Friday, November 21, 2014

Protocol for Audiological Assessment, Hearing Aid and Cochlear Implant Evaluation, and Follow-up

Today’s blog is from the Alexander Graham Bell Association 
and can be read at the Listening and Spoken Language Knowledge Center website. 

Share With Each of Your Child's Audiologists

This audiological protocol is intended to support programs for early detection and management of hearing loss in infants and children. 


This protocol also is a guide to appropriate and ongoing audiology services recommended for children participating in listening and spoken language (LSL) programs.



Alexander Graham Bell Association’s Recommended Protocol for 
Audiological Assessment, Hearing Aid and Cochlear Implant Evaluation, and Follow-up

Table of Contents
  • Contributors and Reviewers
  • I. Introduction
  • II. Overview of Audiological Management
  • III. Recommended Elements of the Initial Audiological Diagnostic Assessment
  • IV. Recommended Procedures to Assess Amplification
  • V. Recommended Audiological Management for Children with Cochlear Implants
  • VI. Recommended Audiologic Management Regarding FM Systems
  • VII. Disclaimer and Copyright

Contributors and Reviewers
Contributors: Carol Flexer, Ph.D., LSLS Cert. AVT; Jane Madell, Ph.D., LSLS Cert. AVT; Joan Hewitt, Au.D., CCC-A

Reviewers: Elizabeth Fitzpatrick, Ph.D. (with collaboration Carmen Barrieru-Nielsen, Au.D.); Stacey Lim, Ph.D., Au.D., CCC-A; Johnnie Sexton, Au.D., CCC-A; Don Goldberg, Ph.D., CCC-SLP/A, FAAA, LSLS Cert. AVT

Adopted June 2014

I. Introduction
This audiological protocol is intended to support programs for early detection and management of hearing loss in infants and children. This protocol also is a guide to appropriate and ongoing audiology services recommended for children participating in listening and spoken language (LSL) programs.

The Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell) recognizes and recommends an audiological protocol that includes the test battery approach as an optimum means to access spoken language. No single test should be used in isolation to define and describe the nature and extent of a hearing loss. Ideally, every listening and spoken language program will have onsite audiological services. But regardless of setting, close collaboration of parents, audiologists, therapists, and educators is essential. Parents should be present and participate in all assessments. Whenever possible, the Listening and Spoken Language Specialist (LSLS®) certified professional also should be present at audiological assessments or communicate his/her questions or concerns regarding the child's hearing or technology.

The recommended procedures and elements in this document are consistent with the following guidelines and position statements:

II. Overview of Audiological Management
  • Initial screening, diagnosis, and confirmation should be completed within the first three months of life—as soon as possible after birth—in order to ensure that appropriate amplification and habilitation is underway prior to age 6 months. JCIH (2007) recommends that screening be accomplished by age 1 month, diagnostic testing be accomplished by age 3 months, and intervention begin by age 6 months.
  • When hearing loss is diagnosed, routine evaluation should occur ideally at four- to six-week intervals until full audiograms are obtained, and at three-month intervals through age 3 years.
  • Assessment at six-month intervals from age 4 years is appropriate if progress is satisfactory and if there are no concerns about changes in hearing.
  • Immediate evaluation should be undertaken if parent or caretaker concern is expressed or if behavioral observation by parent, therapist or teacher suggests a change in hearing or device function.
More frequent evaluation is appropriate when middle ear disease is chronic or recurrent, or when risk factors for progressive hearing loss are present. 

