Dr. Hilary Davis, Listening Related Fatigue

Have you ever been fatigued from listening?  Join me for a conversation with Dr. Hilary Davis as she explains her research on listening-related fatigue and a tool, the Vanderbilt Fatigue Scales, that can be utilized clinically and educationally.  Dr. Hilary Davis is a pediatric audiologist at the Vanderbilt Bill Wilkerson Center. She is the current past president of the Educational Audiology Association.  She received her Bachelor of Science from the University of Texas at Austin and her Doctorate of Audiology from Vanderbilt University. She currently sees patients clinically for hearing aid fittings and hearing evaluations, serves as an educational consultant for local school districts, and aids in recruitment and data management for the Pediatric Auditory Research lab. She is interested in assisting educators with teaching students with hearing loss and the use of remote microphone system technologies in the classroom setting. 

You can reach Dr. Davis at hilary.davis@vumc.org

Download the Vanderbilt Fatigue Scales at https://www.vumc.org/vfs/vanderbilt-fatigue-scales

You can listen to this episode wherever you stream podcasts and at: www.3cdigitalmedianetwork.com/empowear-audiology-podcast

For more information about Dr. Carrie Spangler- check out her Linktree at https://linktr.ee/carrie.spangler.

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to Empower Ear Audiology with Dr. Carrie Spangler.
Carrie: [00:00:14] Welcome to the Empower Ear Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler. A passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode.
Welcome to the EmpowEAR Audiology Podcast. Today I have someone with me. Her name is Dr. Hilary Davis and she is a pediatric audiologist at the Vanderbilt Bill Wilkerson Center. She received her Bachelor of Science from the University of Texas at Austin and a doctorate of audiology from Vanderbilt University. She is an educational audiologist providing services to several districts in the Middle Tennessee area. She also works on research studies at Vanderbilt, focusing on deaf and hard of hearing school age children. When not at work. You'll find her at dance class or hanging with her three year old and ten month old daughter. Hilary is the current past president of the Educational Audiology Association. Welcome, Hilary.
Hilary: [00:01:33] Thank you. I'm so excited to be here with you today.
Carrie: [00:01:36] I know I always love to interview my fellow educational audiologist on the podcast, but I thought before we got started into the meat of the podcast, I would ask you, how did you get into the field of audiology?
Hilary: [00:01:53] It's a good question, and I know people have lots of different answers about how they got into audiology.
For me.
Hilary: [00:01:59] I really went to UT Austin because I was interested in American Sign Language and they had a really good program for teachers, for deaf and hard of hearing teachers. But I took the intro to Communication and Sciences Disorders class. I just happened to take it and fell in love with audiology, the tech component and, you know, just really, really loved that aspect of it. And then once I did my doctorate and I did a school rotation, that was it for me. I wanted to be in the schools doing this. So it really it really puts together a couple of things that I like doing the audiology piece, the hearing piece, but then also working with others who are like the teachers who are working with children with hearing loss. So.
Carrie: [00:02:46] Well, that's a great story. I love how it kind of came full circle for what initially went into you. And then it really plays into everything that you do today, too. And you, in addition to all of the educational audiology services that you provide, you also do quite a bit of research at Vanderbilt. And can you share a little bit about your research and interest there?
Hilary: [00:03:12] Absolutely, yeah. I've been very fortunate to work with lots of researchers at Vanderbilt and I love being able to be a clinical perspective on the research teams. I think it mirrors what we do in research really matters in schools and clinics and then vise versa to take those experiences back to the research side as well. So like you mentioned, I do outreach with schools through Vanderbilt. They contract with us for educational audiology. And then in terms of research, what we're going to talk about today and something that's been a big part of my work has been looking at listening related fatigue for deaf and hard of hearing students. And so we've spent goodness almost a decade working and looking at how fatigue associated with challenging listening situations can impact this population.
