Today's post is cited from:
Maddell, J.
(2015, April). Counseling & support for children with hearing loss. AudiologyOnline,
Article 13758. Retrieved from http://www.audiologyonline.com.
Counseling & Support for Children with
Hearing Loss
Jane
Madell, PhD, CCC-A/SLP, LSLS Cert AVT
April 20, 2015
http://www.audiologyonline.com/articles/counseling-support-for-children-with-13758
Learning Outcomes
- After this course learners will be
able to describe the type of support necessary for children with hearing
loss being educating in mainstream settings.
- After this course learners will be
able to explain how to develop a support group model for children with
hearing loss
- After this course learners will be
able to explain how to discuss bullying with children with hearing loss
Introduction
Dr. Jane Madell: Today we are talking about
counseling and support for children with hearing loss. I have been a
pediatric audiologist for almost 50 years. At the end of today’s
presentation, I hope you will feel more comfortable talking to children about
hearing loss, helping them describe their feelings about being a child with
hearing loss in a mainstream setting, and helping children learn to advocate
for themselves about issues related to hearing loss.
What is the Issue?
Most
children with hearing loss are educated in mainstream settings. The
advantages of a mainstream setting are that children with hearing loss will
have typical language models. The typical hearing children have normal
developmental, academic, and social skills and the same will be expected of the
children with hearing loss from other children and the school faculty. The
children with hearing loss will also have a better opportunity to develop
skills that will serve them as adults. The disadvantage of children in a
mainstream setting is that they do not have significant contact with other
children with hearing loss, and as a result, some of them may feel isolated
and, if language skills are poor, have more limited social opportunities and
not feel good about themselves. That is why I run support groups.
What Kind of Support
do Children with Hearing Loss Need?
Children
who are in special education settings are less isolated, but we know that their
teachers may have lower expectations for them. While not applicable
to every student individually, the average reading level of children who
graduate from a high school for the Deaf is 4th grade. Children who are in the special
education setting may need assistance dealing with people outside of this
closed environment. They depend on the school program and may not be able
to communicate well with people who are outside of this environment.
Types of Counseling
There are
two kinds of counseling: informational counseling, where we tell people facts,
and support counseling, where we help them deal with emotions and
feelings. I am going to touch on both of these today.
Informational
Counseling
Providing
information about hearing loss and management, and very little information
about feelings and emotions, is the basis of informational counseling. We
counsel parents when the hearing loss is diagnosed. At that point, the
children are too young to be counseled. But as children get older, they
need the same information that we gave to their parents when their hearing loss
was identified. They need to understand an audiogram, degree and type of
hearing loss so they can answer questions about, so they can understand what
their hearing loss means. They need to understand the effect of hearing
loss on language, academics, and literacy. They need to know how to
advocate for themselves, how to ask for help when they need it, and how to
explain problems they are having.
Social
skills are dependent on language. If children have good language, they
will have a much easier time socializing. In the early years, children
with hearing loss usually socialize well. But, as they get older and
language becomes more complex, if language is delayed they will have a much
harder time communicating and socializing with their peers.
As children
get older and become more aware of their hearing loss, they start to feel
different and they begin to resist things that can help them. They may
decide they are not going to wear an FM system anymore. They may refuse
to go to therapy. They may not be willing to advocate for themselves.
The data shows that children with disabilities experience more bullying than
other children (Carter & Spencer, 2006). We need to be aware of these
things and help children recognize and deal with these issues.
Supporting Parents
Most
hearing loss is now identified at birth. If we move quickly to fit
children with appropriate technology and enroll them in an auditory therapy
program, a child’s listening age will be equal to their chronological
age. Children can be fit with technology and start therapy early so that
their language delays will be minimized or eliminate. That is an enormous
advantage.
One
disadvantage that some parents see to early identification is that they have
not developed a relationship with their children before they have to deal with
the fact that they have a child with a disability. I can understand that,
but that is not my view as an audiologist.
