Assessment of Auditory Skills

1. Assessment of Auditory Skills

2. Assessment Types Speech Perception Testing Functional Auditory Assessment Development of auditory skills Auditory curricula Auditory Processing Tests

3. �Speech Perception Measures� Formal testing completed primarily by audiologists to assess auditory performance Often completed in soundbooth Designed to assess benefit with hearing aids/cochlear implants or candidacy for these tools Measure discreet listening tasks, mostly to the auditory identification level

4. Examples

5. Speech Perception Tests Glendonald Auditory Screening Procedure (GASP) Lexical Neighborhood Test (LNT) Minimal Pairs Northwestern University Children�s Perception Test (Nu-CHiPs) Word Intelligibility by Picture Identification (WIPI)

6. Functional Auditory Assessment

7. �Because very few formal tests are available to assess functional listening, it is critical to understand the developmental hierarchy of auditory skills (i.e., simple detection through open-set comprehension of spoken language; Erber, 1982) and obtain baseline information regarding discrete auditory skills across that functional continuum.�

8. Assessment of Auditory Skill Development Criterion referenced vs. Norm Referenced Criterion � shows what skills a child exhibits Norm referenced � plots childs performance against a larger group of tested children Auditory Skills assessments are typically criterion referenced measures; i.e. we are less interested in what a child does relative to another child than in: which skills he or she has attained which skills need to be addressed

9. Most assessment measures are �placement tests� incorporated into auditory skills curricula �curricula� � plans for (re)habilitation, goals and activities In other words assessment and intervention approaches are wrapped up together

10. Discreet Auditory Skills Tools

11. MAIS and IT-MAIS Meaningful Auditory Integration Scale Parent interview designed to assess the child�s spontaneous responses to sound in his/her everyday environment IT-MAIS � Infant/Toddler MAIS Vocalization behaviors Alerting to sound Deriving meaning from sound

12. APT/HI-R � Auditory Perception Test for the Hearing Impaired For ages 3+ Assesses: Auditory�Awareness�Tasks� Suprasegmental Aspects: DIP Prosodic Perception Tasks Vowel Perception Tasks Consonant Perception Tasks (manner, voicing, place) Other Segmental Perception Tasks Linguistic Perception Tasks Communicative Comprehension Tasks Gives �performance profile� rather than score Characterizes �mastered�, �emerging�, �missing� skills

13. Assessment Tools/Curricula

14. Among Others� CASLLS: Cottage Acquisition Scales for Listening, Language & Speech. (2001) www.sunshinecottage.org/products/CASLLS SPICE � Speech Perception: Instructional Curriculum and Evaluation (1996). www.cid.edu AuSpLan: Auditory, Speech, Language: A Manual for Professionals Working with Children Have Cochlear Implants or Amplification. (2003). Available via Children�s Hospital Oakland.

15. CHATS: The Miami Cochlear Implant Auditory & Tactile Skills Curriculum (1994) Foreworks Auditory Skills Curriculum (1976) www.foreworks.com DASL II: Developmental Approach to Successful Listening II. www.cochlearamericas.com (1992)

16. Auditory Learning Guide Beth Walker (1995) Unpublished handout based on Foreworks and work by Judy Simser and Sylvia Romanik Provides framework for planning therapy and charting progress No activities included

17. ALG cont. Five Levels Sound awareness Phoneme level Discourse Level Sentence Level Word Level Detailed behaviors that occur concurrently in typical auditory development Color coded to give beginning therapists/teachers a �ballpark� idea of minimum rate of progress expected

18. Auditory Processing Tests There are standardized tests developed for older children in the areas of �auditory processing� Typically not designed for children with hearing loss, but rather to identify �processing� difficulties (higher order auditory skills) in children without hearing loss

19. Some Examples TAPS-3 � Test of Auditory Processing -3 APAT � Auditory Processing Abilities Test Examples of areas assessed: Phonological blending Word/number/sentence memory Auditory comprehension Processing of sentences/extended recall Per Rosado/Allen (2011) used after open-set comprehension is achieved may help determine the child's readiness to be successful in the general education setting may also be used to track and monitor the child's auditory progress or regression in the mainstream setting

20. Practice

21. Strategies to Facilitate Auditory Development

22. External Factors Using Easterbrooks/Estes model, these are aspects that teacher/therapist uses to support or challenge child in their listening development/listening activities Acoustic strategies Teaching techniques

23. Control for the Best Auditory Input Control the environment Reduce noise in your therapy room and in a family�s home Utilize FM when necessary Position the child for the best auditory signal Seated beside child on side of microphone or �best ear� Who goes on that side � parent or therapist? Highchair or no highchair?

