young children’s auditory development: goals and...

Young Children’s Auditory Development: Goals and AssessmentMaryKay Therres, M.S., CCC-SLP, LSLS Cert. AVT || Taylor S. Sands, M.S., CCC-SLP, LSLS Cert. AVEd

What do professionals working with very young children who have cochlear implants need to know?

• Auditory hierarchy of skills• Goals to facilitate development of these skills• Timeline of expectations for skill acquisition*• Monitoring tools

Auditory Skills Pyramid (from AuSpLan)

Level 1 AwarenessShows detection of sound/speech but no understanding. Low Goal: Awareness of voicing.High Goal: Awareness to the Ling sounds. Timeline: one week post-implantAuditory Targets: m, ah, oo, ee, sh, s

Level 2 Suprasegmental-Discrimination/AssociationRecognizes differences in suprasegmental aspects of speech-duration, intensity, pitch, stress. Beginning of associating sound with meaning.Low Goal: Discriminates between one of two speech utterances that differ by vocal length (e.g., goooo-stop).High Goal: Discriminates/associates between one of four speech utterances that differ by suprasegmentals (e.g., sit down - good bye - time to go - shh, it’s night night time).Timeline: six months post-implant Auditory Targets: mmm, brush brush, brush, shh-go night night, num num num

Level 3 Segmental-Association/IdentificationRecognizes word meaning through segmental-vowel and consonant differences. Learning vocabulary and storing word association in his/her lexicon.Low Goal: Associates/identifies between two words that differ by vowels and consonants (e.g., shoe-ball).High Goal: Associates/identifies between twelve words that differ by vowels and consonants (e.g., shoe–ball-boat-cat-dog-cow-fish-horse-car-phone-book-tree).Timeline: by 9 months post-implantAuditory Targets: Vocabulary - basic and expanded - cow, sheep, chicken, pig, moo, baa baa, bak bak, oink oink, neigh, nose, eyes, mouth, ears, run, jump, sleep, sit, eat, drink, stand, colors, big, little, soft, hard, furry, feathers

© Copyright by MED-EL 2016

Level 4 IdentificationIdentifies key words (concrete vocabulary) within a sentence context. Facilitates auditory memory.Low Goal: Identify one key word in a sentence from a closed set.High Goal: Identify 4+ key words in a sentence from an open set.Timeline: by 23 months post-implantAuditory Targets: Put the teddy bear on the blue bed. Put the purple chair next to the fireplace.

Level 5A Processing/Comprehension-BeginningInvolves receptive and expressive components at this level. Facilitates development of abstract receptive language that involve higher order processing skills. Goals should take into consideration the child’s chronological age.Low Goal: Identify objects described by function/description.High Goal: Listen to short paragraph and answer simple questions about the information presented.Timeline: by 33 months post-implantAuditory Targets: Show me something that is yellow, round and hot. Show me something that is an animal, goes in the water and is slow.

Level 5B Processing/Comprehension-AdvancedInvolves receptive and expressive components at this level. Facilitates development of abstract receptive language that involve higher order processing skills. Builds on skills developed at Level 5A. Goals should take into consideration the child’s chronological age.Low Goal: Listen to a four part story and the arrange pictures in order that go with the story.High Goal: Infer meaning from two to three sentences of information. Timeline: by 36 months post-implantAuditory Targets (infer): What is something that that goes on your bed? You use it when you are cold? Mom wants to go to the store to buy groceries. How should she get there?

AssessmentTo ensure a child meets his/her potential for developing auditory skills, it is key to have assessment tools to monitor progress. Tools specific to very young children include the following:

LittlEARS Auditory Questionnaire Parent questionnaire that assesses age-related auditory behavior of children two years of age and under or for children with a hearing age of less than two.Based on normative data from children with normal hearing birth to 24 months.Assists in development of early listening goals.Quick and easy administration of 35 questions in age-dependent order.Total score = sum of all Yes answers.

Progress Assessment FormValues within blue area are considered critical.Test once and compare to trajectory or track progress over time.

Open- and Closed-set Task©Developed by: David J. Ertmer Ph.D., CCC-SLPObjective and developmentally appropriate, within child, criterion-referenced tool for assessing toddler’s ability to imitate and understand spoken words.Administer at 6 month intervals (e.g., at 6, 12, 18 months post-implant or post-amplification).Contains three word lists.Each of the three lists contains three demonstration words and 10 stimulus words.Adult says the word from the targeted word list and child imitates.Child’s production is transcribed on score sheet.After child imitates, then shown set of three pictures and asked to identify which one it is.

Obtain 3 ScoresPhoneme Accuracy: provides a measure of child’s ability to imitate vowels and consonants in words.Score is % correct (matching phonemes).Word Acceptability: provides an estimate of the intelligibility of a child’s spoken words by comparing to adult standard.Score is number correct out of number administered (%).Word Comprehension: measures how well early-emerging spoken vocabulary words are understood.Score is total number of points.

