Family-Centered
Audiologic
(Re)Habilitation
Services
Melissa Hall, AuD
Audiologic Rehabilitation for
Children and Educational
Audiology
SPA 6581 – Spring 2015
Lecture Date: 02/17/2015
Children learn language most
easily when actively engaged in
relaxed, meaningful interactions
with supportive parents and
caregivers.
Welcome to Holland!
By: Emily Perl Kingsley
Audiologic (Re)Habilitation
Family-Centered

Professional works directly
with the family to counsel,
guide, and educate the
family regarding strategies
and techniques that the
parents can use in the
absence of professionals.

Can be provided through
group activities, workshops,
books, discussion, active
participation
Child-Centered
 Professional
works
directly and
consistently with
the child
Parent Empowerment
 In
an early-intervention program, the main
client should be the parent.
 Helping parents acquire the necessary
skills to make appropriate, informed
decisions regarding their child’s holistic
development and education, as well as
gain competency and confidence that
they can advocate in the best interests of
their child

It’s not just about hearing
Parent/Audiologist
Relationship

The following are crucial to establishing and
maintaining positive and supportive
relationships with parents:





Positive attitudes
Effective communication
Provide information
Helping parents to become more involved in
school activities and to support the specific
needs of children and youth who are deaf and
hard of hearing
Strategies to use when difficult situations arise to
facilitate positive outcomes
Positive Attitudes


Effective relationships with families begin with
healthy attitudes
The attitudes that people develop are shaped by:




Experience
Personality
Establishing effective relationships with families
requires a reciprocal understanding in which both
parties share respect and trust to sustain their
partnership
Rapport, Respect, and Trust
Rapport


Critical step toward
a healthy
relationship
Helpful in increasing
our sensitivity to:




How family functions
Family resources &
motivations
Methods of
interaction
Learning styles
 Understanding
and
acceptance can
foster interaction
techniques that
are more likely to
be compatible
with the family’s
style

Rather than
professional’s style
Rapport continued…
 Maintain
a professional atmosphere, but
connect better with families:




Relaxed
Formal
Frank
Gentle
 Avoid
– intimidation or superiority
Home Visits



Establish relationship
Provides
audiologist/SLP with
valuable insights and
information that can
facilitate the
diagnostic, habilitation,
& educational process
Interaction is typically
more comfortable
than in a clinic,
hospital, or classroom
setting
What if a home visit is not
possible?
 If

a home visit is not possible…
Collaborate closely with any home
intervention providers that have been or
are currently involved with families
 Early
Steps
 GET THE RELEASE OF INFORMATION SIGNED –
so you can do a better job for your patients
Rapport - Empathy

The ability to put oneself in the family’s situation and to look
outward from their perspective often provides a more
realistic sensitivity to the family’s concerns and needs and
can result in a stronger partnership with the family

Welcome to Holland! By Emily Perl Kingsley

Aspects:





Development of reflective listening skills
Learning what questions to ask
Learning how and when to ask questions
Interacting in a nondirective and nonjudgmental manner
Genuine care and commitment to assisting the family is
essential
R-E-S-P-E-C-T



Respect does not
necessarily mean
agreement



Describes how people are
treated and the honor they
hold for one another’s
beliefs
Audiologists, regardless of
their own personal biases,
must strive to maintain an
open attitude and
acceptance of the options
a family may choose.
Respect for the family’s:


Time
Need and desire to
understand all
information clearly
Need to make decisions
for their child’s current
and future needs
Respect from the family
for the audiologist’s:



Time
Efforts
Commitment
Respect… “It’s a small world
after all!”

Sensitivity to…







Education and socioeconomic factors
Family constellation/composition
Cultural and religious differences
Sources of support
Personality factors
Attitudes towards child-rearing
The world of hearing loss is surprisingly small…

HIPAA and FERPA
Trust
 Credibility


Professional competence must be
demonstrated before trust with the
audiologist can be established.
The audiologist’s expertise should be
apparent in the technical aspects of
diagnostics and habilitations,
communication skills, collaboration with
other agencies, and follow-through.
TRUST
Audiologists who are careful to only make
commitments they can fulfill will earn trust more
quickly from the families they serve.
Parent/Audiologist
Relationship

