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SLPs and Audiologists: A Dynamic Duo and What Info They Should Share Denise Wray, Ph.D., CCC-SLP, LSLS Cert. AVT The University of Akron

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Presentation on theme: "SLPs and Audiologists: A Dynamic Duo and What Info They Should Share Denise Wray, Ph.D., CCC-SLP, LSLS Cert. AVT The University of Akron"— Presentation transcript:

1 SLPs and Audiologists: A Dynamic Duo and What Info They Should Share Denise Wray, Ph.D., CCC-SLP, LSLS Cert. AVT The University of Akron West Virginia Speech-Language-Hearing Association March 31, 2012

2 The University of Akron’s Auditory-Verbal Clinic: Training Parents as Language Facilitators

3 21 st Century’s Redefinition  Includes both language literacy and vast array of technological literacy (Deane, 2004)  Includes reading, comprehending, and applying these skills proficiently and functionally  Acts as a kind of currency in exchange for improving quality of life/personal fulfillment  Rational Choice Theory of socialization

4 Literacy Defined  “The illiterate of the 21 st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” - Alvin Toffler

5 The SLP’s Role  Prevent reading problems by fostering language acquisition & emergent literacy  Identify children at risk for literacy problems  Provide intervention to children as well as assistance to classroom teachers & parents (ASHA, 2001)

6 Options in Life—”And You’re the One Who’ll Decide Where to Go” (Dr. Seuss, 1990)

7 “Not Making the Grade” (Trelease, 2006)  The U.S. is ranked 49 th in the world in literacy skills (New York Times, Dec. 12, 2004, Michael Ventura)  The U.S. is ranked 28 th out of 40 countries in mathematical literacy (NYT, Dec. 12, 2004)  American businesses spend in excess of 30 billion dollars a year on remedial training (NYT, Dec. 12, 2004)  Less than 5% high school seniors can read at level of New York Times  Yet more than 75% can read on 4 th grade level  40% U.S. households did not buy a single book; young adults least interested  Most book reading done by 30% of public  About 30% will drop out despite 2 decades of intense ed. reform (Time, April 17, 2006)

8 Children fail and drop out of school because they cannot read. Reading affects the entire report card Reading is the tide that lifts all the boats of the curriculum (Trelease, 2001)

9 Gallaudet Research Institute (2008)  “For the 17-year-olds and the 18- year-olds in the deaf and hard of hearing students norming sample, the median Reading Comprehension subtest score corresponds to about a 4.0 grade level for hearing students.”

10 Project Hope Results (1999)

11 Progress Achieved, but Challenges Continue to Exist… (Lyons, 2011)  Early Hearing Detection and Intervention (EHDI) Act of 2010 reauthorized  About half of those referred for a diagnosis following a failed screening are lost to the system (Joint Com. on Infant Hearing sets the “Gold Standard”)  One-third of infants in the system do not receive a diagnostic eval. by 3 mos. of age  More than half diagnosed are not enrolled in intervention programs by 6 mos. of age

12 Parental Choices Changing Dramatically…  In 1995: 40% of families chose spoken language options compared to those who chose sign/visually-based communication modes.  In 2005: 85% chose spoken language options compared to 15% who chose sign. (Brown, 2006)

13 Early Intervention Outcomes  Data from the Colorado Project are showing that children born with a profound hearing loss who obtain a cochlear implant before they are 2, have a high chance of obtaining intelligible speech (Yoshinago- Itano, Sedey, Coulter, & Mehl, 1998).  This outcome is based on having the cochlear implant mapped appropriately and worn consistently.  Direct, repetitive auditory skill instruction as part of an effective early intervention program.

14 Basic neural research now provides data that substantiates the necessity of stimulating auditory brain centers early on

15  We hear with the brain -- the ears are just a way in! What’s the big deal?  Human beings are rich in auditory brain tissue – But children can’t listen like adults!

