So, You Have a Child with a Hearing Loss on your Caseload.

Today's guest post is brought to you from Lynn, an audiologist. I hope it's a great starting place if you're working with hearing impaired students!  

So, You Have A Child With A Hearing Loss On Your Caseload

First Steps for Speech Language Pathologists

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The terms deaf or hard of hearing cover a wide range of conditions and all affect a child’s listening ability and interfere with their language, social and educational development. The number of children in neighborhood preschools and auditory-oral private schools is ever increasing. Many of these students will need support from SLPs to succeed in mainstream classrooms. 

Starting Points

First, below are facts to stimulate your thinking in order to begin by asking the right questions.

Points to Ponder

• 95% of parents of children with hearing loss are hearing themselves

• The trend is that hearing parents are choosing spoken language options such as Auditory-Verbal Therapy for their children with hearing loss

• Auditory based intervention does not use any visual communication systems

• Children with all degrees of hearing loss can learn spoken language through hearing

• Early diagnosis, aggressive audiological management, contemporary hearing technology is essential

• Audiograms no longer predict outcomes

• Hearing loss is not about the ears? – It’s about the brain! We hear with the brain –the ears are just the way in. (www.Carol Flexer.com)

• Children can have sensori-neural, unilateral, fluctuating, and conductive hearing losses. They wear hearing aids, cochlear and baha implants and/or FM systems.

What is Auditory-Verbal Therapy?

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According to The Alexander Graham Academy for Listening and Spoken Language,  “Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012).

Who are Listening and Spoken Language Specialists?

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The AG Bell Academy governs the certification of Certified Auditory-Verbal Therapists (LSLSCert. AVT) and the LSLS Certified Auditory-Verbal Educators (LSLS Cert. AVEd).The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families.

What Do I Need to Know?

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Helen Keller once said, “Blindness separates people from things; deafness separates people from people...” Without prior experience it is difficult to appreciate the impact hearing has on basic human interaction and daily communication.

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If you have the opportunity to see a child who has graduated from AVT or an auditory-oral preschool first and foremost take advantage of theparents’ knowledge. Depend on the audiologist, the AVT’s and the hearing itinerant‘s expertise. In the reference section, there are links to simulations of hearing loss and listening with technology that is insightful. Become familiar with variables that effect hearing such as the impact of noise, distance, room acoustics and equipment malfunctions and ways to manage them. Learn about the child’s listening and learning abilities, social needs, and the IEP accommodations.

Classrooms are auditory – verbal environments where LISTENING serves as the basis for learning. Read this brief children’s story below. Do you recognize it?

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You can read the passage but endings are missing and the words are not distinct. It takes time and energy to figure
out the story. This visual simulation is similar to the listening ability of a child with well-fit hearing aids. The small 
font size represents that sound is perceived more quietly than it is for typically hearing
 children. The child may ‘hear’ but not understand what was said because
 pieces are missing. Do you know the story?

Hearing aids and/or cochlear implants do not restore normal hearing. Students who use hearing aids may not be able to hear all of the sounds of speech even when it is quiet and the speaker is close by. A hearing loss is invisible and therefore it is easy to forget the effort required to attend, learn and participate. Children with language delays or additional learning issues make this even more challenging.

Strategies to Facilitate Listening and Spoken Language

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There are many specific and purposeful auditory strategies and techniques used to teach a child who is deaf or hard of hearing to learn spoken language through listening. Here are three of the most basic and effective. 

Hearing First!

or

You Will Lose the Opportunity for Listening.

Talk about pictures, objects and events before you show them.

This will focus the child on listening and reduce visual dependence.

After you show the materials, repeat and rephrase the message.

This provides repetition and allows the child to “connect” the

auditory and visual information.

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Sit beside the student close to the child’s better ear.

Listening Sandwich

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Present information through hearing.

 Add VISUAL cues, as necessary

Then, SAY IT again to promote listening. “Put it back into hearing.”

Wait Time

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Pausing and Waiting!

Allow time for the child to process and attach meaning to what was heard.

Don’t rescue too soon!

In summary, I have included numerous references, important videos, printable handouts and a wealth of resource materials. This will enable you to further investigate opportunities for supporting children with hearing loss and their families.

