Typically hearing loss is a problem we associate with the elderly, or perhaps with long-time operators of heavy machinery. Rarely do we think of it in conjunction with children and teens, and even when we do, we tend to assume that the disability has existed since birth.
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This, however, is not always the case. Children can lose hearing during their teenage years, sometimes with very little warning. Although the causes differ widely, as do their physiological effects, even the partial loss of a sense vital to communication and human interaction can be devastating to teens, who already suffer from social and emotional trials at this time in life.
Understanding the causes of hearing loss is therefore important, but perhaps more important is understanding the psychological effects this can have on a teen. Only with a firm grasp of how hearing loss affects identity, social interaction and emotional well-being can parents, teachers, speech therapists, psychologists and others hope to help teens adjust to their circumstances.
The following account attempts to paint a portrait of teenage hearing loss, complete with possible causes, distinctions between various types of hearing loss, and the role of speech and hearing in social identity. We will use these components to arrive at conclusions about the psychological impacts of hearing loss in teens, and offer a few suggestions for those hoping to help a student, patient or loved one.
Hearing loss may be due to problems in the inner ear, problems in the outer parts of the ear such as the ear canal, middle ear and ear drum, or a combination of the two. Although a wide range of situations can result in hearing loss, a brief sampling of possibilities includes
- Congenital defect
- Ear infection
- Autoimmune diseases
- Head trauma
- Exposure to loud noises
This last issue is particularly salient to teens these days, as more and more people listen to music for extended periods of time using earbuds. These devices put sound much closer to the eardrum than do headphones, while simultaneously doing a poorer job blocking background noise, explains the Sutter Health Palo Alto Medical Foundation. This in turn encourages kids to turn their music up even higher in an attempt to block it out. Plus, now that MP3 devices can hold so much music, people are now listening to it for longer stretches than ever before, including when they sleep.
The results are grim: 12.5 percent of children between 6 and 19 years of age suffer from some degree of hearing loss, according to the American Journal of Pediatrics. Of course, music is not the only reason a teen may experience hearing loss, but it is a sadly prevalent one.
A brief note before continuing: In order to cover the widest possible range of situations affecting teens with hearing loss, this article will assume that teens either started with a normal degree of hearing and lost it sometime during their teenage years, or began life deaf and have now grown into their teenage years already well versed in the disability. However, since the latter group has a distinct edge over the former in terms of a presumably already established community of other deaf teens, as well as many years to adjust to the circumstances, many of the heaviest psychological impacts discussed within this paper will focus on children who lose their hearing during their teenage years.
Where appropriate, the paper will distinguish between the two possible situations. Where no distinction is made, we can assume that teens who have recently suffered hearing loss and those who have lived with it for a significant amount of time are similarly affected as regards the topic at hand.
Hearing is not an absolute sense. Like vision, which slides along a scale from excellent to good to poor to nonexistent, hearing also ranges. Hearing loss begins with the inability to distinguish softer noises, such as the hum of a refrigerator or the sound of birds chirping. At this level of hearing loss, the quieter parts of speech also begin to slip: Fs, Ss and Ths, which have no “voice” behind them but rather are sibilant in nature.
With moderate hearing loss, the sufferer loses the ability to hear spoken words at all, as well as louder noises like a vacuum. The piano quickly follows. With severe hearing loss, normally loud sounds like motorcycle and semi-truck engines go, and as the spectrum approaches and reaches total deafness, even concussive sounds such as the noise of a drum set, a helicopter prop and a gun report are lost.
It goes without saying that different levels of hearing loss result in different psychological effects. While a thorough treatment of the effects attendant on each level of loss is beyond the scope of this paper, we may sum up this point by saying that with each level of hearing loss, the sufferer loses another tie to the world and the sounds upon which it relies.
For instance, although mild hearing loss may make it difficult to converse in a crowded and noisy environment (say, in a cafeteria or at a football game), it likely will not cause the kind of lasting psychological trauma that severe or total hearing loss would. Once hearing is gone completely (or if a child is born that way), many of the activities of hearing teen life must be altered or accommodated: team sports may become more difficult, classroom learning requires the use of an interpreter and likely special classes, and social activities may change.
Such problems, however, are still somewhat superficial compared to the deep cultural importance society attaches to hearing, usually without even thinking about it. In the next section we will examine the role hearing plays in interpersonal relationships.
