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38 L E A R N IN G TO USE HEARING AIDS which the child had been helped in adjusting to the aid. Two parents said that they had purchased carrying cases for the batteries and microphones when they realized that their children would be too uncomfortable wearing the instruments on their persons. In this way they had circumvented the danger of the child's complete rejection of the aid. In both cases the children were now using the aids maximally and had expressed complete acceptance of their instruments. The parents had purchased loose clothing in many instances so that the children might enjoy greater freedom of move ment. Some had made comfortable braces for the children to wear. Another parent who showed astute judgment in dealing with her child reported that she never called to her son, but always stood in front of him and spoke directly to him. As a result the child was relieved from the fear that he might be missing something. Three children with severe hearing losses had been taught by their parents to keep their aids on the night table close to their beds, so that they could reach out at night and put on their instruments, if necessary. By this device, the parents felt that the child might develop a great er feeling of security about his own safety and would lose some of the feeling of helplessness that hearing loss had engendered. Many of the parents assumed the responsibility of keeping the batteries in good condition. All such devices as providing comfortable clothing, teaching the child to use his aid most advantageously, urging the child to keep the aid close to him at all times, providing carrying cases in those instances where they are necessary aid in making the child more comfortable ; but the subtle influence of attitude toward the child with the disability appears to have far greater effect on the child s' reaction to his aid than do these concrete approaches to the prob lem. In other words, a satisfactory relationship between parent and child appeared to have far more efficacious results in the child's complete acceptance of his aid than did the specific things the parent said or did to get the child to wear the aid. Some parents have encouraged in their handicapped children so great a feeling of ind�pendence that the children are able to travel around the city by themselves, make their own decisions, and choose their own friends. Such parents have fostered within these children a feeling of independence to such a degree that they use their aids
HOME ENVIRONMENT 39 to help them gain greater self-sufficiency. As an example, four aid wearing' girls who had hearing losses of over 5 0 per cent were able to come by themselves from great distances to see the worker. Their parents had encouraged them to use their aids so effectively that the parent felt the child was competent to travel about a large city alone. There appears to be relationship between the parent's confidence in the child and the child's willingness to wear a hearing aid. Some parents reported that before wearing an aid the constant attention the child demanded from the parent made him dependent and lacking in self-sufficiency. After the child began to wear an aid, the parent was less reluctant to allow the child to depend on his own resources. A feelin� of relief at the child's independence as the result of wearing an aid was often expressed. Twenty-eight per cent of the aid wearers still were not allowed to travel about alone, while 5 0 per cent of the no-aid group showed such over protective behavior on the part of the parents. . In those families where the child was treated as an accepted and respected member of his family group, but was not coddled be cause of his handicap, the child had a tendency to use the aid. Where the child was treated as "different" and given an undue amount of attention there was a tendency to reject the aid. In one case a mother who worked always took her daughter along with her on Saturdays because she was afraid to leave the child alone in the house for fear something might happen to her. In another case, the mother did not allow the girl to help with any of the housework in spite of the fact that her employed sister had to do household chores when she came home at night. The following comments indicate the attitude of some of the parents of children still wearing aids : "I have never spoiled H. I treat him exactly like his brother. He fol lows the family characteristic of being stubborn, but that is part of the family behavior and has nothing to do with his failure to hear. I do feel that a great deal of patience is required in dealing with a handicapped child, so I provide him with a variety of experiences to keep him from with drawin g into himself. We take him to the theater whenever we attend and he always goes visiting with us. Even though his brother thinks we favor H., I try to give approximately the same amount of time to both children." "I h ave always been extremely concerned over J's well- being and prog-
40 LEARNING TO U S E HEARING AIDS ress. While I do not favor her, we get along well together and I am care ful not to criticize her. I have encouraged her to be self-sufficient and have always allowed her to take care of herself. In order to help her over come her handicap, I have given her advantages that her brother did not have. She has taken violin lessons, ballet lessons, tennis and swimmi ng les sons. Such activities will help her to overcome her shyness and self-con sciousness and will give her poise and assurance. Although she cannot en joy the theater, we frequently attend the movies together, with J. always wearing her aid. I took her to the rodeo and ice show. She wore her aid and enjoyed both performances. I have always dressed her well, because I feel that she needs the security and confidence that attractive clothes can give her. As a result, she has never been self-conscious about her hearing loss." In both these cases, as the result of intelligent parental handling, the children use their aids to maximum advantage. The relation ship between parent and child is free from conflicts and tensions, and the child is eager to improve his own state, once he feels secure as a member. of his family group. Another good example of wholesome parental attitude with con comitant desirable consequences in the child's acceptance of his hearing aid is the case of Raymond. The Case of RAymond Raymond is a tall, well-developed young boy, almost 1 7 years old, with bright red hair and freckles. He is meticulous in appearance and has a well-scrubbed, wholesome look. His manner is affable and courteous. He wears his aid constantly and expressed an acute need for it. In response to the worker's question as to how he likes it, he said, "Very, very much, very much. I can�t go without it." He described his school progress as "Not so good. I just got pushed through. Mother always had to help me and my teachen helped too." (At this point, Raymond stopped and asked the worker to wait until he changed a battery, because he was afraid he might miss something. He explained that he always carries an extra battery as he cannot get along at all without his aid. ) "I'd be lost, so I carry this battery just in case something should happen." His mother always told each new teacher about his hearing handicap in order to offset any diffi culties he might encounter at the beginning of each term in a new school situation. Raymond in a rather doleful manner said that he never got along with other children because "I guess I just couldn't handle conversation." He had a few friends among the children in the neighborhood, but generally felt left out. He thought that the effort the children had to make in order to talk to him was too much to expect, .
