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Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 63
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 64
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 65
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 66
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 67
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 68
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 69
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 70
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 71
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 72
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 73
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 74
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 75
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 76
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 77
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 78
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 79
Suggested Citation:"Summary, Conclusions, and Recommendations." National Research Council. 1946. Learning to Use Hearing Aids: A Study of Factors Influencing the Decision of Children to Wear Hearing Aids. Washington, DC: The National Academies Press. doi: 10.17226/21371.
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Page 80

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

S U MM A R Y 63 four months. Thirty-four were attending either junior or senior high school and four had left school. The case history method was used for gathering the data. In addition, the Wechsler-Bellevue Intelligence Scales and the Bern­ reuter Personality Inventory were given and the results analyzed. All the children received otological examinations and recordings were made of their hearing losses by means of an audiometric test. SUMMARY OF FINDINGS Following is a summary of the main findings : 1 . The tendency to use a hearing aid successfully appears greater for those subjects who could attribute the hearing loss to some cause other than a hereditary deficiency. In the cases where the family is either uncertain or unaware of the cause, there appears to be difficulty in adjusting to the use of an aid. In families in which a hereditary hearing deficiency was evident, there was a marked tendency to refuse the hearing aid, since to wear the aid would . advertise the family defect. 2. Children wearing hearing aids seemed to be enjoying better health, on the average, than those children who have refused to wear their aids. 3 . Neither parents nor children felt that any speech improve­ ment had resulted from wearing a hearing aid. Improvement in speech during the last four years was attributed to causes other than wearing an aid. 4. For the aid wearing group, the data suggest that the children were good judges of the extent of use of their aids. Those with the severest hearing losses tended to use their aids more extensively and more advantageously than the children with losses of less severity. The no-aid group, however, were influenced by factors other than their need for a hearing aid in their decision to reject it. Some of the children who rejected the hearing aid were suffering marked hearing losses. • 5 . An acute concern over personal appearance seems to motivate many adolescent girls to reject the wearing of an aid. Although as many adolescent girls continued to wear their aids as had discarded

64 LEARNING T0 U SE HEA RING A IDS them, the reason given by the no-aid girls for discarding them was invariably the fact that the aid detracted from their appearance. Relatively fewer adolescent boys discontinued wearing aids and those who did give them up did not consider the factor of appear­ ance as important. 6. Physical discomfort encountered in the use of an aid seemed to bear little relationship to the ultimate acceptance or rejection of the instrumen t. The aid wearing group overcame physical discom­ fort within a three-month period while none of the children who had discarded the instruments gave physical discomfort as of primary importance in affecting his decision to reject his aid. It was evident, however, that many children needed guidance con­ cerning ways of overcoming the several types of physical dis­ comfort caused by wearing the aids. 7. The results of the Wechsler-Bellevue Intelligence Scales in­ dicate that the total group is slightly above the average as com­ pared with the norms for their age range. The aid wearers are :five points higher than the norm while the no-aid wearers are almost five points lower. There is a difference of nine I Q points between the aid wearers and the no-aid group. These data suggest that even though the magnitude of the hearing loss is a factor in influencing these children to wear their aids, there is a greater tendency for the more intelligent child to adapt himself to the aid and to make help­ ful use of it than there is for the less intelligent. 8. The group functioned at a higher level on the performance part of the Wechsler-Bellevue Intelligence Scales than on the verbal part of the test. They performed to best advantage on those tests involving basic perceptual and conceptual skills. 9. J udging on the basis of interviews with the child, his parents, his teachers, and other persons, it would seem that the aid wearers have fewer personality maladjustments than do the children who have discontinued the aid. The better the adjustment, the more likely the child is to accept the wearing of a hearing aid. Parents and teachers reported a greater number of problems and behavior difficulties for the no-aid group thfin for the aid group. 1 0. The results of the Bernreuter Personality Inventory analysis suggested, but did not prove, the existence of better adjustment in the case of the aid wearing than in the case of the no-aid children.

