Lecture 7 - Developing Listening Skills PDF

SLP10414: Aural Habilitation and Rehabilitation LECTURE 7: DEVELOPING LISTENING SKILLS LECTURER/S: PAUL WILLIAM JACINTO, MRS-SP, RSLP 1ST TERM | A.Y. 2024 – 2025 PART 1 loss obstruc...

SLP10414: Aural Habilitation and Rehabilitation LECTURE 7: DEVELOPING LISTENING SKILLS LECTURER/S: PAUL WILLIAM JACINTO, MRS-SP, RSLP 1ST TERM | A.Y. 2024 – 2025 PART 1 loss obstructs that doorway preventing sound from reaching the brain. INTRODUCTION Hearing vs Non-hearing Brain In Aural Habilitation, we look into how to help children who are deaf and What happens when the brain is deprived of auditory stimulation? hard of hearing develop listening skills. We want them to be able to use their hearing devices and develop appropriate listening skills in order to develop spoken language, and the first thing that we need to do in order to develop listening skills is… ENSURE AUDITORY ACCESS Ensure that there is appropriate auditory access This is the listening brain (R) “We hear with the brain; the This is a diagram showing hearing vs a deaf cat’s brain ears are just a way in!” - In the absence of sound, the brain will reorganize to make better use of Carol Flexer (2011) the other major senses, especially vision ○ The area shaded in The brainʼs visual cells migrate to the hearing region yellow is directly ○ They migrate because that part of the brain is now idle involved in speech The brain is very efficient, and is not going to let this huge territory, which perception and is the auditory cortex, go to waste language processing. The auditory cortex is the part of the brain that controls hearing Normal maturation of central ○ It makes sense that other senses will come in and “colonize” auditory pathway is a The brain can only organize itself around the information it receives precondition for normal development of speech and language skills in ○ That means either you use the auditory cortex, or you lose it children The cortex matures in stages, and the level of maturity depends on the Hearing Devices richness of exposure and experience. Level 1 of the cortex probably matures by 12 months. ○ This first stage (the setup stage for the cortex) has the brain being always on. ○ In this period, all it takes to develop auditory pathway is exposure to sounds. We are thankful that advancement of technology led us to the creation of the hearing devices HEARING LOSS IS A DOORWAY PROBLEM These hearing devices give the brain auditory access it would not [However, hearing loss is likened to a doorway problem because] Hearing otherwise have with hearing impairment. 1  The hearing impaired childʼs auditory brain must be accessed, stimulated, and developed to reach the desired outcome of listening and spoken language. The purpose of these technologies(hearing aids, cochlear implants, wireless technologies) is to get the sound (the auditory language information) through the ear, so that it will reach the brain ○ That is why it is also termed as a “brain access tool” SUCCESSFUL TECHNOLOGY FITTING (Madell, Flexer, Wolfe) Speech banana Here we could see that the different sounds across the speech banana Eliminate auditory neural sensory deprivation were distributed. ○ It should provide stimulation auditorily This child should have access across the speech frequency range, even the Access auditory information for the stimulation and development of neural 6000- 8000 Hz frequency range. pathways for cognitive growth If you miss out on the 6000 and 8000 Hz, you're missing out on ○ It should give the recipient access to auditory information grammatical markers, plural, possessives, and non salience morphemes. Improve auditory brain access to spoken language We could see that 50dB hearing, although it is still in the moderate level, ○ We mentioned a while ago that hearing loss is a doorway problem. would give us much access. However, we would want access beyond that. And if the device is successfully fitted, it can give the brain the maybe reaching 30dB to 20dB, which is what we call the speech string different spoken language information it needs bean. Provide auditory brain access of information, sufficient for auditory learning ACOUSTIC ACCESSIBILITY AND TO DELIVER AUDITORY INFORMATION TO THE ○ Auditory learning can be possible with successful technology BRAIN fitting Maximize use of residual hearing The child needs to hear throughout the frequency range. Lay foundation for academic learning using audition The child needs to hear at a soft enough level. Facilitate brain access of information for distance hearing and incidental ○ A lot of information is actually accessed by the child in soft learning Facilitate socialisation speech. Safety ○ At a distance, or maybe their classmates are chatting at the Comfort back, and they could get information from there. Maybe