.....

Listen Learn and Talk

Another Cochlear Innovation

REF: Z60407 Hear now.And alwaysPAL/SECAM

All countries except parts of

the Americas and Asia Pacific

as specified below.

NTSC

The Americas (except

Argentina, Brazil, Uruguay and

Paraguay), Japan, Philippines,

South Korea and Taiwan.Listen Learn and Talk

Part Number: Z60407 ISS 2 August 2005 Second Edition

Copyright © 2005

Cochlear Limited

14 Mars Road

Lane Cove West NSW 2066

Previous edition copyrighted 2003

All rights reserved. No part of this book may be reprinted, transmitted, or reproduced in any

form or by any means, including photocopying, or used by any information storage and retrieval

system, without prior written permission by the copyright owner and publisher.

Printed in Australia

By SOS Printing Group

Alexandria NSW

ISBN 1-920804-07-2 Listen Learn and Talk i

Table of Contents

Introduction and Overview.................................................................................5

Introduction..........................................................................................................................................................................................7

Overview...............................................................................................................................................................................................9

Auditory Habilitation Theory ..........................................................................11

Principles of Learning to Listen...............................................................................................................................................13

Family Based Therapy..................................................................................................................................................................16

Assisting the Therapist ................................................................................................................................................................19

Strategies for Developing Listening Skills..........................................................................................................................20

Integrated Scales of Development .......................................................................................................................................31

Sounds of Speech.....................................................................................................................................................................43

Auditory Habilitation Practice.........................................................................45

Introduction

The Stages of Listening ...............................................................................................................................................................47

Listening Levels................................................................................................................................................................................49

Babies Babble....................................................................................................................................................................................55

The Journey Begins ..................................................................................................................................................................55

Parent Baby Bond.....................................................................................................................................................................56

A Quiet Environment.............................................................................................................................................................56

Sound Awareness.....................................................................................................................................................................57

Vocal Turn Taking ....................................................................................................................................................................57

Performatives ..............................................................................................................................................................................57

Simple Phrases............................................................................................................................................................................59

Auditory Stimulus/Response ..............................................................................................................................................60

Auditory Memory – Item Selection ...............................................................................................................................60

Extension Ideas for Babies...................................................................................................................................................63

Making a Drink ...........................................................................................................................................................................64

Book Share...................................................................................................................................................................................66

Reinforcing Performatives....................................................................................................................................................68

Fruit Salad......................................................................................................................................................................................70

Learning to Listen Sounds .........................................................................................................................................................72

Toddlers Talk....................................................................................................................................................................................73

Playtime..........................................................................................................................................................................................73

Auditory Memory – Simple Directions........................................................................................................................74

47.........................................................................................................................................................................................Listen Learn and Talk ii

Daily Routines.............................................................................................................................................................................75

Auditory Stimulus/Response ..............................................................................................................................................78

Listening at a Distance...........................................................................................................................................................78

Auditory Memory – Item Selection ...............................................................................................................................79

Book Share...................................................................................................................................................................................79

Extension Ideas for Toddlers .............................................................................................................................................81

Eating Breakfast ..........................................................................................................................................................................82

Stacking the Dishwasher.......................................................................................................................................................84

Making Muffins............................................................................................................................................................................86

Making a Father's Day Card ...............................................................................................................................................88

Children Chatter.............................................................................................................................................................................90

Expanding Language................................................................................................................................................................90

Little Helpers...............................................................................................................................................................................91

Playtime..........................................................................................................................................................................................91

Speech ............................................................................................................................................................................................92

Auditory Memory.....................................................................................................................................................................93

Auditory Sequencing ..............................................................................................................................................................95

Experiences Outside the Home ......................................................................................................................................95

Advanced Listening Skills......................................................................................................................................................95

Conversation...............................................................................................................................................................................97

Extension Ideas for Children..............................................................................................................................................99

Developing Auditory Memory.......................................................................................................................................100

In the Garden...........................................................................................................................................................................102

Guess Who? Game..............................................................................................................................................................104

Taped Story ..............................................................................................................................................................................106

Appendix............................................................................................................... 107

Scales of Development and Assessment Tools.........................................................................................................109

Auditory Perception (Listening) ....................................................................................................................................109

Language.....................................................................................................................................................................................109

Speech .........................................................................................................................................................................................112

Play.................................................................................................................................................................................................113

Basic Concepts........................................................................................................................................................................113

Glossary ............................................................................................................................................................................................114

Bibliography and Reference...................................................................................................................................................118Foreword

Listen Learn and Talk was developed as a resource, for children diagnosed with a hearing

impairment under 12 months of age who are part of an auditory habilitation program. A DVD

with three chapters, Babies Babble, Toddlers Talk and Children Chatter accompanies this book.

It covers the development of the child from birth until they are ready for school. The

information contained in Listen Learn and Talk is intended to complement a child's auditory

habilitation program and is by no means intended to replace such a program.

The book was written in a style to engage the parents or primary caregivers, as daily interaction

with their child is important for the development of spoken language. To improve readability the

generic term of 'she' is used to represent the child. Explanation of technical terms used in the

book is provided in the glossary. These terms are printed in gray-bold text. The intention is to

provide a user-friendly resource that has a practical approach to using a variety of strategies and

ideas for integrating listening into the child's everyday life.

Professionals will find it a valuable resource as it contains fundamental information, references,

practical examples and ideas for activities parents can do at home.

This resource would not have been possible without the dedication of Maggie Loaney, Lynne

Richards and Sylvia Romanik. Introduction & OverviewListen Learn and Talk Introduction and Overview

© Cochlear Ltd, 2005 Page 6

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© Cochlear Ltd, 2005 Page 7

Introduction

Developing spoken language through listening in a child with hearing impairment is an exciting

process for everyone involved. As a young child with hearing impairment learns to listen and talk

there is a great sense of anticipation for parents as they embark on the journey that leads to

communicative competence for their child.

Today, because of technological advances, the majority of children with hearing impairment have

the potential to access all of the sounds of spoken language through listening alone.

Improvements in hearing devices such as hearing aids and cochlear implants mean that babies

and children now have access to sounds as never before. However, it must be understood that

simply providing hearing devices does not mean the sounds will automatically be perceived or

interpreted. For this to happen, the child must learn to listen using these devices. By learning to

detect and interpret the sounds, the child's capacity for spoken language is maximized.

Developing spoken language through listening requires an ongoing commitment and dedication

by all involved. Parents/caregivers and families are the key players in their child's development. It

is the parents who are there to provide the wealth of spoken language interaction on a one-toone basis throughout the child's waking hours. As key players, they need to develop an

understanding of the different stages of listening, language, speech and cognition. They need to

learn how to develop listening skills through meaningful everyday interactions with their child.

Only if parents have a clear understanding of what is involved will they be on the right road for

the journey ahead. Parents are the driving force and motivators in their child's development of

spoken language.

In recent years, the recognition of the importance of early diagnosis has led to the introduction

of Newborn Infant Hearing Screening Programs in many countries throughout the world. The

advent of these programs has meant that babies are often diagnosed with a hearing loss within

the first few days of life. This, along with technological advances in devices, such as hearing aids

and cochlear implants, has enormous implications for effective auditory intervention and the

child's potential for developing spoken language. Reports from the second International

Conference on Newborn Infant Screening Diagnosis and Intervention at Lake Como, Italy, May

2002 indicated the significance of early diagnosis, the appropriate hearing device and the

immediate commencement of auditory learning. Stimulation of the auditory pathways as early as

possible is important to prevent atrophy of the auditory channel. If auditory learning begins in

the early crucial years, when the vast growth of development occurs, the child has the

opportunity to develop spoken language alongside her hearing peers.

Generally, when a child is diagnosed with hearing impairment, parents will seek a program to suit

their goals and needs. A family centered auditory habilitation program should focus primarily on

providing parents and extended family with skills, knowledge and confidence to provide the best

possible auditory language learning environment for their child through participation and

practice. Such a program should be based on ongoing diagnostic assessment of the child's

individualized needs. Parents learn about the different stages of listening, language, speech and

cognition. They also gain the skills and understanding to use appropriate spoken language in play

and daily routines. They learn to capitalize on the many opportunities for stimulating listening

and language learning that arise in natural interactions in the home. Parents should also be

provided with knowledge in the area of audiological management so that their child is optimally

fitted with appropriate hearing aids and/or a cochlear implant. Listen Learn and Talk Introduction and Overview

© Cochlear Ltd, 2005 Page 8

In the early stages, parents may feel they are drowning in a sea of information. They may be

overwhelmed with ideas and strategies but may be unable to process all of that information.

Very often, we hear a call for help from parents, "What do we do at home?"

The production of Listen Learn and Talk is an attempt to answer that cry for help. It is not

intended to take the place of an auditory habilitation program, but more to complement such a

program as a comprehensive resource of practical strategies.

Listen Learn and Talk is a guide that demonstrates specific strategies used to develop spoken

language through listening in babies diagnosed with hearing impairment in the first year of life. It

follows the stages of development from birth to school age.

Listen Learn and Talk focuses on the natural bond between parents and their children and

highlights what they do naturally. It is the intention of this package to be practical with a handson approach providing a variety of strategies and ideas on how to integrate listening into

everyday life. Listen Learn and Talk Introduction and Overview

© Cochlear Ltd, 2005 Page 9

Overview

Listen Learn and Talk consists of a book and a DVD. The book is divided into three sections as

outlined below:

Auditory Habilitation Theory

Principles of Learning to Listen

Family Based Therapy

Strategies for Developing Listening Skills

Integrated Scales of Development

• Sounds of Speech

Auditory Habilitation Practice

Introduction

The Stages of Listening

Listening Levels

Babies Babble

• Development of Spoken Language 0 to 15 months

• Extension Activities

Learning to Listen Sounds

Toddlers Talk

• Development of Spoken Language 16 to 30 months

• Extension Activities

Children Chatter

• Development of Spoken Language 31 months to school age

• Extension Activities

Appendix

• Scales of Development and Assessment Tools

• Glossary

• Bibliography and Reference Auditory Habilitation - TheoryListen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 12

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© Cochlear Ltd, 2005 Page 13

Principles of Learning to Listen

This section describes a number of important principles that should be followed during the

learning to listen process.

Early diagnosis and fitting of hearing aids and/or cochlear implant

The earlier your child is diagnosed and fitted with an appropriate device, the earlier language

learning through listening can begin. Digital hearing aids and cochlear implants can allow children

with hearing impairment to access all of the sounds of spoken language. Babies diagnosed and

fitted with hearing aids and/or a cochlear implant have the potential to develop age appropriate

language and speech, provided that they are in a stimulating language enriched environment

where learning through listening is the focus.

Ongoing audiological management is critical

The device should be appropriately and optimally fitted for the child's hearing loss. Her hearing

aids and/or cochlear implant system must be in excellent working order. Consistent use of the

devices is essential. They should be worn all day everyday, during all waking hours.

Audiologists and therapists can assist you to understand how the devices work, which will

enable you to troubleshoot any problems. Good audiological management involves learning

about well-fitted earmolds, keeping the ear canals clear and healthy, understanding audiograms

in relation to your child's hearing impairment, and having regular hearing tests and/or MAPping

sessions. Professionals have a responsibility to ensure that you are provided with as much

information as possible to develop these skills.

Parents and professionals are partners

In partnership with skilled professionals, you play a key role in the delivery of an auditory

habilitation program for your child. In an effective family based program, you should receive ongoing guidance and support from skilled professionals, and there should be an emphasis on your

important role in natural child-centered communication.

Ongoing diagnostic assessment

Therapy should include ongoing diagnostic assessment through observation and evaluation. After

the therapist assesses your child's development, an individual program should be carefully

designed, following the typical stages of development in listening, language, speech and cognition.

As your child progresses, it is important to set new goals. You will play a key role by giving the

therapist information about your child's development at home. The therapist can then work

with you to achieve the agreed goals. This ensures that the program is tailor-made for your

child. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 14

The development of listening is an ongoing process

Once your child has been appropriately fitted, she has the

ability to perceive sounds that can become meaningful.

Learning to listen involves following a sequence of

development, beginning with the detection of sounds and

culminating in the processing of complex language. (See

Integrated Scales of Development pp 31-42.) Even when

your child has learned to listen well, she will need listening

practice to maintain her listening skills.

Have high expectations specific to your child's potential

The key caregivers involved in your child's life should be committed to the auditory learning

program, believe that she will learn to listen and help to develop spoken language through

listening. You and other caregivers should have the opportunity to acquire the skills necessary to

achieve this.

Meaningful interaction is important

Your child's listening experiences should be appropriate to her age, ability and interests. The

sequence of auditory skills should be followed and incorporated into meaningful interactions in

daily life. As your child matures, it is important to change the toys, games and language

accordingly. In this way, the experiences will reflect her changing interests and ensure that the

skill level and complexity of language are increased.

Listening should be FUN

It is important that learning to listen is enjoyable and

meaningful. The more time your child is engaged in

listening, the greater the possibility for the development of

spoken language.

⎯ Judith Simser

⎯ Doreen Pollack Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 15

Spoken language must be clear, and well within your child's hearing range

In the beginning phases of learning to listen, good acoustic conditions are essential. Your child

needs a quiet listening environment. Any extraneous noise will be a distraction that will make

learning to listen harder, if not impossible.

There must be auditory input first

Your child should hear spoken words, phrases and sentences before any visual cues are given.

This is the most effective way of learning auditory patterns. Learning through listening is the

natural way to develop intelligible spoken language.

Many aspects of speech are not visible and are best taught through listening, for example,

suprasegmentals (pitch, duration and intensity) and voicing. When listening is used as the

primary input, your child has the best chance of developing a natural sounding voice with

appropriate rate, rhythm and intonation.

Integrating listening into daily activities

Listening should be integrated into all daily

activities and routines so that it becomes a way of

life. Listening should be part of everyday living,

not just confined to the clinical setting. Provide

every opportunity for your child to practice

listening and talking.

Communication attempts must be acknowledged and encouraged

From the very beginning when your baby interacts by cooing and babbling, acknowledge these

communication attempts verbally. Positive reinforcement will encourage her to communicate

further. This is vital for the development of spoken communication skills.

Set your child up for success

Set your child up for success by providing a sequenced progression of skills in the four areas of

listening, language, speech and cognition. Building on each skill area will provide a comprehensive

foundation on which your child can develop to her full potential.

⎯ Sylvia Romanik Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 16

Family Based Therapy

Why parents are necessary in the auditory habilitation

program.

i

As parents, you are the key figures in your child's life. When

your child is first diagnosed with hearing impairment you will

seek out or be referred to skilled professionals. You will find

these professional services invaluable in understanding and

dealing with the impact of hearing impairment. Professionals

will help you develop the skills you will need to foster your

child's spoken language through listening. Always remember

that you are the essential ingredient in the auditory

habilitation process.

One of the first questions parents usually ask a professional is if their baby will be able to talk.

With the advancements in hearing aid and cochlear implant technology, the answer is Yes, but.

Yes, the technology is available to provide clear access to all speech sounds, but the

development of clear, intelligible spoken language will only happen if a number of other factors

are in place. The most important factors are ongoing, high quality audiological management and

an understanding from you as a parent, that you play the key role in the process. If the goal for

your child is the development of spoken language, you will need to commit to a program of

auditory habilitation. There are many such programs around the world that families can access

to achieve this goal.

In an auditory habilitation program, there will be a partnership between you and the

professionals involved. Therapists will guide and support you and your family. They will provide

you with the skills you will need to develop your child's spoken language through listening within

the routines of daily living. If all family members develop these skills to interact appropriately,

then the benefits will be greater for your child. In turn, you will provide valuable feedback to the

therapists about your child's development at home.

Observing, participating and practicing

In an auditory habilitation program, parents and families observe, participate and practice the

skills and techniques outlined in the following points.

„ Developing skills in audiological management

From the very beginning, your child should wear her hearing device(s) during all waking

hours and the device should always be in excellent working order. Therapists can help you

understand how the device works, and how to troubleshoot any problems. You should

help your child to become independent in managing her own device(s) as early as possible.

i

Kretschmer and Kretschmer, 1978; Ling, 1990; Ross, 1990; Estabrooks, 1994 and 2001 Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 17

It is critical that molds be changed regularly as little ears grow and molds need to fit well for

maximum auditory input. The whistling feedback from ill-fitting molds is distracting and

inhibits the auditory signal. Also, the ear canal needs to be clear and healthy for optimal

listening. Work with professionals to ensure that your child is optimally aided and/or

MAPped at all times. It is important that you and your therapist provide feedback to the

audiologist about the sounds your child hears.

„ Capitalizing on the natural bond and interaction between parents and child

Language develops as a result of the natural interaction between parents and their baby.

The impact of hearing impairment should not inhibit the natural interaction with your child.

This natural, communicative bond is important and needs to be maintained.

„ Learning techniques and strategies to develop listening skills

During the habilitation program, you will learn how to use the multitude of opportunities

that occur naturally at home to develop spoken language through listening. Remember that

it is the techniques and strategies you use that are the key factors, and not the activities

themselves. The book and DVD in this package provide ideas on integrating listening into

play and daily routines.

„ Understanding the stages of language, speech and cognitive development

Knowledge of these stages will enable you to provide language and speech models that are

developmentally appropriate. It is important to be aware of the subsequent stages of

development for your child so you are ready to increase her progress ability and provide

exciting new challenges. Therapists should explain these stages and suggest ways to

promote ongoing progress. (See Integrated Scales of Development pp 31-42.)

„ Understanding the sequential stages of auditory development

Developing language through listening is a natural way to learn language. The hierarchy of

listening begins with the detection of sounds and achieves the ability to process complex

language. You will also learn the importance of using listening as the primary mode for

developing intelligible spoken language. (See Integrated Scales of Development pp 32-43,

The Stages of Listening pg 47 and Listening Levels pp 49-54.)

„ Understanding the importance of play

Play is very important for the development of spoken language and cognitive skills. As your

child develops physically and cognitively, she engages in play. Follow your child's lead by

giving language in context and talking about what she is doing. Model and expand your

child's utterances to enrich her language. Through play, she can learn about the world

outside her immediate environment. She can enter the world of imagination, fantasy and

story telling. Therapists will guide you in optimizing play situations to develop language

through listening. Resources can be adapted to provide interesting and age/stage Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 18

appropriate materials for play. It is not necessary to provide expensive commercial toys.

Language learning can occur through play with simple materials.

„ Providing experiences outside the home

It is important to provide experiences outside the home environment.

An effective way of developing your child's language and cognition is by providing a

multitude of experiences, in particular, hands on experiences. Visits to the zoo, the beach,

the mountains, a farm, a puppet show, the nursery, the hardware store, etc. will provide

stimulus for verbal interactions and language extension activities. Taking photos, creating

scrapbooks, re-enacting experiences and role-playing are some of the ways to reinforce

and extend the new language.

„ Acquiring the skills to record your child's progress

By recording your child's progress, you can assist the therapist in the setting of listening,

language, speech and cognition goals (both short and long term). This is necessary for the

therapy to be diagnostic. By actively participating in the goal setting, you will be better able

to reinforce these goals at home.

„ Developing appropriate behavior management techniques

Providing enjoyable activities will reinforce language learning. As your baby grows into a

toddler and a young child, she will continue to have fun if she knows the boundaries of

behavior. It is important to use the same rules and guidelines as with hearing children. A

child with hearing impairment is a child first and has to learn what is acceptable and what is

unacceptable behavior in the same way as other children. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 19

Assisting the Therapist

As well as observing, participating and learning, you will provide assistance to the therapist in

many different ways. Some of these are described below.

„ Informing the therapist of your child's interests and family events

Children love talking about their interests and about the activities of their various family

members. You know best what your child likes and what will capture her attention. By

providing this information to the therapist, the program can be tailor-made to meet

individual needs.

„ Helping the therapist interpret your child's early attempts at communication

In the early stages, you are the best person to understand your child's communication

attempts. Your input is invaluable and will enable the therapist to respond appropriately. By

being understood, your child is rewarded for her communication attempts. In this way, she

will be encouraged to communicate further.

„ Modeling for your child in therapy sessions

Parents can act as models when new language or new skills are introduced. Some examples

of these are stimulus/response listening tasks and role reversals to encourage vocalization.

Parents can also model the complexity of conversational skills such as turn taking, question

and answer, initiating/ending/changing a topic. It is essential that your child learns these skills

from the earliest possible age.

„ Reporting on your child's development at home

Sometimes in therapy, your child may not exhibit the extent of her language and cognitive

development. You can give the therapist valuable information about her development in

different areas, for example, new vocabulary, new language structures acquired (receptive

and expressive), emerging speech sounds, and generalization of listening skills.

„ Informing the therapist of any cultural issues particular to your situation

This information will further assist the therapist in tailoring the program to meet the needs

of the family, for example, the language relating to religion, cultural celebrations, social

activities, roles played by particular family members.

By taking an active role in therapy sessions, you can develop appropriate skills and

knowledge to provide a listening and language learning environment at home to maximize

your child's spoken language potential. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 20

Strategies for Developing Listening Skills

The strategies used to develop spoken language through listening are outlined below. These

strategies are demonstrated in the DVD under Babies Babble, Toddlers Talk and Children Chatter.

1. Ensure hearing aids/cochlear implants are worn all day everyday

If your child is to develop spoken language, it is vital that her hearing device(s) is in

excellent working order and is worn throughout the day. There will be certain times, for

example, bath time when the hearing aids or implant speech processor cannot be worn

but it is imperative that they are worn at all other waking moments. This maximizes the

opportunities for you to provide your child with language learning experiences through

listening.

2. Be close to the microphone of the hearing device when speaking

When your child starts to learn to listen, be close to the microphone when speaking so

that she receives the maximum auditory input. Being in your child's hearing range is

important as this provides the best access to speech sounds and sets her up for success.

