Delivered in PORA webinars June 2016

1. Counselling for
Parents of Children
Diagnosed
with Hearing Loss
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2. Dr Dimity Dornan AO
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Brisbane, Queensland, Australia – г б К б

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Hear and Say Head Office – ‘эear and Say’

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Hear and Say Centres
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8 Questions professionals may ask themselves when counselling parents:
 Question 1: How should I counsel new parents?
 Question 2: How can I motivate parents to want to teach their
child to listen and speak?
 Question 3: What do parents need to know?
 Question 4: What is most important in teaching parents the skills for
developing their child’s auditory brainф
 Question 5: What if a child needs a cochlear implant, when should
they receive this?
 Question 6: If earlier is better, what are the barriers to a child
receiving an early cochlear implant?
 Question 7: What are the evidence based guidelines for
recommending cochlear implants for young children?
 Question 8: What are the potential outcomes for a child implanted
early?

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The most important thing is to love and talk to your baby!
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Question 1: How should I
counsel new parents? – К
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 Talk, talk, talk
 Interact with baby
 Face to face play
 Smile
 Quiet room
 Enlist support
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Question 2: How can I motivate parents to want to teach their child
to listen and speak?
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Give them HOPE –
“эOPъ is the feathered thing that nestles in the breast and sings a song with
no words and never stops at allг”
Emily Dickenson
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• Transference

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Teach parents the importance of the auditory
brain. Growing the brain of their child is parent’s
main responsibility
• Use it or lose it
• Use it and improve it
• Specific training
improves specific skills
Important Factors:
• Repetition
• Frequency
• Timing
• Interesting
• Early start
• Transference

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Developing the brain for literacy
must start early!
!

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Parents of a child diagnosed early have already been through
pregnancy, childbirth and diagnosis of hearing loss
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Question 3: What do parents need to know?
 Check hearing device
 Quality talking and playing time
 Describe and compare everything
 Stay close
 Use lots of high and low pitched speech sounds
with lots of expression
 Repeat key words often
 щon’t be afraid to use long words
 Children need a super-abundance of words in meaningful situations
 Minimize background noise
 Use slower speech in simple short phrases and lots of sentences
 Use wide variety of words

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Question 3: What do parents need to know? (continued)
 Focus your child on listening by calling the child’s attention to
sounds.
 Take listening walks and talk about what you hear. Watch for
listening behaviour and record new skills learned.
 Make words count - read frequently to your child and talk about
the pictures and the story. Remember the bedtime story every
night.
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 Focus your child on listening by calling the child’s attention to
sounds.
 Take listening walks and talk about what you hear. Watch for
listening behaviour and record new skills learned.
 Make words count - read frequently to your child and talk about
the pictures and the story. Remember the bedtime story every
night.
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Question 3: What do parents need to know? (continued)
 Sing to your child
 Dance and laugh with your child
 Use different rhymes, songs plus actions and finger plays
 Give your child the words they need to say
 Expand on what your child already knows
 Reward your child by responding when she tries to get attention
 Leave a space of time for a young child to take in the words
before a response is expected from them
 “Speak firstб then do”б in other wordsб talk about objects чъыORъ
giving them
 Feed in lots of meaningful words until they overflow into spoken
language
 Reward your child’s best response with love and attention

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Education by qualified professionals
Question 4: What is most important in teaching parents the
skills for developing their child’s auditory brainф
 Consistent pathway for sounds to reach their brain
 Abundance of practice in listening and speaking with loving parents (or
carers)
 Parents can be trained to provide the quality, frequency and intensity of
speech input that has the potential to promote brain development at the
same rate as children with normal hearing (Dornan, et al., 2010).
• Education level of the mother (Ching, et al., 2013)
• Level of parent involvement (Geers, et al., 2003)
• Type of maternal input (Leigh, et al,. 2011)
 By 4 years, typical children need to have heard 46 million words to be
ready for school (Hart & Risley, 1999)
 20,000 hours of listening are necessary in infancy and early childhood as a
basis for reading (Dehaene, 2009)

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(Dornan, et al., 2010).
• (Ching, et al., 2013)
• (Geers, et al., 2003)
• (Leigh, et al,. 2011)
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(Dehaene, 2009)

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Auditory-Verbal Therapy
An education approach in which parents take the leading role and therapists are the guide
and coach of the parents
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Fathers need to be involved too! – !

