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the absence of hearing


other terms for aural (re)habilitation

auditory and audiologic (re)habilitation
Hearing (re)habilitation
(re)habitative audiology


the success of the child's (re)habilitation

effected heavily by the support system that they have:


aural rehab goals

-repair their abilities to as good as it can be
-we want to give patients as much intensity as they will allow with their hypersensitivity
achieve adequate receptive and expressive communication
person can actualize their own resources to meet their unique life situations
help person accept their condition and residual problems associated with HL


most presbycusis loss patients

are hypersensitive


reasons people wait to get help

thing they're too young
gradual loss


procedures for meeting aural rehab goals

use of devices to minimize the hearing loss
teach strategies and problem solving to person so he can overcome personal, psychosocial, education and vocational difficulties resulting from the HK
auditory training
counseling, etc
individual accepts problems associated with hearing lose
services related to, but not part of AR are medical intervention and education
- like 10 year olds with conductive hearing loss


Aural habilitation

remedial effort with children having hearing loss at birth
-need to stress the use of things that will help them hear better
make sure to show the parent that their time matters, that their support is most important


who provides aural rehabilitation

SLP, AuD, caregiver, teachers
all aspects of AD are not performed by one person > team approach


crossover for sounds

at 40-60 decibels


what are the educational needs of AR professionals?

Audiologists (AuD) and SLPs
there is a great need for audiologists (AuD) and SLPs to be well prepared in AR
content areas of competence
need to understand:
-characteristics of hearing impairment
-effect of hearing loss on persons
-communication strategies for hearing impaired persons
-auditory training and speechreading
-amplification (make sure that they understand how it works)


Major professional associations

AAA (american academy of audiologists)
ASHA (American speech-language and hearing association)
EAA (educational audibly association)
ARA (academy of rehabilitation Audiology)


incidents of hearing loss in the USA

14-40 million
why does it vary?
-because children's hearing loss can be transient because of middle ear dysfunction
(10% of the population- 33 million have clinically significant aka permanent loss)


statistics of deaf children

1 million deaf
3 million children are deaf or hard of hearing


children deaf hard of hearing

what about high frequency HL and conductive HL?
school-aged; pre-k
many with additional disability
-ADHD, speech, developmental delay, autism


fastest growing group with age loss

4-5% of them have hearing loss
high frequency noise induced


75+ year old

40-50% need help
high correlation between untreated hearing loss and high occurrence of Dementia
6-8 times more likely
the longer that they wait, the harder it is to acclimate to the aid


how many hearing aids in the US

6-8 million users


impact of hearing loss

adults have more trouble with understanding language
children with congenital loss have expressive and receptive issues
it is all dependent on different situations, different circumstances, different outcomes
-how long of a loss
-start of the loss


how to help adults with hearing loss

get them tested
get them aids
communicate in well lit areas
speak clearly
do not shout
decrease distance from speaker


how to help children with hearing loss

more global approach, working on everything


hearing loss refers to

degree of hearing loss


hearing handicap refers to

interference in communication that results from a hearing loss


factors impacting hearing handicap

1. Degree of Hearing Loss
2. Time of Onset of Hearing Loss
3. Types of Hearing Loss
-sensorineural is the worst
--retrochoclear is the worst
4. Configuration of Hearing Loss
-reverse slop has worst clarity
5. Speech Recognition Ability
-80+ is preferred
6. Attitude of Family
7. Motivation of Hearing Impaired Individual


degree of hearing loss

Can make general statements about handicap and probable needs
However, only a guideline
Audiometrically deaf = 80+ dB hearing loss (PTA)

The greater the degree of HL = the greater the degree of hearing handicap
-But handicap may vary considerably
-Must consider other factors, (e.g. personality, intelligence, motivation, occupation, and environmental conditions)
-Generally, those who rely heavily on communication for their work, may notice significantly greater handicap than those whose jobs are not as verbally demanding

