Notes: Ear Troubles conductive hearing loss, behaviour and learning

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1 Notes: Ear Troubles conductive hearing loss, behaviour and learning Part 1 Hi, my name's Damian Howard, and this presentation has being compiled by myself and Jody Bernie. It's about conductive hearing loss, behavior problems, and learning. Otitis media is middle ear disease, or glue ear, and it's one of the most common childhood illnesses in the western world. Fluid in the middle ear prevents sound being conducted through to the inner ear and this results in some degree of conductive hearing loss, as in contrast to sensory neural hearing loss. Middle ear disease is a relatively minor health problem, but it can have major educational and social consequences. And these are really important for teachers to be aware of. This kind of frequent hearing loss can lead to a thing called auditory processing problems. So a history of fluctuating hearing loss can result in auditory processing problems that continue after the hearing loss has being resolved. So if a child is demonstrating some of the behaviors that are talked about in this presentation and they're hearing test comes back okay, consider whether they may have some auditory processing problems. The conductive hearing loss experienced by kids because of the ear disease can fluctuate. It can come and go, and it can vary from slight, mild to moderate loss. But the formal description of hearing loss can be deceptive, because a mild or hearing loss can have a major educational impact, as you will hear about. How hearing problems can lead to learning and behavior problems is complex. Conductive hearing loss shapes children's social responses at school, especially when it's noisy. So the acoustics and the amplification of schools are often, are important to consider. And schools are often a noisy place because of the talk and activity of many children. Those children with hearing loss or auditory processing problems have the most difficulty perceiving speech when it's noisy. Other children may be able to cope with the degree of background noise that will mean that these kidsin which these kids will have major difficulties, so it's important to be aware of what behaviors occur when it's noisy for these children.

2 So things like being close to air conditioners, fans, heaters, can create noise black spots, but the major noise that's created in schools is through the talk of other children. When children have problems listening, there are two patterns of responses common with children with hearing problems that can be observed by teachers. Firstly, disruptive behavior, talking when not allowed, teasing and being disruptive and distracted. And the second pattern is being quiet and compliant and avoidant, both with teaches and with their peers at times. One aspect of the disruptive behavior is talking when it's quiet. The times that it's quiet in class provide the best times for children with hearing and listening problems to be able to hear what others are saying, so they may wait until these times to be able to engage best with their peers in class. But there are problems with children doing this because the times that it's quietest in class is when teachers are trying to manage noise levels to instruct the class or to allow children to work. So children talking at this time is gonna be seen as disruptive, and they are likely to be seen as a behavior problem. But since the low background noise creates the best opportunity for children with hearing problems to listen, many children with listening problems will take this opportunity to talk. Otherwise, they're likely to remain socially excluded at school. So you can see a pattern that occurs in a situation where children with no hearing loss, when it's quiet they're paying attention, like the little girl in the lower left hand corner looking and watching and listening to the teacher. And when it's noisy, it's noisy because of the, hopefully, work-related conversations that are going on with kids in class. However, in the top half of this diagram, you can see where when it's quiet the kids with hearing loss often take the opportunity to talk and to converse with their peers, often to the irritation of the teacher and their peers who are trying to work. And when it's noisy, those same kids are likely to be not talking as their peers are, but may try and engage through teasing or wandering around the room and doing not what's expected. So this pattern of behaviors breaks school rules so that these children are likely to be seen as having behavior problems. But it's important to understand the background of these behavior problems as being related to listening problems is in class, together with an often noisy school environment.

