Preface: This post represents something I’ve been tossing around in my head for awhile now, and finally decided to share to gather more thoughts on. It comes from a place of personal experience, and should not be treated as something derived from any sort of academic foundation. Please let me know what you think – are these exercises you might use? Do they have a place in current aural rehab practices? What other situations or skills would you like to see addressed? Bare in mind that this is a rough draft with plenty of opportunity for further development and refinement.
The following activities were developed to help empower children who use hearing technology in their day-to-day lives. While there is a wealth of information available on how to best support hearing and speech outcomes in children who use hearing technology, there seems to be a lack of resources available to help audiologists and parents empower children to be their own advocates for their hearing needs. This document aims to fill that need by providing fun, practical activities that parents and audiologists can use to educate, empower, and foster resilience in children who use hearing technology.
The activities are divided into 4 areas:
- Self-advocacy – Speaking up
- Self-efficacy – Taking control
- Education – Understanding
- Identity – Being confident in oneself
Self-advocacy goal: Giving children the skills and confidence to speak up in order to modify their environments to meet their communication needs.
- Begin by telling the child that while you read to them, you’re also going to play a game. Tell them that you might start speaking very, very softly and that it is their job to politely get your attention and ask you to speak up. Have the child practice their attention-getting technique (either a hand raise or a shoulder tap) and have them recite the script for this situation (“Could you please speak louder?”). Then begin reading, occasionally letting your voice become very softly or in a whisper that would be difficult for anyone to hear. Your child should then use their attention-getter, then when acknowledged by you, they should ask you to speak louder. Reward them appropriately and continue reading at a louder level. If the child is not asking you to speak up when they should, check in with them and ask if they can hear you. If necessary, prompt them accordingly (“What should you say to me if you can’t hear me well enough?”).
- Try switching things up by changing the listening challenge. You can occasionally turn your head away from the child and have them ask you to face them when you speak. You can also begin talking more rapidly and have your child ask you to speak slower.
- Try to switch positions for any of these activities. Let the child tell you a story and instruct them to try speaking as soft as they can occasionally. Then, you can ask them to change their communication technique which will help them understand that they aren’t that different – everyone faces communication difficulties and we all need to ask for modifications at times.
Self-efficacy goal: Giving children the skills and confidence to take control of their hearing devices to ensure they are able to meet their communication needs.
Start-up check activity:
- Begin by ensuring the child is familiar with the start-up jingle their hearing devices make upon being switched on. Children whose parents switch their devices on before inserting them may not be familiar with the jingle. Explain to the child that the jingle means the devices are switching on.
- Then, have them close their eyes while you turn off both of their hearing devices. Switch one of them back on immediately. Have the child tell you which device is being switched on.
- Repeat this activity until the child is consistently successful. Let the child try turning their own devices off and have them connect the sound of the jingle with their own actions.
- This skill is very important as a hearing device user, because the presence or absence of the start-up jingle can be used to identify the site of dysfunction of a dysfunctional device. For example, a “dead device” that still plays the jingle suggests a dirty microphone which may be cleaned, while a “dead device” that doesn’t produce a jingle suggests a dead battery, defective receiver, or a blockage in the tubing. For older children, you can explain these steps to them and let them become their own troubleshooters when their devices malfunction.
Listening check game:
- Begin by telling the child that you’re going to play a listening game with them. Then, ask them to pick a string of sounds they’re going to use for the game. The string can be something like “Ba-ba-ba,” or “hup-hup-hup.”
- Then, with both hearing devices on and inserted, ask the child to say their sound-string. Instruct them to listen carefully. Ask them if the sound is the same in both ears.
- Then, have them close their eyes while you turn off one of their hearing devices. Try to touch both of them so its not immediately obvious which one was turned off. Have the child say their sound-string and ask them to listen to their own voice carefully. Ask them if one ear sounds different than the other. When they correctly identify which device was turned off, turn that device back on and let the child use their sound-string again so they can hear the difference.
- Repeat this activity multiple times until the child is consistently successful. Try changing the volume on one device instead and practice that way as well.
