Development of an Auditory Function/ A-V Techniques

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Development of an Auditory Function/A-V
Techniques

• Developed by
• Beth Walker, M.Ed., C.E.D., LSLS Cert. AVT
• Kathryn Wilson, M.A., CCC-SLP, LSLS Cert. AVT
• Megan Katz, MS, CCC-SLP, LSLS Cert. AVT

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Presented by

• Megan Katz, MS, CCC-SLP, LSLS Cert AVT
• Sherri Vernelson, M.Ed., LSLS Cert AVEd

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Agenda

• Auditory Processing, Neuroplasticity of the
  Auditory System and Critical Period for
  Development of Auditory Function
• Normal Auditory Development
• Speech Acoustics
• Auditory-Verbal Techniques and Strategies
• Guide to the Development of Auditory Skills
• Assessment
• Development of an Auditory-Verbal Program

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Learner Outcomes

• Examine research on auditory brain development
  and how this impacts auditory learning of
  children with hearing loss.
• Identify and sequence specific auditory behaviors
  that occur in the development of spoken language
  and will identify components of a detailed model
  of auditory learning.
• Apply information about specific formant
  frequencies of individual phonemes to the
  auditory learning of spoken language.

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• Identify factors that affect the auditory
  reception of spoken language and select
  appropriate strategies and techniques for
  assisting auditory perception of particular
  features of spoken language.
• Predict levels of development in speech,
  language, cognition and communication in relation
  to level of auditory development.
• Develop A-V lesson plans including goals,
  activities, strategies and carry-over ideas for
  specific cases.

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Auditory Brain Development Auditory Processing

• We know what you are thinking.
• What a fun, exciting, interesting, motivating,
  attention-grabbing, fascinating way. to start
  the day!!!

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The goal for children in an AV approach is spoken
language.

• The MOST effective modality for
  acquiring/teaching spoken language is HEARING.
• What do we know about the relationship between
  listening, literacy and success in reading?

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Auditory Brain Development

• Its all about the BRAIN!
• The ears are just the way in

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Quick QuizWell answer these other REALLY
important questions

• Measurable differences in brain organization and
  neural activity is caused by ______ ______.
• Research by Sharma indicates that the brain waves
  of children who begin wearing hearing aids or
  cochlear implants by _____ years of age reflect a
  normal response to sound.
• What is developmental synchrony?

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Is there a critical period for the development of
auditory function?

• A-V Principles 1 2
• Newborn hearing screening programs 21st Century
  technology allow access to the auditory centers
  of the brain
• Access is a good thing!
• In fact, it is great!
• Is it enough?

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Easy Math

• Early identification early appropriate
  technology appropriate intervention by parents
  professionals during the period of maximum
  neural plasticity potential for achieving high
  levels of speech, language, reading, literacy
  success in school.

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Neuroplasticity----Current Research

• The infant brain has neural plasticity.
• Complete maturation of the central auditory
  pathways is required for the normal development
  of spoken language in children.
• The period of greatest neuroplasticity is the
  first
• 3 ½ years of life (Sharma et al, 2002 2004
  Sharma, Dorman, and Kral, 2005).
• Children implanted by 12 months of age may
  demonstrate more benefit than children receiving
  implants later on in the period of maximum neural
  plasticity (Sharma, Dorman, and Kral, 2005).
• When children acquire skills at or near the time
  that they are intended to do so biologically,
  this is called developmental synchrony.

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Making the Connections

• A babys brain continues growing beyond the
  wombnot just in size, but in forming connections
• Born with 100 billion neurons. By 3 years of age
  babies have about 15,000 synapses per neuron,
  three times the synapses of adults.
• What happens to synapses that are not accessed?

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Making the Connections

• Babies are citizens of the world.
• Neurons in the auditory cortex
• Laborers with no job assignments
• As the infant is exposed to spoken language,
  different clusters of neurons in the auditory
  cortex are recruited to respond to different
  phonemes
• Neuron clusters fire only when a nerve from the
  ear carries a particular sound
• By 12 months of age a childs auditory map is
  established

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Making the ConnectionsTraining OR Learning?

