Service Delivery for Children with Multiple Impairments: How Are We Doing?

have multiple impairments cannot help being struck by the complexity of the assessment, intervention, and management process. It is our good fortune that in this modern time, enhanced technology allows not only for the survival of infants born with severe mental and physical challenges, but also for securing their healthy and productive futures. Certainly, the thoughtful application of hearing technology plays a major role in overcoming some of the obstacles posed by these children’s multiple impairments. In this chapter, specific issues regarding audiologic intervention with children having hearing loss in addition to other significant impairments will be addressed. Three main themes form the basis of this discussion: the magnitude and diversity of this population, current hearing aid fitting practices for children with multiple impairments, and the challenges of family-centered service provision. Demographics The term multiple impairments is used here to describe children with hearing impairment and at least one additional disabling condition. It has been estimated that approximately 25% to 40% of all children with hearing loss in Canada, the United States (U.S.), and Europe will have at least one additional impairment (Davis, Fortnum, and Bamford 1998; Holden-Pitt and Diaz 1998; Karchmer 1985; Karchmer et al. 1981; Mencher 1983). A summary of the additional impairments noted in the Annual Survey of Deaf and Hard-of-Hearing Children and Youth: 1996-97 (Holden-Pitt and Diaz 1998) is depicted in figure 1.