Aural Rehab with a Hearing Impaired Teenager
The foremost issue for this 14-year-old will be to ensure maximum acoustic accessibility in both educational and social settings. Because of the lack of speech discrimination in the right ear, when aided she still will essentially have the constraints imposed by a unilateral loss, namely marked difficulties in aversive listening environments. A primary concern, then, will be how this child functions in acoustically hostile environments. If possible, her educational audiologist should try to have sound field amplification systems or a portable personal sound field system available in her major subject area classrooms. In addition, an FM hearing aid or use of the Microlink system with her hearing aid(s) may help her overcome the effects of noise and distance in and out of school.
This child's auditory needs must be determined. The Developmental Index of Audition and Listening (DIAL) is available on the web site of the Educational Audiology Association (EAA) and is useful for determining the auditory needs of children within particular age groups. At the age of 14, for example, this young lady will likely desire to use the telephone to communicate with others in her peer group. Consideration of technology to enhance her use of the telephone, as well as telephone training as part of her overall program of audiologic rehabilitation will be necessary.
Beyond addressing auditory accessibility issues, there are a number of considerations when designing a comprehensive program of audiologic rehabilitation for this 14-year-old. First and foremost will be educational monitoring, hopefully using a proactive approach, i.e., trying to offset the development of academic difficulties rather than attempting to employ remedial strategies to difficulties as they arise. Instruments such as the Listening Inventory for Education (LIFE; available from the EAA) enable input from both the child and the child's teachers regarding how the hearing loss is affecting classroom performance. As a part of educational monitoring, the classroom teachers need to know what effects hearing loss may have on the child's academic performance. This can be accomplished via inservice presentations and/or through written materials such as the excellent publication entitled Questions Teachers Ask- A Guide for the Mainstream Classroom Teacher with a Hearing-Impaired Student by Julie Winslow Otto and Victoria J. Kozak (published by the Central Institute for the Deaf).
A second consideration is the availability of a peer support network for this teenager. Her audiologic management program might include putting her in touch with other teenagers in the community who have hearing losses and/or informing her of online peer support opportunities. For example, web sites such as DeafChildren.org are designed for young Deaf and hard-of-hearing children, ages 17 years and younger.
A third goal of this child's management should be to foster her self-advocacy. Two programs that I have found to be very useful in this regard are the Knowledge Is Power (KIP) program (available for a modest price from the Mississippi Bend Area Education Agency, Special Education Division, 729- 21st Street, Bettendorf, Iowa 52722-5096) and Coping Strategies For Hard Of Hearing Children, another inexpensive self-advocacy curriculum (available from N.I.A., Attn: Wendy Seneca , 521 Hamilton Street, Geneva, IL 60134). These self-advocacy curricula contain practical, relevant information for school children with hearing losses, such as how to talk to others about hearing loss, how to maintain amplification devices, and an explanation of coping strategies.
Another consideration for this child might be a program of auditory-linguistic training. A program I have used successfully with a number of older children is Tye-Murray's (1997) Communication Training for Older Teenagers and Adults, available from Pro-Ed. This program has a variety of training activities, including syllable drill, speech discrimination, sentence recognition and identification, conversational activities, and communication strategies activities. Tye-Murray's program features auditory and speechreading exercises that are ideal for high schoolers, as well as numerous suggestions for increasing and decreasing the difficulty level as needed.
Finally, every effort should be made to involve not only the child's family in the management program, but also the teenager herself. An excellent way to gain the perspective of the child and the parents is to use the Children's Home Inventory of Listening Difficulties (CHILD), which seeks information from both parents and children regarding hearing difficulties that are experienced. The CHILD is useful for pre-teens and younger teenagers and can be purchased from the EAA. The likelihood of the teenager's cooperation and compliance with the management program is probably significantly greater when her opinions and perspectives are considered.