they’re listening in noise. Thus, we need to train children to hear What does technology need to be doing to meet the needs of acoustic at a soft enough level accessibility and to deliver auditory information to the brain? Aided thresholds at 20-25 dB is the goal “MATH” OF HEARING TECHNOLOGY A normally hearing toddler or preschooler listens for about 12 waking hours a day, 365 days per year. This adds up to 4,380 listening hours per year! 2  ○ That’s how much listening you need in order to develop your first In the previous part of our module, we discussed hearing loss being a word. doorway problem, and what we are basically doing is providing auditory Babies listen for about a year before they say their first word. stimulation to the auditory cortex of the brain, and that will impact change [That should not be hard because] Brains are “prewired” This access to auditory information is very vital and it should be made ○ Babies are ready to learn to listen and speak through their accessible to children as early as possible. auditory system If children are identified early, fitted early, and intervened early, then there For typically developing children, we do not really need to are a few more hours to catch up on. train them on how to listen As compared if we have children who are identified late, intervened late, ○ Babies need rich, abundant, and meaningful stimulation so the imagine how much listening hours we need to catch up on. brain builds more connections That simple math strengthens the need for early intervention, not just in Since they are typically developing with typical hearing, if Aural habilitation, but in all of the children with language and they are given rich, abundant, and meaningful auditory communication issues. stimulation, then they begin building language, and that You could liken this to not just hearing, but the amount of time that they happens because the children make connections between could have been receiving language stimulation and the amount of time what they hear, what they see, and between words that they could have been listening to speech and practicing spoken language they hear all together ○ CORTICAL REORGANIZATION Use it or Lose it PART 2 In the previous part, we looked into the auditory cortex being reorganized if the auditory INTRODUCTION stimulation is not sufficient. Once hearing access For that to be avoided, we need to provide is ensured, listening stimulation. skills can be We also need to ensure that they have auditory addressed. Listening access first. skills, once improved, will yield to the NEURAL PLASTICITY acquisition of spoken (AUDITORY PRACTICE) language, which will help with the What we do is actually based on the principle of neural plasticity. children’s academic ○ They believe that the brain can change given different factors in achievement, which the environment and intrinsic factors. will have a potential effect on economics and being able to be a functional ○ Our brain has the ability to change and that is how learning member of society. occurs. These steps will happen because, in aural habilitation, we are developing In terms of being developed into an auditory brain: an auditory brain. ○ What do you know? ○ How much Auditory Practice do we need? 10,000 hours of practice (Gladwell) DEVELOPING AN AUDITORY BRAIN ○ Makes one a master of something 3  46 million words heard by age 4 (Hard and Risley) FACTORS IN DEVELOPING AN AUDITORY BRAIN ○ A study found out by age 4, children should have heard around 46 (LOCHI Study) million words ○ Circle this back to the math of hearing technology– how much INTRINSIC FACTORS listening experience do they miss every year? How much words do Age at provision of optimal amplification they miss hearing every year? Pre/post lingually deafened Children with HL require 3x the exposure to learn new words and ○ If children are post lingually deafened, they have an intact or concepts (Pittman) functional auditory system before they were actually implanted or ○ To learn a specific word, you have to be able to hear and aided. That potentially provided them with enough stimulation to experience it several times for you to be able to understand the build language, so there’s language to work on. vocabulary, use it in conversation, and be able to store it in your ○ But, Pre-lingually deafened children won't have anything to work mind. with even before, so they're building it from scratch. Sir would always liken vocabulary building and vocabulary training for Medical Findings children with language issues (not just hearing loss) to somebody learning Etiology a new language Nonverbal Intelligence ○ If youʼre trying to learn French/Polish, it wouldnʼt take you just Additional Disabilities once (one time) to learn a specific word- you have to be able to ○ One of the most challenging