Across America, more than eleven million individuals are d/Deaf or hard of hearing (DHH). While it’s considered a low-incidence disability, meaning it affects a smaller percentage of the population, the need for support and resources is just as important.
In this article, we will explore the many facets of DHH, from diagnosis to types of hearing aids, language development, Deaf culture, and essential supports and services. Our goal is to equip you and educators with information and resources to help support your DHH child from an early age. To guide us along this journey, we spoke with Janice Myck-Wayne, EdD, special education expert at California State University, Fullerton; Jeni Jackerson, communications specialist at CSD, Fremont; Lydia Sussman, retired lead teacher for d/Deaf and hard of hearing infants at LAUSD and adjunct professor at California Lutheran University; and Lisa Concoff Kronbeck, Undivided public benefits specialist.
Before we dive in, it’s important to understand that hearing loss is a spectrum that varies from person to person. The average human can hear between 0 decibels (dB) to 120–130 dB. Think of being able to hear everything from leaves sweeping down the street to the sound of a lawn mower or a rollercoaster. Anything below that can indicate that there might be some hearing loss that ranges from slight to profound. The following table explains the degrees of loss in hearing. For context, the higher the decibel, the louder the sound has to be for individuals to hear it.
Have you noticed that your child doesn’t respond to loud noises, your baby isn’t babbling yet, or they’re babbling but not developing more speech sounds over time? These moments can be easy to overlook, especially since every child develops at their own pace — but as a parent or caregiver, trust your instincts! You know your child best, and small signs like these could be early indicators of hearing loss.
For older kids, the signs might be different. Maybe your child gets frustrated during conversations, often asking people to repeat themselves, has trouble following directions, or can’t easily tell or notice where sounds are coming from (such as not looking up when a loud plane passes overhead). At school, this might look like daydreaming, falling behind academically, or struggling to connect with teachers and classmates. These challenges can be frustrating, not just for your child but for the whole family.
Even if your child passes their newborn screening, genetic hearing loss can gradually progress as your child gets older. If you’re noticing any signs of hearing loss, don’t wait — reach out to your child’s pediatrician. They can help connect you with an audiologist and arrange a hearing evaluation to better understand what your child may be experiencing.
The sooner hearing loss is identified, the sooner you can access the right supports — whether that’s early intervention services, hearing devices, speech and language therapy, or follow-up medical care. But don’t worry, you don’t have to do it alone. We’ll go over more early intervention supports and services later!
If your child shows signs of hearing loss, an audiologist or ENT will diagnose your child with one of the four types of hearing loss. But before we dive into the types of hearing loss, let’s take a moment to break down the parts of the ear — because different types of hearing loss affect different parts of the ear, and knowing which part is involved can help you make sense of the diagnosis.
Outer ear: the outer ear is made up of:
Middle ear: the middle ear is made up of:
Inner ear: the inner ear is made up of:
Now that our brief anatomy lesson is over, you can see how each part of the ear — outer, middle, and inner — plays an important role in how we hear. When one of these areas isn’t functioning as it should, it can lead to different types of hearing loss. Here are the four main types of hearing loss:
Each type of hearing loss might require a different form of treatment — whether that’s medical care, hearing devices, therapy, or a combination of various approaches. A clear diagnosis will help you, your family, and your child’s care team make informed decisions about how to best support your child’s communication, learning, and development. With the right tools and early support, children with all types of hearing loss can thrive!
Most hospitals and birthing centers perform a hearing test on your newborn before you take your little bundle of joy home. In fact, California has a law requiring newborns to be tested before leaving the hospital. If not, your child’s ENT, audiologist, or speech-language pathologist can screen them or refer you to an audiologist for further testing. Dr. Janice Myck-Wayne emphasizes that these initial screening tests are gentle, noninvasive, and painless. They're thoughtfully designed to identify any hearing concerns as early as possible, and they're not limited to newborns — teenagers and adults can benefit from them too!
Two common hearing tests for newborns are:
If the results show that your child might have hearing loss, the hospital will notify the California Early Hearing Detection & Intervention (EHDI) program or your state’s local Regional Center to initiate early intervention services (more on this in a bit), and send a referral to an audiologist. Feel free to check out the American Academy of Audiology’s Find an Audiologist tool to locate a provider near you. They can run more detailed tests and walk you through the best options for support and treatment.
