For children with hearing loss who are using spoken language to succeed they need to wear their technology all walking hours. If technology is appropriately set children should be willing to wear their technology. But occasionally children reject technology. When this happens we need to know why. Only when we know why can we adjust things so that the children will wear the technology.

 

Why do children reject technology?

Children may reject technology because it is too loud (and then painful), because it is too soft (not able to hear with technology), because it is distorted, the ears are not hearing equally, or because of behavioral issues. Let’s deal with the settings issues before we deal with behavior.

 

Problems with technology settings

Before assuming that behavior is the cause of rejection of technology it is critical to be certain that the problem is not technology settings. When technology is too loud, normal conversational speech will be uncomfortable. We cannot expect little children to wear technology if it hurts or is uncomfortable. If the technology is too soft and the child cannot hear with it why would he want to wear it? If it is distorted and speech is not clear, why would the child wear the technology?

So how do we know if the problem is that the technology is too loud, too soft, or distorted. We have to test. While real ear testing is a good first start in fitting technology it only tells us what is reaching the eardrum. It does not tell us what is reaching the child’s brain. We need to know how the child hears. Aided thresholds will tell us what the child is hearing. Our goal is thresholds at 20-25 dB. If a child is hearing at 5-10 dB, even at one or two frequencies, then he will be uncomfortable and the child may not tolerate the sound and will remove the devices. If aided thresholds are at 30-40 dB, the child will be hearing normal conversation but at a very soft level and will not be hearing soft conversational speech. Why wear things in your ears if you are not hearing well?

If the technology is not matched, and the child hears in one ear but not the other, the child may just not pay attention to the fact that he hears in one hear but not the other. We all have seen children who came in for an evaluation and when we checked the technology, found that one hearing aid or CI was not working. And the child did not know. Some children will be distressed when there is one aid that is not working and will remove it.

 

And what about behavior?

I saw one child for evaluation who would only put hearing aids on if his mother gave him a donut. I had another who would only put hearing aids on if his mom gave him coke in his bottle. I did a home visit mid morning and found a 2 ½ year old running around the living room in his diaper with no hearing aids on. When I asked mom why he didn’t have the aids on, she said he liked to play with out his hearing aids. In these situations who is in charge? It is not the parent.

If a child is not accepting technology and we know the technology is working, we need to look at the relationship between parents and child. Parents need to understand why the child has technology and what happens if the child is not hearing. If they are choosing listening and spoken language they need to know that the child has to hear. If a child is not wearing the hearing aids we need to help parents to know that this is their responsibility to help their children wear the technology. I say to parents “There are things we don’t let children do. We don’t let them throw down the lamp in the living room, we don’t let them run in traffic, and we don’t let them take off their hearing aids.”

Once the behavior has been established it can be difficult to fix. Sometimes parents can just change their attitude and become firm about hearing aid use and children get the message. But sometimes, especially if it has gone on for too long, it can be more difficult to reconcile. Children need to understand what the rules are. If a child does not want to wear the hearing aids, parents need to make it clear that the child does not get to do other things that he may want to do if he does not have the hearing aids on. You want to go play? Put your hearing aids on. You want to build a tower? Put your hearing aids on. You want to watch cartoons? Put your hearing aids on. Once kids understand that their choices are very limited if they don’t wear their hearing aids the behavior will change.

 

Wear the technology

Children really need to wear their technology. If they are not, we need to know for certain why they are not doing it. We need to figure out if it is too loud, or too soft, distorted, or if there is a behavior problem. As soon as we know which it is we will be able to improve the situation. And we need to do so.

 

One of my most favorite activities is running a support group for children with hearing loss. I was lucky enough to get to do that this weekend. I was invited to Phoenix by Anu Mathew, mom, of a child with hearing loss, who has started a group called Support for Young with Hearing Loss (SYHL). Yesterday I worked with a group of 10 kids with hearing loss, all auditory-oral kids, and all mainstreamed. About half had hearing aids and the other half had cochlear implants.

As we know, there are a lot of advantages to mainstreaming children with hearing loss. They are in educational settings in which educational goals are high and in which language models are high. They have the opportunity to build skills which give them incredible life opportunities. The disadvantage is that they do not get to meet, know, and befriend other kids with hearing loss. That is where support groups come in. While kids with hearing loss have friends in their mainstream schools, their typical hearing friends don’t understand the separate issues that a child with hearing loss has. So, having friends with hearing loss helps.

 

What happens in a support group?

 

We first need to assure that communication is not going to be a problem. We seat everyone so that everyone can see everyone else and I have a scribe who types all comments which show up on a screen so that if someone is not understanding what is being said they can read it on the screen. If some group members are using a remote microphone system we use it in the group. I start off by telling everyone the rules. We go around the circle passing the “talking stick” (which may be an FM microphone, or an actual stick, depending on the group) so we know who’s turn it is. Only one person talks at a time, we don’t interrupt, we don’t criticize what others say. No one has to talk if they don’t want to. etc.

I start off with everyone introducing themselves – name, age, grade, technology, and anything they want to say about themselves. Then I pass out a sheet of paper and ask everyone to write down 5 things that family and friends know about them. In yesterdays group I was impressed by how many of the kids wrote that people know their favorite color. I don’t remember seeing that before!

About half the kids included that they had a hearing loss. The other half did not include hearing loss in their list of important things. I am not sure what that means. I once asked a group of kids I was working with when I did this workshop for the CARE project in North Carolina, and one of the kids said “It’s not the most important thing about me”. I thought that was terrific. Years ago, before technology was where it is today, even kids who were “successful” struggled a lot and I am guessing that they would never have said that. But with today’s technology, while these kids still have some problems hearing, they hear so much better than did previous generations, so the hearing loss part of who they are seems not so significant. WOW!!!

 

Problems

 

To break the ice I ask them to tell something funny about living with a hearing loss and we get some funny things – most related to the teachers forgetting to turn off the FM mic and they hear things they shouldn’t hear. Then we get down to business and talk about problems.

We start off going around in a circle and each kid listing problems that they have related to hearing loss. After we have the list, we go down the list, one item at a time, and each person in the group gets to talk about how they handle the problem. Everyone gets to make suggestions to help solve the problem. Lots of the problems are familiar. Hearing in noise, what to do when you don’t follow what is happening in the classroom, (can you ask the teacher or is it okay to ask your neighbor?). One of the group just had a CI device failure and we talked about that. Lots of support from other kids, as well as a little bit of panic. We talk about how to explain hearing loss to peers, how to help teachers understand the difficulties of hearing in a mainstream classroom etc. I offer very little. The kids give each other their own suggestions. Sometimes I give a little hint, usually from things other kids have said over the years, sometimes things I just know as an audiologist. As we finish each topic, we go on to the next. Yesterday the group came up with 9 topics for discussion. We spent about 90 minutes talking, then time for a snack break. Kids get to visit with each other and just talk.

They will meet again without me. Some of the professionals from the community observed and will follow-up. (I usually don’t invite adults to these activities – I see them as kids only events so they are free to say what they want, and definitely no parents.)

 

Please organize these in your community

 

Everyone will be grateful for what they learn from this experience. I have loved almost every moment of my 50 years as a pediatric audiologist but this activity is certainly one of the best.

 

 

*title image courtesy USAR