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Prevalence of children with HL

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While numbers vary depending on the criteria used, it is commonly reported that there are approximately 50,000 youngsters who are deaf in the U.S. educational system (about 1 in every 1,000 children), and the majority of them receive special services.

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How are most children identified with early HL

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newborn hearing screening programs

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Habilitation:

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children having prelingual hearing loss

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• AR should be approached differently for various children

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Based on: o degree o time of onset o age of the child

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Deafness categories for children

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Congenital: hearing loss present at birth • should be served through early-intervention ASAP • Prelingual: onset of loss prior to the acquisition of spoken language • Postlingual: onset of loss after spoken language has been acquired • served in a variety of settings, depending on technological intervention and geographic area

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Before entering school what did AR INCLUDE?

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• Before entering school, AR included parent-infant and preschool programs

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Two-way division

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0-5: before school years; 5-18+: school years o 0-3 years= infancy and toddlerhood o 3-5 years= preschool years o 5-18 years= kindergarten, grade school, junior high, and high school

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What other disabilities may be present?

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• May have visual impairments, motor disabilities, or intellectual disabilities

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What technological advances allow for identification of hearing loss soon after birth through?

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the use of two tests of hearing, otoacoustic emissions (OAE) and auditory brainstem response (ABR).

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What are the disadvantages of protocol screenings?

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o Current newborn protocols may miss some infants with sensorineural hearing loss, including those with the mildest degrees of loss, onset of hearing loss after the newborn period, or those with auditory neuropathy.

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By what age should testing be completed

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testing should be completed by 3 months of age

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Almost all school in the US conduct hearing screenings for?

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kindergarten and first-graders

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• Once of age results should include information on both ears giving:

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otoscopic findings, degree and configuration of loss, type of loss and cause, speech recognition ability (clarity of hearing), most comfortable level (MCL), threshold of discomfort (TD), hearing aid performance (verification), and audibility measures

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What intervals should assessment be taken place?

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From birth-3 yrs children should be seen for audiologic assessment at 3-month intervals, at 6-month intervals during the preschool year, and once a year after that.

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Family-centered practice

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includes a focus on family-identified needs, efforts to form partnerships with parents to address child needs, and empowerment of families as the primary decision makers for their child

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Child-centered practice

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refers to an intervention that provides direct service for the child, with limited direct involvement of the parent in intervention

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What is the purpose of EI?

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Therefore, the purpose of early intervention is to get input from the family so that the family can assist their infant activities, routines, and events of everyday life. <-------------Functional

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Five major principles of family-centered practice include:

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1. To support care providers in developing competence and confidence in helping the infant to learn. 2. Family-identified needs should drive the intervention agenda; the professional should adapt to the values culture, and goals. 3. Family members are recognized as the constant in the child's life and the expert. 4. Families are equal team members. 5. Professionals respect the decision-making authority of the family.

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Family centered practice should focus on the following key ingredients:

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Understanding the family routines and important events • Keeping the intervention focused around these • Directing intervention at the capacities of parents to interact appropriately with the child during these activities • Understanding next steps to development • Having skills in teaching parents effective scaffolding techniques.

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Parents are encouraged to be

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consistent, strategic, adaptive, and informed.

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there is an art and a science to early intervention.

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Art-human side • Science- special knowledge of deafness, infancy, and families that the parent-infant educator brings to the task.

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Tools of trade to be a skilled provider

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• Information resource • Coach/partner • Joint discover • News commentator- • Partner in play • Joint reflector and planner-

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Information resource-

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to provide information in objective ways, so that the families become independent advocates and learners.

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Coach/partner-

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a mindset that shifts the focus from the expert-given toward the "learner-focused".

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Joint discover-

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this prepares the families to try techniques with the child and evaluate how they work.

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New commentator

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-Decisions based on ongoing evaluation of what works. Provides descriptive, objective, specific feedback. Ex.-I notice every time she vocalizes, you talk back. o Points out what the family is doing well. o Confidence building.

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Partner in play

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clinician demonstrates play and then sees if the parent can "try the new skill".

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Joint reflector & planner

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at the end of each session, the parent and clinician work together tp list key observations and successes from the time together.

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interdisciplinary teamwork-

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team members collaborate and are interdependent, rather than working independently.

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What Does The Audiologic Rehabilitation Specialist Provide?

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• Fitting and adjustment to full time use of amplification, cochlear implants, and other devices • Auditory learning( use of residual hearing) • Techniques for optimizing communicative development (whether the family is using auditory, auditory-visual, or visually based approaches. *****Once the child reaches preschool age, these service shift to the center-based models***** •

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center-based models*****

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Regular Preschool setting with assistance • Self-contained programs also are available

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What method of determining a child's usable hearing with amplification.