S U M M ARY 65 The evidence was more dependable for the girls than for the boys. 1 1 . The kind of home from which the child comes seems to bear some relationship to the child's decision to wear an aid. The socio­ economic status of the aid wearers was slightly better than that" of the no-aid group. A greater number of children who had rejected their aids came from deprived environments. 1 2. Although all the parents indicated that they had made some concrete effort to help the child make a satisfactory physical ad­ justment to the hearing aid, it appeared that variations in this type of help were not crucial. 1 3 . The parental attitude toward the child and his handicap was of great importance. The data suggest that a good relationship be­ tween parents and child exerts great influence in fostering a positive reaction toward the wearing of an aid. The overprotected child. and the rejected child alike tend to refuse to use the aid. Discord between parents exerts an unfavorable influence. 1 4. The attitude of brothers and sisters toward the hard-of­ hearing child seems to exercise little if any influence over the tend­ ency to use a hearing aid. 1 5 . In particular, socially insecure children are inclined to re­ fuse to use hearing aids because they fear that the admission of a physical defect will further weaken their social status. 1 6. There was a greater tendency for the children to participate in group activities after using a hearing aid. There was some indica­ tion that the no-aid pupils belonged more frequently to organized groups than did the aid wearers. This would suggest that the forlller found realization of social needs in those groups which had been automatically established and which were not closed to them through the choice of any member of the group. On the other hand, the aid wearers were able to meet their social needs through contacts with friends of their own choice. The activities the whole group preferred were similar to those most liked by normal adoles­ cents. 1 7. The aid wearing groups s1towed consistent improvement in school achievement as soon as they began to wear the aid. For the most part, they used their instruments to best advantage in the school situation. The teachers noted imp rovement in attention and ability to concentrate and the parents, as well as the children, re-

66 LEA RN IN G T0 U SE HEA RIN G A ID S ported that wearing aids relieved the children from tension. Many children found it no longer necessary to secure tutoring and assist'­ ance outside of school. The aid wearing group reported fewer fail­ ure!i and less difficulty in coping with the school situation than be­ fore they had begun to wear their aids. 1 8 . The aid wearing group nevertheless tended to choose those subjects in high school which make a minimum demand on hearing ability. For example, they tended to take subjects requiring me­ chanical and technical skills, and to avoid foreign languages and stenography, both of which depend greatly upon oral classroom activities. 1 9. The attitude of the classmates of the aid users did not prove . to be an obstacle since most of the children felt that the normal curiosity of the others was brief and for the most part sympathetic. In fact, they felt that they gained greater consideration from both teachers and schoolmates after they began wearing the aid. In some instances, the use of aids enabled pupils to feel less conspicuous, as, for example, in the case of the pupil who was no longer required to sit in a front seat. 20. Teachers can do much to helP. the pupils use the hearing aids fruitfully. Although teachers sometimes make serious mistakes in dealing with pupils when they first appear with hearing aids, they are usually wisely helpful. The evidence is that the school may be­ come even more helpful to children venturing to use hearing aids. 2 1 . The school courses of study planned by the guidance coun­ selors and the teachers of these children indicated consideration of the child's disability and preparation for the types of occupation open to him in the future. Most of the children were ·receiving excellent guidance which would assure them of success in their chosen occupations. Although this guidance was sound, the pupils who had rejected the aids showed a greater tendency to flounder and to be less decisive in their plans for the future than did the aid wearers. 2 2 . The aid wearers were mo� realistic in their choice of vo­ cational interests than were the aid rejectors. They planned to en­ gage in those occupations which would make fewest demands on hearing ability and which would not interfere with the wearing of a hearing aid. The aid rejectors were vague as to what they

S U M M A R Y 67 wanted to do and some of the occupations they mentioned appeared to be beyond their capacity. CERTAIN MAJOR CONCLUSIONS From the foregoing array of relatively specific findings several general conclusions of special educational and social significance will be stated for further consideration. First, it should be reemphasized that considerable social signifi­ cance must be attached to the fact that approximately one-third of the pupils provided with hearing aids had discontinued them and for a long time had not used them at all and that others used the aids only occasionally. It is important for society to determine why children should refuse to take advantage of an instrument which had proved so beneficial to other hard-of-hearing children in many vital phases of life. Although the hearing aid often produced a certain amount of annoyance and discomfort when first used , the testimony was over­ whelming that the mechanical difficulties of wearing the instru­ ment were rarely, if ever, the reasons for discarding the device. Nearly all the children testified that when they first appeared with the hearing aid they were confronted with a new and critical problem in social adjustment. The wearing of a hearing aid was al­ most invariably regarded as a threat to their social security and prestige and to their acceptability to other children. Those who continued to wear aids were those who were successful in effecting a satisfactory adjustment. They were the ones who felt that their so­ cial status had not been lowered at all or at least not sufficiently to offset the advantages which use of the aid provided. Others, how­ ever, either did not succeed in making a happy adjustment or else were convinced that their social status or acceptability had suffered enough to more than outweigh the advantages of wearing the aid. In brief, the crucial question in attempting to wear a hearing aid is whether or not one can make the social adjustment. A comparison of the children who continued to wear the hearing aid with those who discarded it shows fairly clear-cut differences. In general, the pupils who continued to wear the hearing aid ap­ peared to be superior in constitutional equipment and in social and

