Training Transcript
Transcript for Auditory Skill Development Training Part 2
Transcript for Auditory Skill Development Training Part 2
– [Instructor] Let’s take a look at auditory hierarchy, including detection, discrimination, and understanding. As we address various levels of listening skills, we will move from easier skills to more advanced and difficult skills, working systematically through the auditory hierarchy, beginning with lower level auditory skills and moving towards more advanced listening skills. Detection is the first level of the auditory hierarchy, and can be thought of as sound awareness. Once a child’s cochlear implant is activated, he or she will begin to notice sounds. In the initial detection phase, the child does not connect the sounds he or she hears with the source of the sounds. Detection is not indicative of the ability to attach meaning to the sound. Instead, detection of sound is simply, “I hear something.” Prior to identifying what he or she is hearing, a child will simply detect sounds, including environmental sounds and voices. Furthermore, it’s important that the child be able to detect all of the Ling Sounds, which we will address shortly. When working on a child’s ability to detect environmental sounds, it’s recommended that you work in a structured setting with minimal distraction, as well as incorporate detection activities into the child’s daily routines. In the detection stage, the early interventionists and the parent assume the role of auditory tour guide during daily routines, drawing the child’s attention to environmental sounds. Please note that although detection is simply, “I hear something,” it would be counterproductive to simply cue a child to sounds in the environment without helping the child attach meaning to those sounds. Parents and early interventionists should strive to lay the groundwork for auditory discrimination skills during the initial detection stage. Serving as auditory tour guides. when parents and early interventionists detect environmental sounds, they should gain the child’s attention, touch their own ear, label the source of the sound, imitate the sound, and then show the child the sound source if possible, thus supporting both detection and discrimination skills at the same time. When the child detects sounds on his or her own, the same scenario should transpire, with the early interventionist and parents helping the child connect meaning to the sound he or she detected. When targeting detection in structured settings, the parent and early interventionist purposefully set up detection activities. These planned or structured activities allow the parent and early interventionists to control the production of the sound, utilize meaningful targets, and provide repetitive practice. Intentionally and repetitively producing an environmental sound gives the child opportunities to practice detection. It is also important to utilize auditory targets that are meaningful and connected with the child’s specific environment. For example, a child that lives on a farm may hear animal and tractor sounds on a daily basis. Meanwhile, a child living in this city will be exposed to other environmental sounds, such as traffic and sirens. This type of individualization makes structured practice functional for the child. Providing repetitive practice for the detection of environmental sounds is more easily accomplished in structured settings where the adults have control of the sound production. If working on the child’s ability to detect the doorbell, for example, the parent and early interventionist can expose the child to the sound repetitively, thus giving the child ample exposure to the sound. This type of repetition is not easily accommodated during daily routines when the sound is an airplane or a car passing by. Another important aspect of the detection stage is the detection of voicing. This includes the detection of any voiced single-speech sound, the child’s name, and other true words. Expose the child to a variety of people’s voices as the qualities of Mom’s voice are different than those of Dad’s voice, and also of the early interventionists. The same scenario described in the detection of environmental sounds is utilized to support the child’s detection of voicing. The detection of voicing distraction is another important auditory detection skill. Detecting a voice and distraction is simply the ability to detect or respond to a voice when engaged in another activity. For example, while the child is engaged in a painting activity, the early interventionist or parent calls his or her name. The engagement of the child in the painting activity makes detecting his or her name more difficult. Proof of detection of the auditory signal is based on the child’s response. Detection of voicing distraction is demonstrated if the child does a number of things, such as ceasing the activity, searching for the source of the sound, or touching his or her own ear. Once again, it’s important to clarify that at the auditory detection level, the child does not have to identify the sound source. Detection is accomplished when the child responds in a manner that indicates that he or she heard a sound. Detection of the Ling Sounds is essential. The Ling Sounds are ahh, eee, ooo, shh, sss, and mmm. The Ling Sounds encompass the frequency range of all speech sounds. Therefore, the child’s ability to detect the Ling Sounds is indicative of his ability to detect all of the aspects of speech. When working with younger children, it is recommended that the Ling Sounds be connected with specific toys. Typically, a ghost represents ooo, a baby represents shh, a snake represents sss, an ice cream cone represents mmm, a mouse or a vacuum represents eee, and a mouth or airplane represent ahh. Choosing detection activities that the child is both interested in and that are developmentally appropriate is an important factor to consider. Activities should be developmentally appropriate, reinforcing, engaging, and most of all, fun. A child interested in trucks, blocks, and puzzles will attend much better to