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
Presented by:
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Megan Katz, MS, CCC-SLP, LSLS Cert AVT
Sherri Vernelson, M.Ed., LSLS Cert AVEd
Agenda
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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
Learner Outcomes
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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.
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!!!
The goal for children in an AV
approach is spoken language.
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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?
Auditory Brain Development
It’s all about the BRAIN!
The ears are just the way in…
Quick Quiz…
We’ll answer these & other REALLY important questions
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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?
Is there a critical period for the
development of auditory function?
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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?
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.
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.
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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.
Making the Connections…
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A baby’s brain continues growing
beyond the womb—not 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?
Making the Connections…
“Babies are citizens of the world.”
 Neurons in the auditory cortex
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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 child’s “auditory
map” is established
Making the Connections…
Training OR Learning?

For the young child,meaningful
contexts are crucial for the auditory
processing of spoken language.

“The hearing-impaired child’s auditory
abilities develop ‘because emphasis is
placed on listening throughout all
waking hours so that hearing becomes
an integral part of his/her personality.”
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(Pollack, 1985)
It’s All About Experience

Experience & Vocabulary
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Vocabulary size correlated with quantity of
maternal “talk”
20 months of age—offspring of talkative
mothers averaged 131 more words than
children of less talkative moms
At age two, the gap doubles
Critical factor—number of times the child
HEARS different words
TV doesn’t produce same results. Why not?
Information within context seems to stimulate
neural circuitry
What happens when the auditory
centers of the brain are not accessed
early?
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Decreased ability to use sound
meaningfully (cross-modal
reorganization)
Physiological changes
Psychosocial factors
When the hearing aids are OFF what
happens?
Auditory Processing of
Spoken Language

“The auditory processing ‘whole’ is
greater than the sum of current
knowledge of its hypothesized
parts.”

(Cole,1992, 2006)
Components of auditory
processing models
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Peripheral hearing structures are
responsible for analysis and conversion of
speech/acoustic information to nerve
impulses for transmission to the brain
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Preliminary processing in the brainstem
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Brief memory storage required
Localization and selective attention
Auditory cortex receives input

Higher level analysis includes: phonetic,
phonological, syntactic, semantic, and
pragmatic/contextual processing
Take Home Points…
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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________.
References
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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.
Let’s Talk about Hearing Age
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Relationship between age at first
amplification and a child’s 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
Other Terms
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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
Application
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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 John’s hearing age? What
is his program (AVT) age?

At a chronological age of 3 years 8 months, John obtained the
following scores on standardized measures of language:
 PLS-4
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101
98
Lang. 100
3 years, 7 months
Peabody Picture Vocabulary Test-III
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AC
AE
Total
A.E.
SS
92
A.E. 3 years, 3 months
Discuss the test results for John in relation to:
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Chronological Age
Hearing Age
Program Age
Application
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Cate is 4 years, 6 months of age. Her severeprofound 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 Cate’s 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 Cate’s present level of functioning in relation to
her:
Chronological Age
CI and AVT Age
Stages of Auditory Development
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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
Auditory
Detection or
Attention
0-2 months
Distance
Hearing
2-4 months
Localization
4-6 months
Presence &
absence of
snd.
Begins to
startle to snds
at increasing
distances
“Orienting
Perceives
reflex”
differences in
Infant searches sounds
for snd.
Modifies speech
to match what
was heard
First responses
are to gross
snds.
Recognizes
mother’s voice
Localizationdevelops
during 1st
years of
listening
Reacts
differently to
different tones
of voice
Imitates nonspeech sounds
Begins to u’stand
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
Discrimination
5-7 months
Auditory
Self-Monitoring
8-10 months
Auditory Ident.
Association
9-11 months
Auditory
Memory
9-12 months
Labels what was heard
Remembers
what was
heard
Object selection
Recalls
critical
elements
Auditory
Sequencing
10-18
months
Auditory
Processing
months
Auditory
Understanding
18-48 months
48-72 months
Remembers
what was
heard in the
correct order
Makes
cognitive
judgments
about what
was heard
Compre-hends
auditory
information in
a variety of
settings
Speech Acoustics
Let’s Review…
Why should we know this?

