Session 20 Handout - New Jersey Speech-Language

Learner Outcomes
From Detection to Comprehension:
Targeting Auditory Skills Development With
Children Who Have Cochlear Implants
List the steps of an auditory skills hierarchy
Define detection, discrimination, identification,
auditory memory, comprehension, background noise,
and signal-to-noise ratio as each applies to auditory
skills development
Discuss appropriate activities for targeting certain
auditory skills along the hierarchy
Amy Lynn Birath, AuD, CCC-A/SLP, LSLS Cert. AVEd
Board Certified in Audiology
THE MOOG CENTER FOR DEAF EDUCATION
ST. LOUIS, MO
Types Of Hearing Loss
How We Hear / Types Of Hearing Loss
Sensorineural (problem with inner ear or higher)
– Abnormal Air Conduction results AND Abnormal Bone
Conduction results which essentially are overlaid (no air/bone gap)
X
X
Conductive
Sensorineural
Mixed
Conductive (problem with outer and/or middle ear)
– Normal Bone Conduction results with Abnormal Air Conduction
results with a ≥15 dB difference between the two
(air/bone gap ≥15 dB)
Mixed (problem with outer/middle AND inner ear/higher)
Graphic from Cochlear Americas Ltd.
– Abnormal Bone Conduction results AND Abnormal Air
Conduction results with ≥15 dB difference between the two
(air/bone gap ≥15 dB )
Understanding An Audiogram
Degrees Of Hearing Loss
Unaided Thresholds
Aided Detection
≤15 dB Normal Hearing
16-25 dB Slight Hearing Loss
26-40 dB Mild Hearing Loss
41-55 dB Moderate Hearing Loss
56-70 dB Moderately-Severe Hearing Loss
71-90 dB Severe Hearing Loss
>90 dB Profound Hearing Loss
Clark, J.G. (1981). Uses and abuses
of hearing loss classification. ASHA,
23(7), 493-500.
Goodman, A. (1965). Reference zero
levels for pure-tone audiometers.
Asha, 7, 262–263.
AC
Unmasked
Right
Left
O
X
AC
Masked
BC
Unmasked
<
>
BC
Masked
[
]
Soundfield
S
S
Right
Left
Aided
AR
AL
Both
AB
CI
Aided
CI R
CI L
CI B
No
Response
1
Listening With A Cochlear Implant
How A Cochlear Implant Works
CI
CI
ox
ox
o
x
ox
CI
CI
CI
CI
CI
CI
ox
xo
Graphic from Cochlear Americas Ltd.
Why Does Noise Matter?
Background noise interferes with important acoustic information
Classroom noise has been proven to adversely affect:
–
–
–
–
Academic Performance – reading and spelling
Concentration
Attention
Behavior
Nelson, P. B. (2000). Improving acoustics in american schools. Language, Speech, and
Hearing Services in Schools 31, 354-355.
Nelson, P. B., and Soli, S. (2000). Acoustical Barriers to learning: Children at risk in every
classroom. Language, Speech, and Hearing Services in Schools 31, 356-361.
What Can We Do To Help?
Install curtains and carpeting, and hang acoustic tiles
Keep windows and doors closed
Arrange furniture to reduce the distance between
students and teacher
Place Flexi-Felt, ChairHuggers, or tennis balls on the
feet of desks and chairs
Place “sound barriers” between the students and
computers and/or other noise producing items in
the classroom
Replace noisy instructional equipment with more
quiet versions or move it to non-instructional rooms
Signal-to-Noise Ratio (SNR) &
Speaker-to-Listener Distance (SLD)
How loud the signal is relative to the noise
How far the student is from the signal (Inverse Square Law)
Crandell, C. & Smaldino, J. (2000). Classroom acoustics for children with normal hearing and
with hearing impairment. Language, Speech, and Hearing Services in Schools, 31(4), 362-370.
What Else Can We Do?
