5/4/19

Pediatrics:
Counselling of Parents with Hearing
Impaired Children

Outline
• Definition of Crisis State
• Responses of People in Crisis

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DEFINITION OF CRISIS STATE

Crisis State
• A ‘hazardous event’ posing some threat to the
individual or family.
• A threat to the instinctual need which is linked
symbolically to earlier threats that have resulted
in vulnerability or conflict in the personality.
• Inability to respond with adequate coping
mechanisms
– threat, loss or challenge of ‘unanticipated’ events, e.g.
death, divorce, demobilization, community disaster.
– May also be apparent in ‘anticipated events’ e.g.
school entry, retirement, marriage.

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Crisis State
• A framework for viewing individuals and
family in situations of urgency and stress,
when a novel situation (not within normal
range of problem-solving mechanisms) raised
and there is a change in the homeostatic
state.

Crisis State
Influencing Factors
• Personality theory, particularly Eriksson’s
Theory of Biopsychosocial Maturational Stages
with relevant tasks for subsequent maturation
and growth.

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Significant
Approximat Psycho Existential
Virtues Relationshi Examples
e Age Social Crisis Question[
p
Feeding,
Basic Trust Can I Trust
0–2 years Hopes Mother Abandonme
vs. Mistrust the World?
nt
Toilet
Autonomy
Is It Okay To Training,
2–4 years Will vs. Shame Parents
Be Me? Clothing
and Doubt
Themselves
Is It Okay Exploring,
Initiative vs. For Me To Using Tools
4–5 years Purpose Family
Guilt Do, Move or Making
and Act? Art
Can I Make
It In The
Competenc Industry vs. Neighbors, School,
5–12 years World Of
e Inferiority School Sports
People And
Things?

Significant
Approximat Psycho Existential
Virtues Relationshi Examples
e Age Social Crisis Question
p

Identity vs. Who Am I? Social

Peers, Role
13–19 years Fidelity Role What Can I Relationshi
Model
Confusion Be? ps

Romantic
Intimacy vs. Friends,
20–39 years Love Can I Love? Relationshi
Isolation Partners
ps

Generativity Can I Make

Household, Work,
40–64 years Care vs. My Life
Workmates Parenthood
Stagnation Count?

Ego Is It Okay To
Mankind, Reflection
65-death Wisdom Integrity vs. Have Been
My Kind on Life
Despair Me?

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Crisis State
Influencing Factors
• Stress theory : stress can be disruptive and
cause serious disturbance in biological,
psychological and social functioning.
– may have disturbed affects, motor and
behavioural reactions, changes in cognitive
functioning and physiological changes.
– changes in equilibrium provides potential for
change adaptive or maladaptive.

Crisis State
Influencing Factors
• Learning theory : concerned with cognitive
processes and functioning, e.g. motivation,
modelling.
• Role theory : concept of role transitions and
problems of role changes throughout the life
cycle.

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Responses of People in Crisis

• Characteristic signs
– emotional e.g. anxiety, shame, guilt
– cognitive confusion, e.g. bewilderment
– perceptual confusion e.g. spatial, temporal
• Phases
– Shock
– Realization
– Defensive retreat
– Acknowledgement
– Adaptation

Phases
Shock
• Initial encounter with critical situation
• Numbness, as if there is no feeling, no self
• No need to plan for the future
• Depersonalisation
• Emergency reaction to the impact
• Initial docility
• Physically but not emotionally present

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Shock “Checklist”
• Do you remember what the audiologist told
you?
• Have you taken constructive action to get
help?
• Are you spending your time in meaningful
activity?
• Have you begun to express normal emotions
such as anger, fear or grief?

Phases
Realization
• Realize that the change is permanent
• Realization of helplessness
• Self structure is threatened
• Inability to plan, overwhelmed by quality of
experience
• Realize responsibility to look over handicapped
child
• Unable to assimilate information
• Go out of control

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Phases
Defensive Retreat
• Situation they cannot handle
• Unbearable panic
• Denial, attempt to restore the old status quo
by refusing to admit there has been a change
that the person must adapt
• Wishful thinking
• Hostility
• Fishing and shopping

Denial “Checklist”
• Do you believe your child is deaf or hard of
hearing?
• Are you able to discuss this?
• Are you angry with the audiologist, your child
or others who may be trying to help?
• Are you seeking another opinion/diagnosis?
• Are you uncomfortable in public with your
child and his/her hearing aids?

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Phases
Acknowledgement
• Acceptance
• No longer resist
• Not experiencing hopeful changed and
fantasies
• Need for new organization

Phases
Adaptation
• Adjustment, restructure life style
• Know things that did not know before
• Eliminate irrelevant reality
• Gradual lowering of anxiety
• Feeling of satisfaction

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Effective Counselling Components

• Information giving when parents are able to
absorb
• Willing to listen
• Have parents talk about their feelings
• Congruent
• Family education
• Parent’s responsibilities
• Parent advocacy

Delivering the “News”

• Prepare in advance to anticipate the impact of
the diagnosis.
• Meet with families in a comfortable setting.
• Seek help from professional counsellors in
difficult situations.
• Allow enough time to meet with families.
• Listen more and talk less. Be careful to provide
too much information.

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Delivering the “News”

• Repeat the same information at a later time
when they are emotionally ready.
• Learn to be comfortable with your own
feelings.
• Read people's body language and facial
expressions.
• Summarize session with a brief plan.

Questions?

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References
• Madell, J. et.al. Pediatric Audiology: Diagnosis, Technology and
Management; New York, NY; Thieme Medical Publishers, Inc.
• Au, D. Pediatric Lecture Notes 2009.

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