Students who are deaf or hard of hearing present additional challenges when a secondary disability is evident. Having prior knowledge that a student has additional educational challenges is helpful in designing a program of support services that will enhance student success. Most often this would occur at the onset of admission to college when a student requests accommodations and documentation is required. It is not usual to encounter students who experience academic difficulty unrelated to their hearing impairment. Although, it may not be obvious at the onset of college learning, it will often become apparent, when the student’s additional academic challenges begin to surface.

Quite often, it seems, secondary disabilities in deaf and hard of hearing students are not easily recognized as the more obvious disability of having a hearing impairment. It is not always true, however, that the hearing impairment is the primary disability. One major reason for this oversight is the lack of proper diagnosis in secondary school. Often, there is simply no assessment conducted. There may be many reasons for this; e.g. unavailable professional staff to evaluate, lack of facilities, lack of knowledge among professional staff about ‘hidden’ disabilities and lack of information about the behaviors associated with a specific disability. Chances are that if the professional staff at the secondary level have not evaluated and diagnosed the secondary disability, it has gone unaltered and unnamed. Unfortunately, it does not simply go away when the student enters college.

Students with more than one disability require additional academic support. Although, they are adults, having never been diagnosed, or even misdiagnosed, they are at loss as to what they need at the postsecondary level. If a secondary ‘hidden’ disability, such as Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), or a learning disability, seems likely, obtaining an assessment would be very wise. This can be achieved through a psychological assessment tools that will evaluate cognitive processing skills. A licensed psychologist can provide this service. The important matter is, to assess a deaf or hard of hearing student appropriately. This means locating, if at all possible, a psychologist trained to evaluate persons who are deaf or hard of hearing. Communication between the assessor and the assessee are important components to the overall evaluation. Equally important, the assessor would need to be familiar with the characteristics of cognitive functioning that are typical for an individual who is deaf or hard of hearing. This will enable the lines to be drawn more clearly in terms of which disability contributes to which academic difficulty.

Persons who are deaf and blind have a dual sensory impairment. The combined disability creates additional problems of communication and mobility. The needs and characterists of each deaf-blind individual depends on the age of onset and the severity of the loss of hearing and sight. Nearly half of deaf-blind individual have Usher's syndrome, a combination of congential deafness or hearing loss and retinitis pigmentosa, (a progressive eye condition).

Usher's syndrome begins with loss of the perpherial vision. The condition worsens to the point where total loss of vision can occur, but is not always the case. Most deaf-blind individuals can see some images, although not with acuracy or clarity. Therefore, some specialized accommodations are helpful in ensuring that a deaf-blind student is able to succeed academically. Tactile interpreting, which involves resting the hands on the interpreter as he/she signs, helps some deaf-blind individuals to follow the interpretation. Sometimes spelling onto the palm of the deaf-blind student is a preferred and workable solution. Others require large print materials, while others prefer to utilize braille. Any of these options can be utilized for the students' benefit.

Other causes may be: inherited conditions, menigitis, trauma, chemical toxins, glaucoma and cataracts.