16  1) The higher auditory brain centers are not fully developed until a child is about 15 years old, 2) and children cannot perform automatic auditory cognitive closure tasks like adults (i.e., “fill in the blanks”).  Therefore, all children need a quieter environment and a louder signal than adults.

17  Greatest in the first 3 ½ years of life  The younger the infant, the greater the neuroplasticity  Rapid infant brain growth requires prompt intervention, typically including amplification and a program to promote auditory skill development.  In the absence sound, the brain re-organizes itself to receive input from other senses, primarily vision – “cross- modal re-organization”; this reduces auditory neural capacity.

18 Niparko, J., Journal of the American Medical Association (2011)  Children receiving cochlear implants before 18 months are achieving age-appropriate spoken language outcomes.  “Babies are primed to learn language, but if not exposed to spoken language early, the window begins to close and by 5 years of age, it is substantially shut.”

19 Critical Keys to a Successful Spoken Language Outcome: *Access the Auditory Centers of the Brain as Early and Completely as Possible; *Then, Practice, Practice, Practice Listening and Talking… *Approach it as a “Neurodevelopmental Emergency” (Flexer, 2008)

20 It’s a new generation of children who are deaf/hard of hearing...because it is all about the BRAIN. Hearing loss is not about the ears; it’s about the brain! Hearing aids, FM systems and cochlear implants are not about the ears; they are about the brain! (Flexer, 2008)

21 “Listening” is the cornerstone of the educational system

22 Why extend distance hearing and “overhearing”? Because the literature in developmental psychology tells us that about 90% of what very young children know about the world, they learn incidentally. And, it’s not just about knowledge, overhearing facilitates social/cognitive development. (Flexer, 1999)

23  Lets make sure the child is hearing optimally!

24 The Ling Six Sound Test as a Measure of Distance Hearing  Serves as a functional listening check for sounds within the speech spectrum  When presenting the sounds – keep loudness and duration constant with distance  Mark the distances in a quiet hallway.  Use the test daily at the child’s greatest distance and also at 2 meters  Obtain a baseline for a child’s overhearing potential! Notify aud. asap if decrease seen

25  Current aided or cochlear implant thresholds  KISS: a descriptor of the client’s hearing level at the various freq; avoid using numbers…not all SLPs can interpret results; do that for them  If a personal FM is recommended, write the report recommending it; SLPs cannot do so.  Preferable programs a child’s technology should use in various situations  Brief narrative: preferred over quantitative numbers that may be meaningless to SLPs

26 Flexer (2010) states that understanding the “Acoustic Filter Effect” of hearing loss explains the destructive impact of early, unmanaged hearing loss: Invisible Acoustic Filter Spoken Language Reading and Writing Academic Competence Professional flexibility Independent function, work, and community contributions

27 Hierarchy of Listening Skills (Erber, 1977)  Detection: ability to respond to presence or absence of sound  Discrimination: ability to perceive similarities & differences among 2 or more speech stimuli  Identification/Recognition: ability to reproduce a speech stimulus by pointing at a picture, writing, or by repeating the speech heard  Comprehension: ability to understand the meaning of speech by answering questions, following directions, paraphrasing or engaging in conversation

28 Detection  Awareness of sound…we’re growing the BRAIN, BRAIN, BRAIN!  Teach conditioned play response and spontaneous alerting responses  However….First obtain a BASELINE…  MED-EL: Auditory Checklist Questionnaire (one for parents and one for of Innsbruck, Austria) to establish auditory goals and objectives for treatment plan ◦ IT-MAIS (Osberger, McKonky-Robbins, Zimmerman-Phillips)  Infant-Toddler Meaningful Auditory Integration Scale  Interview style with 10 probes  Assesses  Vocalization behavior  Alerting to sounds  Deriving meaning from sounds  Available from ADVANCED BIONICS (800) 678-2572 or

29 Detection…Environmental Sounds  Listening Walks- “I Hear That!”  Set the Stage for an Auditory Lifestyle:  Top 10 Strategies for Parents by Jill Bader   303-841-7987  Jabber Journal: kept by the parent  Parent reports sounds the child detects  Parent reports sounds the child makes  Listening is Fun! A Guide for Parents & Families- CD with training manual by Med-El  Tools for Schools and The Listening Room-

