LM205 - Providing Meaningful Sound Access for Medically and Developmentally Complex Children

Abstract:
Historically, research and clinical amplification guidelines for children with hearing loss who wear hearing aids have focused primarily on neurotypical children without additional medical complexities. However, children who are neurodivergent and/or who have additional medical conditions are frequently seen in the pediatric audiology clinic. This presentation will explore how audiologists can use the existing evidence-based framework of care as well as critical thinking skills and collaboration with the family, medical care team, and other allied health professionals to rethink hearing aid candidacy and care for this population to provide meaningful access to sound for children with developmental and medical complexities.

Summary:
The AAA Clinical Practice Guidelines for Pediatric Amplification provides comprehensive guidance for determining hearing aid candidacy and delivering evidence-based care for children with hearing loss who wear hearing aids. However, this document does not explore the considerations and challenges that accompany hearing aid decision-making in children who are neurodivergent and/or who have additional medical conditions that may affect their hearing aid care. 55.2% of children with hearing loss are reported to have an additional disability, making up a sizable portion of a pediatric audiologist’s caseload. These children are just as deserving of high-quality and evidence-based hearing healthcare; however, some audiologists may shy away from amplifying these populations due to lack of awareness on how to best work with complex children.

In this presentation, we will explore instances when audiologists should proceed with fitting amplification on children who are neurodivergent and/or who have additional medical complexities. The decision to amplify should be made based on the child’s audiometric profile, ear canal acoustics, and listening difficulties, with special attention also made to consider the child’s overall medical needs, therapy services, quality of life, and structure of support. In some instances, audiologists are hesitant to proceed with amplification for children who have other medical complexities that take priority over amplification. While the care and upkeep of hearing aids could be seen as cumbersome for some, the potential benefits on the child’s quality of life can be marked. Additionally, children with behavioral or developmental concerns are often overlooked for amplification due to fear of non-use or sensory overload. We will share comments from families of children with Down Syndrome which illuminates their perspectives, that audiologists are sometimes quick to “give up” on their complex children or set expectations too low. Adjustments to treatment protocols and incorporation of additional professionals to overcome some of the barriers and promote success when working with children who are neurodivergent and/or medically complex will be discussed.

Additionally, we will also explore cases where proceeding with amplification may not be advised. In providing amplification the hope of the audiologist should be that we will be providing meaningful access to sound, especially speech content. For some of our medically complex children, such as children spending significant time in the Neonatal Intensive Care Unit (NICU) or Pediatric Intensive Care Unit (PICU), these moments of “meaningful access to sound” are very limited or nonexistent. Overamplifying a world filled with alerts and alarms to a child trying to recover risks hindering their medical progress and exacerbating or creating sensory issues. In this presentation we will review the literature on the acoustics of these environments and provide suggestions on how to work with the family and medical care team.

It is the hope that attendees will leave this session with a more holistic approach to hearing aid fittings with this population – remembering that the ears are one small, yet important part of the child and, likewise, that the audiologist is one small, yet important part of a complex child’s care team.