3 So the disruptive behavior that can also occur is this teasing disruption when the class is allowed to talk. It can be too noisy for a child with hearing loss to be able to listen, so they may tease more when it's noisy and tease to socially engage, because it's their way of staying connected. But this social engagement may not be appreciated by their peers, and they may be seen as being disruptive and resented by their peers. Consider who in your class often tease others and notice, particularly, whether they tease others more when it's noisy. Another aspect of this disruptive teasing behavior can be taking others' things, monopolising class materials, and even damaging others works. This poking, prodding, and even hitting others can be seen as escalating to bullying, but part of the background to that of these social and listening difficulties that create problems in interacting with their peers. Children may tell, boss or demand. When children don't have to listen is when they are doing the talking, so some of these children will seek to talk more and listen less. They may tell, have classroom monologues or boss or demand, to engage when are having hearing problems. And particularly, in younger classes, this can include telling on the others when they're young. They may observe the classroom rules, although they are often the ones who are most often likely to break them. But one of the things that they'll do is tell on others who are breaking them, and this appears the combination of being aware, usually, of what's going on and wanting to get some attention from teachers when they otherwise or have a lot of difficulties in doing that. Another aspect of the behavior for some children is calling out. Some children with hearing loss may call out in class to others and to the teacher's loud comments. And this seems related to students who are having difficulty participating in quiet conversations with peers, may nevertheless call out in response to louder comments heard in class. And these are often the teachers.

4 So in the research that I've undertaken, in some of the videos it was clear where a student was having difficulties participating in the small group conversation with his peers would suddenly turn around and shout out towards some loud comment made by the teacher and but into other people's business and but into the teacher's business in a way that was unappreciated by them. So, also make a list of the children who often call out in class in this way. Part 2 The outcomes of hearing problems that we've just heard about, having difficulty in understanding what's said, teasing and disrupting, as a result of that. Bossing and demanding, calling out, talking when quiet. So when you get this pattern of problems and you observe particularly, that these are more evident at the particular times of the class day, so for example, when it's quiet they're more often likely to talk, and when it's noisy they are more likely to tease and disrupt, then you should consider whether there may be some listening problems behind these behavior problems. And as we said earlier, there is a second pattern that's often common with children with listening problems. Not all children with listening problems have this disruptive pattern. Some children try and cope by complying, keeping quiet and in avoiding engagement in school processes. Children who avoid may often avoid contact with teachers, they may try hard even too hard to please teachers. So, constantly be trying to win attention of the teachers. They may be often isolated or a rely on a special friend to cope, and when this special friend is absent from school, they may have a lot of difficulty in participating in class. The special friend in this context is being used as an additional source of information. The special friend hears and understands the teacher and then helps to explain to their peer. These children often experience higher levels of anxiety, and this can often play out in problems at home. They may have tantrums at home because of the stress experienced at school, so that they are seen as the school angel, home devil.

5 And parents may describe this kind of anxiety-related outburst at home or needing to have a quiet time immediately after they arrive at home, and it's quite out of what teachers observe and experience at school. Conversely, some of the children who are disruptive at school comes home and are quiet and cooperative, because in a home environment throughout the polarities of noise that lead children to have difficulties in coping, nor they are expected to comply with teacher demands at home as they are at school. So there can be a mutual misunderstanding of what happens by teachers and parents. Parents with kids who are disruptive at school but quiet at home find it difficult to believe that their children are behaving in this way at school, and children who are quiet at school but have tantrums at home. Teachers find it hard to believe that those children who are so quiet and placid at school do those kinds of things at home. Children with these kinds of listening difficulties often seek to cope at school by using other means of communication and observation. One of the common ways that they seek to do this is rely more on visual coping strategies. Face watching, that is watching people's faces to give added cues in conversation. This can be lip reading or watching facial expression or watching overall body language, can help the child with hearing problems in one-to-one conversations. But face watching in groups can lead to focusing on one person only and then missing the cues for turn taking. This is another thing that teachers can do when observing children's behavior in class, particularly participation in small groups when there is background noise in class. If you notice children having difficulty taking in the whole group and conversing in the group but just focusing on one person, then this may be an indicator of some listening problem. In groups, children may focus on one person, ignore others, interrupt others, or simply withdraw and not be able to cope. And these kinds of behaviors may be seen as some kind of social immaturity or social interaction problems, when they derive from these listening problems in noisy environments.

