As a result of newborn hearing screening, more and more babies are being fit with hearing aids. About 95% of their parents have had no experience with having a person with hearing loss in the family and hearing devices are a big challenge. Recent information has shown that most children are wearing their hearing aids only 40% of the time – and babies wear their hearing aids only 20% of the time.

If a baby wears hearing aids only 2 ½ hours out of 12 waking hours, it is like missing out on 4 years of early listening and language! Like a mitten string for hearing devices, Ear Gear is a “no brainer” solution to keeping the hearing aids from getting lost, keeping them away from the baby’s mouth, and protecting the devices from moisture and dirt.

The result:

It is easier for parents to keep hearing devices on children so that they can hear their best for all of their waking hours. The spandex covers add extra comfort and come in bright colors that children can choose for themselves. For use with hearing aids, CI processors, and FM systems, Ear Gear truly supports the success of children with hearing loss! -Karen L. Anderson, PhD Director

Ear Gear was selected as the #1 choice for hearing aid retention accessories by parents!

Coupon offer below!

Ear Gear is:

• Acoustically transparent
• Easily cleaned – just wash and dry
• A great solution for mouthing babies, active kids, athletic teens
• In 8 colors so your child can choose, inexpensive enough to collect a ‘wardrobe’ of Ear Gear looks
• I love that it is fully warrantied – if you don’t like it for any reason, just return it

Ear Gear is sold in pairs but can be purchased for children who wear a device on only one ear. Cords to assist in hearing device retention are standard, but for individuals who want to use Ear Gear mainly for sweat/dirt protection there are also cordless models.

How many kinds / sizes of Ear Gear are there?

Lots! If your child or pediatric client uses a hearing device, there is a style of Ear Gear that will fit. Even with glasses!

There are so many kinds and sizes of Ear Gear that it is not practical for Supporting Success to sell it directly. Instead, we have negotiated a GREAT DISCOUNT!

For a 20% one-use discount, send an email to questions@success4kidswhl.com with your ‘keeping hearing aids on’ challenges, strategies and successes! This offer is open to parents, teachers and audiologists. Write Ear Gear in the subject line of your email and I will reply with the coupon code good for 20% off for one month. Note: the 20% coupon cannot be applied to custom orders, applied during flash sales or combined with other coupons. With your help, more great strategies can be added to https://successforkidswithhearingloss.com/hearing-aids-on and more kids can benefit from Ear Gear to help keep their hearing devices on safely and effectively.

“As an infant, our daughter would pull out her aides and safety pins and fishing line were often a tangled mess. Ear Gear was a blessing to our dilemma. At 13 she continues to wear the Ear Gear for security reasons. We appreciate the protection Ear Gear offers her aids. Her current pair is 6 years old but looks like new thanks to Ear Gear keeping sweat and dirt away.”

Just measure the length of your child’s hearing aid to select the style or contact Ear Gear at 1-888-766-1838.
Ear Gear is sent by airmail which takes about 2 weeks to reach the U.S.A., UK, Europe and Australia, and about 3 weeks for Asia, South America, and Africa.

The post Ear Gear – Parent’s choice as most effective for keeping hearing aids on kids! first appeared on Supporting Success For Children With Hearing Loss.

It’s a common misconception that hearing aids “fix” hearing loss like glasses “fix” vision loss. While hearing aids are prescribed for those with hearing loss, hearing aids don’t fix hearing loss. Children with hearing loss haven’t yet developed auditory skills, therefore they will need to have direct instruction in auditory skill development, to understand what they are hearing. In order to provide auditory skill development instruction, teachers need to know how typically developing children develop auditory skills in order to determine the needs of a student with hearing loss.

Before beginning instruction in auditory skill development, assessment is absolutely necessary. Use an assessment that has been vetted as appropriate for children with hearing loss.  Use assessments that will yield results that help determine where exactly instruction should begin. Check out this resource that will help to determine what assessments are appropriate here.

After assessment, teachers and therapists can target areas that will need to have direct instruction.

What do you do with the results of assessment? First, build your knowledge of typical auditory development.

After determining what skill area(s) the student is currently in need of developing, begin instruction with the areas of skill deficits.¹Auditory skills are typically defined in 4 areas of concentration:

• Detection: Detection is the ability to respond to the presence or absence of so It is the essential first step in learning to listen.
• Discrimination: Discrimination is the ability to perceive similarities and differences between two or more speech stimuli. In discrimination activities, same-different tasks are often used. (Example: dog vs. dogs, “Do they sound the same or different?”)
• Identification: Identification is the ability to label by repea.ng, poin.ng to or wri.ng the speech stimulus hear
• Comprehension: Comprehension is the ability to understand the meaning of speech by answering questions, following directions, paraphrasing, or participating in a conversation.

While there is a hierarchy of auditory skill development these skills are not developed independently of one another. Auditory skills are developed in tandem, however instruction can be delivered specifically in each auditory skill development concentration. Consider these factors when evalua.ng and determining service delivery: age on onset, age of amplification, access to consistent auditory training, and language rich environments should be considered when determining type and amount of services for children with hearing loss.

Children need constant exposure to language. Developing language and auditory skills are critical for students who are learning to use amplification. Amplifying a student’s hearing levels doesn’t automatically develop their ability to identify, locate, discriminate, and comprehend what they are hearing. In addition, according to the auditory scaffolding hypothesis, deafness may especially affect cognitive abilities related to learning, recalling, and producing sequential information.  In addition, research indicates that

²Although it is common to consider deafness as affecting the sense of hearing alone, we argue that because sound is the primary gateway to understanding temporal and sequential events, auditory deprivation may result in significant disturbances on a wide range of other tasks (Conway, Karpicke, & Pisoni, 2007). For instance, Bavelier, Dye, and Hauser (2006) have argued that deafness results in a reorganization of cortical function. Therefore, losing the sense of audition early in development may set up a cascade of complex effects that alter a child’s entire suite of perceptual and cognitive abilities, not just those directly related to hearing and the processing of acoustic signals.