- This skill is important because in busy environments it can be difficult for even experienced hearing aid users or audiologists to detect dysfunctional devices by environmental sounds alone. Using a consistent set of speech sounds can help people assess hearing device function using nothing more than their own voice. With practice, they will be able to identify reduced gain and distortions that can help with troubleshooting.
- Have the audiologist use the hearing device software to play the low battery warning through the child’s hearing aids. The audiologist should also play the start-up jingle sound so the child can tell the difference. The audiologist may play a brief game with the child, asking them to tell them what sound they hear (start-up, low battery warning, program change noise, etc.) until they are consistently correct.
- Because hearing device batteries typically last for about a week, children’s practice with changing them may be infrequent and inconsistent. Save some dead batteries and some stickers in a container for practice.
- When the child’s device batteries are dead, have them perform the work of removing the dead batteries, setting them aside, and removing the stickers from the new batteries. You may wish to include a battery tester in this exercise. Using your stock of old batteries, let the child practice 3-5 times before re-inserting the hearing devices.
Education goal: Giving children the knowledge about their hearing loss to ensure that they understand the basic physiological reasons for their impairment and the possible limitations they might face, but also to understand that their impairment is purely physiological and does not devalue their worth or change who they are as a person.
- Find an appropriate diagram of the entire ear online and have the child construct their own model out of construction paper. They should use a different colour for each major piece (eardrum, ossicles, cochlea, etc.)
- Using age-appropriate language, explain to the child how sound turns into vibration which turns into electrical signals in the nerves of the cochlea. Have the child explain the process back to you to ensure they understand it.
- Building on the above anatomy activity, explain to the child how the source of their hearing impairment impacts them. For example, if the impairment is sensorineural, you might explain that there are fewer working nerve cells in their cochlea, so it takes a bigger sound to send a signal to the brain. For children with sensorineural hearing impairment, it is also important to explain that fewer working nerve cells also means they may have reduced clarity.
- Ensure the child understands that their hearing impairment is strictly sensory, and does not affect anything else about them – not their intelligence, creativity, or any other dimension of their character.
Identity goal: Giving children the confidence to wear their hearing devices openly and to explain their hearing identity to others.
- All children with hearing devices will be asked by their peers, “what are those?” and be made to explain what they are wearing in their ears. Being confident in this situation can ensure the child experiences a positive outcome in this situation.
- You may begin by asking the child if anyone has ever asked them about their devices. Explain to the child that most of the time people are curious and that the best thing to do is teach others about hearing devices. Tell the child that you are going to pretend to be a nosy stranger and you’d like them to show their devices to you. If the child is unsure how to respond, suggest they say something similar to the following: “Those are my hearing devices. They help me hear because I don’t hear very well without them.” Then suggest the child remove a device from their ear and hold it out for you to see. Be very positive and affirming in this exercise (“Wow, that’s really cool!”). Practice a couple of times until the child is confident with giving their explanation.
- You may wish to practice responses to other questions as well, depending on the age of the child. Questions like “Can you hear anything without them,” or “Can I try them on” might be good ones to address. Work with the child to decide on appropriate responses.
- After “What are those?” the second-most common question children may receive is “Are you deaf?” Without a strong understanding of themselves and their hearing identity, this question can be very uncomfortable for children who use hearing devices and they may not know how to answer. This discomfort and inability to confidently respond is likely a greater vulnerability to bullies than the devices or hearing impairment itself.
- It may be useful to begin by asking the child questions like, “Has anyone ever asked if you are deaf? What do you usually say to them?” Let them guide the conversation, but ask them probing questions to help explore their feelings.
- Based on the child’s hearing and family’s communication choices, work with the child to develop an appropriate response that they feel comfortable using. Have them practice it with you a couple of times so they are better prepared to use their response in natural situations. The response does not have to include the words “deaf,” “hearing impairment” or other terms used clinically. It may be as simple as “I don’t hear as well as others so I need to wear these devices.”
- Ensure that parents and family members are involved in this process as well, and leave with a complete understanding of the way the child identifies with their hearing ability.