Deaf, DeafBlind, DeafDisabled, Hard of Hearing

Deaf, DeafBlind, DeafDisabled, Hard of Hearing

Deaf woman and child learning sign language



Children with hearing loss can be Deaf, DeafBlind, DeafDisabled, or Hard of Hearing. This phrase can be abbreviated as DDBDDHH.


  • Children who are Deaf have very little or no functional (usable) hearing and often use sign language to communicate.
  • In addition to being Deaf, a child who is DeafBlind may have very little or no functional vision, or may be able to indistinctly see light, shapes, colors, and objects.
  • The label, DeafDisabled or Deaf Plus, is for Deaf children who have one or more disabilities in addition to being Deaf. This may include developmental disabilities like autism, intellectual disabilities, and cerebral palsy; mental health disabilities; and traumatic brain injury (TBI).
  • Children who have some or a lot of hearing, but do not hear as well as hearing children, may identify as hard of hearing or as (The term hearing impaired is offensive.)

The Importance of Early Language

  • DDBDDHH children (DDBDDHH) who have not been fully immersed into American Sign Language (ASL) at a young age may develop early language delays, along with delays in cognitive and psycho-social development. In fact, not having early language can interfere with short-term and long-term memory functions, memory capacity, recall strategies, and organization (Edwards, 2004, as cited in Chandler.)
  • ASL allows full fluency in communication, has its own grammar and syntax, and relies heavily on facial expression and body movement.

What You Might Notice

Many DDBDDHH children normalize their experience of having been sexually or physically abused and/or exploited because they are not aware that it is not normal. Abused children and youth are not likely to discuss the abuse unless they are specifically asked.

If children who are DDBDDHH or are hard of hearing and their parents do not share a common language, it can be difficult to discuss complex issues like preventing or disclosing abuse. These communication difficulties may actually lead some parents to disbelieve their child who reports abuse or inappropriate sexual experiences.

A DDBDDHH child may not be at the same developmental age as their chronological age, and are likely to be delayed in their ability to express themselves.

Children Who are Hard of Hearing

Speech can be delayed and not clear.

Children who cannot hear well are often mistakenly accused of not paying attention or ignoring directions. They may seem to understand but are not getting clear information, miss the point, and become confused.

Family members of hard-of-hearing children often alert them where to look if someone is speaking or where to direct their attention. Without those cues, they may have difficulty in an interview or interaction.

(Adapted in part from Chandler and Centers for Disease Control and Prevention.)

Before Meeting the Child


Find out how the child best communicates: sign language, speaking, writing, or assistive listening devices.

American Sign Language, also known as ASL, is not a universal sign language. People from another country may use that sign language, such as Mexican or Canadian Sign Languages.

  • DeafBlind children and adults use tactile sign language and/or Pro-Tactile (hands on hands to communicate).
  • Children who are Hard of Hearing may hear and speak.
  • Deaf children may also speak fluently and not sign at all. They may communicate using a speech-generating device or an FM (frequency modulation) system, which uses radio waves to send speech and other signals to hearing aids or cochlear implants.
  • Some adults and children may read lips or speech read. However, only about 30-45% of what is being said can be understood through lip reading (Lieu, et al., 2007).
  • English skills vary, because English is a second or third language for many Deaf children and adults. American Sign Language has its own grammar, which means that writing notes may not work well for everybody.
  • Home signs from their own family. Some families develop their own signs.
  • Signed exact English (SEE), which is a system of signing that tries to exactly represent English vocabulary and grammar through signs and finger spelling
  • A mixture of these methods

If the child communicates through ASL, schedule a certified sign language interpreter, preferably with experience interpreting in cases of child abuse. Request separate interpreters for a victim and suspect.

Specify other language needs when requesting interpreters, including: ASL or sign language from another country, Tactile or Pro-Tactile sign language interpreters for children who are Deaf/Blind, Certified Deaf Interpreters (CDI), who are used in combination with ASL interpreters for children who have limited communication skills. CDIs can also help interpret “home” sign, facial expression, slang, foreign sign language, or just gesturing, and can aid the hearing ASL interpreter greatly in communication. If CDIs are unavailable, ask for ASL interpreters who have experience with children and adults with limited ASL skills.

For criminal or civil court proceedings, Texas law requires the use of an interpreter with Court Interpreter Certification (CIC) or Registry of Interpreters for the Deaf (RID) Specialty Certificate: Legal.

(Adapted in part from Texas Health and Human Services.)

Assistive Listening Devices

Become familiar with whatever assistive listening devices the child uses. In addition to hearing aids and cochlear implants, the child may use an independent amplification system. Individual personal amplifiers amplify close sounds while reducing background noises. The listener wears headphones, small earplugs, or hearing aids.


