counseling for parents of children diagnosed with hearing loss - dimity dornan, en-ru

Counselling for

Parents of Children

Diagnosed

with Hearing Loss К

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Dr Dimity Dornan AO ,

© Hear and Say 2016

Brisbane, Queensland, Australia – г б К б


Hear and Say Head Office – ‘эear and Say’


Hear and Say Centres

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8 Questions professionals may ask themselves when counselling parents:

Question 1: How should I counsel new parents?

Question 2: How can I motivate parents to want to teach their

child to listen and speak?

Question 3: What do parents need to know?

Question 4: What is most important in teaching parents the skills for

developing their child’s auditory brainф

Question 5: What if a child needs a cochlear implant, when should

they receive this?

Question 6: If earlier is better, what are the barriers to a child

receiving an early cochlear implant?

Question 7: What are the evidence based guidelines for

recommending cochlear implants for young children?

Question 8: What are the potential outcomes for a child implanted

early?


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The most important thing is to love and talk to your baby! – !

Question 1: How should I

counsel new parents? – К ф

Talk, talk, talk

Interact with baby

Face to face play

Smile

Quiet room

Enlist support

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Question 2: How can I motivate parents to want to teach their child

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Give them HOPE –

“эOPъ is the feathered thing that nestles in the breast and sings a song with

no words and never stops at allг” Emily Dickenson

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• Transference


Teach parents the importance of the auditory

brain. Growing the brain of their child is parent’s main responsibility

• Use it or lose it

• Use it and improve it

• Specific training improves specific skills

Important Factors:

• Repetition

• Frequency

• Timing

• Interesting

• Early start

• Transference


Developing the brain for literacy

must start early!

!


Parents of a child diagnosed early have already been through

pregnancy, childbirth and diagnosis of hearing loss

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Question 3: What do parents need to know?

Check hearing device

Quality talking and playing time

Describe and compare everything

Stay close

Use lots of high and low pitched speech sounds

with lots of expression

Repeat key words often

щon’t be afraid to use long words

Children need a super-abundance of words in meaningful situations

Minimize background noise

Use slower speech in simple short phrases and lots of sentences

Use wide variety of words


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Question 3: What do parents need to know? (continued)

Focus your child on listening by calling the child’s attention to sounds.

Take listening walks and talk about what you hear. Watch for

listening behaviour and record new skills learned.

Make words count - read frequently to your child and talk about

the pictures and the story. Remember the bedtime story every

night.

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Focus your child on listening by calling the child’s attention to sounds.

Take listening walks and talk about what you hear. Watch for

listening behaviour and record new skills learned.

Make words count - read frequently to your child and talk about

the pictures and the story. Remember the bedtime story every

night.

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Question 3: What do parents need to know? (continued)

Sing to your child

Dance and laugh with your child

Use different rhymes, songs plus actions and finger plays

Give your child the words they need to say

Expand on what your child already knows

Reward your child by responding when she tries to get attention

Leave a space of time for a young child to take in the words

before a response is expected from them

“Speak firstб then do”б in other wordsб talk about objects чъыORъ giving them

Feed in lots of meaningful words until they overflow into spoken

language

Reward your child’s best response with love and attention


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Education by qualified professionals

Question 4: What is most important in teaching parents the

skills for developing their child’s auditory brainф

Consistent pathway for sounds to reach their brain

Abundance of practice in listening and speaking with loving parents (or carers)

Parents can be trained to provide the quality, frequency and intensity of speech input that has the potential to promote brain development at the same rate as children with normal hearing (Dornan, et al., 2010).

• Education level of the mother (Ching, et al., 2013)

• Level of parent involvement (Geers, et al., 2003)

• Type of maternal input (Leigh, et al,. 2011)

By 4 years, typical children need to have heard 46 million words to be ready for school (Hart & Risley, 1999)

20,000 hours of listening are necessary in infancy and early childhood as a basis for reading (Dehaene, 2009)


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• (Ching, et al., 2013)

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Auditory-Verbal Therapy

An education approach in which parents take the leading role and therapists are the guide and coach of the parents

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Fathers need to be involved too! – !


Question 5: What if a child needs a cochlear

implant, when should they receive this?