Other types of hearing tests
As mentioned earlier, hearing loss can sometimes develop later in life. If you believe your child might have a hearing loss, reach out to your child’s audiologist to have them conduct one of the following tests:
Speech testing. This type of test has the audiologist saying words at different decibels and asking the participant to repeat the words back.
Tests of the middle ear:
Again, most of these hearing tests cause little to no discomfort, so rest assured that while they might look (or sound) a bit intimidating, they’re designed to quickly and effectively help determine whether there is hearing loss. If you have any concerns, don’t hesitate to talk to your audiologist!
Auditory neuropathy spectrum disorder hearing tests
Auditory neuropathy spectrum disorder is a type of hearing loss that isn’t caused by issues in the outer or middle ear, but instead has to do with how the auditory nerve processes sound in the inner ear. In these cases, doctors use specialized tests to check the auditory nerve pathways and the brain’s response to sound. If a pathway is damaged, this could indicate a potential hearing loss. Also, because the inner ear plays a role in balance, some of these tests will look at things like coordination and fall risk.
Here are a few auditory neuropathy spectrum disorder hearing tests:
If you think your child might have this type of hearing loss, it’s a good idea to start by talking with an audiologist or an ear, nose, and throat (ENT) doctor. If they don’t specialize in auditory neuropathy, they may refer you to a provider who does. These specialists can run the tests above to get a clear picture of what’s going on and help you figure out the best next steps.
About 40% of children diagnosed with a hearing loss also have a co-occurring diagnosis (one or more disabilities). A few of these co-occurring conditions can be Down syndrome, autism, cerebral palsy, ADHD, intellectual disability, or low vision. Some studies suggest that hearing loss is more common in children with Down syndrome due to frequent ear infections and anatomical differences. Similarly, auditory processing challenges are frequently reported in children with cerebral palsy or autism.
Because hearing plays such an important role in early language, communication, and social development, hearing loss can sometimes be mistaken for other developmental delays or other disabilities. For instance, a child who isn’t responding to their name or has delayed speech may be misdiagnosed with autism, when in fact they have undiagnosed hearing loss (or maybe both). Advocating for a hearing test is important if you believe your child has a hearing loss that is being overlooked.
After receiving a proper d/Deaf or hard of hearing diagnosis, they will most likely have a team of specialists that address both co-occurring conditions. Meaning, their team could consist of occupational therapists, speech pathologists, audiologists, special education teachers, and more. Making sure these professionals collaborate together is important in making sure desired goals and strategies are being implemented effectively. Lydia Sussman, retired lead teacher for d/Deaf and hard of hearing infants at LAUSD and adjunct professor at California Lutheran University, recalled that a student with both hearing loss and autism had difficulty wearing their hearing aids due to sensory sensitivities, which meant their care team needed to collaborate closely to adapt and support both needs.
Due to these needs often overlapping, it's important to have a team that understands your child’s full range of abilities and how this connects with their auditory, communication, social, emotional, sensory, and behavioral development.
After a diagnosis, one of the first things the audiologist might talk to you about is hearing aids or a cochlear implant, if your child’s level of hearing loss calls for this type of intervention. The type of hearing aid your audiologist recommends will depend on a few different factors, including your child’s level of hearing loss, the size and shape of their ear, and how comfortable they are using their hands to handle small devices (their manual dexterity). Personal preferences also play a big role. Some kids prefer something more discreet, others want something colorful and fun, and some just don’t care at all. Below are the types of hearing aids that the audiologist might recommend.
As you can see, there are many different types of hearing aids. Hopefully, your audiologist will walk you through the various options and features of each — such as rechargeable batteries, Bluetooth compatibility, and volume controls — to help you choose the best fit for your child’s and family’s needs and lifestyle.
Cochlear implants Cochlear implants are a type of hearing device, but unlike hearing aids, which can be removed and put on as needed, cochlear implants require a surgical procedure to be implanted. Instead of simply amplifying sounds, cochlear implants bypass the damaged parts of the ear and send signals directly to the auditory nerve, creating a new pathway for sound to reach the brain. This type of hearing device is typically recommended for individuals with severe or profound hearing loss.