Degree of loss is more critical in the case of young children especially when the loss occurs before the development of language
In profound loss, voice, speech & language are likely to be substantially influenced
Less severe losses have correspondingly fewer communicative consequences
-But there are notable exceptions


time of onset of hearing loss

4 categories: pre-lingual, perilingual, post-lingual, deafened
Congenital vs Acquired Hearing Loss:
Congenital or pre-lingual hearing losses
Have a great impact on language, voice, and articulation, because the individual may not develop these skills normally
-because Individual does not have constant language stimulation or accurate feedback of his own speech
It has a deleterious effect on social, educational, and vocational aspects of a person’s life
It has a deleterious effect on social, educational, and vocational aspects of a person’s life

Acquired loss or post-lingual: (after 5 years of age)
May be very little impact on language
Some difficulty in verbal communication and other social, emotional, and vocational problems


time of onset of hearing loss

sudden vs gradual
(Sudden is much worse)
sudden loss is often caused by viral and effects one ear

Psychological impact
-sudden is initially worse
-gradual is worse overtime because you look back and
wonder why you didn't do something about it

Speech movements & high frequency sibilant sounds:
After awhile, speech movements will tend to become less precise, affecting high frequency sibilant sounds first: not able to monitor articulation effectively

Progressive (gradual) loss:
Person gradually adjusts to loss, while sudden loss, the person may not know how to listen for clues to distinguish speech sounds
high frequencies effected first


type of hearing loss conductive

the least complicated to help
Paracusis Willisi
Soft voice
dental voice
Sometimes low pitched tinnitus
BCT better and ACT (by more than 10 dB)
BCT < 25 dB HL
Good discrimination of speech if it is loud enough
Conductive loss in children may have significant long-term effects on language and speech


type of hearing cochlear loss

Loud, strained voice (if not amplified)
High pitched tinnitus (can be aggravated, pulsates, come and go)
Recruitment (problem with amplification)
Reduced discrimination, particularly in noise
Normal otologic findings
Both BCT and ACT are worse than 25 dB HL
Possibly hyper-active, frustrated, particularly if a child
Impacts speech & language development of child


type of hearing central loss

Normal or near normal hearing
Extremely poor discrimination for speech, especially in noisy backgrounds (may be fine in quite)
Short attention span/behavior problems
Delayed &/or deviant language
Impacts speech & language development of child


configuration of hearing loss flat

Affects high frequency information most severely & low frequency information least of all
High Frequency (Sloping) Configuration:
Affects high frequency information extremely severely, can hear low frequencies
Extreme difficulty understanding speech, especially in noise
-otitis media, presbycusis


configuration of hearing loss sloping

High frequency information is lost
Understanding speech, especially in noise is poor
-noise and ototoxic meds


configuration of hearing loss rising

Least common configuration
Least impact on speech intelligibility
problems with loudness
-meniere's disease


configuration of hearing loss cookie bite

Should impact speech intelligibility,
But usually does not impact too much


speech recognition ability

This is the clarity of speech: speech discrimination
Speech discrimination of a H of H person is typically better than a person who is deaf
However, things are different, depending on whether or not a CI is used


phonemic regression

This is decreased speech understanding ability, despite near normal hearing
typical of someone with advanced age (central degeneration)
may have had a cognitive event that has effected the processing area of the brain


Attitude of Family & Friends

General Rule:
The more supportive the family and friends, the better are the prospects for effective communication skill building


Motivation of Hearing Impaired Individual

General Rule:
The more motivated is the client to succeed, the better are his/her chances for succeeding in learning effective communication skills
Therefore, degree of handicap cannot necessarily be predicted only from the degree of hearing loss as depicted by the audiogram