According to the auditory scaffolding hypothesis, deafness may especially affect cognitive abilities related to learning, recalling, and producing sequential information. A delay or disorder in domain-general sequencing skills, triggered by lack of auditory stimulation at an early age, could provide a significant impediment to normal development. Indeed, previous work suggests that the profoundly deaf show disturbances in (non-auditory) functions related to time and serial order, including immediate serial recall (Marschark, 2006). (“The Importance of Sound for Cognitive Sequencing Abilities: The Auditory Scaffolding Hypothesis – PMC”).

In conclusion, amplification providing access to sound, access to spoken language, and direct instruction in auditory skill development, will impact a student’s ability for cognitive sequencing.  Early amplification and targeted therapy enhances a student’s probability for auditory-cognitive success.

Works Cited:

¹Compiled by Denise Wray et. al., University of Akron, 2007 from: Erber, N. (1977) “Evalua.ng Speech Perception Ability in Hearing Impaired Children” [Bess, Fred H. (ed): Childhood deafness: Causation, Assessment, and Management.] New York, Grune & StraKon. Estabrooks, W. (2006). Auditory-Verbal Therapy and Practice. Washington, DC: A.G. Bell

²Conway, Christopher M et al. “The Importance of Sound for Cogni.ve Sequencing Abili.es: The Auditory Scaffolding Hypothesis.”  Current directions in psychological science vol. 18,5 (2009) 275-279. Doi:10.1111/j. 1467-8721.2009.01651.x

Author: Michelle Andros, MSEd

Click here to download this article.

The post Hearing Aids are NOT “Glasses” for the Ears first appeared on Supporting Success For Children With Hearing Loss.

Most adults never have to think about hearing aids until they are middle-aged or older. A child with a diagnosis of permanent hearing loss means that you, as his/her parents, will need to understand what hearing aids do and do not do, and how to care for them. The links below are designed to help you begin your education on hearing technology and your important role supporting your child’s hearing device wear. It may also be of interest to read Questions Families Often Ask about their child with hearing loss.

Very briefly, there are three important reasons for your child to use his/her hearing devices all waking hours:

1. Consistent input of sound helps the brain develop – this is most important birth – 3 years. Brain pathways do not develop normally when input is inconsistent.

2. Consistent hearing builds a sense of trust in your child and bonding with you – how predictable the world is and the behavior of those in his life depends on consistent hearing.

3. Language is caught not taught. Your child’s listening bubble is smaller that other children’s. Hearing isn’t restored to normal with hearing devices, but using hearing devices all waking hours allows your child to optimally ‘catch’ the verbal language occurring around him which is necessary for growth in his understanding and use of verbal  language.

What are hearing devices? What do they do?

Hearing Aids – What, When, Why, How

Cochlear Implants – What, When, Why, How

How much can hearing aids/cochlear implants really help?

Just Like You video (Jane Madell & Pediatric Hearing Aid Project)

How much does he need to wear hearing aids? How can I keep them on him!

Setting Reasonable Expectations About Hearing Aid Wear

Hearing Aid Retention Accessories Chart and Ratings by Parents      See webpage

Potential financial resources for hearing aids. Hearing aids are very expensive. Unfortunately there are not always sources of funding readily available when your child’s hearing loss is diagnosed and he or she needs to start wearing hearing aids. Some places, and some audiologists, have loaner hearing aids that can be used until a parent figures out how to buy them or another resource to fund the hearing aids. Some states have insurance coverage for hearing aids for children, so be sure to check your insurance provider. Although it seems very unfair, in many, if not most cases, it is up to the family to find the money.  For your child’s sake, if needed, ask for help from extended family as their help at this time will clearly make a difference in your child’s ability to function as well as possible socially and in school. Some audiologists will allow you to pay over time (like a car loan). There may be extended pay options for hearing aids purchased from places like Costco or Sears (maybe with a recommendation from the diagnosing audiologist). It only puts your child farther and farther behind developmentally the longer it takes to purchase hearing aids. Three months is a long time! Ultimately, it is the responsibility of the family and not the government, school or other provider to make sure your child has the hearing aids he/she needs to succeed. Find other families of children with hearing loss to talk through the solutions they found at this challenging time. If your child needed critical surgery and insurance didn’t pay for all of it, would you wait?

I know I need to check the hearing aids every day. How do I do this?

Hearing Aid Listening Check Instructions- English

Hearing Aid Listening Check Instructions- Spanish

Video describing hearing aids and how to check them daily by the National Center for Hearing Assessment and Management (about 14 minutes) . Hearing Aid Listening Check  – handout from the National Center for Hearing Assessment and Management

Video on troubleshooting a hearing aid if it isn’t working  Video 1 (about 3 minutes)

When should my child be learning how to put on and check his own hearing aids?

SEAM for School Success – provides expectations from age 3 through high school for different skills and stages of being independent with hearing devices.

Updated January 2016.

The post Hearing Aids and Your Child first appeared on Supporting Success For Children With Hearing Loss.

Challenge 1: Well-Fit Hearing Devices

One of the results of the 2015 Outcomes of Children with Hearing Loss Study1 was that well-fit HAs reduce risk and provides some degree of protection against language delay. Greater aided audibility is associated with better language outcomes in preschool. HAs are well-fit when speech is made as audible as possible by closely matching gain to prescriptive targets, the latter of which is dependent upon the child’s degree and configuration of HL. Another finding of this broad study was that 31% of children who are hard of hearing had hearing aids that were not fit to optimize speech perception. Just because a child is wearing hearing aids does not mean that he is perceiving speech as optimally as possible. Results indicated that optimized audibility made positive contributions to children’s language and auditory development, even for the children with mild hearing loss. Children receiving the most benefit from their HAs (i.e., greatest aided audibility after controlling for the influence of unaided hearing) demonstrated a positive language growth pattern, showing steady improvement in standard scores from age 2 to 6 years. In contrast, children receiving the lowest benefit from hearing aids showed no change in standard scores over the same time period. By 6 years of age, there was a cumulative difference between these groups of two thirds of a standard deviation. In addition, aided audibility was positively associated with multiple measures of word recognition in quiet from ages 2 to 6 years and in noise for 7- to 9-year-olds. Children with greater aided audibility had better auditory development outcomes and speech recognition abilities than children with lower aided audibility across a wide range of ages and outcome measures. These conclusions support the inclusion of aided audibility in the model as a factor that moderates the impact of HL on children’s outcomes.