HOME ENVIRONMENT 41 so he did not resent the fact that he was not always included in their games. When Raymond was about three years old, his grandmother discovered that he was hard of hearing after he had failed to respond to a dinner bell rung close to his head. His mother had become blind after the birth of her first child and was totally blind at the time that Raymond was born. Following an operation, she recovered the use of one eye. As a result of her own handicap, she thinks that . she has been especially patient with Raymond. When he was six years old, she began to teach him lip reading. She would point to a table or a chair and then repeat the word with her lips. She said that she and Raymond used to play games when they were visiting or with other people. They would talk to each other witho.ut ut tering a sound. · Raymond was delighted with his mother's attention and care. When he was about seven years old, she realized that he was suffering keenly because the other children excluded him from their games. She noticed that he stood on the sidelines and just watched the others. Al though she felt extremely sad about it, there was nothing she could do. She described an incident in which Raymond showed his reaction to his hearing disability. Up to this time, he had ·never indicated in any way that he was unhappy over his hearing loss. One evening, a group of friends were visiting them. Suddenly Raymond arose and went into the kitchen. His mother followed him and found him crying. In response to a question as to the reason for his withdrawal, he replied that he felt miserable be cause he couldn't hear the jokes of the people. Everybody was laughing and having such a good time, while he was sitting there completely cut off from the camaraderie of the rest of the group. His mother related that she sat down with Raymond in the kitchen and the two of them wept together. Shortly after this, Raymond received his hearing aid and a new world was opened to him. On the way home after he had gotten his aid, he re peated to his mother the new sounds he was hearing. He told his mother that he never knew that footsteps made a noise. When he arrived home, he rushed up to his room, and arranged his aid so that he could use it to best advantage. He placed the microphone on the outside of his jacket, adjusted the earpiece and cord, and attached the batteries to his belt. He paraded in front of the mirror so he could become accustomed to the idea of seeing himself with the apparatus. He asked his father to sit down in the living room and prepare for a surprise. Then he came downstairs and made an impressive entrance with the new aid. His mother said it was the most thrilling moment of the family's life. Immediately after they had finished dinner, Raymond asked his mother to go visiting with him to the homes of the people who had been kind to him when he couldn't hear. He and his mother visited the neighbors who "had been especially kind to Raymond and we showed off the new aid.'' The response of his family
42 LEARNING TO U S E HEARING AIDS and his friends to his new hearing device was of such a nature that he never had the problem of self-consciousness or embarrassment. They visited at the homes of four or five of the neighbors that evening. At each house Raymond showed the mechanism of the aid and insisted that everyone listen so that each could hear what he was hearing. Raymond's entrance into the world of sound was a dramatic one. His environmental influences provided him with a happy experience. Instead of the idle curiosity that greets most wearers when they first put on an aid, Raymond's experience was one of great admiration and joyful sharing of a happy occasion with his family and friends. Significantly enough, on the other hand, a hostile attitude on the part of the parents toward a child is reflected in the child's attitude toward his aid. This is seen in the case of a boy who feels great need for his aid yet wears it intermittently, because he can thus defy his parents and cause them concern. He wears it when he is away from the house, but takes it off when he comes home, even though his parents constantly scol d and nag at him. The attitude of his parents is reflected in the following statement : "S. has al ways given us trouble since he was a baby. He fights with his brothers and is rude to me. I am embarrassed to go out on the street because the neighbors think my son is crazy. When he comes home late at night, he turns on the radio so loud that he disturbs everyone. I have absolutely no control over him. His father would like to send him away from home because he may be exerting a bad influence on the younger boys. He always had trouble in school and I got tired of going there to try to smooth things over." In the case of one girl, the family conflicts between husband and wife resulted in the child's refusal to wear her aid except to the movies. The father is sure that the child is feeble-minded and should be institutionalized. However, her school record and in telligence test score both show that she is of low normal intelligence. During the interview the father revealed that his purpose in want ing his daughter sent away was to punish his wife who was con stantly quarreling with him. This child finds it more comfortable to avoid the tensions within her home by refusing to wear her aid when she is in the house rather than to listen to the bickerings of her parents. In those homes where the relationship between the parent and child is satisfactory, the child is more likely to wear the aid. If the
