First Steps for SLPs That Have A Child With A Hearing Loss On Their Caseload

This blogpost was originally posted in February but is back by popular demand.

 Thanks for all your emails and requests.

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So, You Have A Child With A Hearing Loss On Your Caseload

First Steps for Speech Language Pathologists

      

The terms deaf or hard of hearing cover a wide range of conditions and all affect a child’s listening ability and interfere with their language, social and educational development. The number of children in neighborhood preschools and auditory-oral private schools is ever increasing. Many of these students will need support from SLPs to succeed in mainstream classrooms. 

Starting Points 

First, below are facts to stimulate your thinking in order to begin by asking the right questions.

Points to Ponder

• 95% of parents of children with hearing loss are hearing themselves

• The trend is that hearing parents are choosing spoken language options such as Auditory-Verbal Therapy for their children with hearing loss

• Auditory based intervention does not use any visual communication systems

• Children with all degrees of hearing loss can learn spoken language through hearing

• Early diagnosis, aggressive audiological management, contemporary hearing technology is essential

• Audiograms no longer predict outcomes

• Hearing loss is not about the ears? – It’s about the brain! We hear with the brain –the ears are just the way in. (www.Carol Flexer.com)

• Children can have sensori-neural, unilateral, fluctuating, and conductive hearing losses. They wear hearing aids, cochlear and baha implants and/or FM systems.

What is Auditory-Verbal Therapy?

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According to The Alexander Graham Academy for Listening and Spoken Language,  “Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012).

Who are Listening and Spoken Language Specialists?

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The AG Bell Academy governs the certification of Certified Auditory-Verbal Therapists (LSLSCert. AVT) and the LSLS Certified Auditory-Verbal Educators (LSLS Cert. AVEd).The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families.

What Do I Need to Know?

Helen Keller once said, “Blindness separates people from things; deafness separates people from people...” Without prior experience it is difficult to appreciate the impact hearing has on basic human interaction and daily communication.

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If you have the opportunity to see a child who has graduated from AVT or an auditory-oral preschool first and foremost take advantage of theparents’ knowledge. Depend on the audiologist, the AVT’s and the hearing itinerant‘s expertise. In the reference section, there are links to simulations of hearing loss and listening with technology that is insightful. Become familiar with variables that effect hearing such as the impact of noise, distance, room acoustics and equipment malfunctions and ways to manage them. Learn about the child’s listening and learning abilities, social needs, and the IEP accommodations.

Classrooms are auditory – verbal environments where LISTENING serves as the basis for learning. Read this brief children’s story below. Do you recognize it?

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You can read the passage but endings are missing and the words are not distinct. It takes time and energy to figure
out the story. This visual simulation is similar to the listening ability of a child with well-fit hearing aids. The small 
font size represents that sound is perceived more quietly than it is for typically hearing
 children. The child may ‘hear’ but not understand what was said because
 pieces are missing. Do you know the story?

Hearing aids and/or cochlear implants do not restore normal hearing. Students who use hearing aids may not be able to hear all of the sounds of speech even when it is quiet and the speaker is close by. A hearing loss is invisible and therefore it is easy to forget the effort required to attend, learn and participate. Children with language delays or additional learning issues make this even more challenging.

Strategies to Facilitate Listening and Spoken Language

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There are many specific and purposeful auditory strategies and techniques used to teach a child who is deaf or hard of hearing to learn spoken language through listening. Here are three of the most basic and effective. 

Hearing First!

or

You Will Lose the Opportunity for Listening.

Talk about pictures, objects and events before you show them.

This will focus the child on listening and reduce visual dependence.

After you show the materials, repeat and rephrase the message.

This provides repetition and allows the child to “connect” the

auditory and visual information.

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Sit beside the student close to the child’s better ear.

Listening Sandwich

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Present information through hearing.

 Add VISUAL cues, as necessary

Then, SAY IT again to promote listening. “Put it back into hearing.”

Wait Time

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Pausing and Waiting! 

Allow time for the child to process and attach meaning to what was heard.

Don’t rescue too soon!

In summary, I have included numerous references, important videos, printable handouts and a wealth of resource materials. This will enable you to further investigate opportunities for supporting children with hearing loss and their families.

“I am deaf and I can listen, hear and talk!”

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So, you want to learn more?

This first step is to view the TED Talks video, Establishing a Sound Foundation for Children who are Deaf or Hard of Hearing. Dr. Karl R. White explains the differences in raising children with hearing loss today versus 35 years ago and the key factors for successful language development.

Next, watch a series of short videos of my friend and mentor, Carol Flexer, PhD, CCC-A, LSLS Cert. AVT, as she teaches on auditory brain development, acoustic accessibility, the listening environment, signal to noise ratio and more in her engaging videos. Be sure to scroll down to see Carol!

Read a post from the ASHAsphere blog entitled, “Auditory-Verbal Therapy: Supporting Listening and Spoken Language in Young Children with Hearing Loss & Their Families” Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT.

Investigate the Listening and Spoken Language Knowledge Center a vast site for children and adults with hearing loss, their families and the professionals who support them.