Client-Centered
Counseling
Client-centered
counseling focuses on the client and not on the test results. The
diagnostic process should begin at first contact with the family. We need
to try to understand the parents’ point of view and their concerns. If a
baby is diagnosed at birth, parents will not have any observations yet about
how the baby responds to sound. If the child is diagnosed later, parents
will have a list of their experiences and observations about the way the baby
hears.
Parents
need the opportunity to share their feelings, concerns, and distress. We
need to be prepared for that and accept it. One mother I saw understood
that her child had a hearing loss, but she could not move forward to put
hearing aids on her child. I was concerned about the delay but there was
nothing I could about it. All I could do was sit there and provide
support to her and help her understand that I knew why she was struggling, but
that together we would work it out. We need to give parents a chance to
tell their stories and explain their feelings, and if we can provide them with
support, sooner or later, they will be ready to move on.
Involving Parents
It is
helpful to involve parents in the diagnostic process. When they
participate and help make decisions about what a child is hearing and not
hearing, that reduces their denial mechanism. They begin to see the
audiologist as someone who has included them in what needs to be done.
Parental satisfaction increases when parents are empowered as partners in the
diagnostic process. It makes it much easier to counsel and move from
point A to point B. In a school setting, I know this can be difficult,
but we have to figure out a way to include parents. If we do not, parents
cannot help us navigate the journey to make the children successful.
We need to
actively involve the family in the test protocol. Engage them as much as
possible in scoring and eliciting responses. I frequently have a parent
sitting in the test room next to the child. When the child repeats a word
in a speech perception test that I did not hear or think may have an error, I
ask the parent to tell me what they heard the child say. Having to
understand and repeat what the child is saying helps them to recognize what kind
of errors their child is making. In a home situation where language is
less complex then in school, parents frequently do not get that there are still
problems. If they participate in a test situation with the audiologist,
they can understand the difficulties and what has to happen to make things
better. Ideally, they can look at the results together, interpret them
together, and plan for the child’s future together.
When there
are two parents, I encourage one parent to sit next to me on the tester side
and one parent to sit with the child on the other side. I tell everyone
what I am looking for. If I am testing a newborn baby, I say, “I am
looking for changes in sucking.” If I am working with a child who is 6 to
36 months, I explain about a conditioned head turn. If I am working with
a child who is over 36 months, I talk about the listen-and-drop test and what I
am looking for. I ask the parents to look and tell me what they
see. I help them to understand that if the child throws the toy in or
makes a head turn when there is no sound, it is not an indication of
hearing.
In speech
and language evaluations, it is important for parents to observe and see what
kinds of difficulties the child has. Parents are often surprised in these
situations, because in the home situation where everyone knows what the topics
are, things are much easier to accomplish.
Involving Children
When
children get older, we need to start including children in the diagnostic
process because it helps them understand the issues related to their hearing
loss, and it helps them to figure out what they might do to make things
better. Just like I did with the parents, I discuss why I am doing each
test. I also discuss what my expectations are. Is it good
enough? What is good enough?
I am in the
middle of making a documentary in which I interview several young people who I
have known since I identified their hearing losses, who are now in their 20s
and 30s. One of them talks in this documentary about how much she hated
hearing tests because she did not want to face the fact that she could not ace
it. It made her feel that something was wrong with her and she had a
problem; she did not want to deal with it. That is true of every child we
see. I think we need to help them understand that we are not doing these
tests to torture them. We are trying to understand how their hearing is
functioning and what kind of problems they are having so that we can fix those
thing. I do not want to know how many words the child got wrong; I want
to know what phonemes the child is misunderstanding so I know what settings of
the hearing aid or the cochlear implant I may need to adjust. If you
explain that kind of information to the children, they are better able to deal
with it.
We have to
remember that children with hearing loss do not know what they are
missing. Many of the children I interviewed for this documentary talked
about that. We need to talk about how it impacts school and school
activities when they are missing something how.
