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Sunday, January 24, 2010



According to the Dept. of Education of the U.S. (1992): Specific learning disability means a disorder in one or more of the basic psychological process involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations.
LD is a general term for heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorder are intrinsic to the individual, presumed to be due to CNS dysfunction, and may occur across life span.

Types of LD:
 Difficulties in reading (dyslexia) and writing (dysgraphia)
 Language Processing Disabilities i.e. language understanding and expressive difficulties (dysphasia)
 Mathematical difficulty (Dyscalculia)
 Behavioural problems with poor academic achievement e.g. ADHD (Attention Deficit and Hyper Activity Disorder)
 All areas of academic challenges
 Fine motor disabilities
 Nonverbal LD and
 Visual-perceptual disabilities (low brain process visual information)

Causes of LD:
-Mathematical lag:- lag in mental and physical development for language and mathematical (academic) skills.
-Neurological disorganization: brain injury that inhibit neurological organization such as language, manual competence, visual, auditory competence etc.
-CNS dysfunction
-Malnutrition and vitamin deficiency
-Educational deficiency:- poor teaching attendance, curriculum, material, attitude and poor aspiration.

Life Span View of Learning Disabilities : Assessment and Treatment

Problem Areas: Delay in developmental milestones (eg. Receptive language, expressive language, visual perception, auditory perception, short attention span and hyperactivity)
Assessment: Prediction of high risk for later learning problems.
Treatment: Expert Support

Grades K-1
Problem Areas: Academic readiness skills (eg. Alphabet knowledge, quantitative concepts, directional concepts etc.) Receptive language, visual perception, auditory perception, gross and fine motor, attention and hyperactivity.
Assessment: Identification of LD
Treatment: Preventive direct instruction in academic and language areas, behaviour management and parent training.

Grades 2-6
Problem Areas: Reading skills, arithmetic skills, written expression, verbal expression, receptive language, attention span, hyperactivity, social-emotional and social skills.
Assessment: Identification of LD
Treatment: Remedial corrective direct instruction in academic areas behaviour management, self-control training and parent training.

Grades 7-12
Problem Areas: Reading skills, arithmetic skills, written expression, verbal expression, listening skills, study skills, social emotional and delinquency.
Assessment: Identification of LD
Treatment: Remedial corrective direct instruction in academic areas behaviour management, Tutoring in subject areas direct instruction in learning strategies (study skills), self-control training and curriculum alternatives.

Problem Areas: Reading skills, arithmetic skills, written expression, verbal expression, listening skills, study skills, social emotion.
Assessment: Identification of LD
Treatment: Remedial corrective direct instruction in academic areas. Tutoring in subject (college) or job areas. Compensatory instruction language using aids such as type recorder, calculator, computer, dictionary. Direct instruction in learning strategies.

Language and Communication Disorder

Communication:- It is an interaction that transmits information, and establishes common understanding communication in the process of exchanging knowledge, ideas, opinions and feelings.
Communication disorder could be in both verbal and non-verbal.

Speech Disorder
It is any imperfection in the production of sounds of language, caused by lack of muscle co-ordination, poor voice quality or organic defects results in speech disorder.
Language Disorder
It is a communication problem in comprehending, expressing, or otherwise functionally utilizing spoken language.

Speech disorders are problems with producing speech sounds (articulation), controlling sounds that are produced (voice), and controlling the rate and rhythm of speech (fluency).
Language disorder are problems with using proper forms of language (phonology, morphology, syntax), using the content of language (semantics) and using the functions of language (pragmatics).

Types of Speech and Language Impairment

Speech Impairment:- Speech is abnormal when it is unintelligible, unpleasant or interferes with communication. These are three types:- 1. Voice; 2. Articulation and 3. Fluency (eg: stuttering)
 Speech Voice:- Impairment in the production of oral spoken language due to absence of or abnormal production of vocal quality, pitch loudness, resonance and /or duration. Two aspects of voice are important – pitch and loudness.
 Articulation Fluency:- Abnormal production of speech sound, interruptions in the flow, rate, and/or rhythm of verbal expression. Articulation in the process of producing speech sounds.
 Fluency Problem:- are associated with the rate and flow pattern of a person’s speech. It involves hesitations or repetitions that interrupt the flow of speech. Eg. Stuttering.