As the speaker moves farther away from the listener, sound becomes much softer.

Learning to listen is much easier for your child if you are close to her microphone

(approximately 5 3/4 inches (15 centimeters) from the microphone). Use a normal voice

quality, with normal rate, rhythm and level of intensity. Speaking loudly or shouting does

not make the speech signal more audible but on the contrary can result in a loss of clarity.

At a later stage, learning to listen at increased distances from the speaker is a skill to be

developed. However, in the early stages, the speaker should be close to the microphone so

the speech signal is clear and audible.

3. Have a quiet environment

In the initial stages of listening, it is important to provide a quiet environment. If the

environment is noisy, your child will have great difficulty accessing sound. As she becomes a

good listener, listening in noise is a skill that she will develop. However, in the initial stages,

the speech signal must not be masked by background noise.

4. Use a singsong voice

Using a singsong voice is typical of the way that adults speak and naturally interact with very

young babies. This is particularly important for a child with hearing impairment who is

learning to listen. When a singsong voice is used, there are greater changes in the pitch,

duration and intensity (the suprasegmentals) in the spoken message, providing a wealth of

acoustic information. Highlighting these features will greatly assist in the development of

auditory awareness. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 21

Suprasegmentals convey meaning in sentences. For example, a speaker's surprise can be

understood from the intonation rather than the words used. As these features are not

visible but are highly audible, children with hearing impairment who develop spoken

language through listening alone will readily use appropriate intonation and will have natural

sounding voice quality.

5. Establish eye contact

Eye contact with your baby is extremely important. Eye contact connects you with your

baby, and accentuates the bond between you. By holding your baby close and looking

directly at her face, the baby is in a position to look back at your face. Eye contact is an

important part of spoken communication, as we acknowledge speakers by looking at them.

6. Establish joint attention

Successful communication requires each person to know how to initiate a topic, respect

the other person's choice of topic, maintain a topic, adapt to topic changes and close a

topic appropriately. There are a number of steps in the development of these skills. One of

the first steps is to establish joint attention. You can prepare your child to hold

conversations at a later stage by developing her ability to share attention with an adult

towards an object/activity/event while talking about it.

This can be done in a variety of ways:

• Use interesting objects and toys that capture your child's attention.

• Follow her lead.

• Show clearly when a game or activity is beginning and ending as this signals when to

establish attention and when there is to be a change of activity.

7. Talk about daily routines

In the early stages, your baby is reliant on you for every need, (eating, toileting, bathing,

dressing and communicating). Language is more meaningful when it centers on daily

routines. It is vital to use every opportunity throughout the day to talk about what is

happening when involved in these routines.

8. Develop turn taking

Oral communication involves taking turns at listening and talking. Vocal turn taking is a

prerequisite for spoken conversation. It starts at a very young age. To develop turn taking,

you should vocalize, then wait for your baby to vocalize. Repeat the baby's vocalization,

then add a different vocalization or add some appropriate language. By waiting, you are

signaling to your baby that it is her turn to talk. Children with hearing impairment need to

learn these pragmatic skills just like any other child. Vocal turn taking should be encouraged

from the very beginning. As your child begins to use phrases and sentences, continue to

develop turn taking skills as these are necessary for conversation. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 22

9. Have another person call baby by name

The parent-baby bond is a natural link that needs to be established in the beginning. Usually

a baby learns to listen first to the person with whom she is most involved. She will tune in

to her mother's voice first and make the connection that her mother or father is close by

when she hears that voice. The next step is for baby to learn to listen to other family

members who are significant in her life.

Calling your baby's name is one way of doing this. It is important not to vary the name in

any way at this stage so that, in time, when she hears her name, she will recognize it and

respond to it. By having another person call baby's name, a discrimination task and an

auditory identification task are being introduced into her listening. It is also an opportunity

to reinforce her ability to localize sound and to understand that there is another person

who will interact with her. This is a way of widening your baby's experience for listening,

responding and interacting.

10. Cue into listening

This cue into listening strategy is used to focus your child's attention and alert her to sound.

Cue your child into listening by pointing to your ear and saying animatedly, Listen or I heard

that. Did you hear that? In this way, your child will start to focus on listening and start to

understand where she is hearing sounds. With older children who are processing language

through listening, saying Listen with or without the accompanying gestures helps them

concentrate and cue into listening. Another strategy for older children is to ask them to

look at a specific item in front of them. This is an indication that they are to listen and that

there will not be any visual cues.

11. Have auditory input first

If the auditory pathways are not stimulated in the first few years, the ability to develop

them may be lost. This is why it is essential to commence sound stimulation at an early age.

Your baby needs to start learning to listen the moment the hearing device is fitted. Hearing

children learn language through hearing it, listening to it and imitating it. Your child can learn

in the same way, providing she has an appropriate hearing device and an intensive auditory

habilitation program that focuses on listening first and not vision.

The language input should be through listening first. When introducing something new, for

example, a new toy, the associated sounds or phrase should be said many times BEFORE

the toy is shown. If this is done animatedly, your baby's attention will be held. If the toy is

shown first, your baby will focus on the visual object rather than the sounds. Once the toy

is shown, the sounds can be repeated and other appropriate language can be added while

the baby is playing with the toy.

12. Use listening alone

There are a number of strategies that can be used to hide the mouth when the speaker is

talking. These strategies are used to focus your child on listening and not speech-reading. In Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 23

this way, the input is through listening alone. Once your child starts to process language

through listening, she will not seek visual cues, but until that time the following strategies

can be used:

• Focused attention

Introduce an interesting toy, book, activity or game, to focus your child's attention so

that she receives the language through listening alone without any visual cues.

• Strategic placement of toy, object or hand

Hold a toy, object or hand in front of your mouth in a natural way to ensure your child

receives auditory input alone. For example, hold a puppet in front of your mouth

during play. A hand cue is a useful strategy, particularly in stimulus/response activities. It

is important that the hand is used correctly so as not to mask the spoken message and

prevent the optimal auditory signal from reaching your child

ii

.

Parents and therapists become adept at using a variety of natural ways to ensure the child

receives the spoken message through listening alone.

13. Use acoustic highlighting

Acoustic highlighting involves making the key element of a sentence louder than the other

words around it in the sentence, for example, There is the car, brm brm. This strategy is

used more frequently in the early stages of the listening journey. As your child's listening

skills develop, this strategy will be used less frequently. However, it is still very useful when

introducing new vocabulary or a new language structure. For example, your child might be

having difficulty with the pronoun he. Acoustic highlighting can make it easier to hear, for

example, HE is going to the park. Once your child can hear and identify the word, it is

important to say the sentence with natural rhythm and intonation.

14. Alert to sound source or localize sound

From the very beginning, this strategy is important because it alerts your baby to sound

when she may not hear it for herself. The more this is done alongside developing listening

skills, the sooner your baby will develop the ability to hear sounds from different directions.

Turn your baby towards the source. Your baby will demonstrate that she can locate

sounds by eye gazing; eye movement; pointing; turning her head, etc. Be alert to these

clues, and reinforce this skill by confirming the sound source and naming it. It is important

to use every opportunity to make the association between a sound and what it represents,

for example, Look up in the sky. Look up. There's the airplane.

15. Have one person speaking at a time

One person speaking at a time is the basis of spoken conversation. Obviously in the adult

world, it does happen that people speak over each other. However, adults can cope with

ii

Estabrooks, 2001 Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 24

this and discriminate between different speakers' voices. For a young baby, listening to

more than one speaker at a time is a more sophisticated skill. Your baby should receive

input from one speaker at a time only so that the message is clear.

16. Use repetition

Most young children need to hear language repeated in a variety of contexts before they

process, comprehend and use it. Repetition is a natural strategy to use at the very

beginning of developing spoken language. Parents instinctively repeat information for their

babies. Children with hearing impairment need even more repetition.

You may need to say a new word or phrase fifty or more times in meaningful situations

and in different contexts before your baby comprehends it. Repeating the same sounds,

words or phrases close to the microphone of the hearing device will make the message

more accessible. It is important to vary the experiences so that the repetition does not

become tiresome. For example, if you want your child to learn to listen to phrases

associated with particular toys, say the phrases a number of times before she sees the toys.

The first time particular toys are introduced, they could be hidden under boxes. The next

time they could appear from behind cushions on the sofa. Another time they could appear

from out of the wash basket. You can maintain your child's interest by repeating the

language many times in different situations.

As your child becomes older, repetition can still be used as a technique if she does not

understand or hear the speaker the first time. However, it is an older child's responsibility

to listen and understand directions and instructions after hearing them once. If information

is constantly repeated, your child may learn the bad habit of not listening or processing the

first time something is said. When your child successfully processes after hearing something

once only, reinforce this with praise. In this way, she learns not to expect repetition.

17. Use phrases and simple sentences

It is important to use phrases or short simple sentences in the beginning, then move on to

complex sentences as your child's language develops. The basic language structure is a

sentence and it is important that this be the input from adults rather than single words. For

example, before your toddler takes the lid off a bottle say, take it off and not simply off.

There is sometimes a tendency to reduce the input to single words in the mistaken belief

that this will assist a child who is hearing impaired. Using a phrase or short simple sentence

rather than single words will make the message more accessible because there is more

acoustic information (suprasegmental features and co-articulation effects).

18. Use real names for objects

Your child needs to hear new words and phrases repeatedly before she internalizes them

and starts to use them. It is easier for her to learn the correct name right from the

beginning. Make sure you use real names of objects. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 25

19. Encourage vocalization

Some children may require prompting to vocalize. The following strategies can be used to

encourage vocalization.

Look at your child in an excited or eager way to signal it is her turn to talk. Use this in

conjunction with the waiting strategy (where an adult waits in an eager or excited way to

indicate that a vocal response is required). Move a toy only after your child vocalizes. This is

a great motivating strategy, and is particularly effective with pop up toys, hopping toys, etc.

If these are not available, vocalization can usually be encouraged by simply holding a toy

and expecting your child to vocalize before you move it. Model a response yourself and

have another adult or sibling move the toy to show what is expected.

Another way to encourage vocalization is with your hand. Place your hand in a "gentle

nurturing way" in front of your child's mouth

iii

This indicates that it is her turn to speak. This .

strategy can be used in stimulus/response activities as a way to discover exactly what your

child has heard. The hand can also be used as a prompt for turn taking and can set up an

expectation in your child's mind that she is a participant in the conversation.

20. Capture your child's attention

Your child will learn best in meaningful situations and when her attention is focused. She

will be more receptive to learning if you follow her lead and capture her attention.

It may be necessary to create situations to capture your child's attention. All children love

anticipating what is coming next, so try capturing her interest with objects hidden or only

partially visible. If playing with puppets, use funny voices when making them talk. Dressing in

a funny way, having something of interest on the wall, collecting broken or unusual objects,

or having something slip out of a book can all be effective in stimulating curiosity and

capturing attention.

Do not feel that you have to provide expensive equipment or the latest commercial toys.

Natural products and objects found around the house can be just as attractive to your

child. It is the way the toys are introduced and used that will engage your child, and result

in the most learning.

21. Use auditory stimulus/response activities

Auditory stimulus/response is a way of knowing exactly what sounds your baby can hear

across the frequency range of speech. The following sounds

iv

are used:

• vowels /ar/ /ee/ /oo/,

• fricatives /s/ /sh/ and

• nasal sounds /m/.

iii

Estabrooks, 2001

iv

Ling, 1976 Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 26

Auditory stimulus/response can be started at a very early age. To do this, ask your child to

hold an object to her ear and respond with an action when she has heard the sound, for

example, putting rings on a hoop, dropping plastic animals into a bucket of water. Say the

sounds using a clear voice close to the microphone of the device, ensuring that your child

does not feel the breath stream.

In the beginning, your child will not be expected to repeat the sounds, only to respond

with an action, to demonstrate that she has detected them. At a later stage, she will be

expected to repeat the sounds, demonstrating that she is able to discriminate between

them.

Vary the length of time between each sound stimulus so that your child does not get into a

routine, anticipating when the sound will occur rather than listening to it and processing it.

With a baby, you may need to help her hold the object to her ear and model the

response.

If your child can respond reliably to a stimulus, it will assist in the testing of hearing and the

fitting of hearing aids. It will also help when MAPping the speech processor of a cochlear

implant. Auditory stimulus/response is also useful to quickly check that your child's device is

working and to check listening at any time. If your child is not well, her listening may be

affected and this can be quickly assessed by comparing her responses at that time to her

typical responses.

At a later stage, use auditory stimulus/response activities to fine tune listening for more

difficult contrasts such as place contrast (pa/ta/ka) and also to highlight specific speech

sounds so that your child incorporates them into her repertoire of sounds produced.

As your child develops listening skills and expressive language, use the auditory

stimulus/response activities to give listening practice at greater distances from the speaker.

22. Have two adults model the auditory stimulus/response activity

When beginning auditory stimulus/response, your child may not know what is expected of

her and may be unable to detect sounds at this stage. Use two adults to model what is

required - one to provide the stimulus and one to respond. The person saying the sound

should not respond or your child will be confused about what is expected. The adult who

responds should point to her ear and say with an animated voice, I heard that. When your

child has a turn, the second adult should hold the ring or object up to the child's ear in the

waiting and listening pose.

23. Make it fun

This is a very important strategy. Children love to have fun. Every learning experience

should be enjoyable. When children are actively participating and enjoying themselves, the

most learning will occur. Children have a sense of wonder about their world. They love

anticipating, predicting and demonstrating. Your child will learn best if given the opportunity

to explore her world in this way. When her imagination is captured, she will take part in

and enjoy the learning experience. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 27

24. Provide positive reinforcement

Always give praise to encourage the action or verbal response to be repeated. Your child

may have waved in response to bye bye. She may have heard her name for the first time or

uttered her first word spontaneously. She may have used a plural correctly or followed a

three-element direction.

Rewards can be given in a variety of ways. An effective reward is verbal praise. It must be

immediate and direct. Showing your child pleasure immediately after the action/response

will encourage further responses. It is important that your child is in no doubt as to the

action/response that is wanted again. Verbal rewards have to be expressed in language that

she understands, for example, good listening after a specific listening task. For an older child,

positive reinforcement can be given for her spoken language. I heard that /s/ on the end of

cats. You said that really well.

It is better to praise the positive action or response than to continually point out what your

child is NOT doing. You and the therapist need to be skilful in eliciting the targeted

response through listening. By praising that response, your child will feel confident about

practicing it and producing it again in conversation. The verbal reward can be accompanied

by a physical one, for example, a pat on the back. Rewards in the form of gifts should be

limited. Children need to do things for self-motivation. They need to be pleased with

themselves for a job well done. To over-use gifts as a reward is not preparing your child to

live in the real world where self-motivation is usually the key to success.

25. Use pausing

This strategy is used to emphasize the language input. In the early stages, use a singsong

voice and talk in phrases or short simple sentences. Pause between phrases/sentences to

give your baby time to process before hearing it again. This strategy can also be used when

your child has acquired some listening skills. It can be used to emphasize the key part of a

more complex message or when introducing new vocabulary, a new concept or linguistic

structure. It will give your child time to process and understand the new piece of

information.

26. Use waiting

Waiting is a very useful strategy especially at the beginning of the language learning process.

When you speak to your young baby, wait before you speak again, giving her time to

respond vocally. As you wait, try using a slight turn of the head towards your child to

emphasize that you are waiting for a response. This can be accompanied by a raised

eyebrow, a smile or a comment such as mmm.

Together, these strategies lay the foundations for vocal turn taking. You speak, wait and

listen and when your child responds, you respond with appropriate language. This is the

basis of conversation and should be introduced at a very young age.

Sometimes parents of children with hearing impairment are anxious to feed in as much

language as possible and forget to give their child time to respond. Certainly in the Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 28

beginning, you do need to give a lot of language input, almost a running commentary on

what is happening in your child's world. However, this has to be punctuated with waiting,

so that your child can respond or she will never have the opportunity to learn to talk.

Talking is as important as listening. Children need many opportunities to practice both, so

they learn how to become competent communicators.

27. Model correct language

Modeling is one of the key natural strategies that you and other family members should use

throughout the language learning process. Modeling simply means using the correct

grammar and pronunciation when speaking to your child and repeating her utterances. It

means speaking clearly at all times, giving the appropriate language in context.

Modeling can also be used when a new skill is being learned. A therapist may ask you to

model a response, or you may do this with another family member. For example, if your

child is having difficulty with following a direction, the therapist may have you model what

has to be done. In this way, your child learns what is expected and so will be set up for

success when it is her turn.

28. Promote speech development

You should model correct speech at all times for your child. As her expressive language

develops from babbling to jargoning, to single and two-word utterances, her pronunciation

of words will not be accurate. Speech is a developmental process and different phonemes

emerge at different ages. This depends on your child gaining control, through practice, of

her speech organs, for example, tongue and lips. (See Integrated Scales of Development pp

31-42 and Sounds of Speech pg 43 for the order of acquisition.)

As your child's motor speech skills improve, her approximations will gradually develop until

words can be said correctly. To promote speech development, always give your child

correct models to imitate. Use the Listen strategy to cue her into listening for the correct

articulation before the word is repeated. Highlight specific sounds being omitted. Use

auditory bombardment of specific sounds in games if your child is having difficulty.

Incorporate emerging speech sounds in stimulus/response speech babble activities.

29. Expand and extend language

This strategy of expanding and extending language is used to foster the development of

language. This is done by introducing language that is slightly more complex than your

child's current expressive level.

In the early stages, phrases and short simple sentences should be used in a singsong voice.

Gradually as your baby starts to babble, you and others should repeat the babble and add

more so that she hears different combinations of phonemes. You should also comment

about what your baby is doing. As your baby continues to use more babble, continue to

use simple language to describe what she is doing but also use acoustic highlighting for key

words. Once your baby has started to use jargon and the occasional word, expand the Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 29

word into a phrase or sentence. For example, if your child points to a picture and says Ball,

expand with Yes, that is a ball. You might also extend by adding, You have a ball. Where is

your ball? It is a big ball. Remember to increase the complexity of the input as your child's

language develops.

30. Extend vocabulary

Your child will not learn to listen from overhearing conversation or by hearing information

from the TV or radio. She will only learn new vocabulary and structures by direct input

from you and other adults/siblings. There are many opportunities in all the daily routines to

provide vocabulary input, for example, categories: furniture - table/chair/sofa, desk/dresser;

quantities: pile/lots/bit/grain/slice/some; opposites: clean/dirty, big/small, up/down, inside/outside;

gender: cow/bull, duck/drake, male/female. It is important to introduce new words so that

your child's vocabulary increases at a constant rate. For example, if your child is able to use

the word big, the opportunity is there to extend her knowledge by starting to use

synonyms such as large/huge/enormous, etc. Once your child is a competent reader and

listener, she can acquire new vocabulary and structures on her own, but until that time, she

will depend on you and the rest of the family.

31. Use rephrasing

Rephrasing can be used when your child indicates that she does not understand the

language used. For example, you might say, Do you want the tiny bear? If your child does not

respond, rephrase by saying, for example, The tiny bear is the little bear. Do you want the tiny

bear?

32. Use questioning

Questioning is a common strategy used to check a child's understanding and encourage

vocal responses.

In the early stages of language development, children understand and use simple wh

questions such as What is that? and Where? They also use yes/no questions. Use the Where?

question to promote the use of prepositions, for example, on, in, behind that can be

incorporated into hiding games. The what is? question can be used to expand your child's

vocabulary as she asks for the names of objects.

It is important that you do not continually ask questions that only require a one-word

answer, for example, What is that? and yes/no questions. Questions such as What is that?

should only be asked in context when an answer is really required. It should not be used to

continually test your child.

As your child matures, you can use questions that are more complex so that she learns

how to reason, express ideas, feelings and concepts and develop the skills of problem

solving, predicting and understanding cause and effect, for example, Why? What do you think

will happen? What might happen if? What should he do?, etc. (See Integrated Scales of

Development pp 31-42 for the hierarchy of the development of question forms.) Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 30

33. Use auditory close

This is the strategy of starting a sentence and waiting for your child to finish it, for example,

Humpty Dumpty sat on the…; The moon shines at night and the sun shines in the…It is an

informal way of assessing your child's linguistic skills, concepts and listening ability.

34. Use a natural voice

In the early stages of learning to listen, use a singsong voice and acoustic highlighting with

your baby. As your child's listening skills develop, use a more natural voice with less

acoustic highlighting. Your child needs to hear a natural tone, with appropriate stress,

intonation, rate and rhythm if she is to develop natural sounding speech.

35. Give your child time to process

If your child does not follow a direction or respond verbally immediately, it is better to wait

rather than jump in to rephrase or repeat the information. Often your child will have heard

the message but needs time to process it. Repeat the information if there is no response

after a short delay.

36. Give a direction once through listening

As your child develops more listening skills, establish the expectation that the message will

be said once only. Your child will learn that it is her responsibility to listen and comprehend

the first time something is said. Use the waiting strategy and give your child time to process

the information. If your child does not respond after the message is said once, she needs to

ask for the information to be repeated.

37. Use clarifying

When your child is older, one of the best ways to find out if she has understood the

message is to ask What did you hear? This puts the responsibility on her to listen and

comprehend the information. If she does not understand or if she has not heard the

message, she should be taught the correct language to ask for clarification, for example, I

didn't hear that; Pardon?; Say it again please; What did you say? Would you repeat that please?

This strategy can highlight whether your child is having difficulty with the language or the

concept.

All these strategies can be used to facilitate the learning to listen process. The three chapters in

the DVD, Babies Babble, Toddlers Talk and Children Chatter, show parents and therapists using

these strategies in the home and clinical settings in order to develop spoken language through

listening. Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 31

Integrated Scales of Development

Language enables us to comprehend and express ideas, thoughts, opinions and emotions.

