Development of an Auditory Function/A-V Techniques

Developed by:Beth Walker, M.Ed., C.E.D., LSLS Cert. AVTKathryn Wilson, M.A., CCC-SLP, LSLS Cert. AVTMegan Katz, MS, CCC-SLP, LSLS Cert. AVT

Presented by:

Megan Katz, MS, CCC-SLP, LSLS Cert AVT Sherri Vernelson, M.Ed., LSLS Cert AVEd

Agenda

Auditory Processing, Neuroplasticity of the Auditory System and Critical Period for Development of Auditory Function

Normal Auditory Development Speech Acoustics Auditory-Verbal Techniques and Strategies Guide to the Development of Auditory Skills Assessment Development of an Auditory-Verbal

Program

Learner Outcomes

Examine research on auditory brain development and how this impacts auditory learning of children with hearing loss.

Identify and sequence specific auditory behaviors that occur in the development of spoken language and will identify components of a detailed model of auditory learning.

Apply information about specific formant frequencies of individual phonemes to the auditory learning of spoken language.

Identify factors that affect the auditory reception of spoken language and select appropriate strategies and techniques for assisting auditory perception of particular features of spoken language.

Predict levels of development in speech, language, cognition and communication in relation to level of auditory development.

Develop A-V lesson plans including goals, activities, strategies and carry-over ideas for specific cases.

Auditory Brain Development & Auditory Processing

We know what you are thinking….What a fun, exciting, interesting, motivating, attention-grabbing, fascinating way…. to start the day!!!

The goal for children in an AV approach is spoken language.

The MOST effective modality for acquiring/teaching spoken language is HEARING.

What do we know about the relationship between listening, literacy and success in reading?

Auditory Brain Development

It’s all about the BRAIN!The ears are just the way in…

Quick Quiz…We’ll answer these & other REALLY important questions

Measurable differences in brain organization and neural activity is caused by ______ ______.

Research by Sharma indicates that the brain waves of children who begin wearing hearing aids or cochlear implants by _____ years of age reflect a normal response to sound.

What is developmental synchrony?

Is there a critical period for the development of auditory function?

A-V Principles 1 & 2 Newborn hearing screening

programs & 21st Century technology allow access to the auditory centers of the brain

Access is a good thing!In fact, it is great!Is it enough?

Easy Math…

Early identification + early & appropriate technology + appropriate intervention by parents & professionals during the period of maximum neural plasticity = potential for achieving high levels of speech, language, reading, literacy & success in school.

Neuroplasticity----Current Research

The infant brain has neural plasticity.

Complete maturation of the central auditory pathways is required for the normal development of spoken language in children.

The period of greatest neuroplasticity is the first 3 ½ years of life (Sharma et al, 2002; 2004; Sharma, Dorman, and Kral, 2005).

Children implanted by 12 months of age may demonstrate more benefit than children receiving implants later on in the period of maximum neural plasticity (Sharma, Dorman, and Kral, 2005).

When children acquire skills at or near the time that they are intended to do so biologically, this is called developmental synchrony.

Making the Connections…

A baby’s brain continues growing beyond the womb—not just in size, but in forming connections

Born with 100 billion neurons. By 3 years of age babies have about 15,000 synapses per neuron, three times the synapses of adults. What happens to synapses that are not

accessed?

Making the Connections…

“Babies are citizens of the world.” Neurons in the auditory cortex

Laborers with no job assignments As the infant is exposed to spoken language,

different clusters of neurons in the auditory cortex are recruited to respond to different phonemes

Neuron clusters fire only when a nerve from the ear carries a particular sound

By 12 months of age a child’s “auditory map” is established

Making the Connections…Training OR Learning?

For the young child,meaningful contexts are crucial for the auditory processing of spoken language. “The hearing-impaired child’s auditory

abilities develop ‘because emphasis is placed on listening throughout all waking hours so that hearing becomes an integral part of his/her personality.”

