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Using radio aids with
pre-school deaf children
Sarah Allen, Imran Mulla, Zheng Yen Ng, Sue Archbold & Melanie Gregory
June 2017
Acknowledgements
Thank you to the families for their commitment and invaluable contribution to this research
study and to the professionals who gave their time to support it.
Research was commissioned by the National Deaf Children’s Society and conducted by
The Ear Foundation. There were no conicts of interest to declare.
Recommendations
Findings
• Improving hearing for speech in difcult listening conditions
• Increasing the amount parents talk and interact with their
child
• Having a positive impact on the family’s well-being
Radio aid equipment can be challenging, but benets largely
outweigh any difculties. Successful radio aid use requires timely
and good quality information and support.
Everyday situations present a risk to learning spoken language.
This study shows that using a radio aid can reduce this risk and
maximise potential benets for the child and their family by:
Hearing is essential for learning spoken language and the earlier a child
can hear speech, the better their opportunity to learn to listen and talk.
However everyday life presents challenges for a young child with hearing
loss: noise and distance from their parent when travelling in the car or
buggy, walking and playing outside and even around the house make it
difcult to hear speech and jeopardise spoken language development.
Using a radio aid can overcome these challenges and may reduce the
risk to spoken language.
Radio aid use is well-established for school-age children; however
provision during these vital early years is inconsistent and inequitable.
This study asked 21 families of young deaf children about the benets
and challenges of using a radio aid in everyday life and used quantita-
tive and qualitative measures to capture important predictors of spoken
language outcomes.
Why use radio aids with young
deaf children?
All parents of a young deaf
child should be informed of
the signicant potential
benets of radio aids and
have the opportunity and
support to use this technol-
ogy at home
Professionals should be
knowledgeable about man-
aging the latest technologies
Manufacturers should
respond to the identied
needs of children and
families in everyday life
Access to radio aids should
be equitable for all pre-
school children
Radio aids transmit a parent’s
voice directly to the child to
overcome these daily challenges
of distance and noise.
‘As a parent, it is a massive,
massive reassurance to walk down
the street with him and know
he can hear me’
‘Speech-wise she is picking up
on more; she is using more language
because she can hear what we are
saying more. She is denitely more
vocal with it, more likely
to communicate’
Research commissioned by
Supermarket
3
Executive Summary
The rst few years of a child’s life are a time of rapid and important development.
During this time the foundations for communication are laid and for all children, language
and interaction with their parents is critical to success. Hearing is essential for learning
spoken language and the earlier a child can hear speech, the better their opportunity to
learn to listen and talk. For a baby with hearing loss, ‘hearing technologies’ such as hear-
ing aids and cochlear implants can provide the necessary hearing for speech. However,
crucial early speech and language development occurs in the routines of everyday life,
which are full of difcult listening conditions, for example playing outside, travelling in the
car or a buggy and even around the house. Using a radio aid is one way to help overcome
this by transmitting the speaker’s voice directly to receivers on the child’s hearing tech-
nology to improve the Signal-to-Noise Ratio (SNR). Using radio aids with children in school
is well-established practice; however despite encouraging research ndings, provision of
radio aids for babies and young children during their critical period of language develop-
ment is inconsistent and inequitable.
This study conducted by The Ear Foundation recruited twenty one families to explore the
benets and challenges of radio aid use with a deaf child aged 4 years and under. Using
both quantitative and qualitative measures, the study investigated potential differences
in behaviours with and without radio aid use and sought parents’ insights into the expe-
rience. Findings provide strong evidence for the advantages of early radio aid use and
support equitable access, consistent protocols and funding.
Highlights from this study’s ndings include:
• Everyday listening environments present a risk to learning spoken language: using
a radio aid can reduce this risk
• Using a radio aid facilitates important predictors of spoken language outcomes;
improved hearing for speech and increased quantity of adult language and
parent-child interaction
• Radio aid use can have a positive impact on the well-being of both children and
their parents
• Successful radio aid use requires timely and good quality information and support
to maximise potential benets for the child and their family
• Radio aid equipment can be challenging, but benets largely outweigh any
difculties
‘Speech-wise she is picking up on more; she is using more language because she
can hear what we are saying more. She is denitely more vocal with it, more likely
to communicate’
‘As a parent, it is a massive, massive reassurance to walk down the street with him
and know he can hear me.’
Recommendations:
• All parents of a young deaf child should be informed of the signicant potential
benets of radio aids and have the opportunity and support to use this technology
at home
• Access to radio aids should be equitable for all pre-school children
• Professionals should be knowledgeable about managing the latest technologies
• Manufacturers should respond to the identied needs of children and families in
everyday life
4
Contents
1.0 Background 1
2.0 Methodology 3
2.1 Procedure and Ethics 3
2.2 Data collection and analysis 4
2.3 Participant demographics 6
3.0 Findings 8
3.1 Daily activity log 8
3.2 Client Oriented Scale of Improvement (adapted) 9
3.3 Listening Questionnaire 10
3.4 LENA Paired recordings 12
4.0 Interview ndings 14
4.1 Access to speech in daily life 16
4.2 Communication and spoken language 18
4.3 Well-being 21
4.4 Practical considerations 23
4.5 Engaging with the technology 25
4.6 Choosing the right time 27
5.0 Discussion 29
5.1 Everyday listening environments present a risk to learning spoken language:
using a radio aid can reduce this risk 29
5.2 Using a radio aid facilitates important predictors of spoken language outcomes 29
5.3 Radio aid equipment can be challenging 30
5.4 Successful radio aid use requires timely and good quality information and
support to maximise potential benet 31
5.5 Early radio aid use may improve outcomes and reduce disadvantage 31
5.6 Using a radio aid in nursery requires careful management 32
6.0 Conclusion 33
7.0 Recommendations 33
8.0 List of Figures & Tables 34
9.0 References 35
5
1.0 Background
Language is the foundation not only for communication, but also for learning
and education, our relationships with other people and our experience of life.
Hearing is a vital building block for developing spoken language and the ear-
lier a child can hear speech, the better their opportunity to learn to listen and
talk (Cole & Flexer, 2015; Sininger, Grimes & Christensen, 2010).
The rst months and years of life are critical to the acquisition of spoken
language through hearing. Learning starts early; even newborn babies have
a natural interest in and ability to discriminate human speech from other
sounds. As they grow, babies ‘tune in’ to the sounds being used in the lan-
guage around them. Their brains begin to recognise, organise and learn the
meaning of sounds and this forms the basis for understanding and using
spoken language (Beck & Flexer, 2011).
Early diagnosis of hearing loss and early use of hearing technologies, such
as hearing aids, cochlear implants and bone conducting hearing implants,
have been shown to signicantly benet language development (for example
Pimperton & Kennedy, 2012; Vohr, Topol et al., 2014; Yoshinaga-Itano, Sedey
et al., 1998; Yoshinaga-Itano, 2000). The universal Newborn hearing screen-
ing programme (NHSP) has provided this important early advantage; most
babies with hearing loss are now diagnosed and aided within a few weeks of
life (Wood, Sutton & Davis, 2015).
Children learn spoken language through listening in all their daily routines
and activities; in one-to-one contact, listening to others around them and
importantly, listening to their own speech and vocalisations. As babies, rou-
tines such as feeding, cuddling, washing and playing, involve very close con-
tact with their parents at an “ideal” distance for listening (Brackett, 1992).
