Tip Tuesday: Auditory Teaching Strategies!

It’s October, which is also Audiology Awareness Month so I though I’d share information from the two audiology based presentations I went to during the ASHA school convention (2013) over the summer.

The first of which is a summary of the presentation by Teresa Caraway, PhD, CCC-SLP, LSLS Cert. AVT titled Auditory Teaching Strategies to Facilitate Listening, Language and Literacy Development.

Note: The following information is being shared directly from my notes of this presentation with the permission from Dr. Caraway.

In this presentation, Dr. Caraway shares 12 auditory teaching strategies she believes from which every child with hearing loss or hearing impairment could benefit.  But first she shared a few statements she wanted us to remember:

  1. Every parent we meet as SLPs, and AuDs, never wanted to meet us (b/c they never wanted to have child with HL).
  2. 95% of babies with HL are born to hearing parents.
  3. We need to remember it is not just about the child’s story.  Rather the parents will also have untold stories as well that may affect treatment decisions so we must be aware of this and listen to their stories as well.

Typical brain development was described as the following:
Hear->Listen->Talk->Read->Write->School->Secondary School->Professional Flexibility->Personal Flexiblity

Dr. Caraway’s point was that every thing any of us learn or do in our lives begins with our ability to “hear”.

Important Information about Hearing Development:
  • It takes practice and stimulation to “hear”
  • We are born with 100 Billion neuron at birth that will make connections based on the stimulation they receive
  • Via Cochlear Implants (CI) we now have the technology to reach the auditory cortex
  • The auditory cortex is active when reading and hearing so it is necessary that we are able to connect to the auditory cortex for overall development
  • It takes 20,000 listening hours for a typical child to have a foundation for reading
  • Children with HL require 3xs as much exposure=60,000 listening hours
  • Children need access to ALL sound of speech through their ears and the signal MUST be loud enough!  As SLPs this translates to us working with AuDs to make sure access and intensity levels are accurate.  We need to perform the Ling 6 test (at 3, 6, 20 ft to see where the sound(s) “drop off”)
  • “Eyes Open=Technology On”: Hearing Aids (HA) or any amplification MUST be worn all waking hours.  (if a child only wears a HA for 4 hrs/day it will take 6 yrs to learn what a typical child will hear in 1 year).  DO NOT take the HA off at lunchtime or in the play ground.  Yes! Its loud but these are sounds the child must learn to hear!!!
  • Tip: use sealing agents to get more mileage out of ear molds (especially for rapidly growing ear canals)
  • There is a group call Hearts for Hearing that is fitting 6-9 DAY OLD babies with hearing aids.
  • ALWAYS BEING THERAPY WITH THE END IN MIND!  (meaning we should always ask ourselves where we want to see this student/client in 20 years from now).  However must also work with the parent’s goals in mind as well, not just our own.

Dr. Caraway’s 12 Auditory Teaching Strategies for Listening and Spoken Language:

  1. Be a Director:  you need to direct the child initially to the sounds you hear b/c everything is noise to them.  So you can say “Listen (pause) I hear that.”  The goal is to distinguish between the absence/presence of sound.
  2. Be a Bird dog:  this step you will actually point out what sound you are hearing.  “Listen (pause) I hear that.  I hear the doorbell.”
  3. Hear it BEFORE you See it:  remember audition first; you need to have “ear contact” before “eye contact”.  So you aren’t going to ask the child to “look at you” to make sure they are listening.  You want to draw their attention to the object (rather than your lips) and name that object.  The focus is on growing the brain from audition NOT vision!
  4. Play by Play:  this technique requires you to be like a radio commentator describe the actions (this is the equivalent to self-talk and parallel-talk in a sense as you are describing what is happening, how you are feeling, problem solving out loud, etc.).  Also this step encourages the use of familiar phrases (“Give it to mommy”, “Line up”, etc.)
  5. It’s Your Turn:  with this technique, you are going to expect responses from the child by leaning in toward the child, looking expectantly at him/her waiting for a response.  You may use a hand cue, or cue parents or peer models to help out by modeling “you could say…”, or “you could ask…”. Provide auditory closure activities if the child is not responding or doesn’t know how to respond.  Tip: begin at the most complex level, and give the child time to respond before giving additional cues.  This way you can determine the true level of cuing a child requires to be successful.
  6. Keep ‘Em On their Toes!:  manipulate/sabotoge the environment or be “creatively stupid on purpose” as Dr. Caraway says.  An example would be to pretend you forgot the the child was coming to therapy and say “Oh my gosh, I completely forgot you were coming today.  You’ll have to decided what we are going to do today.”  Use others again as a model (“You could ask…”).  And use embellishments (create wild, crazy stories to keep them motivated).
  7. Make it Easier:  make listening easier by controlling the listening environment, moving closer to the child, siting next to the child on his/her better hearing side (if unilateral HL), (with bilateral CI) switching sides each session, and using acoustic highlight (whisper, sign, say “Listen..”).
  8. Create a Listening Sandwich:  So you are going to say something (audition), then cue the child as needed (signs, pointing, showing ,etc.), then repeating the same direction again (audition).  You made a listening sandwich: audition-cuing-audition.
  9. Beyond the Here and Now:  this is where echos and expansions come into play.  You are going to model what the child just said and expand upon it.  Provide extension to the child’s utterance by sharing information related the current topic or changing the topic.  Bridge the language experiences to books (journals, etc.).
  10. It’s All About Me:  Put the family members names and the child’s past experiences into the book.  Make the book all about the child and talk about it.  Have the parents go home and each week add to the book so the child has to come back and tell you what he/she did that week.
  11. Help Me but Don’t Tell Me:  cue the child by describing the object, it’s category, attributes, etc., ask for the child to provide more information when vague, give a phonemic cue (“it rhymes with…”), suggest opposites.
  12. What did You Hear?:  when kids say “huh?”, “what?”, or “I don’t know”, we tend to repeat what we just said and when we do this we are teaching children they don’t have to listen the first time.  Instead we want to encourage listening by asking them “Well, what did you hear?” (NOT “What did I say?” b/c then they think they are in trouble).  This can also break the habit of that child who constantly uses “huh?” and it builds confidence in a child’s listening skills.  If when the child repeats what he/she has heard and seems to always miss the middle part of the sentence, try to acoustically highlight that part to see if it helps.  If not you may be looking at auditory memory vs. auditory processing issues and may have to consult with the student’s audiologist.

How do we Implement these strategies? We can encourage parents (and ourselves as SLPs) to do so using:  
  • Daily Routines
  • Play Routines
  • Social Routines
  • School Routines
  • Using books (children’s lit is a great way to teach listening and spoken language and you can have discussions about books and expand upon them, etc.)
  • Work on Theory of Mind by making statements such as (these are just some suggestions from Dr. Caraway’s notes): 
    • What if…
    • If I were…
    • I wonder…
    • What could happen…
    • What do you think…
    • When I grow up…
    • This reminds me of…
    • One time…
    • Remember when…
As you can tell this was a wonderful and practical presentation to attend.  I’m so glad Dr. Caraway gave me permission to share this information with you.  Please go to the ASHA website to download her notes from this conference for more information!!!

As always…happy talking and listening!!!

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