“I am deaf and I can listen, hear and talk!”

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Happy Listening!

So, you want to learn more?

This first step is to view the TED Talks video, Establishing a Sound Foundation for Children who are Deaf or Hard of Hearing. Dr. Karl R. White explains the differences in raising children with hearing loss today versus 35 years ago and the key factors for successful language development.

Next, watch a series of short videos of my friend and mentor, Carol Flexer, PhD, CCC-A, LSLS Cert. AVT, as she teaches on auditory brain development, acoustic accessibility, the listening environment, signal to noise ratio and more in her engaging videos. Be sure to scroll down to see Carol!

Read a post from the ASHAsphere blog entitled, “Auditory-Verbal Therapy: Supporting Listening and Spoken Language in Young Children with Hearing Loss & Their Families” Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT.

Investigate the Listening and Spoken Language Knowledge Center a vast site for children and adults with hearing loss, their families and the professionals who support them.

Spend some time at Success For Kids With Hearing Loss where Karen L. Anderson PhD, an audiologist has a wealth of resources including printable handouts regarding the relationship of types and ranges of hearing loss and the impact on listening and learning, social needs, and the potential school accommodations and therapy needs. Be sure to investigate Learning With a HL - Things For the Teacher To Know and Understand

So if you’re ready to dig in, order your own copy of  101 FAQs about Auditory-Verbal Practice. It is an excellent resource edited by Warren Estabrooks, the President and CEO of WE Listen International. The book takes the reader on a journey through current theory, practice, and evidence-based outcomes. It offers knowledge, guidance, encouragement and hope for future generations of children who are deaf or hard of hearing, their families and professionals. 

Lynn is an Audiologist, is a LSLS Cert AVT who has worked with individuals with hearing loss and their families for over 30 years. She has a private practice specializing in AVT, post cochlear implant rehabilitation for children and adults and therapy for individuals with auditory processing disorder. Lynn is actively mentoring and consulting with programs that are transitioning from visual to auditory based and is a site for graduate student observations. Follow her on Facebook or on her blog.

Speech Box {App Review}

Today's app review is for Speech Box. Speech Box was developed by a parent of a child with apraxia with a focus on simple one syllable words. My first response was excitement! Finally a new format for articulation flashcards! Can you believe my clients are sick of the same articulation apps already?!

The Speech Box apps are organized on  the home page like this one. Pick the sound you want to target and click on a box.

The pictures are shown in a pile on the page (it does take a moment for them to load - I used that time to practice our sound in isolation). When you on the buttons at the top left, you can see a list of the targeted words. Here you can easily unselect anything you might not want to work on. For example, when working on /k/, I removed any words with contained /t/ and /d/ to reduce the complexity for a student with a severe phonological disorder.

To practice a target words, just tap the picture. It will get larger on the screen and the target word is produced. To move to the next card, just swipe it away. The kids loved this feature! Plus, when looking at the pile, they are in control of which items are

To add a new card, touch the (+) button. Add the picture and record the word.

 The SLP can also add new boxes.

Pros: 
+The novel format draws student interest and gives this some autonomy because they pick what card is next. They can visually see how many cards are left to finish (that was surprisingly motivating my for guys!)

+Almost all of the 700 photo's included are one syllable words, something often not found in articulation apps.

+The fact that there are photos rather than graphics is a plus for use with other populations

+Once you make a 'box' it can be sent to others (I'm thinking home to parents if they own the app.) I also suggested to the developer to have somewhere SLPs can upload created boxes to be downloaded by other SLPs! Save time and hassle!

+The app is fully customizable, you can add boxes and pictures easily.

+The app is adaptable for much more than articulation/apraxia. Vocabulary and more can be added!


Cons: 

- Several of the picture cards were in the wrong 'box'. This is likely due to the fact that it wasn't developed directly by a SLP. For example in the /g/ box there were many words that end in /ŋ/ (fang) and /dʒ/ (page.) Those sounds are different from /g/ although spelled with the 'g' letter. I also learned my lesson to prescreen all the cards, when 'keg' came up and the sweet 5 year old asked me what is was! (I asked the developer and he's going to remove it. Many low income or ESL families wouldn't frequently use that term unless to mean alcohol. All the other pictures seem appropriate.)