Many factors influence

The strategies used in AR focus on the impact of hearing loss on communication
For adults with later onset hearing loss, language function will not be impacted
--However, how each person responds depends on different demands, self-imposed or externally imposed (families, jobs, etc)
For children with congenital hearing loss, language will most likely be impacted
--If deafness is not in the family, parents will be impacted, while in a deaf family, deafness may be more readily accepted
Different situations, different circumstances, different outcomes


impact of child hearing loss Communication Problems

The most devastating effect of HL is impact on oral communication
Children with severe-profound HL, without CI generally do not develop speech & language normally, because not exposed to language
Varying degrees of difficulty
Presence of Other Disabilities:
Other serious disabilities, e.g. blindness, physical limitations, or mental retardation can complicate the situation
Environmental Consequences:
Educational, vocational, psychological, and social implications
Includes barriers and facilitators that function to make things harder or easier for communication to occur


impact of child hearing loss secondary consequences

Educational, vocational, psychological, and social implications


vocational rehab services

Can be another avenue like medicade
can be utilized in school


rehabilitative alternatives

Little can be done to change innate IQ or native abilities
However, there are a number of AR procedures that may have a significant effect on the personal and environmental factors relevant to hearing loss

Number of AR procedures
Interesting facts:
75% of persons with HL do not use amplification
these people will struggle to maintain their life, may have problems with education. Their social life is effected

There are many unidentified H of H children
Possible resolutions?
30 seconds to do a listening check


history of aural rehabilitation/deaf education first opinion

Aristotle (355 B.C.):
Very influential
“Those who are born deaf all become senseless and incapable of reason. Men who are born deaf are in all cases dumb; that is to say, they can make vocal noises, but they cannot speak”
Misinterpretation of statement molded the interpretation for deafness for centuries
Hearing impaired were thought to be retarded
They are not!


16th century

Cardano (1501-1576) [Italy]:
No reason why people who are deaf could not be taught; they are capable of reason
Wrote about a deaf man who learned to read and write and could learn and communicate with others
Agricola [Dutch]
Wrote book on how deaf people could learn to read & write
Ponce de Leon [Spanish]
Showed that Hearing Impaired could learn to speak & learn
Started school for affluent deaf children at monastery


17th century

This was a time of development of educational philosophy, intellectual growth, scientific thought
Francis Bacon, Bonet, Bulwer (England)
Wallis and Holder quarreled about the best method for teaching deaf people
This created an interest in deafness


18th century

18th Century:
Great growth in services for the deaf
Pereira (1715-1780) and de l’Epee (1712-1789) [France]
Pereira introduced education of deaf to France
De L’Epee founded first public school for deaf in France (manual method)
Deaf education was a public concern
De l’Epee also founded a school for the deaf & wrote a book and brought positive attention to the potential to learn of deaf children
Used fingerspelling, sign language, and speechreading
Heinicke (1727-1790) [Germany]:
Started school for the deaf in Germany (oral method)
Did research into hereditary nature of deafness


19th century

Development in understanding of hearing loss & deaf education
Thomas Braidwood and Watsons [England]
Operators of nearly all of the schools for the deaf in England:
--oral method of teaching
Braidwood’s grandson, John, came to USA & taught school in Virginia in 1815, but did not succeed (poor health)
Sicard [France]:
Manual approach to teaching language to deaf children


19th century time line

1807: Cogwell [Hartford, Connecticut]
Daughter became deaf from scarlet fever
Convinced friends to send Gallaudet to Europe to learn deaf methods
1815: Thomas Gallaudet (minister)
Went to England to learn deaf education methods, but Braidwood would not share methods
Went to Paris, where welcomed (de L’Epee’s school and Sicard)
Returned to USA with Clerc (student of de l’Epee) and set up own school
1817: The American Asylum (later: American School for the Deaf (first school for the deaf: manual approach)
1818: New York School for the Deaf
1843: Indiana School for the Deaf
1856: Gallaudet College in Washington, D.C.:
only liberal arts college in the world for the deaf
1867: Clark School for the Deaf:
(first oral school in USA)


Alexander Graham Bell

huge proponent for the deaf community
Mother and wife were deaf
Invented telephone, and saw its potential for electronically amplifying sound for the hearing impaired
Received money from the Volta Prize for his work with electricity .
Initiated the Volta Bureau in Washington, DC (1867), which became the Alexander Graham Bell Association for the Deaf


20th century

Early 1900’s:
Several schools of lipreading were started for adults


birth of audiology

World War 2:
Recognized the need to rehabilitate hearing impaired servicemen
audiologists were recognized as the professionals responsible for providing the needed services
Hearing aid fittings
Hearing aid orientation
Auditory training
First training program for audiologists:
Northwestern University (1940’s)



