Other People’s Ideas
Calvin Staples, MSc, will be selecting some of the more interesting blogs from HearingHealthMatters.org which now has almost a half a million hits each month. This blog is the most well read and best respected in the hearing health care industry and Calvin will make a regular selection of some of the best entries for his column, Other People’s Ideas.
The fall may be my favourite and most busy time of the year. My kiddos are back in school and so am I. The fall seems to bring so many exciting times for our children; start of school, start of winter sports (hockey), Halloween, pumpkin patches, and corn mazes and the excitement of Christmas off in the distance. The only unfortunate parts of the fall are darkening cooler days as I am one for the heat and the sun! As an audiologist that assesses paediatrics the fall is quite busy seeing children who teachers or parents are concerned about their hearing. In days that are often dedicated to hearing aids, children break up the routine and often provide some unexpected excitement in my day. Here are some blogs for the kiddos!
There are a number of books available now for children with hearing loss. This is a good thing because it is important for children with hearing loss, or any other disability, not to feel that they are alone.
The books are divided into two groups – one for and about children who use spoken language and a second for children who use sign language. These are good for children with hearing loss, for their siblings, and for typical hearing children who want to understand something about disabilities. This is not a complete list, but just what I have my hands on now. I am happy to hear about other books.
Books for Children Who Use Spoken Language
Some books have been written by parents who felt there were no books that spoke to their children. Others were written by hearing aid or cochlear implant manufacturers and others by teens or adults with hearing loss.
A few months back, Wendy Kupfer wrote for this blog about her book Let’s Hear It For Almigal. It tells the story of a little girl with hearing loss who gets cochlear implants. The book covers her adventures and talks positively about her life.
A Birthday for Ben by Kate Gaynor and Karen Quirke is about a 7-year-old who wears hearing aids. Ben speaks and also uses sign language. He has a birthday party where they play games that children who speak and children who sign can all play together. No one feels left out and it is Ben’s best birthday party ever.
Hear Bear Discovers a World of Sound by David and Brooke Sawyer is distributed by Siemens Hearing Instruments. It is about a little bear who had trouble hearing. He went to the ear doctor and the audiologist. He gets hearing aids and then can hear everything.
Mellie Goes to Preschool is distributed by Medel, a cochlear implant manufacturer. Mellie is an elephant who gets a cochlear implant and goes to school, where she learns new words and hears a lot of things.
Cosmo Gets an Ear by Gary Clemente is about a little boy with hearing loss. The book describes the process of getting hearing aids and all the new sounds Cosmo can hear with them.
Abby Gets a Cochlear Implant by Maureen Riski is the story of a little girl who has purple hearing aids and then gets a cochlear implant.
In Ellie’s Ears by Elizabeth Boschini and Rachel Chaikof, a little girl explains her hearing loss to her class. Happy Birthday to My Ears, which is written by the same authors, is a book for very young children and tells about a little boy’s first year with his cochlear implant.
Elana’s Ears by Gloria Lowell is intended for siblings of children with hearing loss. It tells about a sister who is determined to be the best friend and helper for her sister with hearing loss.
In El Deafo, Cece Bell writes about a little girl who loses hearing at age 4 from meningitis. At first she retreats into herself, but then she gets an FM system and is able to hear the teacher. She has trouble hearing in some situations, but the FM gives her super powers because, unlike her classmates, she can hear what the teacher is saying from a distance if the teacher forgets to turn off the microphone. The book touches on different attitudes – disability vs. difference. While I really do not like the title of the book, the topic is a good one.
Books for Children Who Sign
Nobody’s Perfect by the actress Marlee Matlin is about a little girl who attends a mainstream school with an interpreter. She has a birthday party, but the new girl in the class does not attend, so she uses sign language to make friends.
Dad and Me in the Morning by Patricia Lakin is the story of a little boy and his father and it shows how there are many ways to communicate.
Moses Goes to a Concert by Isaac Millman recounts how a little boy and his classmates go to a concert and enjoy the feel of music. The percussionist in the orchestra is deaf and performs in stocking feet so he can feel the vibrations.
In Prudence Park and a Sign Friendship by Christine Burk, a hearing girl meets a deaf girl on the beach and uses her knowledge of sign language to develop a friendship.
Can You Hear a Rainbow? The Story of a Deaf Boy Named Chris by Jamie Riggio Heelan features a 10-year-old boy who uses a variety of communication modalities and hearing aids to communicate.
