Fatigue from Listening with Hearing Loss in School

Fatigue from Listening with Hearing Loss in School

 

Individuals with hearing loss must put forth more “listening effort” and cognitive resources to attend to auditory information, which can be exhausting. The repeated need for extra listening effort in challenging situations can lead to listening-related fatigue. For children, severe fatigue is associated with increased stress, poorer performance in school, and increased absences. Educators, audiologists, and other hearing health professionals can support students dealing with listening-related fatigue. Read on to learn about how to help your student avoid or recover from listening-related fatigue.

Fatigue is often described as being extremely tired, a lack of energy, and/or a lack of motivation to continue on with a task. Intuitively, we understand that we can get worn out from time to time, from both physical tasks (e.g., running) or mental tasks (e.g., focusing all day at work). It is very common to experience this type of fatigue and healthy individuals can bounce back relatively easily with breaks or recovery periods. However, for some individuals, fatigue can be debilitating, and recovery is difficult. This is concerning as long-term outcomes related to fatigue can be negative, affecting quality of life and work performance in adults. For children, severe fatigue is associated with increased stress, poorer performance in school, and increased absences. It can also be a precursor to mental health problems in adulthood.

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Fatigue from Listening with Hearing Loss in School

Fatigue from Listening with Hearing Loss in School

 

Individuals with hearing loss must put forth more “listening effort” and cognitive resources to attend to auditory information, which can be exhausting. The repeated need for extra listening effort in challenging situations can lead to listening-related fatigue. For children, severe fatigue is associated with increased stress, poorer performance in school, and increased absences. Educators, audiologists, and other hearing health professionals can support students dealing with listening-related fatigue. Read on to learn about how to help your student avoid or recover from listening-related fatigue.

Fatigue is often described as being extremely tired, a lack of energy, and/or a lack of motivation to continue on with a task. Intuitively, we understand that we can get worn out from time to time, from both physical tasks (e.g., running) or mental tasks (e.g., focusing all day at work). It is very common to experience this type of fatigue and healthy individuals can bounce back relatively easily with breaks or recovery periods. However, for some individuals, fatigue can be debilitating, and recovery is difficult. This is concerning as long-term outcomes related to fatigue can be negative, affecting quality of life and work performance in adults. For children, severe fatigue is associated with increased stress, poorer performance in school, and increased absences. It can also be a precursor to mental health problems in adulthood.

What does fatigue have to do with listening and children with hearing loss? Recent research has shown that even the “simple” act of listening and understanding can be exhausting. Individuals with hearing loss must put forth more listening effort and cognitive resources to attend to auditory information. The repeated need to expend effort to listening in challenging situations can lead to listening-related fatigue. For children with hearing loss, the school classroom and associated listening requirements can be fatiguing. We know that most modern classrooms can have poor acoustics with significant reverberation times and elevated background noise (challenge #1) and that students have to listen to multiple talkers throughout the day (challenge #2) while multi-tasking by listening and performing other functions, such as note taking (challenge #3). These factors, as well as others, may contribute to a child with hearing loss developing listening-related fatigue.

Children with hearing loss reported feeling physically and/or mentally tired as the result of noisy listening situations. Teachers reported increased distractibility and off-task behaviors compared to children without hearing loss, especially at the end of the school day. Parents noted several coping strategies, including removing amplification devices (e.g., hearing aids, cochlear implants), taking a rest/nap after school, and avoiding noisy social situations as methods to deal with fatigue.

Of course, not all children experience the same challenges or have the same needs. We are interested in determining which children with hearing loss are most at risk for significant fatigue so that we can help them clinically and educationally. To do so, we have been developing pediatric fatigue questionnaires that specifically target listening-related fatigue in children. First, we wanted to better understand the concept of fatigue from children with hearing loss, their parents, and their teachers by hosting focus groups and interviews. Example quotes obtained from participants in the focus groups follow on the next page. These responses, as well as others provided by the participants, helped us to write items (i.e. questions) for our fatigue scales. While analyses are ongoing, we hope to have the Fatigue Scales available online for widespread use later in 2021.