• For the young child,meaningful contexts are
  crucial for the auditory processing of spoken
  language.
• The hearing-impaired childs auditory abilities
  develop because emphasis is placed on listening
  throughout all waking hours so that hearing
  becomes an integral part of his/her personality.
• (Pollack, 1985)

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Its All About Experience

• Experience Vocabulary
• Vocabulary size correlated with quantity of
  maternal talk
• 20 months of ageoffspring of talkative mothers
  averaged 131 more words than children of less
  talkative moms
• At age two, the gap doubles
• Critical factornumber of times the child HEARS
  different words
• TV doesnt produce same results. Why not?
• Information within context seems to stimulate
  neural circuitry

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What happens when the auditory centers of the
brain are not accessed early?

• Decreased ability to use sound meaningfully
  (cross-modal reorganization)
• Physiological changes
• Psychosocial factors
• When the hearing aids are OFF what happens?

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Auditory Processing of Spoken Language

• The auditory processing whole is greater than
  the sum of current knowledge of its hypothesized
  parts.
• (Cole,1992, 2006)

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Components of auditory processing models

• Peripheral hearing structures are responsible for
  analysis and conversion of speech/acoustic
  information to nerve impulses for transmission to
  the brain
• Brief memory storage required
• Preliminary processing in the brainstem
• Localization and selective attention
• Auditory cortex receives input
• Higher level analysis includes phonetic,
  phonological, syntactic, semantic, and
  pragmatic/contextual processing

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Take Home Points

• We hear with the ____.
• Neuroplasticity is greatest during the first
  ___years
• What is the purpose of hearing aids and cochlear
  implants?
• What happens when the auditory centers are not
  stimulated early?
• Full maturation of the central auditory pathways
  is a must for________.

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References

• Bock, P., (2005). How do babies learn to talk?
  Retrieved on July 1, 2007 from http//seattletimes
  .nwsource.com/pacificnw/2005/0306
• Cole, E., Flexer, C. (2007). Children with
  hearing loss Developing listening and talking
  birth to six. San Diego CA Plural Publishing
• Sharma, A., Dorman, M.F., Kral, A. (2005). The
  influence of a sensitive period on central
  auditory development in children with unilateral
  and bilateral cochlear implants. Hearing
  Research, 2-3, 134-143.
• Sharma, A., Dorman, M.F., Spahr, A.J. (2002). A
  sensitive period for the development of the
  central auditory system in children with cochlear
  implants Implications for age of implantation.
  Ear and Hearing. 23(6), 532-539.
• Sharma, A., Martin, K., Roland, P., Bauer, P.,
  Sweeney, M.H., Gilley, P., et al. (2005). P1
  latency as a biomarker for central auditory
  development in children with hearing impairment.
  Journal of the American Academy of Audiology, 16,
  564-573.

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Lets Talk about Hearing Age

• Relationship between age at first amplification
  and a childs chronological age
• Calculated from the day the child begins wearing
  amplification
• Hearing age is the term used to put progress in
  perspective
• Listening experience
• Mixed hearing history

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Other Terms

• Cochlear Implant Age length of time since CI
  hook-up.
• A-V Age length of time enrolled in
  Auditory-Verbal Therapy
• Language Age level of understanding and use of
  language

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Application

• John is an 11 month old boy whose moderately
  severe bilateral hearing loss was diagnosed at
  two months of age. He began wearing hearing aids
  at 3 months of age and began AVT at the age of 5
  months.
• What is Johns hearing age? What is his program
  (AVT) age?

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• At a chronological age of 3 years 8 months, John
  obtained the following scores on standardized
  measures of language
• PLS-4
• AC 101
• AE 98
• Total Lang. 100
• A.E. 3 years, 7 months
• Peabody Picture Vocabulary Test-III
• SS 92
• A.E. 3 years, 3 months
• Discuss the test results for John in relation to
• Chronological Age
• Hearing Age
• Program Age

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Application

• Cate is 4 years, 6 months of age. Her
  severe-profound bilateral hearing loss was
  identified at 13 months of age, and she was
  subsequently fitted with hearing aids at 15
  months.
• What is her hearing age?
• Cate received a cochlear implant at 2 years, 6
  months and began AVT at the same time.
• Note Cate was enrolled in a TC program from
• 16 28 months of age.
• What is Cates CI age? AVT age?

