Hear Them Out In a recent ASHA online conference chat, Ivette Cejas shared how audiologists can provide social and emotional support to children and teens with hearing loss. The Leader listened in. Overheard
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Overheard  |   January 01, 2017
Hear Them Out
Author Notes
  • Ivette Cejas, PhD, is an assistant professor at the University of Miami Ear Institute and director of its Barton G. Kids Hear Now Cochlear Implant Family Resource Center. A licensed psychologist, Cejas specializes in research on pediatric cochlear implantation and, as part of a cochlear implant team, is involved with pre-implantation evaluations, assessment of cognitive functioning and supportive therapy for families of children with hearing loss. icejas@med.miami.edu
    Ivette Cejas, PhD, is an assistant professor at the University of Miami Ear Institute and director of its Barton G. Kids Hear Now Cochlear Implant Family Resource Center. A licensed psychologist, Cejas specializes in research on pediatric cochlear implantation and, as part of a cochlear implant team, is involved with pre-implantation evaluations, assessment of cognitive functioning and supportive therapy for families of children with hearing loss. icejas@med.miami.edu×
Article Information
Hearing Disorders / ASHA News & Member Stories / Overheard
Overheard   |   January 01, 2017
Hear Them Out
The ASHA Leader, January 2017, Vol. 22, online only. doi:10.1044/leader.OV.22012017.np
The ASHA Leader, January 2017, Vol. 22, online only. doi:10.1044/leader.OV.22012017.np
Participant: What are some effective interventions for behavior problems for children with hearing loss?
Ivette Cejas: Unfortunately, there are no systematic interventions that were developed specifically for children with hearing loss. However, several empirical interventions have started to be used in this population. For behavior problems in young children, Parent-Child Interaction Therapy (PCIT) has been used in children with hearing loss with benefit. Other interventions include the Triple P—Positive Parenting Program. For anxiety problems, cognitive behavioral therapy is the intervention of choice.
Participant: We deal with two types of counseling: counseling to provide information and counseling to alter behavior to bring about change. Our education qualifies us for the informational counseling. How do we qualify for the latter?
Cejas: You can take some courses that will help certify you in different interventions. For example, PCIT has trainings and certifies individuals from different disciplines. Other interventions that are effective in teens, such as motivational interviewing, also have training programs that you can look into. However, for children and adolescents in which you are truly concerned about depression or anxiety, you may want to refer to a mental health provider and consult with them to help develop a therapy plan that you can jointly do with the child.
Participant: Can you explain motivational interviewing? This is a new term for me.
Cejas: Motivational interviewing is a counseling technique that helps prepare individuals for change. It helps professionals identify what stage of change the individual is at (e.g., pre-contemplation—not ready; contemplation—thinking about it, etc.) and provides specific tools to help you move the individual through the different stages. It also helps provide guidance on how to deal with resistance and cognitive dissonance (when thoughts and behaviors are different). This is now a widely used tool that has been used for individuals with various problems, but was first developed to help individuals with substance abuse problems. If you are interested in learning more about this, there is a book—“Motivational Interviewing in Health Care: Helping Patients Change Behavior”—that might be helpful to read.
Participant: Are there any data showing difference behaviorally or in social/emotional areas between Deaf/hard of hearing students who may be the only ones in their schools versus students who are being educated with a group, i.e. in a residential school or day program?
Cejas: I am not aware of any studies specifically looking at this, but it is a great question. Most of the research studies do include children in mainstream, inclusion and self-contained programs. But the analyses usually do not point to any differences. Most of them are correlational relationships, and studies mainly show that communication is a predictor of behavioral outcomes.
Participant: I am having trouble receiving support in preparing our graduating high school students who are Deaf or hard of hearing who do not plan on attending college or vocational studies. They feel unprepared. Do you have any suggestions on ways an educational audiologist can assist these students?
Cejas: This is an extremely important issue. We need to better prepare these teens to transition to the “real world.” As an educational audiologist, you might be able to help the teen identify what their plans are. Many teens might not know what they want to do, or they might be resistant to the discussion. For this you can use motivational interviewing to help that teen prepare for change or help motivate them to pursue some sort of employment. I hope this is helpful, as this is more a general counseling issue and there is not one specific technique that I can recommend. It would vary based on each teen.
Participant: I know an 11-year-old boy with a cochlear implant who has been bullied, both at school and on the school bus. I also see in him some social immaturity (e.g., how he reacts to losing, feeling things are unfair, etc.). I know that shouldn’t mean he’s a target for bullies, but I think it might contribute—even to his perception of what is bullying and what isn’t. What are some ways to work on social competence? Is there anything specific to hearing loss that should be addressed?
Cejas: Children with hearing loss are often described as immature compared to their peers. To help improve social skills and social competence, a group setting is often helpful where you can role-play scenarios. For young children who may have some language delays, there are some board games that help target specific social skills that you may use. Regarding the hearing-loss-specific issue, we should be helping these children function like their hearing peers, so our goal should be to help improve their social skills so that they are functioning at a similar level. To help determine specific areas that you can work on, you can use some screening questionnaires for social skills, such as the Social Skills Rating System.

