Deaf with Disabilities (Deaf Plus)

“Deaf/HH Plus is meant to be a positive term, not in any way negative or insensitive to the child who has medical issues along with hearing loss. In fact, I see it as an “A+” or “B+,” meaning the child carries additional positive qualities, but it is a gift that needs to be carefully unwrapped. And it may not appear to be a gift when you first receive it. Time helps you appreciate, understand, and unfold the possibilities. And the “Plus” most often means the child and family has added responsibilities and requires additional expertise.” 

-From Children Who are Deaf/Hard of Hearing PLUS, NCHAM E-book: A Resource Guide for Early Hearing Detection and Intervention

What is Deaf with Additional Disabilities (Deaf Plus)?

Approximately 40% of children identified with hearing loss also have other issues (Gallaudet Research Institute, 2005). Some use the term "Deaf plus" to refer to the child's hearing status combined with additional conditions. The conditions impacting these children are many and varied, including combined vision and hearing loss, children who have hearing levels and are on the autism spectrum, and children with cognitive impairments. Infants and toddlers with multiple issues are more likely to have a vision or hearing loss than their typically developing peers. 

The presence of hearing level may make it more difficult to diagnose other disabilities. Hearing level and other disabilities may interact in such a way as to make it very difficult to notice what is happening. Conversely, the other disabilities may mask hearing level, particularly if these other disabilities are also associated with delays in communication and language development.

When the hearing level is not diagnosed during early childhood, some issues may still be impacting a child's acquisition of language and communication skills. Understanding how hearing level interfaces with a child's other challenges is essential to facilitating language acquisition and communication. A child with a hearing level and other issues may lack skills or gaps impacting development and learning. 

What should every parent know about Deaf Plus and communication?

All children, including Deafplus, communicate; it is the responsibility of parents and professionals to figure out how and what a child is expressing and build on that skill. Affirm what the child is doing and acknowledge the communication that is present. If formal language is not yet present or is only emerging, it is essential to look at the early communicative stages and determine what and how a child is communicating. Exposure in visual language is essential. Do not wait. Start as soon as possible.    

The blending of methodologies and technologies is often required as communication is tailored for each child. Receptive language may rely on one communication system, while expressive language may be strongest in another. For example, a child may be a good hearing aid user and rely on hearing for receptive language but may need a sign for expressive language. 

The development of communication takes time and patience. "Wait time," which exceeds that typically needed by children who are deaf and hard of hearing, is often crucial for these children. 

Above all, approach each child with his/her uniqueness and individual needs in mind. Be willing to let the child teach and lead you. In this way, each child can be assisted in reaching his/her full potential.    

Living with Autism has been the hardest challenge for Antonio, he has a hard time with a change in his routine in general but thrives with routine. He heavily relies on the Picture Exchange Communication System (PECS) and a clear routine schedule to communicate and predict what is happening next. DPAC has worked tirelessly to increase his ability to express his emotions and/or needs through Sign Language and PECS. The PECS system has been a great tool for Antonio to use in addition to ASL since his (CP) limits him from signing clearly. Seven years later, Antonio has thrived immensely! Now he can express his needs through signing, writing, or typing using the notepad on his iTouch device.

The term “Deaf Plus” refers to children who have a hearing loss in addition to other conditions that affect them medically, physically, emotionally, educationally, or socially. This can include: 

➢ intellectual/cognitive disabilities 

➢ emotional and behavioral disabilities 

➢ learning disabilities 


➢ visual impairment 

➢ cerebral palsy 

➢ autism 

➢ orthopedic involvement

➢ other physical disabilities

Challenges among the families and professionals

➢ When special education services are needed, finding an appropriate placement and supports is dependent upon first obtaining a reliable evaluation of the child’s abilities and needs. 

➢ When a child has a complex profile with multiple disabilities, the evaluation becomes more critical. 

➢ Finding qualified evaluators can be extremely difficult.

In addition to language access, one must consider: 

➢ The nature and severity of the disability. 

➢ The child’s age, prior education, and current functioning. 

➢ The child’s ability to work independently and in groups. 

➢ Support services needed – speech and language, mobility, occupational and/or physical therapy, behavioral support, mental health services, etc.

Even in the best of circumstances, we cannot know with certainty what will work for a child with a unique profile of complex needs. We must continually observe, assess, review progress and be prepared to make changes if needed. Successful strategies for children who are Deaf Plus are future-oriented - the goal being to prepare students to participate in society as fully as they desire once they leave school.

Materials & Strategies Used with Children Who are Deaf Plus 

No single specific educational technique is appropriate for all children who are Deaf Plus since each child has unique needs. 

Characteristics of a successful program should include: 

➢ a high level of structure 

➢ specific, clearly stated objectives 

➢ a focus on the individual needs of each child 

➢ instruction that is step-by-step in nature 

➢ practical experiences in natural environments 

➢ consistent routines 

➢ age-appropriate materials are important 

➢ a focus on motivating the child 

➢ to the provision of successful experiences 

➢ an emphasis on the student’s skills in given situations, not his limitations 

➢ over-learning (going over a skill after it seems to be mastered) may be necessary 

➢ planning for the transfer of instruction to real-life situations

There may be specialized programs and services available locally for some children who are Deaf Plus. Coordinating services across many different providers, and with the school, can require considerable effort. 

"He listened and then asked what would help her feel better. Together, the two of them came up with a plan."

CHECK the ARTICLE: Parents magazine: April 2021

Special Education Strategies That Work for All Kids