org

Cross-references

Brief 07.13 — Deafblindness — this library

Brief 08.11 — Working with Interpreters — this library

Brief 10.05 — Sign Language Basics for Paras — this library

Brief 15.03 — Disability Identity and Language — this library

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