Tag Archives: Therapy Tips

Give Me Five!

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You may already know how I feel about flashcards (spoiler alert: I hate them), but there is something to be said for repeated practice as a way to cement new skills. So how do we help children with hearing loss improve their articulation in a way that allows them enough opportunities to practice without resorting to drill-and-kill? Give me five!

Consider this scenario: A little girl with bilateral hearing aids is baking with her mother. One of the ingredients is cinnamon, which the little girl pronounces “cimmamon” (darn those trickily similar nasals /m/ and /n/ all mixed up in that multisyllabic word!).

STEP ONE: Catch and correct!

Once the adult communication partner (here, the mother) notices the child’s misarticulation, it’s time for a catch-and-correct. The adult can use strategies like the auditory feedback loop (“I heard you say cimmamon, but it’s cinnamon”) and acoustic highlighting (“Listen. The word is ciNNamon“) to help the child improve her production.

But that’s not enough! Modeling the word with acoustic highlighting helps the child lay down new “brain tracks” to build a correct internal model of how this word should sound, but it doesn’t give her an opportunity to practice the motor patterns necessary to produce the word correctly. So it’s time for step two…

STEP TWO: Give me five!

Now it’s time to move from perception to production. I like to build the child’s metacognitive skills and emphasize, in an age-appropriate way, that it’s all about the brain, by saying, “Let’s make sure your brain remembers that new word and say it a quick five times.” Then I hold up my fingers as the child practices saying the word correctly, 1… 2… 3… 4… 5!

The level of support necessary will vary by child and by word. Sometimes the child needs a model each time to practice the word. Sometimes we can provide a model for the first few attempts and then fade it out so the child produces the word independently. Sometimes the child is producing it correctly and independently from trial #1. If the child can get the word (with or without support), knock out a quick five to cement that motor pattern and auditory feedback loop and move on!

Two caveats to keep in mind:

No wrong practice! If the child is struggling to produce the word even with modeling and support, don’t have her practice it wrong five times. Dig deeper to find out where the breakdown is occurring and work on those prerequisite skills.

You know your child best. Sometimes they’re in the right mood for a catch-and-correct + give me five, sometimes they’re not. Don’t push it and make the communicative interaction unpleasant. Keep it light, fun, and focused on connection and success.

Moving forward, we’re going to take the information obtained from the child’s error (mistakes are such awesome learning opportunities!) and weave it into future activities for more practice, but the point of the catch-and-correct + give me five strategy is to help the child improve production, give a bit of practice to solidify the new skill, and move on.

ToM Part 2: Best Books for Theory of Mind

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In Part One of this series, I introduced the concept of Theory of Mind (ToM) and why children with hearing loss are at risk to struggle with this particular aspect of cognitive development. Now, let’s dive in to what we can do to help build ToM abilities in children who are deaf or hard of hearing. We’ll start with my favorite thing to do in Auditory Verbal Therapy — read a book! Continue reading →

Give Me a “WHY”

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So often in therapy, I feel that we (professionals) coach parents to use specific techniques (which is great!) and expect them to just do it because we said so (not so great!).  This is not to say that therapists are being authoritative, or pushy, or bad in any way, but I do think that we generally tend to assume that if we say it, parents will do it — and the majority do.  But why?  Other than the rare parent who feels comfortable enough to challenge or question the professionals, I think parents take what we say at face value because there is an enormous power differential between parent and professional. 

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The PAW Strategy for Structuring Your Session

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Therapists (hopefully!) spend a lot of time carefully planning goals and activities for each Auditory Verbal Therapy session, but professional planning is not enough.  Parent coaching is the heart of AVT.  It is not enough for you, the professional, to know what’s going on.  Parents deserve this information, too!  Below, I’ll detail a strategy I came up with called “PAW” that can help you structure your sessions for maximum engagement.

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DO Try This At Home

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If you provide services to families in the home or via teletherapy, you have the advantage of helping them apply AV techniques to their natural environments in real time.  But that’s not always possible.  How can center-based clinicians or teachers make what they do with families “translate” once the families leave their clinic or school?  How can we make center-based services realistic for parents?

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Three Bears, Thirty Ways

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When I coach other professionals, I tell them to work smarter, not harder!  I like to pick just one book and make it work for ALL of the children I see in a week.  My schedule is filled with listeners of all different ages, developmental levels, and needs, but with some creative thinking, you can take a classic story like Goldilocks and the Three Bears and find a gold mine of goals inside.  Here are THIRTY ways to make the Three Bears work for (nearly) everyone on your caseload. 

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A Balanced Plate

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Nutritionists advise diners to think about building a “balanced plate” of proteins, carbohydrates, fruits, and vegetables for every meal.  Eating too much of one thing isn’t good for your health!  An Auditory Verbal session can be imagined in the same way.  Too much focus on one type of goal or activity doesn’t help children achieve the well-rounded communicative competence that we want them to have.  So, how do you build a balanced plate in an AV session?

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Choose Your Highlighter

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Acoustic highlighting is a key strategy in Auditory Verbal Therapy.  By changing the way that we present verbal information (for example, adding emphasis, repetition, or intonation), we can help children tune in to specific aspects of the signal, such as a new word or missed speech sound.  There are many different ways to acoustically highlight, but don’t fall into the trap of thinking they’re all equally good in every situation.  Just as you carefully choose colors to fill in a coloring page, be careful to choose the right highlighter for the job.   Learning that acoustic highlighting exists is just step one.  Here are some thoughts on how to take your highlighting skills to the next level!

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It’s All About Listening/ It’s Not All About Listening

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In Auditory Verbal Therapy, we want children to learn to listen all the time, but we don’t want them to focus just on listening.  We focus on audition, but we don’t focus only on audition.  Listening is an important factor, but it’s not the only factor.  So which is it — is AVT all about listening, or not? 

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Complex and Challenging Cases: WEBINAR RECORDING

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See below for a recording of my May 2016 presentation for Cochlear and the Royal Institute for Deaf and Blind Children/Renwick Centre “Complex and Challenging Cases” [CC]