6 And it's important to discern what the difference is, in terms of children with underlying social problems that ones that are linked to their listening problems. Another thing that children do, with listening problems, is often wonder to observe. The wondering enables the child with hearing problems to observe and talk to others. So they may wonder to watch and see what other people are doing, because they haven't really understood what the teacher's instructions are, or they haven't understand the instructions and they're avoiding getting their into work and just entertaining themselves by wandering around. Children with listening difficulties are often reluctant to try something until they have watched others and get a clearer idea of what's expected of them, so their efforts with their understanding aren't going to lead them to being shamed by being found out to be wrong. Often, this shame of being found to be wrong is such a strong issue for them that they would rather not finish work or not start work, rather than risk being wrong and shamed in public. They're often late in starting a task, and parents of children with these listening problems often say, they don't ever get to finish their work, unless they're given a later opportunity because by the time they've worked out what to do, they're late in starting, and that other children finish before them and things move on to the next task. Looking around, one of the things that happens often with children with this listening difficulties, is that they need to visually monitor what's going on in class. So this looking around helps a child with listening problems monitor what's happening in class, but this can often be seen as inattentive. During the time I was doing my research, I was in a classroom that had a window and the door, and the door was locked during the day, so people visiting the class need to knock on the door and be let in by one of the students. And it struck me that it was, it seemed like it was always the students that I was coming in to observe that were the ones who came to open the door. As far as I know, they won't didn't know I was observing them so I wonder why it was that they always the one who seemed to notice that I was at the door. But later I realised it was their constantly looking around and observing what was going on that led them to see me more often than the other children.

7 However, this looking around to keep in touch with what's going on means that they are often less attentive to their work and don't get things finished. Some of the problems with this kind of visual coping are that the visual coping strategies used by many students with hearing problems can be seen as behavior problems. Wondering is seen as disruptive or avoidant of work. And some children doing this might be considered hyperactive. Looking around in class can be seen as being distracted and inattentive. Children can be perceived the socially immature or disruptive when using face watching in a group situation, because they often ignore or interrupt other children. So we're getting to the part now that says, what are these that educators can do to help in the social, situations in classroom to enable these children to cope better and to learn more effectively. Firstly, making words work better for students. It's important to use language in ways that it makes it easier to understand for these children. So simplifying spoken language, using more frequent repetition, getting close to the child when speaking, increasing the use of gestures when you're communicating, using sound or feel systems or other amplification systems. These are the ways of making the words that are spoken more accessible for students. And obviously, being very aware of the background noise levels as we've talked about earlier. It's also important to avoid listening overload. It's common with these children to see after a period of intense listening, that they just have about of listening overload. They just tune out because it's difficult for them to keep on listening for long periods. It's hard work listening when you have these listening difficulties, so they tire quickly, tune out or seek to entertain themselves by doing something else. Alternative activities that don't place demands on listening is important for these children to give them a time to recover to engage in listening again. Utilising children's visual strength is also an important thing that teachers can do. So using lots of illustrations, diagrams and images in the discussion of what's happening to show what's happening as well as talking. Because when words are connected to actions that children can observe, it makes more sense of what's said and children can guess and understand what needs to be done.

8 Enable students to observe peers so that children who are reluctant to get going on things may be given time to observe others, but then enough time also to engage in the work once they understand what's expected of them. Structure seating to enable observation, for example, in a U-shape sitting that's illustrated here, can help children to observe others and know what's going on rather than need to be rubbernecking all the time to observe what's going on around them in class. In one school where I was doing some work in the two-day training program, after the end of the first day, the teacher went back to school and changed the classroom layout for her students and found that that alone improved the behavior problems in class considerably. This means that managing change is important for children with listening problems, in particular. So ones children with hearing problems of pending change, tell and show how things will be different when things are about to change, and give children with listening problems a chance to observe before the new demands are placed upon them. These are strategies to assist these children to cope with the changes that are often most difficult for them to cope with. We talked earlier about having a special friend. And children with listening difficulties and particularly, aboriginal children, have an enhanced cultural capacity to connect and be supported by peers and provide the support to peers. By utilising this peer support is a powerful way to assist these kids in class to achieve better and to cope better. So it's important to be aware of and support the role of a special friend to foster classroom layout and activities that enable peer support, and to keep class groups more with students having a range of abilities. One student with listening problems commented that he was doing great at primary school until it got to a certain year level and the teacher changed all the social groups in class. The teacher had the idea that changing these groups would help to give more variety to students, but what it did for this student was disrupt their peer coping strategies. In his new group, he didn't have an idea of who to observe for what kind of help and his carefully cultivated peer support of students being willing to help him over the years just went out the window, and for a long period he felt unable to cope in that new changed social group in the classroom.