However as babies start to sit, crawl and walk, they become more independ-
ent from their parents, maybe playing a little further away in a room or moving
from a car seat or buggy which faces the parent, to one which faces away;
this increases the listening distance and reduces the acoustic intensity or
volume of the parent’s speech (Ross, 1992). Everyday activities can also be
noisy; busy mealtimes with siblings, playing in the kitchen while the washing
machine is on or out and about. In fact, it is suggested that babies and young
children under the age of four years spend almost a quarter of their day in
noisy environments (Jones and Launer, 2010). Listening in noise is more dif-
cult than in quiet; adults with hearing loss experience greater difculties lis-
tening to speech in noise and reverberation than adults with normal hearing
(Brown, Hullar et al., 2010; Glyde, Dillon et al. 2012) and even apparently low
levels of noise can interfere with young children learning to listen, particularly
when they also have a hearing loss (Yang & Bradley, 2009). Children don’t
have the language to help them work out what someone might be saying to
them or to work out where one word ends and the next one begins; and it
seems that it is even harder for younger rather than older children (Bradley &
Sato, 2008; Eisenberg, Shannon et al, 2000). It makes sense then to assume
that for a young child with a hearing loss, understanding speech in noise or
at a distance is challenging and that this has the potential to impact on their
spoken language development.
Everyday life
presents challenges
for hearing speech
and jeopardises
spoken language
development
Hearing speech
during early devel-
opment is critical for
spoken language
6
The negative effects of background noise, reverberation and distance can
be overcome by improving Signal to Noise Ratio (SNR ) through the use of a
remote microphone or frequency modulation (FM) system, commonly known
as a “radio aid” (National Deaf Children’s Society, 2017). A radio aid system
consists of a transmitter worn by an adult or key speaker and a receiver worn
by the child. The speech signal is transmitted directly to the microphone
on the child’s hearing aids, cochlear implants or bone conducting hearing
implants, ‘shortening’ the distance between the speaker and the microphone
and reducing the effects of background noise and reverberation (Ross, 1992,
Thibodeau 2010). Many studies have shown the benets of using a radio aid
with hearing aid users in school, not only for improved speech perception
(for example, Crandell & Smaldino, 2000), but also reducing the effort of
listening, which in turn leads to improved concentration and attention (Mulla,
2011).
Studies of younger children have suggested benets of radio aid use in
the pre-school years too (Gabbard, 2003; Moeller, Donaghy et al., 1996;
Statham & Cooper, 2009; Webster, 2015). Mulla (2011) demonstrated
that parents were able to make consistent use of radio aids and outcomes
showed improved language, listening and overall benets associated with the
children’s well being. Challenges of radio aid use with this age group were
also identied, primarily with wearing the device itself; for example, children
pulling at the microphone wire.
Recent technological developments in size, weight, and wireless capability
have made radio aids potentially more accessible for very young children.
Despite a largely strong sense of support for the potential benets of radio
aids with pre-school children, recent surveys of parents and professionals
highlighted inequitable provision and inconsistencies in awareness, under-
standing, information and management of radio aids with this group (Allen,
Ng et al, 2016).
Currently, there is relatively limited evidence for using radio aids with early
identied, pre-school children; the recent technological developments provide
a timely opportunity to undertake research into their use and a study explor-
ing the real-life benets and challenges was recommended in order to con-
sider their use at this vital stage in language development.
1.1 Study aims
The purpose of this study was to explore the question:
What are the potential benets and challenges of radio aid use in pre-school
deaf children using any form of hearing technology?
Through regular longitudinal use of the radio aid, this study aimed to inves-
tigate everyday use of radio aids with pre-school children and provide mean-
ingful evidence in order to:
• Understand the real-life benets and challenges of using radio aids
with young children
Using a radio aid can
overcome challenges
of noise and distance
in everyday life and
may reduce the risk
to spoken language
Provision of radio
aids during this vital
period is inconsistent
and inequitable
7
• Provide information to support parents in making decisions about radio
aid use with their pre-school child
• Produce recommendations for professionals to support consistent
policy and practice
8
2.0 Methodology
2.1. Procedure and Ethics
The study consisted of a series of case studies using a prospective cohort design. Both
quantitative and qualitative methods were utilised to explore the experiences of families
using a radio aid with their deaf 1child in everyday life.
This research was conducted in accordance with The Ear Foundation Research policy,
which follows the British Educational Research Association guidelines (2011) and was sub-
ject to both internal and external ethical review and approval. Study data were anonymised
and maintained in line with the Data Protection Act (1998). Participation was voluntary,
usual care was not affected and no incentive was offered for participation.
Inclusion in the study was open to families of children who met the following criteria:
• Aged 4 years or under at the start of the study
• Any degree or type of hearing loss
• Any type of hearing technology; hearing aid(s), bone conducting hearing implant(s) or
cochlear implant(s)
• Not in full-time education
• Access to a radio aid system for the duration of the study2
Study information and invitations to participate were sent from The Ear Foundation to par-
ents who had participated in a previous survey study about radio aids (Allen et al., 2016)
whose children met the inclusion criteria. Invitations for ToDs and Educational audiologists
were sent to those who had participated in the same study, circulated via the Heads of
Service forum and the British Association of Teachers of the Deaf (BATOD). Professionals
were asked to provide study information to other potential participants, who were invited
to contact the lead researcher directly to nd out more. Parents who expressed interest in
participating were contacted directly by the lead researcher. All families were contacted in
person to provide further explanation of the study and to answer any queries before taking
consent and demographic information.
2.2. Data collection and analysis
The study used both quantitative and qualitative methods of data collection to investigate
potential differences in behaviours with and without radio aid use, to explore parents’ per-
ceptions of the benets and challenges of radio aid use with a pre-school child and provide
an insight into the experience with a view to informing prospective users.
2.2.1. Daily Activity Log
Daily diary sheets were adapted from Mulla (2011) and used each day by families to
record situations where they had used the radio aid. Parents were asked to record per-
ceived benet in each situation by circling ‘Yes, No or Not Sure’. Data captured through
1 The term “deaf” is used throughout this report to refer to child/children with any degree of hear-
ing loss as dened by the National Deaf Children’s Society and Action on Hearing Loss.
2 Note: Responsibility for introducing and managing the radio aid during the study belonged to
the child’s local Teacher of the deaf (ToD), Educational audiologist or parent. The Ear Foundation
audiologist was available for queries.
9
these diary sheets were inputted into Microsoft Excel 2013 and analysed to produce
descriptive statistics and graphs.
2.2.2. Client Oriented Scale of Improvement (adapted)
An adapted version of the Client Oriented Scale of Improvement (COSI) questionnaire (Dil-
lon, James et al., 1997) was used to compare perceived changes when using the radio aid
in ve identied situations. Parents were requested to note their child’s hearing ability and
the degree of change in each situation when using the radio aid. Data captured through
the sheets were inputted in to Microsoft Excel 2013 and analysed to produce descriptive
statistics
and graphs.
2.2.3. Listening Questionnaire
The listening questionnaire was designed to focus on any differences in listening in a
range of situations and environments when using a radio aid compared to when using the
hearing technology on its own. The questions were adapted from the FM Listening Evalu-
ation for Children questionnaire (DeConde Johnson, 2003), the Early Listening Function
questionnaire (Anderson, 2002) and a section was set aside for the detection of Ling 6
sounds (aa, ee, oo, mm, shh, ss) (Ling, 1989). The questionnaire was completed by par-
ents and ToD. The completed questionnaires were inputted into Microsoft Excel and scores
were analysed to produce descriptive statistics and graphs.
2.2.4. Language Environment Analysis (LENA)
The LENA digital language processor (DLP) (Figure 1) is a battery powered all-day recorder
weighing less than 60 g that can be securely snapped into the chest pocket of children’s
specially designed clothing (www.lenafoundation.org). The device has a single microphone
which remains 7-10 cm from the child’s mouth whilst it is in place in the child’s chest
pocket. LENA records all the speech and environmental sounds which occur around the
child during their normal daily activities providing information about the real-life listening
and language environment.
Figure 1: LENA DLP
Families were asked to record a day without using the radio aid and a similar day with the
radio aid about a week apart. A detailed diary sheet was used for each recording day.