An informal survey would likely reveal that most people would rather lose their hearing than their sight. This cultural perception can lead to the related, but not necessarily justified, assumption that hearing is “not all that important,” and that although the situation is a bummer, sign language will fix much of the damage and allow a person to lead a mostly normal life.
At risk of being pessimistic, it is important to realize that sign language is not a total replacement for speech. While it is a valuable and excellent means of communication in its own right, hearing loss causes people to miss many of the audible social cues that hearing teens rely on to interact with others, make decisions, forge personal and social identities, work and form relationships.
Humans are adept at gathering information about their fellows, and voice actually plays a significant role, according to Robert M. Krauss and Jennifer S. Pardo of Columbia University in their study “Speaker Perception and Social Behavior:
Bridging Social Psychology and Speech Science.” Perhaps surprisingly, they explain, people are only marginally less successful at judging a person’s height, age and sex by listening to a two-sentence clip of their voice than when shown a photograph. And while voices may provide a wealth of physical information, they also provide a valuable social marker: Hearing people are capable of recognizing dozens of voices.
This is perhaps less important in the “melting pot” that is modern, developed world society, but dialects can still offer meaningful insight into a person’s background that visual cues alone cannot.
A speech register is a way of speaking. Most people have several, varying from whether they are in a formal or informal situation, or whether they are at work or at home. At work, for instance, they might adopt complex lingo to help them engage with coworkers in a meaningful and efficient way. At home, they may adopt a different way of speaking to interact with children or a spouse. Often the registers of those around us will clue us into the exact nature of a situation. A boss may loosen up after several hours at a work event, for instance, letting us know it’s okay to do so as well; a teacher may require a heightened level of formality on a particular day because they are being observed. To the teen with hearing loss, these are clues that may be missed entirely.
Psychologically speaking, internal state is the most important piece of information conveyed by the spoken word. While theoretically a teen could see physical characteristics and gather register from the setting, and while dialect may not prove that important to day-to-day interaction, the ability to recognize internal state is socially very valuable.
Speech is often laden with emotion, and as the authors of the above study explain, even a small sample such as the word “Hello” can contain enough information to inform the listener about the speaker’s emotional state. While facial expression also conveys some of this same information, and while sign language adeptly contains meaning, valuable social cues are still lost when a person cannot hear.
At this point it is important to note that language as a concept also plays in to the psychological effect of hearing loss. As cited in “Electronic Communication by Deaf Teenagers,” a study conducted by Valerie Henderson, Rebecca E. Grinter and Thad Starner at the Georgia Institute of Technology, children who are deaf from birth and born to hearing parents suffer considerably in the spheres of language and short-term memory acquisition.
While hearing children are able to interact with hearing parents on a daily basis, and the same goes for deaf children with their deaf parents, deaf children of hearing parents do not benefit from the same seamless language interaction. This results not only in “incomplete language models,” but in a 4th-grade reading level by the age of 17 or 18.
Teens who experience hearing loss once they’ve already reached their teenage years, therefore, have a significant leg up developmentally, even if the resulting psychological impacts are initially more severe.
In the following sections, we will discuss specific emotional, social and educational results of hearing loss in teens, as well as the more specific psychological impacts stemming from each. It is once again worth noting that while teens who have been hard of hearing or deaf since birth do suffer some sense of isolation and “differentness,” the significant increase in adjustment time as well as the development of a culture of support throughout their life does limit these impacts for them. Formerly hearing teens, who are forced relatively suddenly to adjust to hearing loss, may feel these impacts far more acutely.
However, it is also worth noting that simply because a teen has experienced hearing loss from a young age does not mean that they fail to notice their “differentness,” nor that they do not experience the feeling of missing out. Therefore we may safely apply each of the following impacts to both situations.
Whether or not children are able to skip the negative effects of early deafness on short-term memory building and language acquisition, hearing loss of any type has significant impacts socially, emotionally and educationally. Although the list of detrimental effects of hearing loss is too lengthy to cover here in its entirety, this section will lay out some main emotional, social and educational concerns. In the following, closely related, section, we will explore how these more factual results in turn produce psychological results.