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Question 5: What if a child needs a cochlear
implant, when should they receive this?
Compelling evidence for cochlear implant younger
than 12 months of age (Otology and Neurology, 2016)

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Evidence for implantation at an early age
(Dettman, et al., 2016)

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Evidence for implantation at an early age
(Dettman, et al., 2016)

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Question 6: If earlier is better, what are the barriers to a
child receiving an early cochlear implant?
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Newborn hearing screening implementation was associated with
reductions in age of cochlear implantation (Dettman, S.J., Choo, D., Dowell, R.C., 2016).
.

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Question 7: What are the evidence based guidelines for
recommending cochlear implant for young children?
 Children with a PTA greater than 60dB HL have a 75% chance
of benefit over traditional amplification
 Children with PTA greater than 82dB HL have a 95% chance of
benefit
 Children implanted under 2.5 years (no significant cognitive
deficits) made normal language progress but retained a delay
approximately equal to their age at implantation
 Conclusions: Hearing-impaired children under three years of
age may benefit from cochlear implantation if their PTA
exceeds 60dB HL bilaterally. Implantation as young as possible
should minimize any language delay
(Leigh, J.R., Dettman, S.J., & Dowell, R.C. , 2016)

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(Leigh, J.R., Dettman, S.J., & Dowell, R.C. , 2016)

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Question 8: What are the potential outcomes
for a child implanted early?
 Children implanted by 12 months of age demonstrate
better language development compared with children
who receive their cochlear implant between 13 and 24
months (Leigh, J., Dettman, S., Dowell, R., & Briggs, R. , 2013)
 Children with hearing loss using an Auditory-Verbal
Therapy approach were able to progress in
development of listening, speech and language at the
same rate of progress as a matched group of children
with normal hearing (same initial language age) over 4
years and 2 months of time) (Dornan, D.A., Hickson, L., Murdoch, B. Houston, T., &
Constantinescu, 2010).

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( й з ) (Dornan, D.A., Hickson,
L., Murdoch, B. Houston, T., & Constantinescu, 2010).

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Darcy and Claudia
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Telepractice helps remote children
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References:
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 Ching T.Y.C., Dillon, H., Marnane, V. et al. (2013). Outcomes of early- and late-identified children at 3
years of age: findings from a prospective population study. Ear and Hearing, 34 (5), 535-552.
 Dehaene S. (2009). Reading in the Brain: The Science and Evolution of a Human Invention. New York:
Penguin.
 Dettman, S.J., Choo, D., Dowell, R.C., (2016) Barriers to early cochlear implantation. International Journal
of Audiology, 1-13 Early Online: http://dx.doi.org/10.1080/14992027.2016.1174890
 Dettman, S.J., Dowell, R.C., Choo, D., Arnott, W., Abrahams, Y., Davis, A., Dornan, D., Leigh, J.,
Constantinescu, G., Cowan, R., Briggs, R.S. (2016). Long term communication outcomes for children
receiving cochlear implants younger than 12 months: A multi-centre study. Otology and Neurotology,
37:e82–e95.
 Dornan, D.A., Hickson, L., Murdoch, B. Houston, T., & Constantinescu (2010). Is Auditory-Verbal Therapy
Effective for Children with Hearing Loss? The Volta Review, 110 (3), 361-387.
 Geers, A.E., Strube, M.J., Tobey, E.A., & Moog, J.S. (2001). Epilogue: Factors contributing to long-term
outcomes of cochlear implantation in early childhood. Ear and Hearing, 32 (1). 84S - 91S.
 Hart, B., & Risley, T. (1999). Observing children and families talking. In B. Hart, & T.R. Risley (Eds). The social
world of children learning to talk (pp. 7-29). Baltimore, MD: Paul H. Brookes Publishing Co., Inc.
 Leigh, J. R., Dettman, S. J., Dowell, R. C., & Sarant (2011). Evidence-based approach for making
cochlear implant recommendations for infants with residual hearing. Ear & Hearing, 32(3), 313-322.
 Leigh, J.R., Dettman, S.J., & Dowell, R.C. (2016) Evidence-based guidelines for recommending cochlear
implantation for young children: Audiological criteria and optimizing age at implantation. International
Journal of Audiology, 1-10 Early Online: http://dx.doi.org/10.3109/14992027.2016.1157268
 Leigh, J., Dettman, S., Dowell, R., & Briggs, R. (2013) Communication development in children who
receive the cochlear implant by 12 months of age. Otology and Neurotology. 34(3), 443-50.