The recordings were uploaded to the LENA software, which uses advanced speech recog-
nition technology to analyse the audio le and work out the number of Adult Words, Child
Vocalisations and Conversational Turns. Recorded and analysed data was compared with
the daily diaries. Matched pairs were identied and checked for reliable comparison. Data-
sets were marked and matched for duration and situation. Word counts for marked data-
sets were inputted into Microsoft Excel 2013 and analysed to provide descriptive statistics
and graphs.
2.2.5. Qualitative Interviews
Throughout the study parents completed a monthly Observation Diary; the diary consisted
10
of structured prompts to elicit parents’ free text responses capturing changes, benets or
challenges of radio aid use in everyday situations.
At the end of the study, a semi-structured interview enabled parents to reect on their
experiences and share their personal perspectives of radio aid use. Using an Interview
schedule and the parents’ Observation Diaries to guide the conversation, interviews were
conducted by the lead researcher face-to-face in the family home or via video or phone call
where necessary. Interview transcriptions were analysed qualitatively using Thematic Net-
work Analysis (Attride-Stirling, 2001). The interviews were transcribed and the responses
were coded and organised into themes. The emergent categories were cross-checked
independently by members of the research team.
2.3. Participant demographics
Participation in the study was open to children using any form of hearing technology. In
total, twenty one families were recruited to participate in the study and of these, one used
a Bone Conducting Hearing Implant (BCHI), two used cochlear implants (CI) and eighteen
used hearing aids (HA). Thirteen families completed the study and eight families did not
complete the study. Six of these eight used hearing aids and two used cochlear implants.
2.3.1 Reasons for not completing the study (n=8):
• No perceived additional benet from using the radio aid: 3
• Inconsistent/ non-established hearing aid use: 1
• Issues with suitability and reliability of radio aid: 1
• Study required too much of the participant: 2
• Unknown reason: 1
Findings are primarily reported on those who completed the study (n=13)
2.3.2 Group demographics (n=13):
• Average age at start of study: 2;11 years (range: 1;5 years-4;2 years)
• Average age at diagnosis of hearing loss: 0;5 years (range: 0 years-2;0 years)
• Average age at start of radio aid use: 2;10 years (range: 1;4 years-4;2 years)
• Established users of radio aid prior to the study: 2 (15%)
• New users of radio aid: 11 (85%)
• Established radio aid users at end of study: 11 (85%)
• The average length of time of trial was 4 months (range: 4-6 months)
2.3.3 Individual demographics are presented in Table 1
Table 1: Individual demographics (n=13)
Participant
number
Age at
diagnosis (y;m)
Hearing loss1Hearing technology Age at start
of RA use (y;m)
Radio aid system Age at start
of study (y;m)
Time in study
(months)2
1 0;1 Moderate-Severe Bilateral hearing aids 2;5 Phonak Roger Inspiro 2;4 4
2 0;0 Severe Bilateral hearing aids 2;10 Phonak Roger Inspiro 2;11 5
3 0;2 Severe Bilateral BCHIs 3;0 Phonak Roger Inspiro 3;2 6
50;1 Moderate-Severe Bilateral hearing aids 2;10 Phonak Roger Pen 3;1 5
6 0;1 Moderate-Severe Bilateral hearing aids 1;4 Phonak Roger Pen 1;5 5
8 0;2 Severe Bilateral hearing aids 1;9 Phonak Roger Inspiro 2;0 5
9 0;0 Mild-Moderate Bilateral hearing aids 2;0 Phonak Roger Pen 2;0 4
11 0;2 Moderate Bilateral hearing aids 2;6 Phonak Roger Pen 2;8 4
12 0;9 Moderate Bilateral hearing aids 3;5 Comfort Audio 3;6 4
13 2;0 Moderate-Severe Bilateral hearing aids 4;2 Phonak Roger Inspiro 4;2 4
15 0;1 Moderate Bilateral hearing aids 3;8 Phonak Roger Inspiro 3;8 5
16 0;0 Moderate-Severe Bilateral hearing aids 3;4 Phonak Roger Inspiro 3;5 4
20 1;3 Severe Bilateral hearing aids 3;3 Genie/ E-Clarity/ Roger pen 2;8 4
12
3.0 Findings
3.1 Daily activity log
Across all the participants, 468 Daily activity logs in total were completed. Across all the
situations reported in the Daily Activity Log, the ndings showed parents perceived clear
benets of radio aid use (Figure 2).
Figure 2. Overall perceived benet of using radio aid in daily situations (n=468)
Parents reported using the radio aid in a wide variety of situations and activities (Table 2).
For analysis, these were grouped into similar situations and activities, for example ‘Pre-
school group’ included all types of groups involving both the parent and child in shared
activities, such as singing or music. Activities involving noise and distance typically showed
the greatest perceived benet; however benet was also perceived by some during less
anticipated situations, such as during indoors 1-1 play.
Table 2. Parent perception of benet in different situations and activities
Activity Benet No benet Not sure
Outdoors (close) 85% 8% 6%
Outdoors (at distance) 89% 5% 5%
Car 89% 1% 10%
Buggy 100% 0% 0%
Nursery (indoors) 84% 9% 7%
Nursery (outdoors) 88% 0% 13%
Indoors (1 adult) 59% 14% 27%
Indoors ( >1 adult) 77% 13% 10%
Indoors (at distance) 88% 13% 0%
Pre-school group 92% 0% 8%
Meal time at home 88% 0% 13%
Shopping 91% 0% 9%
Party 89% 0% 11%
Soft play 91% 0% 9%
Eating out 100% 0% 0%
Family gathering 100% 0% 0%
13
3.2. Client Oriented Scale of Improvement (adapted)
At the end of the study parents were asked to consider ve situations; in the car, playing
outside, during preschool activity groups, shopping in a busy place and whilst out and
about in a buggy. They were then asked to rate any change they noticed when using the
radio aid in that situation on a 5 point scale from ‘Worse’ to ‘Much better’ and also to
report on the amount they currently used the radio aid in that situation (Figure 3).
Figure 3. Reported change when using radio aid in specied situations (n=13)
Although parents were simply asked to rate ‘change’, they often provided more detail
about what constituted that perception of change, often related to ease of communication,
safety, improved child listening and responsiveness. Not all families perceived change in
all situations, but none reported a situation as worse when using the radio aid. Figure 4
shows levels of current radio aid use in these situations.
Figure 4. Levels of current radio aid use in specied situations (n=13)
By the end of the study, families seem to have decided in which situations the radio aid
was useful and to what extent. Only two families no longer used the radio aid at all; having
perceived little benet, they had returned the radio aid equipment. The rest used the radio
aid selectively according to individual perceived benet.
14
3.3. Listening Questionnaire
Collectively, these assessments provided information about the child’s listening skills. 46%
(n=6) were completed by the parent and 54% (n=7) by the Teacher of the Deaf. Numbers
for each measure vary due to some incomplete assessments. Results shown are based on
the end of study assessment only.
3.3.1. Listening Evaluation
The child’s listening for speech was assessed with and without the radio aid in four differ-
ent listening conditions, Quiet, Noise, Auditory only and At distance, using a scale from 1-5
with 1 being “Seldom” and 5 “Usually”. The scores showed improved listening in every situ-
ation when using the radio aid, especially in noise, auditory only and at distance (Figure 5).
Figure 5. Changes in listening without and with radio aid in different situations
3.3.2. Listening Function (ELF)
Using a scale from 1-5 with 1 being “Seldom” and 5 “Usually”, the ELF assessed whether
when using the radio aid the child appeared more aware of voice and environmental
sounds, readily searched for the location of the speaker’s voice, used an increased
amount of babbling/talking and had more interest in communicating.
Figure 6 shows that all the children were reported as being more aware of voice and able
to locate someone talking when using the radio aid. Reports of changes to the child’s
babbling/ talking and interest in communication were mixed. There was little change to
awareness of environmental sounds as might be expected.
Figure 6. Listening function with radio aid
15
3.3.3. Ling 6 sounds
Figure 7 illustrates the number of Ling 6 sounds (aa, oo, ee, mm, shh, ss) correctly identi-
ed by the child in ‘Quiet-close’ (within 3 feet), in ‘Quiet-at distance’ (10 feet), in a ‘Noisy
room-close’ and in a ‘Noisy room-at distance’ both with and without the radio aid.
