Big Goals for Big Kids

A lot of attention in the AVT world is focused on infants and toddlers — detecting hearing loss at birth, fitting them hearing technology ASAP, and getting their families off to a running start with listening and spoken language early intervention.  When all goes well, many of these children can be fully mainstreamed from preschool and have no need for further therapy.  That’s the ideal.  It happens for many children, but not all.  What about children who are identified as toddlers, or implanted late, or have other complicating factors that lead to slower than expected speech and language progress?  What happens when little kids become big kids who still need intervention?


In The Catch-Up Game, I wrote about general techniques and considerations for planning intervention for children who receive cochlear implants late.  Here are some more specific activities that parents and professionals can use once children have outgrown the infant/toddler/preschooler stage but still need listening and spoken language support.


Don’t stop reading out loud.  I think we tend to assume that once a child becomes a fluent reader, there’s no further need to spend time together reading aloud.  This couldn’t be further from the truth for all children, but especially for those with hearing loss.  Reading aloud together has many, many benefits:

  • It builds the Auditory Feedback Loop.  The auditory feedback loop is what we all use to listen to ourselves as we speak and then hear, monitor, and change our own productions as needed (Ever caught yourself saying the wrong word and then backing up and changing your sentence?  You just used the AFL).  AFL weaknesses can occur in children with hearing loss, especially those who do not have access to sound from infancy or who have other language-learning issues.  As the child reads aloud with an adult, they can work together to make sure the child’s speech matches the text on the page, providing an “external AFL” (the parent and the text) as a triple-check.

  • It allows parents and professionals to monitor the child’s articulation in connected speech.  The child may be producing /s/ well at the word level, but does it fall apart when reading longer sentences or paragraphs?

  • Taking turns reading aloud with an adult can help expose the child to age-appropriate material that she may not be able to handle independently yet.  If the class is reading Christopher Paul Curtis’s The Watsons Go to Birmingham – 1963, but your child’s skills fall 1-2 years below grade level, tackling this book alone could mean disaster.  Co-reading it together can help you wade through new vocabulary, concepts, and reading comprehension strategies together.

  • Reading aloud with an adult for some scaffolding and support gives the child access to the same books her peers are reading.  This is important not only for academics, but for socialization!

  • Reading alone silently gives a struggling reader lots of leeway to skip over unfamiliar words, confusing grammatical constructions, or difficult paragraphs without any kind of external checks.  He may be able to get the main idea from a sentence by piecing together key words, but would he be able to use that same syntactical structure in his own spoken language?  The child might have turned every page in the book, but did he really read and understand it?

  • Reading aloud is great for expanding vocabulary.   It’s tempting to think that once a child has all of the vocabulary he or she needs to get through a regular day, our job is done.  (After all, you probably worked so, so hard for those words!)  However, vocabulary is a historically weak area for children with hearing loss, most likely due to their limited ability to overhear and learn words incidentally compared to their hearing peers.  Books can expose your child to words she would never come across in the course of a normal day, and reading aloud gives you a chance to catch and capitalize on these word-learning opportunities.

  • It’s a great bonding experience, and it gives you and your tween/teen a chance to share your thoughts and discuss your opinions together.


Make it functional… give tweens and teens a “why?”  Tweens and teens who still need therapy have probably been “in treatment” for years by this point.  Can you blame them for thinking it’s boring or being resistant?  It’s actually a pretty natural (and healthy) developmental response.  That doesn’t mean, however, that we just quit working toward age-appropriate speech, language, and listening goals.  Instead, we have to get creative (even more so than usual).  We have to give tweens and teens a “why?”, a reason for participating in therapy.  Why am I doing this?  How is it helping me?  How does it relate to my life in the “real world”?  We need to embed targets in activities that are both functional and fun.

  • Make your teen the designated caller.  If a phone call needs to be made in the house, have him do it!  It’s a great way to work on auditory skills as well as conversational pragmatics (social language).

