Back to Basics - AG Bell | Listening and Spoken Language

Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium AVT
ABCs
Back to Basics
ABCs of AVT
Rosemary Richardson Cert. MRCSLT, LSLS Cert. AVT
Sylvia Rotfleisch M.Sc.A., CCC-A, LSLS Cert. AVT
™
AUDITION
BABIES
COMMUNICATION
™
…but……
Why this presentation?
•  The lure of the new electronic toys
and tablets
•  We know that we must be
preparing for the technology of the
future
with all the
glamour and glitz
of new technology and
apps - we risk losing
track of the
basics of AVT
Because……
Why the concern?
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION Children spend too
much time with screen
and media exposure
1 Back to Basics: ABCs of AVT RESEARCH
Research shows that exposure to
phonemes through audio and video
do not show the learning
July 9, 2015 AG Bell LSL Symposium Let’s talk
about
screen time
which is evidenced when babies
have exposure through human
contact
Under 1 year of age
•  On any given day, 29% of babies
are watching TV and videos for
an average of about 90 minutes
•  23% have a television in their
bedroom
1 - 2 years of age
•  On any given day, 64% of
babies are watching TV and
videos - averaging slightly over
2 hours
•  36% have a television in their
bedroom
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION Rapid
increase
in early years
Preschool children
2-5 years old
•  Data varies and shows from 2.2
hours to as much as 4.6 hours
per day
2 Back to Basics: ABCs of AVT Survey of Parents
UK & USA
•  Surveymonkey.com for parents of
children under 2½ years.
•  Asked a range of questions about their
everyday activities.
•  81 responses from parents of children
with typical hearing and with hearing
loss.
July 9, 2015 AG Bell LSL Symposium Our survey showed
How much ‘screen-time’ does your child
have each day?
0-30 minutes
30mins-1 hour
1-2 hours
over 2 hours
0
Research shows
that screen time:
•  Is highest among low-income, AfricanAmerican and Latino children
•  Is an identified factor in childhood
obesity
•  Negatively impacts children’s sleep
•  Puts older children at risk as well •  Undermines learning for babies and
young children Screen time can undermine learning
for babies and young children
•  Time with screens is negatively
correlated with time spent
interacting with parents – which is
essential for learning.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 10
20
30
40
50
Percentage of respondents
60
Screen time can undermine learning
for babies and young children
•  Screen time for children under 3 is
linked to delayed language acquisition.
•  Preschoolers spend less time engaged
in creative play (the foundation of
learning), constructive problem
solving, and creativity.
Screen time can undermine learning
for babies and young children
•  Toddler screen time is associated
with problems in later childhood,
including lower math and school
achievement, reduced physical
activity, and victimization by
classmates.
3 Back to Basics: ABCs of AVT Screen time
•  Research shows benefits of reduced
screen time.
•  Parents are receiving confusing and
inaccurate information about the
educational benefits of screen media
for young children.
The American Academy of Pediatrics,
The White House Task Force on Childhood Obesity
recommends
•  Discouraging any screen time for
children under the age of two
•  Less than two hours a day of
educational programming for older
children
Experiment 1
•  Exposure to live Mandarin enabled
English speaking babies to reduce the
decline in speech perception from their
non-native languages.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION July 9, 2015 AG Bell LSL Symposium Screen time
•  56% of parents of young children
believe that baby videos are good for
child development.
•  For young children, interactive books,
or “e-books,” have been linked to
lower levels of story understanding
and may hinder aspects of emergent
literacy.
Kuhl, Tsao & Lui (2003)
FOREIGN-LANGUAGE
EXPERIENCE IN INFANCY:
EFFECTS OF SHORT-TERM EXPOSURE AND
SOCIAL INTERACTION ON PHONETIC LEARNING
Experiment 2
•  Demonstrated that 9 month old infants
with exposure to the same level of
Mandarin but via audio and video
recordings did not stop the decline
•  Infants' speech perception scores in the
audiovisual and audio groups did not
differ from the scores of infants in the
English control group who were not
exposed to any foreign language material
4 Back to Basics: ABCs of AVT Key Learning
•  Live voice and/or social
interaction matter
•  Increase in attention in
audiovisual group vs. audio
group did not result in an
increase in learning
AVT
We must ensure that the
intention of an AVT session is the
parents’ auditory and communicative
interaction with the child
rather than the child’s interaction with
the therapist or the latest “app.”
ABC
July 9, 2015 AG Bell LSL Symposium Key Learning
•  The results indicate that, although there is evidence that
specific vocabulary items can be learned through
exposure to television programs, the
more
complex aspects of language, such as
phonetics and grammar, are not
acquired from TV exposure
•  These results are consistent with a variety of studies on older
children (preschool age) exposed to language material, both
native and foreign, from children's TV shows.
ABC
Three key areas in AVT:
•  AUDITION - Our knowledge of acoustics and
language to set appropriate goals.
•  BABIES - Our ability to integrate this into a
family’s everyday life.
•  COMMUNICATION - Our ability to coach the
parents effectively to make this happen all day,
everyday at home.
Moon, Lagercrantz & Kuhl
(2012)
Three key areas in AVT:
• AUDITION - Our knowledge of acoustics
and language to set appropriate goals.
•  BABIES - Our ability to integrate this into a
family’s everyday life.
