Supporting Students Who Are Deaf Plus in Educational Settings

Deaf Plus refers to students who are deaf or hard of hearing and also have an additional disability, such as intellectual disability, autism, ADHD, learning disability, or physical disability. These students need clear, explicit instruction, consistent routines, and supports that address both their hearing loss and their other needs.

Supporting Deaf Plus Students

Caption Credit: Image by Denis Kuvaev via Shutterstock

The term “Deaf Plus” refers to having both hearing loss and another disability or eligibility that qualifies the student for special education under the IDEA. It can often be difficult for educational teams to appropriately support students who are Deaf Plus, as some IEP teams will only recognize or focus on one eligibility (i.e., only medical issues, only autism, or only hearing loss) and not address all needs with equity. Lack of knowledge about the impacts of hearing loss by teachers and administrators adds to this challenge. The result leaves some students and families without all of the appropriate supports and services they need in the educational setting. Just as children with hearing loss cannot know when they didn’t hear something, specialists and educators don’t know what they don’t know about a disability they have not studied.

Approximately 40% of children with hearing loss have another disability. Newborn Hearing Screening (NBHS) programs test babies for hearing loss prior to leaving the hospital. However, when children are born with other medical conditions or other disabilities that are evident at birth, their hearing loss is typically identified 2 1/2 months later than children with no other medical conditions¹. Unfortunately, children who have medical conditions identified after the newborn period, including but not limited to ADHD, Cerebral Palsy, Autism Spectrum Disorder (ASD), and other physical/medical conditions that are evident at birth, are often not successfully screened for hearing loss. The children may be screened, but because they are hard to test, the results may not be taken seriously, are documented as unreliable, or are not followed up on while the medical professionals and families deal with other identified and known areas of need. Additionally, while the IDEA indicates that IEP teams should not identify children with hearing loss as being eligible for special education under the qualifying condition of Specific Learning Disability (SLD), there are professionals in the field who recognize that children can have both hearing loss and a learning disability.

General Population vs. Children With Hearing Loss.

The following is a comparison of the rates of some disabilities in the general population vs. children with hearing loss. Rates of Conditions Among Children Who Are Deaf/HH²

For children who are Deaf Plus, it is critical to have complete teams both medically and educationally. From a medical perspective, children who are Deaf Plus need to have all appropriate professionals on their team, including the pediatrician, pediatric neurologist, developmental pediatrician, geneticist, ophthalmologist, otolaryngologist with knowledge of hearing loss, pediatric audiologist, and others as needed. From an educational perspective, the team needs to include, at a minimum, the school psychologist, speech/language pathologist (SLP), deaf/hard of hearing specialist (DHH), educational audiologist (Ed AUD), occupational therapist (OT), adaptive physical education specialist (APE), nurse, physical therapist (PT), and all other appropriate providers.

As a teacher and family advocate, I have worked with students who have hearing loss, plus all of the following additional special education eligibilities:

• Autism Spectrum Disorder (ASD)
• Cerebral Palsy
• Visual Impairment (VI)
• Cognitive Delays
• ADD/ADHD
• Down Syndrome
• Specific Learning Disability (SLD)
• Speech Language Impaired (SLI)
• Emotional Disability (ED)
• Other Health Impaired (OHI)

As an IEP team, it is our job to identify all areas of need, draft goals to address those needs, develop supports and services that are appropriate to meet the goals, and make an offer of Free Appropriate Public Education (FAPE). Eventually, the time may come when one of the most important discussions for the family and the IEP team is to determine the primary eligibility. The team must discuss what primary issue is getting in the way of the child accessing his/her educational experience.

If our students who are Deaf Plus are provided with language access and intervention, be it ASL, total communication, or spoken language, and if the child is closing the gap between their chronological age and their hearing age, the team may need to discuss whether hearing loss continues to be the primary eligibility. Our students will always have hearing loss. They will always be “Deaf,” “Deaf/Hard of Hearing,” or “Hard of Hearing.” This is a condition that never goes away. However, there are times when the IEP team needs to identify if the hearing loss is the primary eligibility or the secondary eligibility.

