How to Encourage Language in Toddlers: Part Two

Encouraging Language: Rule out a Hearing Loss

If you are worried about your child's speech and/or language development, here's the first thing you should do: Rule out a hearing loss.  This does NOT mean standing behind your child and clapping your hands or jiggling some keys around to see if they notice.  A hearing loss can be very mild or very severe.  Each and every type of hearing loss can go undetected for one reason or another.

(This is my little guy after he passed his newborn hearing screening - yay!)

Most every newborn nowadays gets their hearing checked at birth - which is a great thing - but sometimes a hearing loss develops as the child grows.  In addition, newborn hearing screenings are conducted at slightly louder levels, which means that they could pass the test but still have a very mild hearing loss.  What all that means is, even if your child passed a newborn screening, they could still have a hearing loss.  I'm not trying to scare you here.  There's a very good chance that your child doesn't have a hearing loss.  But you'll never know unless you get them tested.  Find a local pediatric audiologist who can give your child a quick test.  I always say that nothing is worse than not knowing.  Do you agree?  The key here is to recognize that even a mild hearing loss can cause significant delays in speech and language development.  Once you have a hearing loss ruled out then you can rest easy knowing that your child will have no problems hearing all the language that you model for them.

Have you heard of this app?

Peek-a-boo Barn 

Have you heard of this darling app?  Peek-a-boo Barn is great for very young kids, ages 1-4.  I like using it with late talkers to encourage vocalizations.  It is good for teaching animal vocabulary and animal noises.  Animals rotate hiding in the barn and the child has to tap the screen for the door to open.  I like it for children with hearing loss too because before you open the door, the animal is making a very quiet noise. When the door is opened it becomes louder.  It's fun to guess what animal is hiding by listening to the sound they are making.  Young children with Down Syndrome or Cerebral Palsy also particularly like this app.  It does not require fine motor coordination.  Because of that my 8 month old loves it!  There is a lite version which is free.  The regular version is $1.99.  Take a look!

Preschool Sorting Activity: Farm and Jungle Animals

Hello reader!  Thank you for stopping by.  Are you a follower?  If you're not would you please become one? I would love some more.

My last sorting activity was pretty popular so I thought I would share another one with you!  Animals are always a fun and easy concept to teach to preschoolers.  It's important for them to start distinguishing that animals live in different places and have different characteristics. You can also use this activity to teach the animal sounds.  This activity could also be a great describing activity.  Instead of cutting the animals out beforehand, show your child the sheet with animals and describe what you're going to cut out next.  See if they can guess what you're talking about!  You can vary the difficulty level.  For example, "I'm going to cut out the animal that says 'Moo'".  Or you could make it more challenging and say, "This animal has a mane, a tail, and you can use a saddle to ride on it."  You can also turn the tables and let your child try to describe an animal.  Kids love being the teacher!  After the animals are cut out you can do the same listening/describing activity again as you glue them onto the animals' home.  Kids love repetition - don't shy away from it!  

Video: Skye

This is Skye.  She was born deaf.  See the possibilities of what a cochlear implant can do by watching her story.

Skye Carter: Hearing for the First Time from Adam Irving on Vimeo.

Auditory Verbal Therapy: Part 10

Auditory Verbal Therapy: Part X

Principle X

Promote education in regular classrooms with typical hearing peers and with appropriate support services from early childhood onwards.

We're talking mainstreaming.  Children who are born deaf can definitely be placed in a regular classroom with hearing peers.  This is happening more and more often.  Parents and professionals should plan and prepare for this if they think it is a good fit for the child.  Many children who are born deaf are also born with other challenges such as Down syndrome or cerebral palsy and may require a specialized setting.  Work as a team to figure out what is reasonable.  Teamwork will be necessary.  The team should consist of: the parent, speech therapist, audiologist, classroom teacher, principle, resource teacher, and AV therapist.  Am I missing anybody?

Auditory Verbal Therapy: Part 9

Auditory Verbal Therapy: Part IX

Principle IX

Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress, and to evaluate the effectiveness of the plans for the child and family.

Every therapy session should be diagnostic in nature.  This means that the therapist should always be alert to the child's progress and performance in listening, language, and speech.  Standardized tests should always be administered every 6 months.  A great standardized test that looks at listening, language, and speech is the Cottage Acquisition Scale for Listening, Language, and Speech (CASLLS).  

Auditory Verbal Therapy: Part 8

Auditory Verbal Therapy: Part VIII

Principle VIII

Guide and coach parents to help their child self-monitor spoken language through listening.