            “Yesterday we took a field trip to a museum. The gentleman was great, but he spoke so fast—she was still missing stuff in a very hectic environment. If things go really, really quick for her, I can tell it’s a lot for her. She has to make an effort and it wears her out.” –Parent of a child with hearing loss

            “When I get tired of listening to things, I just tell my friends, “I’m tired of listening to you, I’m gonna turn you down [turn volume down on hearing aids]. If you need me, tap me.” And I just do that for fifteen, thirty minutes.”–Teen with hearing loss

            “I must remember to give my student a break during one-on-one sessions. He needs a moment to not have to listen and to tune out. If he doesn’t get that break, his behavior is significantly impacted.” –Speech-language pathologist

Educators, audiologists, and other hearing health professionals can support students dealing with listening-related fatigue. Consider signs and symptoms of listening-related fatigue in your students. We found that many children did not realize they were experiencing fatigue throughout the school day. In fact,

Do your students complain of being tired or worn out more frequently than students without hearing loss?

Do they zone out or have trouble concentrating during long periods of listening?

Do they take their devices off throughout the day?

Do their parents note that they require listening breaks or naps after school?

If so, talk to your student about fatigue.

several adults with hearing loss told us that they could not articulate their difficulties with listening-related fatigue until young adulthood.

Students may need support to better understand challenging listening situations and how to advocate for themselves, if needed. Discussing this topic with parents, teachers, and administrators is important too. The students who participated in our study felt limited in their abilities to ask for interventions, such as breaks, because of the structure of the school day. It is important for the whole team to strategize best practices to support each student.

What will help your student avoid or recover from listening-related fatigue?  Although no systematic research has been completed on listening-related fatigue interventions, there are several considerations that may be beneficial for your students.

  • Assess the student’s listening environment. Look for ways to improve acoustics by minimizing background noise or reverberation in the space. Participants repeatedly reported background noise as fatiguing.
  • Provide accommodations, such as preferential seating, captioning, or note-taking by a peer. Anything that may help reduce effort while listening could be helpful for your student.
  • Review the student’s amplification use (both personal amplification and school-owned remote microphone technology). Although research on amplification and fatigue reduction is mixed, teachers reported that students appeared less fatigued when utilizing their technology consistently.
  • Employ good communication strategies (and encourage others to do the same). Participants reported that children got fatigued more quickly when others spoke too quickly or had their back turned. Ensure the child can see the person talking.
  • Review the student’s schedule. Many teachers said the students were worn out toward the end of the day/end of the week. If you can, schedule auditory-heavy content at the beginning of the day or at a time when your student can do their best work.
  • Counsel the student about fatigue. Discuss challenging listening situations and involve them in determining potential interventions or coping strategies to alleviate fatigue if it arises. Practice scripts so the child can appropriately ask for an intervention if needed.

  • Schedule “listening breaks” so the student can intentionally turn off from listening. There is no current consensus on the duration, frequency, or type of break required. Needs may vary based on the individual student. Suggestions from participants in our study included allowing the child to rest their head on the desk, take off their device for a short period of time, complete a leisure activity that does not require listening, or complete a movement break.
  • Be on the lookout for the Vanderbilt Fatigue Scales! Analyses are ongoing but we hope to have the assessments available online for widespread use later this year. Check our website for links to our publications and to keep up-to-date on the release date for the scales.
 
 

Hilary Davis is a pediatric audiologist at the Vanderbilt University Medical Center in Nashville, TN. She sees patients in the Bill Wilkerson Center, provides contract educational audiology services to local school districts, and collaborates on several research studies within the department. Her current interests are fatigue in school-age children with hearing loss and supporting educators as they work with students with hearing loss.

