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Eileen Rall, Au.D., CCC-A Louise A. Montoya, MA, LPC, CSC The Center for Childhood Communication Counseling Guidelines: Supporting Children with Hearing.

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Presentation on theme: "Eileen Rall, Au.D., CCC-A Louise A. Montoya, MA, LPC, CSC The Center for Childhood Communication Counseling Guidelines: Supporting Children with Hearing."— Presentation transcript:

1 Eileen Rall, Au.D., CCC-A Louise A. Montoya, MA, LPC, CSC The Center for Childhood Communication Counseling Guidelines: Supporting Children with Hearing Loss

2 Session Objectives Understand the impact of Understand the impact of the diagnosis of hearing loss on a family system the diagnosis of hearing loss on a family system hearing loss on psycho-social development of a child hearing loss on psycho-social development of a child Become familiar with a pediatric counseling guideline and understand how to integrate it into your practice Become familiar with a pediatric counseling guideline and understand how to integrate it into your practice

3 Child Developmental Model ? Audiologist, Physician Teacher, Speech Language Pathologist

4 Pediatric Counseling Guidelines Birth through transition to school

5 Pediatric Counseling Guidelines Impact of diagnosis Impact of diagnosis Psycho-Social development Psycho-Social development Erik Eriksons model of development Erik Eriksons model of development Development of self-concept (15 mos+) Development of self-concept (15 mos+) Development of social skills Development of social skills

6 Pediatric Counseling Guidelines Diagnosis Diagnosis Birth to Three years Birth to Three years Three to Six years Three to Six years Six to Eleven years Six to Eleven years Eleven through Adolescence Eleven through Adolescence

7 Eriksons Stages of Psycho-Social Development Trust vs. Mistrust (birth – 18 months) Trust vs. Mistrust (birth – 18 months) Autonomy vs. Shame and Doubt Autonomy vs. Shame and Doubt (18 mos – 2 years) (18 mos – 2 years) Initiative vs. Guilt (3 – 6 years) Initiative vs. Guilt (3 – 6 years)

8 Psycho-Social Development Self-Concept An individuals understanding of who they are No self No self Self-awareness Self-awareness Factual self-concept Factual self-concept Egocentric view of self-concept Egocentric view of self-concept Self-confidence and self-esteem emerging Self-confidence and self-esteem emerging Comparative Comparative Peer-pressure Peer-pressure Individuation Individuation

9 Psycho-Social Development Social Skills Healthy Attachment Healthy Attachment Basic Basic Intermediate Intermediate Advanced Advanced

10 Developmental Index of Audition and Listening (DIAL) Functional auditory Functional auditory milestones milestones Palmer and Mormer (1999)

11 Impact of Diagnosis Sharing information Sharing information Recognizing emotional reactions Recognizing emotional reactions Promoting healthy attachment Promoting healthy attachment Positively impacting family systems Positively impacting family systems

12 Sharing Information Medical Model Family Centered Model

13 What are the benefits of Family- Centered Care? (not specific to hearing impairment) Improved teaching skills of parent Improved teaching skills of parent Better behavior from child as a result of improved parental teaching skills Better behavior from child as a result of improved parental teaching skills Decreased parental stress Decreased parental stress Improved satisfaction of services Improved satisfaction of services

14 Recognizing Emotional Reactions Feelings Involved with Grief Shock/Denial/ Numbness Shock/Denial/ Numbness Anger/Fear/Panic Anger/Fear/Panic Sadness/Hopeless Sadness/Hopeless Guilt/Bargaining Guilt/Bargaining Healthy acceptance/adaptation Healthy acceptance/adaptation

15 Grief Core pain can t be taken away. Feelings must be acknowledged, expressed in a safe, caring environment. Feelings must be acknowledged, expressed in a safe, caring environment. Some emotions have an important purpose in helping parents adjust to the diagnosis Some emotions have an important purpose in helping parents adjust to the diagnosis Potential Pitfall: Because parents may have strong feelings of inadequacy Many parents happy to turn over their child to the experts Many parents happy to turn over their child to the experts Professionals eager to rescue Professionals eager to rescue Luterman (1999)

