By Anna Karkovska McGlew, M.A., Elizabeth Rosenzweig, M.S., CCC-SLP, LSLS CERT. AVT, Susan Boswell, M.A., CAE, and Maria Sigillito
The 2014 AG Bell Convention brought the AG Bell community together in Orlando, Florida, for four days of heartfelt connection, the latest evidence-based knowledge in spoken language development, and pure fun under the banner of advancing listening and spoken language for individuals who are deaf and hard of hearing. Parents of children with hearing loss, individuals who are deaf and hard of hearing, and the listening and spoken language professionals that support them made magic real—celebrating successes and achievements, sharing strategies and experiences, and transforming the future of everyone’s life touched by hearing loss.
The convention offered 10 pre-convention workshops, dozens of concurrent sessions and an exhibit hall full of the latest hearing and assistive technology, publications and book signings, early intervention programs, schools and professional development programs, as well as many prizes from the always-popular exhibit hall scavenger hunt and a fundraising raffle.
For the first time this year, AG Bell introduced the teen pass for high school students ages 15-17, which gave teens access to the convention educational program and other activities with specific recommendations for sessions focusing on self-esteem, advocacy and tips for professional success. In addition, AG Bell offered two teen meet-ups which brought teens with hearing loss from all over the nation in relaxed and fun environments, providing the foundation for friendship and connection.
In an inspirational opening general session, AG Bell volunteer leaders affirmed the association’s refocused mission to advance listening and spoken language for individuals who are deaf and hard of hearing. 2014 Convention Chair David Davis, Past President Donald M. Goldberg, Meredith Sugar (President, 2014-2016), and AG Bell CEO Emilio Alonso-Mendoza vigorously articulated the vision for the association's future and the constituencies it represents.
The convention program reflected the organization’s work toward a future defined in its strategic plan in which all families receive unbiased information on listening and spoken language and adequate support from Listening and Spoken Language Specialists (LSLS®), in which individuals with hearing loss live a life free of barriers and one in which the public understands that people with hearing loss can listen and talk.
The session also recognized the 50th anniversary of adults who are deaf and hard of hearing within AG Bell and formally presented the 2014 Honors of the Association award—AG Bell’s highest honor—to John Stanton, chair of AG Bell’s Public Affairs Council, who was profiled in the May/June 2014 issue of Volta Voices.
Rosalind Wiseman, the convention’s highly anticipated keynote presenter, whose work aims to help parents, educators and young people successfully navigate the social challenges of young adulthood, spoke about nurturing socially competent children through parenting and education in the school, managing the inevitability of conflict, and creating the conditions for happiness in our children.
In her engaging, witty and insightful presentation, Wiseman identified four components to happiness: satisfying work or curiosity, hope of being successful, social connection and meaning beyond oneself. She framed this in the context of conflict, drama and bullying. Conflict is inevitable, and teachers and parents should be there to help children manage it. Drama is an exciting, unexpected, emotional series of events, a type of conflict where both people are actively involved and not serious or hurtful. Bullying, on the other hand, is using power or strength to make someone feel worthless by defining them as being a certain way and repeating it over and over again.
In order for adults—be it educators or parents—to create schools as environments of dignity and respect for children to develop and thrive, Wiseman noted that how we talk about conflict matters. Even well-meaning teachers may sound like they are buying into the system to a child who is bullied. When adults paint conflict with black and white strokes only, children perceive this as insensitive and unhelpful.
Instead, in order to model social competence to children, adults need to truly learn to listen to children. True listening means:
- Be prepared to be changed by what you hear.
- Affirm feelings. Don’t voice your opinion about the truth of the story or ask a barrage of questions.
- Ask if s/he is venting or wants advice.
- Don’t use her/his slang.
- Share your experiences without telling her/him how you would have done it.
- Don’t just do something, stand there (unless it is a life-and-death situation).
- If you don’t know, admit it.
When children come to adults and share their experiences of conflict, they are willing to be vulnerable and are not necessarily looking for answers. By truly listening and modeling social competence parents and educators can show children that asking for help is not a weakness, but can be transformative and even life-saving.