Improvements can be seen in all these listening conditions when using a radio aid, most
notably in quiet at distance and in noise both close and distant. Some children could
already identify all sounds using only their hearing aids; however for those who did not, the
gain with their radio aid ranged from 1 to 4 more sounds identied. For example, one child
identied two Ling 6 sounds when using only hearing aids and six Ling 6 sounds when
using the radio aid.
Figure 7. Ling 6 without and with radio aid in quiet and noise, close and at distance
16
3.4 LENA Paired recordings
Paired recordings consisted of a LENA recording on a day without using the radio aid and a
similar day with the radio aid about a week apart. Thirty four pairs of similar activities were
identied representing six different listening environments; in the car, indoors 1:1 with an
adult, indoors with more than one person, outdoors, shopping and at nursery. LENA analy-
sis estimates the number of Adult Words 3, Child Vocalisations 4 and Conversational Turns 5
during each identied activity.
Table 3 presents the cumulative totals comparing the counts of Adult Words, Child Vocal-
isations and Conversational Turns in each listening environment. Green arrows indicate
the percentage increase with radio aid use and the red arrows indicate the percentage
decrease.
Listening
environment
(No onf pair)
Adult Word Count Conversational Turns Child Vocalisation
Without
radio aid
With
radio aid
% Without
radio aid
With
radio aid
% Without
radio aid
With
radio aid
%
Car (7) 766 1994 +160% 32 78 +144% 255 309 +21%
Indoors: 1-1 with
an adult (6)
574 6 6712 +17% 300 401 +34% 1270 1389 +9%
Indoors: more
than 1 adult (7)
4828 4399 -9% 302 267 -12% 1205 1292 +7%
Outdoors (7) 13 47 2587 +92% 90 169 +88% 554 733 +32%
Shopping (3) 626 976 +56% 42 66 +57% 283 317 +12%
Nursery (4) 1790 1572 -12% 37 21 -43% 155 267 +72%
Table 3. Adult word count, Conversational Turns and Child Vocalisations without and with radio aid
(n=number of paired recordings per situation)
Adult words, child vocalisations and conversational turns all increased when the child was
using the radio aid in the car, indoors on a 1-1 with an adult, outdoors and when shopping.
However, Indoors with more than one person and Nursery demonstrated a different
pattern whereby the adult words and conversational turns decreased, and the child vocal-
isations increased. LENA records sounds to or near the child and these are captured as
“meaningful speech”. As an adult moves further away from the child or where there is
3 Adult Word Count (AWC)= estimate of the number of adult words spoken to or near the key child
4 Child Vocalisation Count (CVC)= estimate of the number of key child vocal sounds (babble and
words)
5 Conversational Turn Count (CTC)=estimate of the number of adult-child or child-adult interac-
tions (a vocal sound initiated by the child or adult to which the other responds within 5 seconds)
17
more than one person around the child, their speech is analysed as “distant or overlap-
ping”. In a busy listening environment with more than one adult talking, any adult words
and conversational turns may not be included in the Adult Word count or Conversational
Turns count. Importantly, for a child using a radio aid, he/she should continue to hear the
adult words despite the distance and noise and this may explain why the child vocalisa-
tions continue to show an increase.
18
4.0 Interview ndings
Thematic analysis produced six main overarching themes and sub-themes
related to radio aid use.
Access to
speech in
daily life
Communica-
tion & spoken
language
Well-being Practical
considerations
Engaging with
the technology
Choosing the
right time
4.1 Access to speech in daily life
4.2 Communication & spoken language
4.3 Well-being
19
4.4 Practical considerations
4.5 Engaging with the technology
4.6 Choosing the right time
20
4.1 Access to speech in daily life
Parents talked about how their child could hear and respond to speech more easily using
the radio aid in situations, which would be more difcult using only their hearing aids.
They gave lots of specic examples of these everyday situations, which had three overar-
ching and often overlapping factors: in noise, at a distance, and the position of the child in
relation to the parent.
4.1.1 In noise
For many parents, the main aim of a radio aid was to help their child hear better in noisy
everyday situations:
P20: If we go somewhere noisy, like in shops, he has to be in the stroller [...] so it
meant I could talk to him, whereas before he couldn’t really understand what I was
saying because he would have the noise of the shops
Some parents noticed a difference even in fairly quiet situations or at home:
P5: On a one-to-one basis, I know he can hear me and is taking in what I’m saying,
rather than having to try to hear me due to any minimal background noise eg story
time, playing games
Occasionally, noisy situations can be uncomfortable or distressing for children and difcult
to manage. One family described how they used the radio aid to manage this tricky situa-
tion to enable their child to still hear and be comforted by them:
P3: We took her to [large busy shopping centre] and it quickly became obvious that
she was struggling with the noise. She insisted on having hood up to block out the
background noise, but using the system we knew she was hearing us. Sometimes
we use the radio aid not just as a way to guarantee that she can hear us, but as a
way to ‘dampen down’ extreme background noise
4.1.2 At a distance
Parents described situations both in and out of the house where they wanted their child to
be able to hear them at a distance:
P8: Any situation where there is a distance between us and [child][...] in a café or
restaurant– whenever we leave the house [...] when we go to soft play, walking,
when she is in the pushchair; there is always an option to use it outside
P20: If his brothers ask where I am in the house ‘mummy where are you?’ I could
say I am here and they could locate where I was [...] I can now say to him ‘mummy’s
in the bathroom’ whereas before he just couldn’t do that
Children are often in positions where they cannot easily see the parent’s face for addi-
tional visual or lip reading cues, for example in a forward facing buggy or in a car seat in
the rear of a car:
P9: [In the car] we do it because he can hear us, and he can hear everything clearly,
and because our voices are that way, so if we need to talk to him, we need to turn
around, which you can’t always do; so if you talk directly into that [radio aid] you
don’t have to turn directly to look at him for him to hear you, [it] was really good for
that
4.1.3 Where using a radio aid is less useful
A few parents felt that it was always more useful to use the radio aid; however the majority
described specic times where they had tried the radio aid and found it provided little addi-
tional benet or their child did not like to use it. Limited benet was also reported due to
deteriorating hearing levels and this was the reason for one child being withdrawn during
21
the study.
4.1.3.1 Using the radio aid when you’re close to the child
P6: If you are going to be close to [child] for a sustained period of time, then it’s
not always necessary. When in close proximity it can have little use as [child] can
already hear us
One of the children withdrawn from the study was under 6 months old at the start of the
study; although they used a radio aid with an older child, parents felt that they did not
need to use the radio aid for the younger child who was not yet mobile and largely in close
proximity.
4.1.3.2 Using the radio aid when you can control the background noise
P5: I have not used the FM system a lot at home, the reason for this is we always
keep any additional noise to a minimum e.g. no TV in the background
4.1.3.3 Using the radio aid in group situations or with lots of key speakers
P5: During free play when his key worker was interacting with lots of different
children
Interestingly, for the other family who did not complete the study, the parent reported that
the child was hearing so well using her CI, that use of a radio aid (Mini Microphone) made
no difference in any situation, so they no longer used it.
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4.2 Communication and spoken language
The children in the study ranged not only in age and hearing levels, but also in their devel-
opmental stages; some used age-appropriate speech and language, while others showed
some delay.