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• At 4 years, 6 months of age, Cate has an
  expressive vocabulary of 284 words. She
  consistently uses 3-word combinations
  spontaneously such as I want cookie no want
  that and I do it. She can recall 3 critical
  elements, identify objects when given related
  descriptors and can identify segments of sequence
  stories. She demonstrates accurate vowel
  production and uses /p/, /m/, /w/, /h/ correctly
  in spontaneous speech. Cate uses all
  suprasegmental features of speech appropriately.
• Discuss Cates present level of functioning in
  relation to her
• Chronological Age
• CI and AVT Age

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Stages of Auditory Development

• Follow the normal sequence of development
• A basic premise of Auditory-Verbal education is
  that limited-hearing children need the same
  foundation of listening experiences as a
  normal-hearing child regardless of the age at
  which intervention occurs

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Auditory Detection or Attention 0-2 months Distance Hearing 2-4 months Localization 4-6 months Discrimination 5-7 months Auditory Self-Monitoring 8-10 months
Presence absence of snd. Begins to startle to snds at increasing distances Orienting reflex Infant searches for snd. Perceives differences in sounds Modifies speech to match what was heard
First responses are to gross snds. Recognizes mothers voice Localization-develops during 1st years of listening Reacts differently to different tones of voice Imitates non-speech sounds
Begins to ustand source of snds learns there are all kinds of snds. Stops crying to listen listens to his own snds. Enjoys being whistled or sung to Monitors own vocal play
Begins to listen w/ varying degrees of attn. Enjoys a few noise-makers
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Auditory Ident. Association 9-11 months Auditory Memory 9-12 months Auditory Sequencing 10-18 months Auditory Processing months 18-48 months Auditory Under-standing 48-72 months
Labels what was heard Remembers what was heard Remembers what was heard in the correct order Makes cognitive judgments about what was heard Compre-hends auditory information in a variety of settings
Object selection Recalls critical elements


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Speech Acoustics

• Lets Review

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Why should we know this?

• Knowledge of speech acoustics helps us
• Bridge the disciplines of audiology and
  habilitation
• Judge what speech information is available to a
  child through hearing
• Teach parents what the child can do or has the
  potential to do with his/her aided hearing
• Select strategies to facilitate the processing of
  spoken language through audition

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• ah

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• eye

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/s/ /e/ /v/

• save

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mean

• /m/ /i/ /n/

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tide

• /t/ /ai/ /d/

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Multimedia FUN!

• http//www.utdallas.edu/thib/EARRINGFINAL/EARRING
  WEB_files/frame.htm
• http//hctv.humnet.ucla.edu/departments/linguistic
  s/VowelsandConsonants/course/chapter1.1/chapter1.1
  .htmfour
• http//hctv.humnet.ucla.edu/departments/linguistic
  s/VowelsandConsonants/course/chapter8/speechbird/s
  peechbird.html
• http//www.oraldeafed.org/movies/heardiff.html

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Auditory-Verbal Strategies and Techniques
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Position to maximize auditory input

• Sit behind the child?
• In front of the child?
• On top of the child???
• Beside the child?
• On which side?

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Position to maximize auditory input

• Optimal distance is
• Within ___ inches of the HA microphone
• Within ___ inches of the CI microphone
• Come close to me at 6 dB
• Amplification should be set so that child can
  easily hear you at a distance of ___

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Maintain Favorable Auditory Learning Environment

• This means controlling ___ ___
• In which of the childs learning environments can
  the adult exert control over these factors?
• How?

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PositioningFavorable Auditory Environments

• GREAT website!
• Contains audio files for demo of FM with/without
  hearing aid, what a CI sounds like, simulations
  of auditory neuropathy, etc.
• http//www.utdallas.edu/thib/EARRINGFINAL/EARRING
  WEB_files/frame.htm

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Attention Getters

• The Listen! Cue
• Audition FIRST
• Not show and tell but Tell and Show
• Why hearing first?
• Sing What You Say/Parentese
• Get Closer

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Helps for PROCESSING through Audition

• CLEAR Speech
• Speak Suthun i.e., a slightly slower rate of
  speech
• Acoustic Highlighting more to less
• Lowlighting/Whispering Why?