In the language learning process, understanding the language heard, that is, receptive language,

always precedes the development of expressive language. A young baby will turn when her

mother calls her, or wave goodbye when asked, long before she can say her own name or say

bye bye. As well as learning to understand and express language, the development of pragmatic

skills is necessary in order to use language appropriately in different social contexts and for

different purposes.

From birth to school age is a time of enormous development in a child's life. A baby grows from

a totally dependent being into a competent communicator and an independent thinker and

learner by the time she begins school.

The following tables are an integrated scale that outline typical stages of development in the

areas of listening, receptive and expressive language, speech, cognition and social

communication. They have been adapted from a number of sources:

• Cottage Acquisition Scales for Listening, Language and Speech

• Preschool Language Scale – 4 (PLS 4)

• The Bzoch-League Receptive-Expressive Emergent Language Scale Second Edition

(REEL - 2)

• The Early Learning Accomplishment Profile Kit (E-LAP)

• The Learning Accomplishment Profile Revised Edition Kit (LAP-R)

• The Rosetti Infant-Toddler Language Scale

• St. Gabriel's Curriculum

(For full reference and description, see Scales of Development and Assessment Tools pg 109-

113.)

A child with hearing impairment follows these stages of development. However, she will need

greater exposure to spoken language from the earliest possible time. Language, speech,

cognition and pragmatic skills should be developed concurrently through listening in a systematic

program that follows the typical stages of development.

It is important to remember that the skills listed on the following pages are based on an average.

There is a considerable range between the earliest and latest times children achieve the various

milestones. Your child may not reach a milestone within the given timeframe, but this does not

mean that they will not achieve it. These developmental scales are meant as a guide only. They

have been included to assist in the provision of a program to suit the individual needs of a

particular child. 0 to 3 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 32

Social

Communication

(Pragmatics)

Appears to listen to o

speaker

Has brief eye contact o

but by 3 months

regularly looks directly

at speaker's face,

localizes speaker with

eyes and starts to

watch mouth rather

than whole face

Smiles/coos in o

response, in particular

to mother/caregiver

Cognition

Awareness of familiar o

people/situations

Looks at objects/faces o

briefly

Anticipates certain o

events, e.g. being fed

Speech

Cries o

Begins vocalizing other o

than crying, e.g. coos,

gurgles

Expressive Language

Cries to express hunger o

and anger

Begins to vocalize to o

express pleasure

Occasionally vocalizes o

in response to voicelike sounds

Receptive Language

Startles to sudden o

noises

Responds to speaker's o

face

Responds to talking by o

quietening or smiling

Quietens with familiar o

voice

0 to 3 Months

Listening (Audition)

Auditory awareness o

Responds to sound by o

smiling, head turning,

stilling, startling

Responds to loud o

sounds

Recognizes mother's/ o

caregiver's voice 4 to 6 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 33

Social

Communication

(Pragmatics)

Maintains eye contact o

Loves games such as o

round and round the

garden

Produces different o

vocalizations for

different reasons

Imitates facial o

expressions

Takes the initiative in o

vocalizing and engages

adult in interaction

Starts to understand o

vocal turn taking, e.g.

vocalizes in response to

adult vocal input

Cognition

Looks at objects and o

reaches for them

Starts to learn about o

cause and effect, e.g.

plays with rattle

Recognizes familiar o

people

Brings objects to mouth o

Speech

Laughs o

Blows raspberries o

Coos o

Yells o

Starts to change o

duration, pitch and

intensity (prosodic

features)

Uses vowel [a] as in car o

Produces sounds with o

consonant features –

friction noises, nasal [m]

Plays at making sounds o

Expressive Language

Vocalizes for needs and o

wants

Vocalizes in response to o

singing

Blows raspberries, coos, o

yells

Vocalizes in response to o

speech

Starts to use a variety o

of vocalizations to

express pleasure and

displeasure

Vocalizes when alone o

or with others

Receptive Language

Frequently localizes o

sound source with head

or eye turn

Occasionally responds o

to own name

Discriminates between o

angry and friendly vocal

tones, e.g. cries in

response to an angry

voice

Usually stops crying in o

response to voice

4 to 6 Months

Listening (Audition)

Sound begins to have o

meaning

Listens more acutely o

Starts to associate o

meaning to sound, e.g.

responds to own name

occasionally

Responds to changes in o

inflections vocal

Starts to localize source o

of voice with accuracy

Listens to own voice o7 to 9 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 34

Social

Communication

(Pragmatics)

Begins to understand o

that communication is a

two-way process

Shows a desire to o

interact with people

Becomes more lively to o

familiar people

Demonstrates o

anticipation of activities

Nods, waves and claps o

Calls to get attention o

Requests by reaching o

and pointing

Enjoys frolic play o

Continues to develop o

turn taking skills

Begins book sharing by o

looking at pictures in a

book with adult

Cognition

Imitates physical action o

Recognizes familiar o

objects

Places object in one o

hand and then the

other

Holds one cube and o

takes another

Smiles at self in mirror o

Loves hiding and finding o

games

Gives, points, shows o

Pulls rings off peg o

Speech

Babbles CV CV [pa pa] o

[ba ba]

Clicks tongue o

Uses a "singsong" voice o

Imitates patterns of o

intonation

Uses low central vowels o

most frequently [o]

(hot) [ae] (bat) [a] (car)

Uses some consonants o

[p, b, m, d]

Expressive Language

in CV syllables Repeats o

babble [pa pa]

Starts to respond with o

vocalizations when

called by name

Plays more games, e.g. o

pat a cake, peek a boo,

hand clapping, etc. and

vocalizes during games

Appears to "sing" o

Vocalizes to greet a o

familiar adult

Calls to get attention o

Uses some gestures o

and language

appropriately, e.g.

shakes head for "ho"

Vocalizes loudly o

Receptive Language

Appears to recognize o

names of family

members in connected

speech, even when

person named is not in

sight

Responds with o

appropriate arm

gestures to such words

as up, high, bye bye, etc.

Enjoys music or singing o

Appears to listen to o

whole conversation

between others

Regularly stops activity o

when name is called

Appears to recognize o

the names of a few

common objects by

localizing them when

they are named

More regularly stops o

activity in response to

"no"

Will sustain interest up o

to a minute while

looking at pictures or

books with adult

7 to 9 Months

Listening (Audition)

Localizes sound source o

with accuracy

Discriminates o

suprasegmental aspects

of duration, pitch and

intensity

Has longer attention o

span

Associates meaning to o

words

Discriminates vowel o

and syllable content 10 to 12 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 35

Social

Communication

(Pragmatics)

Starts to understand o

question and answer,

e.g. shakes head

appropriately for "no"

Understanding of o

interaction continues to

develop

Understands greetings o

Turn taking skills o

continue to develop

Vocalizes in response to o

mother's call

Indicates desire to o

change activities

Responds to laughter o

by repeating action

Begins directing others o

by tugging, pushing

Vocalizes with gesture o

to protest

Enjoys games and o

initiates them

Cognition

Resists when toy is o

taken away

Relates an action to an o

object, e.g. spoon with

stirring, car with pushing

Responds to laughter o

by repeating action

Takes peg from peg o

board

Matches two identical o

objects

Attempts to build a o

two block tower

Speech

Imitates sounds and o

number of syllables

used by others

Uses suprasegmental o

features

Uses longer strings of o

repeated syllables

Vowels and consonants o

are systematically varied

[ba di ba di]

plosives Mostly uses o

and nasals [p, b, d, m]

Expressive Language

Uses jargon of 4 or o

more syllables - short

sentence-like structures

without true words

Starts to use varied o

jargon patterns with

adult intonation

patterns when playing

alone

Initiates speech gesture o

games such as round

and round the garden

Talks to toys/objects o

using longer verbal

patterns

Frequently responds to o

songs or rhymes by

vocalizing

Imitates action paired o

with sound

May use first words, e.g. o

mama , bye bye

Receptive Language

Appears to enjoy o

listening to new words

Generally able to listen o

to speech without

being distracted by

other competing

sounds

Occasionally gives toys o

and objects to adult on

verbal request

Occasionally follows o

simple commands, e.g.

Put that down .

Responds to music with o

body or hand

movement in

approximate time

Demonstrates o

understanding of verbal

requests with

appropriate head and

body gestures

Shows increased o

attention to speech

over prolonged periods

of time

10 to 12 Months

Listening (Audition)

Associates meaning to o

more words

Monitors own voice o

and voices of others

Localizes sound from a o

distance

Discriminates speaker's o

competing voice from

stimuli13 to 15 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 36

Social

Communication

(Pragmatics)

Continues to develop o

eye contact with

speaker for longer

periods

Takes turns as o

expressive language

develops

Plays fetching game o

Involves others by o

showing things, e.g.

shoes/clothing during

play

Begins to understand o

"wh" questions

Cognition

Sustains interest in o

desired object for two

minutes and more

Places circle in shape o

board

Builds a tower with two o

cubes

Begins to make marks o

on paper with thick

crayon

Imitates more actions, o

e.g. patting doll

Demonstrates o

functional use of

objects

Removes lid of box to o

find hidden toy

Speech

Imitates alternated o

vowels

Approximates single o

words

Uses most vowels in o

vocal play

Uses more front o

consonants plosives

[p, b, d], nasals [m, n]

Uses fricative [h] o

Uses semivowel [w] o

Expressive Language

Uses 7 or more words o

consistently

Uses voice and gesture o

to obtain desired object

Continues to use jargon o

with more true words

developing

Incorporates pausing o

and intonation into

jargon

Imitates new words o

spontaneously

Sings o

Receptive Language

Understands more new o

words each week

Follows one step o

directions during play

Understands simple o

where questions, e.g.

Where's daddy?

Recognizes and o

demonstrates

understanding of many

objects by pointing

Understands more o

familiar phrases

Begins to recognize o

names of various body

parts, e.g. eyes, hands

Enjoys rhymes o

13 to 15 Months

Listening (Audition)

Identifies more words o

Processes simple o

language

Auditory memory of o

one item at the end of

a phrase/sentence

Discriminates between o

familiar phrases

Follows one step o

directions that are

familiar 16 to 18 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 37

Social

Communication

(Pragmatics)

Requests object or help o

from adult by gesturing

and vocalizing

Initiates vocal o

interaction

Prefers to be with o

familiar people

Shows caution with o

strangers

Imitates other children o

Cognition

Imitates circular scribble o

Places 3 to 6 pegs in o

pegboard

Retrieves desired toy o

from behind an

obstacle

Picks up small objects o

Turns bottle upside o

down to obtain toy

Points to pictures in a o

book and begins to turn

pages

object Demonstrates o

permanence

Speech

Increases single word o

approximations

Most vowels present o

Still mainly producing o

front consonants

[p, b, d, m, n, h, w]

Expressive Language

Jargon disappears o

Increases vocabulary, 10 o

or more meaningful

words

Decreases use of o

gesture – relies on

talking to communicate

Imitates words heard o

Asks for more o

Receptive Language

Understands more o

simple questions

Begins to understand o

longer phrases with key

word in middle of

sentence

Develops category o

vocabulary

Identifies more body o

parts

Finds familiar object not o

in sight

Understands 50 or o

more words

Identifies some clothing o

items, toys and food

16 to 18 Months

Listening (Audition)

Discriminates between o

more phrases

Identifies and associates o

more words to related

objects, e.g. toys, body

parts, food, clothing

Imitates words heard o19 to 24 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 38

Social

Communication

(Pragmatics)

Begins to develop more o

self confidence and is

happy to be with other

people

Initiates pretend play o

Responds to requests o

from adults

Practices adult-like o

conversation about

familiar themes

Uses words to interact o

Requests information, o

What is this? e.g.

Develops turn taking in o

conversation

Cognition

Imitates symbolic play, o

e.g. household activities

Uses one object as o

symbol for another

Places triangle, circle, o

square in shape board

Imitates vertical strokes o

Threads three beads o

Begins to tear paper o

Imitates ordering of o

nesting cups

Begins to categorize o

objects in play

Uses two toys together o

Stacks blocks/builds o

tower

Completes simple pull o

out puzzle

Activates mechanical o

toy

Speech

Approximates words o

Substitutes /w/ for /r/ o

Uses suprasegmental o

features

Most vowels and o

present diphthongs

Consonants [k, g, t, ng] o

emerging

Consonants o

[p, b, m, h, n, d]

established – used in

initial position in words

Consonants often o

omitted in medial and

final position

Expressive Language

Occasionally imitates o

2 - 3 word phrases

Uses new words o

regularly

Increases expressive o

vocabulary to 30 words

or more

Attempts "stories" – o

longer utterances in

jargon to get message

across

Begins to use own o

name when talking

about self

Uses possessive o

pronouns – mine

May ask where o

Where car? questions

By 24 months may use o

2 - 3 word phrases with

nouns, some verbs and

some adjectives

Receptive Language

Completes two o

requests with one

object

Chooses two familiar o

objects

Comprehends action o

phrases

Points to a range of o

body parts, e.g. elbow,

cheek

Begins to understand o

personal pronouns –

my, mine, you

Recognizes new words o

daily

Increases o

comprehension -

syntax decodes simple

By 24 months o

understands 250 - 300

words

19 to 24 Months

Listening (Audition)

Auditory memory of 2 o

items

Discriminates songs o

Comprehends a variety o

of phrases

Discriminates o

descriptive phrases

Follows a two step o

Get your direction, e.g.

ball and throw it.

Identifies by category o25 to 30 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 39

Social

Communication

(Pragmatics)

Enjoys talking, e.g. o

pretends to have a

conversation on the

phone

Completes actions, e.g. o

Give me five

Begins to develop o

parallel play with other

children

Talks more in play o

Shares toys o

Asks for help using two o

or more words

Uses longer utterances o

Cognition

Continues symbolic o

play, e.g. talking on the

phone

Completes actions, e.g. o

clap hands and high 5s

Uses toys appropriately o

Performs related o

activities at play

Turns one page at a o

time

Imitates vertical, o

horizontal lines and

circle

Matches identical o

picture to picture and

shape to shape

Puts two parts of a o

whole together

Understands number o

concept of one and

two

Speech

Loves experimenting o

with prosodic features

Begins to use stress o

correctly

Repeats words and o

phrases

Consonants [f, y] o

emerging

Consonants, o

e.g. [m, p, b] used in

final position

Word/phrases o

medial shortened–

often consonants

omitted

Tends to over o

pronounce words

Different pronunciation o

of the same word

occurs frequently

Whispers o

Expressive Language

Uses 2 - 3 word o

phrases more

consistently

Uses some personal o

me, you pronouns, e.g.

Asks for help using two o

or more words, e.g.

wash hands

Begins to name primary o

colors

Refers to self by o

pronoun me

Repeats 2 numbers o

counting

Answers "wh" o

What's questions, e.g..

doing?, that?, What's …

Who?

Recites nursery rhymes o

and favorite songs

Understands and o

answers "can you". Uses

don't, no negation, e.g.

Receptive Language

Begins to understand o

complex language

Comprehends more o

complex action phrases

Understands functions, o

What do we use for e.g.

– points to cup drinking?

Begins to understand o

size differences, e.g.

big/little

Begins to understand o

prepositions, e.g. in, on,

under

Receptive vocabulary o

increases

Begins to understand o

concept of quantity, e.g.

one, all

Understands pronouns, o

e.g. he, she, they, we

25 to 30 Months

Listening (Audition)

Auditory memory of 2 o

items in different

linguistic contexts

Listens to familiar songs o

on tape

Comprehends longer o

utterances

Listens from a distance o31 to 36 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 40

Social

Communication

(Pragmatics)

Takes turns and shares o

Recites rhymes o

Acts out songs - o

sometimes changes

endings

Engages in make-believe o

activities

Begins to ask o

permission of others

Expresses feeling o

Initiates conversation o

Uses questions for a o

variety of reasons, e.g.

to obtain information,

to request

Cognition

Shares toys and takes o

turns more

appropriately

Develops parallel play o

Begins to develop o

interest in writing and

drawing

Begins fantasy play o

Matches six color cards o

Sorts and categorizes, o

e.g. blocks and pegs

Names object when o

part of it is shown in a

picture

Adds two missing body o

parts to a drawing

Shows interest in how o

and why things work

Completes 2 - 3 o

interlocking puzzle

pieces

Imitates drawing a cross o

Speech

Makes some o

substitutions [f] for [th],

[w] for [r]

Medial consonants still o

inconsistent

Final consonants o

inserted more regularly

Consonants o

[l, r, sh, s, z, ch]

emerging

Vowels and diphthongs o

established

Omits some unstressed o

parts of speech

Pronunciation becomes o

more correct

Whispers frequently o

Expressive Language

Knows gender o

vocabulary

Talks about what has o

drawn

Gives both first and last o

name when asked

Relates recent o

experiences

Converses in 3 - 4 o

word simple sentences

Begins using more o

complex language

Uses questions, e.g. o

who, what, where, why

Uses pronouns, e.g. he, o

she, they, we, you, me

Uses some plurals o

Uses possessives o

Uses more negatives, o

e.g. not, none, nobody

Begins to use o

and/because

Names three or more o

colors

Receptive Language

Understands most o

common verbs

Understands and o

responds to more

complex language and

commands

Carries out 2 - 3 verbal o

commands in one

sentence

Understands several o

prepositions, e.g. in, on

under

Expands concept o

development

Identifies parts of an o

object

Understands time o

concept, e.g. today,

yesterday, tomorrow

What is Understands o

missing?/Which one does

not belong?

31to 36 Months

Listening (Audition)

Continues to expand o

auditory memory - 3

item auditory memory

with different linguistic

features

Sequences 2 pieces of o

information in order

Listens to stories on o

tape

Follows 2 - 3 directions o37 to 42 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 41

Social

Communication

(Pragmatics)

Takes turns o

Plays with other o

children more

appropriately

Shows understanding of o

others' feelings/needs

Interacts through simple o

conversation

Initiates conversation o

Enjoys role-plays o

Cognition

Begins one-to-one o

correspondence

Follows directions using o

concepts, e.g empty,

full, same, different

Develops more difficult o

concepts, e.g. quality,

quantity, texture

Compares objects o

Begins simple problem o

solving

Develops imagination o

Speech

Uses some blends, e.g. o

[mp, pt, br, dr, gr, sm]

Consonants [j, v, th] o

emerging

Some substitutions still o

made, e.g. [gw] for [gr]

in blends

Pronunciations of o

words more stable

from one production to

the next

Expressive Language

Holds conversations o

using many correct

grammatical structures

(plurals, possession,

pronouns, prep, adj.)

Uses "when" and "how o

many" questions

Uses so/because o

Relays a message o

Describes what objects o

can be used for

Starts to answer "what o

if?" questions

What is Answers o

missing?

Identifies which one o

does not belong and

answers Why?

Attempts to answer o

problem-solving

What if? questions, e.g.

Uses about 500 o

intelligible words

Receptive Language

Can listen to a 10 - 15 o

minute story

Comprehends an o

increasing level of

complex language

Understands more o

difficult concepts, e.g.

quality, texture, quantity

Understands concept of o

day/night, e.g.

distinguishes day from

night activities

Follows directions using o

concepts of empty/full,

same/different

Understands locational o

prepositions, e.g. next

to

Begins to understand o

I am comparatives, e.g.

taller than you .

Understands about 900 o

words

37 to 42 Months

Listening (Audition)

Auditory memory o

increases to 5 items

Sequences 3 or more o

pieces of information in

order

Retells a short story o

Follows 3 directions o

Processes complex o

sentence structures

Tracks a 6 word o

sentence 43 to 48 Months

Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2005 Page 42

Social

Communication

(Pragmatics)

Increases confidence o

and self esteem

Requests made from o

others, e.g. shop/retail

assistant

Uses intonation o

appropriately

Initiates conversation o

Adapts to changes of o

topic

Uses language for o

different communicative

intent, e.g. obtaining

information, giving

information, expressing

needs/feelings,

bargaining

Cognition

Draws simple objects o

Understands time o

concepts, e.g. .today/

tomorrow/ yesterday/

morning/ afternoon/

night

Tells how many fingers o

and toes

Associates an object o

with an occupation, e.g.

thermometer/doctor

Continues to develop o

imagination

Concentration increases o

Copies simple picture o

line drawings

Matches patterns o

Makes inferences o

Speech

Reduces omissions and o

substitutions

Most consonants o

established

More blends emerging o

in initial and final

position

Rate and rhythm o

normal

Uses appropriate o

loudness level

Uses appropriate o

intonation

For accompanying o

chart, see Sounds of

Speech pg 43.

Expressive Language

Uses his/her/their o

More consistent use of o

plurals – irregular and

regular

Talks about pictures o

and story books

Uses more o

sophisticated

imaginative play

Uses negatives and o

some modals, e.g.

shouldn't/ won't/ can't

Uses comparisons o

Makes inferences o

Develops colloquial o

expressions

Uses How much? How? o

questions

Uses 800 - 1500 words o

Uses more complex o

language structures

Spontaneous utterances o

are mostly

grammatically correct

Receptive Language

Continues to expand o

vocabulary

comprehension

Understands o

singular/plural

Understands difference o

between past/present/

future

Answers final word o

analogies

Identifies objects o

missing from scene

Understands o

day/morning/

afternoon/night

Makes comparisons of o

speed/weight

Understands 1500 - o

2000 words

43 to 48 Months

Listening (Audition)

Processes longer and o

more complex language

Can you structures, e.g.

find something that lives

in a tree, has feathers

and a yellow crest?

Follows directions with o

more difficult concepts,

Put the thick blue e.g.

square behind the empty

jug.