We also have
to talk about what score is a good enough score. When a child says 60% is
good enough for a speech perception test, I ask if that would be good enough on
a math test. I am doing this test to know how I need to modify technology
settings, change the settings of the technology, and plan therapy or help the
therapist plan therapy. If the child is not able to distinguish between
/s/ and /t/, the therapist has to work on that. Unless I know what the
particular phoneme errors are, I cannot tell either the child or the therapist
what they have to work on. We need to talk about what reasonable
expectations are and how children can use that information.
Listening Bubble
The
Listening Bubble is that concept that helps us figure out how far away a child
can year you. Figure 1 at the top shows a child inside their listening
bubble. Mom is sitting outside the bubble. This child does not even
know that mom is talking because she is outside of his bubble. In the
bottom picture of Figure 1, Mom has moved inside the bubble and now the child
understands that mom is talking. He can listen to mom and figure out what
is she is saying.
Figure 1. The size of
a child’s listening bubble is based on age, degree of hearing loss, and
experience with amplification.
Figure 2
shows a classroom situation. The teacher is standing near the
board. The Listening Bubble encompasses the teacher and the first
child. That child who is sitting close by can easily hear. The
problems with noise and interference will not be a factor for that child.
The speech is loud enough and the child is hearing. In the section
situation, the teacher is wearing an FM system and all of the children are in
the Listening Bubble.
Figure 2. The
Listening Bubble in the classroom; teacher without FM system (top) and teacher
with FM system (bottom).
We need to
help children understand what it means to mishear or misunderstand words.
Speech perception tests are usually described in percent-correct results, and
for some children and parents, that is fine. For a child who does not
understand, Karen Anderson suggested that we think about talking about missing
puzzle pieces. If you have 12 pieces missing from a 100-piece puzzle,
that tells you how much you are not understanding. On Karen’s website
(http://successforkidswithhearingloss.com), there are some pictures of these
puzzles, which is helpful for some children.
Counseling Parents
All the
decisions we make for a child are based on the parents’ choices about what they
want for their child. Parents need to be educated about the
choices. How do we help educate parents? We need to help parents
determine what their goals are for their child. In the beginning, most
parents do not know anything about hearing loss and cannot even begin to figure
this out. “Where do you want your child to be when they are 5? 10?
20? 30?” What the parent says gives us information about how we can help
them plan for their child.
For
example, if a parent says she wants her child to go to school with her siblings
and the children on the block and be whatever they want to be when they grow
up, we need to say, “What does it take to get there?” In order to be
educated in a mainstream classroom, you need to be using listening and spoken
language. If you want your child to go to college, they have a much better
chance of succeeding if they are using listening in spoken language. We
need to be honest when we talk about all of the differences in the
possibilities for educating children with hearing loss. What are the
different communication modes? What are the different educational
options? They are not all the same. This is a topic for another
conversation, but it is important that we are realistic about what the choices
are and that we help parents understand what the different choices mean.
That determines how we plan for a child.
Decision Making
Families
need to make their own decisions. “What is the goal for your child, and
what does it take to get there?” We need to make sure that the decisions
are the parents’ decisions and not our decisions. If we say, “You need
this kind of hearing aid. Now you need a cochlear implant. Now you
need to go to this educational program. Here is the therapist you need,”
the message we are giving to parents is that they are not capable of making
these decisions. They need to be empowered to make the decisions they
need to make with educational support along the way. If we make the
decisions, any successes or failures are attributed to us. If they make
the decisions, they buy into figuring out what is best for that family.
The family needs to learn to take responsibility for doing whatever needs to be
done for a child to succeed.
When
children get older, we unfortunately need to try to start helping them make
decisions, and that is not an easy task. We need to help children
understand the effect of not hearing. “What happens when you do not
hear?” “What happens when you do not hear in school?” “What happens
when you do not hear in social situations?” There are both short-term and
long-term consequences. “You may think it is better today not to wear a
hearing aid because people will see it, and then you will feel bad about what
you look like. But what do people think when you cannot answer
questions?” We need to help children understand that the decisions they
make have consequences.
