Communication Considerations:

Deaf Plus

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1. What is Deaf Plus ?

Approximately 40% of children identified with hearing loss also have other issues (Gallaudet Research Institute, 2005).   The term “deaf plus” is a reference to the child’s hearing status combined with additional conditions. The conditions impacting these children are many and varied, including combined vision and hearing loss, children who have hearing loss and are on the autism spectrum, and children with cognitive impairments.  Infants and toddlers with multiple issues are more likely to have vision or hearing loss than their typically developing peers. 

The presence of hearing loss may make it more difficult to diagnose other disabilities. Hearing loss and the other disabilities may interact in such a way as to make it very difficult to tease out exactly what is happening.  Conversely, the other disabilities may mask the hearing loss, particularly if these other disabilities are also associated with delays in communication and language development.

As etiologies (known causes) associated with hearing loss have changed, the challenges facing families have also changed.    Some issues, although not diagnosed during early childhood, may still be impacting a child’s acquisition of language and communication skills. It is important to understand how hearing loss interfaces with a child’s other challenges in order to facilitate language acquisition and communication. A child with hearing loss and other issues may demonstrate significant splinter skills or gaps that impact development and learning.  Often a parent is the person who best understands a child’s unique needs; this is particularly true of some of the less common etiologies and syndromes.

 2. What issues are at the forefront of Deaf Plus?

It is vital that the uniqueness of each child be honored and respected.  Intervention strategies should be focused on the child’s strengths and on supporting the whole child.  In order to support a child’s communication system, there must be an understanding of all of the issues and how they impact other areas of development. The way the child learns is more than the sum of all of the challenges faced.   

Families with children who are deaf and hard of hearing with other conditions also face unique challenges.  Financial concerns are often heightened due to medical and educational interventions which are required.  In addition to the typical challenges presented by technology related to the hearing loss, these families often have added technology and equipment issues (i.e. walkers, assistive communication devices, and medical interventions such as feeding tubes). Schedules often become very tight as a child receives multiple therapies or intervention services.  Parents may not know any other parents who are faced with the same set of challenges and thus feel very alone.

Few assessment instruments are appropriate for this population, and appropriate assessments are important for setting appropriate expectations and determining strategies to support communication development.  If expectations are too low the child is not provided with appropriate learning opportunities.  If expectations are too high the child’s progress will not be honored. Educational placement is of particular concern as there is no “perfect” program for these children.  Programs for the deaf and hard of hearing often do not have staff with expertise needed to address a child’s other issues, while programs focusing more on physical or cognitive issues often do not have professionals skilled in communicating with deaf and hard of hearing children. A team approach is vital for these children so that all of their issues are addressed.

Although the incidence of children who are deaf and hard of hearing and have other issues is quite high, there is very limited information available in the literature about this population.  Often these children are excluded from research studies, due to the variability in the population. This is a very diverse group of children with widely varying needs. 

3. What should every parent or professional know about Deaf Plus?

All children communicate; it is the responsibility of parents and professionals to figure out how and what a child is communicating and build on that skill.  Affirm what the child is doing and acknowledge the communication that is present. If formal language is not yet present, or is only emerging, it is important to look at the early communicative stages and determine what and how a child is communicating.    

The blending of methodologies and technologies is often required as communication is tailored for each child.  Receptive language may rely on one communication system while expressive language may be strongest in another.  For example, a child may be a good hearing aid user and rely on audition for receptive language, but may need sign for expressive language. 

The development of communication takes time and patience.  “Wait time,” which exceeds that typically needed by children who are deaf and hard of hearing, is often crucial for these children.  

Above all, approach each child with his/her uniqueness and individual needs in mind.  Be willing to let the child teach and lead you.  In this way, each child can be assisted in reaching his/her full potential.    

4. Where else can I find information about Deaf Plus?

Perigoe, C. (editor) (2004).   Multiple Challenges, Multiple Solutions: Children with Hearing Loss and Special Needs. The Volta Review, 104, (5).

Gallaudet Research Institute (December 2005). Regional and National Summary Report of Data from the 2004 – 2005 Annual Survey of Deaf and Hard of Hearing Children and Youth.  Washington, D.C.: Gallaudet Research  Institute, Gallaudet University.

Jones, T. & Jones, J. (2003).  Educating Young Children with Multiple Disabilities. In B. Bodner-Johnson & M. Sass-Lehrer (Eds.),  The Young Deaf or Hard of Hearing Child  (pp.297 – 329).  Baltimore: Brookes Publishing Co.


Dinah Beams, M.A., has extensive experience with deaf and hard of hearing children and their families.  She has served as a Colorado Hearing Resource (CO-Hear) Coordinator for the past ten years, and in this capacity has met more than 400 families shortly after their child has been identified with a hearing loss.  For the last five years she has served as the Lead CO-Hear for the state.  Additional responsibilities in this position include hiring and training providers; writing curriculums, program development, ensuring program quality for all families, and collaborating with other agencies for the purpose of building better systems to serve these families.  Previously she worked as an Outreach Specialist for Beginnings for Parents of Children who are Deaf and Hard of Hearing in Raleigh, North Carolina where she was responsible for workshops, advocacy, and projects to ensure unbiased technical support for families.  She has also worked as both a classroom teacher and an itinerant teacher with deaf and hard of hearing children in Colorado.  Most recently, Dinah has completed several projects for CHIP, including authoring the new CHIP Parent Manual.  In addition to her responsibilities as CO-Hear, she worked collaboratively to develop the state’s Integrated Reading Project (IRP), part of Colorado’s Early Literacy Development Initiative, which is designed to foster the development of early literacy skills in young children who are deaf and hard of hearing.



* Communication Considerations A to Z™ is a series from Hands & Voices that's designed to help families and the professionals working with them access information and further resources to assist them in raising and educating children who are deaf or hard of hearing.  We've recruited some of the best in the business to share their insights on the many diverse considerations that play into communication modes & methods, and so many other variables that are part of informed decision making.  We hope you find the time to read them all!

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