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Desired Sensation Level-a computer based method

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What type of HA is typically used from infancy to school years

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BTE

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• The role of the AR clinician is to

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ensure that the child's device is functioning properly and worn consistently.

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• Auditory learning activities for infants should focus on

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observing and promoting natural listening opportunities throughout natural daily routines.

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• Cole and Flexer (2011) describe a developmental approach to auditory linguistic learning. The process they outline involves four phase of infant auditory learning:

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understanding simple language through listening 4. understanding complex language through listening (in both quiet and noise)

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Koch (1999) applies Eber's classic model in an approach to auditory development that integrates listening, producing speech, and developing language concepts. She includes the following four basic components of listening therapy:

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🍺auditory attention • perception/production • sound/object association • language and listening integration

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Adaptive auditory skill development refers to

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the continual monitoring of a child's responses and adjustment of the level of difficulty of the task to bring about success or further challenge.

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auditory learning" or "auditory communication

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Language, audition, and phonological acquisition are intricately related process that should be addressed in an integrated fashion.

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Learning to Talk Around the Clock (Karen Rossi)

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• Concept is intended to guide the content of home visits conducted in natural settings.

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signature behaviors

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behaviors in language and listening that foster development of spoken language

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Other Resources for Parental Trainin

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• Hanen Early Language Resource Centre in Toronto o developed a plan for children with speech and language delay o provision of It Take Two to Talk o It Takes Two To Talk - The Hanen Centre • Infant Hearing Resource • Support for Learning American Sign Language (ASL) • Project SKI-HI o recently tested and developed the Deaf Mentor Programming o the program utilizes the services of adults who are Deaf as mentors and models of the language and culture o Mentor visits interacts with the child using ASL, while a parent advisor visits in order to help parents promote English acquisition

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Bilingual-Bicultural?

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As previously stated under the Project SK-HI model, the Bilingual-Bicutural (Bi-Bi) incorporates two modes of communication: ASL and language acquisition. • Studies have shown that early bi-bi Deaf monitoring programming has made greater language gains during treatment.

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Evaluations can be formal or informal measures of:

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o speech o language o listening o pragmatic skills o early literacy and learning

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Roles of AR clinician inTypical Preschool Setting AR clinican MUST:

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ensure that the acoustic environment supports the child's need • determine if the room acoustics and teacher strategies support the child's learning • continue to have individual language learning need addressed by the professional •

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Appropriate Practice = Beneficial Practice

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Decision making needs to be informed by knowledge 2. Goals are both challenging & achievable 3. Teaching needs to be both intentional & effective 4. High-quality learning experiences are provided

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• During the early years of of the child's life, hearing families who have a child with D/HH require both

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informational and adjustment counseling (ASHA, 2008)

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Adjustment Counseling

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describe adjustment to hearing loss counseling as the support professionals provide to families as they learn of their child's hearing loss and strive to recognize, acknowledge, and understand the realities of having a child with hearing loss

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guide by your side program (GBYS)

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that is designed to offer parent-to-parent support at the time of diagnosis and in the next few months in the home visit setting

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• Family-to family support groups are often effective when they address

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family-identified needs, may be family-led, and provide ample opportunities for networking with other families

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Benefits of Support Group Interactions

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1. They enable members to recognize the universality of their feelings; members come to appreciate that others in the group have similar feelings 2. They give participants the opportunity to help one another 3. They become a powerful vehicle for imparting information

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Assessment of School-Age Child Includes four general areas:

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1. Communication status, including audiologic and amplification issues, receptive and expressive language, and social communication skills 2. Overall participation variables of academic achievement, psychosocial adaptation, and prevocational and vocational skills 3. Related personal factor 4. Environments factors

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• Basic monitoring of CI can include:

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1. Checking battery function. 2. Monitoring the child's ongoing ability to detect or discriminate the Ling sounds. 3. Use of a signal check device to monitor if a signal is being transmitted. 4. Checking all cords for shorts or intermittencies. 5. Keeping a supply of extra cords, magnets, and batteries.

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Reverberation time (RT)

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is a measure of how long it takes before a sound is reduced by 60 DB once it is turned off.

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In a typical classroom, RT is

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around 1.2 seconds.

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sound treated classroom with carpets, tile, and solid core doors, RT can be

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on the order of 0.4 second.

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CAPD

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central auditory processing disorder

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CAPD involves

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either a delay in development, disordered development, or a specific central lesion.

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CAPD may occur in isolation but CAPD often occurs in conjunction with

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ADHD, LD, autistic spectrum disorders, reading problems and speech deficits.

Ch. 9 AR – Flashcard

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