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.