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Helps for Processing

• WAIT Time Expectant Look
• The ___ the child, the more wait time needed
• The Expectant Look says
• Repetition Why?
• Pause before challenging word/s

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Helps for Processing

• Word position in sentence
• Give a choice
• What DID you hear?

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And if you must

• A-V-A Sandwich or Put it back into hearing
• Give visual context for auditory input
• Point to the picture/object
• Natural gesture
• Facial expression
• Adjust set size

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Helps for Confident Listening

• Modeling
• Converse slightly above childs linguistic level
• Diagnostic Teaching, NOT testing
• Known ?unknown, audible ?less audible

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Other Strategies

• The absent-minded therapist
• Let child be the teacher

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PrerequisitesKnowledge of

• Auditory processing, neuroplasticity of the
  auditory system and a critical period for
  development of an auditory function
• Normal Auditory Development
• Speech Acoustics
• Auditory-Verbal Strategies Techniques
• Assessment of Listening Skills

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Current Models of Auditory Learning

• Cole and Flexer (2007)
• Dickson, C. (1999)
• Estabrooks (1998)
• Pollack, Goldberg, Caleffe-Schenck (1990)
• Romanik, S. (1990)
• Simser (1993)
• Walker (1995, rev. 2009)

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Auditory Learning Guide (ALG)(Walker, 1995)

• Framework for the development of an auditory
  function
• Based on the work of Simser, Romanik Foreworks
  Curriculum
• Comprehensive chart
• Not an exhaustive list

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The ALG is useful for

• Establishing Goals
• Planning therapy sessions
• Documenting progress
• Parent Education
• Professional collaboration

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Auditory Learning Guide

• Five levels
• Sound Awareness
• Phoneme Level
• Discourse Level
• Sentence Level
• Word Level
• Concurrent development
• Timelines are color-coded

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Auditory Learning Guide

• CONSIDERATIONS
• Therapists skill level/experience
• Residual hearing/aided thresholds
• Age at implantation
• Perception vs. production

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Sound Awareness

• DETECTION ONLY, LOW LEVEL
• With optimal amplification, may complete work on
  all steps in one week
• Begins with detection of ANY speech sound
• Quickly progresses to detection of all sounds
• Close range to Distance
• Includes detection of wide variety of
  environmental sounds at various distances

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Environmental Sounds

• Indoor Sounds
• vacuum cleaner, knock on the door, washing
  machine, dryer, teapot whistling, hair dryer, TV,
  radio, smoke alarm, blender, telephone
• Softer Sounds
• clock ticking, cats meow/purr, broom sweeping,
  pages being turned, coins or keys clinking

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Environmental Sounds

• Human Noises
• laughing, sneezing, coughing, crying, whistling,
  walking, snoring
• Musical Instruments
• drum, bells, horn, piano, tambourine
• Outdoor Noises
• thunder, fire engine, airplane, train, car horn,
  garage door, dog barking, rain

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Sound Awareness

• Conditioned Response
• Exposure/Modeling at 16 months
• Most children consistent 24 months
• Audiological Evaluations
• More efficient
• More reliable
• More thorough
• Ling 6 Sound Check
• Daily checks help monitor
• Amplification
• Middle Ear Status

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Phoneme Level

• What?
• Why?
• When?
• Examples
• Alternating vowels
• Identification of consonants varying in manner of
  production

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Discourse Level

• Connected spoken language
• Conversational context
• Discourse
• Dialogue
• Combine with Sentence and Word Level

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Discourse Level Year 1

• Imitate motions of nursery rhymes/songs with
  accompanying vocalization
• To identify songs/rhymes
• Easier to process larger units of language
• To identify the last word read in a passage
• For individuals who can read
• Helps develop good phrasing and improves fluency
• To answer common questions

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Discourse Level Year 2

• To follow a story illustrated by sequenced
  pictures.
• First step toward processing a story through
  listening alone
• To identify an object from several related
  descriptors (closed set)
• Begin with identifying items by function
• To follow a conversation with the topic
  disclosed.
• Tell the child what the topic is or let him choose

