Children with Special Needs Flashcards
What physical and cognitive conditions will add to the complexity of audiologic assessment?
Severe to profound hearing loss
Developmental delays
Physical challenges
Autism spectrum disorder
Attention deficit/hyperactivity disorder
Visual impairment
Functional hearing loss
What are the 4 major etiologic classifications of congenital hearing loss?
Chromosomal origin
Genetic origin
Environmental teratogens
Low birth weight
How many newborns who are deaf or hard of hearing have additional neurodevelopmental conditions?
25 to 50%
Why are these children difficult to test?
Auditory response behavior may not be as predictable
Might not orient to sound
Might be hypersensitive tosound to the extent that they exhibit painful hearing
Might have a preoccupation with or agitation to sound
Cannot be conditioned to sound
Might demonstrate very poor test-retest reliability within a test session and between test sessions
May have problems with speech, responding to sound, and understanding the task
What are some things to expect while testing this population?
Longer time to focus
Latency time
Consider other responses
May fatigue quicker
Unexpected reactions
By appropriately controlling the test environment, can almost any child be tested using behavioral techniques?
Yes
If a child cannot be tested with behavioral test measures, the audiologist needs to take ownership for the inability to test and say “I was unable to test this child” rather than “This child is untestable”
How does testing these individuals usually begin?
With electrophysiologic testing (ABR and OAE)
If this testing indicates no concern, and if parental and therapist observation does not indicate any concerns, additional testing might not be needed
If hearing is a concern, behavioral testing is critical
Is the cross-check principle necessary to complete a hearing evaluation?
Yes
Can observing the child in the waiting room provide clues of the child’s physical and developmental status?
Yes
Temperament of the child
Alertness of the child
Clues about the developmental status of the child (e.g., walking, talking).
Clues about the interaction/communication between the child and their family
Independence/shyness/fearfulness following introduction
Willingness of the child to engage/participate in conversation
What are some rapport-building and anxiety-reducing strategies?
Introduce yourself to the child and family
Complementing the child on attire or toys
Ask about grade level or age
Introduce positive reinforcements/rewards that might be used during or at completion of assessment
Inform the child and family about expectations of what is to come during the assessment (ease anxiety and fears)
Allow the child to touch equipment
Can BOA be useful with this population in conjunction with physiologic measures?
Yes
What are three categories in which BOA testing results might be placed?
No observable response to sound
Responses only to high-intensity stimuli (70–80 dB HL)
Responses to relatively soft and comfortable stimuli (30–50 dB HL)
What are some things to consider when doing BOA?
Remain unbiased when judging the presence or absence of a response
Enlist the assistance of a second audiologist
Reduce habituation by alternating between several differenttypes of stimuli
Enlist the parents’ assistance in determining a response
What are three factors that should be considered when performing VRA?
Judging response behavior (might be more difficult, have second audiologist assist, increase probe trial and control trial duration)
Increasing attention and motivation (darken room, keep child in alert position, minimize distractors, vary auditory stimuli, use longer presentation of reinforcement)
Decreasing false responses (reshape responses, versatile midline distractors, lengthen interstimulus intervals)
When performing CPA on this population, should you customize the task to match their physical and behavioral characteristics?
Yes
What are some considerations for CPA?
Use tactile cues (can be helpful in teaching the task)
Practicing the task together several times
Consider using narrow-band noise or warbled tones (more interesting and novel)
What are some things to consider when performing conventional audiometry on this population?
Several modifications can be made if needed
Remember there is a small testing window
Keep them motivated and attentive by intermittent social reinforcement and providing different response options
What are some things to consider when performing speech audiometry on this population?
Select the appropriate speech perception measures that match the developmental level of the child and their vocabulary level
When are SRT and SAT used for this population?
Can be obtained with a variety of stimulus words or phrases to gain the child’s attention and cooperation
The signal selected can be delivered in repetition until response is obtained
Test trial duration should not exceed 5sec
What must we consider when trying to obtain SRTs for this population?
Must consider the child’s familiarity with the words being considered and the ability to repeat the word
Use pointing tasks, game tasks, or classic repetition games`
Ask child to point to body parts or a parent’s body parts (e.g., “show me your nose,” “eyes,” “hair,” “fingers,” “toes,” “shoes”)
When is physiologic testing required for this population?
If they are not able to participate in behavioral testing
Might be lethargic, hyperactive, combative, tactilely defensive, or unwilling to sit quietly
Might be unwilling or unable to comply with instructions and unable to cooperate for a sufficient length of time for test completion
What are several modified strategies that can easily be incorporated to maximize patient compliance?
Choosing appropriate audiologic tests and deciding on the appropriate order of test presentation are essential to a successful outcome
How are acoustic impedance measures useful?
Useful in the interpretation of other components in the audiologic test battery
Carefully observe the child (is he ready, calm, crying?) and tailor your approach accordingly
Enlist assistance from the parent
This could range from verbal reassurance to gentle restraint of the child
Enlist a second audiologist to provide positive comments or visual distractions such as bubbles
Select screening mode when possible rather than the diagnostic mode