Misunderstandings come in two main forms. The first group is that which occurs between a hearing individual and a hard-of-hearing or deaf individual. According to the National Register of Health Service Psychologists (NHSP), such misunderstandings can include responding inappropriately to hearing individuals, failing to respond at all, or misunderstanding the words spoken by a hearing individual. Such situations often arise when a person is losing their hearing and finding it hard to admit that is the case, thus struggling through interactions as though they were normal. In turn, such misunderstandings can lead to social awkwardness on the part of the person experiencing hearing loss, such as:
- Watching people’s mouths intently
- Asking people to repeat frequently
- Looking puzzled
- Turning televisions and radios to inappropriate volumes
- Talking too loudly or softly
While acknowledging that hearing loss is a problem can help, many people find it hard to do so.
The second set of misunderstandings takes the form of beliefs that hearing people hold about the deaf and hard-of-hearing, and can cause strife when trying to communicate. Teens who do try to adapt to hearing loss through hearing aids, lip-reading skills or sign language often run up against the limitations of all three.
Firstly, explains the NHSP, hearing individuals often assume that “hearing aids function much like eye-glasses, returning the user to something close to the equivalent of 20-20 hearing.” This is not the case. Rather, hearing aids amplify all sounds, so that even when wearing one, a hard-of-hearing individual may still have trouble distinguishing a voice from background noise. This misunderstanding can lead hearing individuals to assume that the person is “back to normal” when in fact they are not.
Secondly, hearing individuals assume that the hard-of-hearing immediately magically attune their other senses to be able to perform such feats as lip-reading, when in reality this is a learned skill that many are not naturally gifted with. Luckily for teens, they do not often suffer from the poor eyesight that makes lip reading difficult for the elderly.
Thirdly, hearing individuals may assume that sign language stands in completely for spoken language. However, as made clear by Krauss and Pardo, this is only a partial substitute. And in the case of people who do not know how to sign, it is not a substitute at all.
The inability to communicate on a spoken level is a significant impact of hearing loss in teens, and results in quite serious psychological impacts. Lacking the ability to converse with a teen with hearing loss, many peers will, often unintentionally, create distance between themselves and the hard-of-hearing teen simply because it is too difficult to communicate.
Unfortunately, the majority of people with whom the hard-of-hearing teen formerly interacted will likely not learn sign language in order to continue to communicate effectively with the affected teen. Rather, those relationships will probably be lost. Over time, attrition will probably eliminate the majority of the relationships the teen formerly experienced. Sad to say, even many family members do not bother to learn sign language, especially if they are not living at home at the time of the hearing loss, and therefore cannot be as close to the teen with hearing loss as they otherwise would be.
Even where teens have experienced hearing loss for some time, and have formed communities based around individuals with similar disabilities, they may still find themselves unable to form relationships with the larger groups that teens value.
Even teens who do not have full or even severe hearing loss may find their ability to learn impacted. Most teachers in traditional middle and high schools unthinkingly engage in many habits that do not affect the majority of their students. These include
- Pacing or turning while speaking
- Talking with their back to the classroom
- Writing on the whiteboard or blackboard
- Bending down while speaking
- Speaking while walking around the room or passing out assignments
- Talking while creating other noises (rustling of papers, stacking of books)
- Taking classes outside
While none of these habits is damaging to a student with normal hearing or only mild hearing loss, teens who are experiencing more severe levels of hearing loss can be greatly affected by such simple interruptions to the normal flow of language. Especially as hearing loss becomes more advanced, and students start to rely more and more on lip reading and contextual clues, traditional teaching styles may prove less and less effective.
Eventually, learning will be all but halted until the teen gets help compensating. This can take the form of classes only for the hard-of-hearing or deaf students, an interpreter in the classroom, or modified lessons to help make learning easier.
Inability to Perform Accustomed Tasks
This especially impacts teens whose hearing loss is more recent. While children who have grown up from infancy without the ability to hear are more used to their disabilities, teens who experience hearing loss later in life often try to continue “business as usual,” with often frustrating results. Team sports, music, even household chores may all become more difficult, if not impossible.
While we might think of the above impacts as “surface-deep,” in that they affect how hearing loss might change a teen’s world on the outside, the following psychological impacts attempt to shine light on how hearing loss changes the internal environment.