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Discourse Level Year 3

• To answer questions about a story with the (topic
  disclosed).
• Precursor to story retelling
• Leads to recalling events, sequencing events and
  ultimately retelling a story
• To answer questions about a story with the (topic
  disclosed) story is teacher audio-taped.
• To recall details of a story (topic disclosed).
• No questions to prompt memory details dont have
  to be in correct sequence
• To sequence the events of a story (topic
  disclosed).
• Start with 3 events and move to 4, 5, more

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Discourse LevelYear 4

• To retell a story with the topic disclosed,
  recalling all details in sequence
• To make identification based on several related
  descriptors (open set).
• No prompts completely open set
• To follow a conversation of an undisclosed topic
• Child is processing well by this stage
• To retell a story about an undisclosed topic,
  recalling as many details as possible.
• To process information while listening with
  competing stimuli. (taped voice with taped
  competing stimuli).

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Sentence Level

• Stimulus-response context
• Develops auditory memory
• MUST give child a communicative reason to respond
• Use imitation as a strategy
• After step 3? 6?, work at this level is often
  unnecessary

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Sentence Level

• Examples of Critical Elements
• One Wheres the kittycat?
• Two I need a red ball. Look under the table.
• Three Mommy wants two pretzels.
• Four
• Color the big star yellow and orange.

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More on Critical Elements

• Independent or Group practice
• Create an activity
• Be ready to share with the group

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Word Level

• Perception of individual words
• Progression
• Acoustic features of the target
• Word placement
• In the context of phrases or sentences

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Word Level

• Vocabulary Development Program- (NOT
  skill-based exercises with single words)
• Learning to Listen sounds
• Power Word list
• Lexicon One
• Theme-based units, Childrens Literature Units
  (Ling Basic Vocabulary Language Guide)

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Content of Learning to Listen Sounds

• Learning to Listen Sounds contain all the
  suprasegmental features, early developing vowels
  and consonants.
• Why do we begin with the Learning to Listen
  Sounds rather than the animal and vehicle names?

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Criteria for Mastery

• Suprasegmentals
• Child must be able to imitate sounds that vary in
  duration, intensity, and pitch.
• Lets name sounds with
• Long duration
• Brief interrupted duration
• Loud intensity
• Quiet intensity
• High pitch
• Low pitch
• Varied pitch

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Criteria for Mastery

• Child must be able to imitate two back vowels,
  two mid-vowels and at least one front vowel.
• Lets identify
• Back vowels
• Mid vowels
• Front vowels

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Criteria for Mastery

• Child must be able to imitate a nasal, fricative,
  and plosive.
• Child must demonstrate spontaneous use AND
  identify Learning to Listen Sounds in a set of
  10-12
• How long should it take to complete the goal?

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• Do we do Learning to Listen Sounds with late
  starters?
• Strategies for input?
• Strategies for identification?

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Power Words

• More Hot/cold
• Up Mine/me
• Mama, Daddy Off/on
• Go Look
• Stop Blow
• Bye-bye Go away
• No Move
• All gone Open

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First Lexicon

• First 30-60 words that young children acquire.
• Need a core vocabulary before child can produce
  two-word combinations
• First Lexicon includes nouns, pronouns,
  adjectives, verbs, position/location words and
  words to indicate denial and rejection

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Learning Contexts Teaching Approaches
Informal Learning Embellished Informal Teaching Semi-Formal Teaching Formal Teaching
Happens in normal, everyday events and interactions Should occur at home and school All learner types Seize the moment Use of strategies to embellish the normal situation Should occur at home and school All learner types Adult directed, pre-planned activities Developmentally appropriate Specific goals and objectives Use of strategies Typically done at school Delayed remedial learners Adult directed Deliberate, direct, methodical Specific goals and objectives Use of strategies Happens in traditional educational setting School age remedial learners
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Types of Learners
Developmental Delayed Remedial
English Language Skills Within one year of typically developing peers 1-2 years behind peers Greater than two years behind peers, scattered language skills
Learning/Teaching context Informal learning Primarily semi-formal, also need informal Formal learning, with generalized to informal
Educational Placement Fully mainstreamed by preschool/kindergarten Mainstreaming by kindergarten may be a challenge due to language gap one hr/pd per year of language delay Social mainstreaming