Ensure adequate lighting, which is not in the child’s eyes
Have the child face the important signal(s)
Do not obstruct the view of your mouth/face
Make sure you have the child’s attention before asking a
question or giving an instruction
Use the “noise” program on the child’s device(s)
Utilize FM/DM Systems
2
FM/DM Systems
Provide a better signal-to-noise ratio when classroom
acoustics are poor
Designed to help overcome
FM/DM Systems
Types:
– Personal:
~ +15 to +20dB SNR
– Soundfield: ~ +10dB SNR
Components:
– Noise
– Distance
– Reverberation
– Transmitter – worn by primary speaker
– Receiver – worn by child
Should be fitted by an Audiologist
Targeting Auditory Skills
Develops the child’s auditory brain
Improves listening skills in a variety of
contexts and environments
Allows for easier development of speech
and spoken language
Impacts phonemic awareness, early literacy,
and reading
Developing And Tracking Auditory Skills
– Tracking Auditory Progress in Children with CIs and
Identifying Red Flags (Amy M Robbins)
– Auditory Learning Guide (Beth Walker)
– Preschool
• ABEL, CHILD, COW, LittlEars, MAIS, PEACH, TEACH, Preschool SIFTER
– School-age
• ABEL, CHILD, COW, LIFE, MAIS, PEACH, TEACH, SIFTER
Diagnostic therapy
Auditory Skills Hierarchy
Detection
Discrimination
– Determining if two sounds are the same or different
(Pattern Perception)
– Differentiating between two or more sounds based on their patterns
Curricula
SPICE and SPICE for LIFE
CASLLS (Sunshine Cottage)
AuSpLan (McClatchie & Terres)
SKI-HI (SKI-HI Institute)
Speech perception testing completed by Audiologist
Auditory skills questionnaires completed by therapist/teacher,
parent, and/or child
– Knowing that a sound is present
Guides
–
–
–
–
Assessing Auditory Skills
(Moog & Biedenstein) (West & Manley)
Identification (Recognition)
– Labeling what has been heard
Comprehension
– Understanding spoken language and responding appropriately
Adapted from Erber, N. (1982). Auditory Training. Washington DC: AG Bell Publications.
3
Other Auditory Skills
Auditory Memory
– The ability to hear and remember what has been said
• Digit Span
• Word Span (related and unrelated)
Comprehension in Background Noise
Localization
Telephone & Electronic Media Skills
Gender & Emotion Identification/Comprehension
Music Appreciation
Detection:
Knowing a sound is present
– Does not have to know what made the sound or
what the sound means
– Where we start
– Must be able to detect before anything else
Tips
Make sure the child’s CI(s) is/are on and working properly before
beginning therapy and/or assessment
ALWAYS do therapy activities auditory-visually BEFORE doing
them auditory-only
When a child has reached a certain skill level using BOTH CIs,
check to see how he/she does with EACH DEVICE
INDIVIDUALLY….one ear may be out performing the other and
need some special attention, specifically on identification tasks
Keep in close COMMUNICATION with the child’s
Audiologist so that you how the child is performing
audiologically, and so that you can let her know your questions
and concerns
Discrimination:
Determining if two sounds are the same or different
This typically is not a targeted skill;
however, it is a tool used to help compare
sounds for assessment/intervention
Task
– Response to environmental sounds, repeated
syllables and/or Ling sounds (m, oo, ah, ee, sh, s)
– Responses could be looking up, vocalizing, doing
something with a toy, raising a hand
Before a child can identify sounds as
whatever they are, the child has to be able to
hear different sounds, even though he may
not yet know what “different” means
Pattern Perception:
Identification (Recognition):
Differentiating two or more sounds based on their patterns
Labeling what has been heard
– Beginning of interpreting prosody (suprasegmentals)
– Typically can tell the difference between sounds that are short vs. long
and words that are one syllable vs. multisyllabic before they know the
sounds or the words
– This may not be a skill that is specifically targeted
Task
– Choosing a picture or object based on the pattern of the
presented auditory stimulus – sound(s) or word(s)
– Next big focus after Detection
– Can be in the form of direct modeling and
imitation or selecting from a group of choices
– Needs some speech sound and/or language base
– Provides information about which specific
sounds a child can hear
Task
– Repeating or choosing a picture or object based
on the sound or word(s) presented
4
Auditory Memory:
Identification Hierarchy
Ling 6 Sounds
Spondees
Monosyllables differing in vowels and consonants
Monosyllables differing in vowels only
Monosyllables differing in consonants only
Rhyming words
– With varied initial consonants
– With minimal contrasts
Remembering what has been said
– Take in information, process it, store it, and recall it
• Short-term Memory
• Working Memory
– Essential for academic success
– Connected to speech and language outcomes
Task
– Digit Span – indicating or repeating a series of numbers
– Word Span – indicating or repeating a series of words
Comprehension:
Understanding spoken language and responding appropriately
– Involves hearing acuity, auditory memory, and language
– This is the ULTIMATE goal
Task
– Repeating sentences, answering questions, following directions,
solving riddles, participating in any level-appropriate language
activity, conversing
– When the child demonstrates the ability to do these tasks
in quiet, practice in NOISE can occur
Comprehension Tasks
Repeating Sentences With A Picture Context
Repeating Sentences Without Context
Answering Questions About A Picture
Following Directions
Solving Riddles
Answering Questions About A Story
The Noise
Targeting Comprehension In Noise
Multi-talker babble
– Auditec.com
Resembles more typical listening situations
Simulated Classroom Noise
– UT Dallas, Erin Schafer and Linda Thibodeau
Helps CI users learn to listen for important information and
seek out the primary speaker
http://www.utdallas.edu/~thib/EARRINGFINAL/AudioDemos/Class_Noise.wav
Restaurant Noise
– Coiffitivity (app)
Improves CI users speech perception in noise
Oba SI, Fu Q-J, Galvin JJ 3rd. Digit training in noise can improve cochlear
implant users’ speech understanding in noise. Ear Hear. 2011;32(5):573–81.