Crucial to establishing & maintaining positive
and supportive relationships with parents:





Positive attitudes
Effective communication
Provide information
Helping parents to become more involved in
school activities and to support the specific
needs of children and youth who are deaf and
hard of hearing
Strategies to use when difficult situations arise to
facilitate positive outcomes
Effective Communication



Parents deserve open, honest
communication.
Audiologist must take time to listen and
acknowledge what parents say.
Not always easy…


Some parents have little motivation or
understanding of the potential consequences
of hearing loss, regardless of our efforts.
Language and cultural barriers distance families
from participating in different environments.
Effective Communication:
Strategies


Listen first
Include parents in the
assessment of the child
and describe each
step of the evaluation
process.




Why?
Acknowledge when
information or answers
to questions are not
known or when
additional information
would be helpful.

Provide parents with written
information to review and
share with other family
members, as well as other
professionals.
Conduct follow-up phone
calls to inquire how the
child is doing and to see if
the family has additional
questions.
Remember to use
strategies for developing
rapport, respect, and trust
in all communications.
Parent/Audiologist
Relationship

The following are crucial to establishing and
maintaining positive and supportive
relationships with parents:





Positive attitudes
Effective communication
Provide information
Helping parents to become more involved in
school activities and to support the specific
needs of children and youth who are deaf and
hard of hearing
Strategies to use when difficult situations arise to
facilitate positive outcomes
Informational Guidance
 Margolis
(2004) reports that approximately
50% of new information is forgotten
immediately, and 50% of new unfamiliar
information is remembered incorrectly.
 Information
is necessary…but quality
practice for parents is paramount to
success!
Informational Guidance – Are
we on track?
 Consistent
and strong parent support
often affects the way a student performs
more than the work of the audiologist and
team.
 Better
results typically are achieved when
the parents and the professionals work
together for the same outcomes.
Informational Guidance

Information is powerful!





Helps to empower parents to make choices for
their child and family and lessen parent
dependency on professionals for critical decisions
Aids audiologists in following a more “empowering
approach” as opposed to an “enabling
approach” when working with families
Present information in a manner that families are
able to easily understand
Individualize for the family, child, and situation
Multiple opportunities to hear and discuss
information
Informational Guidance
 Parent-to-Parent


Communication
State and local parent organizations
Jackson, Wegner, & Turnbill, 2010 – Survey
 Parents
value interactions with other parents
as one of the top sources of support
 Examples
of parent-to-parent
communication opportunities?
Informational Guidance

Quantity


Each family has a different capacity to absorb
various quantities of materials.
Early stages after identification

Give parents enough information to provide an
introduction to the basic areas they will need to
be aware of during their child’s education.


Allows the family to decide how much they want to
read, review, or access on their individual
timetables
Also helps if people relocate and are not seen by
an audiologist for an extended period of time
Informational Guidance

Types of Information

Printed materials

Face-to-face discussion

Computer programs

Internet

DVDs, CDs and other instructional videos
Parent/Audiologist
Relationship

The following are crucial to establishing and
maintaining positive and supportive
relationships with parents:





Positive attitudes
Effective communication
Provide information
Helping parents to become more involved in
school activities and to support the specific
needs of children and youth who are deaf and
hard of hearing
Strategies to use when difficult situations arise to
facilitate positive outcomes
Parent Involvement
Committee and Task Force Work
Classroom Support
Parent Activities
Parent Involvement

Parent Checklist of Questions to Ask When Working with
Professionals:






Do I believe I am an equal partner with professionals and
accept my share of the responsibility for solving problems and
making plans on behalf of my child?
Do I clearly express my own needs and the needs of my family
to professionals in an assertive manner?
Do I treat each professional as an individual and avoid letting
past negative experiences or negative attitudes get in the way
of establishing a good working relationship?
Do I communicate quickly with professionals serving my child
when significant changes or notable events occur?
When I make a commitment to a professional for a plan of
action, do I follow through and complete that commitment?
Do I maintain realistic expectations of professionals, myself, and
my child?
Parent/Audiologist
Relationship

The following are crucial to establishing and
maintaining positive and supportive
relationships with parents:





Positive attitudes
Effective communication
Provide information
Helping parents to become more involved in
school activities and to support the specific
needs of children and youth who are deaf and
hard of hearing
Strategies to use when difficult situations arise to
facilitate positive outcomes
Handling Difficult Situations
Parent and Professional Disagreement over
Services
Uninvolved Families
Differing Opinions in Communication
Modality
Handling Difficult Situations

Parent and Professional Disagreement over
Services

Can occur regarding:
Type
 Amount
 Scheduling


How can we help parents in this situation?