III. Recommended Elements of the Initial Audiological Diagnostic Assessment
The following section is based on the Joint Committee on Infant Hearing 2007 position statement.
Audiological Evaluation
Comprehensive audiological evaluation of newborns and young infants who do not pass newborn hearing screening should be performed by experienced pediatric audiologists. The initial audiological test battery to confirm a hearing loss in infants must include electrophysiological measures and—when developmentally appropriate—behavioral methods. Confirmation of an infant's hearing status requires a test battery of audiological test procedures to assess the integrity of the auditory system in each ear, to estimate hearing sensitivity across the speech frequency range, to determine the type of hearing loss, to establish a baseline for further monitoring, and to provide information needed to initiate the fitting of amplification devices. A comprehensive assessment should be performed for each ear even if only one ear did not pass the screening test. 
Evaluation: Birth to Age 6 Months
For infants from birth to a developmental age of approximately 6 months, the test battery should include a child and family history, an evaluation of risk factors for congenital hearing loss, and a parental report of the infant's responses to sound. The audiological assessment should include: 
  • Otoscopic inspection
  • Child and family history
  • Auditory Brainstem Response (ABR) testing using air-conducted click and tone burst stimuli and bone-conducted stimuli when indicated. When a hearing loss is detected, frequency-specific ABR testing is needed to determine the degree and configuration of hearing loss in each ear for fitting of amplification devices.
  • Click-evoked ABR testing using both condensation and rarefaction single-polarity stimulus, if there are risk indicators (e.g., hyperbilirubinemia or anoxia) for neural hearing loss (auditory neuropathy spectrum disorder or ANSD) to determine if a cochlear microphonic is present.
  • Auditory Steady State Response (ASSR) testing may be used as another means of assessing ear and frequency specific thresholds. ASSR testing can also be used to assess auditory nerve function when no ABR is present.
  • Distortion product or transient evoked otoacoustic emissions (OAE) testing
  • Tympanometry using a 1000-Hz probe tone, and acoustic reflex testing
  • Parent and clinician observation of the infant's auditory behavior as a cross-check in conjunction with electrophysiologic measures. Behavioral observation alone is not adequate for determining whether hearing loss is present in this age group, and it is not adequate alone for the fitting of amplification devices.
Evaluation: Age 6 to 36 Months
For subsequent testing of infants and toddlers at developmental ages of 6 to 36 months, the confirmatory audiological test battery includes:
  • Otoscopic inspection
  • Child and family history
  • Parental report of auditory and visual behaviors and communication milestones
  • Behavioral audiometry (either visual reinforcement or conditioned-play audiometry, depending on the child's developmental level), including pure-tone audiometry across the frequency range for each ear and speech detection, speech audibility (e.g., using the Ling 6-sound test) or speech recognition measures
  • OAE testing
  • Acoustic immittance measures (tympanometry and acoustic reflex thresholds)
  • Electrophysiological testing as described above, if responses to behavioral audiometry are not reliable.
For children of all ages, AG Bell recommends that all results, questions, and recommendations are discussed with the parents in a culturally sensitive manner and in the family’s native language.
Parents should leave the audiology appointment understanding the management plan. They should know when to return for follow-up appointments and what their responsibility is in the process (including monitoring full-time use of amplification technology and monitoring what the child hears with the amplification technology). Parent questionnaires such as the IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scale) and ELF (Early Listening Function) may be useful in the monitoring process.
Written reports should be provided and include:
  1. Descriptions of test procedures, conditions of testing, and reliability estimate
  2. A complete audiogram (if available at the initial diagnosis) with symbol key, calibration, and stimuli identified, as well as an explanation of results using tools such as a "Familiar Sounds" audiogram to support parent/teacher counseling
  3. Copies to parents, as well as to primary care provider, Listening and Spoken Language Specialist, and other health/education providers as requested in writing by parents
  4. Referral to medical, otolaryngological, or other resources (e.g., genetic counseling, social services, psychological counseling, occupational therapy) as appropriate.