Hearing aids:
---Were dispensed to servicemen by government (VA)
--Public had access through hearing aid dealers
> Sold hearing aids and serviced (?) them
> Could not dispense (although many did)
> ASHA felt that it would compromise their
professional objectivity
> Audiologists did the testing, recommendations, lipreading & auditory training, but did not do the dispensation
1978: ASHA said that it was okay for audiologists to dispense



1. Instrumentation became elaborate during the 1960’s
90% of the time it can diagnose/ rule out tumor
2. Diagnosis:
More emphasis on site of lesion of auditory disorders
Diagnosis, instrumentation and research
Away from Aural Rehabilitation (not as interested in AR)


today's emphasis

--on close professional basis with clients and their families
--More humanistic desire to work with people is becoming more predominant among practicing professionals and professors of audiology training programs and their students


60's- present

Infants & Early Development:
Identification programs were developed
Audiologists recognized the need for early identification of hearing loss
AR programs evolved:
As a result of technology improvements
With improved technology for identification and amplification, infants have been fitted with amplification at earlier ages
Evolution from body aids to behind-the-ear hearing aids
Cochlear implants
Late 1990’s: mandatory state-wide neonatal universal hearing screening programs
Need to develop & implement early intervention AR programs


1960’s, 1970’s, 1980’s and 1990’s

Children (HIC) & Regular Schools::
Many hearing impaired children were educated in regular schools: but were not receiving the specialized support they needed (even mild loss children had delays of 1 ½ years in reading and math), etc
Chronic Otitis Media children had and still have serious academic delays
--can lead to cholestiotoma
3 million children are hearing impaired currently (more if consider conductives & high frequency loss)
50,000+ deaf children
Profound HL in newborn infants occurs in 3 per 1000
Profound HL in school-age children, occurs in 9 per 1000
83 of 1000 children have an educationally significant hearing loss
1 per 25 children have any degree of hearing loss


professional issues

Audiologists play an important role in AR:
Early intervention through geriatrics
However, until 1979, ASHA said that audiologists could not dispense hearing aids
Until 1979, 90% of aids were sold without involvement of audiologists
So early on, hearing aids & hearing aid dealers got a bad reputation
This was an issue: not so much now
Still, many hearing aids are being dispensed without expertise e.g. Costco, etc (other big box stores)
¼ of hearing aids used by adults are in poor working condition
Many were dispensed by non-audiologists


issue of non-acceptance of hearing aids

A) Who dispensed aid:
Until 1979, 90% of aids were sold without involvement of audiologists
Therefore: No follow-up
Therefore: Possibly inappropriate fitting
--technology was not good, little adjusting could be done
Therefore, Not properly oriented to aid > problems
B) Vanity


multicultural issues

Our world has many different cultures
The largest minority group in the USA is Hispanic/Latino (16%) followed by Black/African Americans (13%), then Asian Americans (5%)
½ of USA population will have linguistically and culturally diverse backgrounds
--So there will be a large portion of persons with communication disorder who have limited proficiency
with the dominant language

Discrimination, stereotyping, or prejudice can have an impact on the provision of our services: it should not
--We need to recognize that every client comes from a distinct culture influenced by gender, age, race, and the other cultural factors
We need to avoid prejudice and discrimination:
We must be willing to learn about and try to understand others who are different than we are
Possible problem: Deaf culture


Issue of underservice of children with hearing loss in the schools

Hearing impaired children were and still are underserved!
Only 20% are being served
1. Many are not identified: problems with screening & follow-up
2. COM was not traditionally considered to be an educational problem, just a medical problem (it still isn’t in many school programs) or chronic wax problem
3. Unilateral hearing loss, was not considered an educational problem until recently (in many schools, it still is not considered an educational problem) problem areas at risk for are academics, language development, behavior issues
4. Many do not use hearing aids, as needed
5. Educational strategies have not been implemented
AR for school-age children is a priority, & there is an acute need for educational audiologists nationwide!