Language Impairment:- These are three aspects of language: form, content, and use.
 Form:- Lack of knowledge or inappropriate application of the rule system. Three rule systems characterize form in language: phonology, morphology and syntax. [Phonology is the sound system of language; Morphology is the parts of words that form the basic elements of meaning and structures of the world. Eg. Prefixes, suffixes. Syntax determines where a word is placed in a sentence]
 Content:- relates to the intent and meaning of spoken or written statements. Inability to understand or correctly transmit the intent and meaning of words and sentences is also one form of language impairment.
 Use:- It’s a application of language in various communication according to the social situations.

Causes of Speech or Language Impairment:
Speech Impairment:- brain damage, malfunction of the respiratory or speech mechanisms, severely misaligned teeth and cleft lip or palate affects the production of nasal sounds.
Bad practices and Psychological causes:-
-Undue abuse of the voice by screaming, shouting, and straining can cause damage to the vocal cords and results in a voice disorder.
-Stress that creates stuttering – lack of fluency in speaking and repetition of sounds or words.

Language Impairments:
Organic Causes:- -brain injury or diseases damage to the CNS results in aphasia – inability to hear.

Environmental Factors:-lack of stimulation – punishment for speaking or being ignored trying to communicate.

Identification, Assessment and Intervention

Speech Impairment:- Identification has to be do on three aspects of speech – articulation, voice and fluency.
Articulation:- Those who do not use the right motor responses to form the sounds correctly. The speech mechanisms include tongue, lips, teeth, mandible (Jaw) or palate – to form speech sounds. There are four different kinds of articulation errors.
Substitutions, distortions, omissions, and additions;
Substitutions:- One sound is used for another. Eg: I see the rabbit ----(for that)—I tee the wabbit
Distortions:- Give the pencil to sally (the/p/is/nasalized)
Omissions:- A sound or group of sounds is left out of a word.
Addition: An extra sound is inserted or added to one already correctly produced. Eg. I miss her --(for that)—I missed her.
Voice:- Two general reason for voice problems in children—Organic cause (tumor) and a functional cause – Functional cause is due to uses of voices inappropriately – to low, or high in pitch or breathy.
Fluency:- The flow of speech breaks down. Stuttering is a fluency problem.

Language Impairment
Assessment of three aspects of language: form, content and use
Form: - To assess the form or structure of an language. Form cause errors in letter or sound formation, grammatical structure usage, or sentence formation. Those who are not mastered the rules of language might not be able to till the difference between sentences.
Content: - They do not understand the meaning of what is said to them and choose inappropriate words for oral communication difficulty in comprehending the written material in a textbook.
Use:- How appropriately a child uses language in social contexts and conversations.



In the middle of the century (Garwood, 1983) the following six criteria was used to define Mental Retardation. 1. Social Incompetence, 2. Mental “Subnormality” 3. Developmental arrest, 4. a later developmental phenomena, 5. is of constitutional origin, or 6. incurability.

The American Association on Mental Retardation, defined, Mental Retardation as: substantial limitation in present functioning. It is characterized by significantly sub average intellectual functioning, existing concurrently with related limitations in 2 or more of the following adaptive skill areas: -Communication and self care –Home living and social skills –Community use and self-direction, - health and safety, - functional academics, - leisure, and –work.

Mental Retardation has been classified into four educational levels:
1. Educable/ Mildly Retarded: - IQs between 50 to 70 – They are not much difference from normal children in their physical characteristics and general health – they can develop language and social skills – they have little sensor motor impairment – they are delays of only 1 to 3 years – they are capable of learning fundamental academics and personal responsibilities.
2. Trainable/ Moderately Retarded:- IQs between 35 and 49 – their adaptive capacity seriously impaired –they are able to master self-care skills, basic language and functional academics – they can benefit from vocational and social training and, with supervision, and care for themselves – they can educate within segregated schools, training centers or private facilities.
3. Supportable / severely retarded/ dependent mentally retarded:- IQs between 20 and 34 – develop little or no speech and can learn basic hygienic skills.
4. “Life-support” mentally retarded/ profoundly retarded:- IQs less than 20 – they may capable of very limited self care and they require constant supervision in a very structured environment.
Different Types of Classification of Mental Retardation
Educational Intelligence Measure
Normal 85-115
Slow learner Borderline 70-84
75-89 Mild retardation 55-69
Educable Moderate retardation
50-74 40-54
Trainable Severe retardation
25-49 Wech, 20-35, Binet
Custodial Profound retardation
<25 <20 Binet

Causes of Mental Retardation
They are: 1. Organic/ Physiological causes 2. Cultural-Familial Retardation
1. Organic/ Physiological causes
A: Hereditary Factors
B: Hormonal and Metabolic conditions:-

