If a hearing aid, cochlear implant, or Baha has good batteries, then it should be working, right? Not so fast. The Ling Six Sound Check is a simple tool we use to ensure that hearing devices are working and giving the listener access to the sounds of speech. Six sounds, okay… what could be complicated about that? Let’s break it down and look at the science behind this simple check that carries a whole lot of weight.
Dr. Daniel Ling was a famous speech scientist and Auditory Verbal Therapist. His writings about speech acoustics and teaching speech to children with hearing loss form the foundation of much of today’s auditory verbal practice. The Ling Six Sound Check was his invention, and so today, we continue to name this technique in his honor. You can read more about Dr. Ling’s legacy HERE.
Why is the Ling Six Sound Check important? Isn’t it enough that the child wears the hearing aids? Is it enough to say the sounds to myself while I listen to the hearing device using a stethoset (listening tube)?
Though it might seem like it’s enough to check that the hearing device has a working battery and sounds good to you though a stethoset, this tells us nothing about how the child’s brain is using that sound. Without the Ling Six Sound Check, those hearing devices are just some very, very expensive earrings. A young child cannot tell us, “Hey, Mom, my hearing aid is not working today!” The child’s hearing device may be malfunctioning or need a new map, or the child’s hearing may have changed (for example, a progressive hearing loss), but until the child is a reliable reporter, we have no way to know this without checking ourselves. Make sure all of the great language input you are giving your child each day isn’t going to waste — check those devices!
What are the “Six Sounds”?
The six Ling Sounds are: ah, oo, ee, m, sh, s (or, in the International Phonetic Alphabet /a, u, i, m, ∫, s/).
Why do you use these particular sounds?
The Ling Six Sounds span the length of the speech banana. They cover low- to high-frequency speech sounds. If a person can respond to all of these sounds, we can estimate that they have access to all of the sounds of speech. Note that some sounds seem to show up twice on the audiogram below. This is because the sounds we hear are made up of formants, different bands of energy that combine to make one sound, like the chords on a piano. You can read a more detailed explanation of formants HERE.
Why do some people use more than six sounds in the Sound Check?
Some people add additional high-frequency sounds, like /f, Θ/ (“f” and voiceless “th” as in “think”), to see if the listening can hear very high-pitched sounds. Others add plosives like /p, t/ to check hearing abilities for very quiet sounds. Some add a “silent” trial (pausing between presenting the sounds) to make sure the listener is not guessing and can respond to the absence of sound by reporting, “No sound!” or, “I don’t hear anything.”
How often should I do the Ling Six Sound Check?
Frequently! You should perform a Ling Six Sound check every time the hearing devices are put in — in the morning, when they’re replaced after a nap, etc. If you don’t check the devices, then you cannot be sure that the child is hearing all of the language around them, and this is crucial for learning!
Can I use an app to do the Ling Six Sound Check?
I recommend against using apps in general, including for the Ling Six Sound Check. Why? A few reasons: Our brains process recorded/electronic speech differently than live voice. Apps generally have the child touch a picture corresponding to the sound they hear, and then tell them right/wrong. This tells us nothing about the child’s ability to imitate the sound (more on why this is important below), and encourages guessing. With an app, we can’t make changes to test in distance or noise (again, more on why this is important below). Ultimately, we learn to listen so we can speak to other human beings, not press buttons on a device. Your voice is your most powerful tool to help your child, not your phone.
For what ages is the Ling Six Sound Check appropriate?
The Ling Six Sound Check is for everyone! Though the methods we use to conduct the Check will vary based on age and developmental level (see more on that below), you are never too young to be hearing well, and you’re never old enough to be “past” the Ling Six Sound Check. Hearing optimally is for everyone!
How do I do the Ling Six Sound Check for children at different ages or listening skills levels?
For all levels, it’s important to make sure that the child is responding to the sounds received through listening, not looking. Children are smart, so make sure you’re really, really out of eyesight and that other people in the room are not giving any kind of gestural cues or facial expressions to indicate that they’ve heard a sound.
For very young children, it helps to begin with a toy associated with each Ling Six Sound to keep it fun and exciting, as well as build important sound-object associations. The toys used vary from therapist to therapist and country to country, but the most common ones are: ah = airplane, oo = train (or ghost), ee = mouse (or spider), m = ice cream cone (or some other food), sh = baby, s = snake. At the most basic level, we are looking for a behavioral response to the sounds. Start very close to your child in a loud conversational voice level (not shouting — that will distort the sound — just a nice, loud, clear voice). Make the sound and see if your child shows some sort of behavioral indication that he has heard it. This could be anything from changing his sucking pattern if he’s sucking on his fingers, or blinking his eyes, looking around to locate the source of the sound, etc. We want to reward and praise this behavior by pointing to our own ears and indicating, “Yes! You heard that. It was aaaah — the airplane!” and showing the associated toy. It’s important to always pair the real word with the sound once the child has indicated that he hears the sound. Of course, we want to see that the hears “ah,” but long term, we don’t want him going to kindergarten calling an airplane an “ah.”