Auditory Skills ChecklistDeveloped by Nancy S. Caleffe-Schenck, M.Ed., CCC-A, LSLS Cert. AVTAssists in tracking progress of auditory development and in setting goals.Skills should be noted if the child responds using auditory cues only.Verbal scoring (i.e., Never observed, Observed once, Observed greaterthan 3 times) and Number scoring (i.e., 0,1, 2, 3, 4, 5) for total score of 77.

Intrasubject design-comparing child’s score to his/her previous score to determine progressAuditory skills develop in a hierarchal order (Awareness to Processing/Comprehension).Questions• 1 to 7 address Awareness• 8-12 address Discrimination• 13-17 address Identification• 18-27 address ComprehensionGiven this context you can discuss the progress child is making with regards to auditory levels of development.

ConclusionTo help children reach their auditory potential, it is critical to understand auditory development, monitor progress and set appropriate goals.

References AuSpLan, LittlEARS® Auditory Questionnaire, Open- and Closed-set Task©, Auditory Skills Checklist all available at www.medel.com

LEVEL 5A & BProcessing Comprehension

LEVEL 4Identi�cation

LEVEL 3Segmental-Association/Identi�cation

LEVEL 2Suprasegmental-Discrimination/Association

LEVEL 1Awareness

The Open- and Closed-set Task©

*Timelines are for High Goals and should be used as a red flag indicator if child has not acquired skill.

4

11. Intensity:

Child imitates loud vs. quiet sounds. Example: Child uses a loud voice to wake up a doll vs. a quiet voice when the doll is sleeping.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

12. Self-monitoring of speech using auditory model:

Child modifies his/her speech to more closely match an adult model. Examples: Child lowers pitch of voice after listening to adult produce a lower-pitched sound, approximates articulation (such as producing "mmm" in response to hearing "moo"), or modifies speech from "pour" to "more" to match a spoken cue. Acquisition of this skill indicates that the child is able to use audition to improve speech production.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

13. Identification of sounds, words, simple phrases or directions:

Child attaches meaning to basic sounds, words and phrases. Examples: Child looks at a toy duck when mom says "quack quack," or picks up a doll for "baby," or carries out the instruction "open the door."

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

14. Auditory memory of words:

Child remembers groups of words that contain varying numbers of critical {differing) elements. Example: Child finds "little green ball" versus "big red ball" (two critical or differing elements).

None 0

1 critical element 1

2 critical elements 2



>4 critical elements 5

15. Auditory memory of nursery rhymes or songs:

Child recites salient parts of a nursery rhyme or song. None 0

Intonation 1

Actions 2

Keywords 3

Most or all words 4

3

5. Searching for the source of a sound:

Child looks around, but may not necessarily find the sound source. Example: Child glances or moves in search of the sound from a hidden toy.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

6. Identifying a sound source:

Child turns to the source of a sound. The child may turn the wrong way initially but continues to search until the correct source is found through listening.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

7. Distance hearing:

Child responds to sounds at increasing distances. Example: Child responds when called from another room.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

8. Association of familiar sounds:

Child associates a sound with its meaning or anticipated event. Example: Child hears an airplane and points to the sky, or hears a car and goes to the door to look out.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

9. Duration:

Child imitates, through babbling or jargon, syllables varying in length, or imitates a rhythmical pattern with a toy. Example: Child produces 3 discrete syllables for "hop hop hop" vs. a long, sustained sound for "mooooo."

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

10. Pitch:

Child imitates vocal inflection for common utterances, such as falling pitch in "uh oh", or imitates rising inflection for a question such as "more?"

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

2

1. Awareness to sound:

Child nonverbally or verbally indicates the presence or absence of sound. Example: Child's eyes widen when he/she hears mother's voice; child vocalizes in response to initiation or cessation of a sound.

Never observed 0

Observed once 1

Observed 3 or more times 2

2. Attention to sound:

Child attends to what he/she hears for an extended period of time (a few seconds or longer). Example: Child pauses and listens to father's voice.

Never observed 0

Observed once 1

Observed 3 or more times 2

3. Indication of onset vs. offset of sound:

Indication of onset vs. offset of sound: Child is able to indicate when sounds stop and start. Example: Child moves a toy while the adult is vocalizing, stopping when the adult's voice stops, or plays musical chairs appropriately.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

4. Conditioned response to sound:

Child conditions to respond predictably to the presence of sound when in a "listening" posture. Example: Child drops a block when he/she hears a sound.

Never 0

Sometimes (25%) 1

Often (50%) 2

Always (75%+) 3

Auditory Skills Checklist

This checklist may be used to establish auditory goals, or track progress made in auditory areas related to spoken communication. It is expected that skills will overlap and several will be developing at the same time. Listening is an ever-changing process, and this list is not intended to be an exact order of skill development.

To track progress, check the appropriate answer for each item. Skills should be noted only if the child has responded using auditory cues alone, without any visual information such as speechreading or sign language. Additional space is provided to note details, such as whether responses were prompted or occurred spontaneously.