Parents are encouraged to imitate any noises the child makes.  This can be a very fun game for mom and baby, and it helps develop the auditory feedback loop.  The child needs to have the skills of listening to what other people say, and repeat it.  This then transfers into the child being able to listen to their own speech and modify it.  This strength is crucial to developing proper speech and language skills.  All this from saying, "Goo goo" and "ba ba ba" and "mee mee mee"?  You betcha!

Auditory Verbal Therapy: Part 7

Auditory Verbal Therapy: Part VII

Principle VII

Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication.

I think the key word here is expectations.  Parents need to understand that children follow a developmental sequence with regards to language, cognition, and speech.  The child needs to continue on that developmental path.  We can't skip steps.  We can certainly move through them more quickly, and we hope to catch them up to their peers, but there are no shortcuts.

 Another key concept is hearing age.  We have to take into account how long the child has been hearing.  AN important thing to understand is that listening and speech develop together - not separately.  This article is my favorite reference for further discussion on these important concepts.

Auditory Verbal Therapy: Part 6

Auditory Verbal Therapy: Part VI

Principle VI

Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child's life.

Children born with hearing loss, especially if it is amplified late, are not natural listeners.  It needs to become a habit.  And habits can be taught!  Parents need to learn how to take advantage of everyday listening moments and capitalize on them.  For example, the mom and baby are playing with blocks and the doorbell rings. She could just get up and go answer the door, but she would be missing out on a great learning opportunity.  Mom should sit up straight and announce, "I heard something!" and point to her ear.  She is teaching the child to notice sounds as they occur around her.  She is also teaching her that sounds go through the ear/hearing aid/implant thus teaching the child the importance of the device that they wear and its connection with noises. 

Auditory Verbal Therapy: Part 5

Auditory Verbal Therapy: Part V

Principle V

Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child's daily activities.

Dishwashers are loud.  So are air conditioners and fans and fish tanks and lights and washing machines.  A house can be a loud and distracting place, especially for a child with a hearing loss.  They need to hear conversations happening around them in order to learn language, and background noise makes that so much more difficult.  Therefore a big part of AV therapy is educating parents to be more aware of the noises that surround them and convince them how important it is to reduce it as much as possible.  Run the dishwasher at night.  Same with the dryer and washer.  If your lights hum (like the ones in my kitchen - so obnoxious) then just leave them off.  Classrooms are a totally different story but most teachers are open to trying whatever they can to help the classroom be a quieter place.  After all, it improves learning for all children, not just the ones with hearing loss (Nelson, Soli 2000).

Auditory Verbal Therapy: Part 4

Auditory Verbal Therapy: Part IV

Principle IV

Guide and coach parents to become the primary facilitators of their child's listening and spoken language development through active, consistent participation in individualized Auditory-Verbal therapy.

Auditory Verbal Therapy is a big commitment for the whole family.  Most therapists I know have a serious discussion with the parents before they start therapy in order to make sure that they know it will require lots of time and effort. Still, most parents I've met are happy to be involved and learn more.  They feel validated to know that lots of the things they are doing at home already (reading books, singing songs, telling stories) are providing necessary foundations for their child's learning.  They just need to be taught some strategies and skills to use along with those activities that can help strengthen specific skills such as: listening, articulation, auditory memory, sequencing, categorizing, and many more.

Auditory Verbal Therapy: Part 3

Auditory Verbal Therapy: Part III

Principle III

Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language without the use of sign language or emphasis on lipreading.

This might be a therapist or a mom, but whoever it is they are doing it right!  She knows to talk next to but not in front of the child.  She is optimizing listening and inhibiting visual cues.

Guiding, coaching and teaching parents is a big deal.  In fact, my experience with AVT has really helped me realize the power of empowering parents in any type of therapy. Who knows the child the best?  Who spends the most time with them?  Who wants what is best for them?  Who has hopes and dreams for this child?  The PARENTS.  Therefore they are the center of AVT.  When the parents feel knowledgeable and confident, the child's is more successful and the parents no longer feel like helpless bystanders.  The importance of this is reflected in the fact that principles 4-8 also revolve around coaching the parents.

Auditory Verbal Therapy: Part 2

Principle II

Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.

A child born with a hearing loss should be fitted for hearing aids as soon as possible to receive auditory stimulation.  The early years are the most crucial.  The first 3 1/2 years of life are when neuroplasticity is at its greatest, meaning the brain is the most adaptable.  The younger the child, the more adaptable the brain and the easier it will be for them to learn to listen and talk.  Therefore, the older the child, the more difficult it is because the auditory centers of the brain have begun to reorganize themselves. (Sharma et al., 2002; 2004; Sharma, Dorman, and Kral, 2005).