What Can YOU Do?

1. Obtain consent from the families of students on your caseload to be in touch with their audiologists. Having routine consent to contact the audiologist about the child’s hearing levels and amplification devices will save time if questions arise about how well the child appears to be perceiving speech.

2. Invest the time to identify a child’s level of access to speech under typical school conditions. There is no replacement for the critical information obtained by doing a Functional Listening Evaluation. Students with typical hearing score 95%+ in quiet and 90%+ in noise If a student has been trained to routinely respond to Ling sound audibility checks, take the time to perform the ELFLing, which systematically identifies the ability to perceive the Ling sounds at different distances. If you only have a few minutes, at least do the Iowa Medial Consonant Test, which is a fast check of audibility for specific consonant sounds. If a child has 25-70 dB hearing levels and has worn hearing aids for some time, then a 100% score is expected.

3. Hearing aids should be fit so that students with hearing loss of 70 dB or better can perceive all of the speech phonemes in quiet from 3 feet without watching the speaker’s face. If you have a student who does not seem to be able to do this, bring the issue to the attention of the family and audiologist. If hearing devices are the gateway to learning, removing any barrier to that gateway can only benefit the student’s performance.

Challenge 2: Ensuring that Hearing Devices are Functioning

It is a cruel reality that 50% of children’s hearing aids malfunction on any given day2. In the US, IDEA specifies4 for children with IEPs, schools must ensure that the hearing devices worn by students with hearing loss are functioning. This requirement underscores the value of working hearing devices and their necessity if a student with hearing loss is to receive a free and appropriate public education, while the ADA focuses on the discriminatory nature of denying full access to classroom communication. With an effective hearing aid monitoring program in place hearing aid malfunction rates can drop to less than 1%2.

Although the law provides no specifics on who, how or how often hearing device monitoring will occur, there is clear intent that the school bears the responsibility to ensure that this monitoring occurs. This need for monitoring and data gathering was reinforced by the outcome of a 2015 court case5 that ruled that a school violated the IDEA record keeping clause (34 CFR 76.731 ) by not keeping a daily log of whether or not the student was provided daily access to the FM/DM system required by the IEP, and if the student used the FM/DM system each day.

In order to verify that the hearing device monitoring activity has occurred, the school needs to have a record of data that provides evidence of hearing device monitoring, including the daily presence and use of the FM/DM system if this communication access accommodation is included on the IEP.

What Can You/Your School District Do?

1. Include teaching hearing aid independence skills to students as a goal on the IEP or as part of ADA accommodations on the 5043 Plan. Hearing devices can malfunction at any time. ONLY the student – with training – is able to immediately identify when a problem arises, and is in the best position to troubleshoot the device and/or request assistance.6 See SEAM skill hierarchy from Building Skills for Success in the Fast-Paced Classroom or refer to Building Skills for Independence in the Mainstream for teaching independence skills6.

2. Have administration knowledge and support of the legal requirement to perform regular monitoring and necessary data collection. Without clear support from the principal, classroom teachers often view hearing aid monitoring as a ‘good thing to do if they have time’ rather than a required activity.

3. Require that a teacher of the deaf/hard of hearing or educational audiologist meet with classroom teachers and provide instruction in how to monitor hearing device function, including involving the student in monitoring, and delineate expectations for necessary data gathering.

4. Provide clear expectations for data collection processes/forms to be used, how often data needs to be collected (i.e., daily), where it needs to be kept, and who is ultimately responsible for ensuring that monitoring and data collection occurs.

Challenge 3: Students Who Don’t Use Their Hearing Devices

While it may seem funny to turn to a child not wearing their hearing aids and say, “Your brain is in your pocket! Oh no!” it is true that about 25% of students do not (consistently) use their hearing aids7. Rejection of hearing aids can be due to lack of support from home. If the family is not supportive of the child using hearing aids, the student may feel as though they are being disloyal to what parents want by wearing their hearing aids at school. If the family does not want amplification to be used, it should not be included on the IEP and there needs to be a clear understanding of reduced academic achievement expectations and risk for social and/or behavior issues.

What Can You Do?

1. Children can often reject their hearing aids when malfunction issues frequently occur as they learn they cannot rely on hearing better via the technology8. Instruction in hearing aid use, monitoring, and troubleshooting is necessary for equal access to education6.

2. Feeling good about cool hearing aid technology is a good foundation for confidence. Items like hearing aid charms, hearing aid fairy wings, or Ear Gear ‘hearing aid outfits’ can catch the attention of peers in a positive way. With positive experiences, students with hearing loss will be better prepared emotionally to deal with the teasing that seems to be a natural part of late elementary and middle school. Share these ideas with families.

3. As students enter 3rd grade and beyond, having no preparation for resilience to teasing by peers too often results in students rejecting amplification secondary to social rejection concerns, even if they know that the amplification is important for learning. Most students with hearing loss are in their neighborhood school with no other peers who use hearing devices. Developing an identity as a person with hearing loss is not possible without feeling a part of a group of okay kids who happen to have hearing loss and use hearing devices. Connections with other students who use hearing devices, or at a minimum, viewing and discussing Kool Kidz Vidz10 can help students develop a healthier identify and resilience to being a ‘one and only’.

4. The direct involvement of a teacher of the deaf/hard of hearing to instruct students in self-advocacy skills and connect them to similar peers is needed if rejection of hearing devices due to social reasons is to be minimized.6,9 As students reach the secondary grades, they need to be fully involved in problem-solving11 their access challenges and making decisions about their use of hearing devices.