(Pollack, 1985)

It’s All About Experience

Experience & Vocabulary Vocabulary size correlated with quantity of

maternal “talk” 20 months of age—offspring of talkative

mothers averaged 131 more words than children of less talkative moms

At age two, the gap doubles Critical factor—number of times the child

HEARS different words TV doesn’t produce same results. Why not? Information within context seems to stimulate

neural circuitry

What happens when the auditory centers of the brain are not accessed early?

Decreased ability to use sound meaningfully (cross-modal reorganization)

Physiological changes Psychosocial factors When the hearing aids are OFF what

happens?

Auditory Processing of Spoken Language

“The auditory processing ‘whole’ is greater than the sum of current knowledge of its hypothesized parts.”

(Cole,1992, 2006)

Components of auditory processing models

Peripheral hearing structures are responsible for analysis and conversion of speech/acoustic information to nerve impulses for transmission to the brain Brief memory storage required

Preliminary processing in the brainstem Localization and selective attention

Auditory cortex receives input Higher level analysis includes: phonetic,

phonological, syntactic, semantic, and pragmatic/contextual processing

Take Home Points…

We hear with the ____. Neuroplasticity is greatest during the

first ___years What is the purpose of hearing aids and

cochlear implants? What happens when the auditory

centers are not stimulated early? Full maturation of the central auditory

pathways is a must for________.

References

Bock, P., (2005). How do babies learn to talk? Retrieved on July 1, 2007 from http://seattletimes.nwsource.com/pacificnw/2005/0306

Cole, E., & Flexer, C. (2007). Children with hearing loss: Developing listening and talking birth to six. San Diego CA: Plural Publishing

Sharma, A., Dorman, M.F., Kral, A. (2005). The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants. Hearing Research, 2-3, 134-143.

Sharma, A., Dorman, M.F., & Spahr, A.J. (2002). A sensitive period for the development of the central auditory system in children with cochlear implants: Implications for age of implantation. Ear and Hearing. 23(6), 532-539.

Sharma, A., Martin, K., Roland, P., Bauer, P., Sweeney, M.H., Gilley, P., et al. (2005). P1 latency as a biomarker for central auditory development in children with hearing impairment. Journal of the American Academy of Audiology, 16, 564-573.

Let’s Talk about Hearing Age

Relationship between age at first amplification and a child’s chronological age

Calculated from the day the child begins wearing amplification

Hearing age is the term used to put progress in perspective

Listening experience Mixed hearing history

Other Terms

Cochlear Implant Age = length of time since CI “hook-up.”

A-V Age = length of time enrolled in Auditory-Verbal Therapy

Language Age = level of understanding and use of language

Application

John is an 11 month old boy whose moderately severe bilateral hearing loss was diagnosed at two months of age. He began wearing hearing aids at 3 months of age and began AVT at the age of 5 months.

What is John’s hearing age? What is

his program (AVT) age?

At a chronological age of 3 years 8 months, John obtained the following scores on standardized measures of language:

PLS-4 AC 101 AE 98 Total Lang. 100 A.E. 3 years, 7 months

Peabody Picture Vocabulary Test-III SS 92 A.E. 3 years, 3 months

Discuss the test results for John in relation to: Chronological Age Hearing Age Program Age

Application

Cate is 4 years, 6 months of age. Her severe-profound bilateral hearing loss was identified at 13 months of age, and she was subsequently fitted with hearing aids at 15 months. What is her hearing age?

Cate received a cochlear implant at 2 years, 6 months and began AVT at the same time. Note: Cate was enrolled in a TC program from

16 –28 months of age. What is Cate’s CI age? AVT age?

At 4 years, 6 months of age, Cate has an expressive vocabulary of 284 words. She consistently uses 3-word combinations spontaneously such as “I want cookie” “no want that” and “I do it.” She can recall 3 critical elements, identify objects when given related descriptors and can identify segments of sequence stories. She demonstrates accurate vowel production and uses /p/, /m/, /w/, /h/ correctly in spontaneous speech. Cate uses all suprasegmental features of speech appropriately.