purpose of habilitation program

To reduce the potential negative outcomes of a pre-lingual hearing loss to the greatest extent possible



After auditory diagnostic tests are done, and they indicate the need for AR, it is necessary to perform more in-depth workups to determine the feasibility of various forms of AR
Assessment issues help audiologists consider relevant factors that should be evaluated before treatment starts
4 aspects:
Communication Status:
Overall participation variables:
Related personal factors:
Environmental Factors:


communication status

Auditory, visual, language, manual, communication self-report, previous rehabilitation


overal participation variables

Psychological, social, vocational, educational


Related personal factors

Personality type, IQ, age, race, gender


Environmental Factors

Services, systems, barriers, facilitators, acoustic conditions
is their work or school environment supporting them?
are they in the wrong classroom?
is the room conducive to hearing?


mangament (CARE)

Management efforts take the form of short or long-term therapy (habilitation)
May involve individual or group sessions
4 aspects:
Counseling and psychological:
Audibility improvement with amplification:
Remediate communication activity:
Environmental/coordination/participation improvement:


counseling and psychological

Interpretation, information, counseling, acceptance, understanding


audibly improvement with amplification

Hearing aid fitting, cochlear implants, ALDs, instruction and orientation


remediate communication activity

Tactics to control situation, philosophy, personal skill-building
changing what you want to do based on what they can and want to do


Environmental/coordination/participation improvement:

Situation improvement, vocational, educational, social, communication partner, community context


Process of Aural Habilitation(Children)

1. Parental Guidance:
2. Audiologic Services:
3. Auditory Development
4. Cognitive/Language Development:
5. Speech Development:


parental guidance

Support continuity every step along the way


audiologic services

Diagnosis, amplification as soon as possible


auditory development

Provide child with the opportunity to develop awareness of sounds in environment and to develop ability to recognize things by sounds they make; make judgments about what is heard, and where from; use hearing to understand and produce speech


cognitive/language development

Rich linguistic environment to understand language and to express it


speech development

Must have access to hearing speech to permit speech development
get them to use aural communication


process of aural rehabilitation adults

1. Assessment of Hearing
2. Assessment of Benefits of Amplification
3. Assessment of Impact of Hearing Loss
4. Aural Rehabilitation Program
5. Involvement of Other Professionals
6. Involvement of Family


assessment of impact of hearing loss

Important for developing a viable AR program based on individual’s communicative needs
isolation, depression, cognitive decline


aural rehabilitation program

Counseling, modifications of client’s communicative environments, speech-reading, auditory training


involvement of other professionals

Vocational rehabilitation counselor, social worker, educational personnel, SLP, psychologist
For elderly clients in health care facility, involvement of facility personnel (activity director, occupational therapist, social worker, nurses, and aides)


involvement of family

Positive involvement of significant others can strengthen AR program: catalyst in facilitating adjustment and enhancing communication skills of client
family needs to be positive


where is aural rehab provided

Pre-school programs
Regular schools & resource rooms
Residential schools
University clinics
Military facilities
ENT clinics
Hospital clinics
Private practices
Hearing aid dealerships
Nursing homes


Psychological stages of parents

Defensive Retreat
Constructive Action



Characterized by “divorcement of self” from the situation
-Unaware of any feelings
-Parent is there physically, but not emotionally or intellectually
-Cannot absorb much information
-Tends to not remember much of what is said
Common mistake of counselor: give too much information


management of shock

1) Give information about degree and nature of loss
2) Give hope: amplification
3) Make return visit appointment, business card with information on it