Spend some time at Success For Kids With Hearing Loss where Karen L. Anderson PhD, an audiologist has a wealth of resources including printable handouts regarding the relationship of types and ranges of hearing loss and the impact on listening and learning, social needs, and the potential school accommodations and therapy needs. Be sure to investigate Learning With a HL - Things For the Teacher To Know and Understand

So if you’re ready to dig in, order your own copy of  101 FAQs about Auditory-Verbal Practice. It is an excellent resource edited by Warren Estabrooks, the President and CEO of WE Listen International. The book takes the reader on a journey through current theory, practice, and evidence-based outcomes. It offers knowledge, guidance, encouragement and hope for future generations of children who are deaf or hard of hearing, their families and professionals. 

School Success

How do you help your child receive their best education, especially in a mainstream school setting? 

Click HERE for resources from Cochlear Corporation on assisting your child with cochlear implants at school.

Here are some tips to consider at the start and throughout the school year.

1. Assessment and Individualized Education Plan (IEP)

Each year, your child's progress in each area of skill development must be monitored in order to determine the best approach for continuing momentum or improving the rate of progress. The approach to completing this assessment varies by school district. Information gathered for the yearly assessment provides the foundation for the discussion and goal setting of the Individualized Education Plan.

2. Organize a support team to work with your child

Encourage discussions, set up meetings, and highlight the role of each member in your child's support team. There are many people who should be considered members of your child's support team including:

• Classroom Teacher/Special Teacher
• Auditory/Speech Therapist(s)
• Educational Audiologist
• Someone from cochlear implant center/clinic
• School Principal/Administrator
• Tutor, aid, school nurse, others
• Parents + Child + Classmates
• Interpreter, notetaker (depending on age of child)

Each member of the team will play a key role in your child's educational progress, from the teacher who is ensuring your child understands and is on par with academic goals, to the school administrator who provides leadership and allocates funds, to your cochlear implant center communicating your child's changes and progress. As the parent, your job is most important to ensure that you:

• Communicate with all team members
• Monitor equipment, homework and educational progress
• Be a presence at school
• Participate in child's developmental goals
• Ensure a routine for your child
• Provide an auditory learning environment at home
• Encourage your child advocate for himself by talking, asking questions, and engaging with others around him/her

3. Set up an initial meeting with your child's support team

• Show the team your child's audiogram and explain it
• Help the team understand the benefits and limitations of cochlear implant technology
• Show the team your child's technology and let them handle it
• If your child uses an FM system, explain why the FM is important
• Determine who is in charge of troubleshooting and develop a plan for how that will work

4. Review classroom acoustics and ensure proper classroom seating

There are many factors in a child's classroom that may impact their ability to hear, such as noise, distance and reverberation. Keep in mind the following when choosing a child's classroom seat:

• Close to front but visually accessible to entire room
• Seat away from noise generators (HVAC fans, hall doors)
• If your child has one cochlear implant, seat them so that the cochlear implant ear is away from noise sources (HVAC fans, projectors) and towards center of room
• Aquariums often generate noise (from the pump operation) and should not be placed in the classrooms of children with hearing loss

5. Review support services for your child

Work with your child's support team to determine what support is best for your child. When needed, consider options such as FM systems, interpreters, itinerant teachers of the deaf, and other support services. Provide your teacher with extra batteries and troubleshooting tools to use in the classroom.

6. Provide tips to your child's teacher

Remember, your child's teacher may have never taught a child with hearing loss and feel that the "burden" is falling on them. Provide the teacher with some tips such as:

• Always face forward when talking
• Stay within the child's vision, closer is better
• Don't "bounce" around
• Speak clearly, naturally and directly to the child
• Make sure the child is looking at you when you begin speaking
• Ensure volume is appropriate
• Speak just a little slower—too slow is not natural and will make understanding harder
• Don't ask her directly "Did you understand that?"
• Learn to recognize "the look" that means the child didn't get it, or use a signal or "secret sign" so she can tell you she missed something
• Repeat once, then paraphrase
• Explain things a different way
• Encourage the child to ask
• Write difficult (key) word(s) on the blackboard
• Provide key new words/concepts to parents or team members in advance
• Use visual tools, concrete materials or natural gestures to illustrate points
• Write assignments and directions on the board
• When someone else is speaking, point to the speaker
• Understand and use additional amplification equipment - repeat classmates' questions thru the FM system
• If you think the child might have missed a comment, rephrase or restate what another child has contributed
• Don't be afraid of the child's cochlear implant equipment

7. Involve classmates

Many children are not aware of cochlear implants. It is important to involve the classmates at the start of the school year to help them understand your child's technology, learn how to interact with your child, and talk about how your child is the same as other kids, but with a little extra technology to help them hear. You may also want to assign another child as your child's "hearing buddy" to help keep your child on task and share notes, if they are old enough.

Remember, while you want to address your child's individual needs, you also want to place your child in the "least restrictive environment" to serve their needs. Set appropriate, but high expectations. Children with cochlear implants should follow the same learning process as other children.

Hearing in the Classroom and Using FM Technology

Classrooms are auditory- verbal environments.

