The Case of Mary

Mary is a 12-year-old girl with a severe hearing loss and severe mental disabilities. Mary wears binaural

hearing aids for amplification. Mary is minimally verbal she uses gestures and relies on facial cues to

communicate adequately. Mary is also learning manual signs in conjunction with her verbalizations

(total communication). The goals that have been written for her are both academic goals and hearing

services goals Mary is also seen for speech/language services 3 times per week. It is difficult to perform

an accurate audiological evaluation on a child with severe Intellectual disabilities because the cognitive

level of a child helps with accurate testing but the results and diagnosis revealed a severe binaural

hearing loss. Mary always focuses on the speaker’s face, she struggles to look at the speaker’s face

which is indicative of a child who is hearing impaired. The hearing, speech/language therapist and the

classroom special education teacher meet on a regular basis to discuss Mary’s educational plan. The

hearing teacher works on auditory training with Mary and sign language skills. An auditory trainer is also

implemented in the classroom. The hearing teacher and speech/language therapist collaborates with

the classroom teacher on a regular basis to implement the best possible academic program for her

hearing and Intellectual deficits. The hearing teacher feels that because Mary’s vision is not impaired her

visual modality is the strongest and should be utilized to Mary’s fullest capacity. The hearing teacher has

suggested that when the classroom teacher speaks to Mary it is very important that she look directly at

Mary, turning away from Mary will cause her to lose a visual facial cue. The paraprofessionals, nurse,

counselor and all school personnel that come in contact with Mary should be trained how to

communicate with Mary.

The speech therapist is teaching Mary manual signs her sign language program consists of very

functional signs such as eat, drink, stop, give me, want, more, go, walk, help etc. It is recommended that

total communication should be used which is a combination of the manual signs with the words. Other

communication systems should be incorporated such as photos and Mayer Johnson symbols.

Bombarding Mary with different forms of communication will help Mary to communicate and utilize her

hearing to its fullest capacity. The speech/language therapist uses technology and adapted books in the

classroom. The Speech/Language therapist wears a microphone that is attached to a transistor type

system with earphones worn by Mary this is referred to as an auditory trainer. The speech/language

therapist places the earphones on Mary’s ears so that she can hear the books read. The books are

developed on the computer with a piece of software called notebook. The books can then be projected

on a smart board. Books that are developed with notebook software can incorporate sound into books

and allow students to move items around on the smartboard.

Literacy Classroom Goals

1. Mary will identify photo and or MJ symbol vocabulary items from an adapted book or smart

board that is based on a variety of themes by pointing 8/10 times for 3 consecutive sessions.

2. Mary will respond to “who” and “what” questions from adapted books and smartboard stories by

using the manual sign with verbalizations, photos or MJ symbols.

Mary will be encouraged to wear amplification at all times during the lessons. She does not

always tolerate her hearing aids but the auditory trainer should also be used by the teacher and

all service providers.

Math Goals

1. Mary will match 10 numbers to objects, photos and or MJ symbols i.e. one apple, two

oranges, 3 bananas, 4 melons etc. for 3 consecutive sessions.

2. Mary will identify 4 geometric shapes ie; a rectangle, circle, square, and triangle for 3

consecutive sessions.

3. Mary will 4 match geometric shapes to 10 actual geometric shaped objects for 3 consecutive

sessions.

Speech/Language Goals

1. Mary will use 2 word utterances with the manual signs to request items that she desires

in her immediate environment 4/5 times over 3 consecutive sessions.

2. Mary will choose 5 to 6 items that she desires by using manual signs, words or photos for

3 consecutive sessions.

Mary’s special education classroom teacher will use the academic goals above in the

classroom. The hearing teacher helped the teacher set the goals up for Mary. The use of the

auditory trainer, hearing aid, manual signs and visuals should be used at all times. Visuals

should be manual signs, photos, Mayer Johnson symbols and emphasis on facial cues Goal

number 1 under the literacy category is a good goal because it takes into consideration that

should develop and increase her vocabulary based on a story. Math goal number 1 is a goal

that considers Mary’s auditory limitations by introducing her with numerical skills using

visuals. The teacher will also utilize Mary’s visual modality to its fullest capacity by making

sure that she sees all items that are presented to her. Mary is classified as having a severe

binaural hearing loss. She was difficult to test because of her intellectual deficit for this

reason the amount of actual hearing that she has is questionable.

The audiologist tested Mary and she was also seen by an otolaryngologist (eye, ear and

nose doctor). The audiological assessment revealed a binaural hearing loss. Jane’s IQ is 40,

which is the highest level for her category of mental disability. Mary is minimally verbal she

communicates by using one word her speech/language therapist would like to increase her

vocabulary skills to two words. Receptively Jane can respond to and follow simple verbal

commands; Mary is also able to identify vocabulary items that are functional and familiar to

her.

The salient complications of Mary’s disability are characterized by the use of binaural

hearing aids and Mary’s inability to communicate. Mary relies very heavily on facial cues from

the speaker and some of her classmates and neighborhood children are not always sensitive

to her needs. Mary is a good student but when she becomes frustrated she can be disruptive

she will yell continuously at times. Mary is mainstreamed in a regular classroom. There are

other special education students in the class but they have different types of disabilities.

Mary attends school on a regular basis she does not have many absences. Mary is absent

from school when she is ill or has a doctor’s appointment. Most of the students in Mary’s

school are very understanding and helpful toward the students with disabilities. The school is

funded by the state and is a public school. The IDEA law states that all children are entitled to

a free public education in the least restrictive environment. This is a regular school with

special education students who are mainstreamed in regular classrooms. The school also has

an elevator for students who are not ambulatory and students with mobility deficits. The

school provides special education students with a special education teacher,

speech/language therapist, and physical therapist, hearing teacher, vision teacher,

occupational therapist and physical therapist.

Mary is seen by a hearing teacher 2 times per week individually. The speech therapist

also works in the classroom with the special education teacher, which is a requirement of the

district. The speech therapist is working on increasing Jane’s utterance length from one-word

utterances to two word utterances, manual signs are also incorporated with photos and

Mayer Johnson symbols. A total communication approach is being implemented by the

speech/language therapist

Mayer Johnson symbols

Adapted books

Photos can be google photos.

Binaural hearing aids

Smart board

Auditory trainer

REFERENCES

Archives, From Our Print. "Hearing Loss in Children." Advance Journal for Speech and Hearing (February 11, 2008 ).

—. "Noisy Classtrooms Add to Learning Difficulties of Students." Advance for Speech and Hearing ( August 5, 2002 ).

"Understanding ." UnderstandingSpecialEducation.com (Copyright 2009 UnderstandingSpecialEducation.com).