30 Detection…Speech Sounds  Child’s Name…The Calling Game  Start Listening: A guide to pediatric rehabilitation  FREE DVD from COCHLEAR AMERICAS  (303) 790-9010 or  The Ling 6 Sound Test-free pictures from Med-El, Cochlear and Advanced Bionics  Adaptable to any age  Can be paired with “Learning to Listen” sounds as bridge to identification and sound/object association (Pollack, 1985; 1997); Dave Sindrey’s explanation: ◦  Suprasegmentals of speech  Pitch, duration, intensity, timing, and stress  Learning to Listen Sounds/Objects-”Tools for Schools” (Advanced Bionics)  Ooh = ghost  Aah = airplane  Eee = slide, vacuum, Chinese yo-yo  Sss = snake  Shh = baby  Mmm = ice cream cone, any food

31 Intelligibility vs. Audibility (Cole and Flexer, 2008)  Audibility: ability to detect the presence of sound; “I can hear someone talking.”  Intelligibility: ability to discriminate the word-sound distinctions of speech sounds; “I can hear what is being said.”  Persons with hearing loss typically have the most difficulty hearing unvoiced, low energy, but high- frequency consonant sounds (e.g., “f”, “t”, and “s”) ◦ Consonants, particularly high frequency ones, contain 90% of the information needed to perceive differences among sounds which contributes to intelligibility skills.

32 How Do Children Learn Sophistications of Language?  Immersion with good speech-language models  Hearing language repetitively from significant others in a natural setting  Hearing language in a meaningful context

33 Parents as Partners

34 Role of Parents in AVT (Estabrooks, 2006)  Six/ten principles involve parents directly  Model techniques  Plan strategies/understand goals  Be interpreters/partners  Manage behavior  Develop confidence in their interactions  Advocate for child  Record and discuss progress

35  Zero to Three-Child Development Info: key_childdevt  Growth Milestones:  Typical Speech & Language Development:  Speech and Language Developmental Milestones:  Auditory Development Scale:

36 The Art of Reading Aloud

37 Single-Most Important Activity

38 Building a Knowledge-Base Required for Reading Success

39 Surprising Findings… Only 20% of parents read to their children daily Only 20% of parents read to their children daily In both poverty and university-level families, fathers read to children 15% of time while mothers read 76% of time In both poverty and university-level families, fathers read to children 15% of time while mothers read 76% of time

40 Children are made readers on the laps of their parents. (Emilie Buchwald)  Laptops don’t have laps…

41 Cushla and Jennifer’s Stories ( Trelease, 2001, pp. 29-30 )  Share with the family at the outset of session  Make copies for families to share  Recommend Jim Trelease’s book, The Read Aloud Handbook (2001)--available in the public library  Visit Jim’s website: www.trelease-on-

42 5th edition Penguin (2001)

43 Two Reading “Facts Of Life”  Reading is an accrued skill.  The more you read, the better you become.  The best readers read 5 times more than average readers and 200 times more than the poorest readers! (Anderson, Fielding & Wilson, 1988).  Human beings are pleasure-oriented.  We only voluntarily do what we like and avoid what we dislike.  If pain outweighs the pleasure, child develops a “work mentality” about reading and avoids it (Trelease, 2001).

44 Premise is Simple (Trelease, 2001)  The more you read, the more you know;  The more you know, the smarter you grow;  The smarter you are, the longer you stay in school;  The more diplomas you earn;  The more diplomas you have, the more your children will achieve & more career options

45 Converse is Also True  The less you read, the less you know;  The less you know, the sooner you drop out of school;  The sooner you drop out, the sooner and longer you will be unemployed;  The sooner you drop out, the greater the chances of incarceration.