Knowledge of speech acoustics helps us:
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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
“ah”
“eye”
“save”
/s/
/e/
/v/
“mean”
/m/
/i/
/n/
“tide”
/t/
/ai/
/d/
Multimedia FUN!
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http://www.utdallas.edu/~thib/EARRINGFINAL/EARRING
WEB_files/frame.htm
http://hctv.humnet.ucla.edu/departments/linguistics/Vow
elsandConsonants/course/chapter1.1/chapter1.1.htm#fou
r
http://hctv.humnet.ucla.edu/departments/linguistics/Vow
elsandConsonants/course/chapter8/speechbird/speechbird
.html
http://www.oraldeafed.org/movies/heardiff.html
Auditory-Verbal
Strategies and Techniques
Position to maximize auditory input
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Sit behind the child?
In front of the child?
On top of the child???
Beside the child?
On which side?
Position to maximize auditory input

Optimal distance is
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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 ___
Maintain Favorable Auditory Learning
Environment
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This means controlling ___ & ___
In which of the child’s learning
environments can the adult exert
control over these factors?
How?
Positioning
Favorable Auditory Environments

GREAT website!
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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/EARRIN
GFINAL/EARRINGWEB_files/frame.htm
Attention Getters
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The “Listen!” Cue
Audition FIRST
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Not show and tell but Tell and Show
Why hearing first?
Sing What You Say/Parentese
Get Closer
Helps for PROCESSING through
Audition
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CLEAR Speech
Speak Suthun: i.e., a slightly slower
rate of speech
Acoustic Highlighting: more to less
Lowlighting/Whispering: Why?
Helps for Processing

WAIT Time + Expectant Look
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The ___ the child, the more wait time
needed
The Expectant Look says…
Repetition: Why?
Pause before challenging word/s
Helps for Processing
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Word position in sentence
Give a choice
What DID you hear?
And if you must…
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A-V-A Sandwich or “Put it back into
hearing”
Give visual context for auditory
input
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Point to the picture/object
Natural gesture
Facial expression
Adjust set size
Helps for Confident Listening
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Modeling
Converse slightly above child’s
linguistic level
Diagnostic Teaching, NOT testing
Known →unknown, audible →less
audible
Other Strategies
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The absent-minded therapist
Let child be the teacher
Prerequisites
Knowledge of…
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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
Current Models of Auditory Learning
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Cole and Flexer (2007)
Dickson, C. (1999)
Estabrooks (1998)
Pollack, Goldberg, Caleffe-Schenck (1990)
Romanik, S. (1990)
Simser (1993)
Walker (1995, rev. 2009)
Auditory Learning Guide (ALG)
(Walker, 1995)
Framework for the development of
an auditory function
 Based on the work of Simser,
Romanik & Foreworks Curriculum
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Comprehensive chart

Not an exhaustive list
The ALG is useful for…
Establishing Goals
 Planning therapy sessions
 Documenting progress
 Parent Education
 Professional collaboration
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Auditory Learning Guide
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Five levels:
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Sound Awareness
Phoneme Level
Discourse Level
Sentence Level
Word Level
Concurrent development
Timelines are color-coded
Auditory Learning Guide
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CONSIDERATIONS:
Therapist’s skill level/experience
Residual hearing/aided thresholds
Age at implantation

Perception vs. production
Sound Awareness
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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
Environmental Sounds
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Indoor Sounds
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vacuum cleaner, knock on the door,
washing machine, dryer, teapot
whistling, hair dryer, TV, radio, smoke
alarm, blender, telephone
Softer Sounds

clock ticking, cat’s meow/purr, broom
sweeping, pages being turned, coins or
keys clinking
Environmental Sounds
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Human Noises
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Musical Instruments
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laughing, sneezing, coughing, crying,
whistling, walking, snoring
drum, bells, horn, piano, tambourine
Outdoor Noises

thunder, fire engine, airplane, train, car
horn, garage door, dog barking, rain
Sound Awareness

Conditioned Response
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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
Phoneme Level

What?
Why?
When?

Examples:
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Alternating vowels
Identification of consonants varying in manner of
production
Discourse Level
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Connected spoken language
Conversational context:
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Discourse
Dialogue
Combine with Sentence and Word
Level
Discourse Level
Year 1
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Imitate motions of nursery rhymes/songs
with accompanying vocalization
To identify songs/rhymes
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To identify the last word read in a
passage
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Easier to process larger units of language
For individuals who can read
Helps develop good phrasing and improves
fluency
To answer common questions
Discourse Level
Year 2
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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
Discourse Level
Year 3
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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 don’t
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
Discourse Level
Year 4
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To retell a story with the topic disclosed, recalling
all details in sequence
To make identification based on several related
descriptors (open set).
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To follow a conversation of an undisclosed topic

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No prompts; completely open set
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).
Sentence Level
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“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
Sentence Level
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Examples of Critical Elements
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One: Where’s 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.
More on Critical Elements
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Independent or Group practice
Create an activity
Be ready to share with the group
Word Level
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Perception of individual words
Progression:

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Acoustic features of the target
Word placement
In the context of phrases or
sentences
Word Level

Vocabulary Development Program(NOT “skill-based” exercises with single words)
1. Learning
to Listen sounds
2. Power Word list
3. Lexicon One
4. “Theme-based” units, Children’s
Literature Units (Ling Basic Vocabulary
& Language Guide)
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?
Criteria for Mastery