Research
Examples of other similar situations and
resolutions that achieved common goals
Handling Difficult Situations

Uninvolved Families

Families may be:




Result?


Noncompliant
Willing but unable
Dysfunctional
Their children are often left to the schools for education
and support.
Professionals and AR Team


We need to rally and work together so that they are able
to receive the services to which they are entitled.
Audiologists need to be connected to their community
agency network for assistance in arranging transportation
Handling Difficult Situations

Differing Opinions on
Communication
Modality & Educational
Methodology

It is difficult for school
districts to provide the
full range of options
from listening and
spoken language to
signed English to ASL to
cued speech.

Population of children
who are deaf and hard
of hearing is small.

Suggestion

Differing opinions
should be addressed
through objective
means that assess the
effectiveness of the
child’s
communication in the
current modality, as
well as, in alternative
modalities and
methodologies under
consideration.
Characteristics Essential for
Professionals & Family-Centered
AR

Possess:




Basic conviction that, given
an appropriate support
system, people can grow
and change if they so
desire
Nonjudgmental attitude
regarding cultural & lifestyle
differences
Empathetic-not
sympathetic-attitude
Basic conviction that
parents can and do directly
influence the outcomes of
intervention

Be:




A perceptive listener
regarding nonverbal as well
as verbal messages
able to accept parental
expression of a variety of
emotions without
personalizing and
becoming defensive
able to develop a warm,
caring relationship while
retaining a professional role
Respect the privacy of
parents
Family-Centered: Counseling
 Psychological
support, which includes:

Reduction of parental anxiety

Praise for the parents’ achievements

Reassurance on matters relating to their
feelings toward the child as a member of
the family
Family-Centered: Guidance
 Providing
the parents with directions for
further work
 How
to evaluate the results of previous
efforts
 What
to anticipate as a result of further
endeavors and interactions with the child
Family-Centered: Parent
Education
 The
content of parent education will vary
from family to family according to:

Parental needs

Interests

Abilities
Where does family-centered
training happen?
Clinic
Special room in a school
Simulated home setting
Child’s own home
Combination
Cost Effectiveness vs. Quality
of care?
The more home visits
(Potential Cons)




The more the clinician
has to travel
There is less time the
clinician will be
available for work
The clinician’s caseload
will have to be smaller
The program will
become less costefficient
The more home visits
(Potential Pros)


Permit clinician to
make concrete
suggestions relating to
the use of materials
and routines that are
so much a part of the
child’s life
The home is the actual
environment in which
most of the child’s
learning will take place
Assessment Tools
Tool
Authors
Age
Purpose
ABEL (2002)
Purdy et al.
2-12 yrs
24 item questionnaire (aural-oral, auditory awareness,
social/conversational skills)
CHILD (2000)
Anderson & Smaldino
3-12 yrs
Parent and self-report, listening skills, 15 natural
situations
COW (2003)
Whitelaw, Wynne, &
Williams
4-12 yrs
Teacher, parent, child rating scales of classroom and
home listening with devices, specify 5 situations
where improved hearing is desired
ELF (2000)
Anderson
5 mo-3 yrs
Parent observational rating scale, listening
FAPI (2003)
Stredler-Brown & Johnson
Infants-School
Parent, therapist assessment of functional auditory
skills
IT-MAIS (1997)
Robbins, Renshaw, & Berry
Infant, toddler,
older children
versions
Parent interview, spontaneous auditory behaviors
LIFE (1998)
Anderson & Smaldino
6 yrs & +
Student and teacher rating skills, listening difficult in
classroom
Little Ears (2003)
Kuhn-Inacker et al.
Birth +
Questionnaire for parent; 35 age-dependent ?;
auditory development
MAIS (1991)
Robbins et al.
3 yrs +
Parent interview, 10 ?, meaningful use of sound in
everyday situations; attachment with technology
PEACH (2000)
Ching et al.
Preschool-7yrs
Parent interview, 15 ?, child’s everyday environment
(use, quiet, noise, telephone, environment)
Preschool SIFTER
(1996)
Anderson & Matkin
3-6 yrs
Teacher questionnaire, 15 items, children at risk
(academics, attention, communication, class
participation, behavior)
SIFTER (1989)
Anderson
6 yrs – middle
school
Teacher questionnaire, target academic risk
TEACH (2000)
Ching et al.
Preschool – 7 yrs
Teacher interview, 13 ?, everyday environment, use,
quiet, noise, telephone, environment
The Family