IV. Recommended Procedures to Assess Amplification
Identify the hearing instrument, including manufacturer, model, output and response, compression or special feature settings, earmold specifications, and quality of fit. In addition, earmolds need to be well made and acoustically tuned (e.g., tubing, venting, bore size to match the child’s hearing loss in order to maximize the child’s access to sound). The audiologist should listen to the hearing aids at the start of every test session, and should confirm that parents know how to perform a listening check of hearing aids.
  • Electro-acoustic analysis of hearing aids to document hearing aid performance at the following times:
    • At initial fitting
    • At regular intervals (e.g., at follow-up appointments)
    • Upon return from repairs
    • If parental concerns arise from behavioral observation or listening check.
  •  
  • Real-Ear-to-Coupler Difference (RECD) measures
    • Used with prescription method such as DSL (Desired Sensation Level ) or NAL (National Acoustic Laboratories) to establish target gain and output
    • To convert hearing aid performance in 2cc coupler to real ear hearing aid performance
    • To convert hearing levels in dB HL to ear canal SPL (Sound Pressure Level)
    • To assess change in earmold style and fit.
  •  
  • Cortical-evoked response testing to validate hearing aid fittings, where available.
  • Sound Field Aided Response
    • To demonstrate the child’s response to speech for parent education purposes
    • To monitor the child’s auditory progress
    • To assess speech perception at soft (e.g., 35 dB HL) and at average conversational levels (e.g., 50 dB HL) in quiet and in the presence of noise to evaluate the effectiveness of amplification technology. Each hearing aid should be evaluated separately and then both tested together.
    • Assessment of speech audibility using the Ling 6-Sound Test at varying distances (e.g., through 6 meters or approximately 20 feet)
    • Comparison of Ling results with NAL speech-o-gram if available to evaluate hearing aid fitting
    • Functional auditory assessments (e.g., PEACH [Parents' Evaluation of Aural/oral performance of Children], LittlEARS Auditory Questionnaire) to validate hearing aid fitting.
  •  
NOTE: Functional gain measure is an appropriate verification procedure for bone conduction hearing aids and cochlear implants. Verification of amplification requires a RECD measure for children wearing hearing aids.

V. Recommended Audiological Management for Children with Cochlear Implants
  • If adequate access to the full spectrum of acoustic information of spoken language cannot be achieved for an infant or child through conventional amplification, information should be provided to the family regarding cochlear implant (CI) technology, including benefits and risks as documented in published, peer-reviewed literature along with referral to a pediatric cochlear implant center.
  • Upon parental consent, the cochlear implant team will review the audiologic information obtained to date and perform further assessments to evaluate the child’s suitability for cochlear implantation. Speech perception testing should be included in the pre-CI evaluation and used both in determining candidacy and to compare to post-CI evaluations.
  • The LSLS should participate in the cochlear implant candidacy process.
  • Following initial mapping of the cochlear implant speech processor(s), re-mapping should be conducted on the schedule recommended by the cochlear implant team given the child's age, device(s) implanted, number of electrodes activated, and additional individual considerations such as a bilateral or bimodal fitting.
  • Once the speech processor is programmed to provide optimal access to the speech spectrum, ongoing evaluation at regular intervals is recommended (e.g., at three-month intervals for the first year). After this period, routine assessment of performance with the cochlear implant continues to be recommended at six- to 12-month intervals if progress is satisfactory.
  • Sound Field warble tone or narrowband noise thresholds and speech perception testing should be performed whenever the speech processor is programmed and may be helpful along with other troubleshooting techniques whenever problems are suspected. Additional purposes of sound field testing are:
    • To demonstrate the child’s response to speech for parent education purposes
    • To monitor the child’s auditory progress
    • To assess speech perception at average (e.g., 50 dB HL) and at soft (e.g., 35 dB HL) conversational levels in quiet and in the presence of noise, to evaluate the effectiveness of the cochlear implant, or of each cochlear implant in the case of bilateral fitting
    • Subjective assessment of distance hearing using the Ling 6-Sound Test to demonstrate the range of audibility provided by the technology. In a quiet environment, the child should be able to detect all of the Ling sounds at close distances (e.g., one meter or approximately 3 feet) and at substantial distances (e.g., approximately 12 meters or approximately 40 feet).
  •  
  • Immediate evaluation is recommended if parent, caregiver, or educator/therapist observe behaviors suggesting a negative change in performance or express concern regarding device function.
  • Functional auditory assessments (e.g., PEACH, LittlEARS) to validate hearing aid fitting.

VI. Recommended Audiologic Management Regarding FM Systems
  • Every child with hearing loss will benefit from the use of an FM system to reduce the negative effects of distance and competing noise.
  • All technology selected for children should be FM compatible.
  • Validation and verification should be included in evaluations for children using FM systems. See Clinical Practice Guidelines for Remote Microphone Hearing Assistance Technologies for Children and Youth Birth-21 Years (American Academy of Audiology, 2008; available at http://www.audiology.org/publications-resources/document-library/hearing-assistance-technologies).