Auditory Verbal Therapy: Part 1

Principle I

Promote early diagnosis of hearing loss in newborns, infants, toddlers, and children, followed by immediate audiologic management and Auditory-Verbal Therapy.

Most states have implemented a newborn hearing screening program in which many types of hearing loss can be detected.  We need to ensure that when a child is identified with a hearing loss, the family is educated regarding all of their options and that appropriate follow-up is established.  A child can be fitted with a hearing aid as early as one month: the time it takes for a complete audiological exam, molds to be made, and the hearing aid to be ready for the child.

Auditory Verbal Therapy Series: Introduction

Fact:  90-95% of children with hearing loss are born to hearing parents (Mitchell & Karchmer, 2004).  This fact means that most parents who have a child with hearing loss don't know any sign language and would like their child to learn to listen and use spoken language.  With today's technology that is possible!  Which means many parents are choosing Auditory Verbal Therapy because the possibilities that it provides most closely match their hopes and dreams for their child.  I've decided to do a series on the principles of Auditory Verbal Therapy because it is still a relatively unknown area.  I studied these principles very closely in college and someday would like to become one of the current 600 Listening and Spoken Language Specialists.  It's quite the process but I'll get there eventually!  

Join me tomorrow as I discuss Principle I of Auditory Verbal Therapy! 

Fun Fact Friday

Did you know that by the 20th week of gestation a baby's cochlea is fully formed?  That means by the time a child is born they already have 20 (ish) weeks of hearing experience!  That's why they show preference towards their mother's voices at such a young age.  It's also why it's so important to get a child fitted with hearing aids as soon as possible once a hearing loss is detected.  They're already 20 weeks behind so it's important to act quickly if you want your child to develop age-appropriate listening and speaking skills.

Guest Post: Hearing Loss Basics

This article was submitted to me by new blogger John O'Connor from Blogging With John O.  Like me, John has a desire to spread the word about hearing loss and related issues.  We hope you learn something new from it!

In the United States, two to three children in every 1000 suffer hearing loss or are completely deaf. Unfortunately, some hearing loss in small children is not recognized until the child is already behind in language.  Early intervention is necessary to help parents take the necessary steps to prevent delays in language development.

What Precautions Can Be Taken to Prevent Hearing Loss In Children?  

All 50 states offer a newborn hearing screening, Early detection is crucial, and along with early intervention, children can learn to listen and speak without getting behind in language skills.

What are the Causes of Childhood Hearing Loss?

 
Otitis Media

  This condition can lead to permanent hearing loss if left untreated. Otitis media is a middle ear infection that often occurs in underdeveloped Eustachian tubes common in developing children. With this type of infection, the fluid builds behind the eardrum and becomes infected. If the fluid remains there for a prolonged period of time, it can impair hearing.

Acquired Hearing Loss

Certain illnesses can cause hearing loss in children. These conditions include: encephalitis, meningitis, measles, influenza, head injuries, chickenpox, genetic hearing loss, very loud noises and certain medications.

 Congenital Factors

Some children who are afflicted with hearing loss from childbirth may experience loss because of genetics or because of prenatal complications. More than half of children’s congenital hearing problems are due to genetics. Children’s hearing loss can also occur when the mother has diabetes or toxemia during pregnancy. Hearing loss is also more common in children born prematurely.

How to Notice Hearing Loss in Children

•           Children Do Not React to Loud Noises
•           Children Do Not Respond to a Mother’s Voice
•           Children Pull or Rub Ears
•           Children Are Irritable for No Apparent Reason
•           Children Do Not Understand/Follow Directions
•           Child is not reaching early language milestones 
•           Child Has Ear Pain accompanied by a Fever

How to Treat Childhood Hearing Loss

Medications

A pediatrician may prescribe antibiotics to alleviate the symptoms associated with ear infections and hearing loss.

Hearing Aids

Children with hearing loss can begin wearing hearing aids as early as one month old.

 Ear Tubes

A child may need ear tubes to drain the fluid from the eardrum and prevent infection. Children may require an ear, nose and throat (ENT) specialist for this procedure.

Implants

Children may require cochlear implants or electronic devices to help with hearing. These devices should be used only after hearing aids have been found ineffective.

The Ling 6 Sound Test - An Overview

Have you ever heard of the Ling 6 Test?  It's a quick listening test devised by Daniel Ling, who was one of the foremost authorities on teaching children with hearing loss how to listen and speak.  The 6 refers to 6 speech sounds ranging across the speech spectrum, meaning that the frequencies of these sounds span the audiogram from low to high frequencies, 250 Hz to 2000 Hz.

