To Treat or Not to Treat, That Is The (Million Dollar) Question, Part I

To Treat or Not to Treat, That Is The (Million Dollar) Question, Part I

Sammy and Jake both have a hearing loss.  Do they need speech and language therapy?

Some of you may know that hearing loss would be considered a presumptive diagnosis.  This means that this condition automatically qualifies these children for support services. 

What therapy should you give them and how often?

Should they get the same therapy?  If you answered “yes” would grouping them be a good fiscally efficient option?

Without knowing anything more about each of these children it is hard to answer the above questions.

What if I told you that Jake is 10 years old and has a borderline to mild hearing loss while Sammy is 8 years old and has a moderate hearing loss.  Now you know something about the degree of each child’s hearing loss i.e. the severity of the measure of each child’s disability.  However, you will be surprised to learn that this information does not really tell you enough to decide who needs treatment and how much.

There are two terms that have sadly gone out of vogue due to political correctness.  The problem is the replacement terms, while politically correct, do not differentiate as clearly as the old terms.  For this reason I will remain old fashion, and choose to simply not use this vocabulary in a derogatory fashion and voila no one has reason to be insulted.  These terms are “disability” and “handicap”.

Disability, refers to the type and degree of severity of the disorder.  In the example above our two children had a hearing disability of differing degrees.  Some people have physical limitations, others cognitive limitations, or emotional limitations to name a few.  A qualified professional would label their particular type of disability using the diagnostic manual (currently DSM-V).  A disability must be identified to direct appropriate treatment. 

Suppose I told you that Amy hits people when she is frustrated.  What type of treatment would you recommend? 

  • What if I told you that Amy is 16 months old?  Perhaps mom is over reacting, Amy simply hasn’t learned how to handle frustration, so mom will have to train her. 
  • What if I told you that Amy is 30 months and non-verbal?  Then she probably needs to learn how to communicate, perhaps using sign language as a stepping stone to verbal communication and a means of alleviating her frustration. Mom may want professional assistance but needs to think about whether language facilitation is enough or if professional behavioral modification is needed.
  • What if I told you Amy is 6 years old?

Without a diagnosis you cannot answer the question well.  Knowing the age only tells you about the developmental contribution to the behavior.

Handicap, refers to how much the disability affects the individual’s function.  In other words, the consequence or effect of the disability.  Suppose Sammy, in the case above, was diagnosed early on and fitted with hearing aids.  Although Sammy’s disability is greater than Jake’s, his handicap may actually be less than Jake’s who does not have a significant enough hearing loss to warrant hearing aids.  Jake may be functioning on a day to day basis with less hearing than Sammy.

How much does Amy’s hitting handicap her?  At 16 months – not much, but at 6 years – severely.

You need to know both what the disability is and how much of a handicap the person has to determine whether treatment is warranted at this time and what type of treatment is your best bet.

With so many similarly presenting conditions and so many misleading labels how do you accurately diagnose?

Just because someone is a professional does not mean they are the right professional, that is why there are so many medical subspecialties.  Know your experts! 

I don’t fit hearing aids or map cochlear implants even though I am licensed to do so.  Integrity dictates (but it is not required!!) that should I expand my offerings to include hearing aid fittings I go for some additional training, as much has changed in hearing aid technology since I graduated over 20 years ago. CONSUMER BE EDUCATED and BEWARE!



Related Post

Leave a Reply