factors, especially if children come hear it, experience it, several times in order for you to really with cognitive delays, sensory integration issues, visual issues understand the vocabulary, use it in conversation, and be able to ○ These children need not just us, but a whole team to work on their store it in your mind other factors, and that adds to the challenge in improving and developing an auditory brain RANGE OF OUTCOMES Communicative Intent Aural Habilitation would EXTRINSIC FACTORS have a range of Compliance with amplification outcomes. ○ We see this all the time. Sometimes if children don't want or feel ○ It can yield uncomfortable with their hearing aids or implants, or sometimes outcomes that some families forget to monitor if the children are wearing the children with aids or implants, or if the batteries are functional. hearing loss or Habilitation programme deaf would ○ Affects the outcomes. have spoken ○ If it’s more visual vs more auditory. language that is ○ Auditory development would need auditory practice. similar to those Availability of support services of with typical Child’s behavior, focus, and attention hearing. Family dynamics ○ It is also possible that there would be no change at all. ○ The maternal level of education has been shown to be a factor. The ones that affect outcomes are the intrinsic and extrinsic factors. That’s because of the participation, advocacy, time spent with the children, the determination for their children to develop spoken language. We should be familiar with this because this will affect 4  the progress of the child. ○ Since we are learning from the experience of other people, INTRINSIC FACTORS EXTRINSIC FACTORS learning from different researches, we can counsel the parents early on based on these factors. Age at provision of optimal Compliance with amplification Multiple languages amplification In the LOCHI Study, it was found that in a study with 500 children, those that Pre/Post lingually deafened Habilitation programme improved a lot were those aided early or implanted early and had constant monitoring of functional access. Medical Findings Availability of support services ANTICIPATORY COUNSELING Etiology Child’s behavior, focus, and attention Based on the factors mentioned, what can we expect for these Nonverbal Intelligence Family dynamics children? ○ Are we expecting the children to actually develop verbal Additional Disabilities Multiple languages communication through listening alone? ○ Do we need to set the right expectations as to the development Communicative Intent of verbal communication? That’s the most common question. ○ Can my child develop verbal communication? Can they talk? Anticipatory counseling would be beneficial in order for them to PART 3 understand what we can do and what we can’t do It's time for us to set the record straight: What are their roles in terms AVT SESSION of the habilitation for these children? We are going to look at how a typical EV Session goes. We look into AVT Done prior to your first session because this is an approach that facilitates spoken language through We sometimes call it the “orientation interview” or “initial meeting” listening. It is heavy on listening, and since we are on the topic of This is wherein the families talk to the therapist and they provide you developing listening skills, it is very apt to look at how they do it in an AVT with the different audiological tests, and you interview them regarding session. the child demographics and concerns. The bullets below represent the components of an AVT session. All of these components should be present in a session. INTRINSIC AND EXTRINSIC FACTORS COMPONENTS OF AN AVT SESSION Given the audiological information and tests, look at the different factors (pros and cons) and how you can set appropriate expectations HA/CI function check - in a session, you always check for the device with the family. because you have to ensure that they have functional access in terms of Although this can be intimidating, remember that you are trained for auditory. you to set expectations and you know what you’re doing. Development of Listening Skills Counsel and validate their concerns and feelings, so they might be a Speech Perception and Production little defensive, but that’s true for most patients starting out. Language Development Cognitive Development 5  Communication Competence ○ If the patient is performing differently from the Ling 6 Sound Parent Discussion and Goal Setting - parents are guided and coached Check from the previous session, then you query on the status of throughout the session. They also take part in goal setting. the hearing device. Begin asking questions like “Is the hearing device working ANATOMY OF AN AVT SESSION (Rosenzweig) properly?”, “Why is there a difference in terms of performance?” ○ This