I do not
believe that children are fully educated enough or wise enough to make
decisions about whether they should use an FM or whether they should wear
hearing aids. An 8-, 10-, or 12-year-old who is making that decision is
not making it based on a full knowledge of the negative effect of not learning
or on long-term goals. We need to be sure that we are helping children
understand the impact of any decision they make.
Martin, et
al. (1987) studied what information parents get from us and what information
they want from us. Professionals often provide parents more information
than they need on issues related to academic information, degree of hearing
loss, how the hearing aids work, et cetera. A lot of that is because we,
as professionals, are comfortable giving technical information. What
parents want is emotional support and contact with other families, and we are
not good at that. That is something we need to think about.
As
clinicians, we are all faced with difficult decisions. Parents are also
faced with difficult decisions. When parents cannot move ahead, we need
to talk to the parents, and this is a technique that we can also use with
children. “I see you are having a hard time with this. Tell me
about it. What are your concerns about whether we should move you
daughter from a hearing aid to a cochlear implant? What are you thinking
about here?” When I said this to a mother, she said, “My child is hard of
hearing. If I give her a cochlear implant, she will be deaf.” The
have heard this from a number of people, but the first time I heard that from a
parent, probably 15 years ago, I was thinking that her audiogram was not
changing. How does this change it? For this mother, it made all the
difference in the world. She could not move on, because in her view,
receiving a cochlear implant made her daughter more impaired. For me,
that was sad because this child was struggling so much with her hearing loss
that if we made her hearing better, her life would have been easier.
We need to
talk to parents and to children about what they are thinking about. Ask
them what information you can give them to help them think about it. What
do they want to know? Frequently, they can ask you something, given the
opportunity. Both parents and children will be able to ask you something
that you will be able to use to answer. It will make a difference.
I try to
routinely engage both parents and children in a dialogue about what their goals
are and about what kind of progress they are making. “How well are you
doing with your technology?” “How well do you understand in the
classroom?” “What do we need to do to make things easier?” We need
to talk about what success is and what a reasonable expectation is. If a
child says that he wants to hear absolutely everything in the classroom, that
is not a reasonable expectation. We need to try to help him understand
that it is not a reasonable expectation for him or a typically hearing child
either. While setting that expectation, you could say, “You need to hear
as much as you can hear, and it is my job to help that happen.”
We also
need to help them understand what normal speech and language development is and
what they should be hearing in the classroom. We need to listen to
the parents and the children. They are stressed. Life is hard, and
we need to let them explain their concerns. We need to arrange for
support whenever it is available, counseling parent-to-parent, and
child-to-child. We need to be sure we are validating their feelings
because their concerns are legitimate.
Parent Support Groups
The
advantage of parent support groups is that parents get to meet with other
people who have the same concerns and who are living the same
difficulties. Audiologists, teachers of the deaf, and speech language
pathologists think they know what is involved with living with a hearing loss,
but we do not. Those of us who have been in the field for a while have
heard a lot and we have some knowledge, but it is not first-hand experience
like the person dealing with it.
There are different
kinds of groups we can run for parents, such as a newly-diagnosed parent group
or topic-based groups. Some parents will not come for support for
themselves, but if you can arrange a topic-based group, such as how to maximize
your child’s speech and language development or information about transitioning
from elementary school to middle school or middle school to high school, they
feel they will get information that will help them work with their child.
At the same time, they will be meeting with other families and get some support
for themselves.
Sometimes
it is important to have a mothers’ group separate from a fathers’ group,
because mothers and fathers do not all have the same needs. For the most
part, mothers worry more about social and emotional development, and fathers
worry about what the future will be like and what they have to do to prepare
for it. Grandparents can also use a group, because they are often
traumatized by having a grandchild with a disability and do not want to burden
their children with questions. They need to understand what they can do
to help.
I had a
family where the grandparents said, “When you come to my house, please do not
bring your child with their hearing aids on, because we are concerned that
and people will not have anything to do with this family if they see that
we have this disability and our other children will not be easily able to
marry.” That gives a lousy message to both the parents of the child with
the hearing loss and to the child. We need to help grandparents deal with
these issues as well.