68 LEARN ING TO U SE HEARING A IDS economic status. These children on the whole also enjoyed a superior type of encouragement and help during the period of learning to use the hearing aid. They showed, in general, a fuller ;lppreciation of their problem and a better understanding of the positive values of the hearing aid. For example, many of these children · said that they believed �hey could not have graduated from elementary school without the aid, and most of them felt sure that they could not have gone on to high school without the instrument. These children thus revealed a desire to do good school work and were realistic in their recognition of the value of the hearing aid in con­ tributing to that end. These aid wearers as a g�oup felt a great need of companionship and wider social relationships and were eag�r to wear hearing aids in order to be included in the social activities of their peers. The aid provided them with the confidence and self-assurance that lack of communication had denied them and, in many cases, the added security helped them overcome their shyness and timidity. It is of first importance to recall the fact that in this group there was found, to a much greater extent than in the group who dis- · continued the aid, a tendency for the parents to be understanding and helpful in their relations with the children. When the parents had tried to develop a feeling of independence in the child and were not over-solicitous or over-anxious about the child's ability to take care. of himself, the children exhibited a tendency to accept an aid readily and to make maximum use of it. The attitude of the parents in respect to the position of the child in the family group motivated many children to use an aid. For example, when the parents arranged family activities, such as attending the theater, visiting friends, going to church or having parties as a family unit, and having specific chores for the pupils to perform in the home, the children were usually eager to. wear an aid in order to partici­ pate more fully. Aid wearers mentioned the fact that they were no longer cut off from delightful family contacts. Many mentioned their need for humor and fun. Many of them said that one of the impelling forces that made them wear an aid was the ability to hear family jokes and to comprehend those situations which brought forth laughter from the other members of the family group. In the aid wearing group, such evidence of good family relationships

SUMMARY 69 was much more frequently found than in the group of children who had discontinued using the aid. From the findings of this study, it appears that the child who will readily accept a hearing aid is one who. is psychologically and emotionally prepared for it by having achieved a feeling of security within his family group, and by being properly advised and di­ rected during the period of trial in using the aid; Of the pupils who discontinued using the aid, half lived in de­ cidedly inferior environments. All these pupils were slightly lower in intelligence than the aid wearing pupils. They were more fre­ quently described as disciplinary problems either at home or at school. As a group they were more aggressive in their social rela­ tions than were the aid wearers. Most of the children in this group could be classed in a home situation following one of three patterns : Either the parents showed indifference toward the child and his handicap ; or severe tensions were present between the child and his parents ; or friction was evident between the parents themselves. None of these children could be considered as very happy or emotionally well adjusted. Although they described many instances of social failure and em­ barrassment as a result of the hearing loss, they uniformly remained unconvinced that wearip.g a hearing aid would assist them in mak­ ing a satisfactory adjustment. They were afraid that the device would be taken as evidence of physical inferiority and that this would reduce their social security and prestige below its existing level. They were less realistic than other children and were dis­ posed to view any observation of their aid or comment on it as evidence of disapproval. Their sensitivity can be illustrated in con­ nection with the adolescent girls' sensitivity to the way the hearing aid affected their personal appearance. These girls were at an age when they were acutely conscious of their physical appearance, especially the style and character of their clothing. They were very anxious ·to be dressed in a manner that ' made them acceptable to other girls and attractive to the boys. Many of them rejected the hearing aid because they felt that it detracted from their physical attractiveness. They were quite will­ ing to sacrifice school achievement in order to. maintain their status quo among their peers.