LANGUAGE EXPERIENCED IN
UTERO AFFECTS VOWEL
PERCEPTION AFTER BIRTH
•  COMMUNICATION - Our ability to coach the
parents effectively to make this happen all day,
everyday at home.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 5 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Method
Results •  40 Swedish and 40 American (English)
babies were exposed to non-native
phonemes 7-75 hours after birth (average 33
hours old)
•  Neonates sucked at a significantly higher rate
to non-native phonemes than those of their
own language – between Swedish & English
•  Between subjects design – some exposed to
non-native, some exposed to native vowels
•  Time since birth had no effect (between 7
and 75 hours)
•  Controlled audio presentation
•  Applied in both Swedish and English (higher
rate to non-native vowels)
•  Sucking rate on a pacifier measured Key Learning
•  We already know that infants can
detect and discriminate vowels –
studies showing heart rate changes
when ‘babi’ is presented (changing
vowel quality), but this shows that they
can also recognize vowels – i.e.
which are and aren’t familiar in the
language they have been exposed to
in utero
Audition and
Language
•  It’s about the brain!
•  What is the baby’s brain doing to learn
language and how do we facilitate those skills?
•  AVT - diagnostic therapy & work on skills
around the functional application of speech
acoustics to language
•  Enable parents to maximize their child’s
auditory brain development
Key Learning
•  Children with a hearing loss are born
without many of these abilities in place
– we are playing catch-up from the
start, so we need to be clear on our
auditory development milestones
Pattern seekers, segmentation
•  Recognizing name by 4½ months
•  At 6 months babies can remember words
they hear in short phrases if the word
follows their own names
Bortfeld, Morgan, Golinkoff, & Rathbun (2005)
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 6 Back to Basics: ABCs of AVT Pattern seekers, segmentation
•  Name acts as a wedge and helps find
patterns
•  At 6 months they can recognize words
that come after mommy or momma
(NOT Lola) which indicates top down
processing with known words
July 9, 2015 AG Bell LSL Symposium Importance of Audition
"....audition
is the only sense capable
of appreciating all aspects
of speech ....."
Ling
Bortfeld, Morgan, Golinkoff, & Rathbun (2005)
Speech Acoustics
Essential Principles
©RoIleisch ACOUSTICS
ACOUSTICS
SUPRASEGMENTALS
VOWELS and DIPHTHONGS
• Duration
• Intensity
• Pitch
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION •  First formant - F1 lower frequency
•  Second formant - F2 higher frequency
7 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium ©RoIleisch ©RoIleisch INFORMATION FROM VOWELS AND DIPHTHONGS
•  Suprasegmental information
•  Prosody -rhythm, rate, stress
•  Accents and dialects
©RoIleisch Consonants
Consonants
Classification of Consonants
•  Manner
•  Place
•  Voicing
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION • Manners of Production
8 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium ©RoIleisch ©RoIleisch ©RoIleisch ©RoIleisch Consonants
• Place of Production
©RoIleisch ©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 9 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Consonants
• Voicing
©RoIleisch Speech Acoustics
Essential Principles
Low frequency information is easier, more
accessible
• 
• 
• 
• 
• 
Nonsegmentals - duration, intensity,pitch
Vowels - F1 and some F2
Consonant manner information - most
Consonant voicing cues
Nasal murmur
©RoIleisch Speech Acoustics
Ling 6 Sounds
Essential Principles
Why we love them…..
High frequency information is more difficult
and less accessible
•  Vowels - remaining F2
•  Consonant place cues
•  Consonants - fricative manner of production
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION • 
• 
• 
• 
• 
• 
• 
Tells us about access with technology
Quick
Easy
Reliable
Across environments
Different team members
Is equipment working?
10 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Ling 6 Sounds
Ling 6 Sounds
Why we love them…..
Where they stop…..
•  Is there access across all frequencies as
maps change/ equipment breaks
•  Discrimination information – can get limited
•  Areas of concern
•  Modalities needed to teach speech/ language
structures
• 
• 
• 
• 
• 
Access, not telling us everything getting to the brain
Primarily give us information on detection
Not a curriculum
Not intended to be the focus of therapy
Some clinicians won’t move beyond Ling 6 sounds
until mastery
•  Many more than 6 phonemes and features to
address in the English language
Sound Object Associations
Sound Object Associations
a.k.a. Learning to listen sounds
a.k.a. Learning to listen sounds
Why we love them…..
Why we love them…..
•  Early “window” into speech perception
–  Provides information for early aspects of speech perception
even before any expressive language has emerged.
–  Able to have a sense of child’s discrimination in a therapy
setting – not a research lab
•  Opportunity to reinforce use of suprasegmentals
and vowels
–  Aspects which are critical for the underlying intelligibility of
speech
–  Good substitute for babbling when older child may not go
back to that stage, missed babbling or has limited
vocalizations
–  Easy task to teach parents for initial “home fun”
Sound Object Associations
Sound Object Associations
a.k.a. Learning to listen sounds
a.k.a. Learning to listen sounds
Why we love them…..
Where they stop…..
