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Counseling Guidelines: Supporting Children with Hearing Loss

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Presentation on theme: "Counseling Guidelines: Supporting Children with Hearing Loss"— Presentation transcript:

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

2 Session Objectives Understand the impact of
the diagnosis of hearing loss on a family system 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

3 Child Developmental Model
Teacher, Speech Language Pathologist Audiologist, Physician Cognitive ? Social-Emotional Physical

4 Pediatric Counseling Guidelines
Birth through transition to school

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

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

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

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

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

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

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

12 Sharing Information Family Centered Model Medical Model The child
Diagnose Family's Needs Child's Needs and Treat The child

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

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

15 Grief Core pain can’t be taken away.
Feelings must be acknowledged, expressed in a safe, caring environment. 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” 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 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 Guilt: Fathers for not protecting the family Mothers because she secretly believes she’s at fault for the hearing loss Comes between the marriage, family becomes unbalanced (Mother+child, father+work) Danger is overprotection of child. Conveys helplessness to the child.

18 The Hearing Healthcare Professional
a.k.a. “The Healer” 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: Over-controlling Lack self-confidence Self-serving Don’t feel competence Passive Children internalize this powerlessness, helplessness, and head down a path of life long poor self-esteem

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

20 What can you do? Provide immediate, appropriate support
Have appropriate counseling skills Have expert knowledge and experience with living with hearing loss Actively listening No judging the family 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 Their child is not fragile 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 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 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

23 Healthy Acceptance/Adaptation
Acknowledge their preference that their child not be deaf/hard of hearing 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

24 Healthy Attachment Between Parents and Children
Deep enduring connections established between child and caregiver Occurs between birth and age 3 Learned ability 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 Self-regulation of affect and behavior Healthy identity = healthy self-worth + autonomy Morality based upon empathy, compassion and conscience Resourcefulness and resilience for response to future stress Stimulating experiences required for healthy brain development Levy, (2000)

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

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

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

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

30 Healthy Family System Community Extended Family Family Marriage Child
Parent Parent Child Child

31 Unhealthy Family System
Community Extended Family Family Marriage Child Parent Parent Grandma Child Child

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

33 Child Developmental Model
Teacher Audiologist, Physician Insert your picture here Cognitive YOU!! Social-Emotional Physical

34 Psycho-Social Development Erikson’s 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 Mistrust their world if they are left hungry, cold, wet, and unattended

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

36 Self-Concept Birth – 14 months
No sense of self 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

37 Self-Concept 15 months – 2 years
Self awareness emerges 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

38 Self-Concept 2 - 3 years Self concept emerges
Child identifies themselves as: A “girl” or a “boy” A “baby” or “big boy/girl” A “brother” or “sister” or only child By religious affiliation By ability

39 What can you do? Evaluate and support access to alerting devices
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

40 Psycho-Social Development Erikson’s Stages
Initiative versus Guilt (3 – 6 years) Initiative: Increased awareness of self and world outside of home 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

41 Psycho-Social Development Erikson’s Stages
Initiative versus Guilt (3 – 6 years) Guilt: When attempts result in failure or criticism, the child feels: Guilty Incompetent Helpless

42 Self-Concept 3 - 6 years Ego-centric thinking
“I am the world and the world is just like me!” Repetition/Practice Mastery Mastery Competence Competence Self-confidence Self-confidence Self-esteem

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

44 Development of Social Skills/Interaction
Provide information to parents on: Lack of incidental learning due to hearing loss Often deaf/hard of hearing children need specific training on basic and more advanced social skills Use of social skills books Discriminating between “Can’t Do” or “Won’t Do” behavior problems Gresham (1995)

45 Frequent Teaching of Social Skills
For “Can’t do” behavior problems: Use Modeling, coaching, practice For “Won’t do” behavior problems: Use behavior charts, positive reinforcement, effective praise, and noticing (and describing) good behavior Gresham (1995)

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

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

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

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