Discuss Cate’s present level of functioning in relation to her:

Chronological Age CI and AVT Age

Stages of Auditory Development

Follow the normal sequence of development

A basic premise of Auditory-Verbal education is that limited-hearing children need the same foundation of listening experiences as a normal-hearing child regardless of the age at which intervention occurs

Auditory Detection or Attention0-2 months

Distance Hearing2-4 months

Localization4-6 months

Discrimination

5-7 monthsAuditorySelf-Monitoring8-10 months

Presence & absence of snd.

Begins to startle to snds at increasing distances

“Orienting reflex”Infant searches for snd.

Perceives differences in sounds

Modifies speech to match what was heard

First responses are to gross snds.

Recognizes mother’s voice

Localization-develops during 1st years of listening

Reacts differently to different tones of voice

Imitates non-speech sounds

Begins to u’stand source of snds & learns there are all kinds of snds.

Stops crying to listen & listens to his own snds.

Enjoys being whistled or sung to

Monitors own vocal play

Begins to listen w/ varying degrees of attn.

Enjoys a few noise-makers

Auditory Ident.Association9-11 months

Auditory Memory9-12 months

AuditorySequencing10-18 months

Auditory Processing months18-48 months

AuditoryUnder-standing48-72 months

Labels what was heard Remembers what was heard

Remembers what was heard in the correct order

Makes cognitive judgments about what was heard

Compre-hends auditory information in a variety of settings

Object selection Recalls critical elements

Speech Acoustics

Let’s Review…

Why should we know this?

Knowledge of speech acoustics helps us: Bridge the disciplines of audiology and

habilitation

Judge what speech information is available to a child through hearing

Teach parents what the child can do or has the potential to do with his/her aided hearing

Select strategies to facilitate the processing of spoken language through audition

“ah”

“eye”

/s/ /e/ /v/

“save”

“mean”

/m/ /i/ /n/

“tide”

/t/ /ai/ /d/

Multimedia FUN!

http://www.utdallas.edu/~thib/EARRINGFINAL/EARRINGWEB_files/frame.htm

http://hctv.humnet.ucla.edu/departments/linguistics/VowelsandConsonants/course/chapter1.1/chapter1.1.htm#four

http://hctv.humnet.ucla.edu/departments/linguistics/VowelsandConsonants/course/chapter8/speechbird/speechbird.html

http://www.oraldeafed.org/movies/heardiff.html

Auditory-Verbal Strategies and Techniques

Position to maximize auditory input

Sit behind the child? In front of the child? On top of the child??? Beside the child? On which side?

Position to maximize auditory input

Optimal distance is Within ___ inches of the HA microphone Within ___ inches of the CI microphone Come close to me at 6 dB……

Amplification should be set so that child can easily hear you at a distance of ___

Maintain Favorable Auditory Learning Environment

This means controlling ___ & ___ In which of the child’s learning

environments can the adult exert control over these factors?

How?

PositioningFavorable Auditory Environments

GREAT website! Contains audio files for demo of FM

with/without hearing aid, what a CI sounds like, simulations of auditory neuropathy, etc.

http://www.utdallas.edu/~thib/EARRINGFINAL/EARRINGWEB_files/frame.htm

Attention Getters

The “Listen!” Cue Audition FIRST

Not show and tell but Tell and Show Why hearing first?

Sing What You Say/Parentese Get Closer

Helps for PROCESSING through Audition

CLEAR Speech Speak Suthun: i.e., a slightly slower

rate of speech Acoustic Highlighting: more to less Lowlighting/Whispering: Why?

Helps for Processing

WAIT Time + Expectant Look The ___ the child, the more wait time

needed The Expectant Look says…

Repetition: Why? Pause before challenging word/s

Helps for Processing

Word position in sentence Give a choice What DID you hear?

