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2 L E A R NI N G TO US E H E A RIN G AID S cooperate. One letter was returned, unopened, and nine parents did not answer. Two further attempts were made to elicit some reply from these nine parents, but with no success. Two of the parents who said that they would participate did not cooperate in the end because their children were no longer wearing their hearing aids and, in fact, had returned them as early as 1942. One boy came for his otological examination but would not be interviewed 9r tested, and one boy was attending a school for the deaf and was not available. In all, thirty-eight children, twenty-one girls and seventeen boys, were studied and detailed case histories of them are recorded. The method of gathering the data included extensive interviews with each child, administration of intelligence and personality tests, par.,. ent interviews, and school visits. In addition, each child was exÂ aï¿½ined by Dr. Fowler and an audiometric record made of his hearÂ ing loss. PLAN OF THE STUDY The following plan was set up for gathering information and observing behavior. Each child was given the option of being inÂ terviewed either at Columbia University or in his own home. All but two of the children preferred to come to the worker's office. After adequate rapport had been established, the child was enÂ couraged to talk about his attitude toward his hearing aid, his reaÂ sons for his acceptance or rejection of it, his likes and dislikes, his problems, his home and school adjustment, and his social adjustÂ ment. During these conversations, a controlled interview technique was used so that uniformity of pertinent information could be obÂ tained. The interview was structured so that all areas under inÂ vestigation were covered with each subject even though the form of the questions varied depending upon the direction of the subÂ ject's conversation. Notes were usually taken during the interview after a brief explanation to the child that his reactions might prove valuable to other hard-of-hearing children by helping them to arÂ rive at a decision to wear a hearing aid. Carefare was paid for each child in order that no financial burden would be placed on any family. The children were always encouraged to speak freely and to consider the worker as a friend. As a result, many of the chil-
INTRO D U C T I O N 3 dren found emotional release from their tensions and asked for further opportunity to discuss their problems. In some cases, there were three or four contacts in addition to those made for the purÂ pose of the study, but it must be observed that these were at the request of the participant. In addition, each child was given the Wechsler-Bellevue Intelligence Scales, an individual intelligence test measuring both verbal and performance ability. Since this test takes approximately one hour to administer, a further opportunity was provided for careful observation and analysis of work habits and behavior dynamics in a test situation. Finally, as a measure of personality adjustment the Bernreuter Personality Inventory was administered. Further information about the child was secured from either one or both parents. An effort was madeÂ·to learn the parental attitudes toward the child's u!e of a hearing aid and to determine the extent of parental influence on the child's decision. Twenty-seven mothÂ ers were interviewed at length, either in their own homes or in the worker's office. Three of the fathers asked to be interviewed inï¿½ stead of the mothers, because they felt that they were better equipped to give a more impartial and unemotional picture of the child. In two cases, both the mother and the father participated in the interview, and in one case, the mother and older brother were seen. One grandmother was interviewed because the child's mother Â· worked. In three cases, both parents were employed and found it impossible to arrange either a home or an office visit. In one case the mother said she was not interested in assisting with the investigaÂ tion but she had no objection if her daughter wished to particiÂ pate. Data were also obtained on the influence of school as a factor in the decision to wear a hearing aid. Each school was visited and either the principal, guidance counselor, or classroom teacher was interviewed. In several cases, every teacher to whom the child reÂ ported was seen and the case discussed. Records were made of school achievement, the child's progress, his relationships with other children, the attitude of the administrative officers and teachers to the child and his handicap, the suitability of his school program for his needs, his participation in school and classroom activities, and his academic preparation for a vocation. The extent of the child's
L E AR N I N G TO US E H E AR I N G AID S use of his aid in different classroom situations was studied, as well as the purpose for which he most effectively utilized his aid. Finally. each child was given a thorough otological examination by Dr. Fowler and an audiometric record was made of his present hearing loss. The percentage of hearing loss" for speech tones as a factor affecting choices in using a hearing aid was also analyzed. DESCRIPTION OF THE GROUP At the time that each case history was begun the group ranged in age from twelve years eleven months to eighteen years four months. Thirty-four children were still attending school, fourteen in junior high school, and twenty in senior high school. Four members of the group, three girls and one boy, had left school ostensibly to seek employment but only two were actually workÂ ing. One girl was attending a school of bea!Ity culture, and one girl stayed home. The group was quite heterogeneous as to socioÂ economic status. Some of them came from lower middle class famiÂ lies living in the poorer sections of the metropolitan area and New Jersey. A few of the children came from families having substanÂ tial incomes. The father of one boy was a physician, and several other parents were in business for themselves. One family was on relief, and in another case the mother and sister had just begun to earn a livelihood after being public charges for seven years. Some were home owners while others lived in the worst slum districts of lower New Yï¿½rk and the Williamsburg section of Brooklyn. Seven were only children, while one girl had eleven brothers and sisters. As a whole, the group represented a cross-section of the population of the metropolitan area. Of the thirty-eight children studied, approximately two-thirds of the group (twenty-five) were still making some use of their hearing aids. However, this "aid" group, consisting of fourteen boys and eleven girls, varied extensively as to amount of time the aid was used and the purpose to which it was put. Combined stateÂ ments and observations of parents and teachers, in addition to the subject's account, furnished the basis for estimating the extent of use. Table I presents an analysis of aid use. Six children (four girls and two boys) were reported as making maximum use of their 1 Computed according to the Fowler formula.