RECOMMENDED UNAIDED AND AIDED AUDIOLOGIC PEDIATRIC ASSESSMENT PROTOCOLS BY AGE* OF CHILD 

0-6 months

6-12 months

12-24 months

24-36 months

Over 36 months
UNAIDED TESTING





ABR
x
x
X if not performed previously


Immittance testing
X 1000 Hz probe tone
x
x
x
x
OAE testing
x
x
x
x
x
Behavioral testing
250-8000 Hz
X BOA
X VRA
X VRA with transition to CPA
X VRA until child can perform CPA
X CPA
SAT-Ling Sounds
x
x
x


SRT testing
Speech Perception

testing at 40 dB above threshold if possible.
This test may be useful for helping families
understand what the child is hearing.


X Body parts, familiar objects
X Body parts, familiar objects
Begin standardized tests
X Standardized tests
TESTING WITH TECHNOLOGY





RECD
x
x
x
x
x
Cortical Responses
x
x
x
x
x
SAT-Ling Sounds
x
x
x


SRT Testing


x
x
x






Aided thresholds – 250-8000 Hz
x
x
x
x
x
Aided Speech Perception
50 dB HL – Quiet


X Right, Left, Binaural
X Right, Left, Binaural
X Right, Left, Binaural
Aided Speech Perception at 35 dB HL – Quiet



X Right, Left, Binaural
X Right, Left, Binaural
Aided Speech Perception
50 dB HL- /+5 SNL



X Binaural
X Binaural
Note 1: The purpose of all auditory technologies is to deliver the most complete sound possible to the child’s brain, where actual “hearing” occurs. The task of technologies is to access, stimulate, and develop neural pathways that are the basis for listening, talking, reading and learning.

*Note 2:  The age levels presented represent a child’s developmental levels as well as chronological age. A child (or adult) with developmental delays should be assessed with tests appropriate to his/her developmental level, not chronological age.

Note 3: Aided testing refers to whatever technology the child is using. This may be hearing aids, cochlear implants, osseointegrated devices, FM systems, and other. Each ear should be tested separately with technology, as well as binaurally.

Abbreviations used in the chart:
“X” means the test should be performed
BOA - Behavioral Observation Audiometry
VRA - Visual Reinforcement Audiometry
CPA - Conditioned Play Audiometry
ABR - Auditory Brainstem Response Testing
SAT - Speech Awareness Threshold
SRT - Speech Recognition Threshold
RECD – Real-Ear-to-Coupler Difference
OAE - Otoacoustic Emissions Testing


RECOMMENDED AUDIOLOGIC SPEECH TEST PROTOCOLS BY AGE* OF THE CHILD 

Birth-6 months
6-12 months
12-18 months
18-24 months
24-36 months
3-5 years
6-8 years
8+ years
SAT
x
x
x
x




SRT


x
x
x
x
x
x
ESP

x
x
x




NU
CHIPS



x
x
x


WIPI





x
x

PBK





x
x

NU 6
CNC






x
x
HINT -C
or A





x
x

Baby's Bio






x
x
AzBio







x
Note 1: The purpose of all auditory technologies is to deliver the most complete sound possible to the child’s brain, where actual “hearing” occurs. The task of technologies is to access, stimulate, and develop neural pathways that are the basis for listening, talking, reading, and learning.

*Note 2: The age levels presented represent a child’s developmental levels as well as chronological age. A child (or adult) with developmental delays should be assessed with tests appropriate to his/her developmental level, not chronological age.