HOME ENVIRONMENT 43 relationship is unsatisfactory, there i s greater tendency for the child to use the aid as a means of self-assertion against parental domina tion. In addition, when tension exists either between the parents, or between the child and one of the parents, the child presents be havior problems. Many more difficulties were enumerated by the parents of the no-aid group. They were of a more serious nature than those of the aid wearers, but there were some parents who showed under standing and sympathy for the child. Following are some examples of the types of comment made by parents of the no-aid group : "The family has never had to make sacrifices because of I.'s handicap. I seemed to favor her because of her handicap. In return, she likes to fuss over me and show� me more affection than does her brother. She has as sumed much of the responsibility for keeping the house and I let her make the beds and go to the store, because I have to work. She shows resentment if her brother gets anything that she can't have. I have tried not to feel sorry for her, and have avoided making her feel self-conscious about her hearing loss. In fact, I am afraid that I have protected her too much. " " D . has always required more attention than other children. She cannot hear from room to room and the family is constantly shouting at her. However, she seems to hear better when talking with her girl friends than when her mother or grandmother try to make her understand. She doesn't like to help around the house, but when she grows up she will probably be able to earn a living." "A. has been very difficult to bring up. She required more time and attention than her brother, because she has always been difficult to manage. She is extremely stubborn and would hold food in her mouth for hours without swallowing it. As a result, she is still fussy about food. I think she must learn to fight her own battles. She is too dependent on her family and me. " Parental attitude may be considered to play an important part in influencing the child to wear an aid. From the comments and case studies, it is evident that the parents reveal quite different at titudes in dealing with handicapped children. Some parents recog nized difficulties engendered by hearing loss and helped the child to overcome them ; other parents saw the child as a burden and made no effort to assist him in his adjustment. Instead, they in creased the conflicts and tensions already existing as the result of a handicap. No subject said that he had experienced either ridicule
44 LEARNING TO USE HEARING AIDS or embarrassment from siblings. On the contrary, the attitude of the brothers and sisters was generally that of approval, in that the family was spared the exertion of shouting at its hard-of-hearing member, making for greater harmony within the household. In only one case a boy reported that his brother preferred him to get along without �n aid. When the brother was interviewed he said that he would take his younger brother into business with him so that he himself would be spared the embarrassment of having anyone know his younger brother was hard of hearing. In all the other cases, the siblings appeared to approve of any device which decreased the pressures and tensions within the home and were quite willing to have the hard-of-hearing member wear a hearing aid. In two cases, parents felt there was a beneficial effect upon other hard-of-hearing siblings as the result of the wearing of a hearing aid by one member of the family. One parent planned to buy an aid for a younger hard-of-hearing daughter since the child who had received one through the National Research Council Study had found it so helpful. The mother felt that the younger child would readily accept hers because her sister was already wearing one. In another case, a subject's brother had purchased an aid after seeing the success with which she used hers. To conclude, various factors within the home environment ap pear to influence the wearing of a hearing aid. First, the children from better homes seem to be more likely to adjust easily to an aid than do the children from deprived environments. Second, the specific efforts made by the parents to insure the child's physical comfort in wearing an aid were less significant over a long period of time than parental attitude toward the child and his disability. Good relationships within the home and between parent and child appear to be of great influence in fostering a positive reaction toward the wearing of an aid. Third, tensions that had been present within the home in many cases were relieved when the child began using his instrument, although in some cases tension within the home seemed to motivate the child to reject the aid as a means of fighting back at the unsympathetic parent. Fourth, successful use of an aid by one member of the family tends to influence a hard of-hearing sibling also to use an instrument.
SOCIAL RELATIONSHIPS 45 VI. Social Relationships The social relationships of the aid wearers and of the no-aid group were studied in order to determine whether the number of friends, choice of friends, and favorite leisure time activities have any effect upon the decision to wear or to reject a hearing aid. Case studies were also analyzed for apparent changes in social ad justment which might be attributed to · the wearing of an aid. When the aid wearers and the no-aid group are compared as to number of friends, the aid wearers seem to be somewhat more pop ular. Fifty per cent of aid wearers were chosen as companions by other children, whereas only 4 1 per cent of the no-aid group were described as in demand by others. The aid boys were more popular ( 64 per cent) than the aid girls ( 3 6 per cent ) . More boys than girls who w:ore aids were reported by their parents as having friends who came to the house to visit them and invited them to parties and other social functions. For example, one mother said that the children in the neighborhood in variably gather in her son's room after school ; he teaches them to build model airplanes and is considered to be most skillful in pro ducing models himself. None of the girls, however, had a focus of activity within her own home ; they sought their recreation in the homes of their friends or in outside organized activities. The companions of 'the large majority of boys and girls in both groups have normal hearing. Eighty-four per cent of the aid wearers and 92 per cent of the no-aid group said that their friends had normal hearing. Only two aid wearers and one no-aid boy ex pressed preference for hard-of-hearing companions. The former said that they preferred to associate with people who are hard of hearing because it made them feel less self-conscious about their own hearing loss. One girl felt that she always had to tell the young men who invited her out about her hearing loss in order to forestall any embarrassment. Two aid wearers mentioned hard-of hearing friends as well as normal-hearing companions. On the