And if you must…

A-V-A Sandwich or “Put it back into hearing”

Give visual context for auditory input Point to the picture/object Natural gesture Facial expression

Adjust set size

Helps for Confident Listening

Modeling Converse slightly above child’s

linguistic level Diagnostic Teaching, NOT testing Known →unknown, audible →less

audible

Other Strategies

The absent-minded therapist Let child be the teacher

PrerequisitesPrerequisitesKnowledge of…Knowledge of…

Auditory processing, neuroplasticity Auditory processing, neuroplasticity of the auditory system and a critical of the auditory system and a critical period for development of an auditory period for development of an auditory functionfunction

Normal Auditory Development Normal Auditory Development Speech AcousticsSpeech Acoustics Auditory-Verbal Strategies & Auditory-Verbal Strategies &

TechniquesTechniques Assessment of Listening SkillsAssessment of Listening Skills

Current Models of Auditory LearningCurrent Models of Auditory Learning

Cole and Flexer (2007)Cole and Flexer (2007) Dickson, C. (1999)Dickson, C. (1999) Estabrooks (1998)Estabrooks (1998) Pollack, Goldberg, Caleffe-Schenck (1990)Pollack, Goldberg, Caleffe-Schenck (1990) Romanik, S. (1990)Romanik, S. (1990) Simser (1993)Simser (1993) Walker (1995, rev. 2009)Walker (1995, rev. 2009)

Auditory Learning Guide (ALG)Auditory Learning Guide (ALG)(Walker, 1995)(Walker, 1995)

Framework for the development of an Framework for the development of an auditory functionauditory function

Based on the work of Simser, Based on the work of Simser, Romanik & Foreworks CurriculumRomanik & Foreworks Curriculum

Comprehensive chartComprehensive chart Not an exhaustive listNot an exhaustive list

The ALG is useful for…The ALG is useful for…

Establishing GoalsEstablishing Goals Planning therapy sessionsPlanning therapy sessions Documenting progressDocumenting progress Parent EducationParent Education Professional collaborationProfessional collaboration

Auditory Learning GuideAuditory Learning Guide

Five levels: Five levels: Sound AwarenessSound Awareness Phoneme LevelPhoneme Level Discourse LevelDiscourse Level Sentence LevelSentence Level Word LevelWord Level

Concurrent development Concurrent development Timelines are color-codedTimelines are color-coded

Auditory Learning GuideAuditory Learning Guide

CONSIDERATIONS:CONSIDERATIONS:

Therapist’s skill level/experienceTherapist’s skill level/experience Residual hearing/aided thresholdsResidual hearing/aided thresholds Age at implantationAge at implantation

Perception vs. productionPerception vs. production

Sound AwarenessSound Awareness

DETECTION ONLY, “LOW LEVEL”DETECTION ONLY, “LOW LEVEL” With optimal amplification, may complete With optimal amplification, may complete

work on all steps in one weekwork on all steps in one week Begins with detection of ANY speech Begins with detection of ANY speech

sound sound Quickly progresses to detection of all Quickly progresses to detection of all

soundssounds Close range to DistanceClose range to Distance Includes detection of wide variety of Includes detection of wide variety of

environmental sounds at various environmental sounds at various distancesdistances

Environmental SoundsEnvironmental Sounds

Indoor SoundsIndoor Sounds vacuum cleaner, knock on the door, vacuum cleaner, knock on the door,

washing machine, dryer, teapot washing machine, dryer, teapot whistling, hair dryer, TV, radio, smoke whistling, hair dryer, TV, radio, smoke alarm, blender, telephonealarm, blender, telephone

Softer SoundsSofter Sounds clock ticking, cat’s meow/purr, broom clock ticking, cat’s meow/purr, broom

sweeping, pages being turned, coins or sweeping, pages being turned, coins or keys clinking keys clinking

Environmental SoundsEnvironmental Sounds

Human NoisesHuman Noises laughing, sneezing, coughing, crying, laughing, sneezing, coughing, crying,

whistling, walking, snoringwhistling, walking, snoring Musical InstrumentsMusical Instruments

drum, bells, horn, piano, tambourinedrum, bells, horn, piano, tambourine Outdoor NoisesOutdoor Noises

thunder, fire engine, airplane, train, car thunder, fire engine, airplane, train, car horn, garage door, dog barking, rain horn, garage door, dog barking, rain