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Study Skills for Children who are DHH

Study Skills for Children who are DHH

Study Skills word cloud on green background

All Children need direct teaching of study skills so they can efficiently process the information they encounter in school. Executive function issues require direct teaching in study skills. Students with hearing loss can benefit greatly from strategies to help them stay focused on tasks to do. Read on for more about executive function and specific study skills strategies.

Study skills help us manage tasks. People with executive function issues need greater attention to study skills. Executive function refers to mental skills including1 working memory, flexible thinking, inhibition/self-control including controlled attention. Executive function is responsible for many skills, including:

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Study Skills for Children who are DHH

Study Skills for Children who are DHH

Study Skills word cloud on green background
Research2,3 indicates that healthy executive function skills do not require hearing. Age-appropriate language proficiency, whether in sign or speech, is crucial for the development of healthy executive function skills. The greater the language delay the greater the probable need for development of executive function skills. There is also research4 that indicates if a preschool child with hearing loss scores within the normal range in language skills, but exhibits executive function issues, it is predictive of subsequent language development issues.

All Children need direct teaching of study skills so they can efficiently process the information they encounter in school. Executive function issues require direct teaching in study skills. Students with hearing loss can benefit greatly from strategies to help them stay focused on tasks to do. Read on for more about executive function and specific study skills strategies.

Study skills help us manage tasks. People with executive function issues need greater attention to study skills. Executive function refers to mental skills including1 working memory, flexible thinking, inhibition/self-control including controlled attention. Executive function is responsible for many skills, including:

  • Paying attention
  • Organizing, planning, and prioritizing
  • Starting tasks and staying focused on them to completion
  • Understanding different points of view
  • Regulating emotions
  • Self-monitoring (keeping track of what you’re doing)

Students with hearing loss often have difficulty with many of the items listed above, secondary to missing part of communication messages and continually trying to catch up and keep up. Structure is often key to the success of our students, in terms of predictable learning routines and expectations. Yet, outside structure alone will not compensate for the extra organization and strategies our students need to keep pace with their peers. Below is a list of study skills in context to the broader areas of learning. 5

Activities Related to Learning Study Skills Strategies
Processing information
  • Graphic organizers
  • Comprehension strategies
Retaining and recalling information
  • Mnemonic strategies
  • Note-taking
Organizing materials and managing time
  • Time management
  • Materials organization
Selecting, monitoring, and using strategies
  • Self-regulation strategies
Strategies to Build Better Study Skills

The time-honored quotation, “When the student is ready, the teacher will come,” reassures that learning will happen when the time is right. Unfortunately, our standards for teaching and learning are not set up to patiently wait for that time!  Learning requires students to assimilate and generalize information in quick order.  For many of our students who are deaf or hard of hearing, the explicit teaching of study skills will help them become “ready.”

Learning styles, personality traits, interests, motivation, energy level – each student comes with a jumble of these variables.  Keep in mind these personal characteristics in determining which study skills to promote and practice.

Organizational Strategies

Organization is key.  Helping our students become organized begins at the earliest stages of development.  Review these tools for fostering language and cognition, the “pre-study skills” of a study skills curriculum.

Sorting and categorizing:  Emergent language learners are surrounded by disconnected sights and sounds. Structure the environment with items to sort (color, shape, size) or categorize in groups (types of animals, cars, toys).
For older students: group multiplication facts by number; group story events by beginning, middle or end; or group historical events by country or decade or impact.

Break it down:  Prevent the learning task at hand from becoming a drudgery by breaking it down into small parts. Those multiplication facts are overwhelming unless taken one number group at a time.  Drill and practice are most effective if kept in small doses.

Using a Planner: These come in a variety of shapes and sizes and are worthwhile aids for many students.  At best, they foster independent study skills.  At worst, they become one more skill to learn in an already overloaded heap.  Recognize what your student is capable of fitting into his or her study schedule and introduce sparingly.

Clean Workspace: No extraneous devices allowed! The first rule for students of all ages is to keep distractions at a minimum. Provide a designated area in the classroom or home that is well-lit, quiet, and dedicated to studying.

