Play It By Ear Seminar: Day Two

AUDITORY INTERVENTION IN ACTION

Joanna Smith, MS, CCC-SLP, LSLS Cert. AVT and Teresa Caraway, Ph.D., CCC-SLP, LSLS Cert. AVT (both from Hearts for Hearing)

The goal of a listening and spoken language approach to deaf education is not just to create children who can listen to commands and answer simple yes/no questions, but instead to grow competent conversationalists and children who can truly interact in a world full of spoken language and sound.  How do we do this?

Techniques to Facilitate Advanced Language and Higher Order Thinking (these are conversation starters you can use to encourage children to think beyond the “here and now” and expand their critical thinking and conversation skills):

  • “What if…”

  • “If I were…”

  • “I wonder…”

  • “What could happen…”

  • “What do you think…”

  • “When I grow up…”

  • “When I was little…”

  • “One time…”

  • “You won’t believe…”

  • “This reminds me…”

  • “Bet you can’t guess…”

  • “Remember…”

  • “This is like…”

  • “What do you see…”

  • “I think…”

  • “Have you ever…”

  • “How do you…”

  • “Where could he be…”

  • “When you…”

  • “Maybe your Mommy knows…”

Get out of the mindset that therapy should be a directive exchange.  Stop “mind reading” and answering questions for the child.  Instead, help children think for themselves.

SPECIAL ISSUES: AUDITORY NEUROPATHY/DYS-SYNCHRONY and BILATERAL COCHLEAR IMPLANTS

Jace Wolfe, Ph.D., CCC-A (Hearts for Hearing)

Auditory Neuropathy/Auditory Dys-Synchrony is a problem in the “coordination” of the inner ear’s hearing systems.  While scientists used to think the problem was only in the auditory nerve itself (hence the older name, “neuropathy”) new discoveries have found that AN/AD is actually caused by a coordination problem in the auditory brainstem, the auditory nerve, and/or the outer and inner hair cells of the cochlea.  Dr. Wolfe detailed a wonderful testing protocol to determine cochlear implant candidacy in patients with AN/AD.  It is very thorough with lots of tests supported by the latest research.  There’s way too much to explain it all here, but if you are interested in learning more, please leave a comment and I’d be happy to discuss it with you in greater detail.

He also discussed bilateral cochlear implants — what are the pros and cons, how do you decide if it’s right for you, and how do you petition insurance to cover a second implant?  All great information that deserves its own post, so look for that soon!

WORKING TOGETHER: PARENT COACHING AND GUIDANCE

Joanna Smith, MS, CCC-SLP, LSLS Cert. AVT and Teresa Caraway, Ph.D., CCC-SLP, LSLS Cert. AVT (both from Hearts for Hearing)

Why is it critical that listening and spoken language professionals empower parents to be the primary language teachers for their children?

  • Average waking hours per day of a typical two year old: 12

  • Average waking hours per week of a typical two year old: 84

  • Average waking hours per month of a typical two year old: 360

  • Average waking hours per year of a typical two year old: 4,380

So, even if the child receives an hour or two of therapy a week, or attends an oral preschool for 25 hours a week, the vast, vast majority of time is still spent with the parents and other primary caregivers NOT specialists in listening and spoken language.  As professionals, we have to become coaches to equip parents with the techniques and strategies they need to become their own experts in a field they know best — their children!  Think about it:  when an athlete wins a championship game, a gold medal, or sets a world record, he doesn’t go running to his coach for a hug… he runs to his mother and father.  That is our role as listening and spoken language specialists — not to be the hero who swoops in and fixes everything and then takes all the credit, but to be the coach who helps the parents give their children the very best education possible to develop skills for listening and spoken language.

How do we as professionals become better coaches?  Each session, or meeting with parents and child, should have OARS:

O Observation

A Action

R Reflection

S Summary

So, Jimmy and his mother come in for therapy.  First, the parent and therapist observe Jimmy — what is he doing well?  What needs more work?  Then, you act.  What strategies and techniques can we use to help Jimmy reach the next level of listening and spoken language development?  Then, the parent and therapist reflect — did this work well?  Then, the summary — “Okay, Mom, today we did XYZ.  How do you feel about that?  We practiced it together.  Do you think this will work at home?  How can you incorporate this into his daily routine?  What can I do to support you in doing this?”

Some suggested coaching strategies:

  • Show and Share: Have parents/caregivers show you how they do things at home (How do you read books together at home?).  This will help you get a feel for the parent-child dynamic and work to build on what they already do in their natural environment.

  • Test Drive it Together: The “coach” demonstrates a strategy and then gives the parent/caregiver a turn to try it out.

  • Leading by Example: Use the parent as a model in the session for the child to follow.

  • To the Point: Coach provides direct instruction for the parent/caregiver to do an activity.

  • Guided Experiment: Coach says something like, “I wonder what would happen if you ABC with Jenny” to encourage parent to try something new and reflect on the results together.

  • News Commentator: Coach comments on what the parent is doing while parent and child interact to highlight the caregiver’s knowledge and skills in implementing A-V techniques.

  • Secret Message: Coach uses subtle nonverbal cues and prompts to guide parent/caregiver during a therapy session.  For example, the therapist could motion behind the childs back for the parent to wait for the child’s response, not to jump in so quickly with an answer.

  • So What?: Coach explains the purpose of the session’s goals, objectives, and activities so the parent/caregiver understands the reasons behind the therapy and WHY these things are going to help.

  • The Fake Out: Coach encourages parent/caregiver to call her on her mistakes and then purposely messes up to have the parent correct her and give a better examples.

  • Making the Connection: Coach gathers information from parent/caregiver about how these strategies are working in the home and uses that information to suggest modifications.  At the end of the session, ask the parents their three “take home points” from that day and how they will incorporate them at home.

Most importantly, the presenters encouraged professionals to ask parents/caregivers the questions: “What do you need more of from me?  What do you need less of from me?” and to be willing to honestly hear the answers and act on the feedback they receive.  They also advised professionals to ask the question, “What is your greatest concern for your child’s development?”.  Sometimes, parents are so worried about their child’s other issues, or other problems going on in the family, that listening and spoken language take a backseat.  We need to be informed about community resources and other types of therapy (psychological, occupational, physical, sensory integration, behavioral, etc.) to help families resolve the issues that are creating roadblocks on the path to listening and spoken language success for them and their children.  It’s about seeing the child as a whole child who is part of a whole family, not seeing things in isolation.

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