-Phenylketonuria (PKU) [defect in enzyme activity]
-Cretinism (Hypothyrodism)
-Down’s Syndrome (abnormal number and patterns of chromosomes)
-Hydrocephaly:- It involves a fluid accumulation in the cranium which causes an enlargement of the head. (Large head)
-Microcephaly:- Small brain and small head
C: Prenatal Influences-radiation, viruses, vitamins, hormones and drugs
-mumps and chickenpox in early pregnancy
-heavy use of alcohol intake of pregnant women
-poor nutrition and birth injuries
-blood incompatibilities
D: Postnatal:
-physiological –organic problems (meningitis) –malnutrition

2. Cultural-Familial Causes:
-Complications during pregnancy, delivery and infancy – larger family size (5/more) –greater crowding –unskilled and semiskilled labor –severely punished for specific behaviour –environmental influences (neglect, malnutrition and mental disorder)

Identification, assessment and intervention

They exhibit atypical physical features and serious delays in development soon after birth.
Difficulties are: [Infancy and Early childhood]
-Communication skills (speech and language), -self help skills – socialization (ability to interact with others)
Difficulties of childhood and early adolescence
-basic academic skills – reasoning and judgment – social skills to participate group activities and inter personal relationships
Late Adolescence and Adult life
-Vocational and social responsibilities and performance –Unable to understand teachers direction –show in all areas, academic, social emotional and physical – breaks rules of conduct or games –has short interest and attention span

Assessment-IQ Test
Infancy and Early Childhood:- -on sensor motor development –speech language and socialization skills
Late Childhood and Early Adulthood:- -Social skills –Academic skills –reasoning and judgment
Late adolescence and adulthood:- -vocational performance and social responsibility

Intervention-Education and training –good care and medical care

Familial support:- Attitudinal change –Adaptation training –counselling and proper guidance –work with professionals participate in rehabilitation program.

Educational Intervention:- -Placed in regular classes, special self contained classes, special day schools or institutional and adaptive behaviour –mildly retarded children placed in the regular class room, and to receive special help from resource room. –Moderately retarded children may learn in the regular class or special self contained classrooms. –Severely retarded children may placed in special classes, special schools or in group homes.



The visually impaired are broadly classified in two groups based on the degree of visual impairment. They are 1. The Partially (Weak) sighted or persons with low vision and the 2. The Blind. The visual measurement made by Shnellen Chart Notations of Visual Acuity. This chart consists of symbols (numbers/letters) that decrease in size. It read at distance of 20 feet. Visual acuity is measured by reading letters, numbers, or other symbols from chart 20 feet away. It is otherwise called “20/20 Vision”. Symbol size corresponds to the standard distance at which persons with normal vision can recognize the symbol.
There are both legal and educational definitions of visual impairment (Vergason, 1990)
--The legal definition points out the measurement of visual acuity, which is the ability to clearly distinguish forms or discrimination of details at a t specific distance.--

A: Partially Sighted/ Weak Sighted
It is a condition in which one’s vision is seriously impaired, defined usually as having between 20/200 and 20/70 central visual acuity in the better eye, with correction.
B: Blind (Blindness)
It is a descriptive term referring to a lack of sufficient vision for the daily activities of life. Legally, it is defined as having central visual acuity of 20/200 or less in the better eye with correction, or having the peripheral vision concentrated to an extent in which the widest diameter of the visual field covers an angular distance no greater than 20 degree (Vergason, 1990; Heward and Orlansky, 1988)

A: Partially Sighted Pupils:

These are pupils who by reason of impaired vision can’t follow the normal regime of ordinary schools without determent to their sight or to their educational development, but can be educated by special methods involving the use of sight. Such pupils use print materials but may need modifications such as enlarged print or use of low vision aids (Magnification) (Yesetdyke and Algozine, 1995)
B: Blind Pupils: Those are pupils who are totally without sight or have little vision, and who must be educated thorugh channels other than sight (for eg., using Braille or audio-tapes) [Yesseldyke and Algozine, 1995]

Normal Vision: --None 0.8 (6/7.5); slight: <0.8 (Normal)
Low vision: -- Moderate <0.3 (6/18); Severe <0.12 (6/48)
Blindness: -- Profound <0.05 (3/60); Near Total <0.02 (1/60)