shouldn't be confused with a goal wherein you want the child :00 - :05 (first 5 mins) to respond to six sound through conditioned response Check in with parent (s) / caregiver (s) and child If you want to target that as a goal, then you have to spend more time with it, you have to teach the child how :05 - :10 to do it Equipment and Ling Six Sound Check At this point,the first five minutes is just basically checking it so that is why it is very short, you have to be very quick :10 - :50 in terms of doing that Purposeful Play :50 - :60 HA/CI FUNCTION CHECK Wrap-up We make use of different materials during the session :00 - :05 (first 5 mins) For hearing aids, we have what we Check in with parent (s) / caregiver (s) and child call the stethoset. ○ This is called a stethoset The first five minutes is checking in with the parents or caregivers because it looks like a The checking in is very important because this is where you have small talk stethoscope with the parent/caregiver as to the current status of the child. ○ In fact, you could make your own by taking out the You would also ask their experience on how they facilitated or carried over diaphragm of the stethoscope and inserting the mold at the goals at home. the tip wherethediaphragmused to be and then you are Since you are checking in with them, they tend to feel the importance of going to turn on the hearing aids while you are wearing doing carryover at home because we always check on how they did it. the stethoscope ○ They will feel like “I should always do the carryover at home.” ○ You are going to produce the Ling6 sounds. ○ This puts emphasis or significance on the carryover. Listen for the presence of sound, static, breathing It is also a good source of information regarding the current status of the sound, and crackling sound. patient. If you hear something like those, then you have to :05 - :10 refer the Px back to the audiologist. Equipment and Ling Six Sound Check A stethoset may just look like a transparent string that only has one end in the ear. Ling Six Sound Check ○ You will do a very quick Ling 6 Sound Check ○ Ensures that the device is working properly 6  Note: :10 - :50 (Purposeful Play) is discussed in Part 4 SETTING THE STAGE How do we set the stage for listening? We look at ensuring auditory access ENSURING AUDITORY ACCESS Test for the implant processors It is something that you put in the magnet of the implants, then you could We cannot stress it enough. We have to ensure that the child is with check if it is blinking. enough auditory access in order to benefit from therapy. (presence of blinking = the sound is travelling) Ensure audiological assessments and assessments if hearing technology are current and accurate ○ We have to make sure that the assessments done are current and accurate. If it’s not, refer them back to the audiologist and have them retest it. You want to have the updated aided and non aided thresholds. ○ In the early parts of AV, you want them to be tested every month for the first 6 months. Then after that, every 3 months. Establish day-long use of hearing technology ○ Right now, because of the advancement of technology, we could Examples of battery testers request for data logs to ask how long were the hearing aids or the implants worn. The battery should be at least 70%. ○ Sometimes, you could also check for what setting did the patient If it’s below 70%, it needs to be changed. actually use the implants. Was it used in a noisy setting? For instance, was there input from the surroundings or was it just very quiet? Check equipment daily at home, in schools and in therapy ○ This is why we do our CI and hearing aid test. Check equipment at the start of each session Keep technology, including earmold fittings in good working order ○ In AV, we always recommend that the patients have their backup batteries. They should also have backup parts that are usually paired. This will make sure that therapy will go on smoothly even with some device issues. Microphone tester by Med El ENSURING AN OPTIMAL ACOUSTIC ENVIRONMENT We’re going to look at it in the workshop. Environment must be as facilitative as possible for learning to listen 7  ○ Auditory distractions ○ Find all possible opportunities in interactions to make it auditory It can be ensured by making sure there are no auditory distractions. Minimal background noise, and making sure ANATOMY OF AN AVT SESSION (ROSENZWEIG) ambient noise is set to a minimal amount that the patient can actually benefit from the stimulation given during the :00-:05 Check in with parent(s)/caregiver(s) and child session. :05-:10 Equipment and Ling Six Sound Check ○ Overcome effect of distance and background noise :10-:50 Purposeful Play ○ Acoustic landscape :50-:60 Wrap-Up Where the child encounters his greatest number of meaningful interactions