Parental participation can be encouraged by
the teacher and clinician




The extent to which it occurs may be regarded
as an indirect measure of the teacher’s and
clinician’s skills.
Parental aspirations can largely determine the
course of the child’s development.
Parental aspirations can be modified
positively or negatively through counseling,
education, and experience.
In only a minority of cases are parents’
aspirations for their child unreasonable.
Factors
 Parental
aspirations
 Geographical
 Child’s
age
location
Self-Fulfilling Prophecy

Hearing levels are often
treated as an index of
expectation for the child.



“If hearing impairment is
mild, the child is expected
to achieve much.”
“If hearing impairment is
profound, the child is
expected to achieve little.”
Standards of speech and
academic achievement
generally reflect this trend.

The greater the hearing
impairment, the more
difficult it is to learn and the
slower initial progress may
be.


However, other things
being equal, goals should
be similar for both mildly
and profoundly hearingimpaired children.
The rate at which the child
acquired certain
knowledge and skills may
differ, as would the
strategies selected to teach
them.
“If you are not part of the solution,
then you’re part of the problem.”



In general, educational administrators either
appear to remain unaware of the possibilities that
exist for hearing-impaired children, or they are not
sufficiently challenged to act creatively.
Most are happy to accept propaganda that
supports the simple, and demonstrably wrong,
notion that one type of provision can meet the
needs of all hearing-impaired children.
The good news…Administrators are adaptable
and they respond positively to reasoned
arguments, particularly if these arguments are
backed by public pressure.
Parent/Family Roles in
Audiologic (Re)Habilitation
 Observing
 Participating
 Practicing
We learn by observing and
listening, but mostly by doing.

Participation in sessions allows parents to practice
techniques and targets.

Allows for greater confidence and control on the part of
the family

It is not the number of clinician contact hours that develops
a child’s language; nor is it the number of hours sitting at a
table doing “therapy…”

A foundation of language is developed through natural
interaction about subjects that are meaningful and
interesting to a child. Parents are key.
Observing, Participating, &
Practicing - PARENTS

Developing skills in
audiological management

Providing experiences
outside the home

Capitalizing on the natural
bond & interaction
between parent and child

Acquiring the skills to
record the child’s progress

Developing appropriate
behavior management
techniques

Understanding the
sequential stages of
auditory development


Learning techniques and
strategies to develop
listening skills
Understanding the stages
of language, speech, and
cognitive development
Developing Skills in
Audiological Management

Ensure that the child is wearing the appropriately
functioning devices all waking hours

Help the child to become independent in managing their
own device(s) as early as possible

Monitor the fit of earmolds

Work with professionals to ensure that the child is optimally
aided and/or MAPped at all times

The family and the therapist need to provide feedback to
the audiologist about the sounds the child hears
Natural Parent/Child Bond
 Language
develops as a result of the
natural interaction between parents and
their children.
 This
natural, communicative bond is
important and needs to be maintained,
even if the child has hearing loss.
Learn Techniques & Strategies
 Learn
how to use the opportunities that
occur naturally at home to develop
spoken language through listening
 It
is the techniques and strategies that are
the key factors, not the actual activities
(or games)
Understand the Stages of:
Language, Speech, & Cognition



Knowledge of these will allow the family to
provide language and speech models that
are developmentally appropriate
Parents and families need to be aware of
upcoming stages of development, so that
they can increase the progress ability and
provide new challenges
Therapists and Audiologists should explain
these stages and suggest ways to promote
ongoing progress
Auditory Development!

Developing language through listening is a
natural way to learn language.

