Time Out! I Didn’t Hear You (ebook) and insights

Making Sports Accessible to Student Athletes with Hearing Loss

Grant Rauterkus of Tulane University and Catherine V. Palmer of
University of Pittsburgh and University of Pittsburgh Medical Center (UPMC)

Contact Author:
Catherine V. Palmer, PhD

Eye and Ear Institute
203 Lothrop Street
4th floor, Audiology
Pittsburgh, PA 15260


In June 2010, the United States Government Accountability Office found that students with disabilities did not participate in sports or afterschool activities at the same rates as their peers. These students were 56% less likely to play sports. In consideration of the health and social benefits of athletics, the U.S. Department of Education supplied further guidance in 2013 indicating that one reason for a lack of inclusion was that professionals, students, and families are not aware of students’ rights to the accommodations that may make athletic activities accessible.

The book, Time Out! I Didn’t Hear You was published in 1996 as a resource for high school athletes with hearing loss, their parents, coaches, and educational audiologists. The book was published in order to address some of the gaps that would later be described by the US Government Accountability Office with respect to students with hearing loss participating in high school athletics. The book detailed the technology available to athletes with hearing loss and offered guidance for all involved parties, from clinicians to referees, as to how they could ensure that the athlete could access the sport while following the rules. The goal was to provide a resource that could assist in leveling the playing field while respecting the rules of the sports.

Organized athletics at the college level whether NAIA, NCAA Division I, II, or III or intramural/club level have the potential to provide students with important social groups, fitness, and financial support for college.  With under representation of students with hearing loss in high school athletics, they are vulnerable for under representation at the college level. For these reasons and because the process of inclusion in college athletics starts in a student’s transition from high school, the authors were interested in producing an additional resource for all stakeholders (student athlete, University Disabilities Officer, audiologist, coach, athletic trainer) who might be involved in making college level athletics accessible to students with hearing loss. The goal of this project was to update the High School text and create a College level text that would be useful to a variety of stakeholders and clearly address the transition to self-advocacy for the college student with hearing loss. 


High school-age and young adults with hearing loss were surveyed in order to characterize their experience in athletics in high school and college.  Survey questions examined transition plans, inclusion of self-advocacy training, and individual approaches to self-advocacy in college, and technology use. In a separate survey, educational and clinical pediatric audiologists were surveyed to examine their awareness of and participation in an athlete’s transition from high school to college related to participation in athletics.

Student athlete surveys were created in Qualtrics and a link to the survey was supplied to individuals accessing the HearYa online group and the Alexander Graham Bell Association listserve.1 All responses were anonymous and aggregate data were provided through the Qualtrics analysis and reports.

In a separate project, a survey was sent to educational audiologists through a link provided to the membership of the Educational Audiology Association and a link provided via email to two large hospital based pediatric centers in order to assess current knowledge across a number of domains related to promoting accessibility in high school athletics for students with hearing loss.2

Five additional questions related to transition plans were added to the audiologists’ survey for the purposes of the current project. The surveys and data collection techniques were approved by the University of Pittsburgh IRB. 


Student athletes surveyed included 33 respondents. Seventy percent used hearing aids or cochlear implants in high school. Three percent of the respondents reported having mild hearing loss, 18% reported moderate hearing loss, 33% reported severe hearing loss, and 42% reported profound hearing loss. Seventy-three percent indicated that they used hearing aids or cochlear implants once they were in college. Seventy-nine percent of respondents participated in high school athletics, while 45% participated in college athletics. Fifty-six audiologists who specifically work with high school and college age students replied to the survey sent out to professionals.

Forty-seven percent of respondents who were athletes in both high school and college reported using the same communication solutions (technological or non-technological) for participation in athletics in college as they did in high school. With respect to general use of assistive technology outside of athletics (i.e., classroom use), the number of individuals using technological (i.e., devices) solutions in college almost doubled compared to those using assistive devices in high school. While the use of technology increased in college, the use of non-technological solutions (e.g., seating preferences, etc.) went from a third of respondents using these solutions in high school to just 7% using similar solutions in college. The use of assistive devices other than hearing aids in high school and in college athletics did not change, however, and remained extremely low. Only 4% of respondents used assistive devices while playing sports at either level even though a number of these athletes used assistive devices in the classroom to improve communication.

When asked who helped in creating solutions for participation in athletics, 65% of respondents indicated that their parents played a role in the process in high school. Thirty-five percent of respondents indicated that they were not assisted by anyone in creating communication solutions for high school sports. This number rises to 60% reporting that they were on their own in seeking accommodations in college while 6% of respondents indicated that their parents had a hand in pursuing communications solutions for them in college as well. An additional 6% of respondents say that the Office of Disabled Services at their college played a role in securing communication solutions. While 58% of high school athletes had help from their coaches in this process; college head coaches and other staff were involved in the solution process for 13% of the college athletes responding to the survey.

We asked questions of both students and audiologists to gain an understanding of the realities of the transition process for students with hearing loss. Thirty percent of respondents reported meeting with their educational audiologist to talk about transitioning to college. If they reported meeting, the discussion included instruction with respect to accessing extra-curricular activities in college for 21% of these students. Education as to how to be one’s own advocate was reported for 37% of these students. Fifty percent of students in the survey who attended college (athletes and non-athletes in the survey) reported reaching out to the Office of Disabled Services upon arriving at college. A third of the athletes who anticipated participating in college athletics reported communicating with members of the coaching staff at their college prior to attending college.