Introducing the noise
– +5 to +10 SNR
– Noise should come from behind the child
5
From Detection to Comprehension:
Targeting Auditory Skills Development With Children Who Have Cochlear Implants
Amy Lynn Birath, AuD, CCC-A/SLP, LSLS Cert. AVEd
Detection and/or Identification
• AB Clix by Advanced Bionics, LLC (app)
• AB Listening Adventures by Advanced Bionics, LLC (app)
• Animal Sounds by Alligator Apps (app)
• Auditory Verbal Ling Sounds by Mellisa Essenburg (app)
• I Hear Ewe by Claireware Software (app)
• I Hear That by Kenneth Whittaker (app)
• Ling 6 Sound Application by Eric Seneca (app)
• Listening Lotto Outside Sounds by Key Education (game)
• Listen Up Bear by Troll in a Bowl (app)
• Listening Lotto Sounds at Home by Key Education (game)
• Little Ears by Mobiler (app)
• Little Finder by Alligator Apps (app)
Auditory Memory
• Auditory Processing Activities by JoAnn and Roger Jeffries (book)
• Curious George Banana 411 by PBS Kids (website)
o http://pbskids.org/curiousgeorge/games/banana_411/banana_411.html
• Hear Coach by Starkey (app)
• Super Duper® Look Who’s Listening® (game)
• Super Duper® Fun Decks® Serial Recall (card set)
• Webber® Hear Builder® Auditory Memory by Mark Strait and Susie Loraine (software)
Imitating Sentences with a Picture Context/ Answering Questions with a Picture Context
• Create a Scene by Smethport (magnetic board)
o -Beach Playset
o -Construction Site Playset
o -Dollhouse Playset
• Make a Scene by Innivo Ltd. (app)
o Farmyard
o Pets
o Easter
o Christmas
• My PlayHome by Shimon Young (app)
• My Scene by MyFirstApp.com (app)
• Outdoor Fun by Virtual Speech Center (app)
• Richard Scarry books
o -Cars and Trucks and Things That Go
o -A Day at the Airport
o -A Day at the Fire Station
• SPARC Artic Scenes by Susan Rose Simms (book)
• SPARC for Vocabulary by Susan Thomsen and Kathy Donnelly (book)
• Toddlers Seek and Find, by Wonderkind Apps (app)
o My Animals
o My Little Town
o My Animal Circus
• Usborne books by Heather Amery and Stephen Cartwright
o The Usborne Book of Everyday Words
o Usborne First Hundred Words
o Usborne First Thousand Words
Following Directions
• Cranium Hullabaloo by Cranium (game)
• Following Auditory Directions by Jean Gilliam DeGaetano (book)
• Following Auditory Directions CD by Josef Sanders (CD)
• Following Directions Get Ready! Book by Barbara Gregorich (book)
• Following Directions K-2 by Frank Schaffer (book)
• Fun with Directions by Hamaguchi apps (app)
• Listening Skills for Young Children by Trish Novels (book)
• More Fun with Directions by Hamaguchi apps (app)
• Super Duper® Fun Deck® Following Directions (card set & app)
• Webber® Hear Builder® Following Directions by Susie Loraine and Mark Strait (software)
Imitating Sentences Without Context
• Auditory Processing Activities by JoAnn and Roger Jeffries (book)
• Super Duper® Fun Deck® Listening for Absurdities (card set & app)
Riddles
• Super Duper® Fun Deck® Auditory Memory for Riddles (card set)
• What’s In the bag? by all4mychild (app)
• Who Am I? by ©Nth Fusion LLC (app)
Stories With Illustration
• Comprehending More Complex Auditory Information by Jean Gilliam DeGaetano (book)
• LEAP-P (Language Exercises for Auditory Processing Preschool Edition) by Larry Mattes and Patty Schuchardt
(book)
• Listening, Understanding, Remembering, Verbalizing! by Jean Gilliam DeGaetano (book)
• Super Duper® Auditory Memory for Quick Stories™ (software)
• Super Duper® Fun Decks®
-Auditory Memory for Short Stories (card set)
-Auditory Memory for Details and Sentences (card set)
-Auditory Memory for Social Studies Stories (card set)
-Auditory Memory for Science Stories (card set)
• Super Duper® Leap into Listening! (book)
• Super Duper®122 Fold and Say® Auditory & Story Comprehension (book)
Stories Without Illustrations
• LEAP-P (Language Exercises for Auditory Processing Preschool Edition) by Larry Mattes and Patty Schuchardt
(book)
• Super Duper® Fun Decks®
-Auditory Memory for Short Stories (card set)
-Auditory Memory for Details and Sentences (card set)
-Auditory Memory for Social Studies Stories (card set)
-Auditory Memory for Science Stories (card set)
• Super Duper® Look Who’s Listening® (game)
Cochlear Implant Companies Auditory Rehabilitation Resources
• Advanced Bionics
o http://thelisteningroom.com/
o www.bionicear.com/TFS
• Cochlear Americas
o http://hope.cochlearamericas.com/
• Med-El
o http://www.medel.com/us/soundscape/
o http://www.medel.com/us/rehabilitation/
Auditory Skills Questionnaires
ABEL: Auditory Behavior in Everyday Life
Age range: 2-12 years
Purpose: Twenty-four item questionnaire with three subscales (Aural-Oral, Auditory Awareness,
Social/Conversational skills) which evaluates auditory behavior in everyday life.