and opportunities to learn and LING SIX SOUND TEST listen (HOW DO I KNOW WHAT MY CHILD HEARS?) We also have to look at the number of meaningful interactions and opportunities to learn to listen Pronounce the six sound test in close range, 1 meter away, and 2 meters Children with greater communication abilities tend to be away from families with greater number of adult-child Daily checks when a child puts on his/her hearing technology conversational turns How to do this quick test: This may be due to the fact that parent communication ○ Be on the same level as the child skills bring about the greater conversational turns also ○ Place the palm of one hand horizontally from the speaker's mouth However, we can be encouraged to keep our children in so the child cannot see when the adult speaks or what sound is conversation with us and with their family being vocalized. Electronic Media (Ambrose, VanDam & Moeller, 2014) ○ Pronounce the 6 sounds in a normal tone of voice at every ○ The researchers say that children with lower receptive language distance. abilities tend to be from homes with higher instances of electronic media in the background Typical Responses of Listeners: ○ Another factor in play is that these children tend to also be in A young listener families with lower levels of adult-child conversational turns also. ○ Turning his body or head ○ Keep those in mind because it is important in terms of ensuring ○ By pointing to his ear. that children receive enough auditory stimulation As a child becomes older ○ Dropping a block (or other objects) into a bucket MAXIMIZE AUDITORY INPUT ○ Raising his hand Children who are starting to vocalize Increase auditory learning opportunities during your interactions with ○ Imitate some Ling 6-Sounds the children and parent coaching A child who is an experienced listener HOW auditory is my practice? ○ Repeat the Ling 6-Sounds as they are said Ask yourself if you: Make sure that when you facilitate the Ling Six, the activities are ○ Bathe the child in language when he is not looking at my face age-appropriate. ○ Draw attention to environmental sounds, label and describe ○ Provide input primarily through audition ○ Expect the child to be able to learn and listen PART 4 8  :10 - :50 goal? Purposeful Play 3. MATERIALS (Age-appropriate) ○ What materials are appropriate for the child? Now that we have finished discussing how to ensure that our patients will ○ It is not just using “interesting” materials; you have to choose have functional equipment, auditory Ling 6 sound check, it’s time to materials that make sense in terms of age, activity, and motor discuss the bulk of the session: purposeful play skills. It is called purposeful play because when we’re working with young E.g. You are not supposed to use very tiny toys for very children, and we’re developing their listening skills, it’s almost always in young children. the context of play E.g. You are not supposed to use materials that are not culturally appropriate. PURPOSEFUL PLAY (Therres) 4. CREATIVE FRAMEWORK 5. LANGUAGE SCRIPTS First done by identifying child’s level of auditory skill 6. STRATEGIES FOR THE CHILD Then, identify age-appropriate toy/material 7. STRATEGIES FOR PARENT ○ What’s good about children who are deaf or hard of hearing, they *Numbers 4-7 will be discussed during the workshop. almost always have cognitive abilities similar to typically hearing peers WHY PLAY? ○ And if that’s the case, we just have to follow the chronological age expectations in terms of pla, and that is tantamount to If we use play, we're actually targeting multiple facets of development. We age-appropriate toys and materials as well. look at: Choose appropriate auditory goals ○ Physical Development Write out scripts that facilitate the goal ○ Social Development Identify strategies to assist in development of the goals ○ Emotional Development ○ While playing, there is a purpose behind it, and the purpose is to ○ Cognitive/Intellectual Development facilitate our goals ○ Communication Development Fun for the patient SYSTEMATIC PLANNING (Ashley Garber) ○ When youʼre not having fun during therapy, do you think the child This is how Ashley Garber plans out her activities and how she plans out her is having fun too? purposeful play: ○ Make sure that the child is also having fun while doing your 1. GOAL therapy sessions. ○ What is an appropriate goal that you have to target? ○ If they're not having fun, learning is not that fun either. The ○ What do you need to do in order to target that goal? chances of them learning what youʼre thinking is higher if you're ○ What will the child need to show you in order to say that they doing it with fun activities. achieved that goal? ○ Fun activities are not equivalent to using very interesting or 2. ACTIVITY expensive toys. You have to use the toys creatively ○ What activities will allow me to do the things that I plan to do in ASPECTS OF PLAY order to achieve that goal? ○ What activity can allow the child to show me that behavior that I Motor Aspects want him to exhibit in order for me to know that I achieved that ○ Gross Motor 9  ○ Fine Motor ○ For older children Cognitive Aspects ○ Matching, Sorting, Seriating, Labeling STAGES OF PRETEND PLAY ○ Symbolic Play Social Aspects Things you need to be considering SELF PRETEND 12 - 18 months SIMPLE PRETEND 18-24 months PARTEN’S STAGES OF PLAY - SOCIAL SERIES OF FAMILIAR ACTIONS 24 -30 months Unoccupied Play: The child is relatively stationary and appears to be performing random movements without purpose (infrequent) SERIES OF LESS FAMILIAR ACTIONS 30 - 36 months Solitary Play: Child engrossed in laying and doesnʼtnotice other children (0-2 years) ROLE PLAY with other children 3-5 years Onlooker/Spectator Play: Child takes interest in other childrenʼs play but doesnʼt join in, primarily watches (can occur at any age) Parallel Play: Child mimics other childrenʼs play but doesnʼt actively engage INFANTS solitary-functional play with them (2 ½ - 3 years) Often times you’re just using single toys or one Associative Play: Children play with shared materials, intermittently toy at a time working together (3 ½ - 4 ½ years) You’re just providing learnable input Cooperative Play: Organization enters the childrenʼs play; roles and rules (4-5 years) TODDLERS parallel - functional play Even when youʼre planning your AV session,you also have to consider the play level of the patient. You're not supposed to be doing a very dramatic PRESCHOOLERS associative play, constructive play, symbolic play play for somebody who is just in the solitary play. You're not supposed to be doing just functional play for those who are already doing cooperative 4 - 5 YEAR OLDS cooperative-constructive play, socio-dramatic play and play already. begin to play games with rules You have to plan activities using play that is appropriate for the age level. SCHOOL-AGE elaborative cooperative-constructive play, CHILDREN socio-dramatic play and games with rules TYPES OF PLAY If you’re following these play levels, it’s hard for you to miss out on what FUNCTIONAL PLAY would work for the patient. ○ Aka practice play While you’re playing, you’re supposed to provide learnable input ○ Presymbolic ○ It will have a purpose, if when doing play you’re also providing CONSTRUCTIVE PLAY necessary auditory stimulation (speech information, language ○ Create or assemble a structure or object information, cognitive information, and pragmatic). ○ Uses blocks to create something DRAMATIC/SYMBOLIC PLAY PROVIDE LEARNABLE INPUT ○ More of pretend play GAMES WITH RULES TEACHING VS TESTING 10  Test ○ You have to follow the child’s lead in line of “What is the child ○ Auditory intervention session structures as a series of looking at?”, and talk about that, because it is what the child is stimulus/response tasks interested in. ○ It’s very challenge for an auditory intervention to not test ○ Talk about that then pause for the child to process what you said ○ But we’re gearing away from testing, but more on teaching. and then take a turn. Very simple, but very hard to abide by most ○ If you’re testing the child, you have activities that are a series of of the time. stimulus response tasks. The child needs to listen to you, point to something, or SCAFFOLD AUDITORY LEARNING WITH ROUTINES, SCRIPTS, PREDICTABLE TALKING get something The child can be wrong or correct This is about repetitive stimulation. Repetition as an enjoyable ○ That is similar to, for example, you being tested on something that experience is a good thing, so you have to make the experience good. wasn't taught in class. You are not supposed to test right away. You You have to make the experience interesting. are supposed to TEACH first. Infants and young children learn language from repeated, predictable First engage the child in learning before he/she can be expected to experiences perform on a test Daily routines in the home ○ If you want to teach vocabulary, you’re not supposed to line up ○ Eg. Meal time, dressing, toileting, going to places in the car toys in front of the child and say, “Where is the spoon? Can you ○ These routines provide repeated sameness. Those similar get the spoon? can you get the socks?”