A Five Step System to Build Question Answering Skills In Children with Hearing Loss

How many times have you been humming along in a conversation with a child when suddenly, a simple question stops him in his tracks?  Once you get beyond the rote answers to, “What’s your name?” and “How old are you?” many language learners are derailed by novel questions for which they are unprepared.  The problem grows when children are asked to answer questions about material they’ve heard or read.



The ability to answer questions is a telling indicator of a child’s auditory, linguistic, and conversational abilities and a key component of academic success.  How can we help children with hearing loss learn to answer questions in a way that is developmentally appropriate yet systematic enough to be easily replicated by parents and professionals alike?



Let’s follow along with my simple five-step system using the example of an Auditory-Verbal Therapist who is helping a child learn to answer questions about a story presented without visual cues.  The therapist has read a page of Goldilocks and the Three Bears where Goldilocks sits in Baby Bear’s chair and breaks it without showing the illustrations to the child.  Now, the therapist wants to see if the child is able to process that auditory-only information well enough to answer a question about the story.  The therapist asks, “What did Goldilocks break?”



Before we begin our intervention hierarchy, let’s go over one crucial strategy that we will use after every step of this process: AAR: Ask – Answer – Repeat.  No matter which level of intervention the child needs to answer the question, after he responds correctly, the clinician should always reinforce this response by 1) Asking the question again, 2) Answering the question herself, and 3) Repeating the question for the child to answer yet again.  This gives the child another exposure to the question and another opportunity to practice answering it correctly.  It’s also a way for the clinician to model the correct language of the response if the child answers with correct content but with speech or grammatical errors.  For example:



Therapist: What did Goldilocks break?

Child:  The SHair

Therapist:  You’re right!  What did Goldilocks break?  She broke the CHair.  What did she break? [The clinician acknowledges and praises the child’s correct content response, but provides a model answer that is a full sentence with emphasis/acoustic highlighting to help the child correctly articulate “chair.”]

Child:  She broke the chair [Now the child’s response is a full sentence and correctly articulated because of the clinician’s model with acoustic highlighting.]

Now that you’ve mastered AAR, let’s jump into the five-step system.  At the end of the five steps, I’ll discuss the rationale behind this approach.



STEP ONE:  Ask the question “What did Goldilocks break?”

If the child answers correctly: AAR

If the child answers incorrectly, keep going…



STEP TWO:  Give answer options “Did Goldilocks break the chair or the bed?”

If the child answers correctly: AAR

If the child answers incorrectly, keep going…



STEP THREE:  Point to the answer The therapist asks the question again, “What did Goldilocks break?” while pointing to the answer in the illustrations

If the child answers correctly: AAR

If the child answers incorrectly, keep going…



STEP FOUR:  Ask a foil  The therapist asks, “Mom, what did Goldilocks break?” has the foil answer, and then repeats the question to the child

If the child answers correctly: AAR

If the child answers incorrectly, keep going…



STEP FIVE:  The clinician answers the question herself and repeats the question to the child





So, that all might sound nice to you, but… what’s the point?  Why can’t we just see if the child can answer the question and, if not, supply him with the answer?  The answer is twofold: scaffolding  and diagnostics.


Scaffolding means that we provide the child with just the level of support he needs to be successful without over-intervening to the point that we are making things too easy for him.  Each level of this system provides just a tiny bit more information and support, while still keeping the onus on the child to answer to the best of his ability, whether that is an open-set question, a question with answer options, or simply repeating the answer.


Diagnostics  are a key component of auditory verbal therapy.  AVT is based on constantly adapting the therapist’s approach based on the child’s responses to provide maximally effective, targeted intervention.  This system provides much more diagnostic information than a simple +/-: he could answer it or he could not.  Each step of the system yields new insights into the child’s speech, language, and listening abilities.  What do we know about a child who can answer at each of these steps:


Step 1:  This child can accurately answer open-set questions about information presented through audition alone without visual cues.

Step 2:  This child can answer closed-set questions about information presented through audition alone without visual cues.

Step 3:  This child can label objects in a picture, but is not understanding the question form or not processing auditory-only information without visual cues well enough to answer questions about that information.

Step 4/5:  This child is not able to understand auditory-only information or question forms well enough to answer accurately, but does have the auditory ability to imitate an auditory-only answer model.



The AAR component of the system is important in that it gives the child repeated opportunities to hear the question correctly asked and answered, and to practice doing so himself.  We know that children with hearing loss need approximately three times as much exposure to language and language structures to integrate them as hearing children do, and this is a great way to provide that extra exposure in the context of natural, meaningful conversation.

The parent and therapist can use this important diagnostic information to tailor their questions to the child to hit the level of just-right challenge, that fabled “Zone of Proximal Development” where the tasks are just hard enough to stretch the child’s skills but not so hard that the task seems impossible and the child gives up.



This carefully calibrated diagnostic system keeps the child feeling successful while continuing to grow his question-answering skills to achieve the end goal: Listening and spoken language conversational competence.  

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