The following are the some types and causes of Visual Impairment.
1. Refractive Errors:- It is common eye problems. Eg., Myopia (Near sightedness); Hyperopia (farsightedness). The light rays that enter the ye do not fall exactly on the retina. When the eyeball is too long, the image falls in front of the retina and myopia results. They can see things at near to them and they can’t distinguish images at a distance. When the eyeball is too short, the images fall at the back of the retina and hyperopia occurs. They can see things clearly at various distance but requires the lens curvature. (eg. Concave & Convex)
2. Astigmatism: - refers to distorted or blurred vision caused by irregularities in the cornea or other surface of the eye; both distant and near objects may be out of focus.
3. Diabetic Retinopathy: Impaired vision due to hemorrhages and the growth of new blood vessels in the area of the retina.
4. Amblyopia/ lazy eye:- it is a dimness of vision in one eye, causing suppression of the weaker eye and use of stronger eye. This is due to eye muscle imbalance, refractive errors or other defects during infancy.
5. Cataract:- it is a condition of cloudiness in the lens of the eye that blocks the light necessary for seeing clearly. Vision loss depends on where the cataract located on the lens and how dense the clouding is. Treatment will be effective (surgery/ eye glass or contact lenses)
6. Glaucome:- it is a condition in which the normal fluid of the ye (aqueous humor) doesn’t drain properly. This results damage to the optic nerve and results in severe loss of slight or tunnel vision. This person can see only the center of the visual field. If detect early it can treat with controlling the pressure in the eye.
7. Retinitis Pigmentasa:- It is a hereditary condition caused by the progressive degeneration of the retina. Individual first loses peripheral vision, and gradually central vision decreases. Common symptoms indicated colour blindness and night blindness.
8. Retrolental Fibroplasa:- It is a loss of vision results in formation of sear tissue at the back of the lens of the eye. It is due to the concentration of oxygen administrated to the child at birth in incubator.
9. Trabismus:- It is condition in which the eye is turned inward or outward or squints because of weak or malfunctioning muscles. Treatment involves patching the stronger eye, corrective lenses and surgery.
10. Nystagmus: It is a condition results in involuntary, rapid, rhythmic eye movements, usually side to side continuously. It may cause severe visual problems, brain malfunctioning and inner ear problems.

Infectious Disease Trachoma:- It is a common among people of many countries who surroundings are unhygienic and who are crowded together in unhealthy environments wherein dirt abounds. It creates irritation and scaring of cornea which gradually leads to Visual Impairment.
 Syphilis
 Measles
 Typhoid
 Meningitis
 Hypertension
 Diabetes
 Malnutrition
 Vitamin A Deficiency
 Injury and poison

Identification, Assessment and InterventionIdentification:
 Frequently experiences red or inflamed eyes, infectious and rubs them.
 Eye movements are jumpy and blinks frequently
 Experiences difficulty – moving around, reading small print, and loosing place during reading; to identify small details in pictures.
 Lacks interests in lights and visual stimuli
 Rubs eyes frequently, has poor eye hand co-ordination.
 Complaints headaches and eye infection frequently
 Blurred or double vision
 Holding reading material at an inappropriate distance
 Eye discomfort – burning, itching or scratching.
 Unusual facial expression and behaviour.


1. Screen whether the child can see light or not.
2. Visual acuity measurement: -Distance Acuity measurement –Near Vision Acuity Measurement [Hyvarinen (1997) presented procedures]
3. Visual Field: The field of vision of the area which can be see without any movement of the eye or head.
4. Color Vision: - Pseudoisochromatic chart eg: Ishihara plates (These plates are made up of colored dots in which are embedded the shapes or numerals. They are confusion tests of colour blindness. –City University Color Vision Test
5. Contrast Sensitivity:- Luminance is a measure of the amount of light emitted by a surface, and contract sensitivity in the terms applied to the eye’s ability to register differences in the luminance of objects, whether 2/3 are dimensionally presented.
6. Reading Acuity:-
Myvarinen (1997) suggested four measurement methods in Reading Acuity
Threshold: Measure the smallest text size that the child can read at a comfortable distance and the smallest eye that the child can read at a closer distance.
Optimal Size:- Measure how much larger the text needs to be allow fluent reading for a longer period of time.
Reading Speed: Measure how many words per minute and how many errors makes.
Reading Comprehension: Given a story passage and answer the important parts of the story.

It should do at home and school.
Home: - Creating loving and acceptance from family environment. – Develop positive interaction with child and encourage to talk and discuss – giving orientation to senses, listening, touching, smelling and tests – allow child to move freely – maintain close contact with teachers of the child and seek advice from professionals, parents of visually impaired children.
The School:- Reduce distance between teacher and students – Use auditory cues when referring to objects in the class room – seat students near chalk board or overhead projections, or give them freedom to move close to areas of instructions – reduce unnecessary noise to help focus on contact of instructional presentation.