-I wish the app had more variety of syllable complexity. I'll likely add new boxes that contain 2 and then 3 syllable words with each sound. Although children with apraxia need simple syllable structures to start - they eventually move into more complex syllable types (YAY!). The app isn't set up for that, and the SLP will need to add more pictures. Most SLP's don't have much extra time.

-No data collection is included in the app. An SLP app without data collection is really not up to par with the standards by other SLP apps.

-Blends aren't included. 

-Since the app focuses on one syllable words, many of the sounds only have 4 or 5 cards. I wish it had more variety in those sounds. It's only therapy ready for single syllable words. Much of my apraxia caseload is working on medial consonants and two syllable words (CVCV and CVCVC).

-The app currently only functions with a single player (or with only one sounds at a time.) I typically have preschoolers in a group of 2, so I wish I could do a 'split screen' or flip between sounds more easily. As it is now I need to exit the box and load another one.

-Links to twitter and Facebook on the home page are unnecessary.  Those quick little fingers can get a kid onto my Facebook page in just a split second! There is a lock function to disable, but these links still don't belong on a kids app in my opinion!

Overall, the app  has great new way of presenting target words. I love it as a starting place for apraxia therapy. While the app is customizable, it will take prep work and customizing by the SLP. The app is not meant to replace your full set of articulation cards. Limited syllable complexity and lack of data collection are major current concerns with its design. If you're looking for single syllable stimulus items, I'd recommend this app, but if you're looking for a full set of syllable complexities, be prepared to do some work yourself. It's currently priced at $19.99, which is listed at 50% off.


In talking with the developer, many good updates are on the way. This includes blends, data tracking and sentences! Follow Speech Box on Facebook and Twitter(@speechboxapp) to keep up to date with all the exciting new features on the way.


A copy of this app was provided in order to complete this review. No other compensation was provided.

In other news... I'm joining the big TPT sale on Sunday! Don't forget the promo code! If you're looking for materials check out my Resource List with over 80 different SLP stores!

One of my favorite Old Ladies!

Besides my own sweet Granny, this weirdly hungry old lady is one of my favorites. At the beginning of the year I ordered the rest of the books I didn't have, including the Rose version!  

I have typically used this book with my younger preschool crowd. This winter and spring, I'm hoping to use it with my older students as well! I whipped up these pages to use with my k-5 crowd, but it should be adaptable for older and younger student too! Here are the 'Rose' and 'Clover' Sets. 

I'm not the first SLP blogger to make book companions for this little lady. You can check out a sample of those here.  Those packets looked great but didn't have exactly what I needed, so I came up with this one. Find it in my TPT shop. 

There was an Old Lady Who Swallowed  Rose. 

This 36 page activity pack is perfect for speech or language. I've included a sneak peek for each of the activities below. Granny grammar sentences are my favorite! 

•Granny Grammar: Help your students increase their sentence complexity. Give each student a grammar granny (page 33). Granny has different parts of speech written on different parts of her face. Students should develop a sentence. Then look to see which elements they have included. They should color in those parts on the granny in the sentence strip (page 34.) Encourage students to add complexity to their sentences..

•Future Tense Writing: Have your student develop a sentence writing and drawing what he/she would eat if they were the granny.

•Retelling: Cut out the old lady’s head.(page 3.) Cut out her mouth and attach it to an empty tissue box. Use the cards on page 4 to feed the lady pieces of the story. Use the retelling mats on pages 5 & 6 to retell the story or send home as homework.

•Rhyme: Cut out the cards (page 7) and match rhyming words from the story. Pictures make the cards partially self-checking.

•Verb Tense: Cut out each verb card (pages 8-11.) Name the verb from the story indicated on the left side of the card.. Then determine the verb form for past, present and future tense. Use a dry erase marker to fill in the blanks.

•Story Sequencing: Print the story sequencing circles (pages 12-13) and add Velcro. Let students retell the story and add the story parts in order.

•Object Functions: Use the included sheet to let student identify the object functions. If students can ID them receptively, target this skill expressively (What do you do with a clover?)

•Ordinal Numbers: Print and cut the included cards. Have students find matches (ie: first/1st) and then put them in order. My student have such a hard time with this in first grade! 