Reference: Purdy, S., et al. 2002. ABEL: Auditory Behavior in Everyday Life, American Journal of
Audiology, 11:72-82.
CHILD: Children’s Home Inventory for Listening Difficulties
Age range: 3-12 years. (Recommended for children 7-12).
Purpose: Questionnaire for the child and for the parent with 15 situations which rate how well the child
understood speech.
Reference: Anderson K.L, Smaldino J.J. (2000). Children’s Home Inventory for Listening Difficulties
(CHILD). www.hear2learn.com.
COW: Children’s Outcome Worksheets
Age range: 4-12 years
Purpose: Three worksheets (child, parent, and teacher) are requested to specify 5 situations where
improved hearing is desired.
Reference: Williams, C. (2003) The Children’s Outcome Worksheets - an Outcome measure focusing on
children’s needs (Ages 4-12). News from Oticon, January 2005.
www.oticon.com.
LIFE: Listening Inventory for Education
Age range: 6 years and up.
Purpose: Questionnaire which identifies classroom situations which are challenging for the child. There
are two formats of the questionnaire: a teacher questionnaire with 16 items and a child questionnaire with
15 items.
Reference: Anderson K.L., Smaldino, J.J. (1996). Listening Inventory for Education; An efficacy tool
(LIFE). www.hear2learn.com.
LittlEars
Age range: 0 years and up
Purpose: Questionnaire for the parent with 35 age-dependent questions that assesses auditory
development.
Reference: Kühn-Inacker, H., Weichbold, V., Tsiakpini, L. Coninx, S., D’Haese, P. (2003). Little Ears:
Auditory Questionnaire. Innsbruck, MED-EL
MAIS: Meaningful Auditory Integration Scale
Age range: 3 to 4 years and up.
Purpose: Parental interview with ten questions that evaluates meaningful use of sound in everyday
situations (attachment with hearing instrument, ability to alert to sound, ability to attach meaning to
sound).
Reference: Robbins, A.M. Renshaw, J.J., & Berry, S.W. (1991). Evaluating meaningful integration in
profoundly hearing impaired children. American Journal of Otolaryngology, 12 (Suppl): 144-150.
Robbins, A.M. Renshaw, J.J., & Berry, S.W. (1998). Meaningful auditory integration scale.
In W. Estabrooks (Ed.), Cochlear implants for kids. (373-386) Washington DC,
AG Bell Assoc. for the Deaf, Inc.
PEACH: Parents’ Evaluation of Aural/oral performance of Children
Age range: Preschool to 7 years
Purpose: Interview with parent with 15 questions targeting the child’s everyday environment.
Includes scoring for 5 subscales (Use, Quiet, Noise, Telephone, Environment)
Reference: Ching, T.C., Hill, M., & Psarros, C. (2000). Strategies for evaluation of hearing aid fitting for
children. Paper presented at the International Hearing Aid Research Conference, August 23, Lake Tahoe,
USA. (www.nal.gov.au)
Preschool SIFTER: Preschool Screening Instrument For Targeting Educational Risk
Age range: 3 to 6 years
Purpose: Questionnaire with 15 items completed by the teacher which identifies children at risk for
educational failure with five subscales (academics, attention, communication, participation, behavior).
Reference: Anderson, K.L., & Matkin, N. (1996). Screening Instrument for Targeting Educational Risk in
Preschool Children (Age 3-Kindergarten) (Preschool SIFTER).
www.hear2learn.com.
SIFTER: Screening Instrument For Targeting Educational Risk
Age range: 6 years and above.
Purpose: Questionnaire with 15 items completed by the teacher which identifies children at risk for
educational failure with five subscales (academics, attention, communication, participation, behavior).
Reference: Anderson, K.L. (1989). Screening Instrument for Targeting Educational Risk (SIFTER).
www.hear2learn.com.
