For babies with hearing loss, early, consistent hearing device use and having a rich, interactive speech environment are vital for spoken language development, literacy, and learning.1,2 However, achieving this can be a challenge for many caregivers.3,4 Furthermore, evidence shows a persistent attainment gap between children with and without hearing loss throughout their educational milestones.5 As pediatric hearing professionals, we must work together with caregivers and other professionals to effectively support infant hearing device use, and to use the latest evidence to continually improve the support we provide.
Understandably, many caregivers tell us they feel overwhelmed by the amount of information shared with them when their child's hearing loss is confirmed, and many struggle with aspects of hearing aid management, such as troubleshooting and performing listening checks.4,6 Caregivers tell us that common barriers impacting infant hearing aid use include: children pulling aids out, faulty aids, device feedback, long waiting times for new earmolds, distractions from other children in the home, difficulty getting into a routine, and situations in which the child cannot be closely supervised, such as during car rides.4,6,7 We have recently found evidence that children actually start to wear their hearing aids less often in later infancy, particularly among children with severe-to-profound hearing loss.4 This suggests additional caregiver support may be needed to maintain and increase use throughout infancy.
To bring about positive changes in behavior, we need to go beyond providing information and address the deeper issues of beliefs and motivation. Personalized, home-based interventions to improve hearing aid use in toddlers have been successful.8 Early interventionists/teachers of the deaf are uniquely placed and skilled to deliver such interventions, and the messages delivered by all professionals involved in the child's hearing care must be consistent and collaborative. Access to data logging information can be helpful for caregivers to monitor progress and set goals regarding their child's hearing aid use.8 Emerging technologies are likely to make this information easier for caregivers to access, and future interventions may be built around shared online interfaces caregivers and professionals can access to monitor hearing aid use. Developments in how hearing aids automatically recognize speech input may also help develop counseling tools around the quality and quantity of linguistic input, as well as the cruder measure of daily hours of hearing aid use.
With the recent surge in remote healthcare practice, online delivery of interventions is increasingly popular, and indeed many online resources exist to successfully support caregivers in hearing aid use and management.9-11 A challenge for future web-based interventions will be combining the personalized and flexible elements that make interventions successful with the more general elements that make them widely available and feasible for dissemination at scale. The heterogeneous nature of families of children with hearing loss, their belief systems, and the challenges they face make the task even more challenging and the need for flexibility paramount.
A further consideration is the balance of the message we provide to caregivers and the impact this has on broader communication. Naturalistic communicative behaviors extend beyond simple speech input and include the quality of the interaction, such as eye gaze and turn-taking. An over-focus on device use has the potential for caregivers to neglect these behaviors, which in turn could be detrimental to communicative development.12 Experienced hearing professionals will be confident in delivering a strong message on the importance of device use and speech input whilst ensuring caregivers do not neglect these wider behaviors.
At the Manchester Centre for Audiology and Deafness, our team of experts in developmental psychology, behavior change, audiology, and deaf education are working together on research to better understand barriers to infant hearing aid use, and to explore how best to support families to achieve optimum levels of infant hearing aid use and management from the very start, using collaborative working practices. By doing so, we hope to continue to narrow the educational attainment gap between children with and without hearing loss, giving every child the best possible start in life.
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