•  Sound Object association “proto-words”
–  Preliminary cognitive demonstration of a “word”
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION •  Not functional language
•  Artificially worked into therapy (not a lot of
cows in Los Angeles, London)
•  Children get stuck at that level if not moved
beyond quickly
•  Some clinicians won’t move beyond animal
and vehicle sounds until mastery
11 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Let’s make you think
Language skills
•  Analysis of a language milestone
“S carries the greatest morphemic
Pick a language structure
- What age does it develop / emerge?
- What auditory skill / speech feature?
- Where on the audiogram?
Let’s do one together!
Language Development Milestones
Language Skill
Age emergence/
acquisition
Auditory skills
needed /Speech
feature
Frequency range
on audiogram
S morphemic
functions
PLURALS
burden in the English language” (Ling)
• Plurals
• Possessives
• Verbs: Present tense marker – he walks
• Possessive pronouns – hers, his, yours
Diagnostic Therapy
•  Look for diagnostic clues in every part of
speech and every sentence of meaningful
spoken language
•  Speech sampling in ongoing diagnostic
therapy
Speech Pa)erns – low frequency Missing or distorted
speech patterns
Analysis by frequency bands
©RoIleisch ©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 12 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Speech Pa)erns – high frequency Speech Pa)erns – mid frequency ©RoIleisch ©RoIleisch Missing
or distorted speech patterns
by frequency range
From Dr. Ling
LOW
MID
HIGH
(250-500 Hz) RANGE
(1000-2000 Hz) RANGE
ABOVE 2000 Hz
•  Weak or breathy
voice
•  Falsetto voice
•  Poor Prosody
•  Nasalization or
Denasalization
•  Syllable deletion
•  Confusions of
nasals and
plosives
•  Confusion of
voiced and
unvoiced
consonants
•  Omission of
unstressed
morphemes
•  Neutralization
(centralization) of
vowels
•  Omission and/or
distortion of
fricatives.
•  Omission of final
consonants
•  Distortion or
substitution of stops
Morphemes
Classified by frequency bands
Morphemes – low frequency ©RoIleisch ©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION Morphemes – mid frequency ©RoIleisch 13 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Morphemes
classified by frequency range
Morphemes – high frequency LOW
MID
HIGH
(250-500 Hz) RANGE
(1000-2000 Hz) RANGE
ABOVE 2000 Hz
•  Verbs -ing at
300 Hz
•  Irregular past
tense
•  Prepositions -
found all over whole
frequency range usually
unstressed
• 
• 
• 
• 
Articles
Conjunctions
Pronouns
Irregular past
tense
•  Prepositions
•  Verbs-/t/ past
tense “ed”
•  Verbs – [s]
marker
•  Irregular past
tense – vowels –
EAT vs. ate
•  S morphemic
functions
•  Prepositions
©RoIleisch ABC
Bergelson & Swingley (2011)
Three key areas in AVT:
•  AUDITION - Our knowledge of acoustics and
language to set appropriate goals
•  BABIES - Our ability to integrate this into a
family’s everyday life
AT 6-9 MONTHS, HUMAN
INFANTS KNOW THE
MEANINGS OF MANY
COMMON NOUNS
•  COMMUNICATION - Our ability to coach the
parents effectively to make this happen all day,
everyday at home.
Method
Historically it has been thought that
babies learn language first by
discriminating the sound structure of
language (consonants, vowels etc.) and
that learning words came later (9-15
months) when they were able to
understand others’ goals and intentions,
this study shows understanding in babies
aged 6-9 months by preferential looking
on words not targeted/worked on in a lab.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION •  6-9 month old infants were presented with
pictures of two contrasting objects, and parents
were asked to voice the target word at the end of
a sentence. ‘Look at the apple!’ Food related and
body part words were tested as they are thought
to be early developing words for young children.
•  They had different pictures of the same objects
and different pairings to control for the child just
fixating on certain pictures they ‘liked’ more.
•  Procedure allows analysis of the infants gaze
behaviors which indicates comprehension of the
spoken word - a modified “language guided
looking” or “looking-while-listening” technique
•  No training involved in the procedure.
14 Back to Basics: ABCs of AVT Conclusion
•  6-7 month old babies learn words
•  native language learning in the
second half of the first year is not
just focused on acquisition of
sound structures
Caskey, Stephens, Tucker & Vohr
(2011)
ADULT TALK IN THE NICU
WITH PRETERM INFANTS AND
DEVELOPMENTAL
OUTCOMES
Results
•  Infant vocalizations present at 32
weeks, with dramatic increase between
32 and 36 weeks
•  Infant exposure to language as a
proportion of time was small but
increased significantly
•  Significantly more conversational turns
per hour when parents were there
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION July 9, 2015 AG Bell LSL Symposium Key Learning
•  Daily experience allowed young infants to
learn ordinary words
•  Method controlled “normal language
demands” such as generalization
•  Suggests that this precocious language
learning helps to explain why infants with HL
getting CIs before 6 months do better than
those infants implanted just a few months
later when assessed at 2 years (Yoshinaga-Itano C, et al 1998)
Method
•  Sound environment of preterm infants in
the NICU
•  Method: Used LENA to record at 32 and
36 weeks postmenstrual age (up to 8
weeks premature)
•  counted and analyzed vocalizations
•  ‘conversational turn’ if there was less
than 5 seconds between adult and baby
or baby and adult vocalizations
Results
•  Infant exposure to parent language
was:
–  a significantly stronger predictor of
vocalizations at 32 weeks
–  a significantly stronger predictor of
conversational turns at 32-36 weeks than
language of other adults
15 Back to Basics: ABCs of AVT Results
•  Adult conversational words increased
significantly when a parent was visiting,
as did infant vocalizations at 32 weeks
(not at 36 weeks).