This video explains how cochlear implants work:
While cochlear implants don’t restore natural hearing, they can make a big difference in how kids with severe or profound hearing loss experience the world. However, it’s important to remember that success with a cochlear implant looks different for every child. Key factors including your child’s age, how long they’ve had hearing loss, and the support they receive after surgery (such as therapy) can impact how effective an implant is. It’s not a quick fix, but for many families, especially those with hearing parents who use speech as the main form of communication, it can be a valuable option to support your child’s language development.
Cochlear implants in Deaf culture
When talking about cochlear implants, we also have to address the cultural impact that they have for some members of the Deaf community. Some people feel that using an implant might take away from their child’s cultural identity (more on this in a bit) or might push them to adapt to the hearing world instead of embracing who they are as a Deaf person.
At the same time, many others view cochlear implants as a helpful tool. Like a hearing aid, cochlear implants are just one of many ways to support communication and access to sound. The important thing to remember is that this choice is deeply personal. What matters most is making sure your child has access to language, support, and connection in whatever way works for them. We know these conversations can be challenging, but they also open the door to thinking about identity, belonging, and the many ways your child with a hearing loss will interact with the world around them.
Bone-anchored hearing aid (BAHA)/bone-anchored implant (BAI)
BAHA and BAI devices are hearing systems that are also surgically placed behind the ear. Unlike cochlear implants, though, these devices don’t stimulate the hearing nerve directly. Instead, they use bone conduction (vibrations through the bones of the skull) to help your child access sound in a different way. This type of hearing device is often recommended for kids with conductive or mixed hearing loss or for those who are deaf in one ear.
Going beyond hearing aids, there is technology called hearing assistive technology (often referred to as HATs). These tools and devices can make a big difference for kids with hearing loss, especially in loud and overstimulating environments where it can be hard to hear clearly even when using hearing aids or cochlear implants.
These tools aren’t meant to replace hearing aids or implants, but to give your child extra hearing support in specific situations such as in the classroom, at busy restaurants, or even at home. Think of them as helpful add-ons that can make communication clearer and less frustrating. Here are a few common types:
For more information about assistive technology for communication, check out our article Top Communication Tools, Apps, Assistive Technology, and More.
Alerting and safety devices
In addition to HATs, there are some pretty clever alerting and safety devices designed to make your home safer and more accessible. These devices use things like flashing lights, vibrations, or extra-loud sounds to help individuals who are d/Deaf or hard of hearing stay on top of important stuff — such as when someone’s at the door, the phone rings, or a smoke alarm goes off.
They’re especially helpful in those everyday moments you might not think about right away — for example, your child not hearing their alarm clock in the morning or missing the doorbell when a friend comes over. These devices help make sure your child feels confident and independent and can respond quickly when it matters most.
Here are a few alerting and safety devices to keep in mind:
Hearing aids usually cost between $1,000 and $3,000 each, depending on the features and technology level. That’s a big expense — especially if your child needs two. As kids grow, replacements, like earmolds, which can average around $100 each, are often part of the picture too. Cochlear implants can be even more expensive. When you add up the cost of the surgery, the device, and all the follow-up care, the total can range from $30,000 to $50,000. And that’s not even taking into account other assistive technology or therapies. It can add up quickly — and for many families, it can become a financial burden. Unfortunately, many private health insurance plans do not cover hearing aids for children, even when medically necessary. In California, a proposed bill requiring health insurers to cover hearing aids and assistive technology for individuals under 21 has been continuously vetoed.
According to Lisa Concoff Kronbeck, Undivided’s public benefits specialist, if your child has a hearing loss and is on your private insurance plan the first step in figuring out funding is to check with your health insurance provider. Coverage for hearing aids can vary widely, and it’s often limited. Some plans might offer partial coverage, while others might not cover hearing aids and other assistive devices at all. That’s why it’s important to call your provider directly and ask specific questions to understand what’s included before exploring other options. A few helpful questions to ask might include:
If your health insurance doesn’t cover your child’s hearing aids, or if you don’t have insurance at all, there are alternative funding options that may offset these costs
Medi-Cal (California’s Medicaid program)
For children with low-incidence disabilities like hearing loss, there’s a helpful Medi-Cal program called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Through EPSDT (offered through Medi-Cal Kids and Teens), services such as hearing aids, audiology testing, and related care may be fully covered. EPSDT isn’t just for children with disabilities — it’s a bundle of services available to all children under age 21 who have full-scope Medi-Cal. Even if your child already has private insurance, Medi-Cal can often be used as secondary coverage to help with co-pays, deductibles, or anything your primary plan doesn’t cover. If your child doesn’t qualify for EPSDT, it’s good to know that Medi-Cal has a cap of $1,510 (as of February 2025) for hearing aid benefit services.
