Presentation on theme: "Considerations in Pediatric Audiological Assessment of Children With Multiple Disabilities: An Overview Faye P. McCollister, EdD University of Alabama,"— Presentation transcript:
1 Considerations in Pediatric Audiological Assessment of Children With Multiple Disabilities: An OverviewFaye P. McCollister, EdDUniversity of Alabama, EmeritusDiane L. Sabo, PhDChildren’s Hospital of PittsburghUniversity of PittsburghConsulting AudiologistsNational Center for Hearing Assessment and Management
2 Factors to Consider Subject Variables Environmental Variables Test Variables
3 Multiple Disabilities Approximately 40 % of Children with Hearing Loss Will Have Multiple Disabilities(CADS, Gallaudet)Will Require Interdisciplinary Team ManagementWill Require Modifications of Diagnostic Protocols
4 Subject Variables Age Corrected age Chronological age Auditory age Gestational periodChronological ageAuditory ageType of responseLevel of responseDevelopmental ageCognitive levelLanguage level
5 Subject Variables Additional Disabilities Cognitive level Determines appropriate behavioral techniqueDetermines level of response, type of responseDetermines appropriate reinforcerMotor disorders/cerebral palsyHead turn responses compromisedPlay activity may be limitedFatigue
6 Subject Variables Additional Disabilities (cont.) Vision Can not see visual reinforcersCan not process visual instructionsNeeds glasses for assessment, if prescribedSeizure disorderFlicker stimulation with lighted reinforcerAbsence, petit mal, and grand mal seizures
7 Additional Disabilities Other problemsFailure to thriveCystic fibrosisChromosomal abnormalitiesFragile x syndromeDrug exposed babyFetal alcohol syndrome
8 Subject Variables Support equipment Access to booth Need more space VentilatorApnea monitorHead supportWheel chairCommunication boardHead pointerRestraintsAccess to boothNeed more spaceCreates noisePrevents response observation
9 Subject Variables Family Priority of hearing in multidisciplinary diagnostic processResources, social interaction skillsHealth literacyNative language, cultural diversityPreferred method for communication
10 Cultural DiversityIssuesPrevalenceTreatmentfunding and legality
11 Cultural DiversityA growing number or children with hearing loss in the United States are from families that are non-native English speakingThe 2000 U.S. Census shows that nearly one out of five Americans speak a language other than English at home.
12 Cultural DiversityInformational materials should be provided in native languages for parents and at understandable reading levels.Communication options chosen by families for their child should be respected and supported.
13 Cultural DiversityAlberg and Kerr (2004) developed a list of considerations for service providers working with multicultural populations.Families are more comfortable with service providers who speak their language and understand their culture.Printed material should be available in the language of the client base.There may be different dialects among people from the same country.
14 Cultural DiversityRacial, cultural and socioeconomic differences may exist among individuals from the same country.Interpreters may have difficulty explaining medical and technical informationMay be difficult for the family to understand.Families sometimes enter the U.S. illegally.will not qualify for public assistance medical and technical services (e.g., hearing aids)finding financial assistance for these families is challenging, at best
16 Subject Variables Behavior Calm, non-vocal Agitated, vocal, crying Age appropriate attention spanClinging, will not separate
17 Environmental Variables Size of test boothLocation of speakersLocation of observation window, lightedCommercially available reinforcersHandheld reinforcers
18 Environmental Variables Movement Restricting FurnitureHigh chairTable chairInfant carrierPapoose boardBlanket for swaddlingUse blankets/pillows for supportUse belt for stability
19 Environmental Variables Control room/test room communicationAccessible toys for distraction to maintain controlled boredomEar protection for test assistantsVariety of reinforcers to maintain high level of respondingCommercially available reinforcement units,Variety of puppets, lighted obs window
20 Test Protocol Considerations The AudiologistShould be experienced in evaluating young childrenShould adhere to published guidelinesProper facilitiesKnowledgeable about etiology of hearing loss and comprehensive case management
21 Test Protocol Considerations Limited amount of timeCondition with speech, child more likely to respondUse stair case approach, decrease intensity across frequencies selected rather than up and down at single frequencyUse limited number of frequencies(500, 4000, 1000, fill in if possible)
22 Test Protocol Considerations Need Audiological Test BatteryIssue is not always getting equipment on and keeping it on but also the behavioral responses may not be observable or may have interferenceBehavioral with cognitive age appropriate techniquePhysiologic tests
23 Observations Characteristics of auditory responses Developmental characteristicsParent-child interactionAnatomical variationsPigmentation variationsFacial or limb abnormalitiesHirsutism (Hairiness)
24 Test Battery Approach Air and bone conduction OAEs ABR/ASSR Acoustic Immittance
25 Air conduction Allow longer response times Speech stimuli (simple commands) and other broad band stimuliInsert earphones, preferredplacementSound fieldTo assess type of response to sounds
26 Bone Conduction Allow longer response times Issues of keeping vibrator in place especially with cranial malformations; need to ensure adequate pressureIntroduction of masking simultaneously with stimuli
27 Methods VRA TROCA/VROCA Play audiometry Conventional Audiometry Tangible reinforcement often is useful for children with developmental disabilitiesSelection of appropriate reinforcer—needs to be meaningful to the patientPlay audiometryConventional Audiometry
28 ABR/ASSR Air and bone conduction, frequency specific stimuli Issues of noise from child i.e. myogenic noise often highIssues of noise from supportive equipment
29 Acoustic Immittance Tympanometry--high frequency probe tones as needed Acoustic reflex testing--often compromised by noiseCommon problems: excessive cerumen, malformed ear canals, involuntary movements (e.g. teeth grinding)
30 Management of Hearing Loss AmplificationFMs or other ALDsEI
31 Case ReportsNormal pregnancy, delayed developmental milestones, short attention spanHypotonicityCardiac problemVision problemDiagnosed with Down syndromeSuspected hearing lossFrequent otitis media, managed by pediatrician
37 Goldenhar Syndrome Oculoauriculovertebral Dysplasia Unilateral malformation of craniofacial structures (eye, oral and musculoskeletal anomalies)Hearing loss can be sensorineural and/or conductive in one or both earsSensorineural component may not identified because of the assumption of conductive due to malformation
38 Mucopolysacharidosis Examples: Hunter and Hurler SyndromeHunter: x-linked recessive, typically less severeHurler: autonomic recessive
39 Mucopolysaccharidoses Heterogeneous groupExcessive mucopoly saccharides storageVariability in expressionMay have mental retardationConductive, sensorineural, or mixed HL; maybe progressiveFrequent otitis mediaSevere forms may result in death in second decade of life
40 ConclusionThe key to good audiologic assessment of children with multiple disabilities is EARLY diagnosis and frequent follow up.Progressive hearing loss is often associated with multiple disabilities (in association with syndromes)Case coordination is essential for optimizing diagnosis and treatmentEIMedical personnel e.g. neurology, ophthalmology etc.
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