Why is it important?  Well, if you are trying to teach speech to a child with hearing aids or a cochlear implant, you will need to make sure that their amplification device is working properly and that they can hear the sounds in speech.  No point in teaching them speech if they can't hear you, right?  I can't tell you how many times I have done this quick test only to discover that the batteries are dead.  It could even indicate a problem with the mapping of a cochlear implant.   It also provides an opportunity for younger children to practice play audiometry, which is crucial for them to be able to get their hearing aid appropriately adjusted or their cochlear implant properly mapped.

You can expect to be able to do this test in less than a minute after the child is trained.  You will have to start at the detection level - meaning the child simply has to respond that they have heard something, usually by putting a block or bead in a box or a cup each time they hear a sound.  Then as soon as you can, move on to the identification level, by having the child repeat the sound they have heard.  This way you know that not only are they hearing something, but also that they are hearing it accurately.

And now, I'll tell you what the sounds are, in order from lowest frequency to highest.

/m/
/oo/
/ah/
/ee/
/sh/
/s/

Here is a video of me doing the Ling 6 test with my two year old friend:

By the way, he's not looking at me - he's looking at his mom, which is fine as long as mom doesn't have any 'tells' that let him know he should respond.  Which she doesn't.  But you can also place a stuffed animal or poster or something in front of them for them to look at while they are listening.

Other considerations when conducting the Ling 6 Test:
- Do not let the child see you
- Speak at a normal loudness level
- Vary your distances, start close and go to 3 feet, 6 feet, and 9 feet
- Do not present the sounds in a rhythmical fashion, or else the child will begin to anticipate the sounds and may give you false responses.
- Present them in a mixed order each time
- I recommend that every parent who has a child with hearing aids or a cochlear implant administer this test on a daily basis.  Just make it part of your morning routine.

For fellow speechies:  Do you work with children with hearing loss?  Do you have hearing specialists in your districts? Do you only work with children with hearing loss if they have a speech disorder, like a lisp or something?  Our district has hearing specialists but I always was confused on how their role differed from mine.  We always seemed to be working on the same things. And many of my co-workers didn't realize that I do work on listening and language, not just articulation.  I would love feedback in this area.

Book Review: We're Going on a Bear Hunt by Michael Rosen

This book is such a classic!  There are so many things to love about it.

One of my favorite elements is its repetitiveness.  Younger children will pick up on the 'chorus' quickly and enjoy reading along with you.  (Great auditory memory activity for children with hearing loss!)  I also love how well it lends itself to reading with rhythm, as if you're marching. A great activity that goes along with this book is having the child make their own drum, and then take it on a bear hunt! The child can work on following directions, (a crucial skill and one I always try to incorporate somehow).  Then hide your child's teddy bear around the yard or inside the house while they recite the 'chorus':

"We're Going on a Bear Hunt

We're going to Catch a Big one!

What a beautiful day!

We're not scared!"

Another great thing about this song is how easy it is to add actions.  If you need ideas, watch Michael Rosen himself act out the book.  It's quite entertaining.  What a character that man is.

ALSO - prepositions!  This book really reinforces the concepts of 'over' and 'under' and 'through', which are sometimes hard to grasp for little ones.  Throw in actions for these too!

Charlotte from Make Do & Friend had this darling idea to help reinforce the vocabulary and make it fun!  I'm dying to try it!

This book is also fun to use to teach descriptions.  "Long, wavy grass" or "deep, cold river" are some phrases from it.  Have your child come up with their own descriptors.  No wrong answers!  Well, that's not necessarily true.  But you know what I mean.

Another reason I like it (also good for kids with hearing loss) is it teaches onomatopoeia.  "Swishy, swashy" or "squelch squerch" are really fun to say!  They reinforce the idea that certain things (like mud and grass) make different sounds and how we sometimes try to imitate that in English.

FUN STUFF!  What other ideas do you have for this book?

Hearing Journey Website

If you haven't heard of The Listening Room, you need to check it out right now!  Actually, wait until you finish reading this post.  Or go right now.  Either way.  The website is targeted for children with hearing loss, and is provided by Advanced Bionics.  But the activities provided are great for parents and professionals, and for any children with language goals!
There are a few artists, but the main one is Dave Sindrey, who is also a certified auditory verbal therapist and therefore specializes in teaching children with hearing loss how to listen and speak.  And therefore I love him!!!  You have to sign up to enter, but it is free and I never get emails from them.  It's divided into an infant section, kids section (the one I use the most), and an adults/teens section.  In the Kids section, each week there is a new language activity that comes with instructions and a PDF file for you to download.  Most things are not archived so I try to check it frequently and save everything to my computer.  There are also some great informational articles that are great to printout and distribute to parents.  And several activities and articles even come in Spanish which is fabuloso!