Siblings
can also benefit from support. Siblings of children with hearing loss
frequently report that they feel left out. On some level as they get
older, they understand that their sibling has a disability and they need a lot
of help. However, as a young child, they want their parents’
attention. We need to help parents understand that siblings need alone
time with the parent, and we need to give siblings a chance to meet with other
siblings so they can talk about the issues that are causing them grief.
Scheduling
support groups can be difficult. Parent groups can be scheduled during therapy,
in the evenings, in the afternoons, or on weekends. Evening are usually
the easiest time to get parents in. The groups can meet weekly, monthly
or every few months, depending on your schedule and the needs of the
families.
Counseling Older
Children
Now let’s
talk more directly about counseling children. We counsel the parent at
the diagnosis, but then we need to start talking about the children.
Children first start showing grief about having a hearing loss around eight or
nine years of age. We need to address that directly.
I remember
a child who was eight years old, and the family was moving out of town. We
did all the evaluations so they could go to the new school district and be
prepared with all evaluations, and recommendations for services. At the
end of the evaluation, I said to the child, “Do you have any questions for
me?” He said, “When am I going to be old enough so that I do not need
hearing aids anymore?” His mom and I were both stunned. It had
never occurred to us that he did not understand that this was a permanent
situation. It changed the way that I counseled children. Now I talk
to them directly about the fact that hearing loss is permanent. We talk
about how it is not fair that this is the situation, but that this is the situation.
We have to
do some informational counseling with children. We need to give them all
the basic information about hearing loss, degree, type, causes, and their
future. We need to provide them with support. We need to help them
understand that their feelings are reasonable. When a child comes in
after school for an evaluation, and says, “I do not want to be here.
Everyone else went for pizza, and I had to come to see you.” I tell them
they are right and it stinks. It is not fair.
I was
reminded so much of this while recording my documentary where the participants
talked about not liking having to go to therapy before school or after
school. Everyone else got to do fun stuff that they did not get to
do. We need to recognize that and provide sympathy. That is not to
say they do not have to come, but we have to let them know that we understand
and we know it does not seem fair.
We need to
talk to children about social issues that are related to hearing loss and
situations in which hearing is difficult. We need to help them understand
that it is okay to ask for help and how to go about asking for help. We
also have to give them permission to be angry and grieve because of their
hearing loss.
How do we Counsel
Children?
At the time
of each evaluation, we should show the child the audiogram and explain it to
them. They will not get it all the first time, and this is why we will
repeat it. We need to show it to them, show where normal hearing and
hearing loss falls on the graph, and then show them how close they are to
normal hearing when using their technology. Discuss the effect of
everyday listening and the effect of hearing loss on academics.
I talk to
children about where speech information is. “Normal conversation is at 50
dB. Can you hear 50 dB?” If thresholds are at 45 dB, and I start
talking really quietly, then they are not hearing very well. Soft
conversation is 30 to 35 dB. Are they hearing that? With their
hearing aids, I expect them to hear at less than 30 to 35; therefore, they
should be able to hear soft speech. “If you take your hearing aid off,
you are not going to be hearing soft speech.”
“What is
the difference in what you hear with and without hearing aids and with and
without the FM system?” I ask families to bring the FM system when they
come. They may have to borrow it from school, and I know that can be
complicated, but we need to know that the FM is doing what we say it is.
The child also needs to see what he hears with and without the FM in an
organized noisy situation. I think we need to help them understand the
effects of their hearing loss is, what that means for learning and for school,
and what that means for the long-term.
Support Counseling
I ask
children what they want to know about their hearing loss. Since I have
started asking this, a number of children have asked, “Am I going to have this
hearing loss all the time, and is it going to get worse?” We have to figure out
what a child wants to know and move from there. Children may also ask
about what happens if they do not wear hearing aids or when they will be old
enough to not wear their hearing aids anymore. We need to discuss those
issues with them honestly. If a child does not want to discuss it, that
is okay as well. Unless they say, “I do not want to discuss it, but I am
not going to do what I need to do to succeed”, then we need to push our way
in.
