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Treatment Efficacy and Classroom Performance
Authors: Denise Wray and Carol Flexer

One of the basic premises of the auditory-verbal philosophy is the concept of education and participation in the least restrictive environment. A logical question, therefore, is, "does an auditory-verbal early intervention program prepare a child with a hearing loss for the mainstream classroom?" And once in the mainstream classroom, how do auditory-verbally educated children compare, over the years, with their typically hearing peers.

Subjects and Procedure
Because the evaluation of treatment outcome is essential, Carol Flexer. Ph.D and Denise Wray, Ph.D., surveyed the classroom performance of 19 children who had completed an auditory-verbal early intervention program at The University of Akron in Akron, Ohio. Of the nineteen students, 14 have congenital, bilateral hearing losses that are severe to profound (9 profound and 5 severe), 4 have moderate to moderately-severe impairments, and one has a moderate hearing loss in one ear and a profound hearing loss in the other. At the time of the study, eighteen wore conventional hearing aids and one had a cochlear implant. There were eight boys and eleven girls ranging from kindergarten through tenth grade. All were fully included in their home schools. However, three of the students also went to a resource teacher with other typically hearing children for one-half day or less. The other sixteen subjects remained in the regular classroom full time. These results were obtained during the 1994-1995 academic school year, and ongoing results are continuing to be obtained. Teacher participation for all students involved in the study was 100%. A survey entitled the Screening Instrument for Targeting Educational Risk SIFTER (Anderson, 1989) was mailed to all educators involved in teaching the students' main subject areas along with additional questions regarding reading abilities, FM usage, and support services The purpose of the SIFTER is to identify and track students who might be educationally at risk. The SIFTER was selected because it is an immediate, teacher-friendly way to collect data in a variety of skill areas identified as essential for success in the regular classroom (i.e., school behavior, class participation, academics. attention, and communication).

Results
The SIFTER allows for one of three classifications by teachers: pass, marginal pass and fail. For the purpose of this study, marginal scores were classified as "fail". Thus the scoring was dichotomized into either "pass" or "fail" resulting in a more conservative assessment of classroom performance. Of the five areas assessed by the SIFTER (school behavior, class participation, academics, attention and communication), 90% of the nineteen students received a "pass" regarding school behavior. Class participation and performance in academics tied for second place with 84% of the students receiving a "pass" score. Almost three-fourths or 74% of the nineteen students received a "pass" in the area of attention in the classroom. Clearly, the weakest area for the subjects was their communication skills with only 42% of the students receiving a "pass" in this area. However, when the subjects were divided into two groups specifically, kindergarten through third grade versus those students in fourth through tenth grade, a clear distinction surfaced. Only 25% of the younger subjects received a "pass" while 55% of the older students were assessed as passing. This progressive increase in scores suggested a discernible improvement in language comprehension and vocabulary as the subjects matured. Indeed, of the five skill areas, subjects evidenced the most dramatic improvement in communication skills as they aged chronologically. Attention skills and class participation remained essentially unchanged throughout the grade levels. In the academic area, 75% of the K-3 group passed and 91% of the 4-10 group passed. While 100% of the subjects in the K-3 group received passing scores for the school behavior, this number dropped to 82% for the fourth- through tenth-grade levels. Academic performance improved commensurate with communication skill improvement, although despite communication skills being deemed the weakest area for the K-3 group, their academic skills were not necessarily adversely affected.

Responses to the additional questions attached to the survey pertaining to FM usage, reading performance, use of support services, etc., yielded interesting results. For instance, teachers were requested to assess the reading levels of the students in comparison to their peers with normal hearing at the respective schools. Sixteen of the 19 students or 84% reportedly read "at" or "above" grade level. Furthermore, 44% of the 16 students were rated as reading at "above average" levels. These findings were quite remarkable in light of prior findings regarding reading levels of students having severe to profound hearing loss. In fact, 4 of the 19 students were placed in "gifted" or "honors" classes with two of those four having bilateral severe losses and two having profound hearing loss.

Using state-of-the-art amplification technology to achieve better access to verbal communication is an integral aspect of the auditory-verbal philosophy. Therefore, all students relied on amplification in the class and further enhanced their listening through the use of FM systems. Only the student with a cochlear implant was not using a personal FM at school, and this subject was in the process of investigating the possibility. Seventeen of those 18 students used FM systems 80% of the day or more, and teachers reported in 15 of the 18 cases they noted a significant improvement when the child was using the FM system.

Collaboration of professional expertise and effort further corroborate existing literature emphasizing a team approach for successful inclusion of students with disabilities. And, indeed, many of the students received a variety of related support services. For instance, 79% of the students received speech-language services and 37% received either math or reading tutoring in school, ranging from 2-5 times per week. P'orty percent of the students were receiving some type of private auditory-verbal therapy, and 60% received speech -language therapy solely through the school.

The focus of this study was not on the social and emotional issues at stake for students with hearing loss attending regular classrooms. However, it is important to note that 17 of the 19 subjects had passing teacher ratings in the area of school behavior, and 16 of the 19 received "pass" scores in the area of class participation suggesting that these students generally interacted well with their peers. Via telephone interview, parents reported that the children in this study were involved successfully in extracurricular activities with peers having normal hearing. Most families were highly involved in the local parent support group (Natural Communication, Inc.) which provided opportunities for them to interact with other students having hearing loss who were attending their local schools. It was noted that 17 of the 19 subjects were highly involved in activities in school, home, community and/or church settings.

Summary
This survey regarding the educational placement and performance of 19 students who were taught to listen and speak using an auditory-verbal approach reveals exciting information. Not only can children with hearing loss attend their neighborhood schools, they also can earn average or above average grades in comparison to peers with normal hearing, particularly in the content area of reading. These data contribute to the literature emphasizing that early intervention and amplification that allows the auditory centers of the brain to be developed are paramount to the successful mainstreaming of students having hearing loss. As professionals working with children having hearing loss, we must continue to evaluate our students' communication and academic outcomes in order to document program efficacy.

Anderson, K. (1989). Screening instrument for targeting educational risk (SIFTER). Little Rock, AR: Educational Audiology Association Products Manager.

Note: This is a precis of an article published in the Spring, 1997, issue of The Volta Review. Carol Flexer, Ph.D. and Denise Wray, Ph.D. teach in the School of Communicative Disorders at The University of Akron.

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