•  20% increase in turn taking for every
1000 adult words at 32 weeks
•  10% increase for every 1000 word at
36 weeks
Caskey, Stephens, Tucker & Vohr
(2014)
ADULT TALK IN THE NICU
WITH PRETERM INFANTS
AND DEVELOPMENTAL
OUTCOMES
Method
•  Adult word count per hour of 36
preterm babies in the NICU at 32 and
36 weeks was compared with
outcomes on the Bayley III Scales of
infant and toddler development at
ages 7 and 18 months.
•  Input for original study was recorded
using the LENA to make 16 hour
recordings to look at adult speech,
child vocalizations and background
noise.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION July 9, 2015 AG Bell LSL Symposium Key Learning
•  PARENTS MATTER!!
•  Infants vocalized significantly more in
the hour surrounding a feeding, and
adults took more conversational turns.
•  Caregiver ease / baby talk – keep
talking!
Follow-up Study
Follow-up from the Caskey et al. 2011
study to look at language and cognitive
outcomes of the babies to look for links
between adult talk on the NICU and
outcomes at 7 and 18 months.
Conclusion
•  Cumulative adult word count was
associated with higher cognitive
composite, receptive communication
and language composite scores at 7
months.
•  Cumulative adult word count was
associated with higher expressive
communication scores at 18 months
when adjusting for birth weight.
16 Back to Basics: ABCs of AVT Key Learning
•  Association between the number of words a
preterm child hears and their language
development at least over the first 18 months.
•  If other studies have shown that infants ‘hear’
few words from audio recordings, parents
need to know just how important their input
is.
•  Rationale for equipping parents to use ADLs
as a language opportunity!
July 9, 2015 AG Bell LSL Symposium Life is an
AV experience
•  Everything is a language and auditory
experience
•  Dangling carrot principle
•  Maximize situations – everything has a
potential learning experience.
•  Don’t just talk about teachable moments
Child’s Day
Child’s Day
•  Children learn when they are active
learners
•  Children learn when they are
interested
•  Everything we do has language
•  Children are wonderful and beautiful
•  If you play with a child - then it won't be a
drudgery, and they WILL learn
Parent’s Role
Application to the Day
•  NO guilt if doesn’t sit down at a “therapy” table
and “work”
•  Enough to do and worry about – parents are
always teachers
•  Language is more efficiently learned by
abundant exposure than by structured drill which
is not meaningful
•  If you use everything as a learning experience
then you'll always be teaching the child
•  If you teach through the course of everyday
things then you will get the repetition and
language you want to use
Activities of Daily Living
ADL
•  Everything we do has language
•  Part of daily living – take advantage
of them
•  Activities which are done repeatedly
–  Don’t know if ever could teach a child all that they
need to learn in language that way
•  Natural, linguistically real conversations
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 17 Back to Basics: ABCs of AVT Activities of Daily Living
ADL
•  You have to do them anyways!
•  Honest open meaningful everyday life
experiences and interactions –
communication not imitation
July 9, 2015 AG Bell LSL Symposium What do Children Learn in Routines?
From www.hanen.org
•  How their worlds are organized – e.g. after waking
up, they get dressed, brush their teeth and then have breakfast
•  The words that people say in relation to
each routines
•  Social roles - such as how to start a conversation (initiate) and how to
respond appropriately when the other person starts it
•  How to participate with others in a
conversation (even before a child can talk) as an equal conversational
partner
Math
of
ADL
E=mc2
E=mc2
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION E=mc2
English
equals
Milk
and
Cookies
Too!
18 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium ADL Formula
•  Activity (e.g. meals, snacks) A = 5
•  Number of days per year N = 365
•  Language repetition
R = 10
A x N x R
5 x 365 X 10 = 18,250
Our survey showed:
•  The majority of parents spend 1-2 hours
per day feeding their child.
•  60% of parents sing to their children
throughout the day.
•  75% of children are read to between 15
minutes and an hour per day.
Conclusion
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION What are
children doing
today?
What is the
child
doing today?
What does
the child
need
to learn?
19 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Find a way to
teach the
child…
Throughout
the day!
Play
Does communication
make a difference?
Christakis, Zimmerman & Garrison
(2007)
EFFECT OF BLOCK PLAY ON
LANGUAGE ACQUISITION
AND ATTENTION IN
TODDLERS
Method
•  2 sets of blocks were distributed to
parents
•  Along with a list of ideas for playing
with these blocks alongside their
children, to promote communication
and joint attention
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION • 
• 
• 
• 
• 
Illustrative ‘block play’ study
Randomized control trial
Middle and low income families
Children between 18 -30 months old
MacArthur Bates CDI was used to
assess language pre-and 6 months
post. Results
•  Significant increase in language
development of the families who used
blocks
20 Back to Basics: ABCs of AVT Key Learning
July 9, 2015 AG Bell LSL Symposium Bergelson & Swingley (2014)
•  2 possible reasons
–  resulted in more playtime evidenced by
diary and substituted for activities not
conducive to language learning
–  block play displaced TV time
EARLY WORD
COMPREHENSION IN
INFANTS:
REPLICATION AND
EXTENSION
Method
As a follow-up to the 2011 study, the
authors wanted to examine if babies
could show understanding of routine nonnoun phrases as young as 6-9 months.