Sound AwarenessSound Awareness

Conditioned ResponseConditioned Response Exposure/Modeling at 16 monthsExposure/Modeling at 16 months Most children consistent: ~24 monthsMost children consistent: ~24 months Audiological EvaluationsAudiological Evaluations

More efficientMore efficient More reliableMore reliable More thoroughMore thorough

Ling 6 Sound CheckLing 6 Sound Check Daily checks help monitor:Daily checks help monitor:

AmplificationAmplification Middle Ear StatusMiddle Ear Status

Phoneme LevelPhoneme Level

What?What? Why?Why? When?When?

Examples:Examples: Alternating vowelsAlternating vowels Identification of consonants varying in manner of Identification of consonants varying in manner of

productionproduction

Discourse Level Discourse Level

Connected spoken language Connected spoken language Conversational context:Conversational context:

DiscourseDiscourse DialogueDialogue

Combine with Sentence and Word Combine with Sentence and Word LevelLevel

Discourse Level Discourse Level Year 1Year 1

Imitate motions of nursery rhymes/songs Imitate motions of nursery rhymes/songs with accompanying vocalizationwith accompanying vocalization

To identify songs/rhymesTo identify songs/rhymes Easier to process larger units of languageEasier to process larger units of language

To identify the last word read in a passageTo identify the last word read in a passage For individuals who can readFor individuals who can read Helps develop good phrasing and improves Helps develop good phrasing and improves

fluencyfluency To answer common questionsTo answer common questions

Discourse Level Discourse Level Year 2Year 2

To follow a story illustrated by sequenced To follow a story illustrated by sequenced pictures.pictures. First step toward processing a story through First step toward processing a story through

listening alonelistening alone To identify an object from several related To identify an object from several related

descriptors (closed set)descriptors (closed set) Begin with identifying items by functionBegin with identifying items by function

To follow a conversation with the topic To follow a conversation with the topic disclosed.disclosed. Tell the child what the topic is or let him Tell the child what the topic is or let him

choosechoose

Discourse Level Discourse Level Year 3Year 3

To answer questions about a story with the (topic To answer questions about a story with the (topic disclosed).disclosed). Precursor to story retellingPrecursor to story retelling Leads to recalling events, sequencing events and Leads to recalling events, sequencing events and

ultimately retelling a storyultimately retelling a story To answer questions about a story with the (topic To answer questions about a story with the (topic

disclosed); story is teacher audio-taped.disclosed); story is teacher audio-taped. To recall details of a story (topic disclosed).To recall details of a story (topic disclosed).

No questions to prompt memory; details don’t No questions to prompt memory; details don’t have to be in correct sequencehave to be in correct sequence

To sequence the events of a story (topic disclosed).To sequence the events of a story (topic disclosed). Start with 3 events and move to 4, 5, moreStart with 3 events and move to 4, 5, more

Discourse LevelDiscourse LevelYear 4Year 4

To retell a story with the topic disclosed, recalling To retell a story with the topic disclosed, recalling all details in sequenceall details in sequence

To make identification based on several related To make identification based on several related descriptors (open set).descriptors (open set). No prompts; completely open setNo prompts; completely open set

To follow a conversation of an undisclosed topicTo follow a conversation of an undisclosed topic Child is processing well by this stageChild is processing well by this stage

To retell a story about an undisclosed topic, To retell a story about an undisclosed topic, recalling as many details as possible.recalling as many details as possible.

To process information while listening with To process information while listening with competing stimuli. (taped voice with taped competing stimuli. (taped voice with taped competing stimuli).competing stimuli).

Sentence Level Sentence Level

““Stimulus-response” contextStimulus-response” context Develops auditory memoryDevelops auditory memory MUST give child a communicative MUST give child a communicative

reason to respondreason to respond Use imitation as a strategyUse imitation as a strategy After step 3? 6?, “work” at this level After step 3? 6?, “work” at this level

is often unnecessary is often unnecessary

Sentence Level Sentence Level

Examples of Critical ElementsExamples of Critical Elements One: One: Where’s the Where’s the kittycat?kittycat? Two:Two: I need a I need a redred ball.ball.

