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 three 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 signs language skills. An

auditory trainer is also implemented in the classroom. The hearing teacher and speech/language

therapist collaborate 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 it is very important

for the teacher to 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 three 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 ten numbers to objects, photos and or MJ symbols i.e. one apple, two

oranges, three bananas, four melons, etc. for three consecutive sessions.

2. Mary will identify four geometric shapes a rectangle, circle, square, and triangle for three

consecutive sessions.

3. Mary will four match geometric shapes to 10 actual geometric shaped objects for three

consecutive sessions.

Speech/Language Goals

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

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

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

three 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 to 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. The school that is discussed in

this paper 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 two 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 google photos.

Binaural hearing aids

Smartboard

Auditory Trainer

Bibliography.

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

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

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