Re-tells longer stories in o

detail - 5 or more

sentences

Tracks an 8 word o

sentence Listen Learn and Talk Auditory Habilitation Theory

© Cochlear Ltd, 2003 Page 43

Sounds of Speech

Sounds Age Acquired (Years)

1 2 3 4 5 6 7 8

vowels vowels

p popcorn p

m mommy m

h happy h

n no n

w water w

b baby b

k cake k

g go g

d daddy d

t tomato t

ng ring ng

f funny f

y yellow y

r rabbit r

l lion l

s sun s

ch cheese ch

sh shopping sh

z zebra z

j jack j

v velvet v

th think th

TH those TH

zh pleasure zh

* Typical average upper age limits of consonant production

Acknowledgement

Source: Estabrooks, W. (1998) Cochlear Implant for Kids, © 1998 Warren Estabrooks and The

Alexander Graham Bell Association of the Deaf. Inc. Reprinted by Permission.

*Auditory Habilitation - PracticeListen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 46

Left blank intentionally – reverse side of Auditory Habilitation Practice Title Page

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 47

Introduction

The captioned DVD Listen Learn and Talk follows the typical stages of child development in

listening, language, speech and cognition.

The aim of the DVD is to present parents and professionals with strategies that will enhance

spoken language development through listening. The DVD shows practical ways that you can

develop your child's language through listening in your own home. Segments from home and

clinical settings are included to show the need for a guidance program and follow-up at home.

When you insert the DVD into your DVD player, a screen will come up asking you to select the

language you want the DVD to play in. The default setting is English, but you can select French

or Spanish by using the "down" key on your remote control. Once you have selected the

language, the next screen will present you with three chapters to choose from (see below). Use

the "up" and "down" keys on your remote control to navigate between these chapters.

Note that an earlier version of this product used video rather than DVD. As the text has not

changed, people on the DVD will at times refer to “the video”.

Chapter one, Babies Babble shows how a baby develops from diagnosis of hearing impairment

to 15 months of age. It is a very important time for you as parents to bond with your baby.

After a diagnosis of hearing impairment, you may stop talking to your baby, thinking that she

cannot hear you speak. It is vital that this does not happen. Early verbal communication between

you and your baby should be established from the very beginning and continued throughout

your baby's development.

Babies Babble shows you how to establish communication strategies that are prerequisites for

conversation such as eye gaze and turn taking. Understanding the need to wear hearing devices

every waking moment and being close to the microphone of the hearing device when speaking

are key elements of this chapter. The singsong way of talking to your baby is also highlighted.

Chapter two, Toddlers Talk shows the development of the toddler from 16 to 30 months. It is a

time of exploding comprehension of language. As parents, you should provide clear, correct

language models. Your toddler is using her listening to understand more language and is

communicating her needs and wants. She moves from using jargon to single words and simple

phrases. Then to using two- or three- word utterances. The DVD follows four toddlers as their

parents develop their listening, language, speech and cognitive skills.

Chapter three, Children Chatter shows the development of the child from 31 months to being

ready for school. It is a time when children consolidate their receptive and expressive language.

They move from speaking in simple sentences to expressing themselves in complex grammatical

structures. Their speech becomes clearer. They can process more complex listening tasks, such

as listening with background noise. They are becoming listening, thinking and talking individuals. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 48

The Stages of Listening

The stages of listening that a child progresses through are outlined below:

Sound Awareness

Sound awareness is the first step in learning to listen. Your baby starts to detect sounds around

her. She may respond to your voice or to loud sounds in the environment. Observing your

baby's reaction (such as a smile or eye movement) is important to determine whether she is

starting to detect sounds. This skill is the foundation of the learning to listen process.

Associating Meaning to Sound

In this stage, your child begins to associate a sound with its related object and/or starts to

recognize familiar phrases. Sounds are now becoming meaningful.

The most auditorily available sounds are introduced, for example, the /ar/ for the airplane, the

/bu bu bu/ for the boat or blow, blow blow for the mobile. Again, observing your baby's

reaction is important to see if she is able to identify what she is hearing. For example, you may

say, Blow blow, blow the mobile and blow the mobile over the cot every time you pass it. After

many repetitions, your baby may look towards the mobile on hearing Blow blow. This means that

she has started to associate meaning to sound.

Imitation and Expansion

In this stage, your child imitates the language that is modeled. She continues to imitate even after

she has started to produce words and phrases spontaneously.

Auditory Comprehension

Auditory comprehension is the ability to process and recall the language that has been heard. It

involves long- and short-term memory and more complex auditory skills such as sequencing and

auditory association. Auditory comprehension must be developed if your child is to

communicate effectively through spoken language.

Advanced Listening Skills

As your child's ability to comprehend language through listening increases and she is able to do

more open set listening, more difficult listening activities can be incorporated. These are

listening from a distance, listening in background noise, listening to a taped signal with and

without background noise and holding a conversation on the telephone.

Sound

Awareness

Associating

Meaning to

Sound

Imitation and

Expansion

Auditory

Comprehension

Advanced

Listening

Skills

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 49

Listening Levels

The following listening levels may be useful for providing feedback to your therapist. They

provide a comprehensive checklist of the stages of listening that should be developed over the

years prior to school.

Listening (Levels 1-VIII)

9 accomplished, + emerging, – not developed

Level 1 Awareness of Sound

9 + –

• Responds to very low loud gross sounds, such as a drum, bell, or

clacker presented within a 3-foot (1 meter) radius at ear level.

• Responds to music with a strong beat, such as a lively march.

• Responds to loud inside environmental sounds when attention is

directed to the sound (blender, mixer, vacuum cleaner, TV, etc.).

• Responds to outside environmental sounds (car, airplane, fire

engine, ambulance, police car, birds singing, etc.) when attention is

directed to the sounds.

• Indicates when something is heard by pointing to the ear, nodding

head, vocalizing or smiling.

• Shows an awareness of music, inside/outside meaningful

environmental sounds or speech without attention being directed to

the sound.

• Notices the acoustic feedback produced when the earmold of the

hearing aid is partially out.

• Indicates when the hearing aid or cochlear implant is not working.

Level II Sound Has Meaning

9 + –

Responds to:

• Music by dancing, singing or clapping.

• Some simple speech sounds accompanied by gesture (Sh!, Byebye, No-no, or Come).

• Own name.

Associates:

• A specific sound with an object in the environment (I hear that;

that's Mother's car).

• A specific sound with a happening (That's Mother's car… Aha,

Mother's home! Time to eat.)

• Learning to Listen to Sound with a toy, object or happening. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 50

Level III Early Listening ↔ Talking Loop

9 + –

• Imitates gross body movements appropriate to his/her age level

(pat-a-cake, peek-a-boo, follow the leader, Simon says, etc.).

• Responds to music by clapping, dancing, swaying or singing.

• Vocalization increases when hearing aid or cochlear implant is on.

• Imitates laughing, crying, coughing or yelling.

• Imitates mother's vocal play (call to each other with stimulating

rhythmic and inflectional patterns).

• Tests the hearing aid or cochlear implant with voice when turned

on.

• Practices additional vocal play incorporating the vowel sounds ah,

oo and ee.

• Imitates mother's babble play, incorporating new

inflectional/rhythmic patterns.

• Approximates new words or short phrase beginning with the

babbled consonant practiced (mu, mu, mu; Mama, more; That's

mine! More milk, etc.).

• Imitates new babble sounds appropriate to listening age.

• Calls back and forth in calling games, such as Hide and Seek,

incorporating inflection patterns and vowel sounds.

Approximates:

• Temporal pattern of a short phrase.

• Temporal plus inflectional pattern of a short phrase.

• Temporal, inflectional, stress, and articulation of a short phrase.

• Imitates whispering.

Level IV Discrimination (continued)

9 + –

Responds to the presence or absence (on or off) of the following sounds

(first inside, then outside):

• Clackers, noisemakers.

• Music.

• Inside environmental sounds.

• Outside environmental sounds.

• Speech.

Discriminates:

• Loud and quiet sounds in above areas.

• High and low aspects of sound in above areas.

• Fast and slow sounds.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 51

Level IV Discrimination (continued)

9 + –

• A continuous or an abrupt sound.

• Angry or cheerful voice and responds appropriately.

• Daddy's and Mommy's voice.

• A man's, woman's or child's voice.

• Two gross sounds; later, 3 gross sounds (drum, bell whistle).

• Imitates the vowel sounds ah and oo; later, ah, oo, and ee.

• Imitates the consonant and vowel sounds associated with trucks,

cars, fire engines, planes, boats, motorcycles, etc.

• Recognizes own name from the most different family name on the

basis of the number of syllables, vowel and consonant differences.

• Detects the primary signal from other quiet background noise.

• Imitates a few familiar commands with natural gestures (close your

eyes, don't touch it).

• Discriminates familiar words on the basis of syllable length (1 vs 3

syllables, 1 vs 2 vs 3 syllables).

• Familiar words on the basis of vowel and consonant differences

(hat, shoe, coat), with the same number of syllables.

• Imitates a 2- to 3-word sequence.

• Imitates phrases on the basis of rhythmic structure and known

words ("up the slide", "in the car", "to the store").

• Imitates various short familiar sentence patterns (exclamatory,

statement, or question on the basis of inflectional and rhythmic

patterns).

• Between words containing different vowels but the same initial or

final consonant (bat, boat, bee).

• Imitates a 3- to 4-word sequence.

• Discriminates similar phrases or sentences (a big blue truck, a little

black car).

• Among rhyming words (shoe, blue, two).

• Important but minor differences in sentences (in/on, the/a,

he/she).

• Between classes of consonants in syllables (sha, ma, ta vs. see,

knee, bee).

• Within classes of consonants (pa, ta, or ka) (bu, du, gu).

• Remembers and approximates sentences of 7-10 words. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 52

Level V Localization Skills

9 + –

• Locates a sound presented at ear level within a 3-foot (1 meter)

radius in front or on either side, but not behind.

• Locates a sound presented at ear level within a 3-foot (1 meter)

radius behind them.

• Understands and verifies gross, environmental, music, or speech

sounds within 6 feet (2 meters), then 9 feet (3 meters), 12 feet

(4 meters), and finally, within the same room in all directions.

• Understands sounds that come from a specific location or

direction from another room.

• Understands sounds with a specific location or direction outside.

Level VI Distance and Directional Listening

9 + –

• Shows awareness of gross sounds in all directions at 3 feet (1

meter), 6 feet (2 meters) and 9 feet (3 meters).

• Discriminates between gross sounds in all directions in increasing

3-foot (1 meter) intervals.

• Discriminates other aspects of sound (high or low, loud or quiet,

fast or slow, etc.), in all directions at increasing 3-foot (1 meter)

intervals.

• Responds to own name from increasing distances in all directions.

• Responds to a few short, familiar commands at increasing

distances in all directions on the basis of rhythmic structure and

inflectional patterns.

• Discriminates among familiar words of varying syllable lengths at

increasing distances.

• Discriminates familiar vocabulary on the basis of vowel and

consonant differences (hat, coat, shoe) in all directions at

increasing distances.

Level VII Listening in Background Noise

9 + –

Recognizes the following with increasing distances in all directions with

added background noise:

• Own name.

• Familiar words (closed set → open set).

• Short, familiar, descriptive phrases.

• Short, familiar, descriptive sentences.

• Follows familiar, simple one-step commands.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 53

Level VII Listening in Background Noise

9 + –

• Follows more complicated 2-step and 3-step commands with

background noise (go outside; bring me the paper).

Level VIII Auditory Memory and Sequencing

9 + –

Short-term memory:

• Approximates 2- or 3-word phrase by echolalia (I want one).

• Chooses correct picture names from choice of 2, then 3, then 4,

then more (where is the doggie?).

• Selects 2 pictures or objects named correctly, but not necessarily

in order.

• Selects 2 pictures/objects named correctly, in correct sequence.

• Tells which object/picture of 3 is missing.

• Selects 3 pictures/objects correctly out of a choice of 5 or 6 in

sequence.

• Imitates a 4-word sequence (echolalia)

• Repeats random numbers out of sequence (1, 4, 3, 2).

• Imitates nonsense syllables.

• Selects 4 or 5 cards' names out of a choice of 8 or 9.

Approximates a 6- or 7-word sequence by:

• Breaking it into 2 natural phrases and repeating each one after a

model.

• Approximating the whole phrase.

Long-term memory span:

• Knows own first name, then last name.

• Knows names of other family members, including pets.

• Uses 2- or 3-word patterned sequence spontaneously. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 54

Level VIII Auditory Memory and Sequencing (continued)

9 + –

Knows names of the following important people, places and things:

• Family.

• Parts of the body.

• Clothes.

• Foods.

• Toys.

• Other things used.

• Rooms of the house.

• Basic furniture at home.

• Names of feelings (happy, sad, sick, tired, hungry, I like it, I don't

like it, I love it, etc.).

• Common descriptive adjective phrases (It's pretty! Oh, icky! That's

nice).

• Present progressive, tense of common verbs for the things she/he

does (is, am sleeping, eating, playing, working, etc.).

• Generates own 2-word sequence.

• Knows and supplies key words in favorite nursery rhymes or other

repetitive children's stories.

• Rote counts 1, 2… then 1, 2, 3… etc., always adding new

numbers.

• Generates own 3-or 4-word telegraphic language phrases or

sentence.

• Sings the Alphabet Song.

• Sings Happy Birthday.

• Sings seasonal songs or poems.

• Generates 3-, 4-, or 5-word sequence (may not use adult syntax).

• Tells age, address and/or telephone number.

• Knows mother's father's and siblings' names, siblings' ages and

names of parents' occupations.

• Describes past events with fair degree of accuracy and sequence.

Acknowledgement

Source: Estabrooks, W. (1998) Cochlear Implant for Kids, © 1998 Warren Estabrooks and The

Alexander Graham Bell Association of the Deaf. Inc. Reprinted by Permission.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 55

Babies Babble

This chapter is the first on the DVD, Listen Learn and Talk. It charts the development of babies

from diagnosis to 15 months in listening, language, speech, cognition and pragmatics. Segments

from home and clinical settings demonstrate strategies that can be used to develop listening and

talking. (See Strategies for Developing Listening Skills pp 20-30.)

Parents and professionals work in partnership, giving each other feedback on the baby's

progress. Since parents are with their babies most of the time at this young age, they will

naturally provide the key language input. The nature and quality of that input is critical. The oneto-one interaction between parent and baby is the focus of this chapter.

The Journey Begins

The journey begins from diagnosis and fitting of appropriate hearing aids. Depending on the

degree of hearing loss, your baby may be a candidate for a cochlear implant. Whether your baby

has hearing aids and/or a cochlear implant, the principles and strategies are the same. From the

very beginning, your baby should wear her hearing aids and/or cochlear implant every waking

hour for maximum sound stimulation.

It can be a challenging time for you when your baby learns how to reach up and take off the

hearing aids and/or cochlear implant. If you consistently put the devices back on immediately,

your baby will learn that she must keep them on. Place a toy or food in baby's hand to distract

her while you put the devices on. Another strategy is to engage your baby with interesting

activities and talk to her while she plays.

As your baby becomes more interested in her surroundings, she will focus on her toys and be

less likely to remove the hearing devices. Also, as she learns to listen, she will not want to

remove them, as they increasingly become her link to the world of sound.

If your baby continues to take out the devices, check that her ears are clear of wax and infection

and see your audiologist to ensure that your baby is aided and/or MAPped appropriately. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 56

Parent Baby Bond

The natural bond between you and your baby should not be interrupted by a diagnosis of

hearing impairment. All the things you do naturally such as establishing eye contact, beginning

turn taking and using 'motherese' (a singsong voice) should continue. Learning to listen can

begin as soon as the devices are fitted. It is a time to hold your baby close and speak in a normal

voice into the microphone of the hearing aid and/or cochlear implant.

Using a singsong voice, highlights the suprasegmental cues of pitch, duration and intensity,

making speech sounds more audible. Your baby will respond by looking at your face. This is the

beginning of eye contact, which is an important step in establishing communication. Talk to your

baby about immediate things in her environment and alert her to the sounds around her. She

may respond by cooing and gurgling. After constant input, your baby should quieten when you

speak and start to look more intently at faces.

The DVD shows the interaction between a mother and her baby. The mother looks at her

baby's face and holds him close. She talks directly to him, singing and using appropriate actions.

Even though he does not look directly at her all the time, the positioning and auditory input will

help him direct his gaze towards his mother's face. When he does look away, his mother talks

about the things that he is looking at, for example, the picture of a train on the wall.

There are many opportunities at home to use the strategies of speaking close to the

microphone, establishing eye contact and using a singsong voice. Nappy/diaper changing, for

example, is an ideal time as it is one of the most frequent things you do with your baby. Talk

about what is happening. Give correct language in phrases and use real names for objects and

parts of the body.

Babies love to hear singing and will laugh and gurgle, especially when songs are accompanied by

actions. Songs and rhymes are an excellent way to encourage interaction and enhance the bond

between you and your baby. They also promote the development of the suprasegmental

features of speech such as pitch, duration and intensity.

The DVD shows a mother playing a game of tickling that her son obviously loves. The mother

talks about the game she is playing and her son shows his joy by vocalizing. She uses real names

for parts of the body, giving her son every opportunity to hear the language. Repeating language

is essential at this early age.

A Quiet Environment

It is very important in the beginning stages of listening to provide a quiet environment. The ideal

listening condition means no background noise such as TV, radio or other loud household

sounds such as the washing machine and dishwasher. Having carpets and curtains in rooms

where parent/baby interaction occurs can help to diminish reverberation.

Having a quiet environment and speaking close to the microphone will make spoken language

more audible to your baby.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 57

Sound Awareness

After your baby has been fitted with hearing aids and/or a cochlear implant, everyone involved

should start to observe her reaction to sound. She may startle at sudden noises, quieten when

you begin speaking to her or look towards the sound. She will learn to tune into your voice first.

Call her by name and she will learn to respond. Do not vary the way you say it, as she needs to

hear it over and over again before she will respond to it. Always call her for a reason and praise

her when she does turn or vocalize. Once your baby has responded to your voice consistently,

ask other family members to call her so she learns to respond to different voices.

You can alert your baby to a variety of environmental sounds so that she begins to learn that

sounds have associations and meaning. To do this, turn her towards the sound source, point to

the ear, say Listen and then name the sound. For example, with an airplane, turn baby to the

sound source and label it. Say Listen, I can hear an airplane. It's up in the sky. Look at the airplane.

Can you hear the airplane? This is an important strategy to develop the skill of localizing sound. In

the DVD a mother uses this strategy when there is a knock on the door.

Vocal Turn Taking

As your baby begins to hear her own voice, she experiments with her vocalizations. It is a good

time to develop vocal turn taking. Listen to her vocalizations, wait for her to finish, repeat the

sounds and add some new ones with appropriate language. Repeat this often so that turn taking

is built up.

The DVD shows a mother waiting for her baby to stop vocalizing before she responds. This

waiting strategy is an excellent one to use at an early age. It will help your baby to develop vocal

turn taking and create an expectation that she will respond to your voice. Turn taking is another

important step in developing communication skills. The foundations of conversation are being

established.

Performatives

Performatives are sounds that are associated with familiar things in a baby's life. They are used

because they cover the speech sounds of a language and lay the foundations for learning to

listen for speech and language development. (See Learning to Listen Sounds pg 72.)

The DVD shows a therapist introducing some performatives with the appropriate toys. She

introduces each sound through listening first and uses the listen cue to focus the baby. She

repeats the sound several times before showing the toy. The therapist uses the mother to

model the sound and only lets the toy move when mother vocalizes. She repeats this with the

baby. This is an excellent strategy to encourage vocalization.

Always present the sound in association with the name of the toy, for example, the bus goes bu

bu bu, the clown says ha ha ha, the fan goes round and round. Say the sound before your baby

sees the toy. Once your baby sees the toy, repeat the sounds while she plays with it. Use the

waiting strategy after saying the sound so that your baby has the opportunity to imitate it. Use

incidental language but remember the primary focus is on modeling the performatives. In the

early stages, use sounds that contrast in duration to help your baby learn to discriminate and set Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 58

her up for success. For example, the cow goes mooooo, mooooo versus the duck goes quack

quack. Gradually, after many repetitions, your baby will make the association with the toy.

Take every opportunity to use these sounds with your baby. Repetition is the key. Use pictures,

books, toys, animals and real objects to reinforce the sounds and associated language. For

example, use the appropriate sounds and language when playing with a toy bus and when a bus

is seen on the road.

In the DVD, the mother uses feeding and playtime to reinforce some of the performatives

introduced in the therapy session. She speaks close to the microphone and uses a singsong

voice. Learning these sound associations is fun for the baby and will have more meaning if

practiced in her day-to-day world.

It is important to observe baby to establish if she is associating the performative with the object.

Use the waiting strategy to give her time to show that she is identifying the sound by reaching

for the appropriate object or turning to it. If she does this, it means that she is starting to

associate meaning with sound. At this stage, she may also start to use the appropriate sound

spontaneously.

Once your baby identifies a performative, the next step is to learn to identify the name of the

object without the prompt of the performative. Say the word in a sentence and at first use the

strategy of acoustic highlighting, for example, Where's your bus? Give your baby time to

respond. If she does not understand, repeat the sentence with the performative to assist the

child, for example, Where's your bus that goes bu bu bu?

As your baby becomes more alert, she understands more of her world. She may understand a

familiar greeting, for example, bye bye, and may be using her voice more to vocalize for needs

and wants. She has increasing auditory awareness, eye contact and early turn taking skills. She is

interested in people, voices and toys. It is essential to continue to encourage listening

development so that your baby learns that sounds have meaning.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 59

Simple Phrases

As well as using performatives, introduce simple phrases that are part of the natural language

used with babies in their daily routines and play. For example, brush brush brush your hair; up up

up we go; open the door, open it up; pour pour pour it out; take it off. These phrases incorporate a

number of vocabulary groups such as nouns, verbs and pronouns. Learning to identify,

understand and use these phrases is an important step in language development.

