Do Listening and Spoken Language (LSL) Techniques and Strategies Only Benefit Babies and Toddlers?

Recently, I replied to this question from a Teacher of the Deaf 

Q: Can Listening and Spoken Language (LSL) Techniques and Strategies benefit children in the classroom who are 5 and up?  Many of the webinars I've seen the focus is on therapy for babies and toddlers, so I'm curious as to how these techniques will translate to a class of 4-9 school-aged children. I really want to ensure that my students are ready for inclusion settings/mainstream classes.

A: My reply to a great question

I am positive LSL techniques and strategies are beneficial to school-aged students and others! 

My LSL caseload has predominately been with families of babies through kindergarten. However, I have guided families of older children who continued to require intervention for many reasons such as those transitioning from a visual system such as Cued Speech, those identified late such as cross-cultural adoptions, others with autism, hearing loss plus other disabilities and so on.  The same LSL strategies and techniques (Audition First, Auditory Sandwich, What Did You Hear? Etc.)  which place emphasis on learning spoken language through listening apply to all ages with a wide range of needs and goals. I have provided LSL intervention to improve auditory skills and receptive language of children who are non-verbal and those on augmentative communication devices. The same LSL strategies and techniques can be effective when incorporated with teens and adults in post CI rehabilitation.  These LSL techniques can be powerful as a part of therapy for individuals with auditory processing disorders. So unequivocally yes!

Overused Questions

“What color is that?”

Your child is likely thinking, “It’s red. 

You know that!  

So why are you asking?”  

Why as parents do we ask the same boring, overused questions?

Try saying things like,

“I like the colors you used”. 

“It looks like you loved drawing this picture.”

“Draw something that makes you happy.”.

It is easy and important to turn your questions into comments to foster two-way conversations. 

Auditory Hierarchy Minimal Pair Cards

Have you seen this new resource for working on (or collecting data on) auditory discrimination that was recently published by my friend and colleague Kristine Ratliff? It includes colorful and engaging 228 minimal pair cards differing by sound feature. The minimal pair cards were designed using the Auditory Discrimination Hierarchy known as the Listening Ladder created by Dave Sindrey, M.Cl.Sc., LSLS Cert. AVT. 

 https://www.teacherspayteachers.com/Product/Minimal-Pair-Cards-for-Auditory-Discrimination-and-Training-3402073   $6.00

The hierarchy begins at level 1, with sounds differing by duration, intensity and pitch. It progresses by difficulty though ten steps, ending with discrimination of words with final consonants differing by place of articulation.

I downloaded my minimal pair cards on my iPad so they are easily accessible and it saves on ink and printing.

Lynn’s AVT Dollhouse Continuum and How To Follow A Child's Lead

As a follow-up to my post on, Lynn’s LSL Dollhouse Continuum I wanted to share strategies on following a child's lead in Auditory Verbal Therapy while guiding and coaching the families and meeting the child's goals.

Source

I am very intentional when following a child’s lead in order to target specific listening and spoken language areas of need. In reply to your question, I  sometimes brainstorm with the parents but most often model as we play and coach throughout the session a little bit of information at a time. I have found hands-on coaching is most effective. I have a sign in my office that says, “Tell me and I forget, teach me and I may remember, involve me and I learn.”

I have worked with some families who are “good at playing” and many others who do not know where to begin. If the toy doesn’t have batteries and entertains even for a short time they are lost. 

Therefore, I  model how to engage a child in play and also how to join in and play. Being clear about the LSL goals is essential to guide the play.

Here are three strategies, I model and use to Follow the Child’s Lead. 

1. Observe, Wait and Listen (OWL)

Observe for what the child is interested in. 

Wait to give the child a chance to initiate or get involved in an activity

      Waiting can be hard to do! I try to model counting to 10,  looking expectant and leaning forward

Listen to what the child is trying to tell us

2. The parent and I begin playing together with the hope that the child follows and joins in the fun.  When the parents and I are playing (this can be in short spurts) I model the LSL skills we are targeting. 

I love to hear the child come back and use what he just heard modeled. In this situation, language is caught through hearing and not directly taught.

3. I often set up or act out a scenario to encourage the child to communicate. 

For the dollhouse, I may have bits of cracker on the little kitchen table. I often set-up of something unexpected to encourage or give the child a reason to communicate (sabotage).  I always include a broken chair to make a connection to the earlier taught Three Bears story.  

