Development of an Auditory Function/ A-V Techniques

1. Development of an Auditory Function/A-V Techniques Developed by: Beth Walker, M.Ed., C.E.D., LSLS Cert. AVT Kathryn Wilson, M.A., CCC-SLP, LSLS Cert. AVT Megan Katz, MS, CCC-SLP, LSLS Cert. AVT

2. Presented by: • Megan Katz, MS, CCC-SLP, LSLS Cert AVT • Sherri Vernelson, M.Ed., LSLS Cert AVEd

3. Agenda • Auditory Processing, Neuroplasticity of the Auditory System and Critical Period for Development of Auditory Function • Normal Auditory Development • Speech Acoustics • Auditory-Verbal Techniques and Strategies • Guide to the Development of Auditory Skills • Assessment • Development of an Auditory-Verbal Program

4. Learner Outcomes • Examine research on auditory brain development and how this impacts auditory learning of children with hearing loss. • Identify and sequence specific auditory behaviors that occur in the development of spoken language and will identify components of a detailed model of auditory learning. • Apply information about specific formant frequencies of individual phonemes to the auditory learning of spoken language.

5. Identify factors that affect the auditory reception of spoken language and select appropriate strategies and techniques for assisting auditory perception of particular features of spoken language. • Predict levels of development in speech, language, cognition and communication in relation to level of auditory development. • Develop A-V lesson plans including goals, activities, strategies and carry-over ideas for specific cases.

6. Auditory Brain Development & Auditory Processing We know what you are thinking…. What a fun, exciting, interesting, motivating, attention-grabbing, fascinating way…. to start the day!!!

7. The goal for children in an AV approach is spoken language. • The MOST effective modality for acquiring/teaching spoken language is HEARING. • What do we know about the relationship between listening, literacy and success in reading?

9. Auditory Brain Development It’s all about the BRAIN! The ears are just the way in…

10. Quick Quiz…We’ll answer these & other REALLY important questions • Measurable differences in brain organization and neural activity is caused by ______ ______. • Research by Sharma indicates that the brain waves of children who begin wearing hearing aids or cochlear implants by _____ years of age reflect a normal response to sound. • What is developmental synchrony?

11. Is there a critical period for the development of auditory function? • A-V Principles 1 & 2 • Newborn hearing screening programs & 21st Century technology allow access to the auditory centers of the brain • Access is a good thing! In fact, it is great! Is it enough?

12. Easy Math… • Early identification + early & appropriate technology + appropriate intervention by parents & professionals during the period of maximum neural plasticity = potential for achieving high levels of speech, language, reading, literacy & success in school.

13. Neuroplasticity----Current Research • The infant brain has neural plasticity. • Complete maturation of the central auditory pathways is required for the normal development of spoken language in children. • The period of greatest neuroplasticity is the first 3 ½ years of life (Sharma et al, 2002; 2004; Sharma, Dorman, and Kral, 2005). • Children implanted by 12 months of age may demonstrate more benefit than children receiving implants later on in the period of maximum neural plasticity (Sharma, Dorman, and Kral, 2005). • When children acquire skills at or near the time that they are intended to do so biologically, this is called developmental synchrony.

14. Making the Connections… • A baby’s brain continues growing beyond the womb—not just in size, but in forming connections • Born with 100 billion neurons. By 3 years of age babies have about 15,000 synapses per neuron, three times the synapses of adults. • What happens to synapses that are not accessed?

15. Making the Connections… “Babies are citizens of the world.” • Neurons in the auditory cortex • Laborers with no job assignments • As the infant is exposed to spoken language, different clusters of neurons in the auditory cortex are recruited to respond to different phonemes • Neuron clusters fire only when a nerve from the ear carries a particular sound • By 12 months of age a child’s “auditory map” is established

16. Making the Connections…Training OR Learning? • For the young child,meaningful contexts are crucial for the auditory processing of spoken language. • “The hearing-impaired child’s auditory abilities develop ‘because emphasis is placed on listening throughout all waking hours so that hearing becomes an integral part of his/her personality.” • (Pollack, 1985)

17. It’s All About Experience • Experience & Vocabulary • Vocabulary size correlated with quantity of maternal “talk” • 20 months of age—offspring of talkative mothers averaged 131 more words than children of less talkative moms • At age two, the gap doubles • Critical factor—number of times the child HEARS different words • TV doesn’t produce same results. Why not? • Information within context seems to stimulate neural circuitry

18. What happens when the auditory centers of the brain are not accessed early? • Decreased ability to use sound meaningfully (cross-modal reorganization) • Physiological changes • Psychosocial factors • When the hearing aids are OFF what happens?

19. Auditory Processing of Spoken Language • “The auditory processing ‘whole’ is greater than the sum of current knowledge of its hypothesized parts.” • (Cole,1992, 2006)

20. Components of auditory processing models • Peripheral hearing structures are responsible for analysis and conversion of speech/acoustic information to nerve impulses for transmission to the brain • Brief memory storage required • Preliminary processing in the brainstem • Localization and selective attention • Auditory cortex receives input • Higher level analysis includes: phonetic, phonological, syntactic, semantic, and pragmatic/contextual processing

21. Take Home Points… • We hear with the ____. • Neuroplasticity is greatest during the first ___years • What is the purpose of hearing aids and cochlear implants? • What happens when the auditory centers are not stimulated early? • Full maturation of the central auditory pathways is a must for________.