Losing verbal communication – the root form of communication used by the vast majority of humans on Planet Earth – can present a staggering psychological shock to the hard-of-hearing or deaf teen, especially if the loss is new. This shock, and the attendant inability to do many of the things most people take for granted, can manifest in a variety of ways psychologically.
Difficulty making sense of physical environments often goes hand in hand with hearing loss. So much of human endeavor relies on sound to convey meaning, and losing this sense or being born without it inevitably omits a teen from a wider realm of understanding than can possibly be available to them without hearing. The result is often confusion, not only on an emotional level, but on a purely physical one.
Consider the case of a teen trying to cross the street. Even if they look both ways and check that the intersection is clear, they may miss vital cues that would warn a hearing person to stay put. A siren, for instance, can indicate that while the street is clear and the walk signal says go, a large vehicle may soon appear around a corner. A honk can indicate that despite careful checking, the person has missed a vehicle on the go. Such missed signals can result in injury or death.
This is an extreme example, of course. Most deaf teens are not at risk of death by speeding ambulance, but the point remains: Auditory signals inform our world, and missing them can limit understanding and cause confusion. Moreover, awareness of these limitations can cause concern, anxiety and fear, as the teen with hearing loss begins to doubt himself or herself.
Emotionally, and as a response to their changing social situations, teens may begin to check out of their physical environments. For the teen who has been deaf his or her entire life, this may take the form of isolation from peers who can hear, and therefore relate to one another on a different (and sadly, often better) level than they relate to their non-hearing peer. For the teen whose hearing loss came on later in life, this can mean gradual distancing from the hearing peers with whom they used to interact.
Teens may also check out of their environments in more physical ways. If they discover that trying to make sense of a pep rally, a lesson, an outdoor environment or another situation is too difficult, they may stop trying even in situations where it isn’t.
Loss of Self-Reliance
This can result in a loss of self-reliance. Teens who are used to learning more and more as they grow older, but suddenly have to take a giant step back in what they are able to do, may be shaken to the core by this sudden change in circumstance. It can make them doubt themselves, finding it hard to rely on inner strengths even where they do have them.
Hearing loss can initially lead to serious emotional isolation and a sense of loss and aloneness, especially as peers and even family members step back as a result of being unable to communicate.
This initial isolation may last until the teen reestablishes social balance, possibly finding friends who are deaf or hard of hearing, learning which of their hearing peers are still willing to interact, and discovering new learning communities that fill them with satisfaction rather than the helplessness that can result from difficulty learning in traditional environments. As teens adjust to circumstances (whether this means adjusting to a recent hearing loss or adjusting to the trials of middle or high school despite long-time hearing loss), they may become more outgoing and build comfort communicating.
It is worth noting that hearing loss does not result in the abandonment of typical human communication instincts. Henderson, Grinter and Starner note, for instance, that if deaf individuals wish to communicate with someone whom they know to be nearby, they will still seek them out rather than use an alternate or electronic means of communication. This points to a willingness in teens with hearing loss to adjust their new skills to fit old paradigms, which in time may help them adjust in the ways most likely to preserve old relationships and make new ones.
Loss of Identity
Isolation may lead to a shift in the teen’s social and emotional approach to the world and to themselves. Teens with hearing loss who are unable to engage on the same linguistic levels as their peers – talking, joking, picking up social cues – may initially lose the sense of identity they got from interacting with peers. Similarly, many traditional aspects of school life may lose their appeal if the deaf teen is not able to make sense of them or enjoy them as they may once have done, which may eliminate aspects of their identity they considered valuable: the musician aspect, for instance, or the sports aspect.
While the impact may initially be seen by the teen experiencing hearing loss as a negative one, in time the teen will likely develop new skills and interests, which can help replace this loss of identity with new components. The loss of former communication styles will also encourage teens to seek out other individuals who can communicate on their level. This can result in a rebuilding of identity that can be more powerful than the initial identity, if the teen feels supported and surrounded by individuals who understand and help rather than hurt and limit.