4. Giving the child choices is effective. I may offer the bear family or people dolls to use in the dollhouse.  

Have fun playing and listening together! 

Wind-Up Easter Toys to Create Opportunities for Listening and Spoken Language

Wind-up chicks, ducklings and bunnies are common toys at the stores near Eastertime. They are perfect for filling baskets but also young children are fascinated with these toys that require an adult to activate.

Wind-up toys create opportunities for your children to ask for the toy be wound up. These toys set up the communicative environment so your child will need to ask for help to use. Remember not to anticipate the child’s needs before s/he has tried to communicate them to you. Look expectantly when your child should verbalize so s/he learns to verbalize during the pause time.

Sabotage techniques set up situations, which require your child to communicate with others.  For example, arrange the situation so when the wind-up toy stops s/he needs to request the toy to continue. These toys stop suddenly and are motivating, as the child needs to ask for help for then to continue to hop, scurry or whatever. Even placing the fun toy out of your child’s reach can create a need to communicate.  Then, WAIT for your child to initiate, request or comment. Allow your child plenty of processing time and remember don’t jump in too soon and save your child.

Wind-up toys encourage a fun and communicative environment. Since you have your child’s undivided interest use rich language when talking about the toys. Rich language is at and slightly above the child's listening and spoken language level and should be redundant with frequent rephrasing and elaboration.

Auditory Verbal Strategies to Build Listening and Spoken Language Skills

Sherri Smith Fickenscher‎ and Elizabeth Ruddy Gaffney

announce the release of this project. 

It can be downloaded for free on the website of the editor, Cheryl L. Dickson.

http://www.auditory-verbal-mentoring.com

Fooling Around in Auditory Verbal Therapy

Today's post is from Elizabeth Rosenzweig MS CCC-SLP LSLS Cert. AVT at http://auditoryverbaltherapy.net/ posted on April 1, 2015

Playing Tricks in Therapy

Posted on April 1, 2015 by earosenzweig

Serious, boring therapy?  No thank you!  Practical jokes can be a lot of fun, but look beneath the surface and you’ll find a wealth of listening and language goals, too.  Let’s talk about sabotage, theory of mind, jokes, and helping children with hearing loss develop a sense of humor.

SABOTAGE

One way to keep therapy from becoming dry, boring, and predictable is to learn to use the technique called “sabotage.”  It’s not as deceitful as it sounds.  Sabotage is simply doing something out of the ordinary to gain the child’s attention, spark conversations, and create a “communication temptation” that leads to speech, listening, and language growth.

Sabotage works because it quickly captures the child’s interest by providing a break from the expected (hey!  something weird is going on here!) and it creates a situation that requires the child to communicate.  It can be used for children at any level, from babies (where the communication we’re looking for might just be vocalization to call/recognize, e.g. “aah!” + pointing to say, “Mama, look at that!”) to children with advanced language skills (where I might expect them to fully explain to me what is wrong with this situation).  It’s easy to do, it’s tons of fun, and it can spark some great language interactions!

What are some common ways to use sabotage in a therapy session?

• Plan an art project.  Bring out a box of old markers that are dried out, or bottles of glue that have sealed shut, or only enough paper for half of the people in the room.

• Hand a child who is old enough to read a wordless book and ask him to read it to you.

• Put toys inside containers that the child cannot open independently.

• Give the child a toy to play with that is broken, or a game with missing pieces.

• Have a snack.  Try to pour juice into a cup from a closed bottle.  Give everyone a plate except the child.  Give the child a knife (instead of a spoon) for eating yogurt.

• Play dress up.  Put on clothes that are too big or too small.  Put clothing on the wrong place (e.g. a hat on your foot, a sock on your arm).

• Bake something.  Set out the ingredients for the recipe but leave a few out.  Put a whole egg into the bowl without cracking it.

• Put a stuffed animal on your head, or a sticker on your nose.  Pretend not to notice until the child points it out to you.

• Throw a pretend birthday party.  Blow out candles that are not lit.  give the child a “present” with multiple layers of wrapping paper, or a wrapped box with nothing in it.  Try to blow up a balloon that has a hole.

You can also use sabotage to work on listening and self-advocacy skills.  Put a dead battery in the child’s hearing aid or cochlear implant, and see if she will point it out to you.  For children with cochlear implants, use the remote to secretly turn their processor’s volume down.  Will they notice the change?  Speak to the child in a voice that’s too soft, or too mumbly, or turn the background music up too loud.  All of these communication sabotages require the child to speak up about his or her listening needs.