Knowledge of the hierarchy of audition


Begins with the detection of sounds and
achieves the ability to process complex
language
Why it is important to use listening as the
primary mode for developing intelligible
spoken language.
Play!




Play is critical for the development of spoken
language and cognitive skills.
Teach the families to follow the child’s lead by
giving language in context and narrating
what the child is doing.
Model and expand the child’s utterances to
enrich language
Through play, children can learn about the
world outside of their immediate
environments.
Providing Experiences Outside
the Home

Multitude of experiences




Develops child’s language and cognition
Hands on experiences
Provides stimulus for verbal interactions and
language extension activities
Examples:


Zoo, Beach, Mountains, Farm, Puppet Show, Nursery,
Hardware Store
Ways to reinforce or extend new language:



Taking photos
Creating scrapbooks
Re-enacting experiences/role-playing
Acquiring the Skills to Record
Child’s Progress

Assist the therapist in the setting of listening,
language, speech, and cognition goals

Diagnostic Therapy/Diagnostic Teaching


Recognize opportunities for expanding
language experiences
Parents are better able to reinforce goals at
home, if they participate in goal setting.
Developing Appropriate
Behavior Management





Do all clinicians have experience with this?
Hands on training?
Do all parents/families have experience with
this?
Provide enjoyable activities
Important to use the same rules and
guidelines as with hearing children.
A child with hearing impairment is a child first
and has to learn what is acceptable and
what is unacceptable behavior in the same
way as other children.
Behavior Management
Considerations








Parents & Clinic should present a
united front
Prioritize your battles
Once you start, you must follow
through. Establishes precedence
Give child sense of control without
giving over complete control
End the activity before the child has
“had enough”
Establish positive alternatives
Be clear about the rules, provide
consistent consequences
Pictures of rules - Clinician is not the
“mean one”
Topics in Auditory-Verbal Therapy
Pamela J. Talbot, 2002



Preschool – directing
comments to the toys is
sometimes helpful to remove
focus from the child
Pick simple rules
Use rules which state expected
behavior




Use quiet voice vs. don’t yell
Have an end in sight
Once activity is finished, let the
child explore the toy their way
Waiting chair instead of “time
out”
Assisting the Clinician



Informing the
therapist of the
child’s interests and
family events
Helping the therapist
interpret the child’s
early attempts at
communication
Modeling for the
child in therapy
sessions
 Reporting
on the
child’s
development at
home
 Informing the
therapist of any
cultural issues
particular to the
family’s situation
By taking an active role in therapy
sessions, the parents and family
can develop appropriate skills and
knowledge to provide a listening
and language learning
environment at home to maximize
the child’s spoken language
potential.
Strategies for Developing
Listening Skills








Ensure consistent use of
technology
Close to the child’s
microphone
Quiet environment
Singsong voice
Eye contact
Joint attention
Talk about daily routines
Develop turn taking









Cue into listening
Auditory input first
Use listening alone
Use acoustic highlighting
Alert to sound source or
localize sound
One person speaking at a
time
Use repetition
Use phrases and simple
sentences
Use real names of objects
Strategies for Developing
Listening Skills - Continued








Encourage vocalization
Capture the child’s
attention
Use auditory
stimulus/response activities
Model the auditory
stimulus/response activity
Make it fun/positive
reinforcement
Use pausing
Model correct language
Promote speech
development









Expand and extend
language
Extend vocabulary
Use rephrasing
Use questioning
Use auditory closure tasks
Use a natural voice
Give the child time to
process
Give a direction once
through listening
Use clarifying
Strategies
Personal assistive
listening technology




Not just worn, but working!
All waking hours
Maximized opportunities to
provide child with
language learning
experiences through
listening
Allow for pre-teaching in
the event that the
technology cannot be
worn
Close to the
microphone





Maximum auditory input
Being in child’s hearing range
is important as this provides the
best access to speech sounds
and sets child up for success
Farther away – sounds
become softer
Normal voice quality, normal
rate, rhythm, level of intensity
Later stage – learning to listen
at increased distances
Strategies
Quiet Environment
 Initial
stages of
listening
 Noisy – greater
difficulty accessing
sound
Singsong Voice