Conclusion
•  6-9 month olds have robust
understanding of commonly occurring
nouns (even with video presentation)
•  Understanding of non-nouns was more
commonly seen at around 10 months of
age.
•  Non-linear nature of comprehension
development seen – fast acceleration in
words understood at 13-14 months.
•  Correlation between a child’s production
vocabulary and number of words
understood.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION •  Infants were presented with short videos
depicting common nouns and verb
phrases e.g. ball / juice and kiss / eat
•  Video was used to depict the verbs most
accurately, while it was checked they
could understand nouns from a video as
per the 2011 experiment – they could.
•  Infant gaze was measured.
Key Learning
•  Robust research demonstrating
understanding of familiar objects at 6 months.
•  Verb comprehension develops later, perhaps
because of the wider range of variations in
actions that belong to the same verb.
•  Comprehension vocabulary is linked to
production vocabulary – beware children
imitating words they don’t understand.
21 Back to Basics: ABCs of AVT Tincoff & Juscyzk (2012)
DO SIX-MONTH-OLDS LINK
SOUND PATTERNS OF
COMMON NOUNS TO NEW
EXEMPLARS?
Conclusion
•  No indication of abstract comprehension
in 6-9 month olds.
•  10-13 month olds looked significantly
above chance level
•  14-16 month olds showed consistently
high levels of understanding.
•  No link between parent report of
comprehension and expression of those
words and results found.
A Child
with hearing-impairment
A Child - first
Hearing-impaired second
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION July 9, 2015 AG Bell LSL Symposium Method
•  Infants were presented with videos of two
contrasting scenarios e.g. all gone vs. hi,
sleeping vs. wet. Parents spoke a single
sentence describing one of the scenarios
to their child.
•  Procedure allows analysis of the infants
gaze behaviors which indicates
comprehension of the spoken word - a
modified “language guided looking” or
“looking-while-listening” technique
•  No training involved in the procedure.
Key Learning
•  6-9 month olds do significantly better with concrete
than abstract words.
•  10-13 month olds do not show significant difference
between concrete and abstract word understanding.
•  No significant difference in frequency estimates for
concrete vs. abstract words, so must be due to word
type rather than level of exposure.
•  Abstract words were said more often when their
referent was not present (e.g. hi!) than concrete
words e.g. ‘banana!’ – role of vision in word learning
for very young babies.
Play is a
child’s
work
22 Back to Basics: ABCs of AVT Play
•  Guaranteed learning experience
•  Children learn when they are actively
involved and interested
•  Not a drudgery
July 9, 2015 AG Bell LSL Symposium Percent
It’s their daily experience
Time spent ‘just playing’
45
40
35
30
25
20
15
10
5
0
0-1 hours
Conversation = thoughts + language
Play is about conversations to:
•  Share stories
•  Share ideas
•  Retell events
•  Solve problems
•  Negotiate with others
Play should stimulate conversation, not just be
commenting and naming
Playfulness in babies 6-12 months
•  Babies are reaching, grasping, holding, beginning
to let go, dropping, handing things back and forth
•  Love repetition as ‘cause and effect’ begins to
emerge
•  Lots of exploratory play, poking, shaking,
touching, mouthing
•  Love anticipatory games e.g. peep bo, build and
bash
•  Hunt for a lost object
•  Beginning to understand the function of objects
1-2 hours
2-3 hours
3 hours +
Playfulness in babies 0-6 months
•  Face to face play, imitating faces
•  Lots of tactile play with parent, using body
as a play thing
•  Lots of looking together and talking about
things - carrying to the window and
showing and talking
•  Lots of showing them things - especially as
child learns to grasp, 5-6 months
Emergence and development of
symbolic play
“Showing a familiar object to new adult, or a new object to a familiar
adult appeared in itself to be one of the basic forms of
communication for very young children.
(…) Most adults are
responsive to these physical gestures, which are easily
interpreted as sharing. The adults predictably respond with some
type of recognition by looking, smiling, reaching and often by
saying Thank you or Isn’t that pretty? Thus, not only does the
object serve as a vehicle for communication, but sharing objects
is one of the first events in which verbal communication becomes
closely linked to a specific action performed by a child in a social
situation”
From Play by Catherine Garvey, Fontana/Open Books, 1977.
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 23 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium 12 months
9 months
Language
Pretend Play
•  Most vocalizations are •  Quasi-symbolic
pre-verbal. There is no
gestures where the
consistent vocal
function of the object
pattern used to
is ‘represented’ in the
specify the referent
action (e.g. picking up
a pea from a book)
•  Caregiver attributes
intent
12-18 months
Language
•  More single words
emerge
Pretend Play
•  Pretend play becomes
more de-centred and
differentiated from
the self. They begin to
pretend on other
people and toys e.g.
they pretend to feed
mother or a doll and
they pretend at actions
they do not do in real
life e.g. drive a car,
sweep up.
