• Discriminating sounds (i.e. frequencies, decibel levels, speech discrimination)

• Understanding instructions

• Communicating with peers

• Speech clarity

• Intelligibility/context meaning of sounds

• Balance/motor coordination

• Self-image

• Deficits in school achievement

• Problems in conceptualization

• Tendency to take things in very concrete ways

• Society tends to overestimate the skills and social maturity of individuals who have severe hearing impairments because it is a hidden disability, and because there is little knowledge in the general population about cultural deficiencies experienced by deaf persons.

• Potential barriers from other disabilities, (i.e., mental illness, mental retardation, alcoholism, cerebral palsy)

Making a connection between loss of hearing and vocational problems is not difficult. An individual with a moderate to severe hearing loss has obvious work related functional limitations. These limitations relate to almost any job one might enter, because of communication difficulties the person may encounter.

It may be more difficult to show a vocational impediment on individuals with mild hearing losses. Specifically address the functional limitations of the individual, and show how those have caused difficulty in past jobs, or how they will cause difficulty in future jobs.

It is important to know if the client has had special education/training in sign language, or if the client has attended a specialized deaf institution (such as a school for the deaf). It is relevant to learn how the client functioned while at school, especially in a residential setting.

Psychological testing and vocational assessment with the hearing impaired presents a great challenge to the evaluator. The counselor should always refer the hearing impaired to an evaluator who is particularly skilled in areas of manual communication, if appropriate, and working with hearing impairments.

Underestimating a deaf or hearing impaired client's potential is much more prevalent than overestimating the client's vocational intelligence, aptitude, and achievement levels. The counselor should realize this and strive for cultivation of the client's strengths. Intelligence testing results are often not indicative of the client's true level of functioning.

The counselor should be aware of clients whose hearing impairment occurred later in life. In most cases, clients having severe hearing impairments introduced by trauma have a more difficult time with adjustment to their disability, although they will have the advantage of having better speech than a prelingual deafened person.

The nature of this disability involves isolation, segregation, and loneliness, especially for the impaired person in later life. It is common for a client to also have significant psychological disturbances and/or chemical dependency. The client should be referred to a therapist who is trained in manual communication, if appropriate, and hearing impairments.