Inclusive Practices for Children who are Deaf and Hard of Hearing in Early Childhood Education Programs

The issue


Early identification and intervention has improved outcomes for most children who are deaf and hard of hearing (DHH) and has raised expectations for their education in general education settings with hearing peers. A 2015 Policy Statement on Inclusion of Children with Disabilities in Early Childhood Programs by the US Department of Health and Human Services and the US Department of Education , set forth recommendations for increasing inclusion of infants, toddlers and preschool children with disabilities, birth to age 5, in high-quality early childhood programs. The guidance addresses legal and scientific foundations that support inclusion, challenges to providing inclusive early childhood programs, and recommendations and strategies for education agencies to take action to promote a culture of inclusion. This statement raises several questions:

  • What does high quality early childhood inclusion mean?
  • How is the quality and appropriateness of the services, settings, teachers, and other providers evaluated and determined?
  • Do the local programs provide language rich environments that are fully accessible to young children who are deaf or hard of hearing?
  • Are inclusive programs culturally appropriate for the diverse community of American Sign Language (ASL) users?
  • How are families’ goals and expectations for their children considered in decisions regarding placement and services?
  • What training and support is provided for families specific to the language, communication, and technology needs of young children?
  • Do specialists knowledgeable and skilled in working with DHH children provide the necessary assistive technology, access supports, and staff training?

What we know

  • Family-centered early intervention results in better outcomes.
    • Families need information and guidance from experts.
    • Families need confidence to make informed decisions on behalf of their children and families.
    • Families need to be included as collaborative partners.
    • Interactions with families must be relevant to each family’s expectations, values and needs.
  • Early childhood is a critical period for early learning, literacy and social-emotional development.
    • Children’s language development is reflective of their linguistic exposure and experience; children need early, direct and consistent access to language and communication.
    • Early and appropriate fitting of amplification and ongoing management of its functioning and effectiveness is integral to listening and spoken language communication strategies. A listening and spoken language (LSL) approach requires special strategies to effectively support language development.
    • ASL must be delivered to ASL users directly by a teacher who is a competent ASL signer; sign language interpreters are not developmentally appropriate for toddlers and preschool-age children.
    • Children need authentic experiences with age-appropriate, as well as adult language, models and social peers.
    • Language and other developmental or learning delays are difficult for children to overcome.
  • High quality instruction is essential.
    • Appropriate and continuous assessment should guide development of goals, programming, and services.
    • Outcomes are better when early childhood specialists have expertise working with DHH children.
    • High expectations for achievement by families and educational specialists are essential to children’s academic success.
  • Significant challenges exist to deliver appropriate inclusive early childhood education for DHH children.

What we don’t know

  • What are the child outcomes of consultative vs direct services by a specialist or teacher of DHH children?
  • When families choose simultaneous dual language learning, what is the preferred delivery method? Does it matter whether the languages are simultaneously delivered (SimCom) or delivered via LSL part of the day and ASL or signed English part of the day so long as both are delivering a complete message?
  • What are the key elements to implementing a fully accessible, inclusive, early childhood program for DHH children?
  • What are the social-emotional implications of full inclusion for young DHH children?


In order to insure that DHH children are effectively included in early childhood programs, their language and overall development must be continuously monitored and evidenced-based developmentally appropriate practices must be used to guide decisions for services and placement. Inclusive programs are not appropriate for all children. Settings such as those at schools for the deaf or other special schools may be the best option in order to provide full access to language and communication with qualified providers and teachers. The early intervention tenants endorsed in the Joint Committee on Infant Hearing (JCIH) 2007 Supplement provide a practice framework that must be maintained throughout the early childhood experience.

If successful early childhood outcomes are to be realized, program administrators have an indispensable responsibility to families to insure that programs and services are designed to support each child and family’s unique situation and conform to their rights and entitlements.


Posted on Oct 6, 2016 by
Cheryl DeConde Johnson
The ADEvantage Consulting
cheryl {at}

Marilyn Sass-Lehrer
Deaf and Hard of Hearing Infants, Toddlers and Families Interdisciplinary Program
Gallaudet University
marilyn.sass-lehrer {at}

Further reading

Antia, S.D. & Kreimeyer, K. (2015). Social competence of deaf and hard-of-hearing children. New York: Oxford University Press. view details

Moeller, M.P., Carr, G., Seaver, L., Stredler-Brown, A., & Holzinger, D. (2013). Best Practices in Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing: an international consensus statement. Journal of Deaf Studies and Deaf Education, 18, 425-449. view details

Spencer, P.E. & Koester, L.E. (2016). Nurturing language and learning: Development of deaf and hard-of-hearing infants and toddlers. New York: Oxford University Press. view details

Sass-Lehrer, M. (2016). Ed. Early intervention for deaf and hard-of-hearing infants, toddlers and their families: Interdisciplinary Perspectives. New York: Oxford University Press. view details

Yoshinaga-Itano, C. (2003). From screening to early identification and intervention: Discovering predictors to successful outcomes for children with significant hearing loss. Journal of Deaf Studies and Deaf Education, 8, 11-30. view details

Yoshinaga-Itano, C. (2013). Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 19, 143-175. view details