Keep visual aids (drawing, dolls, chalk, or dry erase boards) available.

Let the child know before the interview that family members will not be helping with communication during the interview, and why.

Collect the English and American Sign Language (ASL) names and specific relationships of the people in the child’s life. ASL names are in sign language, and may be the first initial of a child’s name, or some distinctive characteristics, such as long or curly hair.

Because DDBDDHH children may only know the signed ASL names of family members, not English names, obtain pictures of family members or other pertinent people to clarify who the child is talking about.

Physical Environment

Choose a location without loud background noises (copiers, loud air conditioners, or other sounds that may be amplified by the child’s hearing aid or cochlear implant).

Choose a room that is well-lit from internal lamps and lights, rather than sunlight.

Arrange furniture so that you or the interpreter are not sitting or standing in front of a window or bright light, which can throw your face into shadows. The child will need to have a clear view of your face at all times.

Eliminate any visual distractions from the table or desk that might get in the way of the child seeing you or the interpreter.  A large portion of American Sign Language relies on body language and visual cues.

(The above sections adapted in part from Hoffman-Rosenfeld, 2004.)

During the Meeting

First Response

  • Touch the child’s arm or shoulder to get attention, or wave your hand in their field of vision.
  • Do not use people who can sign but are not professional interpreters (such as relatives, volunteers, school staff) except to obtain the child’s name, address, and other basic information.
  • If family is present, do not allow the person with “better” communication to take over.
  • If the child wants to communicate by writing, keep messages short and to the point. English is a second language for many Deaf children. Sign language and English have different syntax.
  • If an interpreter is called, inform the child through speech/gesture/writing how soon they will arrive.

(Adapted in part from Hoffman-Rosenfeld, 2004.)


Match your facial expression and body language to your words and keep eye contact. Speak slowly and do not shout. If the child is Deaf, shouting will not help them hear/understand better.

If the child is reading your lips, look directly at them, speak naturally, and keep your mouth free of distractions. Just looking at the child will help you not move your head too much when you talk. However, lip-reading is not an effective form of communication. People who read lips generally understand only about 30% of what is said, and infer the rest.

Always explain any interruptions: "Someone’s at the door, I’m going to open it now."

Although a child who is hard of hearing may speak clearly, do not assume they can hear clearly. A cochlear implant or hearing aid improves hearing, but the effectiveness of these devices vary widely.

Make sure that only one person speaks at a time, and that it is clear who is speaking. Watch for signs that the child feels embarrassed or afraid to say they do not understand.

Evaluate the child’s knowledge about their family, and vocabulary and signs related to sexual and emotional topics. Ask the child to let you know if they don’t understand something.

(Adapted from Chandler; T. Gentry, personal communication, July 22, 2014; & New York State Office of Child and Family Services.)

Sign Language Interpreters

If the American Sign Language (ASL) interpreter, who is hearing, is having difficulty understanding the child, consider using a Certified Deaf Interpreter (CDI).  As noted earlier, a CDI is specially trained in adapting to an individual’s mode of communication, especially young children who are not yet fluent in ASL.

However, having multiple interpreters present, as well as the interviewer, can be overwhelming for the child, particularly when talking about a traumatic situation. The child may shut down. Take more time for rapport building, slow the pace, and consider meeting more than once.

Other tips on working with interpreters:

  • The interpreter may also assist with written materials.
  • Interpreters have a code of ethics about confidentiality, but because the Deaf community is small, the child and interpreter may know each other. Make sure the child is comfortable with the interpreter.
  • Interpreters often work in teams of two, taking turns to prevent fatigue.

Role of Interpreter

The interpreter’s role is only to facilitate communication and not to provide information or opinions about the crime, or to answer any questions.

Interpreters must be comfortable with interpreting conversations about abuse and sexually explicit events. They should be familiar with idiosyncratic signs for sexual behavior, body parts, and sexual functions. The interpreters should also use the same signs as the child uses.

Your Role

  • Speak directly to the child. Avoid asking the interpreter: "Tell her/him" ... or "Ask her/him"...
  • The child may address the interpreter because they have not used interpreters before, or because they want to know the interpreter can understand and is interpreting correctly.
  • If the child is engaged in an activity (looking at pictures, drawing), pause and gain their attention before continuing with questions.


Generally, an interpreter will sit by the interviewer, and both will face the child, so the child can look at both people at once. A child will watch the interpreter for translation, but will also be looking to you for visual cues.

For videotaped interviews, it’s best to have two cameras recording front views of everyone who is signing.

(Adapted from Chandler; Hoffman-Rosenfeld, 2004; Rainville; and T. Gentry, personal communication, July 22, 2014.)