Jane Russell is concerned that her deaf toddler is becoming isolated at nursery. 'Sam's been going one day a week since he was one, partly because I was keen to develop his social skills,' she says. 'But I've now cut that down to half a day a week because he's getting distressed.'
Twenty-one-month-old Sam communicates mainly through British Sign Language.
'He's been signing since he was nine months old, and nobody at the nursery can sign. I can explain the basic signs, like "drink" or "book", but he's got over 100 signs and his vocabulary's expanding every day. That's one of the main reasons he tends to play on his own at the nursery. He loves books, and he sits in the corner with a book, signing away to himself.
'I only realised how isolated he was when a signing student nursery nurse visited the nursery, and told me he wasn't interacting, but it was becoming obvious that he wasn't happy without signed communication. He used to start screaming when we got to the entrance in the morning. Now it's only three or four hours, and it's not so bad, but we still need extra support. We live in a town and don't have the same networks that you get in bigger cities, and there's certainly no provision for deaf pre-schoolers. At the moment he's still at the age where they tend to play in parallel, but what concerns me is when he gets to the age when they play with other children.'
Left out
Jane is right to be concerned, despite deafness being high on the Government's agenda. The Department of Health is rolling out a new hearing screening programme for newborn babies in England, which will lower the average age of diagnosis from 20 months to three. But deaf children are still losing out on some of the things that their hearing peers take for granted, and the effects can sometimes be quite damaging.
A lot goes on in a hearing environment that deaf children can easily miss out on, as staff from the National Deaf Children's Society (NDCS) explain.
NDCS education development manager Anne-Marie Hall says, 'When children's play becomes less physical and more communicative, some children can get left out.' NDCS director of family services Anne McDowall adds, 'The development of self-confidence and a positive identity, and a sense of worth and belonging, is fundamental. It's the same for all children. If you don't feel good about yourself, obviously it's going to affect how you react with others.'
Mental health
At its most acute, this isolation can result in behavioural problems or depression. Statistics show that deaf children have a higher than average incidence of mental health problems. The Corner House deaf child and family service, which is part of South West London and St George's Mental Health NHS Trust, offers the UK's only specialist in-patient service for deaf children and young people with mental health problems. Its consultant child and adolescent psychiatrist Dr Peter Hindley says, 'Many deaf children miss out on the subtle discussions about what people are saying and thinking, and about why they're doing things. For instance, if a deaf child has seen someone getting upset, other people don't necessarily take the time to explain what's happened, so they miss out on the things that hearing children often take in just by overhearing.'
But nurseries, says Anne-Marie Hall at the NDCS, are in many ways well set up to facilitate the style of communication deaf children need. 'Nursery environments tend to be very visual and colourful, staff are very good at showing children what they're going to do, and the ratio of staff to children is good too.'
Early years guide
Ms Hall adds, 'Mainstream early years professionals haven't necessarily had much experience of working specifically with deaf children, and they're going to get more of them as we see more inclusive environments.'
Nursery age, she points out, is also the time when 'glue ear' is most prevalent, so many nurseries deal with children who don't have permanent hearing loss but are deaf for the time being.
She is keen for early years professionals to contribute to the current development of an early years version of the NDCS's guide for mainstream teachers, Deaf friendly schools, which contains comprehensive advice for primary school teachers. The new guide will focus on practical recommendations for including, communicating and interacting with deaf children most effectively.
Good practice
The Royal National Institute for Deaf People (RNID) also produces a series of publications for education professionals and local education authorities, in addition to its website www.deafnessatbirth.org.uk.The RNID's Jane Frew stresses how much good work is already going on with the under-fives. She lists some of the basic good practice for working with deaf children.
'Above all, make sure you've got the child's attention, visually or otherwise; make sure they can see your face,' she says. 'Deaf children also need to become familiar with the routine of the day, and they need a lot of repetition and reinforcement. Keep repeating and reinforcing messages like "sit on the carpet" or "time for a drink". Don't just ask "did you understand?" because they'll most likely just nod; develop strategies for making sure.
'If a child has hearing aids, remember these don't restore hearing to "normal" -they boost up all noise levels. This is one reason why you should try to keep background noise to a minimum (if that's possible in a nursery!). Maintain as much visual backup as you can. Draw pictures, keep deaf children as close to the front as possible at storytime or singing time, and remember that if you're sitting beside a deaf child, they can't look at your face and a book or a computer at the same time.'
Let them explore
At the same time, Jane Frew emphasises that deaf children should not be cosseted or held back from getting involved. She says, 'Encourage them to play with other children and explore the environment. Obviously, a lot of this is part of the ordinary nursery day, but do make sure you're encouraging deaf children and going through it with them, in as natural a manner as possible.'
Anne-Marie Hall adds, 'At nursery age, parents are the real experts in their children. They'll have a very good understanding of their likes and dislikes, so gather information, and then share it back with parents.'
Parent involvement
One example of such partnership comes from parent Tracy Ansell, who is pleased with how nursery staff have worked with her four-year-old daughter Lauren since she was diagnosed as deaf at the age of nine months. 'We've had our ups and downs, but I'm keeping her at this nursery until she goes to school. I think staff do have to be interested, and the staff at this nursery are great. We've always provided them with written information on how to talk to her, and on any signs we're using, and one of the staff actually came to college with us to learn sign language.
'As long as the nursery staff are happy to make the effort, and there's the right degree of support and attention from staff and other services, I really do think deaf children can flourish in a mainstream environment.'
Sam's mother, Jane Russell, makes several suggestions of her own.
'Acoustics are important. Put mats on the tables, stoppers on the chairs, rugs on the floors, absorbent noticeboards on the walls - things that will cut down on background noise. If you're considering an extension or new premises, think about acoustics, and of course about layout.
'And do send at least one staff member on a British Sign Language course.
It's a short course, but it gives you enough to communicate with a signing child. And then publicise this so that parents know where to find a nursery with signing staff.'
Further information
* RNID 19-23 Featherstone Street, London EC1Y 8SL. Tel: 020 7296 8000 Textphone: 020 7296 8001Fax: 020 7296 8199, email: informationline @rnid.org.uk,www.rnid.org.uk,www.deafnessatbirth.org.uk
* The National Deaf Children's Society 15 Dufferin Street, London EC1Y 8UR.
Tel: 020 7490 8656Fax: 020 7251 5020, www.ndcs.org.uk