Carrie: [00:04:02] Yeah, that's a great topic and I'm so glad you and your team have spent so much time with it, because I think all of us have fatigue at one point or another in our lives. But can you just share a little bit more about what listening related fatigue means?
Hilary: [00:04:20] Absolutely. You're right. Fatigue is a word that especially as working moms like we were talking about before the podcast started. We feel fatigued. That is so true. This this specific term listening related fatigue is really focusing on the challenges that individuals who are deaf and hard of hearing might experience because of challenging listening situations. They have to put forth more effort just to hear and understand what's being said, and it can really cause stress and fatigue. So that's what listening related fatigue is, is specifically focusing on.
Carrie: [00:04:55] All right. So you and your team have been diving into this topic for a long time. So what did you how did this all get started?
Hilary: [00:05:07] Yeah, good question. For a long time, parents, teachers and children have said there's there's something going on where this is more fatiguing. The children we work with or that that we are raising are worn out. There's something going on and there's something that we need to do to address this for our children. So that's really what started it for us. And now, of course, we also like a lot of research, it starts in adults and then we transition that over to children, not the same population, but there are some similarities between them. When we heard adults saying, I am seeing these difficulties, I am seeing the fatigue and how it's affecting me, We knew that this was probably also an issue for children and we wanted to look into that more. We also knew that just from broad literature, fatigue has some really significant impacts on quality of life. People have more difficulty at work, at school, paying attention. All kinds of really poor outcomes are associated with fatigue. So we knew if this was an issue for deaf and hard of hearing children, we wanted to learn more about it.
Carrie: [00:06:13] Yeah. So how did you guys get started with kind of diving into the research? I'm assuming you'd had, like, focus groups and things like that that you really were looking into.
Hilary: [00:06:26] That's exactly right. We first started by saying, okay, we're hearing these comments. Let's pull people together so we can get some rich qualitative information. We did focus groups of parents, of children and then of people who worked at school with children. So that was interpreters, educational audiologists, SLPs general and special and deaf educators to come to come together in groups so that we could really get a better understanding of Is listening related fatigue a problem? What does it look like? What do people do to cope with it? And we wanted to get that information directly from people who knew most about this topic. So that's where this project started. We pulled together those people and were able to create what we called a theoretical framework for better understanding listening related fatigue. If you look at a paper we published in 2021, it's available on our website, It actually has a figure that walks through what we learned after we pulled together these focus groups and analyze the themes that were popping up in those groups.
Carrie: [00:07:28] And then. So why don't you kind of gather that information from the focus groups? What were some of those situational determinants of listening related fatigue that you guys found in that framework?
Hilary: [00:07:42] Yeah, that's a great question. Situational determinants was a fancy term that we used just to meet. What are things that are happening before fatigue is showing up for, for deaf and hard of hearing children. And it's no surprise that, number one was when things are noisy or there's lots of people talking, children, their parents and their teacher said these children seem more fatigued and worn out. Specifically for children, they also mentioned things like the cafeteria, the gym, playing on sports teams and needing to hear lots of different people in a in a big area that was more fatiguing. They were able to describe then that when they felt fatigued, it might be something like feeling physically fatigued, like I have a headache or I'm I need to take a rest. But the big one that we really saw was that children were also saying, My brain is tired, I'm worn out mentally, I can't keep paying attention. I need to zone out or take a break. And so we realized that there were some cognitive things going on as well as a physical sort of fatigue. It was also interesting because parents and teachers would say there seems to be some sort of social emotional component as well. Children might seem angry or frustrated, embarrassed even. There's just these different feelings that are coming up associated with the fatigue as well.
Carrie: [00:09:06] So with that, I know you said that there were some of these things that were popping up, like the anger and those different emotions. But were the children able to describe that when you were talking to them?