TEACH: Teachers’ Evaluation of Aural/oral performance of Children
Age range: preschool to 7 years
Purpose: Interview with teacher with 13 questions targeting the child’s everyday environment. Includes
scoring for five subscales (Use, Quiet, Noise, Telephone, Environment)
Reference: Ching, T.C., Hill, M., & Psarros, C. (2000). Strategies for evaluation of hearing aid fitting for
children. Paper presented at the International Hearing Aid Research Conference, August 23, Lake Tahoe,
USA. (www.nal.gov.au)
Questionnaire descriptions from:
Tharpe, A.M., & Flynn, T.S. (2005). Incorporating Functional Auditory Measures
into Pediatric Practice: An introductory guide for pediatric hearing professionals, Oticon Inc.
http://www.oticonusa.com/~asset/cache.ashx?id=10835&type=14&format=web
TOOLS for SCHOOLS
Tracking Auditory Progress in Children With CIs
By Amy McConkey Robbins, MS, CCC-SLP
What are the auditory benchmarks
for average progress in CI children
during the first year of implant use?
Auditory benchmarks have been
established independently for the
following three groups of children,
based upon research findings and
clinical experience.1,3-6 These groups are:
Group 1: Children implanted in the
preschool years (age four or earlier).
Group 2: Children implanted at age
five or later who have some residual
hearing/speech perception skills, have
consistently worn hearing aids and
communicate primarily through
speech.
Group 3: Children implanted at age
five or later who have little or no residual hearing/speech perception skills
and are highly dependent on sign
and other visual cues for language
learning.
The benchmarks shown for each of the
three groups in Tables 1, 2, and 3 are
based on data collected and reported
by the investigators cited above.
*Note that full-time implant use is an
unconditional prerequisite to auditory
development. If a child is not wearing
the implant during all waking hours—
at home, school, and other activities—
these benchmarks are not applicable.
Children who fail to bond to their device
and wear it full-time within a few weeks
of initial stimulation may exhibit insufficient progress and are at high risk of
becoming nonusers of their implants.
For additional information on Tracking
Auditory Progress in Children with
Cochlear Implants refer to Loud &
Clear, Issue 1, 2005.
Tracking Auditory Progress in CI Kids
ote: Child is credited only for skills in listening-alone
N
conditions. Spontaneous means without prompting or
modeling and when not in a listening set.
Time post-implant child
should demonstrate the skill
Table 1 Group 1 Children implanted at age four years or earlier
Skill
1 mo.
3 mos.
6 mos.
9 mos.
12 mos.
1. Full-time use of CI
2.Changes in spontaneous vocalizations
with CI use
3.Spontaneously responds to name 25%
of time
4.Spontaneously responds to name 50%
of time
5.Spontaneously alerts to a few
environmental sounds
6.Performance in audio booth consistent
with what is reported at home
7.Evidence of deriving meaning from many
speech and environmental sounds
8.Major improvement in language
Table 2 Group 2
Children implanted at age five years or older
(Some residual hearing, consistent HA use prior to CI, primarily oral)
Skill
1 mo.
3 mos.
6 mos.
9 mos.
12 mos.
1. Full-time use of CI
2. Understands some words or phrases,
closed-set
3. Understands many words or phrases,
closed-set
4. Spontaneously responds to
name 50% of time
5. Understands familiar phrases in everyday
situations when listening, auditory alone
6. Spontaneous recognition of own name
versus names of others
7. Knows meaning of some environmental or
speech signals when heard, auditory only
8.Major improvement in language
Table 3 Group 3
Children implanted at age five years or older (Limited or no residual
hearing, limited or no HA use, heavily rely on visual cues or signs)
Skill
1 mo.
3 mos.
6 mos.
1. Full-time use of CI
2.Begins to discriminate patterns of speech
(syllable number, stress, length, etc.)
3. Understands some words in closed set
4.Begins to spontaneously respond
to name
5.Reports when device is not working
(e.g., dead battery)
6.Understands many words or phrases in
closed set
7. Understands a few things, open-set
8. Major improvement in language
TOOLS for Schools by Advanced Bionics
1
Tracking Auditory Progress in Children With CIs
9 mos.
12 mos.
REFERENCES
1. Robbins, A.M. (2003) Communication Intervention for Infants and Toddlers with Cochlear Implants. Topics in Language
Disorders, Vol. 23, no. 1; 16-28
2. Svirsky, M., Robbins, A.M., Kirk, K.I., Pisoni, D., Miyamoto, R.T. (2000). Language Development in Profoundly Deaf Children
with Cochlear Implants. PSY.SCI, 11, 153-158.
3. Osberger MJ, Zimmerman-Phillips S, Barker MJ, Geier L. Clinical trial of the Clarion cochlear implant in children. Annals of
ORL. Suppl 177. 1999;108(4):88–92.
4. Waltzman SB, Cohen N. Implantation of patients with prelingual long-term deafness. Annals of ORL. Suppl 177.
1999;108(4):84–87.
5. Robbins AM, Koch DB, Osberger MJ, Phillips SZ, Kishon-Rabin L. Effect of age at implantation on auditory skill development
in infants and toddlers. Archives of Otolaryngol Head Neck Surg. 2004;130:570–574.
6. McClatchie A, Therres MK (2003) AUditory SPeech & LANguage (AuSpLan).Washington, DC:AG Bell.
JUN09_ 3-01066-B-3
©2009 Advanced Bionics, LLC.