70 L EAR N I N G T0 U SE H E A RI N G A IDS In general, it was the conclusion of the study that the boys and girls who rejected the hearing aid were characterized by a feeling of insecurity in their social relationships. Most of them had a few friends who did not know that they were hard of hearing. Their need for their friends overwhelmed their desire to overcome their hearing handicap. They were apprehensive of jeopardizing their social status in any way. Most of them complained that they wanted more friends and 'rider social activities, just as the aid wearing children did, but they were convinced that the use of the hearing aid was too great a risk to the status quo for them to take in a dubious hope of securing a better social status. In general, the authors of this report believe, although they ad­ mittedly cannot prove it objectively, that more information for these children and more tact and intelligence in directing them would have resulted in enabling them to learn to enjoy the benefits of the hearing aids. SOURCES OF RECOMMENDATIONS FOR IMPROVEMENT IN THE USE OF HEARING AIDS In the preceding section it was concluded that reaching the stage of using a hearing aid extensively and happily represents a con­ siderable achievement in social adjust�ent. Although the advan­ tages of using a hearing aid are numerous and important many dif­ ficulties are encountered by the child when he undertakes to use the apparatus. Certain difficulties in the form of physical discom­ fort or distress are encountered. Although these are usually not crucial, it is possible that improvements in the apparatus may make them still less important. Much more formidable and serious are the difficulties involved in making a new adjustment in the family life and in various other social groups in and out of the school. Indeed the crux of the matter seems to be whether the child be­ lieves that the use of the hearing aid makes him more or less so­ cially acceptable. If he is convinced that appearing with the hear­ ing aid increases his social status or at least leaves it unchanged, he is likely to continue to use the apparatus. If, on the other hand, he feels that wearing the aid results in a loss of social prestige, he is likely to discontinue its use either in certain social settings or in

SUMMARY 71 all situations. It is evident, moreover, that the child's decision is based in part on his own intuition, which is sometimes faulty. Proper psychological preparation might have led him to a different decision. His decision, furthermore, depends greatly upon the ad­ vice, comments, and attitudes of other persons, such as his parents, his teachers, and other children. It seems plain that all of these persons might be advised and managed in such a way as to increase the child's �atisfaction in using the instrument. For these reasons, it seemed advisable to write a last section in which various sug­ gestions growing out of the study, which might conceivably be of value in making h�aring aids more acceptable and more . useful to children, would be offered. It should be pointed out that few of the suggestions contained in the following pages can be said to have been verified by objective evidence secured in this study. Many of them represent suggestions made by the children who wore or refused to wear the aids, and by parents, teachers, and others who have had contacts with children of both groups. Some of the sugges.tions are made by the authors of this study. In some instances they are partly supported by facts unearthed in the study. In others they are surmises based on ob­ servations during the study or on psychological facts and princi­ ples familiar to students of this science. Many of them perhaps will prove in the end to be of little or no value. Many suggestions are offered, some of them obviously very speculative, in the hope that aid manufacturers, parents, teachers, investigators, and other per­ sons concerned with the welfare of the hard-of-hearing child may try them out in practical or in scientific settings. SUGGESTIONS FOR IMPROVEMENTS IN THE APPARATUS AND METHODS OF WEARING AN AID Several suggestions can be made for improvements in the con­ venience and appearance of the apparatus itself. Most of the chil ­ dren mentioned difficulties due to the weight and bulk of the in­ strument. While the children did not actually state that the clum­ siness of the instrument prevented them from making use of it, nevertheless the first impact of the weight and bulk came as a shock to many of them. It is therefore probable that an aid with a smaller earpiece and smaller batteries and microphone might

72 LEARNING TO U SE HEARING AIDS overcome the user's initial distaste. More widespread use of colored plastic earpieces and colored cords was recommended by two of the boys. One boy said he would be glad to wear an instrument if the black earpiece were not so conspicuous. A wide range of colors to blend with the wide range of complexions would give the wearer the opportunity to choose the aid that he considers the least con­ spicuous for his specific coloring. As to the size of the microphone and the batteries, the smaller they are, the better. It is suggested that it might be possible to manufacture the batteries in a flatter shape, so that the bulk might be more easily concealed. Many of the children were not adequately taught how to wear a hearing aid and had to depend on their own imagination or on suggestions provided by parents or other inexperienced persons. Printed diagrams for both boys and girls showing several different ways of attaching both the microphone and the batteries to the body could be provided. The use of additional appliances to keep the instrument comfortably strapped to the body could be shown. Suggestions for eliminating the discomfort caused by the heat of the batteries and friction of the microphone should be given in advance-such as the use of a small strip of felt or satin plush at­ tached to the back of the microphone to prevent rubbins against the skin and to insulate the instrument against bodily temperature changes. Expert advice at the time of making first use of the instrument and help in making the physical adjustment to it would ease the initial physical and psychological impact. The hearing-aid manufacturers might issue bulletins, such as many department stores send to their customers, showing adaptation of the latest styles to the needs of aid wearers. Among the psycho­ logical reasons for rejecting an aid is the desire of young women to wear the current fashions. Therefore their interest in fashion and their identification with normal-hearing individuals would be enhanced by demonstration of the fact that they, too, could wear clothes in keeping with current trends. As an example of this, the type of dresses that are most suitable to aid wearers could be shown in pictures with some information as to where such clothes are sold and the size and price range. If the feminine hearing-aid wearer could anticipate getting her monthly or semi-annual fashion mag­ azine, she probably would not consider her aid as serious a detri-