Summary

Hearing devices are the gateway to optimal school performance for students who are hard of hearing. There is both logical and legal reasons for teachers of the deaf/hard of hearing and school districts to fully support appropriate hearing device use and the skill building needed for students to feel confident when wearing their devices.

References

1. Moeller, MP, Tomblin, JB, et. al, (2015). Outcomes with Hearing Loss Study, Ear and Hearing, 36: 1S-3S, November/December.

2. Langan, L. & Blair, J.C. (2000). “Can You Hear Me?” A Longitudinal Study of Hearing Aid Monitoring in the Classroom. Journal of Educational Audiology (5), 34-36.

3. Summary of ADA information related to students with hearing loss.

4. IDEA Sec. 300.113. (a) Supporting hearing aid monitoring (b) (1)  Supporting cochlear implant processor monitoring.

5. Detroit City School District., 115LRP 31115 (SEA MI 06/12/15). Written summary of court case findings.

6. Instructional materials for 43 separate goals for hearing device independence can be found in Building Skills for Independence in the Mainstream.

7. 2017 Supporting Success for Children with Hearing Loss Survey: Children Rejecting Hearing Devices: Who, Why, When? Findings for 88 respondents representing a combined caseload of 1863 students.

8. Franks, JL (2008). Why do students with hearing impairment resist wearing FM amplification? Master’s Thesis, Eastern Michigan University.

9. Building Self-Confidence & Resilience to Maximize Acceptance of Hearing Devices: Guide to Building Awareness and Skills to Facilitate Daily Use of Hearing Devices Early Childhood Through High School.

10. Kool Kidz Vidz are part of the Teacher Tools library available to members. There are 13 brief videos by students with varying degrees of hearing loss and hearing devices, including discussion questions.

11. COACH – Self-Advocacy & Transition Skills for Secondary Students who are Deaf or Hard of Hearing

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The post Technology Monitoring Is Necessary For Hearing Device Users first appeared on Supporting Success For Children With Hearing Loss.

Each Fall, teachers of the deaf/hard of hearing scramble to contact each of their student’s classroom teachers about the impact of hearing loss on educational performance and what the teacher needs to do to accommodate the student’s unique learning needs.

Without inservicing the teachers, it is likely that they will believe:
(1) hearing devices will ‘fix’ all of the listening issues,
(2) the student will ask when they missed something or didn’t hear completely,
(3) the student is distractible or inattentive, does not pay attention during class discussion
(4) the student may have a learning disorder because they don’t seem to be able to follow directions and get to work like other students,
(5) they do not participate equally in group activities, letting their peers do most of the work

Students with hearing loss don’t know what they didn’t hear because they didn’t hear it, yet they are routinely held accountable for information that they never perceived.

A student will not receive equal access to classroom communication unless the teacher is aware of the impact of the hearing loss and what is required to ‘level the playing field’ for these students.

With sizable caseloads across a number of schools, getting to all of the teachers before the year starts or during the first week of school for a face-to-face meeting can be impossible.

How can the itinerant teacher of the deaf/hard of hearing more effectively contact classroom teachers early in the school year?

INTRODUCE THE STUDENT HEARING ISSUES AND NEEDS VIA EMAIL

• When you send out an email to the teacher, if possible, set it up so that you receive a receipt when the teacher has read the email. This identifies a good window to follow up quickly with the teacher while the information is still fresh in her mind. A lack of a receipt also lets you know those teachers who have not read the information and will need another email contact or personal visit.
• In the email, give the teacher a ‘heads up’ that you will be contacting her to spend some time talking about the students needs. An example of this ready-to-go letter has been included: Dear Classroom Teacher (Word/PDF).
• Once you meet with the teacher, you can further share a general description of the impact of the hearing loss, such as the Relationship of Hearing Loss to Listening and Learning Needs
• Share the SIFTER checklist the previous year’s teacher completed in May, with the new classroom teacher. Include the LIFE-R results as well if possible. This will prepare the teacher to expect to fill out these checklists about one-month into the school year. Summarize other test results, like the Functional Listening Evaluation, Listening Comprehension Test, or examples from observations of the student in previous classrooms.
• Alternately or additionally, provide a brief description of the results such as:
  Through the use of the Listening Inventory For Education checklist, John identified that he has significant difficulty hearing class discussions, social interactions, and communication when there is any noise in the classroom. He is challenged when the teacher moves about the classroom as it prevents him from speechreading, which improves his understanding. Last May, this student’s third grade teacher identified that John continues to perform lower academically, has periods of inattention due to listening fatigue, hesitates after directions, and rarely participates during class discussion. Thus, his hearing loss impacts his ability to fully participate and perceive communication in the classroom environment. John has IEP goals related to developing self-advocacy skills as he has identified that he mainly waits for teacher clarification rather than letting the teacher know, or otherwise getting assistance when he does not completely hear class instructions.
• Some teachers benefit from receiving a link to YouTube videos that describe general information teachers should know when supporting a student with hearing loss in their classroom (example 1, example 2, example 3, example 4, example 5, or search yourself – there are lots of videos available!).
• Alternately, you or your DHH Team can prepare your own brief YouTube videos. Use a private YouTube channel to ensure that no confidentiality questions arise. Develop videos for alike student groups, such as unilateral hearing loss, mild loss with consistent hearing aid use, mild hearing loss with challenging hearing aid use issues, etc. Emphasize educational performance issues (what the teacher will SEE and how it relates to the hearing loss), legal requirements (ADA access, equipment monitoring), and necessary teacher/instructional accommodations.
• Develop a YouTube video that shows what the teacher needs to do to appropriately use and maintain the student’s hearing assistance technology.

For students who have used hearing aids (consistently) since infancy it is no longer most appropriate to share descriptions of the impact of the hearing loss levels with teachers, as the students are actually functioning based on their hearing ability while aided. Due to consistent aided hearing and in recognition of frequent non-use by students with mild hearing loss, there are four versions of this new inservice handout: 20-25 dB, 25-30 dB, 30-35 dB, and 35-40 dB. For other types and degrees of hearing loss the freely available Relationship of Hearing Loss to Listening and Learning Needs still remain relevant.