Support Groups for
Kids
With
today’s technology, over 80% of children with a hearing loss are educated in
the mainstream. They may not have contact with other children with
hearing loss, so support groups give them the opportunity to have like-minded
peers who have the same difficulties and experience similar issues. They
get an opportunity to say what they want to say without worrying about
upsetting their parents, their classmates, or their teachers. It is a
safe space.
I try to do
this by having a pizza party, or if you have it after school, you can have some
snacks. The idea is that you want it to be a comfortable situation.
I group children by age and communication mode. I recently had the
opportunity to host a group where some children signed and some children used
spoken language. That was difficult because their issues were not the
same. Groups work best when organized for children who have the same
communication mode. I include children whose ages span up to four
years. Do not worry about the degree of hearing loss.
I start off
each group with introductions. I say, “Tell us your name, age, what grade
you are in, what degree of hearing loss you have, what kind of technology you
use, and your favorite activity.” This way we know something about who
they are and their audiological background.
Rules. I start off with some rules. Everything that is said
in the room stays in that room. Everything there is safe. We
respect what everyone says. Disagreements are not discouraged, but you
cannot yell or belittle another person. We have to respect what everyone
says. Only one person gets to talk at a time, and we go around in a
circle so everyone gets a turn. If you do not understand what someone
said, you have an obligation to raise your hand and ask for
clarification. That serves two purposes: it helps teach children how to
ask for clarification and advocate for themselves, and it also helps us to be
sure they understand what that other child’s issues are so they can participate
in the discussion. The last rule is that no one in required to
speak. Someone may not want to speak if it is their first support
group. However, by the second or third meeting, everyone wants to
participate.
Topics. I go
around in a circle and I say, “Tell me something funny that has happened to you
because you have hearing loss.” Almost always, the funny thing has to do
with what the child heard when the teacher forgot to turn off the FM
microphone. Then I give the children a piece of paper with five lines,
and I ask them to write down five things that their families and friends know
about them. Sometimes hearing loss is included and sometimes it is
not. What they say about who they are is very important in helping us
understand how they see themselves, which is very important for counseling.
Then I ask
the children to tell something from their list to the group. They do not
have to read the whole list. I collect those and I use those for
counseling. I ask the children if there is anything good about having a
hearing loss. Children sometimes say they have been able to meet new
people. Most of the time, they say it is okay, but not exactly
good.
Then we get
to the meat of the group. What are the problems they have with hearing
loss? I have the children go around in a circle, and we list the problems
on a board where everyone can see what was said. First we list the
problems, and then we discuss them one by one. Most children experience
many of the same problems. For example, one problem is, “I have trouble
hearing on the playground.” We go around and have everyone make
suggestions for what we could do about that.
Some of the
problems are not solvable problems. If you do a support group in the
summer, a very common problem is that they cannot hear when swimming. We
probably cannot fix that unless the child has waterproof technology. It
is encouraging to see that most children experience the same problem, and some
people have figured out solutions, such as, “I tell my friends in advance that
I will not be hear once I take off my hearing aids, so let’s decide before we
go in the water what games we are going to play.”
Someone was
complaining that when she has a sleepover and the lights get turned out, she
can no longer hear. We came up with the suggestion that the next time she
goes to a sleepover, she could bring a flashlights, one for each person.
When the lights go out, they put the flashlight on their face so she gets a
visual cue in addition to whatever she is hearing with her hearing aids.
Everyone makes suggestions. Even if the problem does not get solved, the
fact that the problem is a communal one is very helpful.
Counseling Issues with
Children
Occasionally
children deny that they have a hearing loss or they refuse to wear hearing aids
or an FM system. With younger children, they may be picking up on a
parent attitude about discomfort with hearing aids, and with older children may
be related to attitudes of their peers. We need to talk to everyone about
having a hearing loss and using technology, and we need to give everyone the
opportunity to think about all of these issues.