•Comprehension: Use the included 12 comprehension cards (pages 16-17) as a follow up to the book. Use the Yes/No questions (page 18) as another follow-up activity.

•Articulation Reinforcers: Use the Spin & Cover and Granny Collector games as a general reinforcer for articulation students (or any speech/language target). During Spin & Cover (pages 19-20) the student uses an included spinner and sheet to be the first to cover each item (use bingo chips.) During the Granny Collector game (page 21-22) students use the included game die to collect as many grannies as they can. Be the first to cover each granny and win. Say your sound as many times as you cover grannies!

•Possessive Pronouns: Print one copy of pages 23-24. The old lady has decided to share some items with her dog, Brutus. Decide what items they should have. Say a good sentence as you give them each their objects and explain why!

•Conversation Starters: Use the 12 included conversation starters to discuss topics related to the book.

•Do-A-Dot Reinforcer: Use the included reinforcer as a coloring or Do-A-Dot page.

•Temporal Directions: Print one of each card (pages 28-31) and play the game while working on before/after game cards.

I've also got the March version of this book ready! You can find it in my TPT Store. 

• - Retelling: Cut out the old lady’s head.(page 3.) Cut out her mouth and attach it to an empty tissue box. Use the cards on page 4 to feed the lady pieces of the story. Use the retelling mats on pages 5 & 6 to retell the story or send home as homework.

• •  Rhyme: Cut out the cards (page 7) and match rhyming words from the story. Pictures make the cards partially self-checking.
  
  
  
  
  
• •  Verb Tense: Cut out each verb card (pages 8-11.) Name the verb from the story indicated on the left side of the card.. Then determine the verb form for past, present and future tense. Use a dry erase marker to fill in the blanks.
  
  
  
  
  
  
  
• •  Story Sequencing: Print the story sequencing circles (pages 12-13) and add Velcro. Let students retell the story and add the story parts in order.
  
  
  
  
• •  Object Functions: Use the included sheet to let student identify the object functions. If students can ID them receptively, target this skill expressively (What do you do with a clover?)
  
  
  
  
  
  
  
  
• •  Ordinal Numbers: Print and cut the included cards. Have students find matches (ie: first/1st) and then put them in order.
  
  
  
  
  
  
  
  
• •  Comprehension: Use the included 12 comprehension cards (pages 16-17) as a follow up to the book. Use the Yes/No questions (page 18)
  as another follow-up activity.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
• •  Articulation Reinforcers: Use the Spin & Cover and Granny Collector games as a general reinforcer for articulation students (or any speech/language target). During Spin & Cover (pages 19-20) the student uses an included spinner and sheet to be the first to cover each item (use bingo chips.) During the Granny Collector game (page 21-22) students use the included game die to collect as many grannies as they can. Be the first to cover each granny and win. Say your sound as many times as you cover grannies!
  
  
  
  
  
  
  
  
• •  Possessive Pronouns: Print one copy of pages 23-24. The old lady has decided to share some items with her dog, Brutus. Decide what items they should have. Say a good sentence as you give them each their objects and explain why!
  
  
  
  
  
• •  Conversation Starters: Use the 12 included conversation starters to discuss topics related to the book.
  
  
  
  
  
• •  Do-A-Dot Reinforcer: Use the included reinforcer as a coloring or Do-A-Dot page.
  
  
  
  
  
  
• •  Temporal Directions: Print one of each card (pages 28-31) and play the game while working on before/after game cards.
  
  
  
  
  
  
  
  
  
  
  
• •  Granny Grammar: Help your students increase their sentence complexity. Give each student a grammar granny (page 33). Granny has different parts of speech written on different parts of her face. Students should develop a sentence. Then look to see which elements they have included. They should color in those parts on the granny in the sentence strip (page 34.) Encourage students to add complexity to their sentences..
  
  
  
  
  
• •  Future Tense Writing: Have your student develop a sentence writing and drawing what he/she would eat if they were the granny. 
• 
  
• In my TPT Store: Swallowed a Clover   & Swallowed  Rose
  Ok. If you made it ALL the way to the bottom of that post I think I should do a giveaway! I'll giveaway a copy of each! Just leave a comment below and I'll pick a winner from the comments. Make sure you leave your email with your comment!