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DISCUSSION

The number of adults and children who took part in this study was limited by time and the resources of the author. It is clear, however, that there are definite trends in the opinions of the hearing impaired children and their parents who responded to the questionnaires to the use of brightly coloured hearing aids. The children tended to choose the coloured aids because they liked the different colours and felt they looked "cool". Their parents wanted them to be happy wearing their aids but were also more aware of the possible problems that could arise from high profile, highly visible coloured aids. (Green 1999)

 Stigma.

Although most of the children of both primary and secondary age admitted to wearing their hearing aids most of the time, a majority of children preferred the bright coloured hearing aids to traditional beige ones and said they would be "better" both at home and at school. Silverman and Klees (1989) recommended that, to minimize a negative reaction in their peer group, children learn not to try to hide their hearing loss and certainly bright coloured hearing aids are not easily hidden. They did, however, recommend the use of an "invisible" hearing aid or the smallest visible one appropriate to the child’s hearing loss to reduce any such negativity to a minimum.

The children in this survey would seem to be suggesting that they rarely encounter such attitudes among their friends at home or at school. This bears out the later research by Silverman and Largin (1993) which cited data that indicated that peers may respond more positively to visible hearing aids. The situation may be analogous to that of orthodontic braces used for straightening children’s teeth. In recent years these have become much more obvious, colourful and more acceptable among young people. Consequently, more and more young teenagers are undergoing straightening treatment for their teeth without worrying about being made fun of by their peer group. The wearing of bright coloured hearing aids by children in school may be helping to dispel the image of disability associated with traditional aids.

Very many hearing impaired children are educated in mainstream school now rather than in hearing impaired units or schools for the deaf. The study aimed to discover if there was a difference in attitude to coloured hearing aids between the child who was perhaps the only hearing aid wearer in his school and the child who attended a unit with several other hearing impaired pupils. In the latter case, Goffman’s "undesired differentness" (1963) would perhaps be less apparent as more children would be seen to be wearing hearing aids and thus members of an established, accepted group within the school.

The results of this study would suggest that the children who replied were largely unconcerned that they would look different from other children through the use of their aids. (Ross 1996) Over twice as many children in both mainstream and units thought that coloured aids would be "better" in school and the vast majority of children already wearing coloured aids reported positive comments from their school friends in all the different educational settings.

Other children were aware that perhaps it was not the hearing aids themselves that caused problems. Hearing impaired children are no more likely to be immune from bullying than other young people and can be picked on no matter what size or colour of aid they are wearing.

However, some children were certain that they did not want coloured aids and they knew why. They did not want attention drawn to their aids.

"I am happy with the colour I have got because if I had another colour it would draw attention to them."
(13 year old boy)

The children who felt like this were all in secondary school so it may be a factor of teenagers not wishing to be noticed or marked out as different from their peer group in general rather than feelings of stigma specifically due to the hearing aids.

It would appear, from the replies, that parents still have difficulty deciding whether the benefits of a greater awareness of the child’s possible problems due to the hearing loss outweigh any danger of the child being picked on or bullied for being different. Ross’s acknowledgement (1996) of the effect of the visible sign of the child’s impairment is still evident, especially among the parents of the children who wear traditional beige aids. For example:

"They (the aids) are skin coloured and don’t show up too much, making him more socially acceptable."
(parent of a 6 year old boy.)

"(Coloured aids) may lead to teasing / bullying."
(parent of an 8 year old boy.)

"I think they (coloured aids) are horrid."

This last comment from the mother of a 12 year old boy perhaps indicates more about her level of acceptance of her son’s disability than the aids themselves, especially as he really liked them!

Those parents whose children have chosen coloured aids have decided, presumably through experience, that coloured aids are no greater cause of stigma to their children than beige aids. Their comments included:

"We have had only positive reactions from the coloured aids."
(parents of an 11 year old girl.)

Some parents showed complete acceptance of their children’s hearing loss by requesting coloured aids from their local audiology clinic to increase others’ awareness and understanding.

" I requested them as people were really ignorant with my son."
(parent of an 8 year old boy.)

Cosmetic Factors.

Although many of the researchers in the past have stressed the importance of the cosmetic appeal of hearing aids, Brooks and Johnson (1981); Dempsey (1994); Tate (1994); they did not take brightly coloured aids into consideration. Hearing aids were made in beige, grey or brown to blend in with clothing and hair colour or, at the very least, not to look too garish. Green (1999) was the first to recognise that children may see them as a fashion statement. In this study there was no significant difference in the percentage of boys and girls who preferred coloured aids, although more boys tended to think they would be better at home than at school. The opposite view held true for the girls who replied to the question. This may be due to the accepted view that girls are more fond of wearing bright coloured accessories at home and at school and that boys are less concerned with their appearance.

Many of the children, girls as well as boys, chose their coloured aids as an expression of their football loyalty. This helped to explain the popularity of red and blue amongst the favourite colours. Red was chosen as it represented Manchester United and Liverpool F.C. while blue was the choice of both Everton and Chelsea fans. This enabled the children to gain some kudos over their school mates rather like having the appropriate team colours on a badge.