4.2.1 Hearing & Listening
Despite these different levels, all the children demonstrated changes in their hearing and
listening when using the radio aid:
4.2.1.1 Quicker & more consistent response to speech
P2: [child] would look up or look round for me much quicker; more often when I call
her name
P16: She is more responsive, a lot more responsive when I have worn the radio aid
4.2.1.2 Increased responsiveness to speech
For those children with still limited language, parents noticed increased responsiveness
through the child stilling, looking, responding appropriately or making eye contact:
P3: [child] stills which is how we know [child] has heard us
P2: At home, she was much more aware of my voice and looking round for me
For those using language, parents noticed changes such as joining in with songs and
rhymes, copying words and answering or responding appropriately:
P16: If she was engrossed in something and wasn’t responding I’d say “can you
hear me?” and she always shook her head, but I could tell as she would follow
instructions quite quickly
P6: She will join in and sing songs so she can denitely hear us
P3: She attempts to sign back to us across the room in response
P12: [Child] pauses, looks around or responds using words in my question
4.2.1.3 Increased responsiveness without the need for visual cues
Others showed they were listening without the need for visual cues or lip reading:
P5: [Child] noticeably responds to instructions more, rather than following what his
peers are doing. At stories he can sit further away but still show he is engaged by
laughing or saying words [...] He doesn’t always need to turn around to listen to you
either whereas without it he does rely on you being at his level facing him so he can
see your lip pattern
P20: Before he would have to wait for the song and the visual clues [...] he was able
to participate quicker at the same point as his peers because he was able to hear
what was being asked of him rather than waiting for the other things he had been
relying on
4.2.2 Attention
Both parents and nursery staff frequently commented on the child’s improved attention
using the radio aid.
4.2.2.1 Actively engaged
They reported that the child seemed more actively engaged in activities and
communication:
P16: The radio aid has helped in the sense that she will play- I’m not saying that she
will sit and play for 10 minutes- but she is more engaged
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P5: [Child] is so much more engaged [...] on specic tasks, whereas without it, his concen-
tration and engagement is very limited
4.2.2.2 Improved concentration and focus
They described the child being more focussed and less distracted by other children or
things going on around them:
P12: That’s the biggest thing for us, him being more focussed
P15: He’s a lot more switched on; he used to get a bit bored and dgety but now
he’s straight there, switched on, wants to listen. Now he comes home and tells me
all about the story
4.2.2.3 Increased eye contact
Children were reported to be watching others and demonstrating improved eye contact:
P15: Gain eye contact more often in general conversations directed at the whole
class
4.2.3 Spoken language
This study took place over 4-6 months, so few specic developments in communication
were anticipated. However, important changes were noted, which parents often attributed
specically to radio use:
4.2.3.1 Maximising language opportunities
Parents spoke about how they made more out of everyday opportunities for communica-
tion in situations where otherwise their child had limited access to hearing speech and
learning language.
P8: We are of the school of thought that we need to bombard her with as much lan-
guage as possible and in circumstances where it is difcult to do that [...] we don’t
want to just accept that is dead time; we want to be able to still put the language
into her ears
P6: Normally at distance you wouldn’t be talking to her. It gives that opportunity to
continue to talk. We are trying to feed in as much as we can
4.2.3.2 Increased spontaneous communication
P6: Speech-wise she is picking up on more, she is using more language because
she can hear what we are saying more. She is denitely more vocal with it on, more
likely to communicate
4.2.3.4 Two-way interaction
P5: I think the rst time I had it on, I was in the car with him, I actually had a normal
conversation with him. It was so bizarre!
P15: You can get a nice conversation out of him now when he’s outside when it’s
really noisy and stuff [...] it’s amazing, generally get a nice conversation out of him in
the car now
4.2.4 Speech
Speech and voice were not specically assessed due to the short duration of this study;
however parents noticed changes to important aspects of speech development, which are
likely to be facilitated by improved access to hearing in a wider range of situations.
4.2.4.1 Copying more readily
P5: He copies words and phrases straight away and would appear he’s being able to
get the right sounds out
P5: [Child] is denitely getting more and clearer access to sounds since having the
24
radio aid. He is becoming more consistent in trying to relay a sentence. He copies
words and phrases straight away and would appear he’s being able to get the right
sounds out. He wouldn’t automatically copy [...] before when you would ask him to
say something or a phrase, he wouldn’t’ even attempt to do it, but now he will actu-
ally try and say it straight away. It’s really good.
4.2.4.2. Clearer speech intelligibility
P8: We feel her speech has gotten clearer over the last month of using the [radio]
aid [...] She has been developing anyway, but she is better with articulation and
sounds denitely.
P2: I did nd at times it helped her to say certain words clearer [...] she would gener-
ally repeat it back correctly
4.2.4.3 Changes to intonation, pitch and volume
P16: Pitch seems to have moderated
P5: Less shouting
4.2.5 Behaviour
Parents reported changes in their child’s behaviour both within-child and also in relation to
others.
P5: He seems to be less angry and frustrated, probably because he hasn’t got to try
as hard to listen. It seems to have given him more condence to interact
P20: It changed his behaviour in that he was able to participate quicker at the same
point as the rest of his peers
P6: She’s been more co-operative when asking her to do things
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4.3 Well-being
Throughout their narratives, parents frequently reected on issues of well-being; these
included Emotional, Psychological and Social well-being.
4.3.1 Emotional well-being
Emotional well-being can be dened as “being happy and condent” (NICE, 2012).
4.3.1.1 A sense of condence for children & parents
All families used the words “condent” and “condence” throughout both interviews and
diary entries both for themselves and their child and associated largely positive emotions
with radio aid use. They also variously described their child as being more “alert, engaged,
calmer” and less “angry, frustrated or anxious”, for example:
P5: He panics and is worried when we go anywhere different, it takes him a while to
feel at ease. In that respect it (radio aid) is a massive help
This sense of being happy and condent was also apparent in the parents themselves
P16: I think it has made me more relaxed. For a parent it does help if you are hap-
pier and not stressed.
P5: I feel personally as a parent a lot more condent when we are out.
4.3.1.2 Feelings of self-consciousness
However, despite the generally positive reports, some parents described how their difcul-
ties with the radio aid equipment impacted negatively on both the child’s and their own
well-being through feelings of self-consciousness:
P12: it made his hearing aids heavier and more noticeable […] so for him, more
people became aware that he has hearing aids; if we went to a café, there would be
more kids looking
P20: He got pointed at in classes […] it was just awful [...] I am not embarrassed. I
just don’t want the extra attention. I just don’t want other people looking at us
4.3.2 Psychological well-being
Psychological well-being is described as “the ability to be autonomous” (NICE, 2012).
4.3.2.1 Increasing independence
Parents often described feeling more able to allow their child greater independence:
P12: It gives him that little bit more freedom […] a little bit more independence. With
the radio aid he was able to hold my hand and walk through town, he now has that
independence about him
P16: I was always worried about her doing things outside of the home and (radio
aid) has given me more peace of mind
4.3.2.2 Reducing parental anxiety
Many parents felt less anxious knowing that their child could hear them at a distance for
safety, comfort and reassurance:
P6: Ball pools, soft play, before I wouldn’t let her go in as I was so frightened of her
not being able to hear me […] I don’t have to do that now
P5: It is a massive, massive reassurance to walk down the street with him and know
that he can hear me
4.3.3 Social well-being
Social well-being is about “having good relationships with others” (NICE, 2012).
26
4.3.3.1 Joining in
Many diary entries, both from parents and pre-school group or nursery staff commented
on the child “joining in more”:
P15: Nursery say he’s interacting much more with the other children and a lot with
the adults
P5: Denitely grown in condence [...] wanting to communicate with both staff and
peers
4.3.3.2 Increased participation
In interviews, many parents reported that using the radio aid gave their child greater
opportunity to take part in distant, busy or noisy situations/ activities with other people
because they could listen for reassurance or direction whilst still being part of the larger
group:
P8: If she is not being included because she can’t access all the sounds and lan-
guage and stuff that she needs, then (hearing aid) is not as effective as it could be
[...] (radio aid) is a tool that could enable her to be more easily integrated with the
other kids in a very noisy environment
One grandmother reported on the new-found delights of playing Hide and Seek using a
radio aid:
P20: When you are playing Hide and Seek, you build up the anticipation. A hearing child
would be very excited and giggling […] Before he would hide and he had no idea where
(Grandma) was until she got there, so just building up the anticipation made the game
more exciting, which all of his (hearing) brothers would experience. He hadn’t experienced
that before (using the radio aid)
4.3.3.3 Reduced isolation
A consequence of increased participation is reduced isolation; some parents commented
on this:
P6: It stops her being insular and on her own. Over that distance, if there was back-
ground noise, she wouldn’t hear us talking without it. It’s nice for her to know that
we are around her
P20: Because he was sat in the back of the car, he couldn’t hear or see our face,
so he was almost completely isolated […] out initial response (to the radio aid in the
car) was that it was fabulous!
