Unlocking Behaviors: Hearing Changes
If Jane is experiencing normal, age-related hearing loss, an array of adaptive equipment is available to help support the changes in her hearing ability, while not sacrificing her quality of life.
By Ley Linder, MA, M. Ed, BCBA and Craig Escudé, MD, FAAFP, FAADM
Jane is a 66-year-old woman with a moderate intellectual disability who has been living in a group home for the last 20 years. She has always been known as a friendly, outgoing person with a happy disposition. Over the past couple of years, her support staff has noted that Jane has become less interactive and less interested in socializing. She also seems to be less responsive to others, and sometimes she startles easily when approached. She used to enjoy watching television but has lost interest in this as well.
Medical Discussion
Loss of interest in usual activities, especially those a person enjoys, can be a sign of depression. Jane’s usual “happy” disposition doesn’t seem to be consistent with being depressed. Dementia can also be a consideration when people are less interactive and engaged with others.
Many people with intellectual disabilities are living longer and will also experience conditions associated with age, including age-related hearing loss. Sometimes, when people are startled when someone approaches them from the side or back, it could be because they could not hear them and suddenly saw them and were surprised.
Depression, dementia, and hearing loss would be at the top of the list to rule out.
Behavioral Discussion
As Dr. Escudé noted, the change in preferred leisure activities, such as watching television and socializing, is always a “red flag” that a person is experiencing a change. The changes Jane is experiencing can be more subtle and occur over longer periods of time, making them harder to notice. As always, it is important to rule out potential causes of any decline in functioning ability – as many can be resolved. Behaviorally, one of the ways to identify these potential causes is to look at the temporal components of the change.
· Are the behavior changes seen across time, settings, and people?
· Has this behavior always been the case, and is it worse? Or are these behavioral symptoms new?
· How long has the change in function been observed?
“Many people with intellectual disabilities are living longer and will also experience conditions associated with age, including age-related hearing loss.”
If Jane is experiencing normal, age-related hearing loss, an array of adaptive equipment is available to help support the changes in her hearing ability, while not sacrificing her quality of life. Hearing aids are a common and clear suggestion, but these can be expensive, are easily lost, and various health insurance can be a barrier to access.
Other supportive ideas we have used in the behavioral realm and global support, are related to emphasizing other sensory aids. For health and safety protocols, bed shakers and/or strobe lights for fire alarms, as well as flashing lights for doorbells are common and easily accessed and installed. Also, you can never underestimate the power of training support professionals and caregivers on how to interact with people who are deaf or hard of hearing. For instance, with Jane being startled, it would likely be beneficial to approach her within her normal field of vision, perhaps arranging her living space to promote a larger field of view and providing a visual schedule of her daily routine to assist with her anticipating common events throughout her day.
Outcome
Jane was evaluated by an audiologist and found to have significant hearing loss in both ears. Additionally, there was a large amount of cerumen in her ear canals, and once this was removed, her hearing and her interaction with others improved somewhat. She eventually was fitted with hearing aids, became much more interactive, and was enjoying her favorite television programs again. It’s worth noting that people who have hearing loss have an increased risk of developing dementia, making it even more important to address hearing loss earlier rather than later.
About the Authors:
Ley Linder is a Board-Certified Behavior Analyst with an academic and professional background in gerontology and applied behavior analysis. Ley’s specialties include behavioral gerontology and the behavioral presentations of neurocognitive disorders, in addition to working with high-management behavioral needs for dually diagnosed persons with intellectual disabilities and mental illness. He works closely with national organizations such as the National Down Syndrome Society and the National Task Group on Intellectual Disabilities and Dementia Practices and is the Founder/CEO of Crescent Behavioral Health Services based in Columbia, SC.
Dr. Craig Escudé is a board-certified Fellow of the American Academy of Family Physicians and the American Academy of Developmental Medicine and President of IntellectAbility. He has more than 20 years of clinical experience providing medical care for people with IDD and complex medical and mental health conditions. He is the author of “Clinical Pearls in IDD Healthcare” and developer of the “Curriculum in IDD Healthcare,” an eLearning course used to train clinicians on the fundamentals of healthcare for people with IDD.