In the DVD a mother repeats phrases while she is dressing her baby and getting a drink. She is

close to the microphone and uses a singsong voice.

Observe your baby to see if she is starting to understand some familiar phrases. She may reach

up to take off her hat when she hears the appropriate phrase. Use the waiting strategy to give

her time to respond with the action or to respond vocally. This is the beginning of following

simple instructions through listening. Remember to accept your baby's vocal response and then

model the correct phrase. Repeat the phrases many times in different contexts. A baby with

hearing impairment needs to hear new words and phrases over and over again before she

begins to understand them.

Around your baby's first birthday, her vocalizations begin to change from babble to jargon. This

means that she continues to babble repeated vowels and consonants but adds some single

words. These are approximations of words and are often not expressed in clear speech. You as

parents usually understand the words and model the correct pronunciation. It is important to

continue speaking in simple sentences, not single words. As your baby's understanding develops,

be aware of using expanded language. Your baby needs to hear correct, clear models in

meaningful situations. Use the waiting strategy to give your baby time to respond and encourage

communication attempts. As your baby identifies more words and phrases through listening

alone, start to use a more natural voice with less motherese. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 60

Auditory Stimulus/Response

As part of your baby's listening skill development, a structured auditory stimulus/response

activity is introduced to ensure that she can detect a range of sounds. To develop listening and

speaking skills, it is important to know exactly what sounds your baby can hear. Because she can

now reach for and grasp objects, she can be taught to hold an object to her ear and put it in a

container when she hears a sound. Your baby has to learn to wait, and only place the object

AFTER she hears the sound. In the initial stages, you and the therapist will need to model the

response to teach your baby what to do. You can also take turns giving the sound stimulus as

this develops your baby's ability to localize sound. To maintain baby's interest, use a variety of

toys for this activity, for example, plastic toys in water, pop up toys, vehicles down a ramp.

The Ling 6 sounds are used for the stimulus (/oo/ /ee/ /ar/ /m/ /sh/ /s/). They cover the speech

range from low to high frequency. If your baby can detect all these sounds, she has the potential

to hear most of the sounds of a language.

In the DVD, a mother models the response to the sound stimulus. The mother holds an object

to her ear and when the therapist says the sound, she responds by saying I heard that, then puts

the object in the container. It is obvious that her baby is detecting the sounds as she turns to the

voice.

The next step is for your baby to put the object in the container herself when she hears the

stimulus. When learning this activity, your baby may keep vocalizing. She needs to learn to be

quiet while waiting to hear the sound. This can also be modeled. The mother can vocalize and

the therapist can say Sh Mommy. Listen!

Remember to say these sounds with varying lengths of silence between each one. This is so

your baby learns to listen and give accurate responses and does not get into the habit of

responding to a regular rhythm rather than listening for the sound.

This activity is not only essential for detecting and then identifying speech sounds but also for

checking the function of the hearing aids and/or cochlear implant. Your baby will also have to

perform this activity in hearing tests and for MAPping speech processors. Being able to respond

reliably is important.

In chapter two, Toddlers Talk, you will see a toddler progress from just detecting the sounds to

actually repeating them. Encourage your toddler to do this as it indicates exactly what she is

hearing.

Auditory Memory – Item Selection

The DVD shows a therapist asking a baby to select a toy through listening as the toys are being

put away. The baby successfully identifies the cat. Selecting one item from a closed set is the

beginning of the development of auditory memory. In the initial stages, the word is placed at the

end of a sentence. For example, Let us put away the cat. The next step is to place the word in

the middle of the sentence. For example, The cat wants to go home. Make sure your baby has

processed a word or performative at the end of the sentence before progressing to putting the

word in the middle of the sentence. At first, the word can be acoustically highlighted for

emphasis but this should gradually be decreased to a normal voice.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 61

At home, there are many opportunities for developing auditory memory in a fun way. The

animals can be put to bed, the vehicles can be put in the garage and the toys can be posted in

brightly colored boxes.

The development of auditory memory will be further outlined in Toddlers Talk.

As your baby matures, her cognitive processes will also develop. She loves participating in

activities and begins to imitate routines such as washing her doll. Her play demonstrates the

functional use of objects. Her concentration and attention span are increasing. Her vocalizations

may include some alternated syllables and some imitated words. She may also copy varied

intonation patterns. She is becoming aware of directing conversation at others and her vocal

turn taking is developing. She is processing simple language through listening. For example, she

may identify some words and familiar phrases, begin to follow simple directions and have an

auditory memory of one item or more.

As your baby begins to vocalize with intent, you should respond by expanding language,

introducing new vocabulary and modeling correct grammatical structures.

You play a key role in this remarkable period of your baby's development.

The listening journey has begun.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 63

Extension Ideas for Babies

The extension ideas on pages 64-71 show you how your baby's language can be expanded and

how you can guide your baby through the various steps according to the Integrated Scales of

Development.

Activities

The activities follow the sequence of chapter one of the DVD.

Strategies

The strategies mirror the examples of strategies demonstrated in chapter one of the DVD.

Skills and Concepts

The skills and concepts apply to the stage your baby has reached.

Core Language

This is the language that is repeated many times to help your baby access the particular sounds,

words or sentences she is learning at her stage of listening development. As your child learns to

listen she will not need to hear as many repetitions of the new language.

Extended Language

Use extended language in addition to the core language. This provides an enriched language

environment for your baby.

Related Activities

These are suggestions for using the core and extended language in a variety of daily routines and

activities.

What next…

This shows the progression to the next few steps of the Integrated Scales of Development in

the four areas of listening, language, speech and cognition.

These ideas are only suggestions. You may prefer to use different language that is familiar and

relevant to your own family situation. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 64

Making a Drink

Strategies • Be close to the microphone when speaking.

• Have a quiet environment.

• Use phrases and simple sentences.

• Use repetition.

• Describe what you are doing.

• Capture baby's attention.

• Establish joint attention.

• Establish eye contact.

• Repeat baby's vocalizations.

• Add more babble.

• Use a singsong voice.

• Follow baby's eye gaze.

• Observe baby's response to sound.

Skills/concepts

and language

• Establishing sound awareness.

• Developing association of meaning to sound.

• Developing understanding of real names of objects.

• Developing understanding of action verbs.

• Developing vocalizations.

• Localizing sound by head turning.

• Grasping, reaching and holding.

• Beginning turn taking.

• Developing eye contact.

• Developing joint attention.

Core language

(adult input)

• Mmm I'm thirsty.

• I want a drink.

• Open the door. Open it. Open the door.

• Shut the door. Push it. Push it. Push it shut.

• Yummy water, yum yum yum.

• Take the lid off. Take it off.

• Turn it round. Round and round. Round and round.

• Pour the water. Pour pour pour the water. Pour the water.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 65

Extended

language

(adult input)

• Open the cupboard. Open the door.

• Mommy wants a drink. I'm thirsty.

• Daddy do you want a drink? Daddy wants a drink. He's

thirsty too.

• Get the cups.

• Open/shut the door.

• Where is the water?

• Oh oh the water's cold.

• It's in the fridge. The water's in the fridge.

• Take out the water.

• Pour the water into the glass.

• Wipe it up, wipe, wipe, wipe.

• Oh! Oh! I spilt it.

Related activities

at home

• Making/getting any drink/food.

• Getting food out of fridge/cupboards.

• Putting shopping away.

• Checking cupboards/fridge to see what food is needed.

• Pouring liquids, e.g. bath time, cooking and play time.

• Stacking the dishwasher.

• Watering the garden.

• Feeding the pets.

• Taking lids off containers.

• Switching on fans/lights/machines.

What next… • Encourage longer attention span.

• Introduce new vocabulary for different drinks.

• Introduce other verbs, e.g. shake, stir.

• Use specific phrases in many situations, e.g. take the lid off

(for drink bottle, canned food, toys in containers).

• Develop concepts hot/cold, in/out, inside/outside.

• Encourage baby to vocalize before giving drink.

• Encourage baby to respond to own name.

• Speak in simple phrases and sentences.

• Use a greater variety of babble including consonants and

vowels.

• Use the Learning to Listen Sounds.

• Develop auditory memory for following simple directions,

e.g. wave bye bye. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 66

Book Share

Strategies • Be close to the microphone when speaking.

• Use listening first.

• Use a singsong voice.

• Use repetition.

• Wait for baby to respond.

• Have a quiet environment.

• Capture baby's attention.

• Follow baby's eye gaze.

• Observe baby's response to sound.

Skills/concepts

and language

• Developing joint attention.

• Establishing sound awareness.

• Associating meaning with sound.

Core language

(adult input)

• Turn the page. Turn it over. Turn it.

• Open the book. Open it up. Open it.

• Close the book.

• Close it up. Close it up.

• Look at the…

• The ____ goes ____ (Performatives), e.g. The pigeon goes

coo coo coo. Look at the pigeon it goes coo coo coo.

• Look at the clown. He goes ha ha ha /ha ha ha. He's rolling,

roll roll roll.

Extended

language

(adult input)

• Here's a lovely book. Let's have a look.

• Oh look it's all about…

• Let's see what's on the next page.

• What a beautiful…

• Look! What's up there? It's a pigeon. It's gray. It goes coo

coo. It's flying.

• Look at the goat. The goat is eating the grass. He's hungry.

• Look at the funny clown. He's funny. He's laughing. What's

he doing? He's rolling over.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 67

Related activities

at home

• Sharing photos, magazines, a variety of books.

• Singing songs and doing actions about pictures in the book.

• Using action rhymes and finger plays.

• Reading books with actions/pop up pictures/pictures that

move.

What next… • Encourage vocalizations.

• Develop vocal turn taking by repeating baby's vocalizations.

• Use simple descriptions of things in books and around the

house.

• Use phrases and simple sentences.

• Introduce questions, e.g. where? and answer with a

prepositional phrase, e.g. Where's the cat gone? He's on the

bed.Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 68

Reinforcing Performatives

Strategies • Use listening first.

• Use repetition.

• Use acoustic highlighting.

• Use listen cue.

• Be close to the microphone when speaking.

• Make it fun.

• Have a quiet environment.

Skills/concepts and

language

• Associating meaning with sound.

• Developing vocabulary of objects and performatives.

• Developing turn taking.

Core language

(adult input)

• Here's the bird. It goes tweet tweet.

• Listen. Here's the bus. It goes bu bu bu…

• I can hear the car. It goes brm brm brm…

• Yum yum yum it's lunchtime.

• Here's your lunch, yum yum yum.

• Here's the cat. Meow meow meow says the cat.

• Here's the clown, pop up pop up pop up.

Extended language

(adult input)

• Look at the birds. They're flying, tweet tweet tweet.

• Vehicles, e.g. look at the bright red fire engine, ee-or. It's going

fast. It's going to put a fire out, ee-or, ee-or.

• Here's the bus. It's a bus. Look at all the people/men/children in

the bus.

• Listen, there's Daddy's car. Toot toot. I heard the horn. Daddy's

coming. Here's the car, brm brm.

• Farm animals, e.g. Here's the cow. It lives on the farm, moo

moo. It eats grass, yum yum. The cow gives us milk, moo moo.

Related activities

at home

Give baby as many experiences as you can with the Learning to

Listen Sounds:

Birds in garden Food

Mobiles/cell phones Shopping

Books Blowing bubbles

Pets Washing up

Playtime Vehicles

Bath time

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 69

What next… • Select one object with the sound repeated at the end of the

sentence, e.g. Where's the cat that says meow meow?

(closed set)

• Select one object with only one sound at the end of the

sentence, e.g. Where's the goat that says maa? (closed set)

• Start with 3 items in the closed set and extend to 6.

• Describe objects and their function, e.g. Look at the wheels

on the bus. They go round and round. It's a big bus.

• Here's your cup. You can have a drink from the cup.

• Match object to object. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 70

Fruit Salad

Strategies • Use listening first.

• Model correct language.

• Use expanded language.

• Use listen cue.

• Use another adult/sibling as a model.

• Capture baby's attention.

• Use acoustic highlighting.

• Be close to the microphone when speaking.

Skills/concepts

and language

• Developing understanding of functions.

• Understanding vocabulary related to parts of an object, e.g.

skin, seeds.

• Understanding simple phrases.

• Beginning to follow a simple direction.

Core language

(adult input)

• I have a banana.

• Do you like bananas?

• I like bananas, yum yum.

• It's a big/little banana.

• Peel the skin off. Peel it off. Peel it off.

• I have a knife.

• Cut cut cut, cut with the knife.

• Cut the banana.

• Smell the banana mmmmm.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 71

Extended

Language

(adult input)

• I have a strawberry/kiwi fruit/pineapple.

• Look at the seeds.

• Look at the skin. It feels furry/smooth/rough.

• What do I need to cut with?

• I need a knife. A knife will cut the banana.

• I need a bowl.

• Let's cut up all the fruit. Slice the kiwifruit. Slice it.

• Put all the fruit in the bowl.

• The skin's yucky. Don't you like that?

• Oh you don't want to smell it.

• We don't eat the skin. The skin goes in the trash/rubbish bin.

• It tastes yummy/nice/delicious/yucky.

Related

activities

• Having a tea party.

• Making a sandwich/popcorn.

• Putting faces on cookies/cup cakes.

• Playing with doll's house-windows/doors/chimney/fence. The

pillow goes on the bed. The bed is for sleeping. The bed

goes in the bedroom.

• Playing with toy vehicles-wheels/steering wheel/windshield

wipers/wings on the airplane.

• Labelling parts of the body, e.g. humans/animals.

• Labelling household items, e.g. legs on table, handle on

doors, lids on pots.

What next… • Label all parts of objects that baby is interested in.

• Talk about the functions of many different objects.

• Decrease the use of performatives.

• Develop auditory memory in a closed set with the word at

the end of the sentence. One item selection, e.g. Where's

the…?

• Follow a direction (closed set).

• Develop turn taking.

• Highlight prepositions in, on, under, e.g. The train is on the

track.

• Develop the concepts the same/not the same. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 72

Learning to Listen Sounds

Sound Toy

a(r) airplane

ch ch ch oo train

pop pop bubbles, popping toys

bu, bu bus

beep/brm brm car

brr truck

pu, pu, pu boat

tick tock clock

ow/ouch fall down, cut

oowar oowar ambulance

hee, hee monkey

ha, ha, ha clown, laughter

go running

ho, ho, ho Santa Claus

ya hoo! cowboy

whee slide

wa wa wa baby doll

hi! mirror

meow cat

bow wow, woof woof dog

moo cow

neigh horse

baa sheep

oink pig

quack duck

hoo hoo owl

hop, hop rabbit

whistle bird

cock-a-doodle rooster

caw, caw crow

round and around windmill, top, wheels

mmm food/any good thing

dig dig dig toy shovel

s snake

sh sleeping games

la rocking the baby

up, up, up any up activity

gr- gr- Bear

Acknowledgement

* Adapted From: Estabrooks, W. (1998) Cochlear Implants for Kids, © 1998 Warren Estabrooks

and The Alexander Graham Bell Association of the Deaf. Inc. Reprinted by Permission.

*

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 73

Toddlers Talk

This chapter is the second on the DVD, Listen Learn and Talk. It continues the listening and

language journey, exploring the toddler's spoken language development from 16 to 30 months.

It shows how parents transfer skills demonstrated in the clinical setting to the home

environment.

It is an important time for you as parents, as you are the key language provider for your toddler.

Your toddler is understanding more and more language and you must give expanded language

input and clear, correct models through listening. It is the time to listen to your toddler, talk to

her and give her many varied experiences. Remember, as the toddler is still learning to listen, it is

important to have a quiet environment.

Playtime

Playing with your toddler can be one of the best ways to provide meaningful spoken language.

Most learning will occur when your toddler is interested in the activity. At this age, your

toddler's attention span is increasing and she is able to sustain interest for longer periods.

This is the time to comment on what she is doing and saying. If she does not have the language

for what she wants to say, model the phrases or simple sentences. Repeat the language many

times so she learns to listen and associate the activity with the phrase and later begins to use

approximations of the phrase meaningfully. For example, when having a tea party repeat the

action phrase Pour out the tea many times as other family members or all the dolls have a cup of

tea. Incorporate the word pour into other phrases in a variety of situations such as pouring milk

at breakfast, pouring water into the bath or when cooking. In this way the toddler not only

learns to listen to the word but also learns to generalize it in other contexts.

The DVD shows a mother using action words and phrases while bathing a doll with her

daughter. She gives correct clear language in simple sentences about what they are doing and

uses real names for objects and actions. She uses descriptive words like dirty, wet and sticky to

expand her daughter's concept development. The toddler is actively involved and enjoying the

game as it is meaningful to her. The mother follows her lead but also initiates some activities to

expand the toddler's experiences.

The toddler needs to hear the same language structures over and over in different contexts so

she can process the information. As she develops, these frequent words and phrases will

become part of her first expressive communication attempts.

Notice that the mother uses the waiting strategy to give her daughter time to process the

information and to respond verbally. She uses the strategy of performing an action only after her

daughter vocalizes. For example, she only pours the water after her daughter says pour. This is

called vocalizing on demand and sets up the expectation in the toddler's mind that she has to

respond. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 74

Remember to always extend your toddler's vocabulary. Once she is understanding and using a

particular word or phrase, it is time to introduce a new one. For example, if she knows big

introduce huge/enormous; if she knows It goes round and round introduce It's spinning.

The next segment shows how the mother uses a simple activity like changing batteries in a toy

to model more language. She repeats key phrases and talks to her daughter throughout the

procedure. As well as a language learning activity, it is an excellent way to develop the cognitive

skill of cause and effect. This is an early step in developing the ability to problem solve. There are

many opportunities at home to develop this skill, for example, when playing with battery or

mechanically operated toys, building up and knocking down towers, adding coloring to a cooking

mixture, planting a garden.

Use playtime to maximize your toddler's language learning experiences and to develop cognitive

skills. It can lead to a world of fantasy and imagination. Your toddler is at the stage of exploring

her world. She is eager to learn. Don't miss a single opportunity.

Auditory Memory – Simple Directions

As your toddler's auditory comprehension of language develops, she will understand more

simple directions. At this stage, she will follow only one direction at a time but as she matures

she should be able to process more than one. In the third chapter there are examples of

children following more complex directions.

Following directions can be incorporated into many play situations and into daily routines. For

example, the animals can be given a drink, the dolls can be put in various rooms of the house,

the vehicles can be put in the garage, items of clothing can be fetched, food can be taken from

the refrigerator. Your toddler will show that she is comprehending in a variety of situations; for

example, she might go to the bathroom when she hears It's bath time, or will get the cat's bowl

when she sees the cat and hears It's time to feed the cat. This is a transition to open set listening.

In the DVD, there are several examples of toddlers following directions. In the baby bathing

segment, the mother uses many different action phrases in meaningful contexts and waits for

her daughter to process them. The toddler is starting to follow directions. For example, when

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 75

the mother says shake shake shake the powder, the toddler shakes the powder over the doll. At

this stage she still requires prompting from her mother but this is an intermediate step.

The toddler in the next segment follows a number of directions through listening without

prompts. While she is eating her breakfast, then helping load the dishwasher, she follows simple

directions, which demonstrate auditory processing, the development of auditory memory and

the beginning of open set listening. For example, she points to her cheek, wipes her mouth,

turns the bottle upside down and shuts the dishwasher door when asked to do so. Her parents

use familiar language and only give the directions once.

Daily Routines

Other segments of the chapter two show how you can capitalize on everyday routine activities

such as dressing, eating and cooking in order to model expanded language, develop listening

skills and introduce new concepts. The parents in the DVD not only provide core language that

is repeated, but also use extended language to expand the toddlers' vocabulary and structures.

They provide an enriched language-learning environment. As toddlers process more through

listening, they will more readily tune in to this incidental language.

The parents are using an almost normal rate and rhythm. They expect that the toddler will listen

and understand natural speech and language. They only change the pace or use acoustic

highlighting if the toddler does not understand or if there are new words, new or difficult

concepts or a specific speech sound to be reinforced.

Breakfast Time

The strategies and interaction that you see in this DVD segment can be used at any meal.

Throughout breakfast, the father develops conversational skills by responding to his daughter's

utterances with simple sentences and then adding new information.

The toddler shows that she understands familiar phrases and can follow one direction. She uses

one-word utterances. Father is expanding his toddler's comprehension by using a variety of

language structures and new vocabulary, for example, adjectives (warm lumpy porridge/oatmeal)

negation (It's not empty.) and 'wh' questions (Where's your butterfly clip?).

At one point to promote interest and to set up a language-learning situation, the father

deliberately drops porridge/oatmeal on the tray of the high chair. This is often referred to as

sabotaging. It can be used to expand language. It can also be used in many different situations to Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 76

encourage interaction. For example, a toy can be put in the wrong box, a favorite bear might

lose his eye or a bowl can be given when a cup is requested.

Dressing

The strategy of giving choices to your toddler helps with developing independence and is a way

to introduce either/or questions and structures. When dressing, playing or reading a book, your

toddler's interest is more likely to be maintained if she has chosen what she wants.

In this segment, the mother gives her toddler a choice of two tops/shirts to wear. She describes

them and expects her daughter to vocalize to tell her which one she wants. She then talks about

the one her daughter has chosen. Throughout this segment, the parents talk about what they

are doing and expect their toddler to vocalize, to be a part of the conversation. They use the

correct name for each item of clothing and use appropriate phrases for actions, for example, Put

your legs in your jeans. Put your arms up. They develop concepts by talking about on/off, up/down

and same/not the same.

In the DVD, the mother gives her daughter a choice of two items through listening in a closed

set situation. The next step is to expand the number of items to three. At a later stage, the

mother will give the toddler a choice in an open set situation. For example, while she is working

in the kitchen, she might say, Do you want to wear your pink or your green shirt today?