Compelling evidence for cochlear implant younger

than 12 months of age (Otology and Neurology, 2016)


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Evidence for implantation at an early age

(Dettman, et al., 2016)


Question 6: If earlier is better, what are the barriers to a

child receiving an early cochlear implant? « б б

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Newborn hearing screening implementation was associated with

reductions in age of cochlear implantation (Dettman, S.J., Choo, D., Dowell, R.C., 2016).

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Question 7: What are the evidence based guidelines for

recommending cochlear implant for young children?

Children with a PTA greater than 60dB HL have a 75% chance

of benefit over traditional amplification

Children with PTA greater than 82dB HL have a 95% chance of

benefit

Children implanted under 2.5 years (no significant cognitive

deficits) made normal language progress but retained a delay

approximately equal to their age at implantation

Conclusions: Hearing-impaired children under three years of

age may benefit from cochlear implantation if their PTA

exceeds 60dB HL bilaterally. Implantation as young as possible

should minimize any language delay

(Leigh, J.R., Dettman, S.J., & Dowell, R.C. , 2016)


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(Leigh, J.R., Dettman, S.J., & Dowell, R.C. , 2016)


Question 8: What are the potential outcomes

for a child implanted early?

Children implanted by 12 months of age demonstrate

better language development compared with children

who receive their cochlear implant between 13 and 24

months (Leigh, J., Dettman, S., Dowell, R., & Briggs, R. , 2013)

Children with hearing loss using an Auditory-Verbal

Therapy approach were able to progress in

development of listening, speech and language at the same rate of progress as a matched group of children

with normal hearing (same initial language age) over 4 years and 2 months of time) (Dornan, D.A., Hickson, L., Murdoch, B. Houston, T., &

Constantinescu, 2010).


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L., Murdoch, B. Houston, T., & Constantinescu, 2010).


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References: п

Ching T.Y.C., Dillon, H., Marnane, V. et al. (2013). Outcomes of early- and late-identified children at 3

years of age: findings from a prospective population study. Ear and Hearing, 34 (5), 535-552.

Dehaene S. (2009). Reading in the Brain: The Science and Evolution of a Human Invention. New York:

Penguin.

Dettman, S.J., Choo, D., Dowell, R.C., (2016) Barriers to early cochlear implantation. International Journal

of Audiology, 1-13 Early Online: http://dx.doi.org/10.1080/14992027.2016.1174890

Dettman, S.J., Dowell, R.C., Choo, D., Arnott, W., Abrahams, Y., Davis, A., Dornan, D., Leigh, J.,

Constantinescu, G., Cowan, R., Briggs, R.S. (2016). Long term communication outcomes for children

receiving cochlear implants younger than 12 months: A multi-centre study. Otology and Neurotology,

37:e82–e95.

Dornan, D.A., Hickson, L., Murdoch, B. Houston, T., & Constantinescu (2010). Is Auditory-Verbal Therapy

Effective for Children with Hearing Loss? The Volta Review, 110 (3), 361-387.

Geers, A.E., Strube, M.J., Tobey, E.A., & Moog, J.S. (2001). Epilogue: Factors contributing to long-term

outcomes of cochlear implantation in early childhood. Ear and Hearing, 32 (1). 84S - 91S.

Hart, B., & Risley, T. (1999). Observing children and families talking. In B. Hart, & T.R. Risley (Eds). The social

world of children learning to talk (pp. 7-29). Baltimore, MD: Paul H. Brookes Publishing Co., Inc.

Leigh, J. R., Dettman, S. J., Dowell, R. C., & Sarant (2011). Evidence-based approach for making

cochlear implant recommendations for infants with residual hearing. Ear & Hearing, 32(3), 313-322.

Leigh, J.R., Dettman, S.J., & Dowell, R.C. (2016) Evidence-based guidelines for recommending cochlear

implantation for young children: Audiological criteria and optimizing age at implantation. International

Journal of Audiology, 1-10 Early Online: http://dx.doi.org/10.3109/14992027.2016.1157268

Leigh, J., Dettman, S., Dowell, R., & Briggs, R. (2013) Communication development in children who

receive the cochlear implant by 12 months of age. Otology and Neurotology. 34(3), 443-50.

http://dx.doi.org/10.1080/14992027.2016.1174890

http://dx.doi.org/10.3109/14992027.2016.1157268