Parents and others who work with children with hearing loss feel the need to advocate for the children. However, the most important part of advocacy is learning to advocate for oneself.
When children rely on others to advocate for them, they do not feel powerful. But when they are capable of advocating for themselves they feel good about who they are. They feel competent.
Even very young children can learn some self-advocacy skills. It is important to develop self-advocacy skills early. If a child does not do so at a young age, it becomes more difficult to gain these skills later on.
Pre-school children can learn to put technology on and take it off. They can put it into the “hearing aid box” where it will stay overnight. They need to be taught to recognize when the equipment is not working and to report it to an adult. They can be encouraged to ask for repetition when they do not hear or understand what is said.
By kindergarten, children should recognize that they hear better when they are closer to the talker, and they should be encouraged to move closer on their own. A kindergarten child should be able to ask for specific help if she does not understand: Please repeat, please speak louder or slower, etc.
By first grade, children should be able to let the teacher know if the FM system is not working, and should be able to use a pass mic to improve their ability to hear other children. They should understand the different parts of the hearing aid, cochlear implant, and FM system and be able to talk about what they do.
Second graders should be able to report situations where listening is difficult, to recognize when something does not make sense, to begin to use communication repair strategies, and be able to perform basic troubleshooting.
By the time they are in third grade, children should be able to develop self-advocacy strategies for difficult situations. They should be able to explain to the teacher how to use the FM system, and to have become better able to discuss when there is a communication breakdown.
Who Teaches Self-Advocacy Skills?
Everyone who works with a child with hearing loss should participate in advocacy training. Parents need to wait for children to answer and encourage them to ask for repetition. When the earmold comes out or the hearing aid falls off, we need to help the child make the repair and not do it for them.
We need to ask children if they heard what we said and understood it. If they say “no” we need to ask them what they are supposed to do when they do not understand, and encourage them to ask for repetition or clarification rather than just asking to have the statement repeated. When I ask a child a question, parents frequently jump in and repeat the question to the child “Jane wants to know…..”
That is not helping. It’s true that a child will definitely have an easier time listening to a more familiar voice, but he really needs to be able to communicate with a lot of people. It is a team effort. We all have to work on it.
More information about self advocacy can be found at http://successforkidswithhearingloss.com
School is about to start for a lot of kids. Kids and parents are excited. New clothes, new books, new backpacks. What can we do to make this easier for children with hearing loss as the new year starts?
Preparing the Children
If possible, children with hearing loss should have the opportunity to go into the school in advance so they can see the new classroom, meet the teacher, meet the teacher of the deaf, the speech pathologist, the resource room teacher and anyone else who will be working with the child. This is a good opportunity to get some sense of where things are and what is expected. Even preschool children should know how to put his/her hearing aids on and take them off, and hopefully turn them on and off. By school age, children should recognize when the battery is dead and change it.
It is crucial that technology work well for kids to succeed in school. Parents need to be sure that kids have seen the audiologist a few weeks before school starts to ensure that the technology is working and that the child is hearing at a sufficiently soft level (20-25 dB HL). The technology needs to be FM compatible.
Every child with hearing loss should have a personal wearable FM system at school. Hopefully, at the end of the last school year the school determined what FM system will be needed and ordered parts. Trying to get all the necessary parts for an FM system together on short notice is difficult and may delay a child’s ability to participate in school.
The School’s Preparation
There is a lot for a school to do to meet the needs of children with hearing loss, because the school has the responsibility to see that the children succeed!!
- The school must sure there is a current working FM system for every child who has an FM system on their IEP or 504 plan (which should be every child with hearing loss). In addition, the school needs backup equipment so that if the FM systems break down, children won’t lose out on any information. Repairs can take days or weeks, and during that time the child cannot participate fully in school.
- Someone at the school needs to be assigned the task of charging the equipment daily.
- Someone needs to be responsible for training the child and teachers how to use the FM system appropriately. This is usually best handled by the school audiologist. If the school has no audiologist, there may be a consultant audiologist, or a teacher of the deaf may be able to provide this training.
- Someone at school needs to know how to troubleshoot the child’s personal technology, and there need to be spare batteries at school.
- Everyone needs to understand that the classroom must be quiet.
- Windows and doors need to be closed.
- HVAC systems need to be checked so they are quiet.
- Classrooms should not be near the bathrooms, playground, or gym.
- Kids with hearing loss should be strategically seated so they can both see and hear the teacher, and should be able to move around the room if needed to see and hear.
- We need to be sure the child is able to communicate in the classroom.