To solve problems and deal constructively with conflicts, Wiseman further talked about the SEAL steps. S is for Stop. Who is the conflict with and what is it about? When and where will you talk to the person? E is for Explain. How are you feeling, and what do you want to happen? A is for Affirm and Acknowledge. What rights do you and the other person have in the situation? Do you have a role in the conflict? We all have the right to be treated with dignity and should demand it. L is for Lock. What do you want your relationship to be? Do you want to lock in the friendship, lock it out, or take a vacation? Take your time—you may need to decide this after you speak to the person.
Finally, Wiseman noted that conflict resolution and equipping children to manage it effectively is like test taking: success lies in the preparation to deal with it. And this starts with truly listening! Click here to access Wiseman’s presentation.
For the past nine AG Bell conventions, attendees have had the opportunity to learn about the latest advances in speech and hearing science from experts in the field during a special three-and-a-half-hour Research Symposium sponsored by the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health. For the first time in convention history, the Research Symposium featured a panel of all female scientists who shared their work relating to the theme of Maximizing Brain Adaptability: Enhancing Listening for Language Development, Speech Perception, and Music Appreciation. The scientists approached the topic from different angles, giving attendees a multifaceted view of how current scientific discoveries can be applied to improve the lives of people with hearing loss.
Pamela Souza, Ph.D., from Northwestern University, School of Communication, whose father had hearing loss, discussed the topic of improving audibility to improve speech understanding. Souza investigates how much speech must be audible for listeners with and without hearing loss to be able to understand spoken messages. The general rule of thumb is that if a hearing aid user has aided thresholds within or above the "speech banana," conversational speech should be audible to that person. However, Souza pointed out that speaking levels tend to vary +/- 30 dB around the average, even within the same conversation. While adults with typical hearing need 50 percent audibility of the speech signal to understand 80 percent of the message, adults with hearing loss require 80 percent audibility to understand 80 percent of what is said. For children with hearing loss, the percent audibility needed is even higher, as children have fewer years of language experience on which to draw to fill in the gaps.
Souza discussed some of the "enemies" of good audibility and how adaptations in hearing aid fitting and programming can address them. In noisy and reverberant environments, various types of masking combine to greatly decrease the audibility of the speech signal. In noise, energetic masking happens when background noise overlaps in pitch and duration with speech, causing only glimpses of the message to get to the listener. Informational masking occurs when background noise does not overlap with the speech signal but draws the listener's attention away and causes distraction. In rooms with lots of reverberation, or echo, self-masking (distortion within the speech sound) and overlap masking (residual energy overlaps following sounds), also decrease the intelligibility of the speech signal. While younger listeners with typical hearing are able to adapt to reverberation quickly, older listeners and those with hearing loss have a much more difficult time in these harsh listening environments.
How can audiologists adapt hearing aid fitting to ameliorate these difficulties? Souza noted that children's audibility needs are different than adults and that children need greater bandwidth than adults (access to a greater frequency spectrum). Listeners with typical hearing can hear through 8000 Hz, while most hearing aids only amplify through 3000-5000 Hz. This is not enough, especially for children who are learning language and how to produce speech sounds. Hearing aids that feature frequency gain response (providing more amplification at frequencies where there is greater hearing loss) and directional microphones (that can differentially amplify noise coming from behind vs. speech coming from the front of the listener), or digital noise reduction programs can also be of use. These adaptations will improve the signal the listener receives through their hearing aids, but environmental modifications (reducing noise) and assistive technology (FM or soundfield systems) can also improve audibility to enable people with hearing loss to hear and understand speech better in a variety of settings.
Beverly Wright, Ph.D., from Northwestern University, School of Communication, presented on the topic of improving auditory skills through training. She discussed perceptual learning, the learning of skills in basic tasks that may later be translated into effective interventions for assisting people with hearing loss improve their auditory skills. She began her talk by explaining that perceptual abilities in all of the senses are not fixed but can be improved through practice. Her research centers around training subjects (in this case, adults with typical hearing thresholds) on basic listening tasks, such as pitch discrimination. From her studies, Wright has identified four principles of perceptual learning:
- Just do it. Learning takes practice. Training sensitizes the brain to help it determine which information is important to focus on, and which to discard.
- Practice, practice, practice. The brain needs a high level of exposure to hit the threshold for learning, mastery and retention of a new skill. Practically, this translates into a need to provide children with more talk and language experience to help them hit this threshold.