IN T ilO D U C T ION 5 aids. These six put on their aids when they arose in the morning, and continued to use them, so far as could be determined, for all routine activities during the day. Their utter dependence on their instruments as stated by themselves was later verified by their parents and by the school authorities as well as by the worker's obÂ servation of the children. TABLE 1: EXTENT OF USE OF HEARING AID Boys Girls Total For all daily activities . . ... ............... . ... 2 6 For school and specinc outside activity (movies, theater, clubs, radio) ........ . . . . . . 1 1 2 For school and occasional outside activity .... 0 â¢ â¢ -4 1 s For school only .. . . 0 0 0 0 â¢ â¢ 0 0 â¢ â¢ â¢ â¢ -4 0 -4 For specific outside activity only . .0 â¢ â¢ 0 0 â¢ 0 â¢ â¢ â¢ â¢ â¢ â¢ S 3 8 Not using aid . . . . 0 â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ â¢ 0 â¢ 0 0 0 â¢ â¢ â¢ â¢ â¢ â¢ 3 10 13 Two children who were consistent aid users in school also wore them for some specific outside activities, such as going to the movÂ ies, listening to theoradio, or attending a party. Five children who wore their aids to school every day took them off as soon as they returned home, only infrequently puï¿½ting them on for some outÂ side activity, such as a special party or other social function. Four boys utilized aids in school but never wore them after school. Eight children did not make daily use of their aids, but put them on occasionally either for school or for a specific activity. Included in these eight were a girl who wore her aid for the movies only, a boy who wore his aid only when he had an examination in school, a boy who put on his aid at his employer's request, a boy who listened to the radio with his aid, and a girl who used her aid when practising the piano. The .. no-aid" group: consisting of three boys and ten girls, had not been wearing their instruments since the termination of the previous study in 1 943. It is interesting to observe that eleven of the thirteen children who had rejected their aids asked for permis- â¢ This group will be referred to later, for variety, as the pupils discontinuing or reÂ jecting the use of the aids, the aid rejecters, and in other ways as well as the "no-aid" children or group.
6 L E A R N I NG TO USE HEA R I N G AIDS sion to retain them in case they might require them to cope with the exigencies of the future. Two children voluntarily returp.ed their instruments, saying that they did not want them and that some other hard-of-hearing child might be able to use them. II. Physical Factors Affecting Use of Hearing Aids Three areas included in physical factors that might influence the use of hearing aids were the history and physical constitution of the child, the appearance of the child, and the physical discomforts caused by the aid. PHYSICAL CHARACTERISTICS AND HEALTH OF THE CHILD AS FACTORS HEREDITARY DEFICIENCY AND OTHER FORMS OF DISABILITY AS A FACTOR From the analysis of case history records indicating the cause of hearing loss, the data suggest that the cause as stated by both child and parent may be related to acceptance of a hearing aid. These records show that 80 per cent of the children who were still wearÂ ing hearing aids said that tbey had become hard of hearing through either a childhood illness or some other external cause, such as birth injury or early childhood accident. ( See Table II. ) Only 20 per cent of the cases revealed a history of hearing loss or deafness in the immediate family. Upon further investigation, however, it was learned that 34 per cent of the cases attributing their disability to adventitious causes actually had family histories of deafness. On the other hand, about 5 0 per cent of the group who were no longer using aids attributed their hearing loss to the fact that other memÂ bers of their family were either totally deaf or hard of hearing. Such evidence suggests that once the potential hearing-aid user and his family have accepted a specific cause of hearing loss rather than a hereditary deficiency the tendency to make an adjustment by