1. Parents realize the awfulness of the diagnosis & bears in
-Realization that their child will always be deaf, will always wear aids, will not be able to do and experience many things that normal hearing children do.
2. Parents may be very overwhelmed- bring others with them
-Swamped with guilt: “Why did this happen to me?”
-May see deafness as a punishment for something they did
3. May feel that they have not been good parents:
-May alternate between rejection and masochistic pity by overdoing parenting
4. Loss of hope for the future:
-Deafness is blow to parental expectations
5. Overwhelmed by the responsibility of having to care for a handicapped child:
-May limit family activities, especially if it is first child
6. Very confused and unable to assimilate a great deal of information that is received from friends and relatives
half truths, case histories and referrals to other doctors


management of recognition

1. Luterman says that all we can do is provide the space & time for the parent to “feel bad”
he says that we should not try to make parents feel better: their feelings are valid and should be respect
2. Answer any questions parent(s) have pertaining to hearing loss, treatment, amplification
3. Introduce parent(s) to audiologist/SLP/teacher of the hearing impaired who will be in charge of the aural rehabilitation process, and discuss AR alternatives
4. Fit with amplification & do hearing aid orientation
5. Discuss causes of congenital hearing loss (recessive vs dominant) if this is an issue- genetic counciling


defensive retreat

Perhaps the most dangerous stage as a result of reaction(s) to anxieties
Denial takes many forms:
1) Wishful thinking:
-Parent clings to some miracle cure that will change things around e.g. acupuncture
-This attitude is aided by relatives and friends who also have difficulty accepting the diagnosis: they always know someone who has cured someone of deafness, and they urge the parents to see one more doctor
Clinic Shopper:
-The parent who goes from one clinic to another for the diagnosis s/he wants
-This parent never comes to grips with an effective AR program
---Strain on marital relation: trace family trees to see which parent is responsible

2) Hostility:
-Directed toward the diagnosing audiologist/physician e.g. “How could s/he tell my child is deaf? S/he only looked in his ear for a few moments. Maybe they made a mistake.”
-There may be a breakdown in communication if the blamed partner denies responsibility
-Unblamed partner may take control of child, excludes the blamed partner, who may develop feelings of inadequacy
-Parents may be unable to meet one another’s needs
---This may lead to emotional isolation (possibly marriage breakdown)
-There may be mutual blaming:
---Parental competition for the child

may be okay for a short amount of time and then lose it


management of defensive retreat

1) Have the parent observe during the testing
-S/he can hear how loud the sound must be before the child responds;
-It also allays any concerns they may have about your competency as a diagnostician
2) Help parent see ways out of the dilemma:
-If s/he can see other ways of coping, and that there are many things that can be done by the parents to help create a happy and productive child
3) Explain the etiology of the hearing loss:
-Recessive vs dominant characteristics

hearing loss simulation is always a good option
4) Accept their anger and encourage them to talk about their feelings
Discuss normal reactions, give referrals, if necessary to professional psychologists
5) Give them encouragement
For what they are doing, and for what they have accomplished:
Every little bit is important; encourage them to keep notebooks of progress
6) Get child fitted with amplification
Point out child’s positive responses to sound with amplification
Role of First Steps



-The parent can now state: “I have a child who is hearing impaired and who will always be hearing impaired and while there is nothing I can do about changing that, there are many things I can do about helping my child grow into a productive and happy human being”.
-A time of extreme stress as parents confront reality
-Frequently, parents regress into denial when anxiety becomes too high


management of acknowledgement

1) Support and accept the parent
2) Must convey empathy and trust
to allow the parent the freedom to explore new ways of relating to their child


constructive action

The parents must restructure their life style
Involves a re-patterning and re-growth of values
Sometimes a change in the value system
“I now know that I have a purpose, that my values are so much better and that my life is so much richer since we have had this child. I now know what is important”.
Time of maximum learning and consolidation into a new way of thinking:
Life-long duration



Parents have dreams of the perfect future for their child
Grief is the process where an individual can separate from someone significant that has been lost
Positive Aspects
1. It stimulates a re-evaluation of one’s social, emotional and philosophic environment
2. Often such shifts lead to positive values and attitudes
3. Grieving facilitates growth
4. helps you wrap your mind around the situation


Grieving is a catalyst of growth

Continuous growth requires successful grieving
Grieving is an emotional process which has states that have no specific order
One state is not a prerequisite for another, and some can be felt simultaneously
What is grieved:
The shattered dream > it is the dream that is grieved


successful grieving

Successful grieving depends upon significant human interactions
We cannot grieve alone:
Support is needed from the professional who is working with the child, as well as from the spouse, friends
Unfortunately, in our culture, people discourage us from grieving
It is viewed as psychopathological