BEHAVIOURAL APPROACH: It is following B.F. Skinner model and other behaviourist. It emphasis on (1) to provide highly structured learning environment and teaching materials. (2) The Interventions are likely to be increase or decrease the behaviour towards the goal. And this goal is carefully measured in frequency level in order to promote good education.
PSYCHOANALYTIC (PSYCHODYNAMIC) VIEW: It is based on the work of Sigmed Freud and other Psychoanalytic. (1) focus on unconscious conflicts (2) Motive of behaviour is not on behaviour itself but pathology of one’s personality. (3) So there is need for long term psychotherapy to resolve deep stated problems.
PSYCHO-EDUCATIONAL APPROACH: It is combines the principles of teaching with treatment measured in terms of learning – through everyday functioning at school and at home.
ECOLOGICAL APPROACH: This approach is mainly focus on to improve interactions with family, school and community or neighborhood (rather than treatment)
SOCIAL-COGNITIVE APPROACH: The behaviour is the result of interaction in a person’s physical and social environment, personal factors (thought, feelings, and perceptions), and the behaviour itself.
HUMANISTIC EDUCATION: Love and trust, in teaching and learning are emphasized; and children are encouraged to open and free individuals. It deals self direction, self fulfillment, and self evaluation.
BIOGENETIC APPROACH: Physiological interventions such as diet, medications, and biofeedback are used for the need of the children.



Important Terminology used:

SPECIAL NEEDS: are those with Learning Difficulties, Giftednedness, Socio-emotional OR behavioural problems, communication disorder, Mental disability (Mental Retardation), Sensory Impairments etc.
SPECIAL NEEDS EDUCATION: deals with children / students are risk of repeating and dropping out, having Learning Difficulties are excluded from education.
INCLUSIVE EDUCATION: Promotes education for all. For this education there will not any discrimination such as age, sex, race, religion so on.
INTEGRATION: It emphasis on specific areas such as Functional Integration, - only for activities; Social Integration – for social activity/ contact, Physical Integration.
MAINSTREAMING: It is a concept of serving special needs children according to their needs and potential in regular school program rather than separate schools or special classes.
SEGREGATION: refers to placement of special needs children in separate educational program (They do not have the opportunity as regular school system)
INTERVENTION: It is a procedure for correcting unproductive/ undesired behaviour to enhance individual development.
REMEDIATION: is the process of correcting inappropriate behaviour skills.
REHABILITATION: It is training for special needs children through re-teaching, re-training, educational program.
HABILITATION: It is a process of providing support, training and education for the individual development and holistic development.
HANDICAP: It is a result of any condition or deviation, physical mental or emotional that inhibits/ prevents achievement, acceptance and participation in economic and social activities.
DISABILITY: is a physical, psychological/ neurological deviation that results from impairments for specific function.
IMPAIREMENTS: refers to injury, deficiency, loss of parts of body or that lessening functioning of the individual.


Pasonella and Care (1981) defined Hearing Impairment as a generic term indicating a continuum of hearing loss from mild to profound, which includes the sub-classification of the Hard-of-hearing and Deaf.
A: Hard-of-hearing
A term describe persons with enough residual hearing, to use hearing (usually with hearing aid) as a primary modality for acquisition of language and in communication with others.
 Hearing loss between 21 and 69 Db (decibels)
B: Deaf:
A term used to describe persons whose sense of hearing is non-functional for ordinary use in communication, with or without a hearing aid.
 hearing loss above 70 dB
 They often uses Sign Languages

The Different Categorization of deafness:-
Congenitally deaf (Born deaf) or Adventurously deaf (deafness acquired some times after birth)
Otherwise it can be classified as:
1. Pre-lingual deafness (present at birth/ before speech is developed)
2. Post-lingual deafness (occurring after the development of speech)

In Ethiopia, no documents which helps understand both (Hard-of-hearing and Deaf) terms.
 it can be “idiots” – who can’t be educated to do not, not at all understand.
 In Amharic term “donkoro”
Meaning in Amharic dictionary:-
An individual whose hearing organ doest not at all function; mentally handicapped; and who lacked the ability to understand any language (Kesate Berhan, 1951)

Types of Hearing Impairment
They are three types:
1. Conductive
2. Sensory-neural
3. Mixed hearing loss

1. Conductive Hearing Loss:
It reduced the intensity of sound reaching the inner ear, where the auditory nerve begins.
 sound waves passing through external canal of the outer ear to the eardrum (the bone like structures) pass through inner ear.
 It is any condition hindering the sequence of vibrations or preventing from reaching the auditory nerve may cause conduction loss (Bamford & Sounders, 1994, Gallahger, 1983)

2. Sensory-neural Impairment:
This involves damage to the fine structures in the inner ear or auditory nerve transmitting the impulse to the brain.
 there is also central auditory disorder which results form damage to the central nervous system (CNS).
 This loss results in problem with auditory comprehension and discrimination.