Suprasegmentals


Child must be able to imitate sounds that vary in
duration, intensity, and pitch.
Let’s name sounds with:
 Long duration
 Brief interrupted duration
 Loud intensity
 Quiet intensity
 High pitch
 Low pitch
 Varied pitch
Criteria for Mastery


Child must be able to imitate two
back vowels, two mid-vowels and at
least one front vowel.
Let’s identify:



Back vowels
Mid vowels
Front vowels
Criteria for Mastery

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
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?
Power Words
More
Up
Mama, Daddy
Go
Stop
Bye-bye
No
All gone
Hot/cold
Mine/me
Off/on
Look
Blow
Go away
Move
Open
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
Learning Contexts &
Teaching Approaches
Informal
Learning
•Happens in
normal, everyday
events and
interactions
•Should occur at
home and school
•All learner types
Embellished
Informal Teaching
•Seize the moment
•Use of strategies to
embellish the normal
situation
•Should occur at
home and school
•All learner types
Semi-Formal
Teaching
Formal
Teaching
•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
Types of Learners
Developmental
Delayed
Within
one yearof learners
1-2 years behind
Three
types
English Language

Skills
of typically
developing peers
peers
Remedial
Greater than two
years behind
peers, scattered
language skills
Learning/Teaching Informal learning
context
Primarily semiformal, also need
informal
Formal learning,
with generalized
to informal
Educational
Placement
Mainstreaming by
kindergarten may
be a challenge
due to language
gap
one hr/pd per
year of language
delay
Social
mainstreaming
Fully
mainstreamed by
preschool/kinderg
arten
Types of Learners
Delayed and Remedial Learners CAN
“catch up” with focused
language intervention that follows a
developmental sequence
Lesson Plan Development
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?
Let’s Put it all together…

You will need:

Normal Development Resources:

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
Language Development
Vocab development
Speech Development
ALG Chart
Blank Lesson Plan Forms
A-V Teaching Behaviors:
Establishing Goals

Develop your road map

What’s your destination?


Long Term goals
How ya gonna get there?

Short term goals
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.”
Six-Step Guide To The Development of an Auditory
Function in an A-V Approach
With the parent:
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Evaluate the child’s 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 child’s auditory potential
(audiological information)
Select sense modality (consider hearing 1st)
Develop the target through informal
learning-formal teaching
Evaluate progress toward goal often
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 child’s mind, is the reason
to listen during this activity?
Lesson Plan Development:
Point to Ponder
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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?
Lesson Plan Development:
Point 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
Lesson Plan Development:
Point to Ponder
Develop through:

Informal Learning?

Embellished Informal
Teaching?

Semi-formal Teaching?

Formal Teaching?
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?
Assessment of Listening Skills
Purpose

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
Speech Perception Testing is an
essential feature of a comprehensive
evaluation
Compare various devices
Document progress
Device check
Intervention planning
Selection of strategies
Testing Considerations
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Cognitive level
Vocabulary level
Speech production skills
Chance level
Acoustic feature specificity
Appropriateness of materials
Attention to task
Speech Perception Tests

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Test of Auditory Comprehension
Early Speech Perception Test—closed set/word
level
CID Sentences—open 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 Children’s
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 Head—closed 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)
Early Speech Perception Test
(Low Verbal Version)

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
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
Early Speech Perception Test
(Standard Version)

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Sets are larger
First section examines pattern
perception abilities (monosyllabic,
spondee, trochee & multisyllabic
words).
Spondee word subtest
Monosyllabic word subtest
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
Phonetically Balanced Kindergarten (PBK)50 Word List

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Monosyllabic word lists
Presented auditory-only; open set
Can derive percent word correct or
percent phoneme correct
Considerations: vocabulary level,
speech production level
Word Intelligibility by Picture
Identification (WIPI)

Compares the child’s ability to perceive
words in three conditions

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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
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: child’s 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.
Northwestern University Children’s Speech
Perception Test (NU-CHIPS)

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
Uses monosyllabic words to assess the
child’s 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
Common Phrases Test

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Uses monosyllabic words
50 words per list - one presentation
each
Child repeats correct word
Chance level: 2%
Considerations: vocabulary,
cognition
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
Informal Assessment Tools

Early Learning to Listen Sounds

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Early Phrases/Simple Directions

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time to eat
wave bye-bye
put it in
give it a kiss
Body Parts


ah vs. bu bu bu
meow vs moo
p p p vs. bu bu bu
nose, eyes, ears, mouth, etc
Daily Performance
Ongoing diagnostic teaching

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
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.
Data collection regarding child’s performance

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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
Child’s behavior
Likes and dislikes for particular activities
Areas that need to be addressed in future
sessions