All rights reserved.
TOOLS for Schools by Advanced Bionics
2
Tracking Auditory Progress in Children With CIs
TOOLS for SCHOOLS
Identifying Red Flags
By Amy M. Robbins
Why identify Red Flags?
The acquisition of listening is a developmental process that involves a sequence of cumulative skills—each subsequent skill
depends on the acquisition of earlier skills. For this reason, delays early in listening development often lead to long-term delays,
and long-term delays usually lead to life-long deficits. Clinicians should be familiar with the range of progress in typical children
with implants so they are comfortable raising a Red Flag when a child’s performance lags behind that of his/her peers.
However, it is important to note that what we term a Red Flag is not a diagnosis of a problem or a statement of permanent
disability, but a notice to pay attention to the skill.
What is considered a Red Flag?
Based on the auditory benchmarks provided on the front side of this card, a Red Flag is a delay in a particular skill of three
months or more. It is important to remember raising a Red Flag is an expression of mild concern. The number of Red Flags
raised is based on the length of the delay and the number of skills delayed. Therefore, the greater the number of skills that
are delayed at an interval, the more substantial the concern.
What do we do about Red Flags?
There is little value in raising a Red Flag for a listening skill unless we can suggest ways to monitor and improve that skill.
Remember that a clinical Red Flag is not a diagnosis of a problem but an indication that increased attention needs to be given
to a specific skill area. Below is a table that provides you with tips on how to respond to Red Flags.
Responding to Red Flags
Table 4: H
ow to Respond to
One Red Flag
Table 5: H
ow to Respond to
Two Red Flags
Share ideas with child’s parent
Share concern with child’s parent
Confirm child wears CI during waking hours
onfirm child wears CI during
C
waking hours
Contact CI center regarding possible equipment/
programming changes
Assess that home/school environment creates
a need for child to use the skill
Verify that prerequisites to a skill are
adequately established
Break down skill into smaller steps and teach those steps
Use different materials/teach the skill in another way
Increase the intensity of training toward the skill
Write plan of action/check every month for three months
ontact CI center regarding equipment/
C
programming changes
Utilize any one-flag response
Change teaching methods/techniques
Add sensory modality
Consult with a colleague for new ideas
Refer for learning profile testing
efer to specialists to rule out
R
additional disabilities
Reference: Robbins AM. Clinical Red Flags for slow progress in children with cochlear implants, Loud & Clear.
Valencia, Calif.: Advanced Bionics; 2005:1.
JUN09_ 3-01066-B-4
©2009 Advanced Bionics, LLC.
All rights reserved.
Developed for FIRST YEARS (http://firstyears.org/) - Listening Spoken Language Development Intervention
© Beth Walker, 2009
Auditory Learning Guide
SOUND AWARENESS
PHONEME LEVEL**
DISCOURSE LEVEL
(Speech and Environmental Sounds)
(Speech Babble)
(Auditory Processing of Connected Speech)
SENTENCE LEVEL
WORD LEVEL
Step 1 - Detect * the presence of
any speech syllable.
Step 1 - Imitate physical actions (before Step 1a - Imitate motions of nursery
speech imitations).
rhymes/songs with accompanying
vocalization.
Step 1 - Identify familiar stereotypic phrases
or sentences.
Step 1a - Identify and imitate approximations of “Learning To
Listen” sounds varying in suprasegmentals and vowel content, e.g.,
(a-a-a)/airplane , (u)-(u)/train , (oi) (oi) pig in isolation, at the end,
and then in the middle of a sentence.
Step 2 - Detect* vowel variety, [u]
[a] [l] and raspberries [b-r-r]
Step 2 - Imitate any phoneme that
child produces spontaneously when
given hand cue (or other cue).
Step 1b - Identify nursery rhymes or
songs.
Step 2 - Recall two critical elements in a
message.
Step 1b - Identify one, two, and three syllable words in
isolation, e.g., cat vs. chicken vs. kangaroo .
Step 3 - Detect* consonant variety,
e.g., [m-m-m], [b^] [b^] [b^] and
[wa] [wa]
Step 3 - Imitate varying suprasegmental
qualities in phonemes (vary intensity,
duration, and pitch) aeeee (long) vs [ae ae]
(pulsed); [ae-ae] loud/quiet/whispered; [ae]
high/mid/low pitch.
Step 2 - Answer common questions
with abundant contextual support,
e.g., “What’s that?”, “Where’s
mama?”, “What is ________doing?”
Step 3 - Recall three critical elements in a
message.
Step 2 - Identify words having the same number of syllables
but different vowels/diphthongs and consonants, e.g., horse
vs. cow vs. sheep .
Step 4 - Detect* the presence of
Step 4 - Imitate vowel and diphthong
environmental sounds at loud, medium, variety, e.g., [u], [ae], [au], [i], etc.
and soft levels at close range, at a
distance of 6-12 ft. and at a distance of
greater than 12 ft.