Hilary: [00:09:20] It's a good question, too. It really depended on the children. And I felt like children who are more self aware and those who were more. Had higher levels of language, were probably able to meet us there. When I did a couple of interviews with individuals who were in undergrad or grad school. Those were when they really started to say, okay, now that I'm in college work, I'm able to see this is so fatiguing. Now I can look back on high school and go, okay, that was happening to me then too. I just didn't know that I was doing something differently from my peers. And so I really struggled to communicate that to anyone, they would say. Now I realized when I came home from school every day, took off my hearing aids and just laid flat on the couch. That was because I was really tired from listening and understanding all day. My peers weren't doing that. My peers who didn't have hearing difficulties weren't doing those same things. So it really depended on the child. And younger children really struggled to help explain that information to me, even if their parents would say. Absolutely. I'm seeing this as an issue. Kind of that same example. My child comes home every day after school, takes off their implants, want want to take a rest. The child might tell me, no, I don't have any problems with like hearing and understanding. So it really it really was varied in terms of the responses.
Carrie: [00:10:42] Hmm. That's interesting. So let's just talk a little bit more about the Vanderbilt fatigue scales and how you and your colleagues developed this measurement to target listening related fatigue. And then I think we can answer some of the other question that I think go back to coping and and what we should do afterwards. But I know you guys have three different scales, and I would love if you could just explain a little bit more about those scales.
Hilary: [00:11:15] Sure. I'd love to do that. So those focus groups really informed the development of the scales. We took information and quotes from the focus groups and wrote thousands of items that could potentially be used on these scales through a long series of process. Long process. We statistically reviewed those and made sure that each of the items was relevant, important for the concept of listening related fatigue. And we're going to give us high quality information. We were able to take that through a series of years of review and finally ended up with really short scales. We have one for children one for parents and one for teachers, and they range from 8 to 12 questions, so you can use them very quickly. We wanted to do that because we know time is of the essence and in schools and clinics we have to get the information quickly. So our goal with these scales then is to really identify who is struggling with severe, recurrent listening related fatigue that may impact their quality of life. So you can use these when working with students to get a better understanding of if this is an issue for them. As I've used the scale more, I also use this as a counseling tool. Sometimes I might observe fatigue, but a child's not reporting it. And I'll use this as a jumping off point to really discuss the topic and see if there's something that the team can use from this information to develop an individualized approach for that student to help intervene.
Carrie: [00:12:47] Have you found between the three different scales, like if you do it for one student and you do it with the student and then you have the parent do it and you have the teacher do it, do you feel like they match up or a lot of times they don't match up?
Hilary: [00:13:00] It's a good question. We haven't done much research on that with our scale in terms of if there's differences now in the literature at large. Oftentimes there are differences between parent and child reports on fatigue and other measures, and it kind of makes sense. Fatigue for a child may feel really internalized in a parent or a teacher might not see what's going on for something like that. And then on the opposite side, like we're saying, a parent or a teacher may say, I see all these things, but the child may not recognize that. That's the issue. For me, I see. I see that teacher and parents are usually pretty on the same page with with students, but if there are differences, I use that as a counseling tool. If the parent or the teacher is saying I'm not seeing any issues but the child's reporting or vice versa, it gives me a better holistic picture and really opens up the door for discussion at that point.
Carrie: [00:14:00] Yeah, that's kind of what I've seen too, when I've used it that I see the the child will have a pretty significant score and then the teacher will not have the same report. But like you said, they're kind of internalizing it or they're just really powering through because they want to do well. Yet, you know, they're exhausted by the time they they go home at the end of the day, which is kind of I guess one other question before we move on to like how this impacts them in the school and what we can do to help. But have you found any differences between like degree of loss or  technology, whether it's cochlear implants or hearing aids or mild versus severe type of loss and the ratings?