Stacking the Dishwasher

A simple activity such as Stacking the Dishwasher can incorporate a variety of language

structures and introduce new vocabulary that your toddler needs to hear at this stage. Many

other daily routines offer similar opportunities for language learning. Remember to make the

most of every opportunity throughout the day.

The DVD shows a mother stacking the dishwasher with her daughter to develop language,

concepts and auditory memory. Her daughter follows a one-element direction and uses oneword utterances. The mother takes the opportunity to:

• name items of cookware and cutlery (nouns), for example, Bowl, plate, cup, knife, fork,

spoon

• talk about the place where objects go in the dishwasher (prepositional phrase), for

example, The bowl goes on top.

• describe the objects (adjectives), for example, The knife is sharp.

• talk about the objects that cannot go into the dishwasher (negatives), for example, The

saucepan doesn't go in.

• give a direction (auditory comprehension), for example, Shut the door.

Watering the Plants

Here, mother and her toddler are in the garden learning about the difference between flowers

and trees. The mother uses this opportunity to introduce new vocabulary (lilac) and a negative

structure (There are no flowers). She continues to use language to describe what they are doing.

As your toddler matures, her jargon will become more interspersed with single and two-word

utterances. She will also imitate phrases. She is tuned into listening and processing language

through listening. You need to expand your toddler's comprehension of vocabulary and

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© Cochlear Ltd, 2005 Page 77

language structures. You need to continue to develop auditory memory and encourage your

toddler to talk. Use the strategies of modeling and expanding. Use the waiting strategy to give

your toddler time to process the more complex language she is hearing. Give her time to talk.

Model the correct pronunciation of words and acoustically highlight the specific speech sounds

to be developed.

The next segments on the DVD show how a mother uses these strategies to develop her son's

spoken language and communication skills. It also shows how she incorporates what she has

learned in the therapy session into her daily routines and interaction with her son. In the therapy

session, the therapist uses a variety of activities to target specific speech sounds, for example, /s/:

• cards with /s/ words.

• singing (See Saw).

• experience book of a visit to the zoo.

There are also activities to develop two-item auditory memory and to introduce new

vocabulary.

Baking

The mother uses the activity of making muffins to reinforce some of the goals listed above. She

uses a natural voice and expects her toddler to listen, follow directions and comment on the

actions. Her toddler sits close to her so he can listen and see what is happening. He is very

involved and attentive.

The mother guides her son through the sequence of pouring, stirring and baking. She uses the

language of sequencing to introduce each step, such as, next, after, and then. At each stage, she

explains what they are doing, uses expanded language, models her son's utterances and

comments on what he says. She uses exclamations such as wow to maintain his interest but

always adds something to extend his learning. She builds up his vocabulary, for example, using

stirring rather than round and round. She uses language for concepts of quantity, That's enough,

modifiers too big and comparisons It does look like a hill.

This fifteen-minute activity provided a wonderful learning experience. The toddler was

engrossed and the mother capitalized on this to use enriched language and introduce new

concepts. The toddler processed the language through listening. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 78

Craft

In this activity, the concept of Father's Day is introduced as the mother and toddler make a card

for Dad. This special day will be understood a little better each year. The mother has a variety of

materials to stimulate interaction, for example, tissue paper, paints and crayons. She incidentally

teaches her toddler the names of colors but this is not the main focus of the interaction. She

uses them as adjectives in the context of making the card. The focus is on highlighting the /s/

sound in words, for example, star, snake, expanding vocabulary, e.g. knuckles and following two

directions. When she says I put it on your hand but somehow it got on your arm, the toddler

indicates the correct parts of the body.

The toddler uses jargoning and one or two word phrases. His mother repeats his two words

and adds more so he hears an extended sentence. For example, when he says Where star? the

mother responds with Where's the star? I don't know but I've got plenty more where they come

from. The mother makes excellent use of the strategies of modeling and extending.

Auditory Stimulus/Response

Chapter one of the DVD explains how to introduce a stimulus/response activity with a baby. In

this chapter a toddler holds an object by herself and responds reliably when the therapist says a

sound. She not only detects the sounds but also identifies them. She repeats what she has

heard. This demonstrates that she is able to identify the sounds through listening without visual

cues.

This is an important skill to be developed. Speech babble can now be incorporated into the

stimulus/response activity to practice specific speech sounds. This is demonstrated in chapter

three.

Listening at a Distance

As listening skills develop, a toddler can learn the skill of listening at a distance. The distance

from the speaker to the toddler can be gradually increased. In the DVD there is a short segment

where the mother is playing with her son in the garden. From quite a distance, he processes

what she says about being a kangaroo through listening alone and begins to hop. However,

remember that any new language should still be reinforced in a quiet environment.

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Auditory Memory – Item Selection

In Babies Babble, the initial stages of developing auditory memory with item selection were

described. As your toddler's auditory comprehension of language develops, auditory memory

can be expanded. This can be done by increasing the number of directions to be followed or

the number of items to be selected.

Once your toddler can process single words in item selection, move on to processing two

words. Remember that your toddler's expressive ability will not be at the level of her

understanding. She will not be able to repeat the whole sentence at this stage but will respond

with the appropriate actions. Start with a closed set with only three or four toys and increase

the number in the set as your toddler's auditory memory develops.

There are a number of combinations and word classes that can be incorporated into item

selection activities.

Noun plus noun Find the car and the bus.

Get a knife and a spoon.

Adjective plus noun I want the big spoon.

Where's the mommy

dinosaur?

Noun and prepositional

phrase

Put baby in the bed.

Put the cow in the truck.

Noun and verb Make the fish swim.

Cut the apple.

Noun and possessive

pronoun

Where are my socks?

Developing auditory memory can be very easily incorporated into play situations, book share

and daily routines.

Book Share

A love of books will introduce your toddler to a world of imagination and a world outside her

immediate environment. Toddlers love to hear favorite stories over and over again and will

often sit for a long time listening to, and participating in retelling, a story. They will join in and use

repetitive phrases.

The listening skill of 'auditory closure' can be introduced, beginning with your toddler's favorite

part of the story, for example, I'll huff and I'll puff and I'll blow your house… Waiting for your Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 80

toddler to complete a sentence in this way is a useful strategy to practice listening and to check

comprehension.

Use book sharing to introduce new vocabulary, new language structures and the skills of

sequencing and predicting. Use a variety of questions to see if your toddler has understood

certain parts of the story. Be wary of falling into the trap of just asking What's that? This can be

answered with one word and therefore does not extend your toddler's language or thinking

skills. It is better to use more open-ended questions such as What happened? Where? What do

you think will happen? If your toddler does not offer any solution, model with another adult or

sibling so she can hear a variety of possibilities and learn how to answer this type of question.

This lays the foundation for critical thinking skills.

Commenting is a good strategy to use. By saying I think Peter Pan saw Captain Hook on the pirate

ship, there is an expectation that your toddler will comment on the observation. Also use

comments such as mm, oh oh, oh dear, and wow to encourage your toddler to make her own

contributions. This provides the opportunity to further expand language. Start sentences with

look at and tell me. This is another useful strategy as it invites your toddler to offer her own

ideas, which can then be expanded.

The DVD shows a therapist and toddler sharing the story of Peter Pan. The therapist

demonstrates how to use statements and open-ended questions to expand the toddler's

understanding of the story.

The toddler's mother shares a book with her son at home. He chooses his favorite one that has

a regular rhythm with rhyming words. The mother uses good questioning techniques and

expands her son's language by describing how one of the characters thinks and feels. She

models problem solving to develop his thinking skills. He has an enjoyable time in the process.

The toddlers in the DVD listen and learn through a variety of meaningful activities. Their

attention is captured and they have fun. This is the most effective way to learn to listen and

speak.

Chapter two shows the growth of language comprehension and expression from 16 to 30

months. At two and a half, the toddler has an auditory memory of two items or more, can

follow two directions and can listen from a distance. Expressive language is at the two and three

word utterance level. Often the language produced is in imitation of the adult model but there

are also many spontaneous utterances. The toddler understands early prepositions such as

under, in and on and can answer wh questions for example, who, what and where. Speech is

becoming clearer but there are still consonant deletions and substitutions.

The toddler is well on the way through the listening and language-learning journey.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 81

Extension Ideas for Toddlers

The extension ideas on page 82-89 show you how language can be expanded and how you can

guide your toddler through the various steps according to the Integrated Scales of

Development.

Activities

The activities follow the sequence of chapter two of the DVD.

Strategies

The strategies mirror the examples of strategies demonstrated in chapter two of the DVD.

Skills and Concepts

The skills and concepts apply to the stage your toddler has reached.

Core Language

This is the language that is repeated many times to help your toddler access the particular

sounds, words or sentences she is learning at her stage of listening development. As your child

learns to listen she will not need to hear as many repetitions of the new language.

Extended Language

The extended language should be used in addition to the core language. This provides for an

enriched language environment for your toddler.

Related Activities

These are suggestions for using the core and extended language in a variety of daily routines and

activities.

What next…

This shows the progression to the next few steps of the Integrated Scales of Development in

the four areas of listening, language, speech and cognition.

These ideas are only suggestions. You may use different language that is familiar and relevant to

your own family situation. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 82

Eating Breakfast

Strategies • Model correct language.

• Use expanded language.

• Use repetition.

• Introduce new vocabulary.

• Give the toddler time to respond.

• Encourage turn taking.

Skills/concepts

and language

• Developing understanding of description.

• Following one direction, e.g. Where are your cheeks?

• Developing concepts, e.g. on/off, empty/full, hot/cold/warm.

• Understanding a range of body parts.

• Jargoning decreases.

• More single words emerging.

Core language

(adult input)

• Time for breakfast.

• Here's your porridge/oatmeal/yogurt.

• Get your spoon.

• Here's your spoon.

• Open your mouth. Here comes the porridge/oatmeal/yogurt.

• Here's some more porridge/oatmeal. Have some more.

• There's no more porridge/oatmeal. It's all gone.

• The bowl's empty/full.

• Do you want a drink? Here's your water. Have a drink. Drink

it up.

• It's yummy water/oatmeal/yogurt.

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Extended

language (adult

input)

• I'm hungry. Are you hungry?

• It's time for breakfast now.

• What do you want for breakfast/lunch/morning snack?

• Would you like?…/Do you want… or….?

• I like…/ I don't like.

• You like oatmeal.

• The porridge/oatmeal/yogurt is warm and lumpy/cool and

creamy.

• It tastes sweet/delicious/yucky/horrible.

• Where's the spoon?

• No, not the teaspoon. It's too little. I want the big spoon.

• Oh! Oh! You split the milk. Wipe it up with the cloth.

• Wipe your mouth.

• The serviette holder/bowl/glass is nearly empty. It's not full

any more.

Related activities

at home

• Meal times - dinner, lunch, morning snack, afternoon snack.

• Having a picnic/birthday party/celebrations.

• Playtime – pretending to have a tea party/feeding the animals

on the farm/water play.

• Sharing related storybooks.

What next… • Use adjectives, e.g. size, shape, color.

• Expand language of quantity, e.g. not much, that's enough,

that's too much, that's nearly empty.

• Give choices, e.g. do you want raspberry milk or orange

juice?

• Use pronouns – me, my, mine, you, your, yours.

• Model simple sentences.

• Match objects to pictures in books.

• Develop auditory memory in closed set activities:

- select two items using "and".

- select by descriptive phrase.

- follow two simple directions. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 84

Stacking the Dishwasher

Strategies • Encourage joint attention.

• Introduce new vocabulary.

• Model correct language.

• Use expanded language.

• Have a quiet environment.

• Use repetition.

Skills/concepts

and language

• Developing categorization.

• Developing concepts of open/close, top/bottom.

• Following one direction using preposition "in", e.g. Put the

spoon in the dishwasher.

• Developing cause and effect.

• Learning new vocabulary, e.g. jet, dishwasher.

Core language

(adult input)

• Open/shut the door.

• Where's the big/little/blue bowl/plate/cup/spoon?

• Here's the big/little/blue bowl/plate/cup/spoon.

• Put the bowl/cup/spoon/plate in the dishwasher.

• Where's your cup?

• Oh, it's on the bench/table.

• Here it is. Put it in. Put it in the dishwasher.

• Put it on the top/bottom shelf.

• Turn it around.

Extended

language

(adult input)

• Here are all the spoons/forks/knives.

• Put them in the dishwasher.

• Here's your bowl and cup.

• Put daddy's mug in. Turn it upside down.

• The plates are very dirty.

• The dishwasher will make them clean.

• Where's the detergent?

• Shake the powder and tip it in. The dishwasher is full.

• Let's turn the dishwasher on.

• Can you hear it? It's noisy.

• Everything will be clean soon.

Listen Learn and Talk Auditory Habilitation Practice

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Related activities

at home

• Washing toys.

• Putting clothes away.

• Cleaning up.

• Sharing a book about kitchen activities.

• Bath time.

• Washing the car.

• Packing a suitcase.

• Packing a picnic basket, school bag or lunch box.

• Shopping - putting things in the cart/trolley.

• Putting the shopping items away.

What next… • Use the language of description, e.g. a plastic cup, the bowl

with the rabbit on it.

• Develop language of categorization, e.g. dishes go in the

dishwasher/clothes go in the washing machine/knives, forks,

spoons belong together.

• Develop an understanding of functions of objects, e.g. the

knife is sharp, we use it for cutting.

• Introduce possessives, e.g. daddy's cup, mommy's sandwich.

• Use normal rate and rhythm.

• Use less acoustic highlighting.

• Develop two-item auditory memory with different linguistic

features, e.g. put the big bowl in the dishwasher. Put the

bowl and the spoon in the dishwasher. Put the bowl on the

top shelf.

• Follow a two-step direction, e.g. put in your bottle and shut

the door.

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Making Muffins

Strategies • Model correct language.

• Use expanded language.

• Have a quiet environment.

• Use listening alone.

• Use repetition.

• Capture the child's attention.

• Make it fun.

Skills/concepts

and language

• Following two directions.

• Developing question forms.

• Beginning sequencing.

• Beginning understanding of quantity language.

Core language

(adult input)

• Let's make muffins.

• We need a bowl and spoon. Where's the spoon?

• What else do we need?

• Open the muffin mix.

• Shake the muffin mix into the bowl. Shake, shake.

• What do we need next? What do we do now?

• How much water do we need?

• Stir the mixture round and round.

• Turn the oven on.

• Be careful it's hot.

• Put some mixture into the muffin tins.

• That's enough.

• Use the big spoon.

• It's too big.

• Let's put the tray in the oven.

• In you go muffins.

• Now it's clean up time.

Extended

language

(adult input)

• These muffins are delicious.

• I love muffins.

• Do you like muffins?

• I like chocolate muffins.

• They're my favorite.

• Which ones are your favorite?

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Extended

language

(adult input)

cont.

• Open the packet and tip in the mixture.

• Tip it all in the bowl. Make sure the packet is empty. Mix it

up.

• Stir it with a big spoon.

• Make sure you mix it all up.

• Now what do we need?

• A cup of water and an egg. Who wants to break the egg?

• Uh oh. There is egg shell in the mixture. I'll have to get it out.

• You're mixing it very well.

• Now put a little mixture on a spoon.

• Put it into the muffin tins. Just a little bit. We don't want

them to be too big.

• I'll put them in the oven.

• Be careful, don't burn yourself.

Related activities • Any cooking activity, e.g. making

jelly/porridge/oatmeal/sandwiches/cutting vegetables/icing

biscuits.

• Any activity that has several steps in sequence, e.g. getting

dressed/brushing teeth/making a bed/putting toys away/

cleaning up/simple stories/simple sequence activity with toys.

• Making experience books with photos or drawings in

sequence of something your child likes to do or of an outing,

e.g. swimming/shopping/playing/dressing up/park visit/zoo

visit.

What next… • Auditory memory of 2 items in different linguistic contexts

including prepositions and pronouns. e.g. she is on the bed.

Put the bowl in the sink.

• Auditory memory of 3 items.

• Introduce question, what do we use for…? (function)

• Develop concepts of size and shape.

• Introduce language for sequencing, first, next, then, etc.

• Begin listening from a distance.

• Model pronunciation of new words - highlight to encourage

imitation.

• Introduce more language of quantity, e.g. some, all, half.

• Acoustically highlight particular speech sounds in words and

phrases.

• Develop partitives, e.g. a bag of… a bottle of…

• Develop open set listening – following one direction,

selecting one item. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 88

Making a Father's Day Card

Strategies • Use auditory bombardment.

• Model correct language.

• Use expanded language.

• Use normal rate and rhythm.

• Wait for the toddler to process new information.

• Give time to respond.

Skills/concepts

and language

• Developing number concepts.

• Developing colors as adjectives.

• Following two directions.

• Developing shape names.

• Understanding prepositions, e.g. at the top, in the middle.

• Answering "wh" questions, e.g. What's that? Where's the…?

What's that for?

• Understanding concepts of size, e.g. big and little.

• Using two words together.

Core language

(adult input)

• We're making a card for Daddy.

• Get the paints and paintbrush.

• Fold the card and cut it.

• Cut the card out. Cut it carefully.

• Let's paint a snake.

• A green snake.

• No, that's not green, that's blue.

• Where's the green?

• That's right. That's green.

• Paint the snake.

• I'm cutting out a heart.

• Where will we stick it?

• Get the paste/glue.

• Paste it on, paste, paste/Glue it on, glue, glue.

• Stick, stick stick it on.

• We have two hearts – one, two.

• One at the top and one in the middle.

• Color the hearts red.

• Where's the red?

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 89

Extended

language

• Here's some different colored cardboard and cellophane.

• What color would you like?

• Oh pink, you want pink. That's a pretty color. I think that's

my favorite.

• Is that your favorite color?

• I'll fold it in half, and then you can cut it.

• I'm folding it carefully. Do you want to cut it?

• Cut it out, be careful, the scissors are sharp.

• What will we do first?

• What would you like to do?

• I'm cutting out a big heart. Daddy will like that.

• Oh you've drawn a house. There are no windows or doors

on the house. It needs some windows and doors.

• Paint the door red and the windows blue.

• Let's make a garden around the house.

• Daddy will love this card.

Related activities

at home

• Any craft activity, e.g. painting, drawing, cutting, pasting,

stamping.

• Making a garden/park/beach scene.

• Making a doll’s house/farmyard/garage.

What next… • Develop ideas of sequencing.

• Develop prepositions of place, e.g. in the middle, next to.

• Begin counting.

• Introduce pronouns, e.g. she/they/he.

• Build vocabulary, e.g. synonyms, parts of the whole.

• Use acoustic highlighting for specific sounds.

• Use a variety of speech sounds in words and phrases that

the toddler needs to hear – auditory bombardment.

• Expand "wh" questions, e.g. who, what, where.

• Model pronunciation.

• Develop 3 item auditory memory – closed set.

• Develop open set listening, one direction, one item. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 90

Children Chatter

Chapter three of the DVD, Listen Learn and Talk follows the development of the child from 31

months up to the time they start school. It is a time when children consolidate their receptive

and expressive language skills. They move from speaking in two words and simple sentences, to

expressing themselves using complex grammatical structures. They begin to use past and future

tense and use a variety of question forms. They learn how to retell stories, describe objects,

people and scenes and hold conversations. Their speech becomes clearer. They become little

chatterboxes.

Children's listening skills also develop. They move from listening in a quiet environment to

listening in background noise. Their auditory memory develops from following two directions to

following multi-element instructions. They can gain information from a taped signal and from the

television and can learn to talk on the telephone. They are more aware of the world outside

their immediate environment.

This DVD demonstrates how you can continue to extend your child's spoken language skills

through listening.

Expanding Language

Your child is developing her receptive and expressive language. You need to extend her

language input so she hears a variety of grammatical structures. You should be constantly

expanding your child's language through meaningful interaction and encouraging her to progress

from using simple to complex sentences.

The DVD shows examples of parents expanding their child's language. For example, the

segment in the garden shows a mother following her child's interest to introduce new

vocabulary and develop structures and concepts. She talks about parts of the plants, buds and

stem. She uses language such as:

• Not all the flowers are open. (negative)

• There might be spiders in there. (modal)

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 91

• They are all open and these ones here are closed/I think that one needs lots of water/

When they open up they become beautiful flowers. (complex sentences plus plurals)

• There are not as many buds. There are a few. (comparative)

The mother models language in appropriate situations for her son so he will eventually learn to

use it himself.

Little Helpers

Most language learning occurs when children are engaged in meaningful interaction.

Providing children with varied activities and experiences can create wonderful learning

opportunities. Children of this age love to help their parents around the house. Let them help,

involve them as much as possible and capitalize on the opportunity to develop their listening

and spoken language skills. Give them the language for what they are doing, for example, when

washing up, stacking the dishwasher, making lunch, getting a drink and cooking. Give them their

own dustpan and brush for sweeping and a spade for digging. Let them help with bed making,

dusting and gardening. They may not do it very well but these activities provide a wonderful

opportunity for expanding language.

The DVD shows a child helping her mother with some of these activities. The mother uses

extended language, for example, Put the pants/trousers in daddy's pile, Put it on the dish drainer

please. She builds her daughter’s vocabulary, for example, Rinse it out, Squeeze the sponge. She

expects her daughter to follow two instructions Get the butter and the cheese from the fridge.

Playtime

Through role play, children begin to develop their imagination. They love to play with dolls,

puppets and action figures. These can present opportunities for creative play, developing

thinking skills and practicing language. Role playing in different scenarios can help your child

develop pragmatic skills that are essential if she is to communicate effectively.

The DVD shows a child role playing, pretending she is going shopping for her mother and

having a tea party.