They key to sabotage is to play dumb.  Once the child notices that something is out of the ordinary, expect her to use language (at whatever level) to fix the problem.  Don’t be a mind reader.  You put a sock on your hand and the child pointed?  Great!  But don’t move that sock.  Wait it out.  Whether you’re looking for “No!” or “Foot!” or “Right there!” all the way up to “Socks go on your feet, not on your hands.  That’s that wrong place!” you’ll never get that language unless you give the child time to process and expect language before continuing the game.

 THEORY OF MIND

Theory of mind is the ability to predict and understand the thoughts and feelings of others, to comprehend that what is in my mind is different and separate from what other people experience.  For example: Jane and Tom are in a room and Jane puts the cookie in the cookie jar.  Tom leaves the room, and Jane moves the cookie to the cupboard.  When Tom comes back in, where will he look for the cookie?  A child with developed Theory of Mind skills will know that Tom last saw the cookie in the cookie jar, so that’s where he will look.  A child who does not have the ability to separate what he knows from what Tom knows will say that Tom will look in the cupboard (“I know it’s there, so why wouldn’t he?”).

Children with hearing loss have been shown to be at great risk for delayed or deficient theory of mind skills when compared to hearing peers (see Peterson, 2004, among others).  We hypothesize that this is due to early lack of access to communication and incidental learning (that “overhearing potential” — listening to adults talk through their thought processes can help teach theory of mind).  Playing tricks in therapy is one great way to work on this skill.  Help the child set up a practical joke to play on the parent (or on you, the therapist).  Talk through the why it will work (Mom stepped out of the room, and we hid all of the toys under the table.  When she comes back, she won’t know where they are because she didn’t see us do it), and what you have to do to pull of a good surprise (don’t give it away!).

What are some other ways to develop this important skill?  You can also work on theory of mind while reading books.  Talk about characters’ emotions, motivations, and what they might be thinking or feeling in certain pictures.  The Gruffalo by Julia Donaldson is one of my favorite books for ToM.  Act out various pretend play scenarios (going to the doctor, flying on an airplane, etc.) and use this as an opportunity to think out loud to make each “character’s” inner mental dialogue more accessible to the child (“I am the doctor, and I see my patient has a red face and is sweaty.  Maybe she has a fever”).

SENSE OF HUMOR

Language is about more than correct grammar and articulation.  We also have to consider pragmatics, or the social aspect of language — using appropriate tone, how to enter a conversation, how to speak appropriately in different contexts (e.g. formal presentations vs. joking with family), etc.  This is another area in which children with hearing loss have traditionally experienced some difficulty.  Developing a sense of humor requires a combination of many skills:  You have to have appropriate tone (teasing can be playful or mean depending on how you say it), intelligence and theory of mind to understand why a joke is funny, and the language and grammar to communicate it effectively.

Developing a sense of humor ties in to developing good self-esteem and self-concept regarding hearing loss, too.  If you can laugh about yourself and take mistakes and miscommunications in stride, you can diffuse many awkward situations.  If a child with hearing loss can project comfort with himself, he’ll make others comfortable with his hearing loss, too.

Here are some fun ways to work on humor in therapy:

• Tell jokes.  There are many simple kids’ joke books, jokes on Laffy Taffy wrappers, etc.  Knock Knock jokes follow a particular script or routine, which is great for young children.  Many jokes rely on puns or multiple meanings of words — a great opportunity to work on some metalinguistic (“thinking about language”) skills and phonological awareness.

• Talk about tone.  Take a simple sentence (“I like your blue hat”) and talk about all of the different ways you could say it.  Can you say this sentence like you are angry?  Like you are jealous?  Like you are being sarcastic?  Like you are happy?  Like you a teasing? etc.  Helping children with hearing loss understand and use appropriate tone can head of misunderstandings, either when the child says something that’s taken poorly because of how he says it, or when the child misunderstands another person’s intent in communication.

• Read funny books and sing funny songs.

Auditory-Verbal Therapy - Evidence for the Effectiveness

Today's post is from Jane Madell, Editor of Hearing Health. Hearing & Kids @ Hearing Health & Technology Matters February 24, 2015. 

The post is written by  Dr. Dimity Dornan, the Executive Director and Founder of Hear and Say, an auditory verbal center in Brisbane, Australia

 Here is the link.