46 Initially…Teach Them to Want To Read and…

47 Focus Less on “How” to Read

48 Lifetime Readers Become Lifetime Achievers



51 Everyday Life Experiences

52 Initial Books : Purposeful and Personalized


54 Factors Predicting Reading Success: (Shanahan & Lonigan, Educational Researcher, 2010)  Alphabetic Knowledge -iden. names & sounds of letters  Phonological Awareness -manipulating sounds  Rapid Auto. Naming Ltrs/Digits -quickly name sequences of random letters and digits  Rapid Auto. Naming Objects/Colors  Writing/Writing Name -write letters and one’s name  Phonological Short-Term Memory -remembering spoken language for a brief period of time

55 Early Predictors of Reading Success (cont.)  Concepts About Print -print conventions such as reading tracking, & print concepts like knowledge of author and text.  Print Knowledge- includes alphabetic knowledge, early decoding, and concepts about print.  Reading Readiness -alphabetic knowledge, vocabulary, memory, concepts of print, and phonological awareness.  Oral Language - being capable of generating and understanding spoken language.  Visual Processing -the ability to match or distinguish visually presented symbols.

56 Put Reading First: The Research Building Blocks for Teaching to Read National Reading Panel (NRP) Report in 2000 Charged with reviewing literature in reading instruction Reviewed 100,000 studies Condensed findings into a guide designed for teachers on how to successfully teach children to read based on 5 areas of instruction: Phonemic Awareness Phonics Fluency Vocabulary Text Comprehension

57 Relationships between the letters of the written letters of written language and the sounds of spoken language. Instruction in phonics leads to an understanding of the alphabetic principle Phonics programs are effective when: *Systematic- plan of instruction with selected letter sounds relationships are organized in a logical sequence *Explicit- programs give teachers specific directions directions about teaching relationships *lots of opportunities given to children to apply their learning of sounds and letters Phonics

58 Phonemic Awareness  Ability to notice, think about, and work with the individual sounds of spoken words (understanding that words are made of sounds)  Phonemic Awareness instruction will improve a child’s ability to read words, increase reading comprehension, and spelling. Development Activities: *identify and categorize phonemes *blend phonemes to form words *blend phonemes to form words *segment words into phonemes *segment words into phonemes *delete, add, substitute phonemes to make new words *delete, add, substitute phonemes to make new words

59 Phonological Awareness (phonemic identified by the Nat’l Reading Panel in 2000 as one of the 5 essential building blocks for reading achievement) Phonological awareness is concerned with the awareness of ANY size unit of sound (word, syllable, onset, rime, phoneme) of spoken language. (Richgels, 2001)

60 Phonemic Awareness Phonemic awareness is the ability to hear, identify, and manipulate individual phonemes in spoken words. (The Partnership for Reading, 2001)


62 Fluency The ability to read a text accurately and quickly. Important because it frees students to understand what they are reading. Can be developed by: *modeling fluent reading *having students engage in repeated oral reading Monitoring student progress in reading fluency helpful in evaluating instruction and goal setting and can be motivating to students.

63 Vocabulary Words we must know to communicate. Beginning readers have a difficult time reading words that are not part of their oral vocabulary. The more exposure to oral language children have the more word meanings they will learn. Most vocabulary is learned indirectly in 3 ways: 1)Engaging daily in oral language. 2)Listening to adults read to them 3)Reading on their own.

64 The Importance of Vocabulary (Geers and Hayes, 2010)  Vocabulary knowledge- formal instruction and exposure leads to a child learning and remembering word meanings ◦ Vocabulary knowledge is critical for reading comprehension and expository writing  The more severe the hearing loss, the larger the delay in vocabulary development (Boothroyd, Geers & Moog, 1991) ◦ Vocabulary development speeds up after a child receives a cochlear implant, especially if implantation occurs during or before preschool age  Vocabulary knowledge continuously expands throughout development ◦ Implantation early on, combined with improved phonological decoding, assists with reading and compre., leads to literacy skills comparable to hearing peers

65 Vocabulary is one of the biggest predictors of kindergarten success…therefore, early intervention is not about the child, it is about the family learning about vocabulary development. Think of early intervention as “adult education”.