Note 3: Speech tests are to be presented in unaided and aided conditions. Aided testing refers to whatever technology the child is using. This may be hearing aids, cochlear implants, osseointegrated devices, FM systems and other. Each ear should be tested separately with technology, as well as binaurally.
Abbreviations used in the chart:
“X” means the test should be performed
SAT - Speech Awareness Threshold
SRT - Speech Recognition Threshold
ESP - Early Speech Perception Test. Available at http://www.cid.edu/ProfOutreachIntro/EducationalMaterials.aspx 
WIPI - Word Intelligibility by Picture Identification. Available at http://www.auditec.com/cgi/Auditec2013Catalog.pdf 
PBK - Phonetically Balanced Kindergarten Word Test. Available at http://www.asha.org/eweb/OLSDynamicPage.aspx?title=Childrens+Spondees+PBK-50A&webcode=olsdetails  
CNC - Consonant Nucleus Consonant Test. See Mackersie, C. L., Boothroyd, A., & Minnear, D. (2001). Evaluation of the Computer-Assisted Speech Perception Assessment Test (CASPA). Journal of the American Academy of Audiology, 27, 134–144.
AzBio - See Spahr, A. J., Dorman, M. F., Litvak, L. M., Van Wie, S., Gifford, R. H., Loizou, P. C., … Cook, S. (2012). Development and validation of the AzBio sentence lists. Ear and Hearing, 33(1), 112-117. doi: 10.1097/AUD.0b013e31822c2549
Baby Bio - See Spahr, A. J., Dorman, M. F., Loiselle, L., & Oakes, T. (2011). A new sentence test for children. 10th European Symposium on Pediatric Cochlear Implantation. Athens, Greece, May 12-15.

Disclaimer: The protocol outlined in this document is not prescriptive for professionals who hold the Listening and Spoken Language Specialist (LSLS®) certification to utilize in their scope of practice and is not required by Alexander Graham Bell Association of the Deaf and Hard of Hearing or the Alexander Graham Bell Academy for Listening and Spoken Language. This reference contains guidelines and recommendations for use at the professional’s discretion. AG Bell disclaims any liability to any party for the accuracy, completeness, or availability of this documents, or for any damages arising out of use of this document and any information it contains.
Listening and Spoken Language Specialist (LSLS®), Auditory-Verbal Therapist (LSLS Cert. AVT®) and Auditory-Verbal Educator (LSLS Cert. AVEd®) are trademarks of the AG Bell Academy for Listening and Spoken Language.

© Copyright 2014 Alexander Graham Bell Association for the Deaf and Hard of Hearing. All rights reserved. Alexander Graham Bell Association for the Deaf and Hard of Hearing (2014).

Recommended protocol for audiological assessment, hearing aid and cochlear implant evaluation, and follow-up. Washington, DC: author.

Wednesday, November 19, 2014

H-O-L-I-D-A-Y-S Are For Hearing

Tips for Families of Children With Cochlear Implants

Source 
People love holidays! Adults busily prepare for the festivities while children are abuzz with excitement. Traditions are passed down as family and friends gather. Below are suggestions so you can enjoy the HOLIDAYS and focus on your child’s listening and spoken language.

Holidays are about listening to joyous music, lively conversations and spending time with family and friends.  Encourage your child to be the Holiday Host and greet visitors and take their coats. This will boost your child’s confidence while giving him a chance to talk face to face in a quiet setting.  Role-play upcoming holiday situations and practice good listening strategies. Create a secret a signal so your child can notify you when he is having a difficult time hearing. Keep the holiday music off or at a low volume, as your child is likely not the only one bothered by clatter and background music.

Organize an email and send it your family and friends before you gather for the holidays. Write a quick update about your child’s listening and spoken language progress and his cochlear implant technology. Dealing with this before the holidays will allow you to spend time celebrating rather than answering questions of well meaning friends and family.

Large family dinners are noisy so plan accordingly.  One suggestion is ensuring your child knows the topic of the conversation. Consider using “conversation starter cards around the table which are always fun. Also, have someone special seated next to your child who can repeat a joke or summarize a story if your child mishears.

Include your child in the holiday preparations and focus on vocabulary that is often specific to the season. What is mistletoe? A menorah? The Nutcracker? A manger? A New Year's resolution? Spend time reading holiday stories, cooking traditional foods and learning the words to holiday songs.  You child can create decorations to hang around your home and tell guests about them when they visit.

Devices. Keep your child’s CI accessories charged and ready to use. Role-play so your child is comfortable asking others to wear the FM, Roger system or use their ComPilot and can explain how it helps him hear.  At the dining table place the accessory mic in the middle or concealed in the centerpiece. If you attend a holiday performance or a faith-based service, contact the venue to request extra amplification such as a microphone, a hearing loop and captions.  Another important device is your phone’s camera. Snap photos to include in your child’s Listening and Spoken Language Experience Book.