1. The sections of possible impact on understanding, possible social/emotional impact, and potential educational accommodations have been thoroughly revised.

2. Audibility of speech sounds for soft speech (35 dB), conversational speech (45 dB), and teacher speech (50 dB) have been included. A percent audibility is specified as are missing or audible speech sounds.

3. An example of fragmented listening is provided via a paragraph of instructions with parts of speech eliminated based on decreased audibility.

4. Possible listening challenges in school have been included, derived from the LIFE-R Student Appraisal. You can either check off the items that the student has identified as challenges or leave them as is to raise awareness of difficult listening situations.

5. The footnote contains a check off of important teacher accommodations that you can review to reinforce the necessary accommodations specified in the student’s IEP or 504 Plan.

6. An instruction sheet has been included with suggestions for use with TODAY’S STUDENTS WITH HEARING LOSS!

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The post Dear Classroom Teacher: You Have A Student With Hearing Loss first appeared on Supporting Success For Children With Hearing Loss.

Being closer to the person talking will help the listener with hearing loss to hear more loudly and clearly. Hearing aids amplify all sound and make it seem louder and clearer at ear level for persons with hearing loss, but never ‘corrects’ hearing to a normal hearing level. They are designed to work best in picking up speech within 3’ to 6’ and amplifying it to an optimal level for hearing speech. Therefore, students with hearing loss have smaller ‘listening bubbles’ or shorter listening ranges than their typically hearing peers.

If a student with hearing aids has two dead batteries, then there is a substantial ‘doorway’ obstruction to him being able to perceive speech clearly enough to understand.  Imagine a child attending class each day, but instead of sitting within the classroom, the student is required to stand outside the room and look in. Is it fair to expect him to learn at the rate of class peers when he does not have the same access to instruction? Because students seem to ‘hear’ the teacher, the impact of the hearing loss significantly reducing comprehension of what is said is very often misunderstood and minimized.

Hearing aids and FM/DM systems do not restore normal hearing, but they DO provide much improved access to verbal communication that would otherwise be auditorilly impossible to the child with hearing loss. The Americans with Disabilities Act² requires that schools ensure that communication for students who are deaf and hard of hearing are as effective as communication for others through the provision of appropriate aids and services affording an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others, to participate in and enjoy the benefits of the district’s services, programs, and activities.

It is a cruel reality that 50% of children’s hearing aids malfunction on any given day¹. In the US, IDEA specifies³ for children with IEPs, schools must ensure that the hearing devices worn by students with hearing loss are functioning. This requirement underscores the value of working hearing devices and their necessity if a student with hearing loss is to receive a free and appropriate public education, while the ADA focuses on the discriminatory nature of denying full access to classroom communication.  With an effective hearing aid monitoring program in place hearing aid malfunction rates can drop to less than 1%¹.

IDEA Sec. 300.113. (a) Each public agency must ensure that hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly. (b) (1) Each public agency must ensure that the external components of surgically implanted medical devices are functioning properly.³

Although the law provides no specifics on who, how or how often hearing device monitoring will occur, there is clear intent that the school bears the responsibility to ensure that this monitoring occurs. This need for monitoring and data gathering was reinforced by the outcome of a 2015 court case⁴ that ruled that a school violated the IDEA record keeping clause (34 CFR 76.731 ) by not keeping a daily log of whether or not the student was provided daily access to the FM/DM system required by the IEP, and if the student used the FM/DM system each day.

In order to verify that the hearing device monitoring activity has occurred, the school needs to have a record of data that provides evidence of hearing device monitoring, including the daily presence and use of the FM/DM system if this communication access accommodation is included on the IEP.   

Checklist for Monitoring Responsibilities. Do You/Does Your School District:

1. Include teaching hearing aid independence skills to students as a goal on the IEP or as part of ADA accommodations on the 504 Plan. Hearing devices can malfunction at any time. ONLY the student – with training –  is able to immediately identify when a problem arises, and is in the best position to troubleshoot the device and/or request assistance.⁵   See SEAM skill hierarchy.

2. Have administration knowledge and support of the legal requirement to perform regular monitoring and necessary data collection. Without clear support from the principal, classroom teachers often view hearing aid monitoring as a ‘good thing to do if they have time’ rather than a required activity.

3. Require that a teacher of the deaf/hard of hearing or educational audiologist meet with classroom teachers and provide instruction in how to monitor hearing device function, including involving the student in monitoring, and delineate expectations for necessary data gathering.

4. Provide clear expectations for data collection processes/forms to be used, how often data needs to be collected (i.e., daily), where it needs to be kept, and who is ultimately responsible for ensuring that monitoring and data collection occurs.

What about students who don’t use their hearing devices?

While it may seem funny to turn to a child not wearing their hearing aids and say, “Your brain is in your pocket! Oh no!” it is true that about 25% of students do not (consistently) use their hearing aids⁶. Rejection of hearing aids can be due to lack of support from home. If the family is not supportive of the child using hearing aids, the student may feel as though they are being disloyal to what parents want by wearing their hearing aids at school. If the family does not want amplification to be used, it should not be included on the IEP and there needs to be a clear understanding of reduced academic achievement expectations and risk for social issues. Children can often reject their hearing aids when malfunction issues frequently occur as they learn they cannot rely on hearing better via the technology. Instruction in hearing aid use, monitoring, and troubleshooting is necessary for equal access to education. Finally, as students enter 3^rd grade and beyond, having no preparation for resilience to teasing by peers too often results in students rejecting amplification secondary to social rejection concerns, even if they know that the amplification is important for learning. Most students with hearing loss are in their neighborhood school with no other peers who use hearing devices. Developing an identity as a person with hearing loss is not possible without feeling a part of a group of okay kids who happen to have hearing loss and use hearing devices. The direct involvement of a teacher of the deaf/hard of hearing to instruct students in self-advocacy skills and connect them to similar peers is needed if rejection of hearing devices due to social reasons is to be minimized. Refer here for more information on this intervention.