66 Number of Words Understood by Children who are Typical Gard, Gilman & Gorman (1980) Age# of Words 2300 words 2.5500 words 3900 words 41,500 words 52,500 words 613,000 words 720,000 words

67 Key Study by HART AND RISLEY (1995): The Lines of Demarcation are Drawn Early On… “Meaningful Differences in the Everyday Experience of Young American Children”

68 Hart and Risley 1995

69 Text Comprehension The reason why we read. Text comprehension is purposeful and active. Developed by teaching strategies for comprehension through: *explicit instruction *cooperative learning *helping readers use combinations of strategies being flexible

70 Contact: National Institute for Literacy at ED Pubs PO BOX 1398 Jessup, MD 20794-1398 To download go to the National Institute for Literacy website at

71 Literacy and Deafness: Listening and Spoken Language (2009-Plural Publishing) Lyn Robertson, Ph.D. Auditory-Verbal Therapy and Practice (2006) VHS-Listen to This (2004) Warren Estabrooks, M.Ed., Cert. AVT, Editor Order at www.

72 Children with Hearing Loss: Developing Listening and Talking Birth to Six by Elizabeth Cole & Carol Flexer (2008-Plural Publishing) This text covers the most current and up-to-date information about hearing, listening, spoken language development, and intervention for young children with hearing loss whose parents have chosen to have them learn to listen and talk. It is unique in its scholarly and thoroughly readable style. Numerous illustrations, charts, and graphs illuminate key ideas. Go to: Hear & Listen, Talk & Sing! (Estabrooks & Birkenshaw-Fleming, 2006) Go to:

73  CHECK Ling 6 every day  Monitor auditory and speech/language progress every day.  Have a system for communicating with parents and teachers about progress, especially regression  Slow progress or no progress can be equipment or programming problems that can be improved. Don’t wait until the 9 week juncture to say something. Every minute counts!

74  Consistent use  Programming of the device  Pre-post lingual/duration of deafness  Age of implantation  Emphasis on visual input vs. auditory input  Other learning factors/disabilities  Family support

75  Auditory Sandwich ◦ 1 st presentation is verbal to ensure auditory processing ◦ 2- tactile or visual cues as necessary ◦ Final cue is auditory – again to promote listening  Wait time ◦ to allow the child to process the information.

76 Acoustic Highlighting -enhances the audibility of the spoken message ◦ Use duration, intensity and pitch to highlight words within phrases Use child’s name to gain their attention  “Johnny….”

77  Identify child who asked question  Verbally Repeat Comments and Questions Presented in Class –so they hear both the question and answer  Auditory Spacing- chunk info

78  Cueing with a microphone  “Listen” to gain attention  Pointing to your ear to cue them to verbalize-indicate if you did not hear  Emphasis is on ◦ you hearing them

79  Preferential seating- usually not front row first seat – consider the best auditory and visual situation for teacher and peers

80  Use of pass around microphone when children are reading or answering questions/ask your audiologist about ordering

81  Call on all children by their name so child with hearing loss can track the speaker “Johnny, do you …”

82  Teach all children to find and look at the speaker (track who is talking)

83  Ask what was said to all children so there is a listening/comprehension expectation for everyone  Avoid asking, “Did you hear me?, Did you understand me?”  Instead, ask, “What did I say?”

84  Send home classroom language, words to poems or songs, vocabulary, literature and themes for ◦ auditory, language, speech, pragmatic and written language goals whenever possible.  Share state standards with SLP to tie together classroom and SLP therapy goals.

85 Literature Websites  contains on-line books for both young and advanced readers.  contains printable books; first 30 are free; $29.95/yr. Subscription.  Log onto famous author websites: ex.:;;  website for Shari Robertson & Helen Davig, Read with Me! Stress-Free Strategies for Building Language and Literacy (2002).  teacher-developed materials for school and home available for purchase.   

86 Life is not measured by the number of breaths we take, but by the moments that take our breath away. GeorgeCarlin.doc

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