What’s on Your Mind? By Michael A. Harvey

A power struggle with a teenager over hearing aids. Is it hopeless?

 Dear Dr. Harvey,

 My 15-year-old son is severely hard of hearing but won’t wear his hearing aids. His audiologist said that they would help him in school and that he is missing a lot of what goes on in his classes. His father and I have bribed him, threatened him and begged him to use his hearing aids but nothing has worked. He says only that they don’t help and that he doesn’t want the other kids at school to make fun of him. He looks depressed but says everything’s fine. I would be grateful for any suggestions you may have.

SP, Toledo, Ohio

Dear SP:

 Let me say at the outset that successful psychological adjustment to hearing loss, particularly for adolescents, is not as simple as using hearing aids. However, you certainly have a very valid concern, and, unfortunately, your frustration is shared by many other parents as well as professionals. So-called “nonadherence” to treatment is, in fact, the norm and occurs regardless of age, race, gender, and disease. There is general consensus that most people are unable or unwilling to accept and adhere to medical advice. Between 30 percent and 60 percent of patients are totally nonadherent to medical advice, and between 50 percent and 75 percent of patients fail to take medications properly.

Adolescence presents special challenges. It has been aptly said that “adolescence begins when children stop asking questions, because they know all the answers.” But this is a half-truth. Often their “know-it-all” persona (e.g., your son’s proclamation that hearing aids don’t help), doesn’t match their internal uncertainty. Adolescents may appear overly confident and even rebellious because they are privately quite unconfident; because they, in fact, do not know the answers that everyone around them seems to know.

     An odd paradox, one particularly relevant to adolescents: It is often harder to do something good for yourself when so many others are trying to convince you.One feels powerlessness and perceives adult power as arbitrary, with no invitation for collaborative decision-making.

Adolescents who are hard of hearing are intimately familiar with feelings of powerlessnesswhich inevitably leads to shame -- the perception that their disability thwarts not some aspects, but all aspects of their lives. Adolescents often lack the cognitive tools to figure out what attributes are affected by their disability and what attributes are left untouched.

Consider one 16-year-old, high school student who is hard of hearing and who had been fitted with hearing aids but refused to wear them. Sound familiar? Paul finally agreed to an initial meeting in my office. Midway through our session, he excused himself to go to the bathroom. But instead, he bolted straight to his mother’s car and refused to come out, even though, under the hot, humid, afternoon sun, it was certain torture. His mother later told me that he didn’t understand something I had said, and couldn’t bring himself to ask for clarification. Paul felt that he had no internal resources or outside support to protect him from the shame arising from reduced speech discrimination. I imagined him drawing a picture of himself with a body one-inch tall but with ears having a diameter of over one foot. Shame is perhaps the most potent form of torture.

Adolescents who are hard of hearing, like Paul, and perhaps your son, are lost in an abyss between their internal experience of shame and their external persona of omniscience/omnipotence. Neither view is tenable. It is what cognitive therapists call “all or nothing” thinking, “know-it-all” verses incompetence. Paul bolted from our session because to admit that he didn’t understand me would cause not just embarrassment or even guilt, but would catapult him into the dark, murky abyss of shame. Better to be imprisoned in his mother’s car.

Now let me address your concern about hearing aids. After several months of negotiations, Paul agreed to more meetings (the proximity of McDonalds helped). I told him (correctly) that my wife and kids often accuse me of mumbling and that we should plan for such occurrences. During another conversation, he admitted that, if he were able to better understand the speech of his teachers and classmates, he would learn more, but quickly added that, “Reading doesn’t matter because I’m gonna fish all my life.” More rebellion.

I beckoned him to my computer, went on line, and accessed various websites devoted to fishing: “Is life found at all depths in the ocean? How many fish species are there? Which is the oldest fish, as a class? What is an anadromous fish? A catadromous fish? Can fish swim backwards?” He was intrigued. (I was bored, as I hate fishing.)

One day I proposed the following experiment:

“You will wear your hearing aid every day at school, at least for the next month. But every morning before you wake up, your father will flip a coin, which will determine whether or not he’ll remove the battery. Neither you nor your teachers at school will know if the batteries are in.

 “Every day during this month, you and your teachers will fill out a form and estimate what percentage of classroom conversation you’re able to understand. At the end of the month, we will correlate which days your batteries were in your hearing aid with your and your teachers’ estimations of how much you understood.”

 Without getting lost in research paradigm issues, the point here is that the power struggle of whether or not to wear hearing aids was avoided in favor of a collaborative dialogue which had elements of fun and curiosity. We found a way to have a dialogue which included hearing loss but wasn’t limited to it. But to complete the story, on the 16 out of 30 days that the hearing aid battery was installed, Paul and his teachers rated his understanding as 73 percent and 54 percent, respectively; and on the off days, Paul and his teachers gave a rating of 65 percent and 32 percent, respectively.

Did he live happily every after? Of course not. It is never that simple. Paul only wears his hearing aids sometimes, (almost routinely when his biology teacher lectures about fish), and he still engages in the same kinds of conflicts with his parents, in part, because his self-identity still depends on rebellion. But there has been progress. And he has begun to hang out with some peers who are also hard of hearing -- which is an absolutely essential part of healthy adjustment. Many hard-of-hearing persons report feeling stuck between the hearing and Deaf worlds. 

Collaborating with your son in some kind of activity (hopefully more interesting than fish was for me) which is affected by, but not limited to, hearing loss/hearing aids “stuff” may be helpful. Try to avoid a power struggle that will result in a lose-lose outcome. Bribes, threats and begging often do not lead to true attitude and behavior change. Such collaboration is not an easy process to be sure, but we have all strived to achieve it, at one time or another.

 Michael A. Harvey, Ph.D., is a noted author and psychologist whose specialty is psychotherapy for persons with hearing loss. He regularly lectures both nationally and internationally, including at several SHHH Conventions over the past 20 years. In addition to a private practice in Framingham, Massachusetts, he holds adjunct faculty positions at Boston University; Pennsylvania College of Optometry, School of Audiology; and previously at Gallaudet University.

 

We welcome your questions about psychological issues of hearing loss for possible use in this column. Please send them to: “What’s On Your Mind?”, 7910 Woodmont Avenue, Suite 1200, Bethesda, MD 20814.

     Or e-mail them directly to Dr. Harvey through his website at www.Michaelharvey-phd.com. Please let us know if you wish to remain anonymous should your letter be printed.