Particularly important for child with
hearing impairment

Greater changes in pitch, duration,
and intensity (suprasegmentals)
 Provides for a wealth of acoustic
information, including meaning
 Features are NOT visible, but highly
audible, children with hearing
impairment who develop spoken
language through listening alone
will use appropriate intonation and
have natural sounding voice
quality
Strategies
Eye Contact
 Accentuates
the
bond between
family and child
 Important part of
spoken
communication
 Acknowledgement
Joint Attention

Successful communication
requires:




Each partner knowing how to
initiate a topic, respect the
other person’s choice of
topic, maintain a topic, and
close the topic
Use interesting objects/toys
Follow child’s lead
Show clearly when
game/activity is starting
and endings
Strategies
Daily Routines


Language is more
meaningful when it
centers on daily
routines.
Use every opportunity
throughout the day to
talk about what is
happening when
involved in routines
Turn Taking



Applies to listening and
talking
Vocal turn taking starts at a
very young age
To develop



Parent vocalizes and then
waits for child to vocalize
Repeat child’s vocalization
Add a different vocalization
or add some appropriate
language - EXPANSION
Strategies
Calling baby by
name



Tune in to the mother’s voice
first
Next step is to learn to listen to
other family members who are
significant in the baby’s life
Important not to vary the
name in any way at this stage



Why?
Introduces discrimination and
identification auditory tasks
Reinforces localization
Cue into listening



Use animated
speech
Listen or I heard that.
Did you hear that?
This is an indication
that they are to listen
and that there will
not be any visual
cues
Strategies

Auditory Input First


If the auditory pathways are not stimulated in
the first few years, the ability to develop them
may be lost or severely limited
Hearing children learn language – hearing it,
listening to it, imitating it

Hearing impaired children can learn the same
way


Listening first, vision second
Use an animated voice

Labeling item prior to showing the item, show
the item, and label it again
Strategies

Listening Alone



Strategies used to hide the mouth when speaker is
talking
Focus your child on listening instead of speechreading
Strategies

Focused Attention


Strategic placement of toy, object, or hand


Interesting toy, boy, activity, or game
Hold a toy, object, or hand in front of your mouth in a natural
way to ensure the child receives auditory input alone.
Hand cue

Important to use the hand cue correctly, so as not to mask the
spoken message or prevent the optimal auditory signal from
reaching the child
Strategies

Acoustic Highlighting

Making the key element of a sentence louder
than the other words around it in a sentence.



Used more frequently in the early stages of
listening
Very useful when introducing new vocabulary or a
new language structure


There is the car, brm brm.
He is going to the park. (Introducing pronouns)
**Once the child can hear and identify the word, it
is important to say the sentence with natural
rhythm and intonation.**
Strategies

Alert to sound source of localize sound





The more this is done alongside developing
listening skills, the sooner the baby will develop
the ability to hear sounds from different
directions.
Turn child towards source of sound
Demonstrating the skill: eye gazing, eye
movement, pointing, turning head
Reinforce skill by confirming sound source to
child and naming it. Use every opportunity.
Have one person speaking at a time
Strategies

Use repetition

Young children need to hear language repeated in a
variety of contexts before they…






Process
Comprehend
Produce
Children with hearing impairment need even more
repetition than normal.
May need to say a new word or phrase FIFTY times or
more in meaningful situations and in different contexts
As child gets older, need to transition to understanding
that they should listen to and respond to instructions
after hearing them once
Strategies
Use phrases and
simple sentences




Start with short phrases or
short simple sentences
Expand to more complex
sentences
Adults should input basic
language structure rather
than single words
There is more acoustic
information in short
sentences (suprasegmental
features and coarticulation effects)
Use real names for
objects
 It
is easier for
children to learn
the correct name
from the
beginning.
 Make sure to use
real names of
objects
Strategies
Encourage
vocalization





Prompting
Look at child in an
excited or eager way to
signal turn taking
Move a toy only after
child vocalizes
Use modeling with a toy
to show expectation
Hand cue – signals turn
taking
Capture your child’s
attention






More receptive if you
follow the child’s lead
Hidden objects
Partially visible objects
Funny voices (puppets)
Dressing in a funny way
Does not require
expensive equipment
Strategies
Use auditory
stimulus/response activities
 Way
of knowing
exactly what
sounds the child
can hear.
 Ling 6