SUMMARY 73 ment to her personal appearance. To encourage further such an aid wearer, current fashions in hairdressing and in hats could be shown through the use of photographs or sketches. Adaptations of such fashions to skillful concealment of an aid would bolster the confidence and increase the feeling of security of the aid wearer. Once these girls are convinced of the fact that they can be as at­ tractively groomed and dressed as girls with normal hearing, there is greater likelihood that they will accept the aid. Although the boys as a rule showed much less concern about the conspicuousness of their instruments, they would profit by useful advice. To illustrate, one boy mentioned the fact that usually when purchasing clothing he bought the j acket one size larger than the trousers of the suit. In this way he was able to conceal the bulki­ ness of his instrument. He suggested, furthermore, that the pockets of the suit in which the microphone is carried might be made slightly larger. Bulletins informing purchasers of improvements in the use of an aid might arouse their interest and renew their appreciation of the advantages of wearing an instrument. The stimulation of · printed material showing aid improvements and adjustment of clothing to wearing an aid must not be underestimated. It appears that some aid wearers need reassurance at frequent intervals. SUGGESTIONS FOR GUIDANCE IN MAKING SOCIAL ADJUSTMENT WHEN WEARING AN AID Since many of the children who neglected their instruments showed ·personality difficulties, the need for · guidance in such cases is apparent. Some provision should be made, perhaps, by the hear­ jog-aid companies, for a guidance service to all purchasers of the instruments. A trained counselor who can discuss with the parents and the child the psychological problems involved should assist in the adjustment of the hearing-aid users. Such a service might be offered for a period of one year to all purchasers of instruments. The need for such advice was apparent during the Hearing Aid Study. In a number of cases after the parents had been interviewed and the cases were considered closed by the worker, the parents continued to call to ask for advice about the child. The following are examples of the type of advice these parents needed in dealing

74 LEARNING TO U S E HEARING A IDS with their children : One parent was concerned about the selection of the college to which to send her son because she felt hearing-aid users would be at a disadvantage at certain schools. Another parent asked for reassurance that his child's difficulty was caused by hear­ ing loss rather than by mental deficiency. · Another parent sought advice on a second child in her family using an aid. Still another · parent asked for recommendations as to specific physical activities in which her child could engage. In all these situations it is ap­ parent that the family recognized the problems involved in wear­ ing a hearing aid and that they needed guidance in dealing with the wearer. The children themselves are in need of some direct counseling service. A number of children wrote or called for interviews after investigations of their cases had been concluded. These children actually needed someone to talk to them and discuss their problems witli them. They felt · they were different from other children and they needed reassurance and guidance in order to continue wearing an instrument. While the guidance counselors in schools were able to handle many of the cases, the position of these children was unique in that their adjustment was of a nature quite different from that of the normal-hearing child. A person specializing in the use of hearing aids and the social adjustments involved in adopting them is needed. Some ser.vice is needed that would provide these children with the opportunity to discuss the problems they meet in their everyday life, such as what social groups they would best fit in with, what physical activities they are able to undertake, what musical in­ struments they can play, when they should and when they should not wear their aids. These are all problems that require solution through conferences with a competent specialist trained in dealing with the subtle psychological aspects of the auditorially handi­ capped. Because many of these children feel isolated or "different," it is suggested that group therapy techniques be used with them. Some provision should be made during the first year of wearing an aid for a child to meet other aid wearing children of his age group in order to discuss the problems and difficulties which beset them all. Once the child becomes reconciled to the fact that other children