Playtime also provides many opportunities to further develop listening skills and extend concepts

and language. There are a number of examples in the DVD:

• A mother explains the word monorail by describing the difference between a train and

a monorail.

• A father teaches his daughter the language of games – Who do you think should go first?

I'm going to shuffle the cards, Select a card, Spread the cards out like this.

• A mother introduces the word Antarctica and talks about where penguins live to

expand her son's knowledge.

• A mother gives her son practice with an adjectival phrase - The man with a

yellow/red/blue hat. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 92

Be aware of extending your child's vocabulary at all times, for example, use synonyms such as

sofa, couch or settee. Use category names such as 'musical instruments' for violins, trumpets and

drums.

Speech

By three years of age children's speech patterns are fairly well established. However, they will

need practice listening to and using specific speech sounds in words and phrases. As their

listening skills are refined, the clarity of their speech should improve. There are a number of

strategies that you can use to help your child learn to listen to specific speech sounds.

Auditory bombardment

This is repeated auditory exposure to a particular sound that a child has difficulty producing, for

example, /f/. A fun way to do this would be sharing the story of The Three Little Pigs, saying over

and over again, I'll huff and I'll puff, huff huff huff, puff puff puff and I'll blow your house down.

Another way would be making a collage with leaves. As your child cuts and pastes the leaves,

the word leaf can be repeated in a phrase or simple sentence many times.

Speech babble

As much as possible speech sounds should be introduced through play with toys and their

associated sounds. However it may be necessary to target particular sounds. A quick and

effective way to provide the necessary repetition is through 'speech babble'.

The DVD shows a therapist using the auditory stimulus/response to practice consonant

repetition through listening. The child knows to hold the toy to his ear. This is an indication that

he is ready to listen. He repeats the sounds, for example, /la la la la la / and /uf uf uf uf uf/, /pa pa

pa be be be/ and /ku ku ku tee tee tee/. These sounds should then be practiced in words and

phrases, for example, /ku ku tee tee/ can be incorporated into a cup of tea. /ka ka kee kee/ into

Where's the car key?

Speech babble is also an excellent way to fine tune listening to help your child discriminate

voicing and place contrasts, for example, /pee pee pee/ /bee bee bee/ /tee tee tee/ /kee kee

kee/. Games with rhyming words are another way to fine tune listening and provide speech

practice.

Provide lots of opportunities for adult input and for the child to produce the sound in phrases

and in sentences.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 93

Acoustic highlighting

This is an excellent technique to highlight specific speech sounds at the beginning and end, and

before middle, of words.

The DVD shows a mother with her child playing with stickers of sea creatures. She acoustically

highlights the /s/ sound as they talk about them. Once your child can say the /s/ in words, she

can practice the words in phrases and sentences in other play activities. Acoustic highlighting

should not be continued once your child can produce the sound correctly in spontaneous

speech.

As children mature, they can learn to self-correct their speech. There is an example of this in the

DVD. The therapist has integrated the speech target of /th/ into an auditory memory activity.

Every time it is the child's turn to give directions she has to produce a /th/ sound, for example,

Take out the crocodile and put it on the thick square. When she mispronounces the word, instead

of immediately correcting her, the therapist uses the waiting strategy and the child corrects

herself.

You will need to monitor your child's speech until they can self-correct. This is best done

through listening. In the DVD a father corrects his daughter's speech very naturally during a

game. When she mispronounces the word supposed, he models it, and she repeats it correctly

through listening.

By the time your child is ready for school, most of the speech sounds should be well established.

This will only happen if the auditory habilitation program focuses on targeting sounds through

listening. The DVD shows that this can be done in a fun and natural way.

Auditory Memory

The previous two chapters showed how babies and toddlers develop auditory memory. They

moved from processing one item to two items in a closed set and began open set listening.

Children's auditory memory can be extended to three or more items in different linguistic

contexts in a closed set. The following examples of three item auditory memory are in closed

set activities:

• Three nouns - Get your hairbrush, shampoo and towel (before having a shower).

• Two adjectives and a noun - the fluffy white dog (chosen from a selection of animals

with different characteristics, for example, a fluffy white cat, a fluffy black dog, a sleek

black cat, etc.).

• Two nouns and a verb - The stingray and the dolphin are swimming.

• Noun, preposition and noun - The doll is behind the couch.

• Noun, conjunction and noun - Put the truck and the car on the road.

• Noun, negative and noun - Put the truck not the car on the road.

From this stage, the child progresses to four and five items in a closed set. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 94

Increasing the Difficulty of Closed Set Tasks

familiar vocabulary Î less familiar vocabulary

quiet environment Î noisier environment

small number of items in the set Î larger number of items in the set

prompts Î fewer prompts to no prompts

auditory highlighting of key words Î normal stress and intonation patterns

give direction more than once if

child requests clarification

Î give directions once only

one item to be processed Î five items to be processed

simple sentence structures Î complex sentence structures

live voice Î taped voice

Once your child can follow two directions or select two items in a closed set, she can be

expected to follow one familiar direction or select one familiar item in an open set situation. She

can process one very familiar direction or select one very familiar item when involved in a

routine activity. For example, when cooking, ask your child for a very familiar toy so it is

unexpected and out of context. The same progression for the development of closed set

listening can be followed for the development of open set listening (see above table).

The DVD shows children following more complex directions, for example, using descriptions,

Give me something that goes on the water and has sails (closed set) to I'm thinking of something

beginning with /r/, that goes to the moon and astronauts go in it (open set).

Auditory processing skills such as auditory memory are necessary for children preparing for

preschool and school. Processing complex language, following multi element directions and

recalling details are a part of everyday school life.

The DVD shows a child following multi element directions in a closed set situation. The

therapist speaks quickly and quietly and expects the child to process the information without

repetition. The child asks to have a turn. Reversing roles allows the child to practice using the

complex structure.

Games can be a fun way to develop these skills, for example, board/card/word games which can

be played in the car, while waiting for the doctor/audiologist, or while waiting to be served in a

restaurant. Here are some examples:

I Spy

Alphabet games

I went shopping and I bought…

I'm thinking of something that…

Rhyming games

Category games

Guess Who/What am I?

Which one is different? Which one doesn't belong and Why?

Opposites

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 95

Auditory Sequencing

Auditory sequencing is an important skill to be developed. It is necessary for children to be able

to retell stories, jokes and riddles, follow sequential directions and at a later stage, such as at

school, recall information and recount events they have heard. This skill can be developed in

nursery rhymes, songs, games and stories.

Children love to listen to their favorite story many times and will start to retell it to their parents

and other family members. Encourage your child to take the part of different characters. This

gives her the opportunity to use different pitch, voice quality and intensity. This further develops

her control of the suprasegmentals of speech. It allows her to express emotions, such as anger,

disappointment, surprise, fear or happiness.

Help your child progress from listening to many repetitions to listening to a story once only,

then to retelling it in sequence including as many details as possible. To do this, use puppets,

pictures or toys to tell a story. Ask questions to help your child retell it in the correct sequence.

Move on to having your child retell the story by herself without the prompt of questions but still

with the aid of the puppets, pictures or toys. Extend to open set listening without any prompt

or props and also increase the length of the story to retell.

The DVD also shows a little girl using props to help her retell The Three Little Pigs. Another

segment shows a child beginning the more advanced skill of retelling a tape-recorded story. At

this stage, he is not expected to retell the story but answers questions about it. He will move on

to retelling a story without prompts. Being able to listen to a taped story is a useful skill for

children ready to start school as listening to tapes or television can be a regular part of the

school day.

Experiences Outside the Home

Excellent language learning opportunities are available outside the home. These include visiting

the park, library, different kinds of shops; taking a bus, train, boat or car ride; going fishing, to the

museum or beach.

Making "experience books" of these outings is a great way to introduce and expand language.

They provide a vehicle for using a variety of tenses and new vocabulary and can be used to

develop sequencing skills. The books can be illustrated with simple drawings, pictures, photos

and memorabilia. Be sure to involve your child in making the experience book. At a later date it

can be used to encourage reading, as children love to read about themselves and their

experiences. It can be an effective tool to stimulate conversation.

Advanced Listening Skills

A child's listening skills are also developing during this time. In the beginning of the learning to

listen journey, a quiet environment is the ideal situation to develop skills of detection,

discrimination, identification and comprehension. This should be extended to listening from a

distance, listening in background noise, listening to tapes and talking on the telephone. The DVD

shows examples of children developing these skills. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 96

Listening in Noise

In the early stages of learning to listen it is essential to have a quiet environment. However,

children need to develop the skill of listening in background noise in preparation for preschool

and school. Provide lots of experiences to help your child learn to listen in noise. To set her up

for success, the language should be familiar and there should be a limited number of choices. A

radio or television can be used for the background noise. To extend your child's skills, gradually

increase the volume and move to open set listening.

The DVD segment shows a young boy and his caregiver at the duck pond. The caregiver makes

the most of the opportunity to introduce new vocabulary and expand his language. Because of

the background noise, she speaks close to the microphone of his speech processor.

The DVD also shows a child learning the more advanced skill of listening to a taped story with

background noise. At this stage the child is listening to the story sentence by sentence but will

move on to retelling the whole story.

Talking on the Telephone

Holding a conversation on the telephone is possible for some children with hearing impairment.

This skill is not commenced until the child is able to have an open set conversation without any

visual cues.

When developing the skill of talking on the telephone, begin with a known speaker and use a

closed set of three or more familiar questions or statements varying in length. Introduce a

variety of greetings and closing comments. Increase the number of sentences in the set. Move

from closed to open set by introducing an unexpected question or comment. Gradually this can

be built up until your child can converse with a number of different family members.

The DVD shows a child who has progressed through these steps and is chatting to her aunt.

She is truly a listening child.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 97

Conversation

The DVD shows a child having a conversation with her father. She demonstrates excellent

listening skills such as open set listening, auditory memory and auditory sequencing. She uses

complex language and a number of pragmatic skills, for example, she is able to initiate a topic,

maintain a topic and cope with a topic change.

The child has experienced many years of intensive listening and spoken language input. She is a

communicating child. She is a good listener and her speech is becoming clearer. Her concepts of

shape, size, texture, quantity and color are all developing. These need to be reinforced for entry

into school. She is developing her conversational skills in a variety of contexts and can predict

what will happen. She is overhearing information from the television and is able to listen in

background noise.

She can play creatively and use her imagination. She is a listening, thinking and talking child.

This part of the listening journey is over. A new journey is beginning.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 99

Extension Ideas for Children

The extension ideas on pages 100-106 show you how language can be expanded and how you

can guide your child through the various steps according to the Integrated Scales of

Development.

Activities

The activities follow the sequence of chapter three of the DVD.

Strategies

The strategies mirror the examples of strategies demonstrated in chapter three of the DVD.

Skills and Concepts

The skills and concepts apply to the stage your child has reached.

Core Language

This is the language that is repeated many times to help your child access the particular sounds,

words or sentences she is learning at her stage of listening development. As your child learns to

listen she will not need to hear as many repetitions of the new language.

Extended Language

The extended language should be used in addition to the core language. This provides for an

enriched language environment for your child.

Related Activities

These are suggestions for using the core and extended language in a variety of daily routines and

activities.

What next…

This shows the progression to the next few steps of the Integrated Scales of Development in

the four areas of listening, language, speech and cognition.

These ideas are only suggestions. You may use different language that is familiar and relevant to

your own family situation. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 100

Developing Auditory Memory

Strategies • Use repetition of new language.

• Use expanded language.

• Use listening first.

• Model with adult.

• Give instruction once through listening.

• Wait for child to respond.

• Set your child up for success.

Skills/concepts

and language

• Developing three-item auditory memory – closed set: e.g.

get your cap, shoes and jacket.

• Selecting objects by description, e.g. give me the one that

goes on the water.

• Understanding new concepts, e.g. wide/narrow.

• Understanding new vocabulary.

Core language

(adult input)

• I have a big yellow truck/very old car/little yellow truck/red

racing car/very old train.

• Look at the wide/narrow road.

• The cars go on the road.

• Be careful, drive carefully. Don't go too fast.

• Put the big yellow truck on the wide road.

• Put the big red car on the narrow road.

• Which one goes on the road and is fast?

Extended

language

(adult input)

• This is a very wide road.

• It's like a freeway/motorway. It's like the road we go on to

Uncle…'s house. See the lanes. It's got four lanes. You can go

faster on the freeway/motorway but you mustn't go too fast.

• Look at the narrow road. You have to be careful on the

narrow road.

• Turn the car around. You have to stay on the left hand side

of the road.

• Watch out for the road workers. They're fixing the road. See

the man holding the sign. It says stop, so we have to wait

until he says go. We don't want to have an accident.

• The big yellow truck is digging a hole. See how the driver

picks up the dirt. Then he tips the dirt into the back of the tip

truck.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 101

Related activities

at home

• Using any activity around the home but ensuring that you

have a variety of objects that your child is familiar with in

different colors/sizes/categories.

• Sorting the laundry, e.g. give me daddy's red sweatpants and

his red tee-shirt; put the socks and the tee-shirts in the

basket/on the cupboard/in the washing machine.

• Playing with toy vehicles, e.g. Put the red tip truck on the

wide/narrow road.

• Driving the big black bus up the hill/into the garage.

• Playing card games/sticker games.

• Playing pretend – shopping/tea parties/doll's house/on the

farm/acting out favorite stories/TV/DVD or video characters.

• Helping in the garden/around the house/getting out and

putting away the tools/food/cleaning items.

What next… • Establish three item auditory memory – closed set:

- negation, e.g. I want the…. and the… not the…

- a variety of prepositions

in/on/under/next/to/behind/between.

- pronouns, e.g. you, they, we.

- verb phrases, e.g. the boy/he is riding his bike up the

hill.

- function words/phrases, e.g. I need something that

you can mow the lawn with and something you can

dig with. These should be selected in the correct

sequence.

• Develop advanced listening skills – closed set:

- following simple instructions in the garden/at the

supermarket with background noise.

- following familiar songs on tapes.

• Develop open set listening with:

- two familiar items, e.g. Go and get your… and…

- two familiar directions.

• Reverse the roles to give the child practice. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 102

In the Garden

Strategies • Use repetition of new language.

• Use expanded language.

• Introduce new vocabulary.

• Allow the time to process and respond.

• Model correct pronunciation.

• Use auditory close.

Skills/concepts

and language

• Making comparisons.

• Beginning plurals.

• Expanding vocabulary.

• Using "wh" questions, e.g. who, what, where.

• Using more consonants.

• Expanding concept of categorization.

Core language

(adult input)

• Look at the pretty flowers.

• These are yellow and those are pink.

• This flower has a stem.

• These are leaves growing on the stem.

• Not all the flowers are open.

• These are open but these are closed.

• They're not open yet.

• They're buds.

Extended

language

(adult input)

• Flowers and bushes grow. They have roots.

• Some plants can grow in pots and some in the ground.

• The buds will open out later and become beautiful flowers.

• Be careful when you pick the flowers. Don't break the stems.

• Flowers need water and sunlight so they can grow.

• They have died because the earth is too dry. What a pity.

• We'll have to water the garden everyday, so the plants don't

die.

• Let's pick some of the pink flowers, and put them in a vase.

• These are flowers and they are on a bush.

• This one is a bush. A bush is like a small tree.

• Let's pick a bunch of flowers.

• Take them inside and put them in a vase.

• Fill the vase up with water first.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 103

Related activities

at home

• Talking about small parts of the whole object, e.g. clock

(hands and face), kettle (spout and handle), TV (remote,

screen, picture, switch).

• Planting seeds/seedlings.

• Starting a vegetable garden.

• Keeping potted plants.

• Pressing flowers and leaves.

• Making a collage with garden things, e.g. leaves, seeds, grass.

• Making flowers as a craft activity.

• Making an experience book about the garden/vegetable plot.

What next… • Develop four-item auditory memory in a closed set.

• Develop concept of "what's missing" from parts of objects.

• Develop ideas of categories, e.g. plants (flowers are plants,

trees are plants), vegetables, fruit, vehicles, furniture, tools.

• Introduce more negatives, e.g. none, nobody.

• Highlight /s/ on plurals and third person singular, e.g. I live, he

lives.

• Expand information about how and why things work.

• Introduce comparatives, e.g. I am taller than you.

• Introduce why and because.

• Develop sequencing of a short story.

• Develop time concepts – today, tomorrow and yesterday.

• Develop open set listening – 2-3 items, 2-3 directions, e.g.

Go and get daddy's football cap. Get an apple and put it in

your lunch box. Get your swimsuit and give it to mommy.

• Develop listening in noise – open set, one familiar item and

one simple direction.

• Begin open set listening with a tape. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 104

Guess Who? Game

Strategies • Expand language.

• Model correct pronunciation of words.

• Model correct language, e.g. question forms.

• Use language of clarification.

• Model pragmatic skills of opening/closing a topic.

• Allow time to process more difficult listening and concepts.

• Monitor correct use of complex language.

Skills/concepts

and language

• Using correct question and answer.

• Developing negatives.

• Developing descriptions.

• Making inferences.

• Developing thinking skills.

Core language

(adult input)

• Who will go first?

• You have to shuffle the cards first.

• Then you have to select a card.

• You select one first and then I will.

• OK I think I will have this one.

• Don't look. That's cheating.

• Do you know the rules?

• You have to describe a person.

• Is your person a man or a woman?

• Does your person have a moustache/red hair?

• Yes, he/she does/doesn't.

• Is your person wearing gloves/a silly hat?

• Yes he/she is/isn't.

• That means I have to put down all the pictures of the

women/men with red hair.

• The person who ends up with… wins the game.

• It's your turn next.

Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 105

Extended

language

(adult input)

• Who do you think should go first, the eldest or the

youngest?

• I'm going first because I'm the eldest. Is that OK with you?

• Can you explain the rules to…

• I think this is a great game.

• I like this game, I'm sure I can beat you.

• Select a card and put it in the slot at the front of the board.

• Oh that wasn't a good question. I've only put down two

pictures. I'll have to think next time.

• I'm sorry I didn't understand you. Can you say that again

please/can you repeat that, as I didn't hear you properly?

• I'm just wondering what I might ask you next. I'm trying to

trick you/I'm trying to make it difficult.

• Do you think there are any people in the world with long

crinkly purple hair? Maybe Mommy's hairdresser could give

her long crinkly purple hair.

• Could you describe someone who lives on another planet?

• I can't describe this one, as it is so peculiar.

Related activities

at home

• Playing board games, e.g. Ludo, Snakes and Ladders, Chinese

Checkers, Draughts, Trivial Pursuit, Connect Four.

• Playing bingo, barrier and matrix games.

• Describing procedures, that is telling someone how to do

something, e.g. make a milkshake/brush your teeth/build a

lego construction/do a craft activity.

• Learn and explain rules of games and sports, e.g.

basketball/soccer/football/computer games/hide and seek.

What next… • Develop complex open set listening.

• Develop listening in noise.

• Develop listening to a taped signal.

• Develop an understanding of the rules of the games.

• Develop the ability to explain.

• Model correct pronunciation of multisyllabic words.

• Model and monitor correct speech production.

• Develop pre-school readiness concepts of numeracy and

literacy.

• Encourage problem solving/making inferences/predicting.

• Introduce phonemic awareness skills. Listen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 106

Taped Story

Strategies • Use prompts.

• Ask questions.

• Rewind tape to listen again.

• Use clarification, e.g. What did you hear?

• Use a short simple story.

Skills/concepts

and language

• Retelling a story with a live voice.

• Listening to a taped story with questions as prompts.

• Answering three questions about a taped story.

Core language

(adult input)

• Put the tape in.

• Push the play button.

• Listen to the entire story first.

• Then listen to the questions.

• Answer each question.

• Rewind the tape if you want to listen to the story again.

• Are you ready?

Extended

language

(adult input)

• Make sure the tape recorder is plugged in.

• Put the tape in and press the play button.

• We'll listen to the story and all the questions first and then

go back and listen to the story again.

• If you don't hear part of the story or you do not understand,

tell me and we can rewind the tape and listen to it again.

Related activities

at home

• Listening to other information on the tape, e.g.:

- Procedures.

- Following directions.

- Questions.

What next… • Answer more questions about a taped story.

• Retell a story without questions as prompts.

• Retell a story in the correct sequence recalling as many

details as possible.

• Extend the length of the story.

• Increase the complexity of the story.

• Listen to a story with soft background noise on the tape.

• Talk on the telephone. Auditory Habilitation - AppendixListen Learn and Talk Auditory Habilitation Practice

© Cochlear Ltd, 2005 Page 108

Left blank intentionally – reverse side of Appendix Title Page

Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 109

Scales of Development and Assessment Tools

The following scales of development and assessment tools have been categorized by auditory

perception, language, speech, play and basic concepts. They have been provided as a reference.

A brief description accompanies each scale or test.

Auditory Perception (Listening)

Estabrooks, W. 1998, Auditory-Verbal Ages and Stages of Development in (Levels I – VIII) in Cochlear

Implants for Kids, AG Bell, Washington DC, U.S.A.

This checklist outlines the development of listening from sound awareness to auditory

comprehension including discrimination, identification, localization, auditory memory and

sequencing, listening from a distance and listening in noise.

Tuohy, J., Brown, J. and Mercer-Mosely, C., 2001, St. Gabriel's Curriculum for the Development of

Audition, Language, Speech, Cognition, Trustees of the Christian Brothers, St. Gabriel's School for

Hearing Impaired Children, Sydney, NSW, Australia.

This contains a hierarchical order for the development of auditory awareness and auditory

memory progressing from closed set to open set. The curriculum also includes sections on the

development of language, speech and cognition.

Wilkes, E.M. 1999, Cottage Acquisition Scales for Listening, Language and Speech. Simple Sentence

Level, Sunshine Cottage School for Deaf Children, Texas, U.S.A.