Comprehension Strategies

Study skills provide the framework for comprehension:  their strategies go hand-in-hand. Working on auditory memory to improve retention and recalling information is a natural goal when working with DHH students.

Retelling: Once we tell something in our own words, we begin to implant it in memory. Retelling is a powerful comprehension and study strategy when carefully matched to communication abilities, attention, and interests. Ask young students, “what happened?” and wait, patiently, for the response.  For older students keep your questions specific and structured: instead of asking, “What happened in school today?” ask for the details: “Tell me three new spelling words;” or “tell me 3 things that happened in science,” or “What are 3 things that happened in the story?” Start small and build on the responses.

Visualizing: Another powerful strategy to stimulate memory and learning is to provide students with visual cues.  Take full advantage of manipulatives, videos, photographs.  Language experience stories (pairing pictures with the steps of a science experiment or social studies chapter or fieldtrip) give students visual reminders.  If your only device is paper and pencil, a “quick draw” sketch activates memory and prompts conversation: “Did you actually see bugs in the science lab? Is that a molecule? What are these parts?”

Memorization:  Memorizing just for the sake of memorizing, without context, may be outside the sphere of critical thinking and learning, yet there are times when facts need to be memorized. There are ways to make memorization less tedious:  mnemonics (remembering a list of facts by the first letter of each word such as the names of the Great Lakes: “Super Man helps every one!”), flash cards, treasure hunt to find fact cards, rewards for progress goals, homemade game boards. The bottom line:  make goals achievable, make the activity fun, and make the reward worthwhile to the student.

Writing on paper versus typing on a screen: Researchers suggest that the physical act of writing on paper increases focus and critical thinking. Henriette Anne Klauser, Ph.D.6, believes that writing on paper triggers and 

activates the brain to “wake up!  Pay attention!”  Writing may seem tedious to students when curriculum has been centered on computers and tablets, yet It makes good sense to incorporate writing on paper as one of many options.

Taking Notes: Whether a student is writing on paper or typing on a de vice, the act of taking notes is a skill that requires practice. Provide note-taking materials and directions prior to a video or presentation and options (planner, targeted computer file, PPT handout, etc.) for filing and organizing the information when completed. Graphic organizers designed ahead of time can provide designated spaces for students to write down things to remember and learn. Use these notes to retell and reflect on the event so the purpose for taking them is recognized.

Graphic Organizers: These are invaluable in breaking down information, visualizing, organizing, simplifying, mapping. There is no need to rely on premade materials: simply draw circles or boxes to separate ideas, facts, number families, and there you have it!  Find patterns to copy online or use suggested graphic organizers below to adapt and personalize.

Motivation

The heart of self-determination is personal goal setting. The more you allow students to establish their own goals for learning, the more motivated and successful they will be. Writing personal goals gives students a sense of control, self-awareness, confidence.  Help your students set up attainable daily or weekly goals and use charts or graphic organizers to visually show progress.
Motivation to persist with any task relies on your student’s attention span. After five or ten minutes, take a break!  For students who need activity, give them a chance to move their bodies or run around the playground.  For students who need to be calm, do some coloring or painting.
Remember to provide rewards (tangible or intangible) for time spent on task even when learning the facts or concepts is not yet accomplished.  The primary goal of a study skills curriculum is to establish the routine of studying.  The mastery of information to be learned will be its own reward.

See some materials in Teacher Tools Takeout that relate to areas of study habits include:


https://teachertoolstakeout.com/search?insubgrp=all&q=setting+goals https://teachertoolstakeout.com/0715-specific-advocacy-strategies https://teachertoolstakeout.com/0748-specific-advocacy-strategies https://teachertoolstakeout.com/0842-multiple-meaning-words
https://teachertoolstakeout.com/0901-science-specific-language https://teachertoolstakeout.com/0980-visual-supports-reading

References:

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