- Enough is enough. Too much training over the threshold does not lead to further learning gains. More research is needed to determine the optimal level of focused training needed to hit the threshold of a task.
- Two wrongs make a right. Taking breaks in learning leads to regression unless those breaks are filled with passive exposure. The greatest learning occurs when active training is combined with breaks of passive exposure. In practical terms, this could be translated to mean that children will learn more language when targeted therapy sessions are combined with bathing the child in language all day long.
Wright also noted that in her experiments she has contrasted auditory and visual learning, and found that if there is any competition between the two systems (for example, a subject is participating in an auditory learning task but gets visual exposure instead of passive auditory exposure during breaks), the visual system takes over almost immediately. If there is any competition between the two systems, vision will win. These findings have important implications for counseling parents on communication mode choice for their children with hearing loss, and strongly support an auditory-based approach to the development of spoken language, should that be the parents’ desired communication outcome for their child.
Emily Tobey, Ph.D., at the University of Texas at Dallas, School of Behavioral and Brain Sciences, gave a historical retrospective on hearing loss and language. Her presentation included a number of photographs and illustrations spanning Volta's first experiments in electroacoustic stimulation, to early oral training methods, to the creation of the cochlear implant. Cochlear implant technology, which once consisted of a computer "processor" that filled the entire wall of a room, is now small enough to be worn behind the ear. Just as technology has changed, so have outcomes for children with hearing loss learning listening and spoken language. Tobey shared the results of studies tracking speech, language and listening performance of children with hearing loss over time. Her studies indicated consistently better performance across a variety of measures for children who received cochlear implants at a younger age and who were enrolled in listening and spoken language intervention programs. Tobey stated that we begin to see physiological changes in speech output within 15 seconds of removing a cochlear implant. While it may take longer for these speech changes to become apparent to the human ear, this data provides a strong warning against feeling that "taking a break" from listening has no negative consequences for children who are learning to listen and speak.
Kate Gfeller, Ph.D., at the University of Iowa, School of Music, shared her research on music enjoyment among cochlear implant recipients. Cochlear implants were originally designed with the goal of accurately conveying the speech signal to people with hearing loss. Unlike speech, music contains a far greater range of sounds, and while it is the "rule" that one person talks at a time during conversations, during music, there are often dozens of instruments and voices making sounds together. Because of this, cochlear implant (CI) users have historically reported less ability to enjoy music than to comprehend speech.
Gfeller's work, however, shows that with practice, CI users can actually improve their ability to listen to music, and the benefits of this experience may extend beyond the simple pleasure of hearing a good song. Music is a social experience with the power to evoke deep emotions and connect us to our communities and our world. For children, music presents new vocabulary, often at a slower rate and with multiple repetitions, and enables them to participate in typical early childhood experiences with their peers.
The presentation included many tips for people with hearing loss on how to get the most out of a music listening experience. In Gfeller's analysis, the most salient parts of music for people with hearing loss are the rhythm and lyrics, so choosing music with little or no backing track (such as acapella) is a good place to start the rehabilitation process. Environmental modifications, like listening to music in a quiet room, choosing optimal seating at concerts and assistive technology, such as a DAI (direct audio input) cable or even headphones, can help improve sound quality. Today, the sound quality and performance levels achieved by cochlear implant users are such that learning to play an instrument, not just learning to enjoy music, is not out of reach for CI recipients. Gfeller recommended instruments with constant tuning, like pianos or percussion instruments, as being easiest for children with CIs to learn to play.
In Gfeller's many interviews on music enjoyment with CI recipients, she has identified a number of factors that contribute to success. She noted, though, that accuracy does not always equal enjoyment. Some CI users with good listening accuracy still do not enjoy listening to music, and others with lower accuracy like listening to music a great deal. Gfeller also noted that in her work she did not see statistically significant differences in music enjoyment between users of different CI brands and different processing strategies. Gfeller, a music therapist by training, encouraged attendees to consider music therapy intervention for children with hearing loss, but noted that a music therapist with experience in listening and spoken language is a must, and coordination between all members of the child's team (music therapist, listening and spoken language professional, audiologist) will lead to the greatest carryover of goals. Music enjoyment is within reach of people with cochlear implants. With practice, the brain is remarkably adaptable!
