Dilemma Game Teens and Tweens

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1

Hear your peers

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 clear spoken English 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

  1. Use a counseling tool or questionnaire to find out more about which situations are hardest for him.
  2. Find out why he takes his hearing aid off and explore his interest in a second cochlear implant.
  3. 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.
  4. Or..
2

Time for a change

Time for a change

A mother brings her 13-year-old boy to see you because he has stopped wearing his hearing aids. He was fitted privately with BTE hearing aids with ear molds after diagnosis with a mild cookie-bite hearing loss at 5 years old. He also has mild autism spectrum disorder.

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

He is covered by government health insurance for his hearing but his family is not willing to buy new hearing aids.

How would you deal with the situation?

Suggestions

  1. Try to find out if he is concerned about the aesthetics and, if so, consider less noticeable ear molds.
  2. 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.
  3. Explore the possibility of fitting receiver-in-the-canal hearing aids under state funding.
  4. Or..
3

Can I play sports?

Can I play sports?

A 14-year-old boy 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

  1. Explain 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.
  2. Invite the patient to contact successful athletes with hearing loss who have worked through this problem themselves.
  3. Suggest the coach use an FM (or similar technology) system so the patient can hear through DAI FM receivers worn with the hearing aids during practices and games.
  4. Or..
4

Rules of engagement

Rules of engagement

A 17-year-old high school junior 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

  1. You call the recruiter and advise that the law prohibits discrimination on the basis of disability.
  2. You counsel your patient that he will not be accepted into the military because he has a hearing loss.
  3. You advise your patient to contact his recruiter to find out what the specific rules are for acceptance into military service for individuals with hearing loss.
  4. Or..
5

Who knows best?

Who knows best?

A 12-year-old boy 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, he 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

  1. Explore the reasons why he loves the smaller aids. Are they functionally adequate? Is it a question of aesthetics?
  2. Give him a trial of both sets of hearing aids and ask him to report back on listening situations with and without the FM system.
  3. Discuss with the mother the importance of empowering the child during the transition from childhood to adulthood. Consider carrying out some of the appointment without the mother present.
  4. Or..
6

Fitting in

Fitting in

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

How would you deal with the situation?

Suggestions

  1. Ask the child questions that help you determine whether she identifies herself as a deaf child or not.
  2. Explain to the mother that, even though she has clear speech, there may still be situations in which she is struggling and that it is alright for her to say so.
  3. Explore the possibility that, as she becomes more self-conscious, she might need other deaf peers to communicate and identify with. Recommend support groups, websites, blogs that might help the child make friends who are in the same situations.
  4. Or..
7

Changing the goalposts

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

  1. Consider her options given that her hearing is deteriorating. Think about how she will cope as an independent adult.
  2. 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.
  3. 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.
  4. Or..
8

A problem shared

A problem shared

A 12-year-old girl with severe to profound unilateral hearing loss attends your clinic because she is struggling with localization and in noisy environments. Her mother says she is struggling socially. She often reports that people are talking about her and she fell out with one of her close friends over a misunderstanding. Her school teachers know about her hearing loss but she has never told her friends. She has been 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

  1. Offer a trial of the amplification options e.g. a hearing aid on the poor ear or a cross aid with an ITE on the good ear, making sure you explain why the options are limited.
  2. Explain the difficulties of listening with one ear and give real-life examples of potential communication breakdown and how her friends might feel about it.
  3. Gently explore with her and her mother why they are reluctant to share the fact she has a hearing loss with friends. Does she think they would think less of her? Would her friends be able to communicate better with her if they knew?
  4. Or..

Dilemma

Flip card

Dilemma

Flip card
Dilemma Game Teens and Tweens

The Dilemma Game for Teens and Tweens is a practical tool designed to better prepare hearing healthcare professionals to deal with challenging clinical situations when treating teenagers.

The game consists of a series of cards describing challenging scenarios involving a teen or tween in a clinical setting. Three possible solutions are given, with the understanding that the ‘perfect’ solution might not exist. With no right or wrong answers, the game encourages reflection, critical thinking and analysis of the potential consequences that a practitioner’s choices may have on a client. Players use problem-solving skills to make decisions based on thorough analysis of the situation and the individuals involved.

The Dilemma Game is developed for use with colleagues, within a larger training group, in student training or as an individual exercise. The cards are also applicable for role playing and other learning exercises. Developed in collaboration with members of the Ida Institute community, the dilemmas are based on actual clinical situations.

Card categories

Unaware

The person with hearing loss 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.

OK