Your child can qualify for Medi-Cal either based on household income or through programs that waive income limits due to medical needs. In California, there are two main waivers that allow children to qualify for Medi-Cal even if their family income is too high: the HCBS-DD waiver for children who are Regional Center clients, and the HCBA waiver for children who require in-home nursing due to complex medical needs. These waivers are based on the level of care a child would require if they were placed in an institution—either a facility for people with developmental disabilities (HCBS-DD) or a skilled nursing facility (HCBA). Many children with complex needs qualify through one of these waivers, especially if they receive Regional Center services or need nursing care at home.
Regional Centers
If your child has both a low-incidence disability (such as hearing loss) and a developmental delay or disability, they might be eligible for Regional Center services. If not, you’ll most likely have to look into different funding options. Check out our Regional Center 101 article to learn more about the application process.
California Children’s Services (CCS)
If your child has hearing loss, California Children’s Services (CCS) might be able to help with the cost of hearing aids and related services such as testing, fitting, and follow-up care. CCS is a state program that supports children with certain physical disabilities or chronic medical conditions, including hearing loss. CCS eligibility is based on both your child’s diagnosis and your household income. However, if your child qualifies through a Medi-Cal waiver then income eligibility is not an issue.
If you think your child might be eligible, you can talk to your pediatrician or audiologist about getting a referral, or you can contact your local CCS office directly to start the application process. It might take a little paperwork, but the support you receive could go a long way in making sure your child gets what they need. Even if you’re not sure your child meets the requirements, it’s still worth applying. Some families qualify based on medical need alone, especially if the hearing loss significantly affects your child’s day-to-day functioning. And for families already enrolled in Medi-Cal, CCS is often easier to access.
Hearing Aid Coverage Program (HACCP)
If your child is under 21 in California, and needs hearing aids, the Hearing Aid Coverage for Children Program (HACCP) can help cover the costs — including hearing aids, replacements, bone conduction devices, accessories, and hearing aid–related services such as audiology and follow-up care.
To qualify for the program, you’ll need to meet a few basic requirements:
It might sound like a lot, but the goal of this program is to make sure kids who need hearing aids can get them, regardless of insurance or income. If you’re not sure where to start, reach out to your child’s audiologist or ENT, or your local health department — they can help guide you through the process. It’s important to note that you can also apply for this program while applying for CCS.
School districts (in some cases)
It’s very rare for school districts to cover the cost of hearing aids. However, in some cases, if hearing aids or other hearing-related supports are considered essential for your child to access their education and this is clearly written into their Individualized Education Program (IEP), then the school district may be responsible for providing them. Again, it’s very uncommon — especially if the hearing aids are needed both at home and at school. Realistically, you are more likely to get assistive technology written into the IEP than hearing aids. Still, if you believe hearing aids are the key to helping your child make meaningful progress in the classroom, it’s worth advocating for during the IEP process.
Additionally, be sure to ask your district to provide access to an educational audiologist as a related service. This professional can help with classroom accommodations, consult on hearing assistive technology, and fit your child for ear molds — even if the hearing aids themselves aren’t covered. They can be a key member of your child’s support team in making sure classroom access is as smooth and effective as possible.
Department of Rehabilitation
If you have a teen who’s starting to transition into adulthood, the California Department of Rehabilitation (DOR) might be a great resource to explore. DOR can help cover the cost of hearing aids, assistive technology and related services, especially if your child is preparing for college, receiving job training, or entering the workforce.
They also offer support through d/Deaf and hard of hearing counselors, audiology and hearing aid assessments, and assistive listening technology or rehabilitation devices to help your child communicate and thrive in everyday life. Check out our article How the Department of Rehabilitation Can Help with the Transition to Adulthood to learn whether your child qualifies.
Other assistance programs
There are also plenty of assistance programs out there — from nonprofits to private resources — that can help families afford hearing aids, cochlear implants, and the services that come with them. Some programs offer full or partial financial help for the devices themselves, while others cover things like audiology appointments, fittings, and repairs. A few organizations focus specifically on children, and others are open to people of all ages.