Arrange seating with your child’s hearing in mind. Encourage your child to choose a good seat for hearing at dinner and for the gift exchange. Is there a seat away from the bustling kitchen, or the room when the teenagers are playing video games? When opening gifts, suggest sitting in a circle so your child can both listen and watch.

Your traditions are an important way to expand your child’s listening and spoken language skills. If gift giving is your tradition, choose presents that will provide hours of creative play and stimulate conversation. Most of your child’s memories will be about people, not presents.

Simplify. Ask your child what traditions he feels are most important. You may be surprised by his reply. Consider skipping old traditions that have lost appeal or that your family has outgrown. Time spent together rather than on activities will be most remembered. Keep a Joy Journal to jot down moments of triumphs, laughter, inspiration and the “hearing” miracles you enjoy over the holidays.





Monday, November 17, 2014

Blogroll at the Listening and Spoken Language Knowledge Center

Click HERE to link to some of my friend and colleagues' blogs.










Thanksgiving Guess Who?

Listen & Learn with: Thanksgiving Guess Who?

Reposted from 2012

Click here to download the printables from http://mrshomeec.blogspot.com.





Thanksgiving Guess Who? can be used for a wide range of listening and language targets such as auditory memory, auditory processing, deductive reasoning and a wide range of receptive and expressive language goals. For the game to work, both players must listen, comprehend and reply to each other’s questions accurately.



To Play: First, you will need to print out the game cards.



Number of players: 2 (more players can compete as teams)

    Description: Each player has a one set of 20 different Pilgrims and Indians. Both players select one small Pilgrim/Indian card. Do not let your opponent see it. Put remaining little cards away.
    Lay out your big cards face up in 4 rows of 5.
    Take turns asking each other questions about the cards to deduce which small Pilgrim/Indian your opponent has. Turn big cards face down when they don’t have characteristics you are asking about (i.e. “Does your person have a hat?” “No”...turn all people with hats face down, etc.).
    Once every card is turned face down but one, you can ask your opponent, “Is your person ______?”
If it is, you win the game!
Suggested Listening and Spoken Language Targets:

1. Describing Salient Features:
If your child often communicates by pointing or uses a lot of non-specific vocabulary like that, this, or thing, playing Guess Who? can contribute to using more specific descriptions. It is a good idea to look at the cards together beforehand and warm up by discussing the characters’ distinguishing features.

2. Question Formation:
Forming yes/no questions involve inverting the subject (e.g., your Pilgrim) with either the main verb (e.g., Is your Pilgrim a girl?) or the auxiliary verb as in  (e.g., Does your Indian have a two feathers in his headband?)

 3. Is/Does Question Forms:
When using Thanksgiving Guess Who? for this purpose, require the child to ask all questions using one of two forms:
    Is your pilgrim wearing a bonnet_____?
    Does your Indian have a vest _____?
    Expect your child to answer using full sentences, not a simple yes or no.

4. Have/Has as well as Negation and Contractions:
There are four typical forms for an answer:
    Yes, my pilgrim has _____.
    No, my Indian doesn’t have _____.
    Yes my pilgrim is _____.
    No, my Indian is not _____.

5. Using “Clear speech”:
Producing accurate /s/ and /z/ and other speech sounds can be highlighted in spontaneous speech For example: is, has, does, etc. Thanksgiving Guess Who? is a great exercise in self-monitoring and using clear speech.

Have fun! 

Friday, November 7, 2014

Management of Auditory Processing Disorders (APD)

http://kidshear.com.au/

Typically, an auditory processing disorder results in a significant deficit in how the brain perceives and interprets sound information. Poor auditory processing abilities negatively impact the use of spoken language, receptive and expressive communication, academic learning and social skills.

Research indicates that with appropriate intervention, children with APD can become active participants in their own listening, learning, and communication success. Thus, when auditory rehabilitation is navigated carefully, accurately, and appropriately, an individual’s prognosis is good in spite of being afflicted with APD.

Treatment of APD generally focuses on three primary areas:

1. Changing the learning or communication environment
The primary purpose of environmental accommodations and/or modifications is to improve access to auditorily presented information are often listed in a student’s 504 Plan.

2. Learning and using compensatory strategies
Compensatory strategies teach individuals with APD to take responsibility for their own listening success or failures. The individual uses a variety of active listening and problem-­‐solving techniques to be an active participant in daily listening activities.