24. �Auditory First� Encouraging auditory development by stimulating auditory sense first before others take over Auditory only? Talking about something before showing it Technique: �The Listen Cue� or �I hear that!� Technique: Train yourself to think/say �Listen� instead of �Look�

25. Hand Cue/Covering Used to place emphasis on the auditory signal Hand Cue may refer to: therapist or parent covering his/her mouth when the child is looking directly at the lips adult moving his/her hand toward the child�s mouth as a prompt for vocalization Think of it as just another kind of �Listen Cue� Is not required once listening has been �integrated into his or her personality" (Pollack, 1985) NOT for non-therapy settings

26. Acoustic Highlighting To make speech easier to process: Reduce your rate of speech Increase segmental differences Up up up/dooooown Vary the intensity and rhythm Emphasize key words or phrases position a word for perception (last is easiest to recall) pause before word, chunk phrases increase inflection or stress

27. Particular Techniques Lean in Bringing your voice closer to the microphone increases the signal intensity 6dB rule (halving the distance, increases intensity by 6dB) Whisper Vowel energy is greater than that of voiceless consonants Whispering helps to emphasize the consonant (e.g. �pat�) Sing! Adds prosody, phrasing and pitch changes to words

28. Learning to Listen Sounds A core group of objects/toys paired with onomatopoeic sounds �moo� with a cow �aaaa� with an airplane �hop hop hop� with a rabbit or frog Designed to encourage developmentally appropriate babble with varying vowels and consonants, rhythm and intonation NOT used instead of a word

29. Auditory Sandwich Beginning with auditory information gives a chance to see how it works Opportunity still remains to add stimuli as needed Leave a lasting impression - Put it back into hearing!

30. Increasing Wait Time Our instinct is to repeat and rephrase when a child does not immediately respond Processing time is critical, particularly in the early months post-implant Imparts the expectation that there is something expected of the child Try: Leaning forward and raising your eyebrows or cocking your head a little��expectant look�

31. Repeat or Reword? Start by asking �What did you hear?� Remember that rewording can wreak havoc for the child with attention issues

32. Manipulating Variables Within a listening activity, we have control over the information that we provide to a child Language used in the questions we ask Number of objects we ask our child to get The familiarity of the setting we are in and the toys or objects present Thinking about these variables will allow us to Challenge the child�s auditory abilities Provide support for the child�s auditory abilities as necessary

33. Let�s try one� Putting away clothes Auditory goal: to follow direction with 2 key words �Put away daddy�s shirt� You can make this more challenging or easier by changing How many different clothing items there are How many different people the clothes belong to How much acoustic highlighting you use How much time there is for the child to remember the message before doing the task

34. How exactly?� Lets say you start with Clothes in a pile, across the room There are 4-5 different clothing items for 4 different people The child grabs a shirt, but it isn�t Daddy�s Give him more support Use highlighting to emphasize �Daddy�s shirt� Put the clothes into piles for each person first Make only two piles to choose from Move the clothes closer to you and to the drawers

35. Teach Don�t Test Avoid questions to which you already know the answer Create meaningful connections for every listening activity Target skills across the listening hierarchy (vary input and context) rather than moving didactically through steps

36. Set Up for Success Work at a level where the child can succeed most of the time Begin and end with something the child can get Be specific with reinforcement Avoid the �good job� response Fill the child in on exactly where they went right �You did find a red ball� �I heard you say �meema meema��

37. Providing Choices When a child hits a road block, give them a choice question For earlier listeners, put the correct answer at the end to encourage success Later can change the choice to the first position to challenge them

38. Capitalize on Teachable Moments A teachable moment is a time when opportunity presents itself Stop what you are doing and follow the path that has presented itself You are painting and talking about color when paint gets on the wall You are reading a book when your child points out a picture that doesn�t match the text You are taking a walk when you see an animal�s den

39. Inherent in conversation Switch the role of speaker and listener when playing to allow for modeling of listening behaviors waiting for a complete message asking for clarification Repeating what you hear thinking behaviors strategies for memory and recall Also allows you to listen for use of particular language targets Turn taking

40. Activities for Turn Taking Pulling toys out of a bag Reading pages of a book Feeding or washing or dressing baby �She needs a diaper�, �She needs a shirt� Hiding a toy �Close your eyes�, �Where is it?�

41. Modeling with Others Provides a natural rather than a contrived model Dissolves confusion over pronoun usage and question forms that arise from two person exchanges �It�s your turn� �That�s for me.� �How are you?�

42. How Does This Work? Questions Adult to Charlie �How are you?� Charlie to adult �How are you?� Mom to adult �How are you, Mary?� Adult to Mom �I�m great, thanks� Mom to child �How are you, Charlie?� Charlie �I great� Around the dinner table, everybody takes a turn using similar language �I want xxx please�

43. Sabotage What is Sabotage? A little trick designed to keep them listening Creating teachable moments How is it used? Establish familiarity first Throw them for a loop Why? Eliminates the guessing Establishes responsibility for listening HI kids are not always wrong

44. Sabotage Situational Provide opportunities that require child to talk The lid is on too tight Forget to serve him at dinner Make a mistake that the child will be motivated to draw your attention to Spill, drop, break Verbal Say something silly and unexpected Mismatch actions and words Use with established language targets

45. Video Review