Dilemma Game Teens and Tweens

Use the Dilemma Game for Teens and Tweens to better prepare for challenging clinical situations with young people and determine where they are on their patient journey (see our Patient Journey tool to learn more). The game encourages reflection, critical thinking, and analysis of potential consequences that a practitioner’s choices may have on a client. The Dilemma Game can be used alone or in group training.

Select a scenario card below and read the dilemma. Flip the card over to see possible solutions or create your own. Remember, the perfect solution may not exist.

Hear your peers

A 12-year-old boy has come to your clinic with his father to discuss listening at school. He has a long-standing profound bilateral sensorineural hearing loss. At home he communicates using spoken language, but at school he has a sign-language interpreter. He has one cochlear implant, which he uses consistently, and a contralateral hearing aid, which he uses inconsistently. He is well supported by his cochlear implant center.

He is articulate and easily able to discuss the difficulties of listening and using the devices. He has most difficulty in background noise or when he cannot see the speaker’s face. He is frustrated by a lack of deaf awareness at school and his teachers’ inadequate use of FM accessories.

How would you deal with the situation?

Suggestions

Use a counseling tool or questionnaire to find out more about which situations are hardest for him.
Find out why he takes his hearing aid off and explore his interest in a second cochlear implant.
Ask if he would be interested in giving a talk to his class and teachers about deaf awareness, to include discussions about communication in the classroom.
Or..

Time for a change

A mother brings her 13-year-old daughter, Esther, to see you because she has stopped wearing her hearing aids. Esther was fitted privately with BTE hearing aids with ear molds after being diagnosed with a mild cookie-bite hearing loss at five years old. She also has mild autism spectrum disorder.

Esther told her family that she can hear the teacher fine without the hearing aids, but she does admit to being exhausted at the end of the school day. She says she doesn’t mind what people say about her hearing loss.

Esther is covered by government health insurance for her hearing, but her family is not willing to buy new hearing aids

How would you deal with the situation?

Suggestions

Find out if Esther is concerned about the aesthetics of her hearing aids and, if so, consider less noticeable ear molds.
Give a clear explanation about fatigue from listening with a hearing loss, using current research to show the benefits of wearing the hearing aids all day.
Explore the possibility of fitting receiver-in-the-canal hearing aids under state funding.
Or..

Can I play sports?

14-year-old Darius comes to your clinic to be fitted with hearing aids for a progressive hearing loss. He loves to play football and wants to wear his hearing aids under his football helmet. The advice from the hearing-aid manufacturer is that the hearing aids should not be worn for this contact sport.

How would you deal with the situation?

Suggestions

Explain to Darius why the hearing aids would not work well under a football helmet; they cannot tolerate moisture and the microphones will not be effective with all the padding around them.
Invite Darius to contact successful athletes with hearing loss who have worked through this problem themselves.
Suggest the coach uses an FM system (or similar technology) so Darius can hear through DAI FM receivers worn with the hearing aids during practices and games.
Or..

Rules of engagement

A 17-year-old high school junior named Brent aspires to a career in the military. He has a moderate hearing loss in both ears and is a long-term and consistent user of hearing aids. The recruiter has told him that if he “needs” hearing aids, he will not be able to enlist, but that if the hearing aids “help” him, he will be able to enlist. Your patient tells you he “needs his hearing aids because they help.”

How would you deal with the situation?

Suggestions

You contact the recruiter to see if there are any other roles within this sector of service that may be suitable for Brent.
You counsel Brent that he will not be accepted into the military because he has a hearing loss.
You advise Brent to contact his recruiter to find out what the specific rules are for acceptance into military service for individuals with hearing loss.
Or..

Who knows best?

Shaun arrives at your clinic with his mother to try out some ITE hearing aids. He currently wears BTE hearing aids for a bilateral mixed loss, which runs in the family.

Based on suitability, Shaun is given two ITE options:

• Smaller ITCs, which do not work with an FM system and multiple programs
• Larger ITEs, which do work with his FM system and programs

When he tries the smaller aids, he loves the sound quality and says speech is much clearer. He doesn’t want the larger ones. His mother insists that he needs to be able to use his FM system at school, but he reveals that he hasn’t been using it, or his other programs, even after several fitting appointments to set everything up.

How would you deal with the situation?

Suggestions

Explore the reasons Shaun loves the smaller aids. Are they functionally adequate? Is it a question of aesthetics?
Give Shaun a trial of both sets of hearing aids and ask him to report back on listening situations with and without the FM system.
Discuss with Shaun's mother the importance of empowering the child during the transition from childhood to adulthood. Consider carrying out some of the appointment without Shaun's mother present.
Or..

Fitting in

A mother reports that her 13-year-old daughter, Tess, has become withdrawn since starting in a mainstream secondary school. Tess has a cochlear implant and a hearing aid. With the help of auditory verbal therapy, she had age-appropriate language when she started at her mainstream primary school. She has done well at school. Tess is the only deaf child in her school and her family. Her mother is worried that Tess has started to remove her CI processor.

How would you deal with the situation?