. That is a test. routinary activities will make use of phrases, words, that ○ If you want to teach vocabulary, you have to bathe the child with accompany these daily actions, and they learn what parents say stimulation. and what they are expected to say. ○ Instead of saying “Where’s the spoon? Can you get the spoon?” ○ In your sessions, go through these routines with these parents What you could do is “Wow! You’re holding a spoon. Okay let's and discover if they are providing rich “scripted” narration that hold the spoon, let’s wash the spoon. Let’s use the spoon to scoop can be helpful during daily routines. You have to coach the the milk. Let’s use the spoon to mix it. Oh you dropped the parents to narrate daily routines and help the child join in. spoon.” ○ If practicing outside the home, you have to brainstorm also ○ You are supposed to teach. with the parents about the routines of that specific day Time should be devoted to input ○ You have to set up those routines in therapy settings and ○ To do that, you have to… (next point) practice the scripts that naturally emerge from daily situations FOLLOW THE CHILD’S LEAD Play with toys in a predictable manner ○ You could say many of the same things each time you play Children are most likely to listen to language that describes their interest. ○ E.g. Playing with the pop locks, the one that you pull, “pull it You have to consider what happens when you bring out a therapy toy. out, pull it out” or a wind up toy, “turn turn turn, and then lets Often, we get so wrapped up in our own agenda and locked into the way wait, 1 2 3 go!” we want to play with the toy. We fail to pay attention to what the child has ○ If you use the toy in a predictable manner, then the language noticed, for instance. becomes predictable too then repetition will actually happen “The strongest learning will occur when the child is encouraged to listen to Repeat learning experiences or activities and talk about what he notices and what he is doing with the toy” - Raab, ○ A child benefits from multiple exposures, and that will build on Dunst & Hamby, 2013 language 11  ○ Avoid boredom We should avoid questions like– (e.g. are you washing the baby? are you We should always be sensitive enough to know when it rolling the car? is that your bunny? is that your car? is that your toy?) is time to change things up to prevent boredom These are all questions– instead of questions, we should narrate, because they could not answer those type of questions yet USE SIMPLIFIED RATHER THAN TELEGRAPHIC LANGUAGE We should be providing them with information that will eventually lead them to develop language skills that will be necessary for them to answer questions in the future. PART 5 - AUDITORY SKILLS 1) DEVELOPING AUDITORY SKILLS We all know Erber’s model (image on the R) of detection, discrimination, identification, and comprehension. So, when we are improving auditory skills, we work from detection to comprehension. Erber’s model has been adopted Use simple language that is just above the child’s level when providing by several authors like Pollack, input adding specific skills in between It can be tempting to reduce input to a bare minimum with a goal of the different skills by Erber. providing the most important words for the child to process. Research shows that children benefit more from simplified input where the sentence structure length may be reduced, but the articles and morphemes that naturally occur are retained in the input ○ A benefit of this sort of input is the natural intonational contour is retained. In addition, Articles and morphemes are preserved in the input. Children with hearing loss need to be exposed to these morphemes and articles because they are short in duration and tend to be low in vocal effect. Thus, it is not highlighted in a sentence. The chart above shows examples of how to use simplified, rather than telegraphic language. TURN “NANNY QUESTIONS” INTO STATEMENTS Garber created her own framework and specified the impact of the input Turn questions into statements in terms of the progression of listening skills and the situational context. 12  Auditory awareness aka Detection We want to lay the foundation for discrimination, identification, and comprehension. To determine hearing aid/Cl settings To attract a child's attention and orient him or her to the listening task ○ We want to determine if the hearing aids are working To determine which sounds are available to the child STRATEGIES The usual strategies that we use are the following: Auditory first + Listening Alone ○ We usually alert them to the sound ○ We give emphasis to the listening skill itself Listen Cue ○ “Listen!” The Auditory Learning Guide by Beth Walker dissects the different ○ “I heard that” or “You heard that” listening skills into subskills, very similar to other curriculums ○ That moment, the child is alerted to the sound, then the child will be presented that controlled sound, chances are higher that the What’s good about working with auditory skills is that we have lots of patient will actually respond to you. curriculums Acoustic Highlighting The first thing you need to look into is “What model are you going to use in ○ Will make our speech clearer and more audible terms of intervention?” Pausing ○ Are you going to