Hearing loss is an acoustic and comprehension barrier to accessing verbal instruction. 

Classrooms are auditory-verbal environments with listening serving as the cornerstone of the educational system (Flexer, 1993). The majority of learning takes place through speaking and listening in the classroom. Actually, children spend 45% of the school day engaged in listening activities (Berg, 1987). The teacher does most of his or her teaching by talking, students ask questions, and students listen to both the teacher and other students. Multimedia lesson materials also depend on students listening to a message. 

Below  find some links that many of the families I work with have found helpful in ensuring their child has acoustic access at school.

Click HERE to view this informative video on using the FM in the classroom.

Click HERE to view this informative video on using the FM simulation.

Click HERE to learn about FM Systems work and can be used in a classroom setting from the House Ear Institute. 

Click HERE to read this excellent post: What Does Acoustic Accessibility Look Like and The Impact of Auditory Verbal Therapy on Literacy Skills by 

Carol Flexer, Ph.D., LSLS Cert. AVT, The University of Akron, Kent, OH

Jane Madell, Ph.D., LSLS Cert. AVT, Private Practice

Click  HERE to read information on Classroom Acoustics - Impact on Listening and Learning from http://successforkidswithhearingloss.com

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Below is an exercise that illustrates listening difficulties if classroom acoustics and/or hearing loss causes the higher frequency portions of words to become inaudible. Can you guess the story? Think about how long it took you to figure it out. Those who never heard the story before (imagine new vocabulary in classrooms) may be at a loss to understand the meaning.

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Teacher Guidance: Using FM in the Classroom

Click HERE to access this informative powerpoint presentation.

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Tools to Document the Use of a FM System

ELF, CHILD, SIFTERs, LIFE : www.kandersonaudconsulting.com

CHAPS: www.edaud.org (not free)

DIAL: edaud.org;  Members;  downloadable reference items

COWS: Oticon – http://otikids.oticon.nl/eprise/main/Oticon/com/SEC_AboutHearing/LearnAboutHearing/Products/SEC_OtiKids/Parents/Networking/91180310cow_counsellingtool.pdf

Functional Listening Evaluation and FAPI: http://www.colorado.edu/slhs/mdnc/assessment.html

IT-MAIS: from Advanced Bionics http://www.bionicear.com/professionals/rehabmaterials.asp

Speech in Noise Test: information at http://www.ausp.memphis.edu/harl/rsin.html

Ready for School - Self-Advocacy

How to help your child advocate at the beginning of the school year.

Post Adapted from: http://lslteacher.com/youtube-video-self-advocacy

  

Here is a great youtube video that shows two young boys explaining what their cochlear implants are for and what their friends at school can do to help them.

Click here and watch these kindergarteners tell you about their CIs.

Make a book. Together you and your child can put together a short book with pictures explaining what equipment they use, how it works, and what their friends can do to help them in the classroom. Children as young as kindergarten can put this together with help and share it with their teacher and classmates.

A Powerpoint Presentation can be created at a level based on your child's age and stage.

All About Me letter or poem. Students can write a letter to their classmates or a poem that explains how they hear, their likes/dislikes, and anything else about their equipment or hearing loss.

School Year: Self Advocacy Cards To Give Teachers

Self Advocacy Cards For the Student To Give To Their Teachers

http://listeningandspokenlanguage.org/Quick_Cards_to_Give_to_Teachers/

Many of the daily obstacles in the classroom arise from a lack of understanding about how to best interact with a child with hearing loss. Many teachers have not had a child with hearing loss in their classroom, and while their intentions are always in the best interest of the children, they may benefit from some background information. Cochlear implants, hearing aids and FM systems can be intimidating until explained. Also, many Auditory-Verbal Children function so well that their hearing loss appears invisible upon first glance.

AG Bell has developed some Word Doc templates that outline key information that provides teachers with a better understanding of a child's hearing loss, and some easy ways to avoid some traditional obstacles. We have also found this is a great way to open dialog between the teacher and the student.Variable information to be personalized has been italicized. And additional space has been left for additional information, and any items should be changed to meet your child’s needs.

These templates can be to be written from the parents about their child or from the child themselves. This leads to a great discussion with your child on their needs and how to self advocate to suceed.- See more at: 
http://listeningandspokenlanguage.org/Quick_Cards_to_Give_to_Teachers/#sthash.5j5P5bPA.dpuf

The Parent as the Teacher

The Parent as the Teacher - one of the main premises in Auditory-Verbal Therapy

One of the main cornerstones of the Auditory-Verbal approach is that parents are their child’s primary listening and language models or teachers. Parents who are guided by their Auditory-Verbal Therapist during  weekly sessions can then effectively target goals throughout daily activities and in natural interactions with their child. 

Click HERE for some suggestions for parents to incorporate language learning into their daily routines in an article written by Melissa Chaikof  of  Cochlear Implant Online.

Listening and Learning at the Ice Cream Shop

AUGUST: Listening and Spoken Language Calendar

                                Click  HERE to download your own printable copy of the

                                   Listening and Spoken Language Calendar for August .