Hearing impairment (hereafter referred to as hearing loss) is a disorder that can affect any individual no matter their age, race or gender. According to the Centers for Disease Control and Prevention (CDC) (2014), 6,163 babies were identified as either being deaf or hard of hearing. Not only can this disorder affect all ages, but it can impact almost every aspect of communication. Hogan, Shipley, Strazdins, Purcell, and Baker (2011), found that children with hearing loss exhibit a language delay that is almost 12 months behind their normal hearing peers. This language developmental delay occurs in almost all areas of language including development of vocabulary, knowledge of grammatical and sentence structures and the use of pragmatics (Hogan et al., 2011). There are many ways to counsel a family or child following a diagnosis of hearing loss, from explaining what the results mean, providing information for the parents, or developing an aural rehabilitation plan. The main objective of rehabilitation services for a child with hearing loss is to catch the hearing loss early and provide intervention to maximize the child’s potential later in life.
What is Hearing Loss?
There are three main categories of hearing loss: conductive hearing loss, sensorineural hearing loss and mixed hearing loss. Conductive hearing loss is “when sound is prevented from traveling through the ear canal and middle ear to the cochlea” (Plante & Beeson, 2013). Sensorineural hearing loss occurs when “there is damage to the cochlea or the auditory pathways that deliver information from the cochlea to the brain” (Plante & Beeson, 2013). Lastly, mixed hearing loss is a combination of both conductive and sensorineural hearing loss occurring at the same time (Plante & Beeson, 2013).
In addition to the overarching types of hearing loss, the child’s hearing loss is often categorized into four subcategories: congenital, prelingual, perilingual and postlingual. Congenital means that hearing loss was present at birth, prelingual means the hearing loss began before the age of 3 years old, perilingual means the loss had occurred between the ages of 3-5 years old, and postlingual means the loss occurred after the child turned 5 years old (Flasher & Fogle, 2012).
There are different ways to assess a child’s hearing at birth or during infancy. The first test is called an Auditory Brain Stem Response (ABR). According to Tye-Murry (2009), ABR can be used to determine the degree of hearing loss at certain frequencies. The second test is called Otoacoustic Emissions Testing (OAE). Otoacoustic emissions are “low-level sounds emitted spontaneously by the cochlea on presentation of an auditory stimulus” (Tye-Murry, 2009). The screener either states that the child has passed because OAE’s are present, or refer when they are not (Tye-Murry, 2009). Depending on the severity of the hearing loss, the impact on the child’s life may be more significant, and a more rigorous rehabilitation plan may need to be put into place.
Challenges a Child May Face
The American Speech and Hearing Association (ASHA) identifies four ways hearing loss can have a major impact on children. Hearing loss causes a delay in the development of receptive and expressive communication skills, problems with learning resulting in reduced academic achievement, communication difficulties often resulting social isolation and a poor self-concept, and the hearing loss may have an impact on the career choices the child faces later in life (ASHA, 2017). Children with a significant hearing loss may have problems with reading and writing because of the deficits encountered with vocabulary and syntax (Flasher & Fogle, 2012). Some examples of problems with vocabulary and reading are that children with hearing loss have difficulty understanding abstract words (before, jealous, etc.) and function words (the, an, etc.). They also may have trouble understanding complex sentences and passive voice which will significantly impact their ability to read and comprehend stories (ASHA, 2017). Along with language deficits, children also experience difficulties in social settings. According to Wallis, Musselman, and MacKay (2004), children with hearing loss have a greater risk of developing a poor self- concept (basis for self-esteem) and psychosocial problems than their peers with normal hearing. Psychosocial problems include social isolation, difficulty with empathy, feeling frustrated or intimidated by social interactions etc. (Flasher & Fogle, 2012). Most importantly, children with hearing loss experience difficulties in their academics. According to ASHA (2017), the academic achievement gap between children with and without hearing loss widens as they progress through school; the level of achievement attained is due to the involvement of the parents but also the “quantity, quality, and timing of the support services” the child receives.
Counseling Techniques
Counseling is needed at every stage of a child’s journey with a hearing impairment. There are certain guidelines to ease the news to new parents with a child diagnosed with some severity of a hearing loss. Flasher and Fogle (2012) outline several recommendations to follow when counseling a child’s parents after a hearing loss diagnosis: Simply explain what is going on during the test and what the expected goal is from the child, be sensitive and patient, let the parents know it’s okay to get a second opinion, always remember that this diagnosis may not be the only issue they may be going through as a family, and most importantly keep in mind that the parents will come during many stages of the grieving process. Tye-Murray (2009) suggests parents may go through several different stages of the grieving process including: shock (feeling numb/confused), denial (of the diagnosis or the extent of its consequences), grief (their ideal child is gone), guilt (they did something wrong), anger (their child won’t lead a normal life) and finally acceptance (accept the reality and take steps to deal with the condition). Montoya (2007) suggests speech and hearing professionals should actively listen, abstain from judgement, help build the parent’s self-esteem and competence, and provide immediate, resource-oriented, support for the parents.
As the child progresses during school, there are several ways to provide intervention supports and counseling skills to aid their transition from one grade to another. The child may need special accommodations and supports throughout the school day including, different types of hearing aids or assistive listening devices (ALDs), being placed in a self-contained classroom, or transitioned into a full-time mainstream classroom (Flasher & Fogle, 2012). In addition to the classroom accommodations, the child may need an Individualized Education Plan (IEP) set up to assure the best services are being provided to address both the speech and language deficits exhibited, but also to address any psychosocial problems that may occur due to the hearing loss.
There are communication modes that a speech pathologist may teach a child struggling with language or communication in general. American Sign Language (ASL) is the most common form of language taught to those who are deaf or hard of hearing. ASL consists of different hand signs and the use of facial expression to communicate with one another, however it has unique grammar. Some other modes of communication are manually coded English, which consists of manual signs that correspond to English words, and cued speech, which “uses phonemically based hand gestures to supplement speech reading” (Tye-Murray, 2009).
Psychosocial problems may occur because of a hearing loss, so it is important to address these issues so that they do not impact the child for the rest of their life. Oticon (2006) provided the following strategies a professional, in an academic setting, could use to improve the development of social skills: develop a program with coping strategies, allow the child to accept their differences because of the hearing loss but enable them to realize that it is not what defines them as a student or person, develop activities centered around inclusion, and help the class understand what hearing loss is and the effects it may have on their fellow classmates.
Hearing loss affects almost every aspect of a child’s life including academics, social skills and language skills. It is important to diagnosis the impairment early, so the child can receive the proper interventions to allow the child to reach their full potential in school and in life. Speech Pathologists play an important role as both interventionist, but also counselor for both the child and the parents of a child with hearing loss. They provide counsel for the new parents of an infant who just received a diagnosis of hearing loss, no matter the severity. They also provide coping skills to help the family through the grieving process. Once the child reaches school-age, Speech Pathologists provide the student with therapy to improve the language difficulties and social deficits that accompany hearing loss. They also educate the child’s classmates who do not have a hearing loss, on what hearing loss is and how it impacts their fellow classmate. They help practice inclusion, and help the child gain their self-esteem and assure the child that this is just a disorder they have, it does not define them or all that they can achieve in their life. It is important for Speech Pathologists to make sure the child knows they are not the disorder they have.