activities that involve these interests. It’s much easier to engage a child in activities that he or she enjoys. Utilizing toys and activities that the child has access to on a daily basis is preferable. Let’s take a look at an example of a detection activity. Imagine that we wanna target a child’s ability to detect the Ling Sound shh. To do this, the early interventionist could choose to train the child to put a baby in a crib or on a bed when he or she hears that sound produced. The child is detecting the difference between the absence of sound and the adult’s production of the Ling Sound shh. Thus, it’s important to remember that only the baby in bed would be utilized during this detection activity. If more than one toy is available and the child is expected to complete an action using the toy associated with the auditory signal, the child in this instance is being asked to discriminate sounds instead of simply detecting the presence of sound. Detection activity should involve a single toy, a single auditory target, and the completion of an action when the target sound is produced. Examples include the placement of a ring on a ring stacker or the placement of a piece in a puzzle in response to an auditory target. A detection activity odes not involve more than one toy, more than a single auditory target, or the discrimination of one sound versus another. When a child demonstrates auditory comprehension, he or she is actually demonstrating an understanding of the words he or she discriminates. Tasks demonstrating auditory comprehension include the identification of single words, the identification of critical elements in short phrases, sentences, and short stories, following directions tasks, and answering questions about stories. Comprehension of single word tasks include having the child identify pictures or objects when named, or identify his or her own body parts when named. The identification of critical elements in short phrases includes the child’s ability to identify a single element, such as point to the balloon, the identification of two critical elements, such as point to the purple balloon, and the identification of three critical elements, such as point to the purple balloon on the ceiling. Following direction tasks include following age appropriate one, two, and three-direction tasks, thus the directs become more complex, such as get the ball, get the ball and give it to dad, get the ball, give it to dad, and sit down. When choosing auditory comprehension tasks, it is vital to take the child’s developmental level into account. A child should not be expected to complete auditory tasks that are beyond what would be expected for his or her age or developmental level. Tasks should also be fun and reinforcing. Short term auditory memory is yet another important auditory skill to address. Auditory memory refers to the ability to take in information presented orally, process or analyze the information, store it in your mind, and then recall what you heard. Auditory memory basically involves attending, listening, processing, storing, and recalling information. It is developmentally appropriate to target auditory memory skills with children older than two years of age. Many therapists utilize numbers to target and to test a child’s auditory memory. The use of numbers is thought to ensure that short-term auditory memory is being tested in isolation. Thus, the therapist says one, five, nine, two, and the child repeats the digits in the correct order. With children under the age of two, exposure to auditory memory tasks utilizing targets such as animal sounds is considered more developmentally appropriate than the use of numbers. When targeting auditory memory, it is beneficial to work with true words. Working with true words provides practice that is functional and meaningful. Closed set activities with predetermined topics, such as food, clothing, and animals, can be utilized to practice auditory memory. For example, prior to a real or pretend trip to the grocery store, the child listens to the adult read the shopping list, then remembers and repeats the items on the list. Of course, the smaller the number of items on the list, the easier the listening task. In the previous levels of the auditory hierarchy we reviewed, the child was learning to listen. The child now begins to listen to learn using his or her listening skills to process auditory stimuli. At this level in the auditory hierarchy, the child is learning to do several key things, including use audition to learn new words and use them appropriately, learn and use the rules of grammar, and understand spoken language. The child will be learning to converse and answer questions within the context of a picture stimulus, and converse and answer questions regarding familiar topics. Auditory processing includes the ability to actively participate in face-to-face auditory conversations, as well as conversations over the phone or on Skype. Children in preschool or school settings will begin to comprehend information presented within the context of the classroom. Ultimately, the child begins to learn incidentally through audition. Work within the auditory processing level of the auditory hierarchy is ongoing, as the targets within this level become more sophisticated as the child gets older. In other words, new challenges equal more learning opportunities and more occasions to practice and hone auditory processing skills. However, once again, it is important to remember that expectations of the child’s proficiency at this level must be gauged by those that are developmentally appropriate. We’ll now address some of the factors that positively or negatively affect a child’s ability to discriminate auditory information at various levels in the auditory hierarchy. As demonstrated in our previous discussion of the auditory hierarchy, the acoustic contrast of specific auditory targets affects the level of listening difficulty. The greater the acoustic contrast, the easier the listening task. For example, the discrimination of a four-syllable word, such as watermelon, versus a