24-30 months
Language
•  Simple sentences and
early grammatical
structures appear
Pretend Play
•  Play sequences become
more complex with
evidence of advanced
planning and increased
symbolization in object
substitutions
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION Language
•  First conventional word
typically appears
Pretend Play
•  First truly playful
gestures appear e.g.
pick up a cup, make
drinking noise, smile at
mother, carry on
drinking. It is obvious
from the affect and
expression that they
are pretending. The
behaviour is clearly
differentiated from a
request for a real
drink.
18-24 months
Language
•  Emergence of two word
stage
Pretend Play
•  Beginning of simple
sequence in pretend
play e.g. in play with
tea set and dolls, may
pour tea, stir tea, drink
Getting the play level right
in our sessions…
This is normal development, children with
hearing loss often have delayed play
(see Richardson & Honck 2014 presentation)
We need to know the levels so that we can work
developmentally.
Play at the right level stimulates conversation
24 Back to Basics: ABCs of AVT ABC
Three key areas in AVT:
•  AUDITION - Our knowledge of acoustics and
language to set appropriate goals
•  BABIES - Our ability to integrate this into a
family’s everyday life
•  COMMUNICATION - Our ability to coach the
parents effectively to make this happen all day,
everyday at home.
July 9, 2015 AG Bell LSL Symposium Principles of LSLS Auditory-Verbal Therapy
(LSLS Cert. AVT™) 1.  Promote early diagnosis of hearing loss in newborns,
infants, toddlers, and young children, followed by immediate
audiologic management and Auditory-Verbal therapy.
2.  Recommend immediate assessment and use of
appropriate, state-of-the-art hearing technology to obtain
maximum benefits of auditory stimulation.
3.  Guide and coach parents to help their child use hearing as
the primary sensory modality in developing listening and
spoken language.
4.  Guide and coach parents to become the primary facilitators
of their child's listening and spoken language development
through active consistent participation in individualized
Auditory-Verbal therapy.
5.  Guide and coach parents to create environments that
support listening for the acquisition of spoken language
throughout the child's daily activities.
Principles of LSLS Auditory-Verbal Therapy
Principles of LSLS Auditory-Verbal Therapy
(LSLS Cert. AVT™) (LSLS Cert. AVT™) 6.
7.
8.
9.
10.
Guide and coach parents to help their child integrate
listening and spoken language into all aspects of the
child's life.
Guide and coach parents to use natural developmental
patterns of audition, speech, language, cognition, and
communication.
Guide and coach parents to help their child self-monitor
spoken language through listening.
Administer ongoing formal and informal diagnostic
assessments to develop individualized Auditory-Verbal
treatment plans, to monitor progress and to evaluate the
effectiveness of the plans for the child and family.
Promote education in regular schools with peers who
have typical hearing and with appropriate services from
early childhood onwards.
Coaching parents
Why?
•  Parents have 4000 hours with their child each
year!
•  Children learn to understand their mother’s
voice quickest – (Bergelson & Swingley 2014) –
children didn’t show recognition responses for
common objects when it was not their mother’s
voice.
•  6 of the 10 AVT principles include the phrase
‘guide and coach parents’’
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 6 of them are
GUIDE AND COACH
the parent (primary caregiver)
Caskey, Stephens, Tucker & Vohr
(2014)
ADULT TALK IN THE NICU
WITH PRETERM INFANTS
AND DEVELOPMENTAL
OUTCOMES
25 Back to Basics: ABCs of AVT Key Learning
•  Association between the number of words a
preterm child hears and their language
development at least over the first 18 months.
•  If other studies have shown that infants ‘hear’
few words from audio recordings, parents
need to know just how important their input
is.
•  Rationale for equipping parents to use ADLs
as a language opportunity!
July 9, 2015 AG Bell LSL Symposium The challenge
•  We are constantly improving our practice with
young children as the technology changes
and research further informs us. Are we
seeking out the same information about
parents?
•  What about those families that don’t seem to
‘get it’?
•  Research into ‘adult learning’ and ‘team
working’ in a range of sectors has transformed
our ways of working with parents in the UK.
Key themes in
adult learning
Learning about
learning and
brain training
from the worlds
of sport and
medicine.
Key themes in
adult learning
1. 10,000 hours of practice makes an expert
(Ericsson 1991)
2. The practice needs to be purposeful
3. Praise the process, not the outcome
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 1. 10,000 hours of practice makes an expert
(Ericsson 1991)
2. The practice needs to be purposeful
3. Praise the process, not the outcome
Ericsson 1991
TOWARD A GENERAL
THEORY OF EXPERTISE
26 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Ericsson
10,000 Hours of Practice
Creates Experts
Ericsson 1991
Ericsson used violinists to examine the
factors that separated someone who
was ‘expert’ from others.
Brain research (Fields, 2005) shows
relationship between degree of myelination
and hours practised in concert pianists.
Method
Conclusion
•  Divided violinists into groups according
to their reported skill by their tutors and
independent examiners: outstanding
(would go on to be international
soloists), extremely good (would play
in world’s top orchestras) and the least
able group (who would still go on to be
excellent music teachers and have a
career in music).
•  Examined a range of factors in their
histories to look for commonalities.
•  Large commonality in biographical
histories – started playing at similar
ages, similar number of teachers and
instruments played…but one significant
difference.