MED-EL CORPORATION AND NANCY S. CALEFFE-SCHENCK ALL COPYRIGHTS RESERVED

3ListThe Open- and Closed-set Task©

Phoneme Accuracy Word Acceptability Word Comprehension

Stimulus Word(# phonemes)

[Phonetic transcription]

Transcribed Response(# phonemes matched*)

*Ignore consonant voicing errors

Criteria for Word Acceptability:• At least two matching phonemes

(consonants and/or vowels)AND

• Correct number of syllables *Ignore consonant voicing errors

Acceptability: Yes / No

Picture Selected (1, 2, or 3)• 2 pts = correct ID without repetition

• 1 pt = correct ID following a repetition

• 0 pts = incorrect ID or no response

1. Book (3)[bʊk] ( /3)

1 2 3 NR

Rep? Y / N Pts:

2. Balloons (6)[bʌlunz] ( /6)

1 2 3 NR

Rep? Y / N Pts:

3. Pig (3)[pɪg] ( /3)

1 2 3 NR

Rep? Y / N Pts:

4. Cup (3)[kʌp] ( /3)

1 2 3 NR

Rep? Y / N Pts:

5. Cookies (5)[kʊkiz] ( /5)

1 2 3 NR

Rep? Y / N Pts:

6. Doll (3)[dal] ( /3)

1 2 3 NR

Rep? Y / N Pts:

7. Kitty (4)[kɪti] ( /4)

1 2 3 NR

Rep? Y / N Pts:

8. Nose (3)[noz] ( /3)

1 2 3 NR

Rep? Y / N Pts:

9. Mommy (4)[mami] ( /4)

1 2 3 NR

Rep? Y / N Pts:

10. Juice (3)[dʒus] ( /3)

1 2 3 NR

Rep? Y / N Pts:

(Total 37 phonemes) % phonemes matched:( /37) X 100= %

% acceptable words:( /10) X 100 = % Total number of points:

Notes:

Scoring Sheet

Child’s Name: Date: Chronological Age:

Location: Clinician: Parent Present: * Yes * No

Amount of Sensory Aid Use (Months):

Demo 1: Zebra Completed: * Yes *No Demo 2: Pretzel Completed: * Yes * No Demo 3: Cat Completed: * Yes * No

© 2015 MED-EL Corporation and David J. Ertmer. All rights reserved. This form may not be reproduced in any form without the specific written permission of the author or publisher.









• Correct number of syllables*Ignore consonant voicing errors





1. Ball (3)[bɑl] ( /3)

1 2 3 NR

Rep? Y / N Pts:

2. Bottle (4)[bɑdl] ( /4)

1 2 3 NR

Rep? Y / N Pts:

3. Puppy (4)[pʌpi] ( /4)

1 2 3 NR

Rep? Y / N Pts:

4. Cat (3)[kæt] ( /3)

1 2 3 NR

Rep? Y / N Pts:

5. Car (2)[kɑr] ( /2)

1 2 3 NR

Rep? Y / N Pts:

6. Dog (3)[dɔg] ( /3)

1 2 3 NR

Rep? Y / N Pts:

7. Daddy (4)[dӕdi] ( /4)

1 2 3 NR

Rep? Y / N Pts:

8. Apple (3)[ӕpl] ( /3)

1 2 3 NR

Rep? Y / N Pts:

9. Mouth (3)[mɑʊθ] ( /3)

1 2 3 NR

Rep? Y / N Pts:

10. Cheese (3) [ʧiz] ( /3)

1 2 3 NR

Rep? Y / N Pts:



Notes:

Scoring Sheet




Demo 1: Sheep Completed: * Yes *No Demo 2: Toast Completed: * Yes * No Demo 3: Fish Completed: * Yes * No










• Correct number of syllables*Ignore consonant voicing errors





1. Boat (3) [bot] ( /3)

1 2 3 NR

Rep? Y / N Pts:

2. Baby (4) [bebi] ( /4)

1 2 3 NR

Rep? Y / N Pts:

3. Bubbles (5) [bʌblz] ( /5)

1 2 3 NR

Rep? Y / N Pts:

4. Keys (3) [kiz] ( /3)

1 2 3 NR

Rep? Y / N Pts:

5. Cow (2) [kɑʊ] ( /2)

1 2 3 NR

Rep? Y / N Pts:

6. Duck (3) [dʌk] ( /3)

1 2 3 NR

Rep? Y / N Pts:

7. Diaper (4) [dɑɪpɚ] ( /4)

1 2 3 NR

Rep? Y / N Pts:

8. Airplane (5) [ɛrplen] ( /5)

1 2 3 NR

Rep? Y / N Pts:

9. Milk (4) [mɪlk] ( /4)

1 2 3 NR

Rep? Y / N Pts:

10. Shoe (2) [∫u] ( /2)

1 2 3 NR

Rep? Y / N Pts:



Notes:

Scoring Sheet




Demo 1: Tiger Completed: * Yes *No Demo 2: Orange Completed: * Yes * No Demo 3: Cow Completed: * Yes * No


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