use a developmental, remedial, or combined ○ Will alert the child that something is supposed to be heard or model? about to be heard ○ Developmental - simply plotting skills on developmental checklists Wait Time → once plotted, you will be led to the next goal in the hierarchy. ○ Allows them to process things ○ Remedial - look at specific auditory skills using the different We usually alert them to the sound checklists gearing towards improving each of the listening skills We usually give emphasis to the listening skill itself where you will base your goals at. ***Use of Controlled Sounds vs Uncontrolled Sounds ○ You want the child to respond to noise makers This discussion will look into the specific listening skills and how to help develop You can control whenever you want to hit the drum or the following listening skills: shake the maracas 1. Developing auditory awareness ○ For uncontrolled sounds, for example the phone rings 2. Developing auditory discrimination Itʼs an uncontrolled sound but you need to alert them to 3. Developing auditory patterning that sound In Sir Paul’s center, before they are near the train station 2) DEVELOPING AUDITORY AWARENESS (DETECTION) so they can hear the train when it passes by. Sometimes, the child hears it and they don’t PURPOSE know when it’s going to pass by. So, you alert 13  them to that sound. different suprasegmentals. E.g., Doorbell, dog barks ○ “hop-hop-hop” with dolls, or “jump-jump-jump” on the It’s harder to prepare the child for those sounds trampoline. Draw swirls along lines for long sounds; going up for ○ However, if you are working with controlled sounds, you can rising sounds. prepare the patient for that sound. Pausing Cx: Listen, I think we’ll be hearing something Wait Time At that moment, the child is alerted to the sound. Then, ○ In order for the patient to process the sounds that are given and the child sound will be presented to the sound. Chances wait for their response if they can match the speech patterns are higher that the Px will actually respond to you. ○ If you are working with patterning, you always have three things in mind: 3) DEVELOPING AUDITORY DISCRIMINATION 1. Early Learning To Listen Sounds (ELTLS) 2. Early Phrases Auditory discrimination is not usually targeted. 3. Songs However, in some curriculums, they would label skills as “to discriminate [such] and [such]”. However, they are actually pertaining to identification LEARNING TO LISTEN SOUNDS PURPOSE Early Learning to Listen Sounds (ELTLS) are sounds that are very audible for children To determine if the child can detect differences or similarities in two It is designed in a way that each of the sounds in American English is stimuli. represented in every sound To test perpetual difference between speech patterns E.g. If you want the patient to be exposed to /b/ ○ /bababa/ for the bus 4) DEVELOPING AUDITORY PATTERNING ○ baa for the sheep ○ beep beep for the car Auditory patterning is a skill that is coined by Garber wherein she isolated If you want the patient to be exposed to patterns like long vs short identification of suprasegmental patterns from identification of segmentals interrupted sounds (words itself). ○ You can target in therapy by using ELTLS such as the airplane that When the child is in the auditory patterning stage, or if you want the goes ahhhh vs the duck that goes quack quack patient to develop it, what you want is for the child to learn speech You could make use of ELTLS to expose the patient to loud vs soft sounds patterns. ○ A boat that goes /papapa/ vs a bus that goes /BABABA/ ○ Differentiates loudness and exposes the patient to differences in PURPOSE loudness You could also expose the patient to differences in pitch To learn speech patterns ○ UPUPUP (low pitch), eeeeeeeeee (high pitch) ○ Airplane that goes up AAAAAAA (high pitch), and goes down How? AHHHHHHHH (low pitch) Match speech patterns Use ELTLS to expose the patient to different patterns and sounds ○ Motor ○ Visual ○ Use motor and/or visual indicators to alert the child of the EARLY PHRASES 14  Also fun to use, these are phrases that are commonly heard by children. Commonly said to them by parents, such as: ○ Go to sleep ○ Eat your food ○ Yuck, it’s dirty ○ Ouch, that’s hot ○ Let’s go up the stairs ○ Let’s ride the bus Learning to listen sounds and phrases are hallmarks of teaching spoken language through listening because they’re audible, they're easy to hear and they follow normal language development. They’re fun, and they represent each of the speech sounds and varied rhythm. SONGS Rhythm: You could vary the rhythm with songs Expose them with songs,(e.g. for each of the animals– provide a song, duck songs) bus song. You can use a lot of nursery rhymes. The songs will provide a lot of opportunity for them to actually learn varied patterns as well. 15