single-syllable word, such as peach, is easier than the discrimination of two four-syllable words, such as watermelon versus macaroni. Familiarity is another factor that affects the level of listening difficulty. Familiar vocabulary, voices, and topics are easier to discriminate than those that are novel. The type of set utilized in the presentation of auditory targets also affects the level of acoustic difficulty. Closed sets are those in which the child is shown the specific auditory targets he or she’s listening for. For example, a field of seven animals is placed in front of the child. The child knows that the auditory target will be one of those seven animals. Bridge sets are those in which the child does not know the exact auditory targets, but does know the category of the words that will be presented, such as food, animals, or clothing. Referencing the previous example, the child will know the auditory target is an animal, but will not have a specific set of animals to choose from. Open sets indicate nothing to the child regarding the auditory targets or the category of the targets. Open sets are, of course, the most challenging to discriminate as the target can literally be anything. Set size is yet another factor affecting the level of auditory difficulty inherent in a listening task. Larger closed sets are more difficult to discriminate than smaller closed sets, thus listening for a specific auditory target when the set size is eight objects is more difficult than when the set size is four objects. The linguistic complexity of the auditory targets contributes to the difficulty of the listening task. For example, short, simple phrases and sentences are easier to discriminate than longer, more complex sentences. Rate of speech is another factor that negatively or positively impacts the level of difficulty of a listening task. A quicker rate of speech increases the difficulty of a listening task. Thus, a slower rate of speech is easier to discriminate than a quick rate of speech. For example, the cat chased the mouse into the house is more difficult to discriminate than the same sentence presented at a slower rate, the cat chased the mouse into the house. Be cautious of slowing your speaking rate so much that you distort or lose the suprasegmental qualities of your voice. The intent is to slow your rate of speech production. Without sounding like a robot. Yet another factor to consider is the presence of background noise. Background noise adversely affects a child’s ability to discriminate auditory information. Listening tasks presented with background noise are more difficult than the same tasks presented in quiet environments. It is important that listening tasks be practiced in the presence of background noise once they have been mastered in quiet environments. In essence, learning to listen in the real world means listening in the presence of various levels of background noise the majority of the time. The distance from the source of the auditory signal to the child also affects the ease of the listening task. The auditory task becomes increasingly more difficult the further away the source is from the child. As previously noted, when discussing background noise, it’s important to target auditory skills that have been mastered in close proximity at a distance too. Again, listening in the real world means listening at close range, as well as listening to sounds presented from further distances. The final factor we will discuss is the child’s physical and emotional state. Children who are ill, hungry, tired, or experiencing extreme emotions, such as sadness or excitement, will find listening more difficult. When working specifically on a child’s auditory skills, it is important that the child does not have access to lip reading. An auditory hoop or the hand cue can be utilized to prevent the child from reading the early interventionist’s or parents’ lips during auditory activities. The use of an auditory hoop or the hand cue isolates auditory input as the only input available to the child. It thus teaches the child to trust his or her hearing. An auditory hoop consists of double thickness, acoustically transparent fabric typically utilized to make speakers, and an embroidery hoop. The hoop is held in front of the early interventionist’s or parents’ mouth, as shown here, to block the child’s visual access. It’s important that a book, piece of paper, or other solid object is not utilized. It is critical that the visual barrier be acoustically transparent. The hand cue consists of the early interventionist or parent using a hand to cover the mouth when presenting auditory information to the child. The correct use of the hand cue is technically more difficult than the use of the hoop. A person’s hand is not acoustically transparent, and thus there is a risk that the auditory signal will be changed or distorted. The correct positioning of the hand is vitally important to decrease the likelihood that the auditory signal is being distorted. The overuse of the auditory hoop and hand cue should be avoided. When a child is playfully engaged in an activity and is not looking at the speaker’s mouth, the hoop or hand cue is not needed. Acoustic highlighting includes the use of exaggerated intonation, stress, and an auditory space marker to make listening easier for the child. Adding additional inflection, pitch, and tone to the words you produce makes auditory discrimination easier. When considering the discrimination of mmm versus ooo, a production void of exaggerated intonation, such as mmm, ooo, is much more difficult to discriminate than the same sounds produced with an exaggerated intonation, such as, mmm, ooo. The use of stress is a useful way to highlight target words. For example, if upon hearing the direct to go get your coat, the child instead gets his shoes, the direct can be restated using stress to highlight the correct word, “Go get your coat.” The use of an auditory space marker is yet another way to highlight target words. For example, if upon hearing the direct to go get your coat, the child instead gets his