3. Mixed Hearing Loss:
It is occurrence of both conductive hearing loss and sensory-neural impairment.
 for conductive hearing loss, can reduced by medical care with help of amplification of sound.
 But not possible with sensory-neural impairment.
Causes of Hearing Impairment:
It is in terms of:
 Birth period:- prenatal, perinatal and postnatal (Taylor, 1992)
 Genetic & environmental factors
 Chromosomal abnormalities, diseases, toxins etc. (Mittler, 1970)
 Ear structure:- Outer, Middle and Inner (Gardwood, 1983)
Other Causes:
-Hereditary – pregnancy – Rh incompatibility – Prematurity – Trauma – High fever – Infection – Measles

Identification, assessment and Intervention:
1. Identification: The primary identification is usually done by parents, teachers and doctors.
The following sign and symptoms are present to determine Hearing Impairment (Tirussew, 1998)
- Inattention, restlessness and distraction
- Complaints of ear ache, or visible discharge from ear
- Giving inappropriate answers to questions; watching and following what other children do.
- Needing to sit near a sound and asking for more volume, on TV, tape or record player to be turn-up.
- Some irritability or typical aggressive outbursts; behaviour upsets in school.
- Failure to turn immediately when called by name unless other visible signals are given.
- Speech limited and use of gestures and nail-biting
- Best work in small group

Heward and Orlansky (1988) offered following auditory behaviours as guides in the early detection of Hearing Impairment:
1 Month:

- will jump in response to loud noises
- will begin to make gurgling sound
3 Months:

- will aware of voices
- may quite down to familiar voices
- awakens from sleep when there is a loud sound
6 Months:
- make vocal sound when alone
- turn head towards sound or when name is called
- vocalize when spoken to directly
9 Months:
- responses differently to a cheerful versus angry voices
- tries to copy the speech sounds of others
- turn head towards sound or when name is called
12 Months:
- can locate a sound sources by turning head (whether the sound is at the side, above or below ear level)
- recognizes own name
- uses single words correctly
- laughs spontaneously
- attempts imitation of sounds and words
- responses to music or singing
24 Months:
- has more than 50 words in vocabulary
- uses two words together
- playing with sound-making objects
- shows understanding of many phrases uses in a daily life.
2. Assessment:
1. Audiological (hearing) assessment:
- careful observation of main sign and symptoms of Hearing Loss
- study the consequences and causes of hearing loss with the help of parents
- Distraction test, introduces a sound source behind and to either side of the child. In response, the child may turning the head (Freeland, 1989).
- Co-operation testing, where test is done as a game
- Tuning fork assessment; (for sound amplitude)
- Audiometric Assessment
2. Communication assessment
3. Assessment of speech and language development
4. Psycho-educational assessment
5. Personality assessment
6. Ecological Assessment :- Micro system – Exo System – Meso System – Macro System

3. Intervention:
It involves doctors specialized in children’s ear, teachers of the deaf, speech therapist, psychologist, audiologist, and parent (Freeland, 1989)

The Family:
The communication with a deaf child, the parents should observe the following points:
1. Develop positive attitude toward their children
2. Speak as clearly as they can and realize an exaggeration of the mouth is not required. – They will develop tip-reading skill.
3. Consider the gestures and try to use them with hearing impairment
4. Try to have hearing aids for the hard-of-hearing.
5. Communicate in home sign language and talk to the deaf children as much as possible.
6. To give opportunity for deaf child to communicate in sign, pointing gestures and noises.
7. The family should develop different strategies

The School:
- Teaching small groups
- Enhance positive self concept
- Develop IEP (Individual Educational Program)
- Deal crisis calmly and effectively
- Reduces distance between teacher and student
- Speak slowly
- Reduce background noises
- use face-to-face contacts
- during class uses visual clues
- encourage independent activities, cooperative learning and social skills.
- Listening to what the child has to say and allowing time for reply.