Hilary: [00:14:50] Yeah, like most of what we do, we know that a mild hearing loss is not a mild hearing loss in terms of impact. And conversely, you know, a profound hearing loss is not always profound. In the same way, it's more of how much does someone want to and need to stay focused in a certain listening task. So any any type of degree, laterality or type of hearing loss can result in significant fatigue. And I think that's important to remind the team, especially when unilateral hearing losses or mild hearing losses get kind of tossed to the side. Sometimes those children can still say they're really, really fatigued and that might be because they are, like you said, really motivated to stay involved in what's going on and they might be really feeling pressure to do well at school or to hear what the teachers say. Sometimes my students with unilateral hearing losses have just anecdotally, some of the highest ratings of fatigue and. It may be because some of them are unaided, you know, don't have any sort of amplification device as well. But it definitely can be anybody, any person who has any degree or laterality  of hearing loss can have a report of significant fatigue.
Carrie: [00:16:11] That's interesting. But it makes a lot of sense and it really speaks to the importance of doing these scales so we can find out more information. And it doesn't really matter what their degree of loss or laterality is. But so if we have someone at the school that's doing these scales and they see that there's some significant scores or even borderline significant scores, how can we as educational audiologist, as SLP, teachers of the deaf, anybody who's happen to be working with this student help in this aspect?
Hilary: [00:16:51] Yep. That's what that's like. The golden ticket question. I wish that there was like a formula that once we got a score, we'd know exactly what to do. I think the tricky part is, is although we're identifying that some children are struggling with fatigue, there hasn't been any research done yet that says when we get a score of 32, that means we need to implement these things. We've created a handout that's available on our website. Now that is a summary of some of the other publications that we've done, including some of the coping strategies that were recommended to us in the focus groups. We've put them all into a PDF document that you can download for free, think it's things that as professionals working with deaf and hard of hearing children, there are things we're thinking of anyway, but it can be helpful to have it all in one place to reference. We want to make the situation as best as we can as least challenging as possible. Right? So less background noise, What does that mean? We want to make it a good listening environment, so anything that you might acoustically modify, the technology, you might provide the preferential seating, you might provide any of those things that we're thinking of will also be really important. I think the other thing is, and again, there's no systematic way to do this, but really to be encouraging and thinking about listening breaks. What does that mean for a student? For some children, it really is written in. As you know, they get a five minute break after every auditory heavy lecture or group activity. For other students, it's more as needed. The teacher might say, Oh, they're really struggling. I'm going to send them down the hall to get a drink of water. They can reset and not have to listen for a minute and then they can come back. But again, there's not any research on that. It's just things that we've pulled together from reports of parents and teachers and children telling us these things seem to help us once the child feels fatigued.
Carrie: [00:18:45] Yeah, it would be interesting in the future to be able to do like a pre and a post with their listening related, you know, the fatigue scales and seeing if these different accommodations and support for different students actually helped with that.
Hilary: [00:19:01] Absolutely. And I encourage people to use it in that way. If they implement some sort of strategy, you can absolutely re administer the questionnaire. I get that question a lot via email. So I would say do it and let me know how it goes.
Carrie: [00:19:16] Yeah, we're learning as you go, right? But I, I will say that I feel like I've really incorporated this into all of my batteries now because I think it's so important to get that input from every member of the team and especially the child who's actually sitting in the classroom or experiencing things after at the end of the day too. But what what do you see in the future as far as this ten year project that I know has been so important to you and your team, what do you see going on with it?
Hilary: [00:19:53] Yeah, there's lots of ideas floating around, a few things that we have kind of in the works and trying to still figure out are some intervention type research studies that we can get a better handle on understanding if there's anything that can systematically be done once a child is experiencing a lot of fatigue. The other thing is knowing that there's other populations outside of the deaf and hard of hearing population that may also struggle with communication based fatigue. So anyone who has difficulty processing and decoding language may struggle with this. So APD, English language learners, speech and language disabilities, etc., those are things that we'd also want to look at. I think also just on our website, we're really hoping to expand and share our information in new ways. So infographics and PDF handouts, things that are really relevant to educators, educational audiologists, SLPs, the whole team, deaf educators. So we want to have really ready at the. Things that you can take to a meeting and say, these are ways that we can help this student. Those are things we things that we're working on and hope to help those who are serving deaf and hard of hearing students.