•  By the age of 20, the expert group had
spent 10,000 hours practising. The
middle group an average of 8000 and
the lowest of 6000. There was a
significant different between groups.
Key Learning
•  Practise matters! (for both parent and child)
•  We need to motivate parents to want to
practise and to know ‘what it is going to take’
to hone their skills and their child’s.
•  Consider cultural attitudes:
Parent on cultural
differences
–  “Is being expected to teach your child something
that is typical in your culture?”
–  This is what it’s going to take…
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 27 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Key themes in
adult learning
1. 10,000 hours of practice makes an expert
(Ericsson 1991)
2. The practice needs to be purposeful
3. Praise the process, not the outcome
2. Practise needs to be purposeful
•  Learning from medical students and
surgeons.
•  Concentrated expertise
APPLICATION Equip parents to practise
purposefully: How many times a day do you
think you could…..
Key themes in
adult learning
1. 10,000 hours of practice makes an expert
(Ericsson 1991)
2. The practice needs to be purposeful
3. Praise the process, not the outcome
Praise the process, not the outcome
•  Mueller & Dweck (1998) praised students for the outcome
‘You’re so clever’ vs. hard work ‘you worked really hard at
that.’ Results were similar but after being given an
impossible test, they were given the first test again. Those
praised for effort did 30% better than previous test, those
praised for outcome did 20% worse.
•  Praising in a specific, but appropriate way:
‘I love how you…..’
‘did you notice how they way you….meant that he really….?’
‘ I can see how hard you’re working to integrate that goal into
everything you’re doing!’
All parents need these messages, but,
how do we deliver them in a way that
matches their learning styles?
Insights Colour Theory
Fisher 2013
First, we need to know our own!
Discuss:
•  How do you learn?
•  How do you like to receive feedback?
•  What do you do if you make a mistake?
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 28 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium What is your profile:
on a good day…
What is your profile:
on a bad day…
COOL BLUE
•  Cautious
•  Precise
•  Deliberate
•  Questioning
•  Formal
FIERY RED
•  Competitive
•  Demanding
•  Determined
•  Strong willed
•  Purposeful
COOL BLUE
•  Stuffy
•  Indecisive
•  Suspicious
•  Cold
•  Reserved
FIERY RED
•  Aggressive
•  Controlling
•  Driving
•  Overbearing
•  Intolerant
EARTH GREEN
•  Caring
•  Encouraging
•  Sharing
•  Patient
•  Relaxed
SUNSHINE YELLOW
•  Sociable
•  Dynamic
•  Demonstrative
•  Enthusiastic
•  Persuasive
EARTH GREEN
•  Docile
•  Bland
•  Plodding
•  Reliant
•  Stubborn
SUNSHINE YELLOW
•  Excitable
•  Frantic
•  Indiscreet
•  Flamboyant
•  Hasty
How to share
information/coach:
How do you like to
receive your feedback:
COOL BLUE
•  In writing
•  Time to reflect
•  Precise & evidence based
•  Consistency of information
EARTH GREEN
•  Sincere, supportive
environment
•  Values honesty
•  Be gentle!
•  Focus on the emotions
FIERY RED
•  Stick to highlights
•  Focus on facts, not
emotions
•  Likes to be in charge
SUNSHINE YELLOW
•  Compliment and praise
them
•  Focus on positives
•  Be demonstrative and
enthusiastic!
COOL BLUE
FIERY RED
•  Task focused & relevant info
•  Thorough & well structured
information
•  Likes well prepared delivery
•  Likes things in writing
•  Direct, to the point info
•  Brief and precise
•  Results focused, outcome
driven
•  Stick to highlights
EARTH GREEN
•  Patient, supportive
environment
•  Allow time
•  Likes to be asked for their
opinion
•  Wants to know you care
SUNSHINE YELLOW
•  Values friendly, sociable
delivery
•  Two way discussion
•  Likes to be entertained
•  Fast paced
Benton, van Erkom Schurink &
Desson (2008)
Insights Discover Evaluator
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION Researchers at the University of Westminster
(London) and Insights Discovery UK tested the
validity of a psychometric evaluator, that AVUK
has found helpful in examining our team
working with parents. Psychometric science
attempts to impose objectivity on the measure
of human performance and aspects of
personality, any psychometric tests must meet
demonstrable criteria in order to be an
objective measure.
29 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Method
•  Aimed to measure and analyze key
psychometric statistics to ascertain the
accuracy of the Insights Discover
Evaluator as a psychometric tool.
Including:
–  Validity
–  Reliability
–  Normative data
Key Learning
•  Psychometric tools can be reliable ways of
analysing personality preferences and
learning styles.
•  We therefore have an evidence based way
of analysing the learning styles of our
parents to best meet their needs and coach
them effectively.
Ways we can match
learning styles
Conclusion
•  Strong evidence of the model’s reliability
was found.
•  The model has good predictive validity
•  The results compare favourable with
other (Jungian) based instruments
•  “In summary we have strong evidence to
support the four colour measures
calculated from Insights Discovery model
as being both reliable and valid.”
The
Disclaimers….
We are not trying to:
box people
judge them
We are trying to:
understand how people like to receive
information and match that as best we can,
knowing how we most like to give information!