Click here to access the Research Symposium booklet.
AG Bell chapters play an important role in advocacy on many levels by working to support national initiatives, and also by being active in statewide initiatives to support individuals with hearing loss. Advocacy was a focus of the 2014 Chapter Presidents meeting at the convention, which shared strategies from two state campaigns to expand access for hearing aids.
Jeanine Gleba, recipient of the AG Bell Award of Distinction for 2013, shared grassroots advocacy tips that led to the passage of the 2008 New Jersey hearing aid insurance mandate. In another presentation, Kelly Jenkins provided an overview of a current initiative to obtain hearing aid coverage in Georgia through the creation of the “Let Georgia Hear” initiative she co-founded with Sara Kogon.
Jeanine Gleba was propelled to advocacy when her daughter Grace was born, and she found that her health plan would not cover the cost of hearing aids that her daughter needed to access sound and develop listening and spoken language. Gleba felt that early hearing detection and intervention were futile unless children could have access to the hearing technology that they need. Similarly, the motivation for Kelly Jenkins’ parent-led advocacy effort was her daughter Sloane, who is a ballerina, a gymnast, a horseback rider and a 4-year-old with bilateral hearing loss and pink hearing aids.
Currently, 20 other states have passed hearing aid insurance legislation and additional states have efforts underway. It is important to note that self-insured plans are not required to comply with state insurance mandates, although Medicaid already covers the cost of children’s hearing aids. In Georgia, hearing aids are not covered by the Affordable Care Act’s Essential Health Benefits plan.
Gleba became a “mom on a mission” and launched a nine-year advocacy effort for a hearing aid mandate in New Jersey which was finally passed in 2008 and named “Grace’s Law” after her daughter.
Gleba began her advocacy effort with little background knowledge about the legislative process, and encouraged those entering the advocacy arena to arm themselves with knowledge of the legislative process and an understanding of state politics. When communicating with legislators and staff members, Gleba emphasized that advocates must be accurate with facts, brief, reasonable and realistic, and above all, persuasive and passionate.
In Georgia, Jenkins created a nonprofit organization for the initiative, which allowed the organization to fundraise and garner the support of allied and related organizations that represent audiology, pediatrics, hearing instrument specialists as well as women’s organizations.
She encouraged advocates to be present in large numbers whenever a bill is up for a vote and to keep their cause on the radar of legislators, particularly those who are the primary sponsors of the bill who need to champion the cause and push for passage.
Both advocates emphasized the importance of networking and reaching out to those typically opposed to hearing aid insurance mandates to make a personal connection.
The key to all advocacy efforts, Gleba noted, is to get the word out and keep the issue alive. A business plan/position statement can help coordinate a multifaceted effort that integrates traditional media and online/social media as well as nonprofit support and personal relationship building to promote passage of the legislation.
Particularly effective strategies are letters to the editor of a local newspaper, social media, petitions, events and press releases. In all advocacy efforts, the two most important words that should be used frequently are “thank you” to legislators and to supporters for their efforts.
Above all else, both advocates noted that advocacy efforts are guided by patience and persistence and the knowledge that while a bill may not pass in the first legislative session it is introduced, dedication over time will result in a greater likelihood of passage.
The concurrent sessions were organized in six learning tracks: communication, educational/clinical management, living with hearing loss, professional practice, technology and learning labs. Below is a sample of some of the great information that was shared at the convention.
Harnessing Apps’ Potential
In a presentation titled “Explode the App!” Lynn A. Wood, M.A., CCC-A, LSLS Cert. AVT, and Dave Sindrey, M.Cl.Sc., LSLS Cert. AVT, invited attendees to consider the potential of apps to enhance listening, auditory skill development and spoken language. Many apps are powerful, creative, captivating and visually enchanting tools that have the potential to open a universe of books, games, music and entertainment for learning. With intentional planning and thoughtful guidance, apps can stimulate a child’s brain through listening, so that learning is caught not taught.
However, the presenters cautioned that many apps do not naturally provide opportunities for turn-taking and talking; back-and-forth conversation with mom, dad, siblings or peers; conversational skills such as beginning and changing topics or extended commenting; brainstorming with “popcorn” thoughts; and thinking out of the box—or the app. Further, the more time preschool children and babies spend with screens, the less time they spend interacting with their parents. Even when parents co-view, they spend less time talking to their children than when they are engaged in other activities. In short, there is a time and a place for technology and its use must be managed.