Step 3 - Identify a picture that
corresponds to a story phrase in a
three or four scene-story.
Step 4 - Complete known linguistic
messages from a closed set (ex: nursery
rhymes, songs, familiar stories).
Step 3a - Identify words in which the initial consonants are
the same but the vowels and final consonants are different,
e.g., ball vs. bike .
Step 5 - Detect* whispered [hae]
[hae] and [p] [p] [p]
Step 5 - Imitate alternated vowels and
diphthongs, e.g., [a-u] [e-I] [a-I]
Step 4 - Identify an object from several Step 5 - Answer common questions about a
disclosed and familiar topic: a) without pictorial
related descriptors (closed set).
Step 6 - Detect* the sounds of the
Six Sound Test.
Step 6 - Imitate consonants varying in
manner (fricatives, nasals, and plosives).
Use phonemes previously produced, e.g.,
/h/ vs. /m-m-m/ vs. /p/
Step 5 - Follow a conversation with the recording.
Step 6 - Recall four or more critical elements
topic disclosed.
in a message to follow multiple element
directions.
Step 7 – Detect* the sounds of the
Six Sound Test at various
distances.
Step 8 – Locate the direction of
sound if amplified binaurally.
Step 7 - Imitate consonants differing in voiced
vs. unvoiced cues, e.g., [b^] [b^] vs. [p] [p] and
then with vowel variety, [bobo] [pae-pae]
Step 6a - Answer questions about a
story with the topic disclosed.
cues b) over the telephone c) on audio/video-
Step 8 - Alternate consonants varying
Step 6b - Answer questions about a
in place cues, first with varying vowels, story with the topic disclosed; story is
e.g., /ma-ma/ /no-no/; /go-go/ bi-bi/, etc. teacher-recorded.
Step 7 - Complete known linguistic
messages (open set).
Step 5a - Identify words in which the vowels & final consonants
are identical but the initial consonants differ by three features manner, place of articulation, and voicing, e.g., mouse vs. house .
Step 8 - Follow open set directions and
instructions (disclosed).
Step 5b - Identify words in which the vowels & initial consonants
are identical but the final consonants differ by three features manner, place of articulation, and voicing, e.g., comb vs. coat .
Step 9 - Alternate syllables with varying Step 7 - Recall details of a story (topic Step 9 - Recall specific elements in a
consonants and same vowel, e.g., [bi], disclosed).
sentence by answering questions about an
[di], [ho] [go]
undisclosed but familiar topic.
Step 8 - Sequence the events of a
story (topic disclosed).
This guide is intended to aid professionals in the beginning stages of
learning an auditory-based approach. As professionals acquire more
experience in auditory teaching, children should progress more rapidly.
The information on this chart was adapted from Judy Simser’s article in the
Volta Review (1993) (** items), from the Auditory Skills Program, New
South Wales Department of School Education, from the Foreworks Auditory
Skills Curriculum (1976, North Hollywood, CA), and from teacher input.
Notes:
* A detection response could include turning head, pointing to ear,
clapping, dropping a toy in a container, etc.
Reference:
Simser, J.I. (1993). Auditory-verbal intervention: Infants and toddlers. Volta
Review 95(3): 217-229.
Step 10 Repeat each word in a sentence exactly.
a.) predictable sentences “I’m going to the grocery store
to buy cereal and milk.”
b.) less predictable sentences “A woman hit me so I told
her to calm down.”
Step 9 - Retell a story with the topic
Step 11 - Recall specific elements in a
disclosed, recalling all the details in
sentence by answering questions on an
sequence.
undisclosed topic.
Step 10 - Make identification based
on several related descriptors (open
set).
Step 11 - Follow a conversation of an
undisclosed topic.
Step 12 - Retell a story about an
undisclosed topic, recalling as many
details as possible.
Step 13 - Process information in
noise and at various distances.
Step 14 - Process group
conversations.
Step 3b - Identify words in which the final consonants are
the same but the vowels and initial consonants are different,
e.g., food vs. card .
Step 4 - Identify words in which the initial and final
consonants are identical but the vowels/diphthongs are
different, e.g., book vs. back .
Step 6 - Identify words in which the vowels and the final/initial
consonants are identical but the initial/final consonants differ by
two features: (a) manner and place (voicing in common), moat vs.
goat ; (b) manner and voicing (place in common), man vs. pan ; (c)
place and voicing (manner in common), boat vs. coat .
Step 7a - Identify words in which the vowels and final
consonants are identical but the initial consonants differ by
only one feature - manner of articulation, e.g., ball vs. mall .
Step 7b - Identify words in which the vowels and initial
consonants are identical but the final consonants differ by only
one feature - manner of articulation, e.g., cloud vs. clown .
Step 8a - Identify words in which the vowels and final
consonants are identical but the initial consonants differ by
only one feature - voicing, e.g., coat vs. goat .
