In my last blog I discussed what kind of information audiologists needed to give to families and interventionists. This week I want to talk about what kind of information families and interventionists need to give to the audiologist. We, as audiologists, cannot really do our job if we do not get information from those who see these kids more often than we do. They are more likely to know if the technology is working well and if it is not. Only by asking direct questions will the family and the interventionists know that we want the information and that we will use the information in management.
How many hours a day is the child wearing the technology?
This is obviously critical. If a child wears hearing aids 4 hours/day it will take him 6 years to hear what a typically hearing child hears in one year. (This, of course, results in not learning language since you have to hear it to learn it!) Getting the correct answer to this may take some probing. If we ask a family how many hours the hearing aid is on and they say “all day” what exactly does that mean? It is useful to probe a little. Do you put it on as soon as he wakes up? How many hours a day does he nap? Do you keep it on when you go out for a walk? in the car? What about after the bath? When does it come off for the night? What about with babysitters? You can then calculate approximately how many hours the hearing aid is worn with the family so they see exactly what you are getting at. Even if the hearing aid data logging can tell you how many hours it is used, the questions are a good counseling tool because they help the family recognize that the hearing aid is not on that much. Then it is time to remind them about the number of hours of listening it takes to learn to listen.
Does the child like the technology?
Does he want to put it on in the morning? Does it require a lot of coaxing to get it on? How often does he take it off during the day? If he does not like it, do you know why? Is it too loud and, therefore, uncomfortable? Does he still have trouble hearing with the technology? Maybe it’s not loud enough. Are there specific situations where he does not want to wear it? The car? The playground? Are there social issues that are a factor? Is he getting teased at school about having to wear hearing aids or cochlear implants? In order to assist the child and family in using technology optimally, we need to know the answer to these questions.
A 12-year-old I know who has had a CI for many years, and was a successful auditory-oral communicator, was still giving his parents a problem about putting the implant on first thing in the morning. He recently saw a new audiologist who changed his CI program and he is hearing much better. Now he reaches for the CI when the gets out of bed. He just was not hearing well enough with his old CI program. The change in his behavior happened overnight.
What kind of noise environment is the child in?
Is the child at home in a relatively quiet environment or are there four other children there all day. Is she in daycare, and if yes, how many kids and how many adults? If in school, what kind of class is it? How many kids, teachers, how noisy is the room? Getting this kind of information can justify to families and others about the need for FM very early.
Is there any evidence the technology is not working well?
Sometimes when a child is rejecting a device or not making progress it is because she is not hearing well, so checking out how the child is using the device will help. You may want to ask if the child ‘s auditory skills are progressing as expected. It is also important to verify that skills are not deteriorating.
What is the child hearing?
We want to check with the family and others working with the child if she is hearing all phonemes or are there some she consistently does not hear, or hears only when they are loud. Are there perception errors she is consistently making (e.g., slipper for kipper, missing the final /s/)? How far away can she hear? To have optimal access to incidental language we want a child to hear at 15 feet, at least in quiet.
If a child has a gravelly, nasal, or other unusual voice quality, it may indicate that he is not hearing well, so we should listen to check it out, and also ask family members if this voice quality is typical.
Language should be progressing at a rate of one year’s development in one year’s time. If a child is not making that kind of progress, we need to look at all the factors that contribute and figure out what exactly is wrong.
Using the information
By collecting the information and acting on it, we can modify technology so that we are sure kids are getting what they need in order to be the best they can be. We need to listen to other clinicians, respect their input, and act on it.