SUMMARY 75 have similar problems and a like handicap he will more readily make an adjustment to it. If the children are given an opportunity to talk about the experiences encountered when the hearing aid is first worn and to discuss such difficulties with their peers, they are likely to become more confident that an adjustment can be made. Successful users would have much to offer the reluctant user. Such group therapy under skillful guidance would be of great value to the aid user. Adjustment to social life by aid users must be a gradual process and must also be a part of the learning process. The aid user can­ not be thrust out upon the world to make his own social adjust­ ment as soon as he has been given his aid. He must be taught how to use the aid in social situations. It is suggested, for example, that frequent dances be held for these people to which normal-hearing people are not admitted. These dances might be preceded by a short period of instruction as to the best way to adjust the instru­ ment to dance music and the best way to wear the instrument while dancing. In this way, awkwardness or discomfort in a social situation would be prevented and the adjustment to a similar sit­ uation with a normal-hearing group would be much easier. Movies might be provided that show the various activities of aid users. Once the aid user or potential aid user is convinced that he can engage in a wide range of normal activities, the adjustment to the aid will be made much easier. Such activities as hiking, movie-go­ ing, theater-going, playing baseball ( for the boys ) , playing tennis, and playing golf, might be shown. The best way of adjusting an aid for various specific situations should · be demonstrated in the movie. Many children stated that it was a long time . before they were able to find out the exact place in the movie house where they could hear to best advantage. Instruction on such points as these would have eased the adjustment period. SUGGESTIONS FOR PARENTS Since the attitude of the parent appeared to be of great impor­ tance in the child's decision to wear an aid, the desirability of de­ veloping the proper attitude by the parent is evident. The parent must be convinced of the fact that his child can enjoy a wide range of normal activities once he has overcome his hearing diffi-

76 LEARNING TO U SE HEARING AIDS culty. Parents should be shown the types of family activities which children appreciate and how to enable the hard-of-hear�g child to enter them more fully and enjoyably when they wear a hearing aid. Parents must be persuaded not to penalize the child merely to conceal the fact that the family includes a hard-of-hearing case. Timidity and fear on the part o { the parent seem to do the child more harm than does actual difficulty resulting from his loss. The parent must be told that he should not pamper his child but that he should help him lead a normal life. The parent-child relation­ ship is one which requires wise guidance and, in some cases, some form of therapy. Again, a trained counselor would be of great use to the parent seeking guidance. Without some effective education of the parents, numerous children will not succeed in learning to use the aid. SUGGESTIONS FOR THE SCHOOL AND TEACHERS The school should make preparations to receive and assist the child wearing a hearing aid. A visiting teacher might go in advance to the school to discuss such problems as seating arrangements, the ability of the child to take physical training, the subjects in which the hard-of-hearing child needs special coaching, his participation in group activities, and other problems. In time, this special infor­ mation should be familiar to all teachers. The manufacturer might have an expert to prepare special material for teachers and to give them guidance on particular problems. To send a child into a class­ room entirely unequipped to cope with the problem is unfair both to the teacher and to the child and hjs classmates. Preparation of some kind must be made and pertinent up-to-date information concerning the needs of the hard-of-hearing child should be avail­ able in some form. In those schools where the teacher had discussed with the other members of the group when the child was not present the fact that the child was wearing a hearing aid, the results were uniformly good. In such schoolrooms the aid wearing child may still arouse curiosity ; but such curiosity can be easily satisfied without harm to the aid wearer if the pupils are properly forewarned and advised. If the teacher presents the fact that the child needs an aid in order to carry on the daily tasks and must not be subjected to ridicule

SUMMARY 77 or embarrassment, the other children usually rally to the child's support. When the situation has not been openly discussed, some children may taunt and humiliate the aid wearer. He need not be treated as a special case. He should be given the sa:me duties and responsibilities and be held to the same standards as the other mem­ bers of the class. Some aid wearers stated that they had been em­ barrassed by well-meaning teachers who asked them questions about their instruments in front of the whole class. Other children expressed gratitude that their teacher had discussed their difficulty with the class when they themselves were not present. The teacher should be able to judge the children in her classroom and their re­ actions to such a situation. The teacher should probably hold a private conference with the child and settle several matters of policy. For example, the teacher can find out in a private con­ versation in what part of the room the aid wearing child would like to sit. Children appreciate the sincere interest of their teachers and react favorably to such attention and thoughtfulness. The teacher should be a well-informed and dependable friend to whom the aid wearing child may go for help in any of his difficulties. In general, it may be said that the one child in three, aproximate­ ly, who refuses to continue to wear the hearing aid is the child who is not well informed about its uses and values and who is not wisely treated and advised by his parents, teachers, and companions when he begins to use the instrument. When proper information and guidance are made available to these persons as well as to the child himself there will pro13ably be only a few who fail to enjoy the real advantages of a modern hearing aid.

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