Perhaps the first state seen in grieving
We deny in many ways:
1) Reject:
The diagnosis,
The permanence or impact of the diagnosis, or
May not follow through on recommendations or cooperate with the efforts
2) May deny the impact of the handicap: may seem like ideal parents, may say “What’s the big deal?”
Denying parents may appear to be in a nonproductive, passive state,
Which serves no positive function and
Interferes with parental cooperation in intervention


Denial is not purposeless

It serves a distinct and important purpose:
-The parents need time to constructively incorporate what -has occurred
-The denial is not stagnant:
-The parent is distressed and agitated
-These behaviors are a sign that the denial is not passive
-It is an active process in which much is occurring underneath the surface on both the preconscious and conscious levels


positives of denial

The parent is accumulating information and searching for inner strength
The parent is using denial to buy the time needed to find the inner strength and external mechanisms to deal with what has occurred
Parent needs someone whose attitude conveys an acceptance that acknowledges the denial
The denial ceases when the parent attains such strengths



Manifestation of guilt is in any one of 3 ways:
1) Actual stories documenting how the parents indeed causes their child’s handicap (e.g. drug ingestion)
2) Parent’s belief that the impaired child is just or fair punishment for some specific and awful action that they have committed in the past
3) Guilt reflected in the parent who basically states: “good things happen to good people & vice versa"

The prevalent temptation is to try to take away the guilt:
We must be able to validate the legitimacy of the parent’s feeling without seeming to confirm his judgement of fault
A significant other can make the difference:
Accept the guilt as part of a normal, necessary and facilitative process of grief


positives of guilt

*Guilt can facilitate growth*
It allows people to re-evaluate our personal beliefs
Professionals need to realize that guilt does not yield to argument, cajoling, coercing or irrefutable scientific evidence
For guilt to be effective, the parent must be able to share the feelings with an empathic, significant other



Depression is anger turned inward:
The parent is angry because s/he feels incompetent to prevent whatever occurred to their child
Moses says that a depressed person does not need cheering up
What he needs:
He needs someone who will allow him to feel the depression that s/he experiences and to be available to talk about how impotent s/he feels



Everyone has an internalized concept of justice
An unpredictable event, such as having a handicapped child, threatens the feelings of security around such a belief system:
-Our ideas about fairness are disrupted, we feel frustrated
Sometimes anger is towards the deaf child
-Who has intruded upon their lives and disrupted it
Since anger toward the child is considered bad, they often displace the anger upon other, especially spouses, siblings and professionals
Ask them why are you so angry


positives of anger

Often the parents need support from the very one(s) whom they are alienating
Positive Aspects of anger:
It allows the parent to re-assess and reconstruct the internal conception of justice which has been disrupted by the birth of the deaf infant:
We must have an internalized sense of justice



This is related to how one balances responsibility for the welfare of another human with the right to have an independent life of one’s own
The new pressures and responsibility can be overwhelming
2 temptations:
-Tun away or
-Become a professional parent of a deaf child
Our role:
-Accept the feelings: do not say “calm down” because the anxiety facilitates a restructuring or one’s attitudes concerning responsibility


positives of anxiety

It is a time when realistic expectations need to be clearly spelled out along with the understanding that parents have lives beyond their hearing impaired child


factors that influence acceptance of deafness

1. Parents’ adaptive capacities
2. Personality factors, as they are influenced by the marriage relationship
3. Hearing impaired child’s ordinal position in the family
4. Family’s cultural background


parents' adaptive capacities

How they are able to cope with unusual or unanticipated events
Coping mechanisms of parents may differ significantly


Personality factors, as they are influenced by the marriage relationship

Relationship of both spouses to their own parents will have a considerable bearing on the nature of the marriage and how they handle the diagnosis of deafness