From there, we can work up. Can the child put a block in the bucket when he hears a sound (conditioned play)? Can he choose from a set of the toys on the table which one he hears? Can he repeat the sounds? Can he respond to the sounds over greater distances (three feet? six? twelve?), or with background noise?
What can we determine about a child’s hearing based on their responses to the Ling Six Sound Check?
If the child responds to all Ling Six Sounds, we can be reasonably sure that he has access to the sounds of speech at conversational levels. If the child is missing some sound, that can also tell us about his hearing. For example, missing “s” or “sh” tells us that there is a problem with high-frequency hearing. If a child confuses sounds, this also gives us good information. For example, “m” and “oo” share some formant information. If a child is confusing those two low-frequency sounds, it’s time to head to the audiologist for a new map. Likewise, if a child is imitating the sounds and says “ee” for “s,” that tells us his current hearing technology is not giving him enough high-frequency access. Based on information from the Ling Six Sound Check, we can tell if the child is hearing well with their current hearing technology, if their hearing loss may have changed and so we need to look into new technology (either reprogramming the hearing aids or considering cochlear implant candidacy), if the child’s devices need a new program or MAP, if a cold or middle ear fluid is affecting the child’s ability to hear, if the hearing devices may need a new battery or be broken, and more!
My child doesn’t want to participate in the Ling Six Sound Check. Help!
Children tend to go through phases with this, due to boredom with the task or just normal child behavior. Shake it up and keep it interesting! Maybe the child would like to throw a ball, or hop, or draw a circle, or put a sticker on a paper each time she hears a sound. Repeating the sounds is ideal, but if all you can get is a detection response (I do something to show I heard the sound), take it! Using other children or adults as a foil can also help (who can repeat the sound first?). You may have to change your approach each day until the child reaches the point where he’s able to just rattle off the sounds in imitation and get through the Check in 30 seconds each morning. Don’t give up! You’ll get there!
If my child hears speech well in conversation, do I still have to do the Ling Six Sound Check?
Yes! In conversation, we have context. The child might not hear /s/ well, but if he has good language and you say, “Put your dishes in the -ink,” he can fill in “sink” and follow that direction, so we would never know that his hearing device is not giving him full access to sound. Appearing to hear well in conversation is not enough, because our brains will fill in the blanks using context clues. Checking the sounds individually gets at the really fine hearing abilities that can be missed in conversation.
If my child is bilateral (wears a hearing device on each ear), what should I do? What if my child uses an FM system?
Ideally, we want to check the child’s responses with each part of their system separately. If we do the Ling Six Sound Check on a child who is bilateral with both devices on, one ear could be totally “off air” but the child may still be able to repeat all sounds using the other ear alone. Test each device alone if you can by having the child remove one, do the check, and then switch sides. Test again when the FM system has been attached. Very young children, or children who are antsy, may not sit still for all of this. Testing both ears together is better than testing nothing at all, so aim for ear-specific information, but do the Check in the bilateral condition if that’s the best you can get at the time.
If my child responds to all of the sounds of the Ling Six Sound Check, does that mean they can hear and understand everything?
No. The Ling Six Sound Check is a great estimate that the child can hear across the speech spectrum, but it doesn’t tell us everything about the child’s hearing. This becomes a problem when some people make the Ling Six Sound Check the be-all, end-all of speech perception. It’s a good, quick tool for daily checks, but detailed speech perception information (formal audiological tests that look at hearing in noise, discriminating between similar words, etc. are also needed).
Are there any cultural considerations or adaptations of the Ling Sounds in other languages?
Yes! In some cultures, the /s/ sound is used to teach children to go to the bathroom, so it’s not considered polite for use in therapy (you may want to substitute /f/, which is also a high-pitched, quiet sound). Other families may prefer a train over a ghost as the sound-object association for /u/ (“oo”) for religious reasons, or want to use a more familiar food than ice cream for /m/. Dr. Ling developed this Check based on the sounds of English. If the family speaks another language, they may have additional sounds they’d like to add in. Do a little research about the low-, mid-, and high-frequency sounds in their language, and adapt the Check as needed. Remember that the Ling Six Sound Check is a means to an end. Collaborate with the family to find sounds, methods, and toys that are culturally appropriate and work well for them.