Summary: Deaf and hard of hearing children can face significant challenges developing the language and literacy skills needed to succeed in school and become self-sufficient adults. The federal government supports these children through the Early Hearing Detection and Intervention (EHDI) program, which awards grants to states to develop systems to screen and diagnose newborns and infants for hearing loss and refer them for appropriate interventions. Also, the Individuals with Disabilities Education Act (IDEA) supports and funds early intervention and special education services for children with disabilities, including deafness and hearing loss. To better understand how federal programs support deaf and hard of hearing children, GAO was asked to examine the: (1) extent of hearing loss among children, (2) settings in which these children are educated, (3) factors that help deaf and hard of hearing children acquire language and literacy skills, and (4) challenges to providing appropriate interventions for these children. GAO analyzed data on hearing loss; reviewed research literature; interviewed educators, national organizations, parents, and state and federal officials; and examined relevant federal laws and regulations. A draft of this report was provided to the Departments of Education and Health and Human Services for review and comment. Each provided technical comments, which were incorporated into the report, as appropriate. GAO makes no recommendations in this report.
Available data indicate hearing loss affects a small percentage of children. In 2008, the prevalence of hearing loss among infants under 12 months was 0.1 percent, or about 1 diagnosed case per 1,000 screened. While the Centers for Disease Control and Prevention (CDC) does not collect hearing test data for children under age 12, other than EHDI data, federal surveys conducted from 2005 to 2009 estimated 3 percent or fewer of children nationwide under age 12 had hearing problems. Based on nationwide hearing examination data for youth aged 12-17 from 2005 to 2008, an estimated 1 percent had at least moderate hearing loss in one or both ears. Deaf and hard of hearing children are educated in a variety of settings, from regular classrooms to separate schools for the deaf. Data from the U.S. Department of Education (Education) indicate that in fall 2008 the majority of these children who received special education did so in regular early childhood programs or regular classrooms for at least part of their day. Experts GAO interviewed agreed that several key factors are critical for helping deaf and hard of hearing children acquire language and literacy skills. Early exposure to language--either spoken or signed--is critical because during the first few years of life it is easiest for children to learn language. Also, parents need to have information on the full range of communication options available so that they can make informed choices to meet their children's individual needs. Similarly, experts told GAO that education for these children should be individualized and that there should not be one standard approach for educating them. Additionally, having skilled professionals, such as qualified interpreters in regular classrooms, is important for ensuring that children with hearing loss receive the same information as their hearing classmates. Limited information and resources are challenges to providing deaf and hard of hearing children with appropriate interventions. Experts indicated that parents may not always receive information on the full range of communication options available, and may not understand the importance of enrolling their children in early intervention services. Additionally, a lack of data can limit efforts to evaluate early intervention outcomes. The EHDI law calls for CDC and the Health Resources and Services Administration in the Department of Health and Human Services (HHS) to support states in the evaluation of early intervention efforts--programs that are, in part, provided under IDEA. These agencies suggested that privacy requirements may restrict the information that EHDI and early intervention programs can share, limiting efforts to evaluate outcomes for children. However, HHS and Education are taking a number of steps to identify best practices for sharing data and tracking the outcomes of deaf and hard of hearing children who receive early intervention services. Experts also cited a shortage of qualified teachers and interpreters as a major challenge. Moreover, providing services for these students can be costly and it is difficult for schools to provide a variety of options, especially in rural areas.