Hearing impaired child’s ordinal position in the family

New parents may not know how a child should react to sound and therefore do not suspect a hearing as early as experienced parents


family's cultural background

In families where a child’s language development and educational achievement are highly valued, detection of deafness is more apt to occur earlier because of increased attention to articulation and language


common mistake made by professionals

appears to be that the professional instructs, sermonizes and tries to manipulate the parent into an approved course of action with all the right attitudes; the parent listens
this counseling is doomed to failure:
-Most parents do not remember what is said to them, and
-When they do try to recall another’s words, it is usually filtered through a great deal of fear and misunderstanding


changes in feelings seldom come from what?

someone telling them toy should not feel that way
-Changes in feelings seem to come about best when the feelings are accepted by both the counselor and parent
-Effective counseling must involve more that just input of information: this is important but only when the parent can absorb it (when parent asks the question)


counselor must have certain characteristics

1) Be willing to listen and have parents talk about their feelings: counseling involves emotional restructuring
2) Be aware of own feelings and attitudes and do not project them to the client
3) Be empathetic in that s/he is able to appreciate the feelings of the client
4) Have a positive regard for the client; have time and respond sensitively to the parent


role of the counselor

1. Guidance
2. Give support
suggesting support group: talking to someone that has been in a similar situation can be helpful
3. Provide information
Use a nondirective approach


how to help them understand what is going on with the client

1. Show picture of ear:
Describe parts, using layman’s terms
2. Show where hearing loss is:
Describe causes
Refer for medical treatment
Stress importance of continued use of medication
Stress importance of audiological follow-up
Strategies for language stimulation/development
Strategies for environmental modifications


sensorineural hearing loss

1. Same as conductive loss up to description of what is causing loss
2. If noise induced suggest responsible hearing decisions; hearing protection devices (HPDs); annual rechecks
3. Amplification:
-Medical clearance (from ENT; if they are 13+)
-Emphasize that medical treatment cannot help, but amplification can
-Discuss briefly limitations and benefits of hearing aids
---Make earmold impression (or send to reliable audiologist)
4. AR and role of SLP
Discuss aural rehabilitation program


Parent education is the focus of counseling

Parent education involves family education:
-The child and parent do not exist in a vacuum, and other family members must be considered e.g. siblings, grandparents
-Grandparents often become fixated at defensive retreat stage and have difficulty accepting the diagnosis
often there is role reversal in that the parents pass the denial stage and begin to parent their own parents

show them youtube videos, give them literature, invite other family members to sessions


Siblings of a deaf child also require a considerable amount of attention:

Often there is a tremendous energy drain on parent’s time and physical resources, to the detriment of the other hearing siblings, who may be required to assume responsibilities, such as baby sitting, long before they are ready
Siblings can develop much resentment toward the hearing impaired child if the parents do not incorporate them into the therapeutic program and have them participate in all family decisions affecting them


The parents are also important

they need to be healthy too, they need to take care of their children
Often they become so involved with the deafness that they ignore their own personal needs
They need time for themselves
Parents’ responsibility:
-The inclination is often to give up responsibility for managing their child to the professional who “knows so much more”
Inclination of some professionals:
-It is to assume the responsibility for educating the child; little parent education takes place; and parent becomes less confident in his/her own ability to manage the child


In order for the AR program to be a success

Role of the parent:
Must assume responsibility in educating her/his child
Group experiences can be helpful for enhancing parental confidence
Parents can be helpers as well as being helped, and the opportunity for peer instruction enhances the parent confidence
Role of the professional:
Provides the needed support and guidance in a sensitive and indirect manner


adventitious loss

Problems of the person with adventitious hearing loss:
identify with normal hearing
cannot function as normal hearing
they once had normal hearing, and therefore now know what they have lost
impacts on family, social life, career


the stages through the adventitious loss

their problems are caused by others who do not speak clearly
directed towards audiologist and/or physician
feelings of isolation, and that nothing can be done to resolve their problems
they should have done things differently to avoid having a hearing loss


Management: of Hearing Loss

Hearing aid fitting:
sometimes they are relieved, sometimes they rebel against being fitted with amplification
they must accept their hearing loss
they must be motivated
support systems
family/spouse/significant other
counseling (SLP)/audiologist
self-help groups