This developmental checklist is for assessment and diagnostic planning for therapy. The listening

section progresses from sound awareness to comprehension of paragraphs including phonetic

listening skills. This instrument also includes listening, speech and cognition in an integrated

approach.

Language

Bzoch, K. and League, R. 1991, The Bzoch-League Receptive–Expressive Emergent Language Test

(REEL-2), 2nd ed. Pro-Ed, Austin, Texas, U.S.A.

This scale designed for infants and toddlers up to 3 years, measures and analyzes emergent

language for intervention planning. Results are obtained from a parent interview and are given in

terms of an Expressive Language Age, a Receptive Language Age and a Combined Language

Age.

Carrow-Woolfolk, E. 1999, Test for Auditory Comprehension of Language (TACL-3), 3rd ed. Pro-ed,

Austin, Texas, U.S.A.

This test is comprised of three subtests and measures comprehension of vocabulary,

grammatical morphemes and elaborated phrases and sentences used by children from 3 to

9 years 11 months. The child has to select a picture from a choice of three to correspond to a

word, phrase or sentence spoken by the examiner. Test scores are converted into standard

scores, percentile ranks and age equivalents. Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 110

Dunn, L.M. and Dunn, L.M. 1997, Peabody Picture Vocabulary Test-(PPVT Forms 111A and 111B),

3rd ed. American Guidance Service, Circle Pines, MN, U.S.A.

This test measures a child's understanding of individual words (receptive vocabulary). It is

designed for children from 2 years 6 months to 18 years. Raw test scores are converted into

standard scores, percentile ranks and age equivalents.

Edwards, S., Fletcher, P., Garman, M., Hughes, A., Letts, C. and Sinka, I. 1997, The Reynell

Development Language Scales III (RDLS111), 3rd ed. NFER-NELSON London, U.K.

This test assesses receptive and expressive language using real objects rather than pictures for

the child to interact with. It is designed for children aged from 15 months to 7 years. The

comprehension scale comprises sections such as agents and actions, attributes, locative relations,

vocabulary and complex grammar, and inferencing, etc. The expressive scale comprises sections

such as verb phrases, auxiliaries, clausal elements, inflections, etc.

Fenson, L., Dale, P.S., Reznik, J.S, Thal, D., Bates, E., Hartung, J.P., Pethick, S. and Reilly, J.S. 1993,

The McArthur Communicative Inventories: User's Guide and Technical Manual - Words and Gestures

8 to 16 Months. Words and Sentences, Paul H. Brookes Baltimore, MD, U.S.A.

The words and gestures inventory is for parents to complete about their child's ability to

understand and/or use words and gestures. It includes vocabulary categories (animals, toys,

clothing, action words, etc.) and also asks about the child's gestures, games, routines, actions and

objects, imitation skills and pretend play. The words and sentences inventory is to record the

child's use of words in categories such as body parts, furniture and rooms, games and routines,

etc. It also has a section on sentences and grammar. This examines the child's use of nouns and

verbs, word endings and simple sentences.

Gardner, M.F. 2000, Expressive One Word Picture Vocabulary Test, 3rd ed. Academic Therapy

Publications, Novato, CA, U.S.A.

This test examines a child's receptive vocabulary. It is designed for students from 2 to 18 years.

Gardner, M.F. 2000, Receptive One Word Picture Vocabulary Test, 3rd ed. Academic Therapy

Publications, Novato, CA, U.S.A.

This test examines a child's receptive vocabulary. It is designed for students from 2 to 18 years.

Glover, M.E., Preminger, J.L. and Sanford, A.R. 1995, The Early Learning Accomplishment Profile Kit

(E-LAP), Kaplan Press, Lewisville, NC, U.S.A.

This is a criterion-referenced tool for young children from birth to 36 months. The book

provides guidance in programming for infants, young children and children with special needs.

The kit provides developmental data for gross motor, fine motor, cognitive, language, self-help,

and social/emotional skill areas; learning activity cards; and IFSP forms for individualized planning.

It also specifies the materials, procedures and criteria for each item to be assessed.

Moog, J. and Kozac, V. 1983, Teacher Assessment of Grammatical Structures (TAGS), Central

Institute for the Deaf, St Louis, MO, U.S.A.

This assessment consists of rating forms to be completed by the therapist regarding hearing

impaired children's understanding and use of grammatical structures in sentences of at least four

words that contain a subject and a verb. The grammatical categories are noun modifiers,

pronouns, prepositions, adverbs, verbs and questions.

Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 111

Rossetti, Louis Ph.D. 1990, The Rossetti Infant-Toddler Language Scale, LinguiSystems Inc, Moline,

Illinois, U.S.A.

This criterion-referenced instrument assesses preverbal communication skills and verbal areas of

gesture, pragmatics, play, interaction and attachment, language comprehension and language

expression for children from birth to 3 years old. Behaviors are observed by therapists or

caregivers.

Sanford, A.R. and Zelman, J.G. 1995, Learning Accomplishment Profile. Revised Kit (LAP-R), Kaplan

Press, Lewisville, NC, U.S.A.

This criterion referenced tool follows on from the E-LAP. It is a guide for individualizing

educational programming for the age range 36-72 months. The book enables the teacher to

identify appropriate learning objectives for each child and measures individual progress in the

areas of cognition, language and personal-social. It specifies the materials, procedures and criteria

for each item to be assessed.

Tuohy, J., Brown, J. and Mercer-Mosely, C. 2001, St. Gabriel's Curriculum for the Development of

Audition, Language, Speech, Cognition, Trustees of the Christian Brothers, St. Gabriel's School for

Hearing Impaired Children, Sydney, NSW, Australia.

This provides a developmental sequence for the structure of English from birth to 6 years. It

outlines the receptive and expressive skills in three monthly intervals from birth to 12 months

and then in six monthly intervals to 6 years. Grammatical structures are included. This curriculum

also includes sections on the development of cognition, speech and audition.

Wiig, E.H., Secord, W. and Semel, E. 1993, CELF-Preschool – Clinical Evaluation of Language

Fundamentals – Preschool, Examiner's Manual, The Psychological Corporation, San Antonio,

Texas, U.S.A.

This test assesses receptive and expressive language deficits in children aged from 3 years to

6 years 11 months. Norm referenced scores are provided for six monthly age intervals.

Expressive subtests include tests of word structure, referential word knowledge and sentence

recall. Receptive subtests assess understanding of basic concepts, linguistic concepts and

sentence structures.

Wilkes, E.M. 1999, Cottage Acquisition Scales for Listening, Language & Speech (CASLLS), Sunshine

Cottage School for Deaf Children, San Antonio, Texas, U.S.A.

This developmental checklist is for assessment and diagnostic planning for therapy. The language

section includes steps from pre-verbal through to complex sentences including pragmatic

development. This instrument also includes listening, speech and cognition in an integrated

approach.

Zimmerman, I.L., Steiner, V.G., and Pond, R.E. 2002, Preschool Language Scale-4, (PLS-4), The

Psychological Corporation, San Antonio, Texas, U.S.A.

This is a standardized test of auditory comprehension and expressive communication for infants

and toddlers. The auditory comprehension subscale assesses basic vocabulary, concepts and

grammatical markers in preschoolers and higher-level abilities such as complex sentences,

making comparisons and inferences, etc. in older children. The expressive communication

subscale asks preschoolers to name objects, use concepts that describe objects, express

quantity, use grammatical markers, etc. For older children it includes word segmentation,

completing analogies, telling a short story in sequence, etc. This test also includes an articulation

screener and a language sample checklist. Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 112

Speech

Goldman, R. and Fristoe, M. 2002, Goldman Fristoe: Test of Articulation 2, AGS Publishing, Circle

Pines, MN, U.S.A.

This test provides information about a child's articulation ability by sampling both spontaneous

and imitative speech production of students from 2 to 18 years. Pictures and verbal cues are

used to elicit single word answers that demonstrate common speech sounds. It measures

articulation of speech sounds, determines the types of misarticulation and compares individual

performance to national, gender differentiated norms.

Ling, D. Ph.D. 1991, The Phonetic-Phonologic Speech Evaluation Record: A Manual, Alexander

Graham Bell Association for the Deaf, U.S.A.

This test evaluates the segmental and nonsegmental aspects of speech at both the phonetic and

phonologic levels. Phonetic level responses are obtained through imitation. Phonologic level

responses are obtained from spontaneous language samples.

Paden, E. Ph.D., and Brown, C. M.S. 1992, Identifying Early Phonological Needs in Children with

Hearing Impairment, AG Bell, Washington DC, U.S.A.

This standardized test assesses how young children with hearing impairment spontaneously use

first-level phonological patterns. It numerically rates whether the child's patterns are missing,

emerging or mastered.

Tuohy, J., Brown, J. and Mercer-Mosely, C. 2001, St. Gabriel's Curriculum for the Development of

Audition, Language, Speech, Cognition, Trustees of the Christian Brothers, St. Gabriel's School for

Hearing Impaired Children, Sydney, NSW, Australia.

This outlines the development of early speech, the development of auditory feedback skills, and

an order for the acquisition of vowels, diphthongs and consonants. It provides a developmental

checklist of phonological processes. The curriculum also includes sections on the development

of cognition, language and audition.

Wilkes, E.M. 1999, Cottage Acquisition Scales for Listening, Language & Speech. Simple Sentence

Level, Sunshine Cottage School for Deaf Children, Texas, U.S.A.

This developmental checklist is for assessment and diagnostic planning for therapy. The speech

section tracks objectives from the renowned motor speech program of Dr. Daniel Ling (both

phonetic and phonologic) and also links these objectives to phonetic listening development. This

instrument also includes listening, language, and cognition in an integrated approach.

Williams Hodson, B. 1983, The Assessment of Phonological Processes, College-Hill Press, Inc,

U.S.A.

This test uses pictures to elicit single words. Its method of analysis of the productions highlights

deficient patterns of speech and provides a starting point for a phonological approach to

remediation.

Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 113

Play

Lowe, M. and Costello, A. 1988, Symbolic Play Test Second Edition, NFER-NELSON London, UK.

This test is based on a developmental study of representational play in infants 12 months to 36

months. It evaluates children's spontaneous non-verbal play skills in a structured situation.

Objects are presented in a standard manner and left to the child's free use. The purpose is to

assess if the child has developed concepts and symbolism, which precede and develop alongside

receptive and expressive verbal language. Criterion referenced age scores are available.

Basic Concepts

Boehm, A.E. 1986, Boehm Test of Basic Concepts-Revised (BOEHM-R), The Psychological

Corporation, San Antonio, Texas, U.S.A.

This test is administered to kindergarten students and tests basic concepts of comparison,

direction, position, quantity and time.

Bracken, B. 1998, Bracken Basic Concept Scale-Revised (BBCS-R), The Psychological Corporation,

San Antonio, Texas, U.S.A.

This measures basic concept acquisition and receptive language skills of children aged from 2

years, 6 months to 8 years. It includes several conceptual categories – colors, letters, numbers,

counting, sizes, comparisons, shapes, direction/position, self/social awareness, texture/materials,

quantity, and time/sequence. Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 114

Glossary

Acoustic

highlighting:

Emphasizing the key element of a sentence more than the

other words around it.

Acoustic: Pertaining to the sense of hearing; pertaining to the science of

audible sounds.

Alveolar: A speech sound formed by the action of the tongue against the

upper teeth, for example, [t, d, s, z, l, n].

Articulation: The production of speech sounds by movement of the tongue,

lips and jaw.

Auditory

bombardment:

The technique of targeting a particular sound through

repetition and acoustic highlighting.

Babbling: A stage in the development of speech in babies - it follows the

limited vocalizations of a baby's first few months. During the

babbling stage, the baby produces a variety of sounds in

consonant vowel combinations, which increase in complexity.

Bilabial: A speech sound formed by the action of both lips,

for example, [p, b, m]

Closed set listening: Processing language through listening with the aid of prompts.

Closed set listening tasks are used in the initial stages of

learning to listen. There are a limited number of objects from

which to choose to assist the listener to successfully identify,

comprehend and recall the language.

Co-articulation: The effect one sound has on the production of another sound

adjacent to it.

Competing stimuli: Any background sounds or noises that tend to mask the

speech signal making it more difficult to hear what is being said.

Listening with competing stimuli is a more difficult listening task

to be achieved.

CV syllable: A syllable containing a consonant and a vowel, for example,

[pa].

CVC syllable: A syllable containing a consonant, a vowel and a consonant, for

example, [pat].

Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 115

Decibel (dB): The standard unit for measuring the intensity of a sound.

Diphthong: A vowel glide in which the tongue begins in the position of one

vowel and moves towards another vowel, for example, the

diphthong [ai] in the word high - the tongue starts in the

position of [a] and moves towards the [i].

Echolalia: An infant's repetition of sounds made by others, a normal

occurrence in childhood development.

Frequency: The rate of vibration (cycles per second) of molecules when a

sound is produced is the frequency of that sound. It is

measured in Hertz (Hz). As the cycles per second increase,

that is, as the frequency increases, the sound is perceived as

being higher.

Fricative: A speech sound which has audible, turbulent breath flow, for

example, [f, th, s, sh].

Incidental language: The language used in addition to the core language associated

with an activity, game or daily routine.

Inflections: Changes in the pitch or tone of the voice.

Intensity: The measured quantity (loudness) of a sound expressed in

decibels.

Intonation: The melody or tune of the voice in speaking.

Jargoning: The stage that follows babbling in the development of speech

and language - the vocalizations of the child start to have

identifiable intonation patterns and recognizable words.

Localization: The ability to locate the direction of a sound.

M L U: Mean Length of Utterance is the average number of

morphemes used by a speaker - this is mainly used to describe

a child's development in producing longer utterances.

MAPping: The tuning of the cochlear implant to achieve a range of

sounds, which are audible to the wearer.

Medial consonants: Consonants in the middle position in a word, for example, the

/t/ in little.

Modality: A sensory channel such as hearing, vision or touch. Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 116

Morpheme: The smallest unit of meaning in a language - a word or part of a

word, for example, unladylike has morphemes 'un', 'lady' and

'like'.

Motherese: The special way that mothers/caregivers talk to small children -

sometimes described as a singsong voice.

Nasal: A speech sound in which the voice escapes through the nasal

passage, not through the mouth, for example, [m, n].

Object

permanence:

The understanding that objects are real and don't cease to

exist when they can't be seen.

One-to-one

correspondence:

Being able to count a number of objects - not simply rote

counting.

Open set listening: The ability to process language through listening alone without

prompts, for example, story retelling - open set listening tasks

are for experienced listeners.

Performatives: Sounds used by adults in conjunction with the name of an item,

for example, the moo of the cow, the bu bu of the boat. These

sounds may be the child's first words.

Phoneme: The smallest sound in a language that carries meaning, for

example, [s, t, e, u, etc.].

Pitch: The quality of a sound judged by a listener to be lower or

higher.

Place contrasts: Sounds which are produced in the same way but differ because

of the place they are produced in the mouth, for example, [p]

and [k] are both plosives but [p] is produced at the front of the

mouth and [k] is produced at the back..

Plosive: A speech sound produced with a sharp burst of air, for

example, [p, b, t, d, k, g].

Pragmatics: A set of rules which governs the use of language in social

contexts

v

.

Prosody: The tune and rhythm of speaking - features include pitch,

duration and intensity.

v

Bates, 1976

Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 117

Role-plays: Play acting a character in a particular scenario.

Segmentals: Consonants, vowels and diphthongs.

Stimulus/response: An activity in which the stimulus is a sound or sounds delivered

by an adult to another person listening - the response can be

an action, for example, putting a peg in a board or a verbal

repetition of the sound(s). This establishes what the listener is

able to hear.

Stress: A greater degree of loudness of a syllable in a word, for

example, reduce, or of word(s) in a sentence, for example, That

hat is not yours.

Suprasegmentals: Features of speech such as intensity, duration and pitch.

Syntax: The rules of sentence construction in the grammar of a

language.

Tracking: Repeating reliably every element of a message.

Vocalizations: Sounds produced by babies in the early stages of developing

speech and language.

Voicing/voiceless

pair:

Two sounds which are produced in the same manner and in

the same place in the mouth but one is voiced and the other is

unvoiced, for example, [s,z] – [s] is unvoiced and [z] is voiced:

[t,d] – where [t] is unvoiced and [d] is voiced. Some other

examples are [f,v]; [p,b]; [k,g]; [ch,j]. Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 118

Bibliography and Reference

Bates, E. 1976, Language and context: Studies in the acquisition of pragmatics, Academic Press,

New York, U.S.A.

Bzoch, K. and League, R. 1991, The Bzoch-League Receptive-Expressive Emergent Language Test

(REEL-2), 2nd ed. Pro-Ed Austin, Texas, U.S.A.

Clark, G. M. Cowan, R. S. and Dowell, R. C. 1997, Cochlear Implantation for Infants and Children,

AG Bell, Washington DC, U.S.A.

Cole, E. B. 1992, Listening and Talking. A Guide to Promoting Spoken Language in Young Hearing–

Impaired Children, AG Bell, Washington DC, U.S.A.

Estabrooks, W. 1994, Auditory-Verbal Therapy for Parents and Professionals, AG Bell, Washington

DC, U.S.A.

Estabrooks, W. 1998, Cochlear Implants for Kids, AG Bell, Washington DC, U.S.A.

Estabrooks, W. 2001, 50 Frequently Asked Questions About Auditory–Verbal Therapy, Learning to

Listen Foundation, Canada.

Estabrooks, W. and Marlowe, J. 2000, The Baby is Listening, AG Bell, Washington DC, U.S.A.

Estabrooks, W. and Schwartz, R. 1995, The ABCs of AVT: Analyzing Auditory-Verbal Therapy, AG

Bell, Washington DC, U.S.A.

Flexer, C. 1999, Facilitating Hearing and Listening in Young Children: Early Childhood, 2nd ed, AG

Bell, Washington DC, U.S.A.

Flexer, C. and Richards, C. 1998, We Can Hear and Speak! The Power of Auditory-Verbal

Communication for Children who are Deaf or Hard of Hearing, AG Bell, Washington DC, U.S.A.

Glover, M. E., Preminger, J. L. and Sanford, A R. 1995, The Early Learning Accomplishment Profile

Kit (E-LAP), Kaplin Press, Lewisville, NC, U.S.A.

Kretschmer, R. R. and Kretschmer, L. 1978, Language development and intervention with the

hearing-impaired, Baltimore, MD: University Park Press, U.S.A.

Ling, A. 1974, Schedules of Development in Audition, Speech, Language, Communication for HearingImpaired Infants and Their Parents, AG Bell, Washington DC, U.S.A.

Ling, D. 1976, Speech and the Hearing-Impaired Child: Theory and Practice, AG Bell, Washington

DC, U.S.A.

Listen Learn and Talk Appendix

© Cochlear Ltd, 2005 Page 119

Ling, D. 1989, Foundations of Spoken Language for Hearing-Impaired Children, AG Bell,

Washington DC, U.S.A.

Ling, D. 1990, Foundations of Spoken Language for Hearing-Impaired Children, A.G Bell,

Washington D.C, U.S.A.

Ling, D. and Ling, A. 1977, Basic Vocabulary and Language Thesaurus for Hearing-Impaired Children,

AG Bell, Washington DC, U.S.A.

Ling, D. and Ling, A. 1978, Aural Habilitation: The Foundations of Verbal Learning in HearingImpaired Children, AG Bell, Washington DC, U.S.A.

Pollack, D. 1985, Educational Audiology for the Limited Hearing Infant and Preschooler, Charles C.

Thomas, Springfield, IL, U.S.A.

Romanik, S. 1990, Auditory Skills Program for Students with Hearing Impairment, NSW Department

of School Education, Sydney, NSW, Australia.

Ross, M. (Ed.) 1990, Hearing-impaired children in the mainstream, York Press Inc., Timonium, MD,

U.S.A.

Rossetti, L. 1990, The Rossetti Infant-Toddler Language Scale, LinguiSystems Inc, Moline, Illinois,

U.S.A.

Sanford, A. R. and Zelman, J. G. 1995, Learning Accomplishment Profile Revised Edition Kit (LAP-R),

Kaplin Press, Lewisville, NC, U.S.A.

Schwartz, S. and Miller, J. 1996, The New Language of Toys: Teaching Communication Skills to

Children with Special Needs, A Guide for Parents and Teachers. 2nd ed, AG Bell, Washington DC,

U.S.A.

Simser, J. 1989, Learning to Listen, Federation of Junior Deaf Education Conference, Sydney, NSW,

Australia.

Tuohy, J., Brown, J. and Mercer-Mosely, C. 2001, St. Gabriel's Curriculum for the Development of

Audition Language, Speech, Cognition, Trustees of the Christian Brothers, St. Gabriel's School for

Hearing Impaired Children, Sydney, NSW, Australia.

Wilkes, E. M. 1999, Cottage Acquisition Scales for Listening, Language and Speech, Cottage School

for Deaf Children, San Antonio, Texas, U.S.A.

Zimmerman, I. L., Steiner, V. G. and Pond, R. E. 1991, Preschool Language Scale-4, (PLS-4),The

Psychological Corporation, San Antonio, Texas, U.S.A. The Listen Learn and Talk Package is an auditory habilitation

program for children with a hearing impairment identified

under 12 months. It consists of a book and a DVD. This

program was developed for parents and professionals as a

resource to supplement the child's habilitation program. The

program follows the natural development of the child from

birth to pre-school age. It contains ideas and strategies for

developing spoken language through listening.

The first section of the book provides information on the

importance of parent participation in the habilitation process,

auditory habilitation strategies and an integrated development

scale from birth to 48 months. The second part relates to the

DVD demonstrations, expanding on the strategies shown and

providing additional ideas for activities at home. The book also

includes a glossary, a list of scales of development and

assessment tools used by professionals.

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