What are the four
main stages again?
Model auditory
stimulus/response activity
 One
to provide the
stimulus and one to
respond
 Can be used with
all types of
activities
Strategies

Make it fun


When children are actively participating and enjoying
themselves, the most learning will occur
Provide positive reinforcement


Always give praise to encourage the action or verbal
response
Rewards

Verbal praise – must be immediate and direct


Other rewards


Will encourage further responses
Be careful with gifts, food, and other tangible items
It is better to praise the positive action or response than
to continually point out what the child is NOT doing.
Strategies
Use pausing



Used to emphasize the
language input
Pause between
phrases/sentences to give
the baby time to process
before hearing it again
Can be used to
emphasize the key part of
a more complex
message, new
vocabulary, new
concept, or linguistic
structure
Use waiting





Very useful at the beginning of
learning language
Wait for return vocalization
Pair waiting with raised
eyebrow, smile, or turning your
head toward child
Parent speaks, waits, and
listens. Then when the child
responds, parent responds with
appropriate language
Listening is as important as
talking
Strategies
Model correct
language
 Use
correct
grammar and
pronunciation
 Speak clearly at all
times
Promote speech
development





As child’s expressive language
develops from babbling to
jargoning, to single and twoword utterances,
pronunciation will not be
accurate
ALWAYS give the child correct
models to imitate.
Little sponges!
Highlight specific sounds being
omitted
Use auditory bombardment of
specific sounds missed
Strategies
Expand and extend
language




Introduce language that is
slightly more complex than
the child’s current
expressive level
Repeat the utterance the
child says and add more
Also use acoustic
highlighting for key words
added
Expand single words into
phrases or sentence
Extend vocabulary

Many opportunities
in daily routines to
provide vocabulary:





Categories
Opposites
Quantities
Gender
Synonyms
(big/enormous/huge/
large)
Strategies
Use rephrasing
 Example:



Do you want the tiny
bear?
If child does not
respond, rephrase…
The tiny bear is the
little bear. Do you
want the tiny bear?
Use questioning

Early language
development

What is that?


Where?


Used to expand child’s
vocabulary for the
names of objects
Prepositions
Make sure to ask
questions that don’t just
require a one-word
answer
Strategies



Use auditory closure
Starting a
sentence/phrase
Waiting for child to
finish it
Informal way of
assessing child’s
linguistic skills,
concepts, and
listening ability
Use a natural voice



Early – singsong voice and
acoustic highlighting
Later – use a more natural
voice with less acoustic
highlighting
Child does need to hear
natural tone, appropriate
stress, intonation, rate and
rhythm

Why?

To develop natural sounding
speech
Strategies

Give your child time to process



Wait rather than jumping in to rephrase or repeat right away
Repeat if there is no response after a short delay
Give a direction once through listening

Later on – establish the expectation that the message will be
said only once



Learn responsibility
Encourage child to ask for repetition rather than just giving it –
teaches child to request
Use clarifying

Later on


What did you hear?
Teach the child to advocate

Say it again please. What did you say? Would you repeat that
please?
Child-Centered Transition


May occur when the clinician is able to spend
an increasing amount of time working directly
with the child.
The transfer from primarily family-centered to
primarily child-centered (while still engaging
the family) training should be decided upon
the relative contributions of the child’s
development that can be made by the
parents at home as compared with those
made by the teachers or clinician
References





Cochlear. (2005). Listen learn and talk: Another cochlear
innovation. (2nd ed.). Alexandria, NSW: Cochlear Limited.
Cole, E. B., & Flexer, C. (2007). Children with hearing loss:
Developing listening and talking birth to six. San Diego, CA:
Plural Publishing, Inc.
Deconde Johnson, C., & Seaton, J. B. (2012). Educational
audiology handbook. (2nd ed.). Clifton Park, NY: Delmar
Cengage Learning.
Ling, D. (2002). Speech and the hearing-impaired child:
Theory and practice. (2nd ed.). Washington, DC: Alexander
Graham Bell Association for the Deaf and Hard of Hearing.
Ling, D., & Ling, A. H. (1978, 1980, 1985). Aural habilitation:
The foundations of verbal learning in hearing-impaired
children. (3rd ed.). Washington, DC: AG Bell Association for
the Deaf, Inc.