Look Look underunder the the table.table. Three: Three:

MommyMommy wants wants twotwo pretzels.pretzels. Four:Four:

Color the Color the bigbig starstar yellowyellow and and orange.orange.

More on Critical ElementsMore on Critical Elements

Independent or Group practiceIndependent or Group practice Create an activityCreate an activity Be ready to share with the groupBe ready to share with the group

Word Level Word Level

Perception of individual words Perception of individual words Progression:Progression:

Acoustic features of the targetAcoustic features of the target Word placementWord placement

In the context of phrases or In the context of phrases or sentences sentences

Word Level Word Level

Vocabulary Development Program- Vocabulary Development Program- ((NOT “skill-based” exercises with single words)NOT “skill-based” exercises with single words)

1.1. Learning to Listen soundsLearning to Listen sounds

2.2. Power Word listPower Word list

3.3. Lexicon OneLexicon One

4.4. ““Theme-based” units, Children’s Theme-based” units, Children’s Literature Units (Ling Basic Vocabulary Literature Units (Ling Basic Vocabulary & Language Guide) & Language Guide)

Content of Learning to Listen SoundsContent of Learning to Listen Sounds

Learning to Listen Sounds contain Learning to Listen Sounds contain all the suprasegmental features, all the suprasegmental features, early developing vowels and early developing vowels and consonants.consonants.

Why do we begin with the Learning Why do we begin with the Learning to Listen Sounds rather than the to Listen Sounds rather than the animal and vehicle names?animal and vehicle names?

Criteria for MasteryCriteria for Mastery

SuprasegmentalsSuprasegmentals Child must be able to imitate sounds that vary in Child must be able to imitate sounds that vary in

duration, intensity, and pitch.duration, intensity, and pitch. Let’s name sounds with:Let’s name sounds with:

Long durationLong duration Brief interrupted durationBrief interrupted duration Loud intensityLoud intensity Quiet intensityQuiet intensity High pitchHigh pitch Low pitchLow pitch Varied pitchVaried pitch

Criteria for MasteryCriteria for Mastery

Child must be able to imitate two Child must be able to imitate two back vowels, two mid-vowels and at back vowels, two mid-vowels and at least one front vowel.least one front vowel.

Let’s identify:Let’s identify: Back vowelsBack vowels Mid vowelsMid vowels Front vowelsFront vowels

Criteria for MasteryCriteria for Mastery

Child must be able to imitate a nasal, fricative, Child must be able to imitate a nasal, fricative, and plosive.and plosive.

Child must demonstrate spontaneous use AND Child must demonstrate spontaneous use AND identify Learning to Listen Sounds in a set of 10-identify Learning to Listen Sounds in a set of 10-1212

How long should it take to complete the goal?How long should it take to complete the goal?

Do we do Learning to Listen Sounds Do we do Learning to Listen Sounds with “late starters?”with “late starters?”

Strategies for input?Strategies for input? Strategies for identification?Strategies for identification?

Power WordsPower Words

MoreMore Hot/coldHot/cold

UpUp Mine/meMine/me

Mama, DaddyMama, Daddy Off/onOff/on

GoGo LookLook

StopStop BlowBlow

Bye-byeBye-bye Go awayGo away

NoNo MoveMove

All goneAll gone OpenOpen

First LexiconFirst Lexicon

First 30-60 words that young First 30-60 words that young children acquire.children acquire.

