1 Hearing Aid Orientation & Education for Children & Their Families Anne Marie Tharpe Vanderbilt University U.S.A.
2 Hearing Instrument Orientation & Education Parent Education Physical Fit Child Education
3 Parent Counseling
4 Top Topics at Diagnosis: i. Causes of hearing loss ii. iii. iv. Coping with emotional aspects of HL Understanding the audiogram Learning to listen and speak v. Understanding the ear and hearing (Roush & Harrison, 2002)
5 Parents Priorities Later On: i. Learning to listen and speak ii. Realistic timelines for learning to listen and speak iii. Cochlear implants iv. Communication options v. Responsibilities of early intervention agencies vi. Legal rights (Roush & Harrison, 2002)
6 Empowering Parents to Help Their Newly- Diagnosed Child Gain Communication Skills Amy Robbins (2002) Hearing Journal
7 Days, Weeks, Months After Identification Phase I = day of diagnosis until hearing aid fitting Phase II = early weeks just after fitting Phase III = after adjustment to hearing aid until ~ 6 months post-diagnosis (Robbins, 2002)
8 Phase I 3 Things Parents Can do at Home i. Continue to talk to your child sing songs, be animated, finger play, gestures ii. Begin a journal of your experiences iii. Contact the John Tracy Clinic for correspondence course (806 West Adams Blvd, Los Angeles, California, USA ; (Robbins, 2002)
9 Phase II 4 Things to do at Home i. Keep a weekly hearing aid calendar ii. Refer to your child by name always have a purpose iii. Use hands-to-ear response when a sound occurs iv. Note changes in vocalizations as well as auditory responses (Robbins, 2002)
10 Phase III Home Communication Goals i. Imitate your child s vocalizations (intonation pattern & sounds) ii. Encourage an anticipatory response to sound iii. Select 3 common sounds in your home for the baby to learn (Robbins, 2002)
11 AAA (2003) Validation of aided auditory function is a demonstration of the benefits and limitations of aided hearing abilities and begins immediately after the fitting and verification of amplification.
12 Pediatric Working Group Recommendations: Validation Accomplished over time with input from parents, teachers, and speechlanguage pathologists Use of functional assessment tools
13 Functional Assessments Instruments that evaluate behaviors as they occur in realworld settings an audiogram doesn t tell the whole story
14 Audiogram 1. Level of detection only 2. Cannot predict speech perception from threshold level on audiogram 3. Cannot predict suprathreshold performance
15 Right = 90% Left = 100%
16 Right = 100% Left = 70%
17 Right = 44% Left = 20%
18 Why Do We Need Functional Assessment Tools? We used to see this child for initial assessments Now we see these children
19 Age of Identification Until very recently, average age of identification of severe-to-profound HL has been 2.5 years is now closer to 6 mos in areas with newborn hearing screening ALSO
20 Disabilities That Occur with Deafness (%) Deafness with No Other Disabilities Learning Disability Intellectual Disability Attention Deficit Disorder (ADD/ADHD) Blindness and Low Vision Cerebral Palsy Emotional Disturbance Other conditions ~48% Gallaudet Research Institute, Jan 2003
21 Changing Criteria for Cochlear Implantation Children as young as 9-12 months of age are now receiving cochlear implants
22 Challenges in the Assessment of Infants & Toddlers: Developmental level Compliance issues Few appropriate measures Floor effects
23 Functional Assessments Parents Teachers Audiologists Speech Language Pathologists Early interventionists
24 Concerns: Parents may not provide accurate report Natural pride could lead to overestimate of child s abilities
25 Advantages of Structured Interviews: Provides data more representative of progress parent observes child in a variety of situations More likely to reflect what the child knows Based on wide variety of situations, valuable in monitoring change
26 Uses of Functional Assessment Tools To assess child s current auditory skill level To assess child s benefit with amplification To determine a child s risk for academic difficulties To determine a child s communication needs in the home, school, or other settings To involve parents in their child s auditory assessment
27 Potential Limitations The majority of these tools do not have published psychometric data at this time. They are not sensitive enough to compare technologies Validity & reliability of parental observation is not known for specific tools With these data alone, it would not be appropriate to document significant change in performance. They consist of one part of a test battery only
28 Value-Added Benefits Parents learn to become good observers of auditory behavior & part of the evaluation process May improve communication between parents & early interventionists May result in faster determination of changes in a child s hearing
29 Examples of Functional Assessment Tools: Meaningful Auditory Integration Scale (MAIS) Screening Inventory for Targeting Educational Risk (SIFTER) Early Listening Function (ELF) Listening Inventories for Education (LIFE) Parents Evaluation of Aural/Oral Performance in Children (PEACH)
30 Hearing Aids: The Physical Fit
31 Earmolds Earmold material must be soft, but not too soft (vinyl rather than silicone) Must ensure that sound bores are patent High frequencies will be reduced if sound bore is narrower than standard #13 tubing (reverse horn effect)
32 Temporary Solutions to Earmold Feedback Water-based solutions such as Otoferm TM
33 Children are NOT little adults!
34 Infants & Young Children: Are not motivated to wear HAs Work hard to remove them! Work hard to chew them!
35 Safety Features Volume control cover Tamper-proof battery door Retention devices
36 Battery Ingestions Approximately 1400 battery ingestions by children under age 6 years in U.S. annually (most by children 1-2 years of age) Majority of batteries from hearing aids 33% of batteries come from child s own hearing aid (Dire, 2004)
37 Retention Devices
38 Retention Devices Wig tape
39 Infant Ear Hooks
40 Infant/Child Earmolds
41 Behavioral Retention Timing is everything Make it fun Take control Be consistent
42 Hearing Aid Use & Care Stethoscope Battery tester Dri-aid kit Air blower
43 Hearing Aid Use & Care
44 Status of Hearing Aids Study Ross, 1977 Bess, 1977 Reidner, 1978 Diefendorf & Arthur, 1987 Overall % malfunction 50% 25-30% 60% 30% Smitherman, Tharpe, & Bess, %
45 HA Decorations & Colors
46 Pediatric Kits
47 Child Education
48 Can start very early
49 Knowledge is Power (KIP) A program to help students learn about their hearing loss
50 KIP Developed and distributed by: Mississippi Bend Area Education Agency (800) (phone) (319) (fax)
51 KIP Designed to impart knowledge in a systematic manner allowing pupils with hearing loss to gain acceptance, manage their hearing loss, and progress toward a higher self image
52 KIP Areas of Emphasis: Anatomy Causes of hearing loss Hearing measurement Hearing aids Cochlear implants Assistive listening devices Coping with a hearing loss Rational emotive education Stories Legislation Transition Resources
53 KIP Can be used with any school-age student with a hearing loss if content and presentation adjustments are made to match the student s ability and language development. Pre/post tests and worksheets are written at 2 or 3 levels of difficulty. A parent handout is provided at the end of each chapter so the material can be discussed at home.
54 KIP Example: Causes of Hearing Loss Level 1 Some people are born with a hearing loss. YES No Level 2 If you have a sensorineural hearing loss, your hearing will get better as you get older. TRUE FALSE
55 KIP Example: Coping with a Hearing Loss Level 1 Do you have to ask people to repeat what they have said? Level 2 Does your family accept your hearing loss?
56 Thank you!