Suggestions

Ask Tess questions to help you determine whether she identifies herself as a deaf child or not.
Explain to the mother that, even though Tess has clear speech, there may still be situations in which her daughter is struggling and that it is alright for her to say so.
Explore the possibility that, as Tess becomes more self-conscious, she might need other deaf peers to communicate and identify with. Recommend support groups, websites, and blogs that might help her make friends who are in similar situations.
Or..

Changing the goalposts

Alice, 16, has a severe bilateral hearing loss. Her speech is clear and she is thriving at secondary school where she is well supported and particularly enjoys music and singing. Recently, however, she has noticed that her hearing is deteriorating and she is struggling to use the telephone. You carry out an audiogram that shows a deterioration in both ears and speech testing reveals how much she is relying on lip-reading. She has never considered herself a candidate for cochlear implants and the idea scares her.

How would you deal with the situation?

Suggestions

Consider her options given that her hearing is deteriorating. Think about how she will cope as an independent adult.
Discuss the possibility of cochlear implants and talk through the likely outcomes for someone with her experience of deafness. Include the perception of music through cochlear implants in your discussion.
Try to put her in touch with musicians with similar hearing so that she can get an idea of how they manage with different hearing amplification options.
Or..

A problem shared

12-year-old Noura has severe to profound unilateral hearing loss and visits your clinic because she is struggling with localization and in noisy environments. Her mother says she is struggling socially. Noura often reports that people are talking about her and she fell out with one of her close friends over a misunderstanding. Her teachers know about her hearing loss but she has never told her friends. She was referred for a CIC hearing aid but her impairment is too severe. She is very reluctant to try a visible RIC or BTE hearing aid. Her mother is keen and says her friends needn’t know because she wears a headscarf at school.

How would you deal with the situation?

Suggestions

Offer Noura a trial of the amplification options such as a hearing aid on the poor ear or a cross aid with an ITE on the good ear. Make sure to explain why the options are limited.
Explain to Noura the difficulties of listening with one ear and give real-life examples of potential communication breakdowns and how her friends might feel about them.
Gently explore with Noura and her mother why they are reluctant to share the fact Noura has a hearing loss with friends. Does Noura think they would think less of her? Would her friends be able to communicate better with her if they knew?
Or..

I hear everything

Naya is 11 years old and was just diagnosed with a bilateral mild sensorineural hearing loss and subsequently fitted with hearing aids. She keeps removing them and claims that she can hear everything. Her parents have diligently tried to have her wear the hearing aids consistently but are giving up.

How would you deal with the situation?

Suggestions

Set up times to meet with Naya and build a trusting relationship with her. Explore her challenging listening environments with her.
Invite Naya to participate in a social group of other children with hearing loss to explore identity, acceptance, and self-determination.
Connect Naya with a peer mentor who uses hearing technologies successfully.
Or..

A failed hearing screening

17-year-old Mateo was referred to your audiology practice after failing a school hearing screening. He reports no problems hearing and is annoyed to be at the appointment. His case history reveals that he loves listening to loud music and is an avid hunter. The audiological assessment reveals hearing loss consistent with a mild, noise-induced hearing loss.

How would you deal with the situation?

Suggestions

Refer Mateo for a medical evaluation.
Inform Mateo and his parents about the short- and long-term impact of hearing loss and tell them about the benefits hearing devices could offer.
Counsel Mateo about protecting his hearing from further damage.
Or..

Could I have hearing loss?

Grace, 14, sees a poster about the potential signs of hearing loss and feels she has some of the indicators. She has only ever seen the elderly with hearing aids and is confused about whether she could have hearing loss. She doesn’t want to share her feelings with her family, but she tells a guidance counsellor at school who then reaches out to you for support.

How would you deal with the situation?

Suggestions

Arrange a meeting with Grace to screen her hearing and discuss why she thinks she has a hearing loss and what the next steps could be.
Ask teachers about Grace’s academic performance, listening behaviors, and any concerns about her ability to access auditory information.
Arrange a meeting with Grace and her family to take a full case history and help Grace discuss her concerns.
Or..

Friends say there’s a problem

Luca is a 13-year-old who has been flagged for a hearing screening due to academic and communication difficulties. He is struggling in school and his friends report that he cannot hear them well. They say they often help him by repairing communication between him and his teachers and peers. Luca fails the hearing screening, leading to a full assessment, which indicates bilateral, sloping moderate to moderately-severe sensorineural hearing loss. He admits that he doesn’t hear as well as his friends but insists it is not a problem for now and will seek help if it gets worse. His parents are ambivalent and do not support any further intervention.

How would you deal with the situation?

Suggestions

Meet with Luca and his family and teachers to explain the impact of the hearing loss on Luca’s education.
Discuss Luca’s communication challenges with him and identify strategies to support his needs.
Inform Luca’s teachers about his hearing loss and discuss options with them.
Or..

What will my friends say?

Teachers suspect 16-year-old Ryan of having some degree of hearing loss. You are asked to assess him and provide recommendations. The results indicate a mild to moderate sensorineural hearing loss. Ryan isn’t surprised by this and starts to describe his communication challenges. He is interested in trying hearing aids but is concerned that his peers will make fun of him.

