How do parents know if their children with hearing loss are receiving enough assistance? I frequently hear from parents who are concerned about how their children are performing. The parents report that they have done what has been recommended but their children do not seem to be doing as well as they think they are capable of doing.
NEWS ALERT: Children with hearing loss need more assistance than what hearing aids or cochlear implants provide.
Technology has improved so much that children are doing better now than they were able to do only a few years back. But our children seem to be victims of their own success. Because hearing loss is now usually identified within the first few months and children are fit with hearing aids almost immediately, they have access to sound and auditory brain development early. As a result, they have much less catching up to do than children identified at age one or two years. Because the kids have language and talk well, everyone assumes that they do not need any help. THAT IS NOT CORRECT.
Every child needs to be carefully evaluated to know what services he or she needs.
Evaluation with technology is CRITICAL. It is not sufficient to test unaided hearing and to program hearing aids using real-ear measurements or computer programing of cochlear implants. Testing with technology is essential. Both threshold testing and speech perception testing are critical. It is not sufficient to test speech perception at one level – normal conversation. Children live in a variety of noise situations and we need to test them in a variety of conditions to know what to recommend. Speech perception needs to tested at normal conversational levels, at soft conversational levels, and in competing noise. Test results will provide very important information about areas of difficulty and will inform the audiologist about how to adjust the technology settings to improve performance and assist in making recommendations for therapy and school.
No matter how well a child seems to be doing it is ESSENTIAL that children with hearing loss receive complex speech-language and listening evaluations. Evaluations need to look in detail at all aspects of speech and language. To succeed in school, a child must have language skills that are as good as those of their peers. When reviewing the language scores, we do not want to look at only the total score but also at individual scores.
The total score on a language test will include areas in which the child excels as well as areas of weakness. The areas of weakness need to be identified and therapy must be designed to improve those skills. The listening evaluation needs to assess how a child is hearing in a variety of conditions and at short and longer distances, because that is what will be needed to function in school. In addition, the vocabulary for the listening evaluation needs to be appropriate for the child’s grade. Using a kindergarten vocabulary list to test a child in third grade will not provide information about what is needed for school functioning.
And here is another piece of bad news. Evaluations every 3 years are not enough. We expect children to improve their skills over time, and they may develop new problems. If we do not continue to evaluate them, we cannot possible expect to know what to do in therapy.
Children with hearing loss have a more difficult time learning in a regular class because, no matter how good their technology, they are not receiving a perfect signal. They will have difficulty hearing from a distance and in noise. As a result, they may need more repetition, which can be difficult in a regular classroom setting. Almost every child with hearing loss would benefit from preview and review of academic vocabulary and concepts. Often this responsibility falls to the parents, but it is actually the responsibility of the school district for many reasons. Parents are not trained educators and this kind of tutoring can make parent-child relationships difficult.
The teacher of the deaf or special educator at the school should meet with the child with hearing loss several times a week to preview vocabulary prior to its being covered in class and to review after the concept is covered in class to be sure that concepts are correctly learned. Unfortunately, this does not usually happen until a child starts to fail. We need to be sure that it happens early so that we can prevent a child from failing.
Social skills and advocacy
Children with hearing loss need to be monitored to be sure their social skills are good and that they are socializing with peers. Social skills are closely related to language, so children with delayed language are likely to have a difficult time socializing, especially in higher grades. Children also need to learn self-advocacy skills. They need to be able to monitor their technology, know when it is not working, report problems, take responsibility for the FM system and ask for clarification when they do not understand.
Every child with hearing loss needs to use an FM system in all academic classes. As kids get older they will start objecting to using and FM system because they do not want to call attention to themselves. Everyone working with children need to work on helping kids understand that they need to hear well and that the FM system helps. (This is a topic for future discussion in this blog.)
Parents are the ones who have to push to see that children get the services they need. But, parents need help knowing what to ask for. Most schools do not routinely provide everything that would be beneficial. Many school programs operate on the failure model – as long as the child is doing well enough and is not failing, no additional services are provided. I operate on the “every child deserves to be the best he can be” model and do not want to wait for failure.
Parents can get assistance from their audiologist, speech-language pathologist, listening and spoken language specialist, or teacher of the deaf to determine what services are needed. Parents need to insist on frequent regular evaluations to be sure their kids are progressing and they need to get help from all the professionals involved to help maximize performance.
It can be done. Every kid deserves to be the best he can be. Just do it!!!