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4.4 Practical considerations
In this study, a variety of radio aid makes and models were used by families; one family
(P20) tried three radio aid systems during the course of the study including two systems
with wired receivers, so had a range of experiences to draw upon. Parents openly shared
both positive and negative feedback about the practical considerations of using a radio aid
with a pre-school child.
4.4.1 Choose a simple and reliable system
Parents valued simple systems that are easy to set up and explain to others, reliable and
easy to check that they are working correctly:
P13: It was basically switch it on and it connects automatically. It’s literally on, done
P20: it is easy to use, the touch screen is easy to follow, really easy to use [...]. It just
comes in and out of range, so I don’t have to worry that it is switched off
4.4.2 The fewer wires, the better
As described, a variety of radio aid systems were used in this study; some systems involve
wires more than others.
P8: Having been given the one we have got with the cable and everything it isn’t
quite as easy- the cable can get tangled up
4.4.3 Batteries
4.4.3.1 Battery safety is an issue
The most signicant and recurrent concern was the lack of a locking battery compartment
when the receivers are in place on the child’s hearing aids. In fact for a few families, this
affected the amount of use they made of the radio aid.
P8: We don’t have the safety catch now [...] we have a bit of a worry about the
batteries because it is very easy to open and take the battery out, which at nursery
with her friends, is a little bit dangerous. We take them off in the car [...] if they were
locked we would feel more condent leaving them in [...] that has been the biggest
drawback
P6: There hasn’t been a problem with it apart from the worry of the batteries
[...]. If they could make a way to secure the batteries that would be the biggest
improvement
4.4.3.2 Battery life is affected
Using a radio aid takes more energy from the hearing aid batteries.
P16: With the radio aid, it uses up the batteries really quickly so if she wasn’t wear-
ing the radio aid, we could go about 2 weeks, but with the radio aid I am changing
them weekly. Whereas I get them free at the clinic, I have actually been buying them
because I have been getting through them so quickly
4.4.4 Size, weight & visibility
4.4.4.1 Wearing the receivers
Most parents reported no issues with their child wearing the extra receivers on their hear-
ing aids and many parents chose to leave them on all the time; however it was a problem
for some:
P2: The extra piece on her HA was heavy and would cause her HA to come unstuck
from behind her ears when playing [...] She has been asking me more frequently
to help her stick her HA back [...] so that is why I did not want to just leave them
on. This has happened at home, when we’ve been out and also in the car. This has
28
sometimes put me off wanting to use the FM
P12: It made his hearing aids heavier and obviously much more noticeable
4.4.4.2 Wearing the transmitter and microphone
Regardless of device, parents described their issues with wearing the transmitter and
microphone:
P5: My only problem with the radio aid, I nd it annoying! Having also a one year old
and having to continually pick them up, the system can be knocked around
P3: We were quite conscious of it, when we rst had it, and it was a really bit weird,
when I was in a shop, and anybody noticed it, they maybe thought I was a secret
shopper or something.
P2: I feel the whole FM receiver has too much to it for everyday/ all day use in
terms of wires, ear piece and receiver and sometimes I would nd it stressful using
it because of this […] I would have to take her HAs out and clip the piece on which
when I’m a busy Mum is not very easy to do or quick. If it could be built into her HA
without extra pieces clipped onto them and used without wires and bulky pack, it
would be better/ easier as I know it would benet her
They also shared concerns around wearing the equipment to make their child’s listening
experience pleasant and effective:
P1: You can’t wear a necklace, I can’t wear a scarf, it gets in the way
P1: If it’s windy I don’t [use it], I don’t think she likes the wind.
4.4.5 Valuable equipment
4.4.5.1 Responsibility
Several parents referred to the value of the equipment and the responsibility of this:
P15: Sometimes I worry a bit [...] I think because they’re quite expensive, I don’t
want him to take it out and throw it, it’s kind of hard to judge that sometimes
4.4.5.2 Inconsistent advice from insurers
Parents were given differing advice about liability and insurance for the radio aid:
P8: We were told that we needed to speak to our insurer to make sure it is covered,
so we are covered
P20: I spoke to my insurers and they wouldn’t let me insure it because it wasn’t
mine, I didn’t own it
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4.5 Engaging with the technology
Engaging with or “buying-in” to the radio aid appears to be important for not only for trying
it out, but also for continued use. Several factors emerged as important for engaging with
the technology.
4.5.1 Knowledge of radio aids and how they might help
4.5.1.1 Awareness & understanding
Several parents had not heard about radio aids before joining the study; of those who had
heard of them, their local ToD or organisations such as the National Deaf Children’s Soci-
ety or The Ear Foundation had been the source of information. Several thought that radio
aids were just for use once a child started school:
P5: The radio aid, as I understood it, was only what they had at school [...] It was
obviously something that was available, but we didn’t really know a lot about them
Most parents had a concept of what the radio aid would do, look like and what it was used
for:
P8: Obviously the radio aid doesn’t amplify, just makes your voice closer to her hear-
ing aid
4.5.1.2 Expectations
It seemed important that parents have realistic expectations of what the radio aid might
offer as well as how to manage it; difculties can arise when there isn’t a clear understand-
ing or expectation:
P9: There needs to be, it can’t be a ‘this is going to x everything’, it needs to be a
‘this is going to help’ [...]. I’m disappointed by my own expectation, not what it’s actu-
ally delivered
P2: I did not really know that much about it [...] I don’t think I knew properly. I
suppose I was thinking I’d just use it every day for all situations but then when I was
using it, I did not nd it very easy to use [...] And because I didn’t really see it work-
ing really, really well for her […] the benet didn’t seem huge enough, it just didn’t
outweigh, I just found it more stressful
4.5.2 Access to the technology is essential
4.5.2.1 Access depends on local policies
Families in the study accessed their radio aids from their Local Authority Teacher of the
Deaf or private providers. Some families considered taking part in the study, but were una-
ble to access a radio aid because of local Education or Cochlear Implant service criteria/
protocols:
P8: It was a bit of a battle to get it. I think [...] she was 1½ coming towards 2. When
we did get it, it wouldn’t work with the rst lot of hearing aids and we didn’t start
using it until September.
4.5.2.2 Equipment must be suitable and reliable
Access to a suitable radio aid was also an issue, with problems such as reliability and
wired systems:
P20: LOADS (of difculties)! The wired system is MASSIVELY unsuitable for home
use and those who do anything other than sit still.[...] They all have their pros and
cons but for us as a family, without a doubt, the wireless one is best
30
4.5.3 Develop condence with the technology
Learning to use new technology can be challenging; parents in this study encouraged oth-
ers to persevere and develop condence over time.