Audiologists reported having a systematic program in place for assisting high school students in developing the self-advocacy tools necessary for seeking accommodations in college at a rate of 26%. When asked whether they considered a student’s potential participation in extra-curricular activities in the development of a transition plan, 39% of the audiologists reported that they have never created a transition plan. Eighty percent of the audiology group reported never having reached out to an Office of Disabled Services at a student’s prospective college. Some of this inattention to the college transition for athletes may relate to the audiologists’ responses indicating that 9% of respondents did not believe that school athletics could be included in an Individual Education Plan (IEP) and 20% did not believe that assistive technology could be used in athletics as well as 14% indicating that they believed hearing aids could not be used during sports because of rule limitations.

Fifty-two percent of the audiologists responding indicated that they did not feel knowledgeable in the area of making athletics accessible to students and desired more information. For many educational and pediatric audiologists, time limitations may dictate that they focus on classroom accessibility. Many may not feel that they have sufficient background in specific athletic activities to recommend solutions. It is important to acknowledge that this survey represents a small sample of audiologists who may be involved in making activities accessible to students with hearing loss, but the results do point to a need for a resource specific to communication solutions for sports and the rules that surround there use may be useful to students, families and audiologists, and other stakeholders. It would be ideal for all interested parties to have the same understanding of the rules that surround these activities and what would be considered reasonable accommodations.


Given the results of both the athlete survey and the audiologist survey, it is apparent that there is a knowledge gap in terms of laws regarding appropriate accommodations for student athletes as well as a gap in knowledge of how assistive devices can be used in athletics.

The High School edition of Time Out! I Didn’t Hear You was updated to include a focus on needed transition plans and movement toward self-advocacy in the junior and senior year in high school.

The College edition of Time Out! I Didn’t Hear You was produced to provide needed information to all the stakeholders who may be involved at the college level who may not be familiar with technological and non-technological communication solutions as well as rules surrounding these accommodations.

In addition, the section related to special solutions which includes dealing with retention and moisture which can be an issue in all sports when using electronics (hearing aids and assistive devices) was enhanced and updated. Both books include the following chapters: 

In order to update the high school resource to include important transition information for high school students interested in participating in college athletics at any level and to produce a college resource that addressed current gaps in knowledge or action, an implementation science approach was pursued. This included surveying former high school and college athletes with hearing loss as well as posing specific questions related to transition plans to pediatric clinical audiologists and educational audiologists. An implementation science approach was undertaken in order to ensure that the resource would be useful to student athletes given the transition to self-advocacy that is inherent in college level accommodations. 

  • The Ear, Hearing and Communication,
  • Assistive Devices and Communication Strategies,
  • The Law and Legal Practice,
  • Communication Needs Assessment,
  • Sports Specific Communication Solutions,
  • Officials, and
  • Resources.
  • Two appendices include Statewide Relay Phone Numbers and
  • Protection and Advocacy Organizations. 

The audiologist may want to review the laws related to sports accommodations for students and then move to the sports specific solutions.

Depending on the solution, the reader then may want to refer back to the Assistive Devices and Communication Strategies to see suggestions for hearing aids that work well under helmets and for creative retention strategies that do not interfere with the particular activity.

The Communication Needs Assessment Chapter provides a systematic approach to identifying what technology the student currently uses, what new challenges may be posed by the specific athletic activity, and what communication solutions may best address these challenges.

For coaches and athletic trainers, it may be helpful to have a better understanding of the impact of hearing loss and the various communication solutions that are available. Likely, coaches and athletic trainers are already familiar with the rules of the sport, but the sport specific chapters may be helpful to understand how various technology can fit into the rule structure or where technology may be helpful in practices even if it is not allowed in competition.

For parents trying to support their high school or college student athlete, the entire book may be helpful to review hearing, technology, laws related to accessibility, and the rules of various supports when it comes to communication solutions.

Our goal was to create a resource that is easy to navigate and useful to all stakeholders working towards inclusion of student athletes with hearing loss. 

To access the free download of the books, use the button or following link:


1. Toole, K., Palmer,C.,Levine,B.,Rauterkus, G. (2017). Athletic accessibility for high school students. American Academy National Conference: AudiologyNOW, Indianapolis, IN (April, 2017).

2. Rauterkus, G, Palmer, C., Toole, K., Levine, B. Jorgensen, L. (2017). Time Out! I Didn’t Hear You – College Edition. American Academy National Conference: AudiologyNOW, Indianapolis, IN (April, 2017).


The authors greatly appreciate the help of Dr. Suzanne Yoder and Dr. Cheryl DeConde Johnson in making the survey link available to target populations of respondents. Kristen Toole and Brandon Levine were instrumental in updating the High School edition and these updates are included in the college edition as well. Thanks to all the athletes and audiologists who completed the surveys.

Grant Rauterkus is studying Neuroscience at Tulane University. 

His research interests include hearing protection and hearing solutions for target populations. Specifically, he has investigated the fidelity of musicians' hearing protection. Currently, he is focused on the successful transition of athletes with hearing loss from competition and study in high school to college.

Past special event in Baltimore

Digital dust
Book cover of older edition of Time Out! I Didn't Hear You

Older, first edition of the book, now out of print.

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