Each program has its own set of eligibility requirements, which might be based on factors such as income, age, type of hearing loss, or insurance situation.
In the list below, we’ve put together a list of organizations to help you get started.
For more support navigating funding options for your child’s hearing aids or other related needs, check out our How Do We Pay for it All article. It offers a detailed breakdown of additional benefits and resources that might be available to your family.
For many parents, learning that your child has hearing loss can feel overwhelming. While we’ll discuss the steps you can take to support your child, it’s important to first acknowledge a key distinction: the difference between medical and cultural perspectives on d/Deafness.
For some, hearing loss is viewed through a medical lens — something to be diagnosed and treated. But for others who are Deaf or hard of hearing, their hearing status isn’t a disability that needs fixing; it’s an integral part of their identity, culture, and community. Recognizing this distinction can help you navigate your child’s journey with a more informed and open perspective. It’s also important to recognize that both perspectives are valid. Just as important when discussing Deaf culture is using the correct capitalization. The uppercase D in Deaf refers to individuals who identify with and participate in the Deaf community. In contrast, the lowercase d is used for people who have hearing loss but may not be involved in Deaf culture. To include both groups, you might see the term written as D/deaf or d/Deaf. It’s also important to avoid outdated and offensive terms like “hearing impaired,” “deaf-mute,” or “deaf and dumb.”
Deaf culture is about so much more than hearing loss — it’s a thriving community built around identity, language, and shared experiences. Many Deaf individuals see themselves as part of a linguistic minority, meaning they’re connected by a shared language like American Sign Language (ASL) or another signed language. Like any culture, Deaf culture has its own values, traditions, and rich history.
The roots of Deaf culture can be traced back to the 17th and 18th century, when formal Deaf education and community-building efforts began. The first school for the Deaf in the United States was the American School for the Deaf (ASD), established in 1817 by Thomas Hopkins Gallaudet and Laurent Clerc, a Deaf educator from France. Clerc introduced elements of French Sign Language (LSF), which mixed with local sign languages and home signs evolved into American Sign Language (ASL).
As the demand for Deaf education grew, Gallaudet University was established in 1864 in Washington, D.C., the first — and still the only — university in the world specifically designed for Deaf and hard of hearing students. These early milestones laid the foundation for a rich and connected Deaf community and helped shape the vibrant culture that continues to thrive today.
Deaf culture embraces Deafness through the concept of “Deaf Gain,” which highlights the unique strengths, perspectives, and experiences that come with being Deaf. Rather than viewing deafness as a disability that needs to be “fixed,” Deaf culture sees it as a cultural identity defined by rich communication, social interaction, and shared experiences. At the heart of this identity is sign language, which is the foundation of Deaf communication and community.
Why cultural identity matters
Jeni Jackerson, communications specialist at CSD, Fremont, states, “Deaf culture and cultural identity are essential for a Deaf/hard of hearing child’s overall development, self-esteem, and sense of belonging. It helps them feel understood, valued, and included. Being part of Deaf culture ensures that DHH children have full access to communication. It helps them see that being Deaf is not a limitation, but a unique and valuable part of who they are. With the foundation of their cultural identity, they learn strategies to navigate a phonocentric society while embracing their Deaf identity. Not only being a part of this hearing-centric society, but it also reinforces that Deaf people have a rich history and play an important role in society. By embracing Deaf culture and fostering cultural identity, DHH children gain confidence, communication skills, interpersonal skills, and a strong foundation for their future. It’s essential for their holistic development and long-term success.”
Jeni’s words are a great reminder that Deaf culture is more than just a community — it’s a vital part of how Deaf and hard of hearing kids build confidence, connection, and a sense of identity. It is welcoming to everyone across the hearing spectrum, including hearing family members, friends, educators, and CODAs (children of Deaf adults) who want to be part of the community.
When people take the time to learn about ASL and Deaf culture, it helps bridge the gap between the Deaf and hearing worlds. By embracing Deaf culture, you’re helping open the door to stronger communication, deeper relationships, and a more inclusive world for your child.
DHH support organizations
Find more California-specific organizations and resources here.
Next up in our series, our article on supporting a child with hearing loss at home, school, and in the community. It's filled with expert tips on IEP assessments, accommodations, therapies, and more!
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