- Does the teacher know how to use the FM system? If there is no pass-around mic, is the teacher repeating all the comments of other students?
- Does the student have sufficient language to understand what is happening?
- Is the teacher checking to be sure that the child hears? (e.g. Asking questions to ascertain that the child got the message.)
- Is the child using interpreters? Are the interpreters helping with or interfering with socialization?
- Does the teacher speak at a reasonable rate and face the child when speaking?
- Is classroom lighting good?
- Who is monitoring academic performance and making sure that the child is doing not just “okay,” but as well as s/he is capable of doing?
- Do the school staff have sufficiently high expectations or are they satisfied with “good enough”?
- Is someone responsible for pre-teaching and reviewing academic material? How is that person getting the academic material to work on?
- Is the school waiting for the child to fail before it provides academic assistance?
For school to be successful, children must be able to socialize with peers. If a child cannot communicate, socialization will be poor. Data shows that language level is a significant factor in socialization skills. Kids need to have the same language level as their peers if they are going to socialize. Is someone at school working on socialization skills? Support groups for kids with hearing loss will also help with socialization. (For more on such groups, see my post on the topic from March 2012.
Teaching Kids to Advocate for Themselves
Who at school is working on helping children learn to advocate for themselves? Advocacy includes helping kids both recognize when they are not hearing or understanding and helping them ask for clarification.
Is this a long list? Yes it is, but every item on it is crucial in helping kids succeed. Please let me know what I have left out.
The incidence of hearing impairment among children rose by 15% between 2001 and 2011, according to a study published last week in Pediatrics, an online publication of the American Academy of Pediatrics (AAP). The article, “Changing Trends of Childhood Disability,” reported an overall increase of 15.6% in childhood disabilities of all types over that period of time.
For their study, the authors used data collected from nearly 200,000 subjects by the National Health Interview Survey (NHIS) from 2001–2002, 2004–2005, 2007–2008, and 2010–2011. They noted that the findings from 2001-2011 represent a continuation of a growing prevalence of childhood disability over the past 50 years.
Despite the overall increase in disabilities over the latest 10-year period studied, the incidence of physical disability health conditions in children actually declined by 12%. However, that was more than made up for by a 21% increase in disabilities related to mental and neurodevelopmental health, such as such as ADHD and autism.
FASTER INCREASE AMONG MORE AFFLUENT FAMILIES
The five authors reported that a disproportionate percentage of the nearly 6 million children who were disabled in 2010–2011 lived in poverty. The highest rate of disability, 102.6 cases per 1000 population in 2010–2011, was found in that economic sector.
Surprisingly, however, the largest increase in the disability rate, 28.4% over the 10-year period, was found among children living in households with incomes 400% or more above the federal poverty level. According to the writers, this was the first time since the NHIS began tracking childhood disability in 1957 that prevalence occurred disproportionately among socially advantaged families. They noted, “This unexpected finding highlights the need to better understand the social, medical, and environmental factors influencing parent reports of childhood disability.”
While the study did not examine why this occurred, Amy J. Houtrow, MD, PhD, the lead author and chief of the Division of Pediatric Rehabilitation Medicine at Children’s Hospital of Pittsburgh, speculated that it may be because there is less stigma attached to getting help for a disability than in the past.”
Her co-authors were Kandyce Larson, PhD, and Lynn M. Olson, PhD, both on the AAP staff; Paul W. Newacheck, DrPH, of the University of California at San Francisco; and Neal Halfon, MD, of the University of California at Los Angeles.
ASHA CALLS FOR EARLY INTERVENTION
In a statement responding to the article in Pediatrics study, the American Speech-Language-Hearing Association (ASHA) noted that along with the rise in hearing problems from 2001 to 2011, the study found a whopping 63% increase among U.S. children in disability associated with speech problems. ASHA stated that the findings “underscore the importance of early intervention for rising numbers of children who are experiencing communication disorders.”
Elizabeth McCrea, PhD, president of the Rockville, MD-based association, said, “While the reasons behind the marked increase in speech and hearing problems may not be fully clear, the data argue for continued improved awareness among parents and the larger public about these disorders as well as speedy intervention at their earliest warning signs.”
She added, “Unlike many other conditions, early intervention often has the potential to prevent or reverse a communication disorder—or at least dramatically reduce the negative consequences it has on children’s academic and social success as well as their overall development. This is why ASHA urges parents to educate themselves about the signs and seek an assessment from a speech-language pathologist or audiologist if they have any concern at all.”