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“Mind the Gap”

It’s that time of year again when our young patients have gone back to school! Although we try to provide them with all the equipment and skills that they will need to excel in the classroom, as our patients grow into teenagers, it can be increasingly difficult to know whether we have adequately prepared them for the challenges that they are going to face. In order to help us explore this topic, we asked Professor Kris English, PhD from the University of Akron/NOAC to give us some tips and resources to help us with this challenging age group of teens/pre-teens. We would like to express our gratitude to Kris for her support and enthusiasm while writing this newsletter.

The title “Mind the Gap” sounds familiar. What does it mean?

It refers to a sign found everywhere in the London Subway system. The phrase cautions passengers to pay attention to the space between the station platform and the train (Figure 1). A very helpful reminder in a literal sense – but it’s also used figuratively, and in this article, I’d like to discuss how to “mind the gap” between audiologists and teenage/pre-teenage patients.

Fig 1

Readers know that, quite often, audiologists and teens stand on two sides of the “hearing aid/FM use” gap. Audiologists are keen to see teens and pre-teens with hearing loss use their hearing aids full-time. Our patients, however, often decide not to adhere to this recommendation. The opposing positions create tension, leaving audiologists feeling frustrated and patients feeling angry and unsupported.

How to mind this particular gap? Teens are not known for their gregarious nature with adults, so we need to consider how we share the “talk time.” Estimate the amount of minutes given to the patient to carry the conversational ball; it’s quite possible we do virtually all of the talking.

How can we change the proportion of talk time, and engage teens in potential “change talk”?

Instead of attempting to establish a rapport with this age group, we might strive to develop “common ground.” Although these concepts may sound interchangeable, in clinical settings developing common ground means a concerted effort to exchange perspectives specifically to help each person understand the other’s views. Until we know what a teen’s views are regarding his or her life with hearing loss, we can’t expect to be trusted, and we will not be made privy to specific dilemmas.

One way to open up conversation would be to consider using the “Self-Assessment for Communication – Adolescents” tool (Appendix A), adapted by Judy Elkayam, AuD, Educational Audiologist. This self-assessment tool focuses the discussion on hearing loss, but gives the teen control over how it will be discussed. Filling out a paper-and-pencil tool and then discussing one’s answers leads to more self-disclosure than a face-to-face query. In brief: the audiologist asks the teen to expand on the recorded answers (i.e. tell his/her story); the teen describes personal experiences; the audiologist attends to the personal story with respect and a disinclination to rush to the rescue; the teen perceives someone is paying attention and cares. Why does this last outcome matter? Because "people almost never change without feeling understood" (Stone et al., 1999, p. 29). When teens feel understood, maybe they will consider change. If not feeling understood, they almost certainly will not consider change.

What other materials are available to help audiologists develop common ground with teens?

Audiologists know that teens need to develop strong self-advocacy skills in their very near future. A “common ground” activity can involve using a curriculum on self-advocacy (English, 1997), wherein teens can develop a knowledge base needed for their adult lives. The curriculum can be found on the following four links:

Unit 1: What is Self-Advocacy and Why is it Important?
Click here to view: http://gozips.uakron.edu/~ke3/SelfAdvIntroUnit1.pdf

Unit 2: Knowledge is my Power Base
• Four lessons addressing a teen’s legal rights in high school, college, and work. Please note: These lessons are based on US disability law; readers from Canada and elsewhere will need to adapt this material.
Click here to view: http://gozips.uakron.edu/~ke3/SelfAdvUnit2.pdf

Unit 3: Personal and Interpersonal Skills to Help Me Protect My Rights
• Four lessons on setting goals, expressing needs, negotiating, resolving conflicts
Click here to view: http://gozips.uakron.edu/~ke3/SelfAdvUnit3.pdf

4: Putting It All Together: Using Knowledge with Skill
• Five lessons addressing transition to post-high school settings:
Click here to view: http://gozips.uakron.edu/~ke3/SelfAdvUnit4.pdf

As we create time and provide material for teen conversations, are there any tips to keep in mind?

Less is more! Refrain from immediately problem solving and instead:

  • Ask the teen what s/he has done to solve the problem to date.
  • Ask if s/he has considered solutions but not yet tried them.
  • Ask if the teen would like your help.
  • If the answer is yes, co-generate options and ask the teen which one(s) would be worth trying.
  • Ask if the teen would be willing to attempt a solution and report back on the outcome.

Easier said than done; after all, we are professional problem-solvers! But at the end of the day, we can’t affect real change for another; only the person with the challenge can do that. The responses described above are meant to convey our philosophy that the teen owns this hearing loss, and thus owns the responsibility of managing it. We are part of a support system but we cannot force anyone to do anything; however, we can help them find their way to their goals.

An unknown writer once pointed out, ‘Young people don't know what age is, and old people forget what youth was.’ I appreciate the generous spirit behind this adage: gaps between generations are a part of life, not a crisis. They can also be managed. Surely we can find ways to give teens room to talk to us, share their worries and doubts, provide a safe environment for them to consider change, and lessen that gap between us.

Appendix A

Self Assessment of Communication – Adolescent. Click here to view this document.


Elkayam, J., & English, K. (2003). Counseling adolescents with hearing loss with the use of self-assessment/significant other questionnaires. Journal of the American Academy of Audiology, (14)9, 485-499.

English, K. (1997). Self advocacy for students who are deaf and hard of hearing. Austin, TX: PRO ED.

Stone, D., Patton, B., & Heen, S. (1999). Difficult conversations: How to discuss what matters most. NY: Viking Press.

Wright, K., English, K., & Elkayam, J. (2010). Reliability of the Self-Assessment of Communication – Adolescent. Journal of Educational Audiology, 16, 30-36.

Phonak Pediatric Advisory Board Members:
Marlene Bagatto, John Bamford, Andrea Bohnert, Adrian Davis, Melody Harrison, Kevin Munro, Patricia Roush, Susan Scollie, Richard Seewald, Patricia Stelmachowicz, Anne Marie Tharpe and Jace Wolfe.