Carrie: [00:21:06] Good. Well, I can't wait to see those, because I know I'll be attaching those to emails and downloading those as well when talking to different teams. Hilary, Is there anything I didn't ask you that you wished I would have asked you about this topic or educational audiology.
Hilary: [00:21:23] I don't think that there's anything you didn't ask me. I think one thing that has been a question that has come up that I think is important for listeners to know is that even if you get a lower or borderline score on the Vanderbilt fatigue scale, dig deeper. We know that this isn't a significant problem for everyone, but it is a problem for some students. And not all students know how to describe it or really understand the topic. So I always say if you're getting a score but you're feeling like it's not exactly accurate, combine that information with your other observations, your other data points, what others are telling you, and still consider some of those intervention strategies if you feel like it would help the student. Just because you don't get the highest score possible on the Vanderbilt fatigue scale doesn't mean you can't educate the student, educate others and really use it to your benefit. So I would also hope that in the future we're able to have some sort of educational materials that helps to explain this topic and really delve into how we can provide additional services and supports.
Carrie: [00:22:30] Yeah, that's a great point because kind of like what we talked about at the beginning. Children don't always have the words or don't recognize why they're feeling those different feelings, but then when you have the opportunity to sit down with them and go through the scales and ask additional questions like a counseling tool, then they start to recognize, Oh, wait, maybe because I was in the gym at a basketball game all day long, I am exhausted because I had to concentrate so hard. But they didn't recognize that until they had the actual vocabulary and tools for that.
Hilary: [00:23:06] Absolutely. That's so true. And one thing another thing that we didn't hit on as much, but I think it's important for people to realize, you know, children who are struggling at school are often the ones that we think of, Oh, we really need to check in on them and make sure, you know, are they fatigued or are they having extra difficulty because of whatever struggles they're facing? The other population that we really need to focus on are actually those children that are working so hard and doing so well that they're just pushing through that fatigue and really, you know, they're motivated students. They're really putting a lot of pressure either on themselves or feel pressure from teachers or parents to perform well. Those are sometimes the students that get overlooked, I think, because they are looking good on paper, but they may be some of the ones that are the most worn out just because of how much constant effort they're putting forth to do that. Well.
Carrie: [00:23:58] Yeah, that's a really good point. What? So I know you mention that on the website. You guys have your articles and resources and the scales. Is there anything else that I missed on the website?
Hilary: [00:24:15] The website is still it should be updated here in the next week or so. What we're working with our web developer to do that, you're going to be able to find a paper version you can fill out of the scale as well as PDF Fillable versions, if that's helpful for you. You can also feel free if you use Google forms or other things to send out scales. You can transform this into anything you want to make it as usable as possible. And then, yes, you'll be able to find references to our articles as well as those infographics and handouts there. It also has our contact information on the website. So if you want to reach out to us emails, the best way to get in touch with us. Always happy to answer questions or hear your feedback on how you're seeing fatigue. Show up for your students or how you're using the Vanderbilt fatigue scales. It just helps us make things better for the students that we serve.
Carrie: [00:25:02] Well, Hilary, I know this is such an important topic that we don't really always talk about, but is very evident in populations and like you said, and other populations as well, such as auditory processing and English as a second language and all of that. So I'm hoping our listeners  today, we'll go to the fatigue scales and take a look and download and start implementing their the scales into their everyday practice. So thank you. Hilary For being a part of today's podcast. It was such a pleasure to have you. And like I said, I always enjoy connecting with you. whether through Educational Audiology association or other topics that we both hold dear to my heart. So thank you again for being here today.
Hilary: [00:25:54] Thank you for having me. It was a great time.
Announcer: [00:25:56] This has been a production of the 3C Digital Media Network.