References

1. Langan, L. & Blair, J.C. (2000). “Can You Hear Me?” A Longitudinal Study of Hearing Aid Monitoring in the Classroom. Journal of Educational Audiology (5), 34-36.

2. Summary of ADA information related to students with hearing loss.

3. IDEA Sec. 300.113. (a) Supporting hearing aid monitoring (b) (1) Supporting cochlear implant processor monitoring.

4. Detroit City School District., 115LRP 31115 (SEA MI 06/12/15). Written summary of court case findings.

5. Instructional materials for 43 separate goals for hearing device independence can be found in Building Skills for Independence in the Mainstream.

6. 2017 Supporting Success for Children with Hearing Loss Survey: Children Rejecting Hearing Devices: Who, Why, When? Findings for 88 respondents representing a combined caseload of 1863 students.

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The post Brain On? Hearing Device Monitoring is Necessary for Access to Education first appeared on Supporting Success For Children With Hearing Loss.

In 2012, Jane Madell, PhD and I sent out a survey to a variety of groups of parents of children who are hard of hearing or deaf, asking them what strategies they used to keep hearing aids on their children when they were very young. We also asked them to rate the various hearing aid retention accessories that are available. The results provide valuable information for families to know and for audiologists and early intervention professionals to share with the families they support. Jane and I then developed the information into three 2-page brochures that can be provided to families based on the age of their child. Again, thank you parents for sharing your expertise. Karen L. Anderson, PhD, Director.

Downloadable Keeping Hearing Aids On Brochures for Families

The brochures address why and when hearing aids are needed; basic problems keeping hearing aids on for children in that age range; and hearing device retention accessory information. Print out as a two-sided document and fold as a brochure. Provide to families as their child grows throughout early childhood. Audiology clinics and early intervention programs are encouraged to print brochures to have copies readily available for families when hearing aid retention issues are discussed.

Download and print your brochure information now! Select the brochure below and print! Both sides is suggested, using 28# or 30# paper.

Babies and Hearing Aids – 0-12 Months: 0-3 months; 4-6 months; 6 months; 9 months; 12 months; how to keep hearing aids out of your baby’s mouth; how to discourage his practicing the skill of yanking off the hearing aids

Toddlers 12 to 24 months: during the second year; about 20 months; how to discourage your child from yanking off the hearing aids; checking the hearing aids daily with toddlers

Preschoolers and Hearing Aids – 2-5 Years: the terrible twos; the curious threes; the sensitive fours; checking hearing aids daily with preschoolers

Spanish version of the 3 brochures

Can’t print and want to receive a copy of each brochure by mail? to receive the three brochures, sent in an envelope to you at no cost (English version, US only).

Also available: Oticon USA has made the content of these 3 brochures available in one brochure called the Children’s Retention brochure (#15500-3025). It is available for ordering through pediatrics@oticonusa.com. You can request up to 10 free per order or download them from the Oticon website at: https://www.oticon.com/your-hearing/children-with-hearing-loss/why-childrens-hearing-is-important Spanish version also available! Thanks Oticon!

Ear Gear was rated top by families for effectiveness for keeping young children’s hearing aids on and safe! Once this finding was evident, a special price was negotiated with Ear Gear for families/professionals who wish to try Ear Gear!

• Hearing Review Article: Improving Hearing and Hearing Aid Retention for Infants and Young Children: A practical survey and study of hearing aid retention products. This lead article in the February 2014 Hearing Review is for professionals, describing the survey, results based on parent and audiologist responses and acoustic transparency information for hearing device retention accessories. By Karen Anderson & Jane Madell
• Advance for Speech and Hearing article: If We Could Improve Just One Thing: Getting the Most Out of Early Hearing Loss Identification, by Karen Anderson is an easy to read summary of the information, appropriate for professionals and families.
• Hearing Aid Retention for Infants and Young Children: Jane Madell & Karen Anderson, Volta Review Article, Sept/Oct, 2014. For families describing the Children’s Hearing Aid Retention Project survey and results.
• Understanding Limited Use of Amplification in Infants and Children who are Hard of Hearing: Ryan McCreery, Elizabeth Walker & Meredith Spratford. ASHA SIG 9 Perspectives in Hearing and Hearing Disorders in Children, 25, 15-23
• Hearing Aid Use for Children with Hearing Loss: A Literature Review: Karen Munoz & Melanie Hill. ASHA SIG 9 Perspectives in Hearing and Hearing Disorders in Children, 25, 4-14.
• Trends and Predictors of Longitudinal Hearing Aid Use for Children Who are Hard of Hearing: Walker, EA, McCreery, RW, Spratford, M. Ear and Hearing, 36(Supplement 1), Nov/Dec 2015.

Summary information on hearing aid retention survey results and acoustic transparency click here

When the kids were little, one of the strategies we used to keep their aids in their ears was to let them decorate their aids with stickers, charms, and colorful tubes. Letting them personalize their aids was a great way to help them connect with their aids and make them their own. Parent of two children with hearing loss.

Parent’s Strategies Supporting Full-Time Hearing Aid Wear

What helps parents understand their child’s need to use hearing devices all his/her waking hours:

• Talking with other families that had children with hearing loss.
• Speaking with an adult or older child that has hearing loss/hearing aids/cochlear implants and/or viewing videos on the internet of these individuals describing their experiences/abilities.
• Understanding that early exposure to hearing actually develops structures in the brain that allows sound to be processed so it is meaningful – this time cannot be made up at a later age.
• Watching my child’s reaction to sound around him when he wears his hearing aids.
• Recognizing that children will not learn to language to speak or speak clearly until they can hear the speech sounds clearly and that these delays will affect readiness for school.
• The “math” of hearing aids: Babies listen for about a year before they say their first word. If a baby with hearing loss is awake for 8 hours day and only wears hearing aids for 2 hours then he will only be able to ‘tune in’ to the hearing world 25% of the time. It may take up to 4 years for his first word. A school-aged child is awake about 100 hours/week. If he only wears hearing aids in school, that is about 30 hours/week. If the child is only wearing hearing aids 30% of the time then the students can expect 30% achievement since listening and language development occurs all waking hours.
• Learning more about hearing loss by listening to simulations of my child’s hearing ability.
• Getting over my fear of putting the hearing aids into his ears and how to check them daily.