Need a core vocabulary before child Need a core vocabulary before child can produce two-word combinationscan produce two-word combinations

First Lexicon includes nouns, First Lexicon includes nouns, pronouns, adjectives, verbs, pronouns, adjectives, verbs, position/location words and words position/location words and words to indicate denial and rejectionto indicate denial and rejection

Learning Contexts & Teaching Approaches

Informal Learning

Embellished Informal Teaching

Semi-Formal Teaching

Formal Teaching

•Happens in normal, everyday events and interactions•Should occur at home and school•All learner types

•Seize the moment•Use of strategies to embellish the normal situation•Should occur at home and school•All learner types

•Adult directed, pre-planned activities•Developmentally appropriate•Specific goals and objectives•Use of strategies•Typically done at school•Delayed & remedial learners

•Adult directed•Deliberate, direct, methodical•Specific goals and objectives•Use of strategies•Happens in traditional educational setting•School age remedial learners

Types of Learners

Three types of learners

Developmental Delayed Remedial

English Language Skills

Within one year of typically developing peers

1-2 years behind peers

Greater than two years behind peers, scattered language skills

Learning/Teaching context

Informal learning Primarily semi-formal, also need informal

Formal learning, with generalized to informal

Educational Placement

Fully mainstreamed by preschool/kindergarten

Mainstreaming by kindergarten may be a challenge due to language gap

one hr/pd per year of language delaySocial mainstreaming

Types of Learners

Delayed and Remedial Learners CAN “catch up” with focused

language intervention that follows a developmental sequence

Lesson Plan Development

Lesson Plan Development in the A-V Approach

How do you know what to do when a child has a spoken language delay?

Do you use a specific model for spoken language development?

What model do you use for development of language?

Why should you?

Let’s Put it all together…

You will need: Normal Development Resources:

Language Development Vocab development Speech Development

ALG Chart Blank Lesson Plan Forms

A-V Teaching Behaviors: Establishing Goals

Develop your road map What’s your destination?

Long Term goals

How ya gonna get there? Short term goals

Lesson Planning and A-V Teaching Behaviors

“Writes thorough, specific goals, specifying weekly targets and ideas for effective carryover.”

“Demonstrates continuity in planning from session to session.”

“Plans for parent education in each session.”

Six-Step Guide To The Development of an Auditory Function in an A-V Approach

With the parent: Evaluate the child’s present level of auditory

development within the context of a detailed model for normal auditory development

Determine next appropriate target Compare acoustic characteristics of the

target with child’s auditory potential (audiological information)

Select sense modality (consider hearing 1st) Develop the target through informal learning-

formal teaching Evaluate progress toward goal often

Lesson Plan Development: Point to Ponder

Hearing children learn language through listening as they seek to extract meaning from their environment (Ling, 1986) What, in the child’s mind, is the reason

to listen during this activity?

Lesson Plan Development:Point to Ponder

What is your major focus? Helping the parent to integrate new

strategies into established daily routines?

Helping the parent integrate new activities that promote listening into his schedule?

Both? Neither?

Lesson Plan Development:Point to Ponder

Hearing children develop auditory behaviors in conjunction with speech, language and cognitive goals Integrate goals within one activity rather

than teaching each area in an isolated activity

Develop auditory behaviors in coordination with “hearing age” rather than chronological age until the gap is closed

Lesson Plan Development: Point to Ponder

Develop through: Informal Learning? Embellished Informal

Teaching? Semi-formal Teaching? Formal Teaching?

Meet Veronica

ALG goals Strategies used Parent education How did Veronica respond?

What would you do next?

Independent Practice Consider:

Learning context Type of learner Current level of development Select appropriate activities:

Listening age Chronological age interests

What are the next steps?

Assessment of Listening Skills

Purpose

Speech Perception Testing is an essential feature of a comprehensive evaluation

Compare various devices Document progress Device check Intervention planning Selection of strategies

Testing Considerations

Cognitive level Vocabulary level Speech production skills Chance level Acoustic feature specificity Appropriateness of materials Attention to task

Speech Perception Tests

Test of Auditory Comprehension Early Speech Perception Test—closed set/word

level CID Sentences—open set/sentence level Glendonald Auditory Speech Perception Test

(GASP)—closed set/word and open set/sentence level

PBK-50 (kindergarten word lists)—open set/word level

WIPI (Word Intelligibility by Picture Identification)—closed set/word level

NU-CHIPS (Northwestern University Children’s Perception of Speech)—closed set/word level

IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scales)

MAIS (Meaningful Auditory Integration Scales)

Mr. Potato Head—closed set/sentence level SERT (Sound Effects)—environmental

sounds MAC (Minimal Auditory Capabilities Test) Lexical Neighborhood Test (LNT) Multisyllabic Lexical Neighborhood Test

(MLNT) open set/word recognition

APT HI (Auditory Perception Test for the HI)

SPICE (Speech Perception Instructional and Curriculum and Evaluation: For Children with Cochlear Implants and Hearing Aids)

LIFE (Listening Inventory for Education Communication Skills Checklist

(Med-EL)

Early Speech Perception Test(Low Verbal Version)

Used to estimate speech perception abilities in children (age two and up) with limited verbal abilities

Determines if the child has the ability to identify words in small closed sets, based on patterns as well as phonemes

Toy or picture stimuli

Early Speech Perception Test(Standard Version)

Sets are larger First section examines pattern

perception abilities (monosyllabic, spondee, trochee & multisyllabic words).

Spondee word subtest Monosyllabic word subtest

CID Everyday Sentences

Used to assess speech recognition at a sentence level.

Key words are used to derive a percent correct score

Considerations: cognitive level, vocabulary level, speech production skills

Phonetically Balanced Kindergarten (PBK)-50 Word List

Monosyllabic word lists Presented auditory-only; open set Can derive percent word correct or

percent phoneme correct Considerations: vocabulary level,

speech production level

Word Intelligibility by Picture Identification (WIPI)

Compares the child’s ability to perceive words in three conditions Speechreading w/ hearing aids, without

hearing aids and auditory only w/ hearing aids Stimuli are pictures of single syllable

words in a closed set of 6 Chance level-17% Considerations: cognitive level,

vocabulary

Lexical Neighborhood Test &Multisyllabic Lexical Neighborhood Test

Designed to assess word recognition. The LNT has single syllable words and the MLNT uses 2 & 3 syllable words. All words were selected from those known by 3 to 5 year old normal hearing children

Each has an easy and a hard list Consideration: child’s speech production skills Reference: Kirk, K.L (1998).Assessing Speech

Perception in Listeners with Cochlear Implants: The Development of the Lexical Neighborhood Tests. The Volta Review, 100, 63-85.

Northwestern University Children’s Speech Perception Test (NU-CHIPS)

Uses monosyllabic words to assess the child’s perception skills

4 choice/50 words - one presentation each Point to picture of target word

represented on picture plate Chance level: 25% Consideration: vocabulary level, cognition

Common Phrases Test

Uses monosyllabic words 50 words per list - one presentation

each Child repeats correct word Chance level: 2% Considerations: vocabulary,

cognition

Informal Assessment Tools

Ling Six Sound Test task of 6 sounds presented at normal conversational level each sound represents critical information in a different

frequency range optimal information in minimal time

Why do we use the task? Predict the ability to recognize various speech features monitor changes in hearing d/t ME dysfunction measure changes in aided performance day to day measure the effects of distance observe changes in audibility between hearing aids and

hearing aids in combination with FM

Informal Assessment Tools

Early Learning to Listen Sounds ah vs. bu bu bu meow vs moo p p p vs. bu bu bu

Early Phrases/Simple Directions time to eat wave bye-bye put it in give it a kiss

Body Parts nose, eyes, ears, mouth, etc

Daily Performance

Ongoing diagnostic teaching

The AVT must be able to assess why a child is having considerable difficulty with particular goals and drop back to lower steps on the hierarchy.

When a child is demonstrating competency with particular goals/skills, the AVT must be able to move on to new areas (goals/skills that can be accomplished with support).

AVT must know prerequisite skills as well as those 1-2 levels above the selected target.

Data collection regarding child’s performance

Responses to auditory information New sounds produced (spontaneous or imitated) New words comprehended and used Areas of concern Mistakes made in auditory perception or speech

errors Child’s behavior Likes and dislikes for particular activities Areas that need to be addressed in future

sessions