4.5.3.1 Getting started
Parents valued the support of the professional in setting up and learning to use the device:
P15: My ToD had already set it up for me, and all I had to do was switch it on, and
that was it. It was very easy
4.5.3.2 Condence in it working
Understandably parents need to know how to tell if the radio aid is working for their child:
P8: We were a bit reticent of using it at rst [...] Once we got comfortable with it and
we were condent that it was working all the time then it was pretty easy [...] Keep
on using it until you are condent that it is working in the way you expect it to and
then you won’t be worrying about it
4.5.3.3 Establish a routine
Most families admitted that it took a bit of time to use the radio aid consistently, but found
it helped to establish a routine:
P5: There have been many occasions when I have walked out this door and got to
the end of the street and thought I have forgotten his radio aid [...] but it is just get-
ting into that routine
P3: It lives in my handbag or her bag so if we go out somewhere it’s already in the
bag [...] everything get’s put on charge every night anyway, it’s just habit. Because it
would be a nightmare if we ended up somewhere the next day and needed it and it
was dead
4.5.4 Find what works for you & your child
When asked about their top tips for using a radio aid, many parents encouraged an exper-
imental approach to nd out what works best for you and your child. The children them-
selves frequently demonstrated their preference and control even when they had little or
no language, for example by choosing not to listen or indicating when they wanted or didn’t
want to use it.
P12: It’s about not worrying about when and where; it’s about just trialling it at
different places and what works for you as an individual and not being fazed by it
[…] Literally trial and error, when we went out, we’d just try it and if he liked it, we’d
carry on and if he didn’t like it, we switched it off, we’d wait a bit and then try again
later […] It is also knowing your child [...] If your child doesn’t like it, try it again in a
different setting
P3: We are in general noticing that she is becoming aware of the system and in busy
situations has indicated she wants it on. If at home we forget we are wearing it and
it is still on she will come to us and try to turn it off
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4.6 Choosing the right time
All those who had tried the radio aid with their own child, were in favour of other children
with hearing loss using a radio aid. Thinking about when would be the “right time” for chil-
dren to start using it; parents came up with a range of things to consider.
4.6.1 As early as possible
P6: It would be nice to get a radio aid with the hearing aids initially really […] I think
the sooner the better really
4.6.2 The child’s mobility
P1: As soon as they get mobile, as soon as they start running around and walking
and going places that is an ideal age for them to have it […] when they’re becoming
a bit more active, that’s when it should be introduced. And I think every child should
have one because they’re really good
P3: Once they’re older and you’re worried about them going off walking, the safety
part is really important.
4.6.3 Speech & language development
Some parents described the importance of early access to speech for spoken language
development and the value of increasing that access through using a radio aid:
P3: But the whole thing [...] about making sure they can hear you clearly, for that
speech development [...] at that age is really important.
4.6.4 Consistency of hearing aid use
Establishing consistent hearing aid use in a young child is a challenge experienced by most
parents, often made worse when the child suffers repeated ear infections or has other
medical or developmental needs. This study identied that when hearing aid use is incon-
sistent it can be a barrier to getting started with a radio aid, yet other studies have found
radio aid use helped to establish hearing aid use (e.g. Mulla, 2011):
P12: I would say if a child was wearing hearing aids consistently, I think that is the
time to introduce it.
4.6.5 Before starting education
Even parents, who reported that their main purpose for a radio aid was to use in nursery or
school, felt that it was important for the child to become familiar with it before they started
in education. They did not like the idea of introducing something new, like a radio aid, dur-
ing times of change or uncertainty:
P1: Denitely before starting nursery so it’s not a new thing when starting nursery
as well
P16: I do think they should be offered them at nursery and also use it at home
rather than keep it at the school, as it benets children
4.6.6 When it’s the right time for you and your child
When they had been happy with their radio aid experience, parents often described the
“right time” as the one that they had experienced. Those who had wanted to have one
sooner described that as the right time:
P5: I would have introduced it a lot sooner knowing how he copes with his hearing
loss as it is now
Subsequently, they often reected on this and suggested that earlier could be better; this
usually came with a caveat suggesting that the “right time” is the one which is right for you
32
and your baby.
P20: Don’t just sign up for it just as you have heard your baby is deaf, because you
are going to need a couple of months to getting used to putting in the hearing aids
and maintaining them [...] maybe get familiar and condent with their hearing aids
and when you are alright with their hearing aids and condent with that then look
into a radio aid
However, early awareness and knowledge of radio aids was perceived as very important:
P12: It should be available as an option. The more you know, and the more options
there are the better. If you start to close doors and you don’t have them available to
you and not presented those options, the doors are closed
They recognise that all children and families are different and how, when and where a
radio aid “works best” may differ.
P5: It might not be the right thing for everybody. I guess every child is different,
hearing loss is different, different reasons, other things to consider. I know it won’t
be necessarily helpful for everybody, because everybody is different
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5.0 Discussion
The rst few years of a child’s life are a time of rapid and important development. During
this time the foundations for communication are laid and for all children, language and
interaction with their parents is critical to success. Hearing is an essential component of
successful spoken language development and for deaf children, early and consistent expe-
rience of sound through appropriate amplication has been repeatedly shown as the major
factor in developing spoken language (for example, Ching, 2015).
5.1 Everyday listening environments present a risk to learning spoken
language: using a radio aid can reduce this risk
Learning occurs in all the routines and interactions of everyday life (for example, Beck and
Flexer, 2011); however this study clearly illustrates that the life of a young deaf child is full
of difcult listening situations which jeopardise language development, for example in the
car, out and about, in a buggy or at social events such as parties and meals out.
Previous studies have reported improved listening responses with radio aid use in these
challenging conditions (Gabbard, 2003; Moeller et al., 1996; Mulla and McCracken, 2014;
Statham & Cooper, 2009; Webster, 2015). Both quantitative and qualitative ndings from
this study add to this evidence base for pre-school children, demonstrating that using a
radio aid signicantly improves a young child’s listening for speech in noise, at distance
and without visual cues. Improved listening was also observed and reported in quieter
situations, such as during parent-child interaction at home. Concerns have previously been
raised about a child’s ability to develop sound localisation skills when using a radio aid;
however this study suggests that young children are often more aware of people talking
and able to locate the speaker with radio aid use.
Continued use of a radio aid over time indicates the benet parents perceive for their child,
having tried a range of situations and eliminated those which they did not nd useful. End-
of-study reports show the majority of parents found many situations were better or much
better when using the radio aid and for the situations in which they found benet, the
majority used the radio aid 50-95% of the time.
Using a radio aid seems to be of benet in the challenging listening conditions of daily life
and may lessen their risk to spoken language development.
5.2 Using a radio aid facilitates important predictors of spoken language
outcomes
Improved listening for speech with radio aid use is well-documented; however the link with
spoken language outcomes has been inconclusive (Moeller, 1996; Mulla, 2011; Mulla &
McCracken, 2014). This study provides a new and fascinating insight into how improving
hearing for speech or audibility through radio aid use may help a young child to develop
spoken language.
Hart & Risley (1995) demonstrated that the amount of language spoken by a parent to
their child within the rst three years of life partially predicts the child’s language and
academic achievement at 9 and 10 years. Deaf children receive a reduced amount of
34
language in difcult listening situations; to compensate for this, they require not only
improved audibility, but also a greater quantity of linguistic input (Van Dam, Ambrose et al.,
2012). This study substantiates existing evidence that using a radio aid improves audibility
in noise and at distance, thereby providing the child with more of what parents are saying
to them. In addition, it also suggests that when using the radio aid in some situations,
adults used more words, increasing the important quantity of language. By recognising
that their child can hear them when using the radio aid in challenging listening situations,
this study also suggests that parents make more of everyday opportunities for language.
Parent-child interaction is also vital to language development (for example Zimmerman,
Gilkerson et al., 2009; DesJardin & Eisenberg, 2007); however a child’s reduced linguistic
ability and lack of responsiveness can cause two-way conversations to break down. This
study demonstrates that not only do parents report their child as responding more quickly
and consistently to speech when using the radio aid, but also shows an increase in conver-
sational turns in some situations. This suggests that when using a radio aid a young child
is more responsive, which encourages parents to keep the conversation going, thereby
increasing parent-child interaction as well as the quantity of linguistic input.
Demonstrating the increase in these predictive factors is a new and important nding and
suggests radio aid use can be a contributory factor to successful language outcomes.
5.3 Radio aid equipment can be challenging
To achieve any benets of radio aid use, the technology needs to be in place and used with
condence. However, this study highlights several issues with the equipment.