• Three types of learners

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Types of Learners

• Delayed and Remedial Learners CAN
• catch up with focused
• language intervention that follows a
• developmental sequence

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Lesson Plan Development
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Lesson Plan Development in the A-V Approach

• How do you know what to do when a child has a
  spoken language delay?
• Do you use a specific model for spoken language
  development?
• What model do you use for development of
  language?
• Why should you?

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Lets Put it all together

• You will need
• Normal Development Resources
• Language Development
• Vocab development
• Speech Development
• ALG Chart
• Blank Lesson Plan Forms

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A-V Teaching Behaviors Establishing Goals

• Develop your road map
• Whats your destination?
• Long Term goals
• How ya gonna get there?
• Short term goals

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Lesson Planning and A-V Teaching Behaviors

• Writes thorough, specific goals, specifying
  weekly targets and ideas for effective
  carryover.
• Demonstrates continuity in planning from session
  to session.
• Plans for parent education in each session.

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Six-Step Guide To The Development of an Auditory
Function in an A-V Approach

• With the parent
• Evaluate the childs present level of auditory
  development within the context of a detailed
  model for normal auditory development
• Determine next appropriate target
• Compare acoustic characteristics of the target
  with childs auditory potential (audiological
  information)
• Select sense modality (consider hearing 1st)
• Develop the target through informal
  learning-formal teaching
• Evaluate progress toward goal often

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Lesson Plan Development Point to Ponder

• Hearing children learn language through listening
  as they seek to extract meaning from their
  environment (Ling, 1986)
• What, in the childs mind, is the reason to
  listen during this activity?

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Lesson Plan DevelopmentPoint to Ponder

• What is your major focus?
• Helping the parent to integrate new strategies
  into established daily routines?
• Helping the parent integrate new activities that
  promote listening into his schedule?
• Both? Neither?

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Lesson Plan DevelopmentPoint to Ponder

• Hearing children develop auditory behaviors in
  conjunction with speech, language and cognitive
  goals
• Integrate goals within one activity rather than
  teaching each area in an isolated activity
• Develop auditory behaviors in coordination with
  hearing age rather than chronological age until
  the gap is closed

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Lesson Plan Development Point to Ponder

• Develop through
• Informal Learning?
• Embellished Informal Teaching?
• Semi-formal Teaching?
• Formal Teaching?

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Meet Veronica

• ALG goals
• Strategies used
• Parent education
• How did Veronica respond?
• What would you do next?

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Independent Practice

• Consider
• Learning context
• Type of learner
• Current level of development
• Select appropriate activities
• Listening age
• Chronological age
• interests
• What are the next steps?

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Assessment of Listening Skills
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Purpose

• Speech Perception Testing is an essential feature
  of a comprehensive evaluation
• Compare various devices
• Document progress
• Device check
• Intervention planning
• Selection of strategies

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Testing Considerations

• Cognitive level
• Vocabulary level
• Speech production skills
• Chance level
• Acoustic feature specificity
• Appropriateness of materials
• Attention to task

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Speech Perception Tests

• Test of Auditory Comprehension
• Early Speech Perception Testclosed set/word
  level
• CID Sentencesopen set/sentence level
• Glendonald Auditory Speech Perception Test
  (GASP)closed set/word and open set/sentence
  level
• PBK-50 (kindergarten word lists)open set/word
  level
• WIPI (Word Intelligibility by Picture
  Identification)closed set/word level
• NU-CHIPS (Northwestern University Childrens
  Perception of Speech)closed set/word level

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• IT-MAIS (Infant-Toddler Meaningful Auditory
  Integration Scales)
• MAIS (Meaningful Auditory Integration Scales)
• Mr. Potato Headclosed set/sentence level
• SERT (Sound Effects)environmental sounds
• MAC (Minimal Auditory Capabilities Test)
• Lexical Neighborhood Test (LNT)
• Multisyllabic Lexical Neighborhood Test (MLNT)
  open set/word recognition