EXAMPLE:
A student has hearing loss and is also on the autism spectrum. No matter if the family has chosen total communication, ASL, or spoken language with regard to the hearing loss, there may come a time when the hearing loss has been addressed; the communication needs have been addressed; the child is doing well with regard to his hearing loss; and the team needs to consider if the autism is actually the primary reason that the child is not fully accessing education. Even if the child’s deafness or hearing loss becomes the secondary eligibility, we need to ensure that the DHH Itinerant and Educational Audiologist remains a respected member of the IEP team. All providers who have another area of specialty need to have the benefit of the DHH lens present to support them as they serve the student. This same discussion applies to all of the other special education eligibilities.

References

1. Gallaudet Research Institute, 2005
2. http://www.infanthearing.org/ehdi-ebook/2015_ebook/9-Chapter9ChildrenPLUS2015.pdf

Key classroom strategies for Deaf Plus learners

• Use step-by-step instructions.
• Provide consistent routines.
• Use visual supports (charts, pictures, graphic organizers).
• Give explicit instruction in language and communication.
• Repeat and over-learn skills after they are mastered.
• Plan for real-life transfer of skills.
• Use hands-on, practical activities.
• Focus on strengths, not limitations.

Frequently Asked Questions 

What does the term “Deaf Plus” mean?
The term “Deaf Plus” (or “DHH Plus”) describes students who are deaf or hard of hearing and also have one or more additional disabilities, developmental differences, medical needs, or learning challenges. Under the Individuals with Disabilities Education Act (IDEA), approximately 40% of children with hearing loss are identified as having co-occurring conditions.

What disabilities commonly co-occur in Deaf Plus students?
While any condition can compound a hearing loss, the most common developmental and learning challenges include:

• Cognitive & Intellectual Disabilities (occurring in roughly 23% of cases)
• Neurodivergent Conditions: Autism Spectrum Disorder (ASD) and ADHD
• Physical & Motor Challenges: Cerebral Palsy and orthopedic impairments
• Sensory Gaps: Visual impairments (Deaf-Blindness)
• Learning & Behavioral Challenges: Specific Learning Disabilities (SLD) or social-emotional needs

What classroom accommodations and strategies help students who are Deaf Plus?
Effective teaching strategies must focus on a child’s unique strengths while addressing both the hearing loss and secondary diagnoses. Vital supports include:

• Visual Instruction: Utilizing object schedules, picture communication systems, and predictable visual routines.
• Explicit Language Instruction: Breaking down concepts into clear, step-by-step instructions with frequent repetition and “over-learning” opportunities.
• Environmental Adjustments: Minimizing background acoustic noise and optimizing room lighting for visual access.
• Multi-Sensory & Hands-on Activities: Incorporating tactile items and experiential learning to bridge language gaps.

What communication methods are most helpful for Deaf Plus learners?
Communication access must be highly individualized. Depending on the child’s specific developmental path, an educational team may utilize American Sign Language (ASL), total communication (signs paired with spoken language), Augmentative and Alternative Communication (AAC) devices, high-accuracy captioning, tactile sign systems, or professional educational interpreters.

How do IEP teams plan effective programming for a Deaf Plus student?
An effective Individualized Education Program (IEP) must look at the student through a dedicated “DHH lens” to ensure that hearing loss access isn’t ignored or masked by the other disability. The IEP team must construct goals addressing all areas of need, integrate specialized assistive technology, and periodically determine whether the hearing loss acts as the primary or secondary eligibility hindering classroom access.

Why is an interdisciplinary collaborative team critical for Deaf Plus success?
Because co-occurring disabilities interact and amplify one another, specialists cannot work in isolation. Success requires continuous collaboration between parents, Teachers of the Deaf/Hard of Hearing (TODHH), educational audiologists, speech-language pathologists (SLPs), occupational therapists (OTs), and school psychologists to ensure accommodations remain consistent across all settings.

Can Deaf Plus students participate in inclusive classrooms?
Yes. When provided with comprehensive language access, Universal Design for Learning (UDL) frameworks, and tailored placement supports, many Deaf Plus students can thrive in inclusive environments alongside their typically developing peers.

Additional Resources:
Deaf Plus Additional Needs
10 Low-Tech Ideas for Virtual Instruction
Creating the Least Restrictive Online Learning Environments
Access Check
e-Learning

This Special Education Overview Video provides an excellent real-world example of how school districts structure physical environments, multidisciplinary staff, and continuous language models across grade levels to successfully support diverse DHH learning tracks.

Author: Melinda Gillinger, M.A.
Special Education Consultant
www.melindagillinger.com

Click here to download the original article, including author information

Originally published: March 2020
Last update: June 2026