How would you deal with the situation?

Suggestions

Meet with Ryan to provide more information about hearing aids. If possible, bring demo hearing aids and DM systems/HAT.
Connect Ryan with a peer mentor who has hearing loss and uses amplification successfully.
Arrange a meeting with Ryan and the school guidance counsellor to discuss Ryan’s fears about being teased. Brainstorm ideas together for how to manage his concerns.
Or..

Ready to try again

Sarah is an 18-year old who has a known mild to moderate sensorineural hearing loss that was diagnosed at age five. However, she stopped wearing her hearing aids a few years ago in high school because she felt like she heard fine without them. Now that she has started university she is struggling and ready to try hearing aids again. She has done some internet research and wants to be fit with the “invisible” hearing aids she found online.

How would you deal with the situation?

Suggestions

Complete a hearing test and go over all amplification options with Sarah
Explain to Sarah whey this hearing aid may not be the best option given limited connectivity opitions
Arrange a hearing aid trial with recommended hearing aids
Or..

How much is too much?

16-year-old Jacob is a long-time user of bilateral hearing aids and a DM system. He is entering grade 11 at school. He gets great grades and plans to apply to university for engineering. He reaches out to you to ask for advice about his course load which includes both grade 11 and 12 courses as well as many optional classes that he is not willing to give up.

How would you deal with the situation?

Suggestions

Set up a meeting with Jacob and his teachers to address the effect of hearing loss on cognitive load and accommodations that could help.
Encourage Jacob to schedule one period without a class to acquaint himself with lesson vocabulary ahead of time or to work on assignments.
Arrange a meeting with Ryan and the school guidance counsellor to discuss Ryan’s fears about being teased. Brainstorm ideas together for how to manage his concerns.
Or..

Going it alone

Christine, 14, consistently uses bilateral cochlear implants and a personal DM system. She is a hard worker with a very supportive family. In the past, her parents would talk with teachers about her hearing needs in the classroom, but she has now requested independence regarding her academics. Without parental involvement, some of her teachers are not providing the support she needs, and her grades are suffering. She reaches out to you for support.

How would you deal with the situation?

Suggestions

Support Christine in conducting an all-teacher meeting to explain the impact of her hearing loss and outlining her learning needs and required accommodations.
Help Christine create a Top 5 Tips sheet to be shared with teachers at the start of each semester that would include details of required accommodations.
Have Christine consider asking her parents to partner with her in advocating for her needs at school.
Or..

Worried about online learning

Mi-sun is an 18-year-old high school student who plans to take some of her classes through online learning. The course content is presented through live lectures, recorded lectures, videos, and collaborative assignments. Mi-sun comes into your audiology office visibly upset and worried about missing course content through online learning.

How would you deal with the situation?

Suggestions

Ask Mi-sun to show you the online platform that she is using and explore accessibility options with her.
Help Mi-sun to access captioning (live/auto generated/captioning services/closed captioning).
Suggest the use of remote microphone technology via direct audio input.
Or..

Old enough to know

A 16-year-old boy named Louis was previously fitted with bilateral hearing aids and a personal DM system. Louis is a very high achiever who is at the top of his class for all subjects. He states that since he is performing above average academically, he no longer requires the DM system. His parents want him to continue using the DM system but recognized that their son is old enough to make some of his own choices.

How would you deal with the situation?

Suggestions

Administer a Functional Listening Evaluation with and without the DM system with distance and noise variables and explain the results to Louis.
Make sure Louis understands the need to use other communication strategies and how to advocate for himself.
Suggest an agreement between Louis and his parents that states the DM system will be reintroduced if Louis doesn’t maintain specific grades.
Or..

Dilemma Game Teens and Tweens

Select a scenario card below and read the dilemma. Flip the card over to see possible solutions or create your own. Remember, the perfect solution may not exist.

Card categories

Unaware

In the first stage of the patient journey, the person is experiencing communication problems but may be managing without acknowledging the problem. They may also feel bewildered or frustrated. Family and friends may begin to notice the person's hearing difficulties.

Exploration

The client realizes that hearing loss is impacting their life. They may recognize their hearing loss and begin to map the problems it causes. The client may “self-test” by raising the TV volume or by attempting to control other environmental sounds.

Preparing

The person with hearing loss reaches a tipping point and is ready to consult a hearing care professional. The client gathers information about hearing loss from a variety of sources, including their personal network, general practitioner, and the internet.

Action

The client actively seeks referral to a hearing care professional. They meet a hearing care professional for an interview and case history, hearing test, and recommendations, leading to decision making.

Managing

The client seeks counseling, treatment, hearing solution fittings, and considers other assistive devices. They develop new communication strategies and may accept or reject of the recommendations of the hearing care professional.

Living well

The client undergoes a process of adaptation and change. They observe the social impact and continue to self-evaluate the success or failure of the treatment outcome. The problem is resolved or the client becomes aware of new problems.