16 Feelings Involved with Grief Shock/Denial/Numbness - protects parents from deep pain and allows parents to build up energy for the work ahead of them Shock/Denial/Numbness - protects parents from deep pain and allows parents to build up energy for the work ahead of them Anger - Parents feel cheated. Anger hides their fear. Many professionals are very afraid of the anger and respond defensively. Need to help parents capture and direct their energy effectively. Anger - Parents feel cheated. Anger hides their fear. Many professionals are very afraid of the anger and respond defensively. Need to help parents capture and direct their energy effectively.

17 Feelings Involved with Grief Sadness/Hopelessness – expressing grief – moving forward Sadness/Hopelessness – expressing grief – moving forward Guilt: Guilt: Fathers for not protecting the family Fathers for not protecting the family Mothers because she secretly believes she s at fault for the hearing loss Mothers because she secretly believes she s at fault for the hearing loss Comes between the marriage, family becomes unbalanced (Mother+child, father+work) Comes between the marriage, family becomes unbalanced (Mother+child, father+work) Danger is overprotection of child. Conveys helplessness to the child. Danger is overprotection of child. Conveys helplessness to the child.

18 A vicious cycle begins when parental helplessness and powerlessness intersects with professionals need to help, save, assume the powerful, expert role with families A vicious cycle begins when parental helplessness and powerlessness intersects with professionals need to help, save, assume the powerful, expert role with families Results in parents who are: Results in parents who are: Over-controlling Lack self-confidence Over-controlling Lack self-confidence Self-serving Dont feel competence Self-serving Dont feel competence Passive Passive Children internalize this powerlessness, helplessness, and head down a path of life long poor self-esteem Children internalize this powerlessness, helplessness, and head down a path of life long poor self-esteem The Hearing Healthcare Professional a.k.a. The Healer

19 Parents with Unresolved Grief Can Be: Emotionally overwhelmed Emotionally overwhelmed Stuck in anger Stuck in anger Frequently suppressing their emotions Frequently suppressing their emotions Depressed or passive Depressed or passive Unrealistic or stuck in denial Unrealistic or stuck in denial Disorganized, confused Disorganized, confused Actively searching for the cause of the hearing loss Actively searching for the cause of the hearing loss Yoshinaga-Itano (2001)

20 What can you do? Provide immediate, appropriate support Provide immediate, appropriate support Have appropriate counseling skills Have appropriate counseling skills Have expert knowledge and experience with living with hearing loss Have expert knowledge and experience with living with hearing loss Actively listening Actively listening No judging the family No judging the family Build parental self-esteem, self-confidence Build parental self-esteem, self-confidence Yoshinaga-Itano (2001)

21 What can you do? Help families understand The etiology, emphasizing that cause was not parents intention The etiology, emphasizing that cause was not parents intention Their child is not fragile Their child is not fragile Their child can do anything, but, may have to do some things differently Their child can do anything, but, may have to do some things differently That taking good care of themselves and their marriage = taking good care of their child That taking good care of themselves and their marriage = taking good care of their child Luterman (1999)

22 What can you do? Inform parents that: Children with congenital and pre-lingual onset of hearing loss do not experience grief until sometime between 7 – 9 years of age Children with congenital and pre-lingual onset of hearing loss do not experience grief until sometime between 7 – 9 years of age Parents need to keep their grief away from child. Child will misunderstand and misattribute parents grief Parents need to keep their grief away from child. Child will misunderstand and misattribute parents grief Child has best chance of resolving their initial grief if parents have positively resolved their initial grief Child has best chance of resolving their initial grief if parents have positively resolved their initial grief

