Treatment Areas: Hearing - (Central) Auditory Processing
Once a hearing loss is identified, recommendations may be made regarding amplification through hearing aids, FM systems or cochlear implants. Any type of hearing loss impacts a child’s ability to perceive speech and therefore has an impact on communication. Specific intervention to address auditory skill development is critical to a child’s ability to achieve to his or her potential. Development and use of semantic, syntax, phonological and pragmatic communication skills as well as speech sound production must be systematically evaluated and directly targeted. A comprehensive aural habilitation program includes acquisition and management of appropriate auditory devices, as well as specialized, systematic, focused individualized instruction in each of these areas.
A comprehensive treatment program includes the following components:
- Auditory Training
- Developing and Establishing Language
- Speech Production
- Equipment Management
- Self-Advocacy
Auditory Training
Auditory training involves teaching the child how to identify, discriminate and localize sounds, and attach meaning to sounds. Training begins with gross environmental sound perception and discrimination (i.e. bells, knocking on the door) and pattern perception (i.e. long sounds vs. short sounds) then moves to more complex speech sound discrimination and word identification. Training the auditory system to discriminate between phonemically similar words such as bat-boot-bite or school-tool-mule in various contexts is targeted. Beyond these basic auditory training skills, intervention includes skills related to the integration of auditory information to obtain meaning from language that is heard. Instruction in how to process auditory information includes skills in auditory closure ("shut the _____"), auditory memory (recall of verbal information) and the ability to extract meaning from auditory information (i.e. follow directions, understand stories, answer questions).
In the context of this instruction, children with hearing loss are also taught to understand and identify useful visual information that supplements auditory input. This not only includes the placement of the articulators during speech (i.e. lips and tongue), but more importantly facial expressions, body language and contextual/environment cues.
Developing and Establishing Language
A hearing loss impacts development of spoken language in all areas: form (syntax/morphology/phonology), content (semantics) and use (pragmatics). With an impaired hearing and perceptual system, children are unable to acquire vocabulary, understand and apply grammar rules, discriminate and apply rules for word endings, effectively relate information in an organized, sufficient manner and understand and develop language pertinent to specific social situations. Therapy is necessary to systematically and explicitly address skills in these areas.
Improving Speech Production
A child’s ability and capacity to perceive speech impacts his/her sound production. Children who are hearing impaired often benefit from multisensory (visual, kinesthetic, tactile) instructional practices to supplement their auditory abilities. The goal is to develop automaticity in the production of both consonants and vowels from the syllable to discourse levels. Selection of speech targets is based on the following factors:
- where the sound is articulated in the mouth (i.e. on the lips as in /m/ or in the back of the throat as in /k/)
- how the sound is produced (i.e. by stopping air flow as in /b/ or restricting it as in /s/)
- if the voice is on or off (i.e. /d/ is voiced and /t/ is voiceless)
This is in contrast to articulation therapy for children with other types of communication disorders when targets are typically chosen based on a developmental assessment. Treatment may also address difficulties with voice quality which can relate to pitch, resonance, rate and rhythm.
Managing Equipment
A child who is hearing impaired is dependent on consistent and proper amplification in order to access speech, language and learning throughout the day. Independent and confident use and management of equipment can be directly taught within therapy sessions. This involves:
- inserting/removing hearing aids/implants
- changing batteries
- cleaning systems
- managing program changes within the equipment
- understanding components of the systems
- troubleshooting problems as they arise
Self Advocacy
Self-advocacy for a hearing impaired child involves teaching him/her how to recognize listening challenges and effectively manage them in various situations. Recognizing and handling communication breakdowns and understanding how to modify situations or circumstances to best address his/her listening needs involves developing an awareness and understanding of his/her hearing abilities and monitoring access to sound and language in light of those challenges. Self-advocacy is a skill that is developed as children mature and become more aware of their hearing challenges. It is important for parents and professionals working with children to remember that not every child with a hearing loss naturally and independently self-advocates. It may be appropriate to work on developing skills in this area as students progress through elementary and middle school grades.