This past week I had the wonderful opportunity to visit the University of Wisconsin, where I went to grad school, and to meet with the graduate students to talk about what makes a good pediatric audiologist.
In preparation for this talk I asked colleagues in audiology, speech-language pathology, listening and spoken language, as well as parents of children with hearing loss to give me their thoughts. I am very grateful to everyone who shared their thoughts as well as to the students and faculty at UW who listened and participated in the discussion.
The goals of pediatric audiology are to maximize auditory function for children with hearing loss, and to monitor performance of audition, language, literacy and socialization skills of the children we work with.
Pediatric audiologists need to:
- Be warm and caring
- Be patient
- Be willing and able to work around difficulties
- Believe that deaf kids can be whatever they want to be
- Believe that it is our job to get them there
- Understand that there is no such thing as “good enough” for kids with hearing loss
- Work hard to validate technology – to know for sure that kids are hearing what they need to hear
- Recognize that we work as part of a team
- Recognize that parents are a critical part of the team
What does it take?
- Communication skills
- Great skill sets
What is involved in “attitude”?
Families need to feel that their audiologist is there for them. The successful pediatric audiologist needs to be supportive, to believe in the success of children with hearing loss, believe that families can do what they need to do, have the ability to work as part of a team, have an open mind, be patient and creative, be accepting of differences, be willing to try new things, look at the whole child, and doesn’t say “can’t”.
No matter how wonderful an audiologist’s clinical skills are, without good communication skills they will not be the best they can be. We need to be able to talk to parents in language they can understand. (If you are not an audiologist, you don’t know what a severe to profound bilateral sensorineural hearing loss is or a Type A tympanogram.) We need to be able to explain tests and test results in terms that are clear to non-audiologists. Audiologists need to be able to help families understand the effect of hearing loss on auditory brain development, language, literacy and social development.
When counseling families or kids, we need to be fully available. That means sitting down with phone and beeper off when we counsel. We cannot expect families to feel comfortable asking questions and opening up if we appear to be running out the door.
Audiologists need to see themselves as a member of a team. No audiologist works alone. Kids will only be successful when everyone on the team listens to and respects every one else on the team. We need to find a way to communicate with parents, speech-language pathologists, listening and spoken language specialists, classroom teachers, teachers of the deaf, physicians, and any other clinician working with the children. We need to value the input that other members of the team can share about what children are hearing and what they are missing and be willing to use that information to modify technology settings. We need to be able to write clear, concise and consumer friendly reports that everyone can receive in a timely fashion.
Obviously, pediatric audiologists need to know a lot. We need a sound theoretical foundation about auditory disorders, clinical practice, testing and detailed understanding of speech acoustics. The reason we fit technology is to provide access to speech, and understanding speech acoustics will enable us to recognize what the children we are working with are missing so we can modify technology to enable them to hear. We need sound clinical skills to enable us to test in all conditions.
A good pediatric audiologist knows a lot about child development and will recognize the presence of other disorders and know how to refer for additional evaluation and management, will know how to test children with special needs, and will recognize the effect of audition on child development.
We need to understand children and know how to encourage cooperation. Being a test assistant is a very difficult job but one which is just as critical as that of the lead audiologist in obtaining reliable test results. Recognizing when children are getting tired of a toy and understanding how to select and change toys will make the difference in how much test information can be obtained in one test session.
A critical responsibility of any pediatric audiologist is selection and management of technology. A critical part of this responsibility is validation. Only by appropriately validating technology can we be sure that children are hearing what they need to hear. Validation includes obtaining aided thresholds in right and left ears and assessing speech perception at normal and soft conversational levels in quiet and in noise. Another significant responsibility is recognizing when children are not hearing well with hearing aids and knowing when to consider cochlear implants. Fitting and managing FM systems and helping families and school staff to understand the importance is critical.
This is just the start about what is involved in being a good pediatric audiologist. Basically, love children, continue to learn, and go for it. And as one person suggested – you also need a good immune system so you don’t get every cold that comes in with the kids.