Kris English, PhD

The University of Akron/NOAC

Even the most family-centric audiologists can find themselves on a different page than parents on the topic of consistent amplification. One reason may be our training: we have been taught to emphasize the relationship between amplification and the development of speech and language. While true, it is also possible that families are not following our logic. In fact, logic may not be part of their reactions at all. At the moment, families’ uppermost concern may be centered around their child’s emotional development: Will our baby be happy? Feel safe? Will she know we love her?

Families intuitively want to nurture and bond with their baby, and hearing actually supports that process. But even as hearing is taken for granted, so are the effects of hearing on parent-child bonding. Our challenge is to align our communication with what families value, and be comfortable talking to parents about the importance of their child hearing “the love in their voice.”

Following are two topics: A brief summary of selected research describing listening skills in infants with no hearing loss, and then a suggestion on how help families use amplification for the express purpose of bonding with their baby. We can think of this process as “auditory imprinting.”

Babies are Born Listening

Babies hear their mother’s voice for many weeks before they are born, and after birth are ready to listen for mom at surprisingly sophisticated levels. For instance, Querleu et al. (1984) tested 25 newborns, all less than 2 hours old, by presenting recordings of five women speaking the babies’ names. One voice was the baby’s mother, and four voices were unknown to the baby. Three observers independently rated each baby’s reaction to each voice as nonexistent, weak, or strong. They found that when the babies heard their mother’s voice, they had strong reactions almost half the time. Not a robust finding, but remember, the babies were only 2 hours old but already telling us that mom’s voice is meaningful to them.

A classic study by DiCasper and Fifer (1980) found that not only does baby recognize mother’s voice, but actively prefers it to others. The researchers recruited 10 mothers to record reading from Dr. Seuss immediately after they delivered their babies (agreed, that alone is amazing). Their newborns were later placed under headphones before they were 24 hours old. After obtaining baseline sucking rates (using nonnutritive nipples and computer software to calculate rates per minute), the researchers presented recordings of mother and other women reading. Babies quickly learned they could control the input: when they sucked on the nipple at a rate lower than their baseline, that action would deliver an unfamiliar female voice. When they increased their sucking rate, they would hear their mother’s voice.  Once they learned the relationship between sucking rates and voice input, they consistently “chose” mother using an increased rate. Think about it: a 1-day old baby is capable of mastering an elementary lesson in cause-and-effect based on what he or she heard, and it is mom’s voice that facilitates that learning. Continue reading →

Kris English, PhD

The University of Akron/NOAC

Here is a thought-provoking experiment. Ask audiology students to visualize the first moments of a typical appointment with a new patient.  The patient sits down, and the audiologist says, “So what brings you here today?”  Got the image? Now freeze that frame! And then ask, “In this scenario, who has power: the patient or the audiologist?”

Interestingly, students tend to say, “the patient.”  When asked why, the explanations tend to recognize the patient’s power of autonomy: ultimately, a patient can and will decide whether to follow to our recommendations (Calman, 2004). A reassuring answer! But remember, I was referring to the beginning of the appointment, not the end.  It seems possible that we could overlook a new patient’s vulnerability, and be unaware of an initial state of powerlessness. If we are blind to it, we are not likely to take active steps to start shifting the balance of power in the patient’s direction (Goodyear-Smith & Buetow, 2001).

Empathy 101 and Power.  To understand what powerlessness feels like from a patient’s point of view, let’s put ourselves in their shoes. Before and during our first appointment, we would have many questions, and experience some anxiety, worry and doubts. We would have absolutely no idea what to expect. We would see unfamiliar technology, framed diplomas and licenses hanging on the wall, and models of strange anatomy sitting on shelves. We would see brochures and posters about new hearing aid technology – something we have been avoided thinking about, and now it’s “in our face.” At this moment, we have little going for us – except for our unique story. This is a type of latent power: our story is valuable but it will have no impact if we are not given an opportunity to share it.  Is anyone interested?

Across from us is the audiologist, Dr. Somebody, with a white coat and specialized training and expertise. Dr. Somebody will determine how we start the appointment, what steps we take along the way, and how we conclude the appointment. It is reassuring to have an expert take the lead; it’s why we made this appointment in the first place. But it does means that we are still relatively powerless.  Will it always be that way?

Initially, there is an inescapable power inequity in the patient-clinician relationship, a situation not unique to audiology. Palmer (1998) notes that “Virtually all professionals have been deformed by the myth that we serve our clients best by taking up all the space (i.e, holding all the power) with our hard-won omniscience…” (p. 132). Continue reading →