shoes, the direct can be restated using a pause directly prior to the target word, such as, “Go get your coat.” The following are examples of some of the potential auditory pitfalls or mistakes to avoid when working on auditory skill development with children with hearing loss. Providing premature visual supports when the child responds with an incorrect answer, allowing inadequate processing time, the overuse of acoustic highlighting, the use of non-functional vocabulary as auditory discrimination targets, working on auditory skills only in quiet environments at close range without support for the transition of those skills into louder environments and at further distances, targeting only audition during treatment sessions without simultaneously working on speech and language skills, accepting pointing or gesturing to targets without expecting the child to vocalize his or her response, and the insufficient involvement of the child’s primary caregivers in the auditory sessions. As you recall, a child working on detection skills is only expected to indicate that he or she has heard something. Once the child’s ability to detect environmental sounds is established, the focus shift to the identification or discrimination of meaningful environmental sounds. While targeting the detection of environmental sounds, the child was only expected to indicate that he or she heard something. In the discrimination level of the auditory hierarchy, the identification of the sound source is established. Thus, when the child hears the dog bark, he or she labels the source of the sound by indicating in some fashion the sound he or she hears is the dog barking. We will now shift our focus to the discrimination of sounds or words based on the suprasegmental and segmental aspects of speech. Some of the easiest differences to discriminate are words with differing suprasegmental qualities. The suprasegmental aspects of speech include stress, intonation, pitch, and intensity. The initial stages of suprasegmental discrimination encompass the identification of long continuous sounds, such as mooo and baaa, versus short discrete sounds, such as boo and quack, versus intermittent sounds, such as tick tock, tick tock. These sounds varying in suprasegmental aspects are often referred to as the learning listen sounds. Basic suprasegmental discrimination also encompasses the ability to discriminate words based on the number of syllables, sentences versus common phrases versus single-word utterances, and the discrimination of songs versus nursery rhymes. Higher-level, and thus more difficult suprasegmental discrimination encompasses the discrimination of stimuli with similar duration, but differing stress and intonation patterns, and the discrimination of sentences differing only in the duration of ley words. suprasegmental perception activities target the discrimination of long versus short discrete versus intermittent sounds, one versus two versus three-syllable words, words versus phrases versus sentences, songs versus nursery rhymes, and sentences differing only in the duration of key words. An example of a basic suprasegmental activity includes playing with a set of farm animals and working with the child to discriminate long versus short discrete versus intermittent sounds, such as moo versus quack quack versus cock-a-doodle-doo. What the child might be instructed to do is to pretend to feed the animal that corresponds with the sound that he or she hears. Another example of a suprasegmental activity targeting the discrimination of syllable differences includes feeding a doll specific foods that correspond with the auditory stimuli. Thus, the child might be listening for the differences between bean versus apple versus banana. An example of a suprasegmental activity that includes listening for the differences between the production of a single word, a common phrase, or a complete sentence entails playing with the dollhouse and completing directs based on the auditory stimuli presented. So for instance, the child listens for the cues eat versus sit down versus time to brush teeth, and completes the appropriate activity with one of the dollhouse characters following the auditory presentation. An example of a suprasegmental listening activity targeting the discrimination of songs versus nursery rhymes might entail completing the actions associated with a specific song or nursery rhyme when the auditory stimulus is presented. So for instance, the child listens for either the production of “Hickory-Dickory-Dock” or the production of “Twinkle, Twinkle, Little Star,” indicating which one he or she heard by choosing either a clock toy or a star. An example of a suprasegmental perception listening activity targeting sentences differing only in the duration of key words might entail making sandwiches with the child. The child listens for specific key words to sequence the ingredients of the sandwich, such as put on the cheese versus put on the lettuce versus put on the bologna. Segmental discrimination is also referred to as vowel and consonant perception. Vowel and consonant perception encompasses the discrimination of the Ling Sounds, the discrimination of words differing in vowels and consonants, such as cake versus fish and boot versus shirt, the discrimination of words based on vowel differences, such as pie versus pea and cat versus cut, the discrimination of words based on consonant differences, such as mat versus cat and take versus cake, and the discrimination of words based on syllable differences, such as mommy versus tummy and batter versus butter. When choosing target words, it is important to choose words that are familiar and meaningful to the child. This is a very exciting time to work with children with hearing loss. The success of the Wyoming Newborn Hearing Screening programs in the identification of newborns with hearing loss, coupled with advanced technology and appropriate early intervention services, continues to have a positive impact in the outcomes of children with hearing loss. Thank you for investing your valuable time in watching this tutorial.