Children with hearing loss are often described as immature compared to their peers. To help improve social skills and social competence, a group setting is often helpful where you can role-play scenarios.

Participant: From a prevention perspective, there’s research that looks at risk behavior and attitudes toward hearing protection. It’s one thing to inform children and young adults about the harmful effects of loud sound; it’s another to provide counseling in order to change their attitude (behavior) regarding the use of hearing protection. There are programs (Listen to Your Buds and Dangerous Decibels), but they are training programs that are not universal. We can’t refer entire populations to behavioral specialists. How does the local audiologist motivate children to use hearing protection?
Cejas: Hearing protection is a big issue. I would first start off by determining why the child is resistant to wearing the protection. If you identify the reason, then you can specifically work on that issue. For example, if it is an issue related to appearance or being different, then you can encourage and educate the child on what they see as “different.” Also you can use reinforcement techniques to reward the child for wearing the protection; however, you would probably need to get the parents involved in this. And the parents also have to view this as important; otherwise the child will not see it as truly important. If you are in a clinic setting, it is helpful to have events where you focus on this and can get the parents informed so that they can also use protection, which will then help you when talking with the child/teen.

Start off by determining why the child is resistant to wearing the protection. If you identify the reason, then you can specifically work on that issue.

Participant: Regarding building social skills, I think that is where we get stuck in the schools. They may not be low enough in their language scores to qualify for services—even though they could use help with the pragmatics—and our social workers don’t do direct service, so it falls to the audiologist or teacher of the Deaf and hard of hearing (which my district doesn’t have). I don’t always feel qualified to address some of those issues.
Cejas: Unfortunately, this is an issue in many school districts. I have had to advocate for many of our children who are doing well in terms of language but struggle in other areas. This is where it would be helpful if you have some behavioral questionnaire to support your concerns. There are simple games that you can incorporate with some of your kids to talk about the various social skills and role play with them. However, if you ever feel that you cannot help a child with a specific issue, and the school does not have someone to help, such as a social worker or counselor, then you may need to talk with the parent about your concerns and possibly refer to help get the child these services outside of school. Once you start the discussion with the family, you may find out that they are also concerned, or possibly the child’s clinic has also communicated their concerns, and your conversation may finally help motivate the family to pursue services.

If you ever feel that you cannot help a child with a specific issue and the school does not have someone to help, such as a social worker or counselor, then you may need to talk with the parent about your concerns.

Participant: A child’s IEP could be used to put an anti-bullying plan in place for a child who is being bullied due to their hearing loss. Have you seen this done? What sorts of goals are included? What kind of outcomes have you seen?
Cejas: This is rarely done, and I have only heard of this a few times; however, it can be done. Goals are more related to interactions with peers and usually don’t have the word “bullying” in it. For example, it can mention positive relationships with X peers, or the goal can target social skills or self-advocacy, since many kids don’t know how to communicate about these issues. You can then use the behavior questionnaires or some of the advocacy questionnaires to see if they are improving. Many schools may not be open to putting this on their IEP, but if bullying is a larger issue at the school, maybe you can look into getting the GREAT [Gang Resistance Education and Training] program at your school to help educate the entire school on bullying prevention. It is a wonderful program and we are beginning to look into making adaptations for children with hearing loss.
Participant: In our clinic we have a number of teens with hearing loss who use their amplification in school but refuse to use it at home. Would you have any suggestions on how to deal with that/help them?
Cejas: I have seen this as well. Again, this is where the parents play a key role. For these kids, I have had counseling sessions to educate them on their hearing loss and how much benefit they get with the hearing aids or how much they are missing when they don’t have them on. It is also important to know why they don’t wear them at home. If you identify the reason, you can create a plan with the family to reinforce the teen wearing them at home. Teens like to work for rewards too, so this has been effective, but the parents have to be willing to track and help implement the plan.
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January 2017
Volume 22, Issue 1