22. References • Bock, P., (2005). How do babies learn to talk? Retrieved on July 1, 2007 from http://seattletimes.nwsource.com/pacificnw/2005/0306 • Cole, E., & Flexer, C. (2007). Children with hearing loss: Developing listening and talking birth to six. San Diego CA: Plural Publishing • Sharma, A., Dorman, M.F., Kral, A. (2005). The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants. Hearing Research, 2-3, 134-143. • Sharma, A., Dorman, M.F., & Spahr, A.J. (2002). A sensitive period for the development of the central auditory system in children with cochlear implants: Implications for age of implantation. Ear and Hearing. 23(6), 532-539. • Sharma, A., Martin, K., Roland, P., Bauer, P., Sweeney, M.H., Gilley, P., et al. (2005). P1 latency as a biomarker for central auditory development in children with hearing impairment. Journal of the American Academy of Audiology, 16, 564-573.

23. Let’s Talk about Hearing Age • Relationship between age at first amplification and a child’s chronological age • Calculated from the day the child begins wearing amplification • Hearing age is the term used to put progress in perspective • Listening experience • Mixed hearing history

24. Other Terms • Cochlear Implant Age = length of time since CI “hook-up.” • A-V Age = length of time enrolled in Auditory-Verbal Therapy • Language Age = level of understanding and use of language

25. Application • John is an 11 month old boy whose moderately severe bilateral hearing loss was diagnosed at two months of age. He began wearing hearing aids at 3 months of age and began AVT at the age of 5 months. • What is John’s hearing age? What is his program (AVT) age?

26. At a chronological age of 3 years 8 months, John obtained the following scores on standardized measures of language: • PLS-4 • AC 101 • AE 98 • Total Lang. 100 • A.E. 3 years, 7 months • Peabody Picture Vocabulary Test-III • SS 92 • A.E. 3 years, 3 months • Discuss the test results for John in relation to: • Chronological Age • Hearing Age • Program Age

27. Application • Cate is 4 years, 6 months of age. Her severe-profound bilateral hearing loss was identified at 13 months of age, and she was subsequently fitted with hearing aids at 15 months. • What is her hearing age? • Cate received a cochlear implant at 2 years, 6 months and began AVT at the same time. • Note: Cate was enrolled in a TC program from 16 –28 months of age. • What is Cate’s CI age? AVT age?

28. At 4 years, 6 months of age, Cate has an expressive vocabulary of 284 words. She consistently uses 3-word combinations spontaneously such as “I want cookie” “no want that” and “I do it.” She can recall 3 critical elements, identify objects when given related descriptors and can identify segments of sequence stories. She demonstrates accurate vowel production and uses /p/, /m/, /w/, /h/ correctly in spontaneous speech. Cate uses all suprasegmental features of speech appropriately. • Discuss Cate’s present level of functioning in relation to her: • Chronological Age • CI and AVT Age

29. Stages of Auditory Development • Follow the normal sequence of development • A basic premise of Auditory-Verbal education is that limited-hearing children need the same foundation of listening experiences as a normal-hearing child regardless of the age at which intervention occurs

32. Speech Acoustics Let’s Review…

33. Why should we know this? • Knowledge of speech acoustics helps us: • Bridge the disciplines of audiology and habilitation • Judge what speech information is available to a child through hearing • Teach parents what the child can do or has the potential to do with his/her aided hearing • Select strategies to facilitate the processing of spoken language through audition

34. “ah”

35. “eye”

36. /s/ /e/ /v/ “save”

37. “mean” /m/ /i/ /n/

38. “tide” /t/ /ai/ /d/

39. Multimedia FUN! • http://www.utdallas.edu/~thib/EARRINGFINAL/EARRINGWEB_files/frame.htm • http://hctv.humnet.ucla.edu/departments/linguistics/VowelsandConsonants/course/chapter1.1/chapter1.1.htm#four • http://hctv.humnet.ucla.edu/departments/linguistics/VowelsandConsonants/course/chapter8/speechbird/speechbird.html • http://www.oraldeafed.org/movies/heardiff.html

40. Auditory-Verbal Strategies and Techniques

41. Position to maximize auditory input • Sit behind the child? • In front of the child? • On top of the child??? • Beside the child? • On which side?

42. Position to maximize auditory input • Optimal distance is • Within ___ inches of the HA microphone • Within ___ inches of the CI microphone • Come close to me at 6 dB…… • Amplification should be set so that child can easily hear you at a distance of ___

43. Maintain Favorable Auditory Learning Environment • This means controlling ___ & ___ • In which of the child’s learning environments can the adult exert control over these factors? • How?

44. PositioningFavorable Auditory Environments • GREAT website! • Contains audio files for demo of FM with/without hearing aid, what a CI sounds like, simulations of auditory neuropathy, etc. • http://www.utdallas.edu/~thib/EARRINGFINAL/EARRINGWEB_files/frame.htm

45. Attention Getters • The “Listen!” Cue • Audition FIRST • Not show and tell but Tell and Show • Why hearing first? • Sing What You Say/Parentese • Get Closer

46. Helps for PROCESSING through Audition • CLEAR Speech • Speak Suthun: i.e., a slightly slower rate of speech • Acoustic Highlighting: more to less • Lowlighting/Whispering: Why?

47. Helps for Processing • WAIT Time + Expectant Look • The ___ the child, the more wait time needed • The Expectant Look says… • Repetition: Why? • Pause before challenging word/s

48. Helps for Processing • Word position in sentence • Give a choice • What DID you hear?

49. And if you must… • A-V-A Sandwich or “Put it back into hearing” • Give visual context for auditory input • Point to the picture/object • Natural gesture • Facial expression • Adjust set size

50. Helps for Confident Listening • Modeling • Converse slightly above child’s linguistic level • Diagnostic Teaching, NOT testing • Known →unknown, audible →less audible