To avoid the trap of simply downloading apps and then letting the apps lead, Sindrey and Wood recommend “exploding” the apps to make them meaningful tools for listening and language development. Their criteria for good apps provide positive answers to the following questions:
- Is the app engaging and motivating?
- Does it teach the targeted content?
- Does it facilitate meaningful exchanges with a communication partner?
- Can the content be customized for its pace, repetitions, talking turns and background noise?
- Does it teach functional listening skills or language following accepted treatment principles?
- Can the app be a motivator or an extension for similar traditional themed activities or content to facilitate learning?
The presenters offered further considerations and guiding questions for parents, numerous examples of how to explode apps, plenty of specific app recommendations, and a plethora of auditory-verbal listening and language building strategies to incorporate when using apps with their children. Click here to access their informative and insightful presentation. Click here to peruse other insightful presentations from the convention.
Traveling and Packing with Hearing Loss
In another informative and practical presentation, “Travel Tips and Emergency Preparedness,” Tina Childress, M.A., CCC-A, covered traveling for people with hearing loss by plane, train and car, as well as assistive listening devices, packing, water protection, power supplies, lodging, emergency identification, and being prepared at home. Coming from the dual perspective of an audiologist and a late-deafened adult with bilateral cochlear implants, Childress’ passion to bring clear and understandable information to consumers and professionals was on display throughout her presentation.
For traveling by plane, Childress offered advice on everything from making a flight reservation and creating a traveler profile, to checking in, to going through the metal detector with hearing technology, to informing the flight crew and traveling companions about hearing loss status and need for accommodations. She provided similar detailed advice for traveling by train and by car, especially if unaccompanied.
Childress advises travelers with hearing loss to assume that their luggage will be lost if checked on a flight, so that they have an easier time answering the following question to themselves—What do I need to keep my hearing aid/cochlear implant going?—and pack these items in their carry-on. For cochlear implant users, these include charger (for outlet and for car), batteries, alternative power options, cables, earhooks, headpieces and a spare processor. For hearing aid users, items for the carry-on include batteries, charger (if using rechargeable batteries), earmold blower and cleaning tools for wax.
Click here to access Childress’ comprehensive presentation. Childress also provided her social bookmarking site containing hundreds of links related to hearing loss searchable by tags and categories. Click here to peruse other insightful presentations from the convention.
Ensuring the Validity and Reliability of Audiologic Tests
In “Reviewing Audiologic Test Results to Improve Management,” Jane R. Madell, Ph.D., CCC‐A/SLP, LSLS Cert. AVT, and Carol Flexer, Ph.D., CCC‐A, LSLS Cert. AVT, discussed what it means to have valid and reliable audiologic tests in order to maximize the quality of auditory input for children with hearing loss, so that they can achieve their best spoken language. Madell and Flexer emphasized the following main ideas:
- Establish the degree of hearing loss not for its own sake, but to assist in selecting technology and planning management.
- Whenever a test is used as part of a diagnostic protocol, the validity and reliability of the test are important because professionals are relying on the results of these tests to determine technological and therapeutic management.
- Behavioral and electrophysiological audiologic tests are valid only if professionals are using correct test protocols and interpretation, and using tests on appropriate populations.
- The whole point of technology is to get sound and spoken communication to the child’s brain. Children speak what they hear. If their speech is “distorted,” it is likely that the brain is receiving distorted sounds.
- Interpreting audiologic test results includes estimating the child’s performance outside of the test situation and making appropriate recommendations.
The presenters provided a number of important questions that audiologists, LSLS, speech-language pathologists and parents should be asking about pediatric audiologic testing. Click here to access Madell’s and Flexer’s presentation. Click here to peruse other insightful presentations from the convention.
Thank you to all attendees, volunteers, presenters, sponsors and exhibitors for making magic real and for advancing listening and spoken language for individuals who are deaf and hard of hearing. We look forward to seeing you in Denver, Colorado, in 2016! Visit the 2014 Convention page for other highlights from the convention, including video interviews with convention attendees.