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• APT HI (Auditory Perception Test for the HI)
• SPICE (Speech Perception Instructional and
  Curriculum and Evaluation For Children with
  Cochlear Implants and Hearing Aids)
• LIFE (Listening Inventory for Education
• Communication Skills Checklist
• (Med-EL)

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Early Speech Perception Test(Low Verbal Version)

• Used to estimate speech perception abilities in
  children (age two and up) with limited verbal
  abilities
• Determines if the child has the ability to
  identify words in small closed sets, based on
  patterns as well as phonemes
• Toy or picture stimuli

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Early Speech Perception Test(Standard Version)

• Sets are larger
• First section examines pattern perception
  abilities (monosyllabic, spondee, trochee
  multisyllabic words).
• Spondee word subtest
• Monosyllabic word subtest

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CID Everyday Sentences

• Used to assess speech recognition at a sentence
  level.
• Key words are used to derive a percent correct
  score
• Considerations cognitive level, vocabulary
  level, speech production skills

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Phonetically Balanced Kindergarten (PBK)-50 Word
List

• Monosyllabic word lists
• Presented auditory-only open set
• Can derive percent word correct or percent
  phoneme correct
• Considerations vocabulary level, speech
  production level

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Word Intelligibility by Picture Identification
(WIPI)

• Compares the childs ability to perceive words in
  three conditions
• Speechreading w/ hearing aids, without hearing
  aids and auditory only w/ hearing aids
• Stimuli are pictures of single syllable words in
  a closed set of 6
• Chance level-17
• Considerations cognitive level, vocabulary

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Lexical Neighborhood Test Multisyllabic Lexical
Neighborhood Test

• Designed to assess word recognition. The LNT has
  single syllable words and the MLNT uses 2 3
  syllable words. All words were selected from
  those known by 3 to 5 year old normal hearing
  children
• Each has an easy and a hard list
• Consideration childs speech production skills
• Reference Kirk, K.L (1998).Assessing Speech
  Perception in Listeners with Cochlear Implants
  The Development of the Lexical Neighborhood
  Tests. The Volta Review, 100, 63-85.

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Northwestern University Childrens Speech
Perception Test (NU-CHIPS)

• Uses monosyllabic words to assess the childs
  perception skills
• 4 choice/50 words - one presentation each
• Point to picture of target word represented on
  picture plate
• Chance level 25
• Consideration vocabulary level, cognition

108
Common Phrases Test

• Uses monosyllabic words
• 50 words per list - one presentation each
• Child repeats correct word
• Chance level 2
• Considerations vocabulary, cognition

109
Informal Assessment Tools

• Ling Six Sound Test
• task of 6 sounds presented at normal
  conversational level
• each sound represents critical information in a
  different frequency range
• optimal information in minimal time
• Why do we use the task?
• Predict the ability to recognize various speech
  features
• monitor changes in hearing d/t ME dysfunction
• measure changes in aided performance day to day
• measure the effects of distance
• observe changes in audibility between hearing
  aids and hearing aids in combination with FM

110
Informal Assessment Tools

• Early Learning to Listen Sounds
• ah vs. bu bu bu
• meow vs moo
• p p p vs. bu bu bu
• Early Phrases/Simple Directions
• time to eat
• wave bye-bye
• put it in
• give it a kiss
• Body Parts
• nose, eyes, ears, mouth, etc
• Daily Performance

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Ongoing diagnostic teaching

• The AVT must be able to assess why a child is
  having considerable difficulty with particular
  goals and drop back to lower steps on the
  hierarchy.
• When a child is demonstrating competency with
  particular goals/skills, the AVT must be able to
  move on to new areas (goals/skills that can be
  accomplished with support).
• AVT must know prerequisite skills as well as
  those 1-2 levels above the selected target.

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Data collection regarding childs performance

• Responses to auditory information
• New sounds produced (spontaneous or imitated)
• New words comprehended and used
• Areas of concern
• Mistakes made in auditory perception or speech
  errors
• Childs behavior
• Likes and dislikes for particular activities
• Areas that need to be addressed in future
  sessions