23 Healthy Acceptance/Adaptation Acknowledge their preference that their child not be deaf/hard of hearing Acknowledge their preference that their child not be deaf/hard of hearing Accept the permanence of the hearing loss Accept the permanence of the hearing loss Understand and have entire family take consistent action to make necessary changes create accessible/effective communication environment for deaf/hard of hearing child Understand and have entire family take consistent action to make necessary changes create accessible/effective communication environment for deaf/hard of hearing child

24 Healthy Attachment Between Parents and Children Deep enduring connections established between child and caregiver Deep enduring connections established between child and caregiver Occurs between birth and age 3 Occurs between birth and age 3 Learned ability Learned ability Result of ongoing reciprocal interactions characterized by protection, need fulfillment, limits, love and trust Result of ongoing reciprocal interactions characterized by protection, need fulfillment, limits, love and trust Levy (2000)

25 Healthy Attachment Can Lead to Development of: Basic trust and reciprocity Basic trust and reciprocity Self-regulation of affect and behavior Self-regulation of affect and behavior Healthy identity = healthy self-worth + autonomy Healthy identity = healthy self-worth + autonomy Morality based upon empathy, compassion and conscience Morality based upon empathy, compassion and conscience Resourcefulness and resilience for response to future stress Resourcefulness and resilience for response to future stress Stimulating experiences required for healthy brain development Stimulating experiences required for healthy brain development Levy, (2000)

26 Potential Consequences of Insecure Attachment: Self-regulation deficits: Impulse control Impulse control Self-soothing Self-soothing Initiative Initiative Perseverance Perseverance Inhibition Inhibition Patience Patience Levy (2000)

27 Potential Consequences of Insecure Attachment: Development of problem behaviors: Impulsiveness Impulsiveness Hyperactivity Hyperactivity Inattention Inattention Seeking stimulation Seeking stimulation Poor self-image Poor self-image No friends No friends Oppositional and defiant Oppositional and defiant Disruptive Disruptive Manipulative Manipulative Blames others (internalized helplessness) Blames others (internalized helplessness) Levy (2000)

28 What can you do? Inform parents that: Inform parents that: Teach parents about the importance of healthy attachment Teach parents about the importance of healthy attachment Support them through the feelings associated with grief Support them through the feelings associated with grief Help them understand the impact hearing impairment has on communication – avoid misunderstanding communication difficulties Help them understand the impact hearing impairment has on communication – avoid misunderstanding communication difficulties

29 Healthy Family System Feels empowered Feels empowered High self-esteem (especially for the mother) High self-esteem (especially for the mother) Feeling that burdens are shared Feeling that burdens are shared Achieved healthy acceptance of the diagnosis Achieved healthy acceptance of the diagnosis Luterman (2001)

30 Healthy Family System

31 Unhealthy Family System

32 What can you do? Inform parents Inform parents Be a sounding board Be a sounding board Listen Listen Coach Coach Acknowledge Acknowledge Brainstorm Brainstorm Support Support Model strategies Model strategies Refer to professionals when needed Refer to professionals when needed

33 Child Developmental Model Audiologist, Physician Teacher Insert your picture here YOU!!

34 Psycho-Social Development Eriksons Stages Psycho-Social Development Eriksons Stages Trust versus Mistrust (birth – 18 months) Babies learn to: Trust their world if they are kept well-fed, warm, dry, and receive regular human touch Trust their world if they are kept well-fed, warm, dry, and receive regular human touch Mistrust their world if they are left hungry, cold, wet, and unattended Mistrust their world if they are left hungry, cold, wet, and unattended

35 Psycho-Social Development Eriksons Stages Autonomy versus Shame and Doubt (18 months – 2 years) Toddlers want to rule their own actions and bodies Toddlers want to rule their own actions and bodies With success develop Autonomy With failuredevelop Shame and Doubt in their own abilities With failuredevelop Shame and Doubt in their own abilities

36 Self-Concept Birth – 14 months No sense of self No sense of self Child views themselves as extension of their parent/caregiver Child views themselves as extension of their parent/caregiver Classic test: red nose in the mirror; All children 12 months and younger do not know they are seeing themselves in a mirror Classic test: red nose in the mirror; All children 12 months and younger do not know they are seeing themselves in a mirror