We need to
ask children about their specific concerns; encourage both children and parents
to share concerns. Discuss that everyone has difficulty hearing
sometimes. Children have to believe that they are not the only people who
have problems hearing. I encourage parents to say, “I am sorry, I did not
hear that. Can you say it again?” so that children recognize that they
are not alone.
With older
children and teenagers, we need to specifically discuss speech perception test
results and help them understand that while they may hear well at normal
conversational levels and in quiet, they may not hear well for soft speech or
in competing noise. We need to test in different conditions, because parents
and children need to understand what their limits are. If children see
that they are doing poorly, we may be able to convince them to use an FM
system. If we cannot prove to them that there is a problem, we have no
reason to expect that they would use an FM system. Showing their
weaknesses and how they can overcome those with technology can go a long way in
convincing them that the situation can be better.
Counseling with
Teenagers
With
teenagers, talk about the effects of normal and soft conversational levels in
quiet and in noise. Talk about the pieces of the puzzle that they are
missing, the Listening Bubble, and how comprehension is more difficult with new
information, which is more complex and why you need to get every bit of the
message. Talk about how tired children are at the end of the day and what
we can do to lessen that strain.
We need to
start talking to teenagers as they start rebelling about the life-long impact
of hearing loss. Data shows that adults with hearing loss who wear
hearing aids earn 50% more during their lives than those with hearing loss who
do not wear hearing aids and try to get by (Kochkin, 2010). One study
showed 30% of people in prison have hearing loss (Jacobson, Jacobson, &
Crowe, 1989). Maybe not hearing and not knowing what is happening is
causing people to make bad choices, and we need to talk to children about
this.
Self-Concept
We need to
help teenagers deal with their self-concept. Children, especially,
internalize what other people say about them, but recognize that everyone does
this to a degree. Children need to learn to tune out those inferior
self-perceptions, and it is very hard to do. Young children are not ready
to do it. Many children with hearing loss or with other disabilities have
a poor self-concept, partly related to language; the better the language, the
better the self-concept.
If children
do not have an opportunity to be social, they are not going to develop social
skills. We need to make sure that they have the opportunity to develop
good social rules so that they know how to communicate. The better a
child hears, the better able they are to communicate, which builds a better
self-concept.
The Hearing Aid Effect
Some people
think about self-concept and the “hearing aid effect”. Just the fact that
you are wearing the hearing aid or other technology amplifies a difference
between you and the people around you. If children with hearing loss have
to go to therapy every day, they will have fewer opportunities to
socialize. If they are shy or if their skills are not good, they will
have fewer opportunities to communicate.
Self-Expression
We need to
make sure that our children have the vocabulary to talk about their emotions
and describe what they feel is happening to them. They have to learn to
recognize both their emotions and the emotions of the people around them.
That is how we communicate.
Greenberg
and Kusch (1993) created a social competency scale. Social competency
requires good communication skills, the capacity to think independently, the
capacity to be self-direct and have self-control, understanding the feelings of
others, flexibility, the ability to tolerate ambiguity and frustration, and the
ability to maintain healthy relationships. Children who can do those
things will have good social competency. We need to be sure that we know
our children have these skills, and if they do not, we need to work on
improving them. We are not just audiologists. We are part of a
team, even if all the team members are not located in our facility. The
parents are always included as part of the team.
The Child
Peer Relationship Scale is a good way to help get children to tell us where
they stand. It is not a test, and it opens up a possibility for
dialogue. Choices on this scale are listed in Figure 3.
Figure 3. Questions
for children to address on the Child Peer Relationship Scale.
If we get
children to mark which of the statements relate to them, these lead to a good
starting point for discussions, both in individual sessions and in support
groups.
Clark and
English (2004) developed an I
Start/You Finish game
to begin a conversation about feelings. Ask each question to each child,
going around in a circle. Topics on this game are:
- I am happy when ____________.
- I am sad when ______________.