  • Recipes, building projects, and do-it-yourself kits are a fantastic way to stretch vocabulary and build teens’ ability to follow complex, multi-step directions.  They also build important life skills for independent living, and you get a great product at the end.  It’s a win all around.

  • Get out of the therapy room.  Go to the mall, plan a budget, and ask salespeople for advice.  Go to a restaurant, order something new, and have a conversation in a crowded room.  Go apply for a part time job, fill out the application, and have an interview with a potential employer.


Let tweens and teens take charge of their own goals.  At this point, they’re not babies anymore, and it’s a lot harder to “trick” a teen into working with a fun activity than it is with a preschooler.  Don’t fight this drive for independence — capitalize on it!

  • Let teens in on the “behind the scenes” of their own assessments and scores.  Let them know which strengths and weaknesses have been identified.  Some may think they are “doing just fine.”  Gently help point out to them where they’re missing the mark.

  • Ask the tween/teen to self-assess.  What areas of communication are hardest for you?  In which areas do you excel?  This can serve two purposes:  First, it gives adults an idea of how realistic the child is about his own abilities.  Second, it can help you work collaboratively with the child to work on mutually-identified areas of need.

  • Have the big kid pick their own goals.  Your assessments may have identified ten different areas for remediation, but an older child is highly unlikely to commit to the practice and follow-through needed to make progress if she’s not also motivated to improve in that area.  I would much rather work on the three goals the teen feels would have the greatest immediate impact on her communication if it means I’m working with, not against, her.

  • Don’t shield teens from the consequences of their own decisions.  If a teen decides not continue improving his speech, language, and listening skills, the social and academic ramifications will soon be enough to convince him that it’s time for a change in direction.

  • Tweens and teens are old enough to take their own data on their performance.  Ask questions like, “Which sentence did you think was written the best?” or, “How well do you think that cashier was able to understand you?  Why do you think that?” or, “On a scale of one to ten, how well do you think you did in therapy today?”  This build self-monitoring skills, the auditory feedback loop, and internal motivation.


Board games.  Language-based board games are an excellent way to work on both social language and more complex syntactical (sentence structure) skills.  A few of my favorites include: Catchphrase, Taboo, Scattergories, Apples to Apples, Balderdash, and Last Word, but really, any game your tween or teen enjoys will do.  It’s our job as the adult to find ways to weave language and listening goals into the experience.  For example, it’s one thing to know how to play a game, but another task entirely to explain to a friend how to play it.  Use these interactions to build social skills as well as higher-level language goals.


Low level goals + big kids = now what?  What if you have a child who is older (let’s say nine years and up), but is still really, really struggling with some more basic speech, language, and listening skills.  What then?  You can’t just pull out your baby games and Learning to Listen toys and expect things to go well.  For these children, I like to use developmentally complex activities (like those mentioned above), with language goals cut down to their level.  It’s important to keep this balance in mind.  No one likes being patronized, especially not tweens and teens!


Prioritize your goals.  For a child who got a very late start, or who has many other complicating conditions, it might not be realistic to expect age-level skills and that “I can’t believe he’s deaf” outcome.  And that’s okay.  We have to work smart and decide which interventions and goals are going to lead to the biggest change in this child’s life.  Which skills will help him the most in the long run for academic and vocational success?  If I have to make these kinds of difficult decisions, my rough hierarchy is this:

auditory comprehension + language content > language form + overall intelligibility > specific phoneme articulation

Meaning that Goal #1 is that the child will understand what others say and have the vocabulary to communicate back his own message, even if it is not grammatically perfect, Goal #2 is to polish up that grammar and make the child’s spoken language intelligible (not perfect, but understandable), and Goal #3 is the icing on the cake: polishing up that speech.


Do you have an older child, tween, or teen who is in need of support from an Auditory Verbal Therapist?  No matter where you live in the world, I can help you via teletherapy.  Contact me and let’s make a plan for success!

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