In this post: Red Flags Barriers to Optimal Auditory Development and Parenting and Teaching with Love and Logic®.
Red Flags: Barriers to Optimal Auditory Development Joan Hewitt, Au.D., Encinitas, CA Jane Madell, Ph.D., LSLS Cert. AVT, Private Practice Sylvia Rotfleisch, M.Sc.A.
When children are not doing well with their hearing technology, some common issues come to mind — is the child involved in appropriate auditory-based therapy? Are parents involved? Are there other developmental issues? But when all of these factors are in place yet the child is still not making appropriate progress, Hewitt, Madell, and Rotfleisch believe we as professionals are responsible to find a solution. Often, they asserted, the solution lies in the technology. All members of the child’s team are responsible for identifying red flags and working hard to solve the problems to give children the access to sound that they need to succeed.
The most basic red flags can be identified through behavioral observations. If a child is hearing well with his technology, he should want to wear it all the time. Sometimes rejection behaviors like refusing to wear the technology or pulling it off are due to improperly programmed technology that is either overstimulating the child or not providing enough information to be beneficial (in essence, becoming a useless earplug worth thousands of dollars). The child’s auditory development and progress in therapy can also be red flags for insufficient progress.
Inappropriate audiological services are a red flag for poor progress in children with hearing loss. Ineffective audiological intervention does not take into account the child’s access to all phonemes and their aided speech perception. Hewitt and her colleagues recommended audiological test batteries that assess the child’s equipment unilaterally, bilaterally, and with their FM system. Testing should include unaided thresholds, aided thresholds (R, L, binaural), and speech perception testing (R, L, B) at 50dB HL (conversational level), 35dB HL (soft speech), and 50dB HL +5 signal to noise ratio (listening in noise). Madell noted that speech perception testing can be conducted as soon as children know some words. Nonstandard speech perception testing with words the child knows, age- and developmentally-appropriate standardized speech perception tests, and phoneme perception are all tools for audiologists to use to check that hearing technology users have true, complete access to the sounds of speech. Children need to achieve speech perception scores between 90-100% to have the excellent access to speech that is required to succced in mainstream environments. Remember, “If it’s not a good score on a math test, it’s not a good score on a speech perception test!”
Inappropriate therapeutic intervention can negatively affect children’s progress with hearing technology. Therapy that involves the child but not the caregivers, fails to check technology daily, does not follow a developmental model, does not use audition as the basis for developing speech and language, and promotes visual language development will not give children the tools they need to use their technology well to develop speech and language through listening. In addition to these factors, educational placements that do not communicate with families, use FM technology appropriately, or stress academics over language development are also detrimental to children’s progress.
Another red flag is ineffective support at home. If parents do not know how to support their child’s development through listening, cannot integrate language development into daily activities, do not know how to monitor technology, or are out of touch with goals in therapy and at school, they are not equipped to help their children succeed. Parents must be proactive participants in their children’s therapy, and professionals must guide and coach parents to give them the skills they need to support intervention in the home.
Problems with speech, language, and audition may alert professionals to problems. Lack of auditory access, as evidenced by children who rely on visual cues for speech information (heavy reliance on speechreading), have regression or deterioration in auditory skills, or cannot hear over distances, are all red flags that require a trip to the audiologist. Poor voice quality, syllabification, vowel recognition, or consonant development are speech errors that may be corrected through technology. The presenters noted that speech production errors are often really speech perception errors. Parents and professionals should also be on alert for children who have a lack of language development. Again, this problem may be attributable to lack of auditory access.
All three presenters encouraged the audience to take careful data and record test results for children. Never assume anything without data from intervention to back up your claims. However, if appropriate parental and interventional supports are in place, it is likely that the red flags the child is presenting can be traced back to suboptimal technology. Though technological measures like Real Ear to Coupler Difference (RECDs) and Neural Response Telemetry (NRTs) measure the theoretical performance of the equipment, they tell us NOTHING about how the sound is being perceived and used by the child’s brain. Only through aided speech perception testing and careful observation can we validate the results from these machines in real- world listening conditions. As part of their presentation, Hewitt, Madell, and Rotfleisch presented an excellent chart of red flags for over- and under-amplification and poor clarity for both hearing aid and cochlear implant users, which can be found in their handout HERE. Audiologists must also ensure that children’s equipment is balanced between ears so that devices are working together, not competing and distorting sound.
With optimal early amplification, intervention, and family support, it is reasonable to expect that the vast majority of children with hearing loss CAN develop speech and language through listening. When “red flags” arise on their journey, professionals and parents must work together as a team to investigate barriers that may affect the child’s ability to make full use of today’s amazing hearing aid and cochlear implant technology.
Parenting and Teaching with Love & Logic®
Sherri J. Fickenscher, M.S., CED, LSLS Cert. AVEd, Clarke Schools for Hearing and Speech, Byrn Mawr, PA
Parents and professionals alike struggle to find the best ways to manage behavior. If children cannot behave and pay attention, the challenge of learning to listen and speak — or learning much of anything — becomes infinitely more difficult. Finkenscher presented on one system for managing behavior — Love and Logic®. This method intends to build children’s self-concept, share the control through offering choices (where both options are acceptable to the parent — “Would you like the blue cup or the red cup?”), offer empathy, then consequences when children make poor choices, and share the thinking (make internal decision making and emotional language audible to the child — talk them through adult reasoning processes). Finkenscher reminded the audience that good discipline is like a savings account, not a credit card. Making changes in beahvior can be difficult at first, but ultimately pays off greatly. She said, “When we do the right thing with difficult children, it will almost always feel like the wrong thing in the short term.”
Some Love and Logic® techniques include:
Neutralize arguing and whining with an empathetic one-liner (“I love you too much to argue”)
Hit the pause button when children are whining (keep repeating your one-liner and refuse to engage in negotiations or prolonged battles)
Set limits without anger, lecture, or threats
If the child creates a problem, the adult hands it back in loving ways (don’t stand between the child and his problems, stand beside him and help him to figure it out himself)
Anger and frustration from the parent fuel the child’s misbehavior
Offer choices whenever possible (if both options are acceptable to the parent)
Read my notes from another Love and Logic® session presented at AG Bell 2008 HERE. Read more about positive behavior management through relationship building HERE.
Elizabeth A. Rosenzweig 