Services and Settings for Deaf and Hard of Hearing Infants, Toddlers, and Young Children

The issue


The U.S. Centers for Disease Control and Prevention documents that 98 percent of the nearly four million babies born annually in the United States are screened through newborn hearing screening systems. However, many babies—over 40 percent—who are referred for confirmatory audiological testing on the basis of the screen (those suspected of being deaf or hard of hearing) do not receive it and are lost to follow-up. That means that a large number of these babies go unidentified. Then, of the approximately 5300 babies who are confirmed to be deaf or hard of hearing, only around 2400 receive early intervention services by age six months. Early hearing detection and intervention (EHDI) systems are not identifying a large proportion of DHH babies, thus these children are not entering early intervention in a timely manner.

What we know and what we don’t know

When DHH babies are identified early and begin receiving early intervention services by age six months by interventionists specifically trained to work with them, their outcomes are significantly better than those identified later. Deafness-specific programming by interventionists who understand and appreciate the value of alternative interventions is key. It is only those programs that include these elements that have been able to demonstrate success with early-identified babies.

After identification, then what? In the United States, early intervention and preschool programs favor services in “natural environments”—the home and community settings—and “inclusion” preschools—settings that have few children who are deaf or have disabilities. The U.S. Department of Education promotes this practice in a number of ways. For example:

  • It requires states to set targets for locations where children receive services and to collect and report data on those goals. However, it does not measure the sufficiency or quality of services to DHH children in these locations. Their impact on outcomes is thus unclear.
  • It offers significant assistance to states in supporting “inclusion,” although it does not offer similar assistance to states in supporting specialized settings such as schools for the deaf.
  • It issues policy statements that emphasize “inclusion” while remaining silent on the value of specialized settings.

Although research claims to cite the benefit of “inclusion” for all children, this research does not include representative samples of DHH children. DHH children comprise around one percent of the early intervention/Part C and IDEA age 3-5 populations. A comprehensive research review that did look at the experience of DHH children came to the conclusion they face great difficulties with communications and interactions with hearing peers in “inclusive” settings.

The Americans with Disabilities Act requires programs that are sponsored by state and local governments, such as education programs, to provide “effective communication” to DHH individuals. The U.S. Departments of Justice and Education have issued guidance on how this law must be applied on behalf of DHH students. Public schools and programs must ensure that communication with DHH students is “as effective as communication with students without disabilities.” Schools must provide communication-related “auxiliary aids and services.” And in determining appropriate auxiliary aids and services the public school must give “primary consideration” to the request of the DHH student (or parent). While this guidance should pave the way for better language access for deaf children in schools and programs, at present there is no monitoring in place to ensure this is happening.


Until EHDI systems resolve loss to follow up issues, we can expect to see many late-identified DHH children. Many of these children will experience language delays because of a lack of early intervention.

“Inclusion” settings will not be successful unless they are able to provide deafness-specific interventionists and programming and able to meet children’s language, communication, and developmental needs.

Specialized settings provide deafness-specific interventionists and programming and thus are an important part of any early intervention or education system.

Federal, state, and local education systems should collect data on DHH infants, toddlers, and young children to track their outcomes. The goal should be that outcomes for this population are commensurate with those of hearing peers.


Posted on Oct 20, 2015 by
Barbara Raimondo
Policy Consultant
baraimondo {at}

Further reading

Raimondo, B., & Yoshinaga-Itano, C. (2016). Legislation, policies, and role of research in shaping early intervention. In M. Sass-Lehrer (Ed.), Early intervention for deaf and hard-of-hearing infants toddlers and their families (pp. 105-134). New York, NY: Oxford University Press. view details

Sass-Lehrer, M. & Young, A. (2016). Evidence-based practice in early intervention: The proof of the pudding is in the eating. In M. Marschark, V. Lampropoulou, & E. Skordilis (Eds.), Diversity in deaf education. New York, NY: Oxford University Press. view details

Yu-Han Xie, Y., Potměšil, M., & Peters, B. (2014). Children who are deaf or hard of hearing in inclusive educational settings: A literature review on interactions with peers. Journal of Deaf Studies and Deaf Education, 19, 423-437. view details