Auditory-Verbal Therapy has been shown to be effective for developing listening and spoken language for children with hearing loss (Dornan, et al., 2010). To maximize listening and spoken language development, children with hearing loss require optimal amplification in combination with specialized listening and spoken language early intervention. Amplification alone does not allow for optimal spoken language development (Wilkins & Ertmer, 2002).

In Auditory-Verbal Therapy, parents are valued members of the early intervention team. In partnership with the Auditory-Verbal Therapist, parents are guided and coached to facilitate their child’s spoken language development through listening.

Auditory-Verbal Therapy successfully develops the listening and spoken language of children with hearing loss by stimulating auditory brain development, enabling children to make meaning of what they hear and laying down neural pathways for speech and language development (AG Bell Academy for Listening and Spoken Language 2013; Chermak et al, 2007; Cole & Flexer, 2007). Learning through listening is the most effective way of developing spoken language, cognition and literacy skills (Cole & Flexer, 2007). Auditory-Verbal Therapy, with its foundation in teaching through listening, has been proven to be most effective in developing the spoken language and educational outcomes of children with hearing loss.

In Auditory-Verbal Therapy, parents are valued members of the early intervention team. In partnership with the Auditory-Verbal Therapist, parents are guided and coached to facilitate their child’s spoken language development through listening.

                               

Research shows that children with hearing loss in an Auditory-Verbal Therapy program:

 • Graduated with no gap between their chronological and language ages and developed spoken language in line with normally hearing peers (Constantinescu, Dornan, Rushbrooke, Brown, McGovern, Close, Hickson & Waite, In review; Dornan, Hickson, Murdoch, & Houston, 2007, 2009; Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010; Fulcher, Purcell, Baker, & Munro, 2012; Hogan, Stoke, White, Tyszkiewicz, & Woolgar, 2008; Rhoades & Chisolm, 2000).

• Made, on average, 12 months’ progress in 12 months for their spoken language development, which is in line with expectations for children with normal hearing (Dornan, Hickson, Murdoch, & Houston, 2007, 2009; Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010; Rhoades & Chisolm, 2000).
• Progressed at the same rate for spoken language, self-esteem, reading and mathematics as a matched group of children with normal hearing (Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010).
• Achieved age-appropriate spoken language as early as 6 months after amplification and around 12 months of age – when identified at birth and fitted with optimal amplification and enrolled in Auditory-Verbal Therapy before 12 months of age (Constantinescu, Waite, Dornan, Rushbrooke, Brown, Close, & McGovern, submitted).
• Performed better for spoken language and listening than a matched group of children in an Auditory-Oral (listening and lip reading), or Bilingual-Bicultural program (AUSLAN and written English) by 3 years of cochlear implant use (Dettman, Wall, Constantinescu, & Dowell, 2013).
• Achieved comparable social inclusion outcomes to normally hearing peers (Constantinescu, Phillips, Davis, Dornan, & Hogan, In review).
• At 3 and 4 years of age, speech production results showed that
(1) All children produced single phonemes + clusters following typical developmental patterns.
(2) All children had increased their inventory for consonant clusters from 3  to 4 years of age.
(3) The number and type clusters produced were at least in the average range when compared to normative data.