37 Self-Concept 15 months – 2 years Self awareness emerges Self awareness emerges Recognize self in a mirror Recognize self in a mirror Classic test: red nose in the mirror; Most children 15 – 24 months will notice the red on their nose and be curious or embarrassed Classic test: red nose in the mirror; Most children 15 – 24 months will notice the red on their nose and be curious or embarrassed

38 Self-Concept years Self concept emerges Self concept emerges Child identifies themselves as: Child identifies themselves as: A girl or a boy A girl or a boy A baby or big boy/girl A baby or big boy/girl A brother or sister or only child A brother or sister or only child By religious affiliation By religious affiliation By ability By ability

39 What can you do? Evaluate and support access to alerting devices Evaluate and support access to alerting devices Include the child in conversations about hearing loss - positive Include the child in conversations about hearing loss - positive Support families in developing relationships with other families with children with hearing loss and with D/HoH adults and older children Support families in developing relationships with other families with children with hearing loss and with D/HoH adults and older children

40 Psycho-Social Development Eriksons Stages Initiative versus Guilt (3 – 6 years) Initiative: Increased awareness of self and world outside of home Increased awareness of self and world outside of home Eagerly attempts new tasks and play activities Eagerly attempts new tasks and play activities Successful attempts at new tasks help children learn and master many things, which becomes self- reinforcing (proud of themselves) and self-controlling to gain the approval of adults Successful attempts at new tasks help children learn and master many things, which becomes self- reinforcing (proud of themselves) and self-controlling to gain the approval of adults

41 Psycho-Social Development Eriksons Stages Initiative versus Guilt (3 – 6 years) Guilt: When attempts result in failure or criticism, the child feels: When attempts result in failure or criticism, the child feels:GuiltyIncompetentHelpless

42 Self-Concept years Ego-centric thinking Ego-centric thinking I am the world and the world is just like me! I am the world and the world is just like me! Repetition/PracticeMastery Repetition/PracticeMastery Mastery Competence Mastery Competence CompetenceSelf-confidence CompetenceSelf-confidence Self-confidence Self-esteem Self-confidence Self-esteem

43 Professional as Coach ProfessionalParentChild Parents teach their child. Professionals support and coach parents as they teach their child.

44 Development of Social Skills/Interaction Provide information to parents on: Lack of incidental learning due to hearing loss Lack of incidental learning due to hearing loss Often deaf/hard of hearing children need specific training on basic and more advanced social skills Often deaf/hard of hearing children need specific training on basic and more advanced social skills Use of social skills books Use of social skills books Discriminating between Cant Do or Wont Do behavior problems Discriminating between Cant Do or Wont Do behavior problems Gresham (1995)

45 Frequent Teaching of Social Skills For Cant do behavior problems: Use Modeling, coaching, practice For Cant do behavior problems: Use Modeling, coaching, practice For Wont do behavior problems: Use behavior charts, positive For Wont do behavior problems: Use behavior charts, positive reinforcement, effective praise, and reinforcement, effective praise, and noticing (and describing) good behavior noticing (and describing) good behavior Gresham (1995)

46 Examples of Basic Social Skills Eye contact Eye contact Smiling Smiling Listening (for friendship) Listening (for friendship) Introducing yourself Introducing yourself Meeting new people Meeting new people Joining a group Joining a group Giving compliments Giving compliments

47 What can you do? Promote effective communication strategies - for all (including YOU!) Promote effective communication strategies - for all (including YOU!) Evaluate and support access to age- appropriate activities Evaluate and support access to age- appropriate activities Talk to families about social skill development Talk to families about social skill development Foster development of initiative Foster development of initiative

48 Thank you! Eileen Rall, Au.D., CCC-A (215) or Center for Childhood Communication at The Childrens Hospital of Philadelphia 34 th and Civic Boulevard, Room 112 Philadelphia, PA 19104


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