An interesting comment was made by one parent who felt that it was good for children to be able to wear hearing aids that looked completely different from those worn by "old persons". Another felt that the colours made the aids look attractive and "modern". It would appear that, at last, hearing aid companies, like those who make spectacles for children, are making an effort to appeal to the younger population, even though they do not constitute a large proportion of their customers.

"Cool" was a word that came up over and over again in the children’s replies.

Either they considered the colours to be "cool" themselves or their friends had described them as such. In addition to the examples already quoted, children wrote:

"You look cool!"
(12 year old boy)

"They think they are cool and colourful"
(12 year old boy)

Even when the colours themselves were not chosen, the translucent cases which display the innards of the aids, were regarded as desirable buy both the hearing impaired children and their peers.

Not all the children loved the coloured aids though, even when they had them! One 13 year old girl with pink aids wanted ones "the same colour as my skin"

Her parents and audiologist had suggested coloured aids in an attempt to increase her acceptance of her aids and the need to wear them. This had obviously been unsuccessful as she did not want anyone to see the aids and was still very resentful of having to wear them.

One other young boy felt he had been given blue aids because they were his father’s favourite colour. He would have preferred green! As hearing aid manufacturers usually make a small charge to change the colour of the hearing aid case, there could be a cost implication to the NHS or to the families if children are permitted to change their aid colour on a frequent basis. When taken as a percentage of the price of an aid, however, this charge is negligible and really should not be a deterrent.

The child’s position in the family had no significant bearing on whether he or she preferred coloured aids. 60% of parents whose only or first child was hearing impaired expressed a preference for coloured aids for him or her. This would seem to be suggesting a much more positive and open attitude to hearing aids among parents now that they appear more cosmetically "acceptable".

Many parents were aware that, although their young children liked and wanted coloured aids, when they became teenagers or went to secondary school they

might change their minds. If changing the colour is perceived as difficult or expensive then children may not get the colour they want. Almost half the parents surveyed felt that teenagers did not like to be noticed and that their attitude to their hearing aids might alter when they changed school to be with a cohort of children who might not have had experience of hearing loss.

Confidence

One factor that was stressed frequently by parents was the increase in confidence shown by their children after they started wearing coloured aids or ear moulds.

"She already has coloured ear moulds….we feel coloured aids would be a perfect match. Having coloured moulds has given her a huge boost to her confidence."
(parents of a 12 year old girl)

The parents whose children already wear coloured aids were much more convinced of the benefits of the colour in increasing their children’s self esteem.

Many of the parents of children with traditional beige aids, although perhaps a little more hesitant, expressed a willingness to try coloured aids, especially if the children wanted them. This would suggest that the acceptance of coloured aids would increase among parents if audiologists could and would provide more of them. Much of the modern advertising literature for hearing aids shows coloured versions of the different models, so although many parents and children expressed surprise that coloured aids existed at all, their availability should become more widespread. In some cases, however, parents reported that even their local audiology departments had not seemed to be aware of the existence of such aids. Those who do not offer the choice of coloured aids may be subconsciously confirming Ross’ view that, as part of society, audiologists can be influenced by feelings of stigma either real or imagined.

National Health Service Provision

Children whose hearing aids are issued from the National Health Service range do not have the choice of coloured aids other than grey or brown which have been designed to be les s visible against grey hair or darker skin than the traditional beige aid.

When NHS aids were manufactured "in house" by the Medical Research Council, the limited numbers would have made it financially unviable to provide different colours even had the technology been available. Now that all NHS aids are sourced through the commercial hearing aid companies there would appear to be no such reason for not providing coloured versions of behind the ear aids.

Many of the children who are successfully aided from within the NHS range have slight or moderate losses. These children are almost invariably educated within mainstream schools unless they have additional special educational needs. The results of this research and that of Silverman indicate that the peers of hearing impaired children are now more tolerant of hearing aid wearers than in previous years and that the visibility of their aids can be a positive factor in acceptability. The hearing impaired children themselves do not regard coloured aids as a stigma or "badge" of their disability, in fact many children actively prefer them and yet these children are not even offered the choice of coloured aids. Hearing aid manufacturers maintain that providing coloured cases costs very little extra.

They have not even bothered to research how popular they will prove before  providing them and yet the NHS regards them as an unnecessary expense.

Only pressure brought by the children, their parents and their local audiologists will correct this inequality. There may be logistical problems over stock and replacements but these surely are not insurmountable and ought to be discussed by the Health Service Commodity Advisory Group. It is to be hoped that coloured hearing aids will soon be as available, in the NHS, as coloured ear moulds are already.

Ear Jewellery

Some years ago, a company in Canada produced a catalogue of different coloured and shaped covers for post aural hearing aids. These covers, which are attached to the aid by the simple means of a loop of elastic, come in the shape of lightning flashes, bat wings, fish, bananas and many other popular designs. They are also available in a wide variety of colours, zigzags and polka dots which can be swapped to suit the wearer’s mood or outfit. A copy of the brochure is included in the appendix, and the jewellery is currently available through the Internet. The interchangability of the designs would seem ideal to satisfy the ever-changing fashion desires of the average teenager and yet there would be no cost implications for audiology departments. Parents might also be happier for their children to be wearing "different" hearing aids for different occasions. It is to be hoped that a similar company could be started in this country.

 


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