Using Normal DevelopmeNtal milestoNes with very Young Children who have Cochlear implants By Krista S. Heavner, MS, CCC-SLP/LSLS Cert AVT® Why should we use normal developmental milestones? 1. Children who are deaf have the potential to learn to hear and speak with a cochlear implant. 2. specific goals can be developed for children with cochlear implants using normal developmental milestones for vocabulary, speech, and language as a guide. 3. progress can be measured to determine if a child is meeting appropriate milestones. Begin by establishing the child’s “hearing age” to use normal speech and language milestones to monitor the performance of children who are deaf, you must first establish the child’s hearing age. When a child’s cochlear implant is activated he/she celebrates a hearing birthday, and a “hearing age” is used to indicate the child’s length of time with the cochlear implant. skill level at the hearing age is compared to the chronological age. When there is a gap between the two ages, therapy goals are set to help the child “close the gap” with the ultimate objective that the implanted child will eventually reach the skill level of his normalhearing peers. Children 1 year of age and older are approved for cochlear implantation. the table below, from asha.org, includes listening and speaking milestones for children birth to 2 years of age with normal hearing and can be useful for assessing the post-operative progress of children with cochlear implants.1 Hearing and Understanding Talking 0–3 Months 0–3 Months • startles to loud sounds • Quiets or smiles when spoken to • seems to recognize caregiver voice and quiets if crying • increases or decreases sucking behavior in response to sound • makes pleasure sounds (cooing, gooing) • Cries differently for different needs • smiles when sees parent 4–6 Months 4–6 Months • moves eyes in direction of sounds • responds to changes in tone of your voice • Notices toys that make sounds • pays attention to music • Babbling sounds more speech-like with many different sounds, including p, b and m • vocalizes excitement and displeasure • makes gurgling sounds when left alone and when playing with youtools for toDDlers by advanced Bionics 2 Using Normal DevelopmeNtal milestoNes Therapy Planning each therapy session should contain goals and activities related to each area of development: audition, Cognition, speech, language, and vocabulary, as well as activities parents can do with their children to reinforce the concepts learned in therapy. Auditory Goals Below is a list which includes some examples of activities that may be included at each level of the auditory hierarchy. Hearing and Understanding Talking 7 Months–1 Year 7 Months–1 Year • enjoys games like peek-o-boo and pat-a-cake • turns and looks in direction of sounds • listens when spoken to • recognizes words for common items like “cup”, “shoe,” “juice” • Begins to respond to requests (“Come here,” “Want more?”) • Babbling has both long and short groups of sounds such as “tata upup bibibibi” • Uses speech or non-crying sounds to get and keep attention • imitates different speech sounds • Has 1 or 2 words (bye-bye, dada, mama) although they may not be clear 1–2 Years 1–2 Years • points to a few body parts when asked • Follows simple commands and understands simple questions (“roll the ball,” “Kiss the baby,” “Where’s your shoe?”) • listens to simple stories, songs, and rhymes • points to pictures in a book when named • says more words every month • Uses some 1-2 word questions (“Where kitty?” “Go bye-bye?” “What’s that?”) • puts 2 words together (“more cookie,” “no juice,” “mommy book”) • Uses many different consonant sounds of the beginning of words Hierarchy of Listening Skills adapted from Figure 4.1, estabrooks, W. (ed.) 2006. auditory-verbal therapy theory and practice, p. 78. Detection Identification • Conditioned play response • spontaneous alerting response • suprasegmentals - prosodic features of speech - loudness and pitch - angry and sad voices - male, female, and children’s voices • segmentals - initial “sound” vocabulary - Words varying in number of syllables • Words in which the vowel is constant and the consonants contrast in manner, place, and voicing • two critical elements in a message • auditory monitoring of segmentals Discrimination • same/different tasks - one, two, three-syllable word discrimination - minimal pair discriminationtools for toDDlers by advanced Bionics 3 Using Normal DevelopmeNtal milestoNes **it is important to note that children with cochlear implants may not need formal teaching of each goal at each level due to advances in cochlear implant sound processing. often children do not require formal training at the discrimination level. Speech and Language Goals Use of the chart below can be helpful for establishing specific goals for acquiring new vocabulary. Rate of Vocabulary Acquisition2,3 12 months First expressive word appears 18 months 20–100 words 24 months 300 words 36 months 900 words 48 months 1,500 words 60 months 2,500 words Therapy Tips 1. Write very specific short-term goals. example: “Given auditory input, child will learn 10 new words per week. Child will demonstrate comprehension of 2–3 critical elements in a message through audition alone.” 2. therapy sessions are diagnostic, so stay one step ahead of the child’s skills (or two!) and be prepared to adjust the activity as needed. 3. therapy is fun and functional. avoid activities the child has mastered in the past, except for review. 4. the parent can be an active participant, not a passive observer. Don’t forget to involve mom and dad! 5. set high expectations for the child from the beginning. 6. Be prepared for the unexpected! When therapy “falls apart” have a bag of tricks to engage the child, such as a hand puppet or a pop-up toy, to get the session going. References: 1. How Does Your Child Hear and talk? available at asha.org/public/speech/development/child_hear_talk.htm. accessed october 5, 2006. 2. Flexer, C. 1994. Facilitating Hearing and listening in Young Children. san Diego, Ca: singular publishing Group, inc. 3. sindrey, D. 1997. listening Games for littles. london, ontario. Word play publications.
Posted on: Fri, 07 Jun 2013 08:09:59 +0000
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