- The thing I like most in the world
is ____________.
There are
also two self-assessment scales for teenagers. The Self-Assessment of
Communication - Adolescents (SAC-A) and Significant Other Assessment of
Communication - Adolescents (SOAC-A) are also helpful in helping children to
open up.
Discussing Scenarios
We can also
discuss scenarios. For example, “The teacher is talking in the front of
the room. Does your teacher do that? Is it hard to hear to your
teacher in that situation? What makes it easier? What makes it more
difficult?”
Another
exercise you can do in a group or individually is list the advantages and
disadvantages of both hiding the fact that you have a hearing loss and
acknowledging that you have a hearing loss. Let the children work those
things out. It helps them come up with a plan for themselves. One
14-year-old in a group decided that she could not wear her hearing aids
anymore. She did not want to be hearing impaired or have anyone else know
it. Although her best friends knew that she had a hearing loss, most of
the children in her class did not. When we did this exercise, the other
children in the group were able to talk to her about what a ridiculous idea
that was; I did not have to say a word. They were able to convince her
that she needed to start wearing aids again, and she did.
Keeping the Door Open
We need to
keep the conversational door open so children know that we are hearing what
they have to say. We need to encourage them to describe how they
feel. We should repeat what they said so that we are sure we understood
what they have said.
Bullying
We also
need to discuss bullying, as it is a prevalent issue. We know that
children with disabilities are bullied more than the average child, and the
average child is bullied too much. It is important that every time we see
a child that we ask them if their school has a bullying policy. “Do you
know what you are supposed to do if you see someone being bullied or if you get
bullied? Do you know the difference between bullying and teasing?
Have you seen people be bullied? What have you done about it? Has
anyone every bullied you? Tell me what happened? Have you told
anyone?” We need to go through this because we are a safe place for these
children. We need to give them the opportunity to talk to us.
Other Tools
The Ida
Institute has some wonderful materials. One tool is called My
World. There is a home situation, a classroom situation, and an outside
environment situation. There are pieces of furniture and individual
people. For younger children, this is helpful for them to describe a
situation that they may not want to talk about, but they can move the pieces
around and explain situations that are problematic as they “play” in their
simulated world.
Summary
At all
stages, it is important that we empower both parents and children, and help
them to process all of the feelings related to living with a hearing
loss. We need to involve both parents and children as we do diagnostics
and help them understand the results. We need to talk to them about the
Listening Bubble, how it relates to the audiogram, and how it relates to
learning.
We need to
help both parents and children think about their goals, both short-term and
long-term. We need to provide counseling for children, because they need
it also. Support groups are one of the best ways to do this. For
older children and teenagers, we must be testing in noise so they can
understand first-hand that struggling is real. In this way, they are more
likely to cooperate in doing what needs to be done. We need to give them
a chance to express their feelings, and there are both positive and negative
things we can say. We need to resist the urge to rescue children and
families, and help them develop the skills to rescue themselves.
References
Carter, B.
B. and Spencer, V. G. (2006) The fear factor: Bullying and students
with disabilities. George Mason University. International Journal of Special
Education, 21(1), 11-23.
Clark, J.G.
& English, K. M. (2004). Counseling
in audiologic practice: Helping patients and families adjust to hearing loss. Boston, MA: Allyn &
Bacon.
Greenberg,
M. T., & Kusche, C. A. (1993). Promoting
social and emotional development in deaf children: The PATHS Project.
Seattle, WA: University of Washington Press.
Jacobson,
C.A., Jacobson, J.T., & Crowe, T.A. (1989). Hearing loss in prison
inmates. Ear
& Hearing, 10(3), 178-183.
Kochkin, S.
(2010). MarkeTrak VIII: The efficacy of hearing aids in achieving compensation
equity in the workplace. Hearing
Journal, 63(10), 19-26.
Martin, F.,
George, K., O'Neal, J., & Daly, J. (1987). Audiologists' and parents'
attitudes regarding counseling of families of hearing impaired children. Asha, 29(2), 27-33.