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Behaviour management and wearing a CI

Query: I am a health visitor and am currently working with a three year old child who is deaf and I was hoping to gather some information to provide to mum. The child has recently had cochlear implants which he is starting to tolerate for longer periods throughout the day. He is making sounds and has a little sign. However, mum has concerns regarding his behaviour, particularly in relation to wearing his CI and how to manage this correctly. Would you have any information/advice/techniques I could offer to mum.?

Reply: We often get questions about behaviour and how to develop consistent all day use of hearing technology. I think the simple answer to questions about behaviour is it is all about communication – it is making sure we understand the child’s wants and needs and they understand ours. Developing that communication – however that works is central to improving both use of technology specifically and behaviour generally. Apart from that, deaf children have similar behaviour issues that a typically developing 3 year old has – so the same strategies will work – as long as communication is clear and it is understood by the listener.

In terms of wearing his technology -It is so important that this little guy wear his processors for all waking hours. For him to have the best opportunity to develop age appropriate listening and language skills this is key. This can be an exhausting time in the beginning for families as they feel they spend all their time putting them back on. The key to this is to be

1. Consistent – developing a routine that is consistent and reliable – the child quickly learns when it is expected.

2. Persistent – we have to be more persistent and stubborn than the 3-year-old

3. Unemotional – don’t show annoyance, sadness, stress

For developing good listening and spoken language skills then consistent device use is essential and you must treat processor use as you would any other non-negotiable decision parents make for their children: wearing a seatbelt, brushing teeth, going to the doctor, wearing a helmet when riding a bike as examples. Establish in the beginning that mum or dad puts the processor on and also are the ones to take it off at the end of the day. If the child removes the processor it needs to be replaced. If the child is really not tolerating it and wanting a break - then the parent should remove it for a short break time – if the child learns that they can take it off and it isn’t replaced they will continue to do this. In the very beginning it is the parents job, as the child grows up then it is important to develop self care of their technology but in these early days with establishing consistent all day wear then it is the carers job.

Being unemotional is equally important – the child could be removing the device or showing adverse behaviour for attention and they don’t really mind whether it is positive or negative attention. It is important to deal with it as matter of factly as possible without the emotions playing a part – this is sometimes easier said than done as we know that both the parent and the child can be feeling very emotional about the whole thing.

If you continue to have problems with wearing the device then you begin to go through the following things.

Is it pain? Cochlear implants should not be painful to the wearer ever.

Do a visual check of the child’s head and make sure that the incision site isn’t inflamed and make sure there isn’t a deep imprint in the skin of the coil indicating that there might be pressure on the scalp.

Check the area around the ear, where the processor sits, where the ear hook goes over the ear. Make sure that it is very red or rubbed – this may indicate that the ear hook needs adjustment. If you see anything out of the ordinary, call the clinic.

If the child has a pained reaction when you put the speech processor on even though nothing is obviously wrong to you, do a little experiment: put the CI on turned off. If the child still reacts as if he is in pain, then you know the cause is behavioural, not physical, in nature.

Is it programming? Is the child’s CI map current? If you have noticed any significant changes to the child’s responses let the clinic know. If you notice changes in responses to the Ling Sound check then let the clinic know about this change. If the child continues to refuse to wear the speech processor, a trip to the clinic is essential. It may just be a matter of adjusting the programming, decreasing the sensitivity, or making special programs for noisy environments.

Is it situational?

Is the child willing to wear the CI in some settings but not others? With some people, but not with others?

Take a few days and track times of speech processor use and non-use to see if you notice any patterns occurring? Often, we hear things like “He’s perfectly willing to wear the cochlear implant in therapy or at school but he refuses to wear it at home!” This is usually a clear indicator that processor refusal is a learnt behaviour. Kids are smart — they learn really quickly what they can get away with and how different people respond – just like they know who will let them stay up 5 minutes later or give in to an ice-cream. If, from day one the consistent message has been, “You wear your speech processor,” then the child doesn’t know anything different. If the message has been inconsistent then the child will pick up on that and behave accordingly!

Here is a link to some ideas to help with help establishing consistent use of technology.

Ideas to help keep technology in place

Posted on February 12, 2018 15:16

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