Ways we can match
learning styles
•  Live coaching within the session – do they need
the excitement of being involved (yellow) or time
to reflect and analyze? (blue)
•  Communicating with families via email – short and
to the point (red), full of emoticons (yellow),
specific details (blue) or lots of niceties(green)?
•  Take home messages – do we keep them direct
and brief (red) or do we add extra information
about how things felt (green)?
•  What about goals?
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 30 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Key take
home messages
•  We can work on our ‘diagnostic’ skills with parents
learning styles as much as we do with their children!
•  Work out their style and have strategies to match it.
•  Check in – ‘how does this feel for you?’ (green) vs.
‘Is this working for you?’ (red!)
AUDITION
•  Hearing first, last and always
–  Goals should always start from hearing.
–  Go back to hearing to figure out where you are
going, where you are stuck, where you have been
successful.
Back to Basics
ABCs
AVT
BABIES
•  What are they doing everyday….anyways?
• ADL – Activities of Daily Living
• Play - Play is children’s work
COMMUNICATION
COMMUNICATION
•  We can work on our ‘diagnostic’ skills with
parents learning styles as much as we do
with their children!
•  Work out their style and have strategies to
match it.
•  Check in – ‘how does this feel for
you?’ (green) vs. ‘Is this working for
you?’ (red!)
•  Honest, open, interactive
•  Meet the parent and the child where they are
•  Communication not imitation, linguistically
true
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 31 Back to Basics: ABCs of AVT July 9, 2015 AG Bell LSL Symposium Language Development Milestones
birth – 12 months
Language Development Milestones
birth – 12 months
Language Skill
Age emergence/
acquisition
Auditory skills
needed /Speech
feature
Frequency range
on audiogram
Language Skill
learning sounds are
meaningful
at and from birth
vocalizations
learning to
6-7 months old understand first words
recognizes name
4.5 months
LOW
fundamental freq
750 Hz
LOW
various speech
features across the
audiogram
LOW
various speech
features across the
audiogram
learning to understand 6-7 month old
first words
nonsegmentals,
vowels, consonants
nonsegmentals,
vowels, consonants
Language Development Milestones
12 - 24 months
Language Skill
Age emergence/
acquisition
Present progressive – 19-28 m ing Auditory skills
needed /Speech
feature
nasal murmur Age emergence/
acquisition
often – mama, dada/papa,
bottle, more playing with sounds/
babbling stages Auditory skills
needed /Speech
feature
nonsegmentals,
vowels, consonants
Vowels, manner 3-11 months understanding simple
requests, commands, 7-12 months language of routine LOW
various speech
features across the
audiogram
MID
vowels/ consonants detection 1000 Hz MID
nonsegmentals 1000 Hz Language Development Milestones
24 - 36 months
Frequency range
on audiogram
Language Skill
Age emergence/
acquisition
LOW
300 Hz prepositions – in, on 27-33 m Auditory skills
needed /Speech
feature
nasal murmur regular plural –s
27-33 m
S/ Z
irregular past tense 25-46 m vowels regular past -ed 26-48 m manner
place cue
REFERENCES
Frequency range
on audiogram
Frequency range
on audiogram
LOW
300 Hz HIGH frequency
4000-8000 Hz
HIGH frequency
3000 Hz for
discrimination HIGH frequency
1500-4000 Hz REFERENCES
Benton, S., van Ekrom Schurink, C., & Desson, S. (2008) An overview of the development, validity and
reliability of the English version 3.0 of the Insights Discovery Evaluator. University of Westminster
Business Psychology Centre, London, UK.
Courage, M., Murphy, A., Goulding, S., & Setliff, A. (2010). When the television is on: The impact of
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©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION Ericsson, KA & Smith, J. (1991) Toward a general theory of expertise. Prospects and Limits.
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Mueller, C.M & Dweck, C.S. (1998) Praise for intelligence can undermine children's motivation and
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Photo Credits
Photo Credits
www.e-z.net/~iswizard/christianfamilywebsite
Images/page11_b.jpg
www.madison.com/articleimage/231937pets.jpg
homepage.mac.com
www.homeharvest.com/ orgfert.htm
www.bbc.co.uk/health/images/200/child_walking.jpg
www.goerie.com/family/MKT-f-fish.jpg
www.emergencyseatbeltcutr.com
ww
w.cs.berkeley.edu/~mikechen/photos/family/DSCN1371-jefferychasing-birds.jpg
www.eaglevisionservices.com
www.svcn.com/archives/campbellreporter
www.childcarecenter.ilstu.edu
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www.ono-ken.co.jp/index/index_portrait/child-dog.jpg
www.placer.ca.gov/
www.crocus.co.uk/
www.sacdhhs.com
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www.americaslibrary.gov
www.elainebankston.com
www.cornerstonebaptistchurch.org
www.health.state.mn.us
www.child.com/images/
www.indexstock.com/store/GetThumb.asp
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www.churchextension.org/images/s_02.jpg
graphics.iparenting.com/
www.e-z.net/~iswizard/christianfamilywebsite
www-1.ibm.com/industries/retail/global/images/fsiintell.jpg
Drawing credits
www.bananasinc.org/ providerLinks.php
www.robynsnest.com/images/boymischief.gif
www.rangerdj.com
www.edu.idtv.tv/week1.htm
©Richardson-­‐Quayle & RoIleisch DO NOT DUPLICATE WITHOUT PERMISSION 33