Children With Hearing Loss

Elizabeth B. Cole, EdD, CCC-A, LSLS Cert. AVT, is the former Director of CREC Soundbridge in Connecticut and a former professor at McGill University in Montreal, and is now enjoying a very active semi-retirement.+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++Carol Flexer, PhD, CCC-A, LSLS Cert. AVT, received her doctorate in audiology from Kent State University in 1982. She was at The University of Akron for 25 years as a Distinguished Professor of Audiology. Dr. Flexer lectures and consults extensively nationally and internationally about pediatric audiology issues.

Preface
Acknowledgments

Part I. Audiological and Technological Foundations of Auditory Brain Development

Chapter 1. Neurological Foundations of Listening and Talking: We Hear with the Brain
Introduction
Begin Conversations with the Critical Question: What is the Family’s Desired Outcome?
Typical Infants: Listening and Language Development
Auditory Neural Development
New Context for the Word Deaf
Hearing Versus Listening
A Model of Hearing Loss: The Invisible Acoustic Filter Effect
Putting it all Together in a Counseling Narrative: Think About Hearing Loss as a Doorway Problem
Summary
Next Steps: What Will It Take to Optimize the Probability of Attaining a Listening and Spoken Language Outcome?

Chapter 2. The Audiovestibular System
The Nature of Sound
Unconscious Function
Signal Warning Function
Spoken Communication Function
Acoustics
Audibility Versus Intelligibility of Speech
The Ling 6-7 Sound Test: Acoustic Basis and Description
Audiovestibular Structures
Data Input Analogy
Outer and Middle Ear
Inner Ear to the Brain
The Vestibular System: The Sensory Organs of Balance

Chapter 3. Hearing and Hearing Loss in Infants and Children
Introduction
Classifications
Degree (Severity): Minimal to Profound
Timing: Congenital or Acquired
General Causes: Endogenous, Exogenous, or Multifactorial
Genetics, Syndromes, and Dysplasias
Connexin 26
Genetic Testing
Syndromes
Inner Ear Dysplasias
Medical Aspects of Hearing Loss
Conductive Pathologies and Hearing Loss
Sensorineural Pathologies and Hearing Loss
Mixed, Progressive, Functional, and Central Hearing Losses
Synergistic and Multifactorial Effects
Auditory Neuropathy Spectrum Disorder (ANSD)
Vestibular Issues
Summary

Chapter 4. Diagnosing Hearing Loss
Introduction
Newborn Hearing Screening and EHDI Programs
Test Equipment and Test Environment
Audiologic Diagnostic Assessment of Infants and Children
Test Protocols
Pediatric Behavioral Tests: BOA, VRA, CPA, Speech Perception Testing
Electrophysiologic Tests: OAE, ABR/ASSR, and Immittance
The Audiogram
Configuration (Pattern) of Thresholds on the Audiogram
Formulating a Differential Diagnosis
Sensory Deprivation
Ambiguity of Hearing Loss
Measuring Distance Hearing
Summary

Chapter 5. Hearing Aids, Cochlear Implants, and Remote Microphone (RM) Systems
Introduction
For Intervention, First Things First: Optimize Detection of the Complete Acoustic Spectrum
Listening and Learning Environments
Distance Hearing/Incidental Learning and S/N Ratio
ANSI/ASA S12.60-2010: Acoustical Guidelines for Classroom Noise and Reverberation
Talker and Listener Physical Positioning
Amplification for Infants and Children
Hearing Aids/Hearing Instruments
Bone-Anchored Implants for Children
Wireless Connectivity
Hearing Assistance Technologies (HATs) for Infants and Children: Personal-Worn RM and Sound-Field FM and IR (Classroom Amplification) Systems
Cochlear Implants
Auditory Brainstem Implant (ABI)
Measuring Efficacy of Fitting and Use of Technology
Equipment Efficacy for the School System
Conclusion

Part II. Developmental, Family-Focused Instruction for Listening and Spoken Language Enrichment

Chapter 6. Intervention Issues
Basic Premises
Differentiating Dimensions Among Intervention Programs
Challenges to the Process of Learning Spoken Language
Late to Full-Time Wearing of Appropriate Amplification or Cochlear Implant(s)
Disabilities in Addition to the Child’s Hearing Loss
Ongoing, Persistent Noise in the Child’s Learning Environment
Multilingual Environment
Educational Options for Children with Hearing Loss, Ages 3 to 6