9 And very importantly, as we've heard earlier, is to be aware of background noise possibly inhibiting participation in groups, and to generally be very aware of the noise environment in the classroom and realise that an increased noise environment is going to impact much more on these students with fragile listening skills. When the background noise goes up, their listening overload time is going to become shorter and their ability to cope, generally in those classrooms is gonna be diminished. It's also very important to have a strength focus for these children. The very fact of having these listening difficulties structures the experience of these children to often experience fire. They are seen as not able to cope with tasks as well as other children because they haven't been able to understand what was said. And so their capacity and their intelligence is likely to be questioned, or their motivation is going to be questioned and they're going to be seen as lazy or unmotivated. So these children, through virtue of their past listening difficulties, are going to have had a hard time and they themselves may observe other children understanding and knowing what to do through listening better than they, so they may come to believe that they are not as smart as other children. So these experiences in failing in listening to learn tasks, often thinking that they're dumb, feeling excluded in social groups because they have difficulty in participating in them, these children often become very sensitive about failing, being shamed, or excluded. So it's really important to have a strength-focused approach with these children that involves affirming and enabling strengths, especially in public situations. So to encourage these children to participate by recognising what they are good at, and to affirming that in public, so that inevitable challenges that they experience in school environments are counterbalanced by that awareness of their strengths, and talking to family too about helping children to affirm their strengths in a home environment. Also amplification, because one of the things that can help these children learn and talk more effectively is to hear what's said more easily. So sound amplification systems can help teachers to hear better. Now, a sound amplification system is a bit like a PA system, where there are amplifiers in the room that link to a microphone held by the teacher, or possibly a teacher and hand-held

10 microphone that can be passed around to students. And what this does is to increase the volume of what the teacher is saying to the whole class group. So it takes away from the shame involved in having individual amplification so the children aren't shamed by having that hearing aids in the classroom. And it makes it easier for everyone to hear better, and the evidence from research carried out with amplifiers, with sound or feel systems in the classroom, shows that children over a course of time can have as much as 30% improved achievement in the classroom. And in my experience, it's also evident that children's behavior problems and teacher stress often reduce as well. Another option in terms of amplification is a handheld device, which can be very useful for teachers and support teachers who are working with individual children in the classroom. This type of handheld device can be taken by the teacher when they're working individually with children, and so the individual child that they're working with has the amplified voice of the teacher right in their ear so that they can hear clearly with that additional individualised attention, despite other children working and creating background noise. This is a not so common device that I think is often very useful in classroom situations. Sound or feel systems cover that situation where the whole classroom is given amplification, but often teacher time is taken up providing individualised support to children with listening problems trying to do so despite the background noise amongst other students. So this assists to make that individualised assistance far more effective for those students with listening problems. So, looking at the better outcomes and how they can be achieved, this is a summary of some of those things. So utilising visual learning strengths, making words work better so that children can hear them more effectively, avoiding listening overload by not talking too much and making sure that there are visual prompts to accompany words, using sound or feel systems and handheld amplification, consciously working to manage change to prepare children for what they're going to experience, and supporting the use of peer support. So helping children to learn from other children. And having a strength focus, making sure that children's overall abilities and strengths are focused on publicly in the classroom and helping them to recognise what their strengths are so that they belief in themselves is encouraged,

11 because that sort of confidence is going to encourage them to engage in what's happening in the classroom. You can get more information and resources through contacting me directly, on And there's a good resource that has lots of further information that's available at

Otitis Media and Conductive Hearing Loss By Damien Howard PhD

Otitis Media and Conductive Hearing Loss By Damien Howard PhD 1 This book This book is to help parents and families understand more about what happens when children s middle disease causes them to have