3. Auditory Rehabilitation for APD
Auditory Rehabilitation targets maximizing auditory processing skills rather than only putting accommodations in place that are usually visual in nature and do not impact the auditory disorder. Research shows that vision is not a good substitute for hearing. If it were, APD would not present with such challenges.


http://www.gemmlearning.com/


Auditory Rehabilitation Therapy involving a systematic program of auditory training
includes two main areas:

Improving the individual’s auditory processing, auditory memory and auditory attention
1. auditory association abilities.
2. auditory comprehension and direction following abilities.
3. auditory closure abilities.
4. auditory memory ability to retain auditory information both immediately and after a delay.
5. auditory memory sequencing.
6. linguistic auditory processing for higher-­‐level language, learning and
communication.
7. auditory processes for auditory integration.
8. ability to attend to important auditory information including attending in the midst of competing background noise and verbal distractions.

9. auditory comprehension/receptive and expressive language including vocabulary, syntax, morphological markers, complex sentence structures, conceptual language, social and pragmatic language.
10. communication repair strategies and clarification techniques


Recruiting higher-­order skills to help compensate for the auditory deficit
Examples based on an individual’s needs are targeted and may include such as learning and using:
a) auditory retrieval strategies to improve word retrieval of known but evasive vocabulary
b) synonyms to circumvent word-­‐finding blocks
c) categorization or grouping to facilitate auditory memory
d) chunking to aide in recall of sequences of numbers and other types of information 

e) mnemonic devices to assist in auditory memory
f) creating and use of a verbal description when referring to concrete items and situations


The degree to which an individual’s auditory deficits will improve with therapy cannot be determined in advance. However, with appropriate auditory rehabilitation, individuals with APD can become active participants in their own listening, learning, and communication success. 

Thursday, November 6, 2014

Listen and Learn with a Thanksgiving Guess Who Game


Click here to download the printables.



Thanksgiving Guess Who? can be used for a wide range of listening and language targets such as auditory memory, auditory processing, deductive reasoning and a wide range of receptive and expressive language goals. For the game to work, both players must listen, comprehend and reply to each other’s questions accurately.

To Play: First, you will need to print out the game cards.

Number of players: 2 (more players can compete as teams)

    Description: Each player has a one set of 20 different Pilgrims and Indians. Both players select one small Pilgrim/Indian card. Do not let your opponent see it. Put remaining little cards away.
    Lay out your big cards face up in 4 rows of 5.
    Take turns asking each other questions about the cards to deduce which small Pilgrim/Indian your opponent has. Turn big cards face down when they don’t have characteristics you are asking about (i.e. “Does your person have a hat?” “No”...turn all people with hats face down, etc.).
    Once every card is turned face down but one, you can ask your opponent, “Is your person ______?”
If it is, you win the game!
Suggested Listening and Spoken Language Targets:

1. Describing Salient Features:
If your child often communicates by pointing or uses a lot of non-specific vocabulary like that, this, or thing, playing Guess Who? can contribute to using more specific descriptions. It is a good idea to look at the cards together beforehand and warm up by discussing the characters’ distinguishing features.

2. Question Formation:
Forming yes/no questions involve inverting the subject (e.g., your Pilgrim) with either the main verb (e.g., Is your Pilgrim a girl?) or the auxiliary verb as in  (e.g., Does your Indian have a two feathers in his headband?)

 3. Is/Does Question Forms:
When using Thanksgiving Guess Who? for this purpose, require the child to ask all questions using one of two forms:
    Is your pilgrim wearing a bonnet_____?
    Does your Indian have a vest _____?
    Expect your child to answer using full sentences, not a simple yes or no.

4. Have/Has as well as Negation and Contractions:
There are four typical forms for an answer:
    Yes, my pilgrim has _____.
    No, my Indian doesn’t have _____.
    Yes my pilgrim is _____.
    No, my Indian is not _____.

5. Using “Clear speech”:
Producing accurate /s/ and /z/ and other speech sounds can be highlighted in spontaneous speech For example: is, has, does, etc. Thanksgiving Guess Who? is a great exercise in self-monitoring and using clear speech.


Have fun!