References:
AG Bell Academy for Listening and Spoken Language. (2013). The AG Bell Academy for Listening and Spoken Language. See
http://www.listeningandspokenlanguage.org/AGBellAcademy/ (last checked 1 Jan 2013).
Chermak, G., Bellis, T., & Musiek, F. (2007). Neurobiology, cognitive science and intervention. In G. Chermak & F. Musiek (Eds.), Handbook of (central) auditory processing disorder: Vol. 2. Comprehensive intervention (pp. 3-28). San Diego, CA: Plural Publishing.
Cole, E., & Flexer, C. (2007). Children with hearing loss: Developing listening and talking birth to six. San Diego, CA: Plural Publishing.
Constantinescu, G., Phillips, R., Davis, A., Dornan, D., & Hogan, A. (In review). Benchmarking social inclusion for children with hearing loss in listening and spoken language early intervention.
Constantinescu, G., Waite, M., Dornan, D., Rushbrooke, E., Brown, J., Close, L., & McGovern, J. (In review). Outcomes of an Auditory-Verbal Therapy program for young children with hearing loss.
Dettman, S., Wall, E., Constantinescu, G., & Dowell, R. (2013). Communication outcomes for groups of children using cochlear implants enrolled in Auditory-Verbal, Aural-Oral, and Bilingual-Bicultural early intervention programs. Otology & Neurotology, 34, 451-459.
Dornan, D., Hickson, L., Murdoch, B., & Houston, T. (2007). Outcomes of an Auditory-Verbal program for children with hearing loss: A comparative study with a matched group of children with typical hearing. The Volta Review, 107, 37-54.
Dornan, D., Hickson, L., Murdoch, B., & Houston, T. (2009). Longitudinal study of speech and language for children with hearing loss in Auditory-Verbal Therapy programs. The Volta Review, 109, 61-85.
Dornan, D., Hickson, L., Murdoch, B., Houston, T., & Constantinescu, G. (2010). Is Auditory-Verbal Therapy effective for children with hearing loss? The Volta Review, 110, 361-387.
Fulcher, A., Purcell, A.A., Baker, E., & Munro, N. (2012). Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age. International Journal of Pediatric Otorhinolaryngology, 76, 1785-1794.
Fulcher, A., Baker, E., Purcell, A., & Munro, N. (2014). Typical consonant cluster acquisition in auditory-verbal children with early-identified severe/profound hearing loss. International Journal of Speech-Language Pathology, 16(1), 69–81.
Hogan, S., Stoke, J., White, C., Tyszkiewicz, E., & Woolgar, A. (2008). An evaluation of AVT using rate of early language development as an outcome measure. Deafness and Education International, 10(3), 143-167.
Rhoades, E.A., & Chisolm, T.H. (2000). Global language progress with an Auditory-Verbal approach for children who are deaf and hard of hearing. The Volta Review, 102, 5-24.

Wilkins, M., & Ertmer, D. (2002). Introducing young children who are deaf or hard of hearing to spoken language: Child’s Voice, an Oral School. Language, Speech, and Hearing Services in Schools, 33(3), 198-204.

Learning To Listen Sounds

This printable handout of the Learning to Listen Sounds can be found HERE on the John Tracy Clinic's blog with Ideas and Advice for Parents of Children with Hearing Loss. Similar information is available at many Auditory Verbal Therapy websites.

REPETITION: Everyday Activities and Routines to Build Listening and Language Skills

Today's post was adapted from a blog written with help from 

Joanna Brachmaier, a rehabilitation and education specialist at MED-EL.

http://www.medel.com/blog/build-language-skills-routines/

Intended for children ages 3–9.

Routines by definition happen the same way over and over, but that doesn’t mean they need to be boring. No, in fact they can be beneficial! Use the repetition to help your child build language skills.

Repetition Helps Build Language Skills

By speaking the same words or phrases over and over you can build and reinforce your child’s understanding of these words and phrases. When incorporated with routines, you can help your child to learn specific words and phrases without needing any special toys or materials.

Here are some of the different routines that you can use to build language skills:

• Cleaning the house or a specific room
• Having a bath
• Cooking or preparing for meal time
• Reading a book
• Putting on clothing in the morning
• Getting undressed in the evening
• Going to bed

What to Do

Depending on the specific routine or activity, here are some of the different things that you can do:

• Use straightforward, but meaningful, language:
  • “Up, up, up! Go up on to your bed.”
  • “Your pajamas are under the blanket.”
• Prepare your child by setting the scene:
  • “It’s night time, it’s time to go to bed!”
  • “Now let’s read a book.”
• Narrate what you are doing:
  • As you grab the toothpaste, say “now it’s time to squeeze the toothpaste onto the toothbrush.”
  • As you grab a pair of pants, say “now here are your pants”
• Name each and every object when you first use it or approach it:
  • “Let’s grab the forks and knives.”
  • “Don’t forget to tie your shoe laces.”
• Imitate the sounds that your child will hear:
  • “The bath water goes splash, splash, splash!”
  • “The zipper goes ziiiiiiiiiiip.”
• Encourage your child to respond, like saying the word or sound or giving objects names:
  • “What sound does your stuffed animal make?” If it’s dog for example, then encourage them to say “Bark! Bark!”
  • “Where is the broom and dustpan?” Then encourage them to say, “In the closet!”
• When dressing, give your child the chance to choose:
  • “Do you want the red shirt or the yellow shirt?”
  • “It’s cold outside. What clothes do we need?”

Make sure to encourage your child to play an active role in all of these activities so that he or she engages with the words you’re using. Soon, by doing these exercises over and over again you can help your child to build language skills. Once you feel they’ve mastered some words then move onto more difficult ones. Your child’s progress might surprise you!