Parent strategies for keeping the hearing aids on the young child’s head:

• Put the hearing aids on first thing in the morning so they felt normal on the head; never, never take a day off!
• Sing whenever the child pulls off the hearing aid; child will want to ‘hear music’.
• Cap over the hearing aids with strings under the child’s chin, crisscrossed and then tied behind the neck so the child cannot easily untie the strings and pull the cap off.
• Clips to hearing aids attached to barrettes in hair; if child pulls off hearing aids it also pulls hair.
• Snugly fitting earmolds that have a tube that fits around the outer ear to make the hearing aid harder for the child to yank off the ear; cement the tubes into the earmolds.
• Toupee tape to help support a large hearing aid or FM + hearing aid on a tiny ear. Suggestions for tape:
  • Topstic – pre-cut strips
  • Phonak hearing aids Stick’n Stay – shaped like hearing aids
  • Hollywood Fashion Tape – can come in already pre cut strips and less abrasive than some wig tapes (from Amazon, Target, Walgreens, etc.)
• Use clips to the back of the child’s shirt or collar – even if he pulls out the hearing aids at least they won’t get lost
• Combine Ear Gear and toupee tape.
• Tube Rider collection as a fun way to keep a child interested and proud of her hearing aids.
• Make sure your child’s day care provider keeps the hearing aids on at all times. If you pick your child up and consistently notice that the hearing aids are off, find a new child care provider.
• Brightly colored earmolds and Ear Gear or SafeNSound name straps that the child can ‘show off’.
• Children are more likely to try to pull of their hearing aids if their hands aren’t busy doing something else!
• It helps to know that all children go through a phase where they take off their hearing aids. Persistence in putting them back in, using accessories to keep them on the child’s head and keeping the child distracted and ‘happily listening’ helps to get through these trying periods.
• Different strategies are needed as children’s dexterity changes. Tape/clips/Ear Gear alone or in combination.

Parent strategies for keeping the cochlear implant speech processor on the young child’s head:

• Sew baby socks on his undershirts for the battery packs of his CI.
• Snug-fitting caps or headbands to keep the headpiece/processor on the head.
• Taping the CI head piece with medical tape to his head – if he yanked it off it would pull a bit of hair as a deterrent.

Strategies for keeping devices on the child’s head while in the car:

• Wrap a blanket around her that has a Velcro strip so she can’t bend her elbows while she es in her carseat (only need to do this a week or less before most children won’t bother the aids anymore).
• Mittens! Use suspender clips and elastic and put through his coat sleeves. That way the mittens are always handy and it is more of a challenge for him to get them off. When he was concentrating on the mittens, he was leaving the hearing aids alone.
• Short Pringle can tubes over his elbows so it made it hard for her to reach her ears. Place special ‘car toys’ that she especially likes in her reach. They are only kept in the car so she will look forward to playing quietly in her seat.
• Inflatable “water wings” over his elbows.

Need more information to help your child or support families better? Consider Achieving Effective Hearing Aid Use in Early Childhood, an in depth 80-page guide by Karen Anderson, PhD.

Parents may be interested in:

One-page handouts: Relationship of Hearing Loss to Listening and Learning Needs

• 16—25 dB Hearing Loss
• 26 — 40 dB Hearing Loss
• 41 — 55 dB Hearing Loss
• 56 — 70 dB Hearing Loss
• 71 — 90+ dB Hearing Loss
• Unilateral Hearing Loss
• Fluctuating Hearing Loss
• High Frequency Hearing Loss
• Reverse Slope or Mid—Frequency Hearing Loss
• Spanish version of Relationship of Hearing Loss to Listening and Learning Needs, all handouts together

Parents may also be interested in:

Communication Building Blocks There are a multitude of resources available that describe the different communication choices or continuum of communication modalities that may be used by children and their communication partners to develop language. This resource presents different aspects of communication as building blocks that can be combined and recombined based on the child’s learning style, desired mode of the family and changing communication situations. It is meant to introduce the concept of communication choices in an unbiased manner and emphasizes that any choice of communication modality can change as the child develops.

Updated January 2016.

The post Strategies for Keeping Hearing Aids on Young Children first appeared on Supporting Success For Children With Hearing Loss.

Brochure: Special Considerations for Parents Raising a Teenager with Hearing Loss

Gather information on your child’s ability to listen and understand in the classroom: Starting School LIFE (Listening Inventory For Education) – This is an assessment that is typically administered by the hearing professional on the school staff. It is a self-report measure that is appropriate to use with secondary students. The child provides information on their school listening settings, rate different situations for their ability to hear and understand, and then identify different ways in which they respond when they do not hear clearly. Family members can request that this tool be used by school staff. Also to request is the Teacher LIFE-R  in which the classroom teacher (Kindergarten-Secondary) rates the student’s listening behaviors in school settings and his or her use of self-advocacy, communication repair and technology independence skills. Although not ideal, it is also possible for family members or a neutral third party (i.e., clinical audiologist) to administer the Student LIFE-R to their child if they feel as though they need this information to advocate for services or supports with the school district and the school staff have not agreed to administer this tool.

