d f hld Practices or Children Using - Infant Hearing...Routine: The language of the daily activities of the classroom: transition, snack, instructional routines,Less etc. Challenging

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d f h ld

Boys Town National Research Hospital

Auditory Practices for Children Using Sign and Spoken Language


Catherine Cronin Carotta, Ed.D.Associate Director

Center for Childhood DeafnessBoys Town National Research Hospital

Katie Brennan, M.S., CCC‐SLPAuditory Consultant

Center for Childhood DeafnessBoys Town National Research Hospital


AUDITORYAUDITORY

TACTILE

TACTILE

VISUALVISUAL

Adaptation of Koch, ACRN 2013


Adaptation of Koch, ACRN 2013

Communication ContinuumCommunication Continuum

FullyAuditory

Communicator

MostlyAuditory

Communicator

MostlyVisual

Communicator

FullyVisual

Communicator

Boys Town National Research HospitalBoys Town National Research Hospital

McConkey Robbins, 2001; Nussbaum, Scott, Waddy‐Smith, Koch, 2004

A AV AV VA V

Communication ContinuumCommunication Continuum


(McConkey Robbins, 2001; Nussbaum, Scott, Waddy‐Smith, Koch, 2004)

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Cochlear Implant:


Implant: Identification

A AV V O OS S W WV V

E’s VocalizationsE’s Vocalizations


Early Speech Perception TestEarly Speech Perception Test


Single Word and Multiple ElementsSingle Word and Multiple Elements

ACLC 1 El 88%/58% ACLC 2 El 90%/ 32%


ACLC 1 Element: 88%/58% ACLC 2 Elements: 90%/ 32%

ACLC 3 Elements: 60% ACLC 4 Elements: 20%

Child E: 4;9 mos.

ACLC Sign/Spoken Spoken

1 Element 88% 58%

2 El 90% 32%


2 Elements 90% 32%

3 Elements 60% DNT

4 Elements 20% DNT


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E’s ContinuumE’s Continuum

Oral ‐ ‐ ‐ OS ‐ ‐ ‐ OS ‐ ‐ ‐ SO ‐ ‐ ‐ Sign ✓

(McConkey Robbins, 2001; Nussbaum, Scott, Waddy‐Smith, Koch, 2004)

Understanding of Auditory/Visual/Sign

Use of Sign and/or Spoken Language

Auditory ‐ ‐ ‐ AV ‐ ‐ ‐ AV ‐ ‐ ‐ VA ‐ ‐ ‐ Visual ✓


N/A Picture/Signs ‐ ‐ ‐ P/SG‐ ‐ ‐ GP ‐ ‐ ‐ GP‐ ‐ ‐ Gestures ✓

Words ‐ ‐ ‐WV ‐ ‐ ‐ VW ‐ ‐ ‐ VW ‐ ‐ ‐ Vocalizations ✓

(Waddy‐Smith, Clerc Center, 2004)

(ACRN, 2011)

(ACRN, 2011)

Use of Vocalizations and/or Words

Use of Gestures and/or Pictures/Signs

Expectations Expectations -- PerformancePerformanceName: E Understanding of Auditory/Visual Language

A = Auditory V = Visual

EXPECTATIONS A Av AV VA V

Parents X X

Educational Staff

X X

SLP X X

PERFORMANCE A Av AV VA V

Home X X Classroom X X

Speech session X X


p

Name: E Use Of Spoken Language and/or SignO = Oral S = Sign

EXPECTATIONS O Os OS So S

Parents X X

Educational Staff

X X

SLP X X

PERFORMANCE O Os OS So S

Home X X

Classroom X X

Speech session X X

AA--V Continuum DiscussionV Continuum Discussion


AA--toto--V PlanV PlanAuditory Av AV Va Visual

Does not require visual support for clarification

Mostly Auditory:

Needs some visual support for clarification

Equal need for auditory and visual supports

Mostly Visual:Understands some spoken words/phrases

Visual:Does not understand spoken

words/phrasesAdaptation of McConkey Robbins, 2001; Nussbaum, Scott, Waddy‐Smith, Koch, 2004


• When deciding which strategy to use, consider…what is your desired response?