Step 8b - Identify words in which the vowels and initial
consonants are identical but the final consonants differ by
only one feature - voicing, e.g., bag vs. back .
Step 9a - Identify words in which the vowels and final
consonants are identical but the initial consonants differ by
only one feature - place of articulation, e.g. bun vs. gun .
Step 9b - Identify words in which the vowels and initial
consonants are identical but the final consonants differ by
only one feature- place of articulation, e.g., sheep vs. sheet .
revised: 9/3/10
Identification
Spondees
Airplane
Backpack
Baseball
Bathtub
Birdhouse
Cowboy
Cupcake
Doorknob
Flashlight
Football
Lunchbox
Mailbox
Paintbrush
Playground
Popcorn
Rainbow
Raincoat
Scarecrow
Snowman
Suitcase
Toothbrush
Toothpaste
Monosyllables Differing In Consonants Only
Cake, Game, Paint, Plate, Rake, Snake, Tape, Train
Bike, Dime, Kite, Light, Nine, Pie, Slide, Tie
Boat, Bone, Comb, Ghost, Nose, Soap, Stove, Throw
Cloud, Clown, Couch, House, Cow, Mouth, Shout, Owl
Boy, Coin, Foil, Oink, Point, Void, Voice (Boil)
Boot, Broom, Glue, Juice, Moon, Roof, Soup, Tooth
Book, Bush, Foot, Hood, Hoof (Cook, Hook, Push)
Ball, Chalk, Dog, Salt, Saw, Yawn (Fall, Jaw)
Box, Hot, Job, Lock, Sock, Mom, Top (Clock)
Brush, Bug, Bus, Cup, Drum, Duck, Jump, Sun
Bird, Burn, Church, Dirt, Girl, Purse, Stir, Worm
Bee, Cheese, Feet, Leaf, Peach, Sheep, Teeth, Tree
Back, Cat, Dad, Flag, Grass, Laugh, Map, Tab
Bed, Desk, Dress, Egg, Leg, Neck, Nest, Wet
Bib, Chip, Fish, Kiss, Pig, Pin, Six, Witch
Monosyllables Differing In Vowels Only
Back, Beak, Bike, Book
Ball, Bell, Bowl, Bull
Bat, Bite, Boat, Boot
Bean, Bone, Bun Barn
Bead, Bed, Bird, Bud
Cake, Coke, Cook, Kick
Call, Coil, Cool, Curl
Can, Cane, Coin, Cone
Cat, Coat, Cut, Kite
Hat, Heart, Hit, Hot
Net, Night, Note, Nut
Lake, Lick, Lock, Leak
Man, Men, Mane, Moon
Mice, Moose, Mess, Mouse
Peel, Pole, Pool, Pull
Pain, Pan, Pen, Pine
Pat, Pet, Pot, Putt
Paw, Pay, Pea, Pie
Read, Red, Ride, Road
Sheet, Shirt, Shout, Shut
Tap, Tape, Top, Type
Tea, Tie, Toy, Two
Tail, Tile, Tall, Tool
Weed, Wide, Wood, Word
Identification
Rhyming Words With Minimal Contrasts
s/f/voiceless th
Sought, Fought, Thought
Sin, Fin, Thin
Singer, Finger
Sun, Fun
Sail, Fail
Sat, Fat
Seat, Feet
Sell, Fell
Sight, Fight
Sir, Fur
Sit, Fit
Six, Fix
Soot, Foot
Soil, Foil
Sound, Found
Sing, Thing
Sink, Think
Sank, Thank
Saw, Thaw
Sick, Thick
First, Thirst
p/t/k
Pea, Tea, Key
Pick, Tick, Kick
Pear, Tear, Care
Peas, Tease, Keys
Pen, Ten, Ken
Pan, Tan, Can
Pin, Tin, Kin
Pole, Toll, Coal
Poo, Two, Coo
Pool, Tool, Cool
Pop, Top, Cop
Post, Toast, Coast
Pub, Tub, Cub
Part, Tart, Cart
Pot, Tot, Cot
Pail, Tail, Kale
b/d/g
Bad, Dad, Gad
Bait, Date, Gate
Bash, Dash, Gash
Beer, Dear, Gear
Bet, Debt, Get
Big, Dig, Gig
Bill, Dill Gill
Bow, Doe, Go
Boo, Do, Goo
Boar, Door, Gore
Boat, Dote, Goat
Bong, Dong, Gong
Buy, Dye, Guy
Bum, Dumb, Gum
Bun, Done, Gun
Bust, Dust, Gust
m/n
Mail, Nail
Map, Nap
May, Neigh
Me, Knee
Meat, Neat
Met, Net
Mice, Nice
Might, Night
Mill, Nil
Mix, Nix
Moose, Noose
Mope, Nope
Mum, Numb
Moo, New
Mock, Knock
Mow, No