Chapter 7. Auditory “Work”
Introduction
The Primacy of Audition
The Acoustics-Speech Connection
Intensity/Loudness
Frequency/Pitch
Duration
The Effect of Hearing Loss on the Reception of Speech
A Historical Look at the Use of Residual Hearing
The Concept of Listening Age
Auditory “Skills” and Auditory Processing Models
Theory of Mind and Executive Functions
How to Help a Child Learn to Listen in Ordinary, Everyday Ways
Two Examples of Auditory Teaching and Learning
Scene I: Tony
Scene II: Tamara
Targets for Auditory/Linguistic Learning
A Last Word

Chapter 8. Spoken Language Learning
Introduction
What’s Involved in “Talking”?
Intentionality/Speech Acts
Presuppositional Knowledge
Discourse/Conversational Conventions
Other Essential Rule Systems in English
How Does a Child Learn to Talk?
Relevance for Intervention Decisions
How Should Intervention Be Organized?

Chapter 9. Constructing Meaningful Communication
Introduction
The Affective Relationship
The Child’s Development of Interactional Abilities
Joint Reference, or Joint Attention
Turn-Taking Conventions
Signaling of Intention
Characteristics of Caregiver Talk
1. Content: What Gets Talked About?
2. Prosody: What Does Motherese Sound Like?
3. Semantics and Syntax: What About Complexity?
4. Repetition: Say It or Play It Again
5. Negotiation of Meaning: Huh?
6. Participation-Elicitors: Let’s (Keep) Talk(ing)
7. Responsiveness
Issues About Motherese
How Long Is Motherese Used?
Motherese: Why Do We Use It?
Motherese: Is It Immaterial or Facilitative?

Chapter 10. Interacting in Ways That Promote Listening and Talking
Introduction
The Emotional Impact of a Child’s Hearing Loss on the Family
Adult Learning
What Parents Need to Learn
Role of the LSL Practitioner
Components of Intervention for Babies and Young Children with Hearing Loss
When to Talk with Your Child and What to Talk About
A Framework for Maximizing Caregiver Effectiveness in Promoting Auditory/Linguistic Development in Children with Hearing Loss
Background and Rationale
Structure of the Framework
Getting a Representative Sample of Interacting
Discussing the Framework with Parents
Ways of Addressing Parent-Chosen Interactional Targets
Determining and Sequencing Targets Specific to the Child’s Development of Auditory, Language, and Speech Development
Relationship between Family and LSL Practitioner
Teaching Through Incidental and Embellished Interacting
Teaching Through Incidental Interacting
Embellishing an Incidental Interaction
Teaching Spoken Language Through Embellished Interacting
Teaching Listening (Audition) Through Embellished Interacting
Teaching Speech Through Embellished Interacting
Preplanned Parent Guidance Sessions or Auditory-Verbal Therapy/Instructional Sessions
Where Should the Auditory-Verbal Therapy (LSL)/Instructional Sessions Occur?
What Happens in an Auditory-Verbal Therapy/Instructional Session to Address Child Targets?
Components to Be Accomplished in a Typical Preplanned Session to Address Child Targets
Sample Preplanned Scenario
Substructure
About the Benefits and Limitations of Preplanned Teaching
What Does the Research Say?

Appendix 1: How to Grow Your Baby’s/Child’s Brain through Daily Routines
Appendix 2: Application and Instructions for the Ling 6-7 Sound Test
Appendix 3: Targets for Auditory/Verbal Learning
Appendix 4: Explanation for Items on the Framework
Appendix 5: Checklist for Evaluating Preschool Group Settings for Children With Hearing Loss Who Are Learning Spoken Language
Appendix 6: Selected Resources
Appendix 7: Description and Practice of Listening and Spoken Language Specialists: LSLS Cert. AVT and LSLS Cert. AVEd
Appendix 8: Principles of LSLS Practice
Appendix 9: Knowledge and Competencies Needed by Listening and Spoken Language Specialists (LSLSs)
Appendix 10: Listening and Spoken Language Domains Addressed in This Book

Glossary
References
Index