Learning to communicate with teens who are experiencing or have experienced hearing loss can be difficult, especially as those who love or wish to help them undoubtedly hope to avoid causing additional psychological stress. A full treatment of the subject is not within the scope of this paper, but the South Carolina Hospital Association recommends a few steps for communicating with teens with hearing loss:
- Get the person’s attention before speaking and cue them into the topic of conversation before beginning
- Speak slowly and clearly while looking at the individual if you are relying on lip reading, and do not cover your mouth with anything
- Make eye contact and speak directly to the teen with hearing loss, whether or not an interpreter is involved
- Use body and facial expression as well as gestures to supplement the discussion
- Ask open-ended questions to encourage longer responses than “yes” or “no,” which will help ensure understanding
- In groups, invite the deaf or hard-of-hearing individual to choose the best seating for communication
- Slow down, don’t pace, and don’t use unfamiliar words
- Be respectful, and don’t speak loudly, overly slowly, or with exaggerated enunciation, which only distorts the position of the mouth so that words become less, not more, recognizable
- Treat the interpreter, if using one, as a professional deserving of respect and courtesy
- Keep in mind that “deaf” and “hard-of-hearing” are different, and that teens may react differently to these situations (for instance, a hard-of-hearing teen may be sensitive to a noisy environment that a deaf person wouldn’t hear)
- Use written communication where helpful, but always remember to face the teen to engage in real communication
Unfortunately, it is not possible to completely undo the psychological damage caused by social distance and isolation, emotional turmoil and learning difficulty. However, several steps may help to create a more positive outlook after suffering hearing loss.
Foster a Sense of Self
Many teens with hearing loss suffer from a lack of ability to identify with themselves as a hard-of-hearing or deaf individual. Disabilities cause serious problems in social and emotional life, and greatly impact the ability to engage in activities and duties that the hearing take for granted. It is therefore helpful to foster in the teen a sense of self that incorporates the disability, and possibly even creates positive associations with it.
Help the teen find new interests to which hearing loss is not a barrier. Perhaps they can no longer play piano, or cannot star on the football team now that they can’t hear snap counts, but chess and writing require no hearing. Introducing the teen to a range of new activities can help them find those they love, that bring peace and meditation, and that help them to see themselves as valuable individuals who have something to offer the world in spite of the disheartening disability.
For readers, it may help to introduce literary characters who are deaf or hard of hearing. While it may be difficult to find students at school who share their issues, the Slideshare presentation Adolescent Literature with Deaf Characters highlights a wealth of young literary characters suffering the same fate. In some ways, literary characters offer even more insight than peers do, as teens may get to know them and meditate on the themes presented in private.
Moreover, teens with hearing loss may discover that they still enjoy a wide range of activities that their hearing friends participate in. Some sports rely heavily on visual stimulus and input and so are still possibilities for the hard-of-hearing, while board or computer games, or other pursuits that rely heavily on limited communication, close proximity and a high degree of visual interaction are still very accessible to teens with hearing loss.
Build an Understanding Community
One of the most important steps toward learning to live a meaningful life with hearing loss is building a community of people who understand exactly what the teen is going through. Conferences such as the American Society for Deaf Children’s Annual Event or Deafhood Youth Northwest help students interact with deaf peers, but perhaps more importantly, they build self-identity as a valuable teen with hearing loss. Support groups for teens who are deaf or hard of hearing also exist, and many school districts offer rich curricula to teens with hearing loss.
Learn to Communicate
In the initial time after hearing loss, or in the first few years of adolescence for kids who have lived with it their entire lives, communication is compromised. Whether due to the hearing loss itself or to changing bodies and hormones, it becomes more difficult to achieve understanding. Working toward it is one of the primary ways to help teens adjust to hearing loss.
Teenagers need space to work out issues, meditate on problems, grow and be by themselves. This does not change simply because the teen experiences hearing loss, or because they have grown up with it. Although some aspects of self-reliance may be compromised, it is important to let the teen decide which aspects those are rather than enforcing help in ways a teen does not appreciate.
If a teen has recently experienced hearing loss, you should also expect them to need space to adjust to the circumstance. It will not happen overnight, and the psychological impacts detailed above may persist for a while. The best thing to do is to allow these feelings to run their course so that they can morph into new personal insights.
Only by respecting the psychological damage inherent in hearing loss can parents, teachers, family members, counselors, friends and others enable the teen with hearing loss to move on to a new and more fulfilling identity, one that embraces rather than rejects the disability.
Careers Helping People with Hearing Loss
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… Electronic Communication by Deaf Teenagers … Valerie Henderson, Rebecca E. Grinter, and Thad Starner … Georgia Institute of Technology GVU Center, College of Computing