Teens (and tweens) supporting one another: Knowing who you are is all about the groups you feel you are a member of and how well you think you are accepted by the group. Children who are ‘one and onlies’ with hearing devices in their school or grade may feel as though they are very different from their peers, even though in most ways they are just the same! Being able to also consider themselves part of a group of other children with hearing loss and being able to talk about common issues can go a long way toward a more positive self-identity. There may be a social group through your child’s school district or even organized by the state. Ask your child’s teacher of the deaf/hard of hearing or educational audiologist if they are aware of an informal group of children with hearing loss that is available for your child to join. There are also blog sites for teens with hearing loss such as http://bf4life-hearing.weebly.com that supports kids who are deaf or hard of hearing meeting other kids who have a hearing loss. After about age 10, a child’s peers have a greater influence than their family members on how positively they view themselves. Consider the connections your child makes with other children with hearing loss prior to age 10 and the ongoing opportunities for conversations as they approach their teen years as ‘insurance’ for positive attitudes towards themselves and their hearing devices. It would help parents to keep in touch too! Your local or state Hands & Voices chapter will continue to be a valuable resource to you as your child grows, even into the challenging teen years!

Explore attitudes, discuss, strengthen self-esteem: When issues of feelings about hearing loss and challenges are discussed with a hearing professional, the student may gain understanding in how hearing loss is affecting him/her and provide insights on how the problems may be better managed. Family members can request that the following tools be used by school staff.  The Significant Other Assessment of Communication – Adolescent (SOAC-A) asks the child and his or her friends (other students) complete the questionnaire and compare answers. Although not ideal, it is also possible for family members or a neutral third party (i.e., clinical audiologist) to administer the Self Assessment of Communication – Adolescent (SAC-A) to their child if they feel as though they need this information to advocate for services or supports with the school district and the school staff have not agreed to administer this tool. This authors of this test, Judy Elkayam, AuD and Kris English, PhD, have granted their permission for use of the SOAC-A and SAC-A.

The post Growing Up with Hearing Loss: Challenges & Resistance first appeared on Supporting Success For Children With Hearing Loss.

Hearing aid basics: HEARING AIDS – What, When, Why, How – A quick rundown on hearing aids and family choices.

Goals for hearing aid wear: Setting Reasonable Expectations About Hearing AidWear – This information provides an overview of how hours of hearing aid wear translates into lifelong learning.

Instructions for how to perform a hearing aid listening check:  A video is now available providing instructions for parents, teachers and early interventionists about how to check and monitor hearing aid function. There is also a written handout that can be printed to have available.  Watch the Hearing Aid Listening Check video developed by the National Center for Hearing Assessment & Management. This 13+ minute video takes awhile to load, but has great information for anyone new to working with hearing aids on little ears!

Introduce the needs of your child with hearing loss to your child care provider.  Whether it be a child care center, a neighbor or a family member, share the 4-page handout Welcoming the Child with Hearing Loss into Child Care with them. 

Cochlear implant basics: Cochlear Implants – What, When, Why, How – A quick rundown on cochlear implants and family choices.

Listening Skill Development: Auditory Skills Checklist – Children with normal hearing learn how to listen and develop their auditory skills as a part of their experiences and growth. Because children with hearing loss do not hear everything (even with hearing aids or cochlear implants) they will not learn auditory skills at the same rate of typically hearing children unless families provide them with auditory experiences. This checklist shows how listening skills develop over time and provides the steps to improve auditory development as your child grows.

Word-by-word language development: Graphs of Typical Vocabulary Development – boys and girls –  Language is caught, not taught! It is surprising how quickly young children learn words! This resource shows ‘average’ growth in the number of words a child knows as he or she grows and can be useful for setting the stage for families about the ‘work to be done’ to help their child learn language at a pace similar to children without hearing loss.

The post Hearing Aids, Cochlear Implants – Ways to Help Daily Hearing first appeared on Supporting Success For Children With Hearing Loss.

The type of interactions that happen in a child’s first year of life are very important in determining his level of trust and security as he grows.

Children who use hearing devices all waking hours learn to depend on their hearing.

“This is the way the world sounds.”
“This is how close mommy needs to be before I hear her.”
“If someone is at the door I know it because I can hear the door bell.”

Psychosocial development – Potential impact of hearing

*In the first 12 months of life babies are learning trust versus mistrust. The challenge in this stage of development is to prevent children from perceiving that the world is inconsistent, which teaches that it is undependable, unpredictable, and possibly dangerous. Parents and other caregivers need to recognize how being able to consistently overhear people talking within a certain distance builds a sense of trust.

Imagine being a 9 months old and crawling. You see a houseplant in the corner of the room and want to explore what it is. Mommy is on the other side of the room. As you start to crawl toward the plant, she sees where you are going and says “no, no – we don’t touch plants.” Her voice isn’t angry. You know the words no-no and she has now linked no-no to the plant. You consider other places you can crawl. Contrast this with not being able to hear Mommy tell you no-no. You continue to crawl toward the plant. She sees you disregard her warning and may tell you no-no again. You are now farther away and can’t hear her voice at all. Suddenly Mommy picks you up. She has an angry face and voice. You don’t know what you did wrong and you’re scared.

 To build language and trust, it is important to recognize the general size of your child’s listening bubble. Your child will be able to hear sounds farther away when a room is quiet. You may need to be much closer for him to realize you are talking when there is ANY noise in the room.

Use the Early Listening Function (ELF) Questionnaire to discover the size of your child’s listening bubble.

If he is of preschool age or older, involve him in this ‘listening game’ to figure out the size of the bubble. Different voices, distances, pitches of sounds all can make a difference in how close he needs to be to the sound source to hear. Remember, barely hearing a sound does not mean it is loud enough to understand.

Hearing devices generally work most effectively for receiving sound at distances as far as 3-6 feet. Think about how far it is when you are standing at the kitchen sink and your child is sitting at the table or on the floor. Is it further than 6 feet? Knowing the size of your child’s listening bubble will help you to stay close enough so that what you are saying will contribute to his language growth over time.

*This information is based on Schleisinger, H.S. (1978). The effects of deafness on childhood development: An Eriksonian perspective. In L. S. Liber (Ed.) Deaf Children: Developmental perspectives (pp. 157-169). New York, NY: Academic Press.

Original post March, 2012 (c) Karen L. Anderson, PhD

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