As long ago as 1996, Moeller reported the challenges of using radio aids, with parents
reporting equipment as “bulky”, “cumbersome”, “visible” and feelings of self-conscious-
ness. There have been many technological advances over the twenty years since that
study but similar difculties continue to be reported by parents. Unlike the Moeller (1996)
study, parents in this study reported few issues of poor reliability or need for repair, per-
haps reecting the more modern technology. However the current families still complained
of physical difculties, bulky and uncomfortable equipment. Issues of wire entanglement
and visibility continue to be a challenge, not only because they interfere with the physical
activity of the child and adult, but also because they make both feel self-conscious. Par-
ents are also extremely anxious about the safety of the devices, particularly the batteries.
These issues impact on the well-being of the parent and can even reduce the amount of
use of the radio aid, limiting benet for the child. Integrated wireless devices are likely to
address some of these issues, but currently their provision is limited.
Despite the challenges of equipment, most parents in the study persevered with using
their radio aid suggesting that they perceived enough benet from it to outweigh the
difculties.
5.4 Successful radio aid use requires timely and good quality information
and support to maximise potential benets for both child and family
Importantly this study highlights the impact of radio aid use on parents and children
for their social, emotional and psychological well-being, the “building block for healthy
35
behaviours and educational attainment” (NICE, 2012).
Self-efcacy, the condence and belief in one’s ability to perform a task, is linked to suc-
cessful outcomes; Meyer, Hickson et al. (2014) demonstrated this link in relation to hear-
ing aid use and it could reasonably be assumed that the same would apply to using radio
aids. Like Mulla (2011), most parents in this study showed condence in managing a radio
aid in daily life. Families also demonstrated self-efcacy through actively engaging with the
radio aid, experimenting with what worked for them, persevering through difculties and
making decisions and choices.
Self-efcacy is improved by being well-informed, having a clear understanding of the
purpose, benets and challenges of the task, appropriate expectations and receiving both
practical and emotional support (Meyer et al. 2014). This study highlighted that where
there was uncertainty or a lack of condence in the equipment and its benet for the child;
this had a negative impact on well-being and was linked with less consistent use.
Findings also showed that using a radio aid will be a different experience for every family.
Best practice guidance supports self-efcacy by recommending that “professionals pro-
mote the process wherein families gain the necessary knowledge, information and experi-
ences to make fully informed decisions [...] in response to the child’s or family’s changing
abilities, needs, progress and emotional well-being” (Moeller, Carr et al, 2013) and that
information provided to families should be” unbiased, comprehensive, clear accessible
and accurate” (National Deaf Children’s Society, 2017).
Whilst provision of radio aids to pre-school children may be focussed on improving listening
and spoken language outcomes, successful use requires effective and positive support
through well-informed choice and genuine collaboration between parents and profession-
als with up-to-date knowledge and skills.
5.5 Early radio aid use may improve outcomes and reduce disadvantage
Current legislation has a clear focus on early intervention and improving outcomes. There
is no clear understanding of what ‘early’ means in relation to radio aid use; however the
National Deaf Children’s Society Quality Standards (2017) recommend that “every deaf
child should be considered as a potential candidate for provision with a personal radio aid
as part of their amplication package, at rst hearing aid tting”. In this study, the parents
largely supported ‘early’ use and whilst their views on the most appropriate time to intro-
duce a radio aid varied, they all agreed that a radio aid should be introduced before the
child starts full-time school. Regardless of age, once they became aware of radio aids and
the potential to use one, all the parents were keen to try it and all would recommend that
other families try a radio aid with their pre-school child.
The Equality Act (2010) requires local authorities and education settings in Great Britain to
make reasonable adjustments to ensure children with hearing loss are not disadvantaged;
this includes a duty to provide “auxiliary aids” when needed and to make proactive reason-
able adjustments before the child is substantially disadvantaged. Despite these recom-
mendations, access to radio aid use at home is not equitable across the UK and there are
inconsistent criteria and protocols for radio aid provision (Allen et al., 2016).
This study provides strong evidence for the advantages of early radio aid use supporting
36
the introduction of consistent protocols and provision.
5.6 Using a radio aid in nursery requires careful management
Radio aids are widely used in schools and the benets have been reported for many years
(for example Ross, 1992). Although nurseries are noisy environments and there are clear
reasons for improving SNR, the dynamics of the nursery setting are different to those often
experienced in a classroom. In this study, radio aid use was largely reported as benecial
in group activities where the child was primarily listening to only one key speaker, such as
the group leader. However, less benet was perceived in group situations with more than
one key speaker or where the adult was quickly changing between conversations with
more than one child. Adult word count and Conversational turns also decreased in these
situations; as previously explained this result may be due to the limits of LENA’s recording
distance.
Overhearing speech is benecial for language learning and research has highlighted chil-
dren as young as 16 months of age can learn language by overhearing two adults convers-
ing without any form of scaffolding (Floor and Akhtar, 2006). Although this can be positive
when the child is playing on their own and a parent/ key speaker is wearing the radio aid
transmitter; in nursery settings and group play, the dominant speech signal coming from
the radio aid can inadvertently mask out important speech from peers or other nursery
staff.
Similar to parents, any staff who use a radio aid need information and practical guidance
to understand and implement it effectively and appropriately.
37
6.0 Conclusion
This study shows clear and quantiable benets of radio aid use with pre-school children.
The ndings substantiate existing knowledge about the challenging listening environments
of young deaf children and the benets of improved SNR in noise and at distance. These
ndings demonstrate that radio aid use facilitates the important predictors of improved
language outcomes, audibility, parent-child interaction and quantity of words. They also
provide a new insight into the impact of radio aid use for these children and their families
and provide a substantial evidence base for informing professional practice and commis-
sioning decisions.
7.0 Recommendations
• All parents of a young deaf child should be informed of the signicant potential
benets of radio aids and have the opportunity and support to use the technology
at home
Parents with a newly diagnosed deaf baby need to understand the importance
of hearing speech to the development of spoken language and the challenges of
everyday listening environments. Introducing radio aids as a tool in their child’s
hearing management raises their awareness and gives them options to consider.
Evidence-based information helps parents to have appropriate expectations of the
potential uses and benets of radio aids.
• Access to radio aids should be equitable for all pre-school children
Recognising the long-term benets of early intervention for language and communi-
cation and the subsequent impact on educational achievement, this current evi-
dence supports early introduction and equitable access to radio aids for pre-school
children. To ensure equity for all deaf children who would benet; consistent criteria
and protocols need to be developed and implemented and UK Governments and
local authorities should ensure adequate funding is provided.
• Professionals should be knowledgeable about managing the latest technologies
Technology changes rapidly. Teachers of the Deaf and Audiologists need to remain
up-to-date on the latest technologies available and how best to t them.
Teachers of the Deaf and Audiologists need knowledge of the latest evidence-based
information in order to support the introduction and use of radio aids with pre-school
children.
• Manufacturers should respond to the identied needs of children and families in
everyday life
Parent experience of using radio aids with young children continues to indicate is-
sues and concerns with the equipment, which limit its access and use. Manufactur-
ers of radio aid equipment need to understand and address these important real-life
concerns about the technology.
38
8.0 List of Figures & Tables
Figures
1. LENA DLP
2. Overall perceived benet of using radio aid in daily situations
3. Reported change when using radio aid in specied situations
4. Levels of current radio aid use in specied situations
5. Changes in listening without and with radio aid in different situations
6. Listening Function with radio aid
7. Ling 6 sounds without and with radio aid in quiet and noise, close & at
distance
Tables
1. Individual demographics
2. Parent perception of benet in different situations and activities
3. Adult word count, conversational turns and child vocalisations without
and with radio aid in specied situations
39
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(Footnotes)
1 As reported by parents and Teachers of the deaf.
2 The time in study is based on the start date of the rst assessment (mostly Daily
Activity Log) and last assessment (Listening evaluation).