– Input/imprint (receptive)

Imitation (receptive/expressive)

Auditory Learning Strategies Auditory Learning Strategies


– Imitation (receptive/expressive)

– Comprehension (receptive)

– Use (expressive)

• Direct child’s auditory attention (“Listen”)

• Auditory Sandwich

• Tell, then show

• Use parentese

Auditory Strategies Auditory Strategies -- InputInput


• Acoustic Highlighting

• Low‐lighting

• Auditory space

• Modeling

• Repetition

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Auditory SandwichAuditory Sandwich






• Model, then WAIT

• Ask, “What did you hear?”

• Use a partner as a model

• “Tell mom…”

Auditory Strategies Auditory Strategies -- ImitationImitation


• Auditory closure

• Give target in the form of a question (Did he jump?)

• “Can you say…?”

• Give a choice

• Give a direction and pause in natural context/routines

• Ask a variety of questions

A id ki t !

Auditory Strategies Auditory Strategies -- ComprehensionComprehension


– Avoid asking too many!

• Sabotage/change a familiar routine

Checking ComprehensionChecking Comprehension


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Checking ComprehensionChecking Comprehension


• Stop talking!

• Look expectantly and WAIT

• Sabotage the situation

Auditory Strategies Auditory Strategies –– Encourage UseEncourage Use


• Role reversal

• Obligatory context

Encouraging Expressive CommunicationEncouraging Expressive Communication


Encourage UseEncourage Use


Auditory Chain / SupportAuditory Chain / Support

Natural Cues

Indirect

DirectVisual/Verbal

DirectVisual Language

Cues


Cues Cues

• Routine• Repeat Phrase• Say With Facial Expression• Say With Speech Reading• Point To The Word Or Picture

• Say With An Eye Gaze• Say With Natural Gesture• Say Shorter Phrase

• Say With A Point To Object• Ask Child To Repeat

• Say Phrase OrWord With Sign

Adapted from DynaVox Systems LLC

1. What’s the auditory content & level?

2. What’s the set type & size?

3. What’s the A‐V plan?

Focused Auditory ProcessFocused Auditory Process


4. What’s the auditory strategy?

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6. What’s the auditory chain/support?

7. What’s the visual support?

8. Did it work?

Focused Auditory ProcessFocused Auditory Process


9. How will you modify?

Modify: Auditory Skill LevelModify: Auditory Skill Level

Identification Identification

ComprehensionComprehension

Identification

Comprehension


DetectionDetection

DiscriminationDiscrimination

Detection

Discrimination

Modify: Set Size or TypeModify: Set Size or Type


Less Challenging

MoreChallenging

New: Language and concepts being presented for the first or second time

Review: Language and concepts that h b t d t dl

Modify: Content/ContextModify: Content/Context

More Challenging


have been presented repeatedly over a period of at least 2 weeks

Routine: The language of the daily activities of the classroom: transition, snack, instructional routines, etc.Less

Challenging

Modifications: CueingModifications: Cueing

Natural Cues

Indirect

DirectVisual/Verbal

DirectVisual Language

Cues


Cues Cues

• Routine• Repeat Phrase• Say With Facial Expression• Say With Speech Reading• Point To The Word Or Picture

• Say With An Eye Gaze• Say With Natural Gesture• Say Shorter Phrase

• Say With A Point To Object• Ask Child To Repeat

• Say Phrase OrWord With Sign

Adapted from DynaVox Systems LLC

• Erber, N. (1982). Auditory Training. Washington DC: Alexander Graham Bell Association for the Deaf & Hard‐of‐Hearing.

• McConkey Robbins, A. (2001). A sign of the times: Cochlear implants and total communication

ReferencesReferences


Cochlear implants and total communication. Advanced Bionics Loud & Clear (4)2, 1‐7.

• Nussbaum, D., Scott, S., Waddy‐Smith,B., & Koch, M. (2004). Spoken language and sign: Optimizing learning for children with cochlear implants. Paper presented at Laurent Clerc National Deaf Education Center, Washington, DC.

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Katie Brennan, MS, CCC‐SLPCathy Carotta, Ed. D., CCC‐SLP

Boys Town National Research Hospital555 N h 30th S


555 North 30th StreetOmaha, Nebraska 68131

[email protected]@boystown.org


A production of the Lied Learning & Technology Center at Boys Town National Research Hospital

©2014


Documents

d f hld Practices or Children Using - Infant Hearing...Routine: The language of the daily activities of the classroom: transition, snack, instructional routines,Less etc. Challenging