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ASHA speech and language milestones
Birth to 3 Months
- Startles to loud sounds
- Quiets or smiles when spoken to
- Seems to recognize your voice and quiets if crying
- Increases or decreases sucking behavior in response to sound
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Birth - 3 Months
- Makes pleasure sounds (cooing, gooing)
- Cries differently for different needs
- Smiles when sees you
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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 Chuckles and laughs
- Vocalizes excitement and displeasure
- Makes gurgling sounds when left alone and when playing with you
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7 Months-1 Year
- Enjoys games like peek-a-boo and pat-a-cake
- Turns and looks in direction of sounds
- Listens when spoken to
- Recognizes words for common items like "cup", "shoe", "book", or "juice"Begins to respond to requests (e.g. "Come here" or "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
- Uses gestures to communication (waving, holding arms to be picked up)
- Imitates different speech sounds
- Has one or two words (hi, dog,dada, mama) around first birthday, although sounds may not be clear
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1 - 2 Years
Hearing and Understanding
- 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.
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1 - 2 Years
Talking
- Says more words every month.
- Uses some one- or two- word questions ("Where kitty?" "Go bye-bye?" "What's that?").
- Puts two words together ("more cookie," "no juice," "mommy book").
- Uses many different consonant sounds at the beginning of words.
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2 - 3 Years
Hearing and Understanding
- Understands differences in meaning ("go-stop," "in-on," "big-little," "up-down").
- Follows two requests ("Get the book and put it on the table").
- Listens to and enjoys hearing stories for longer periods of time
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2 - 3 Years
Talking
- Has a word for almost everything.
- Uses two- or three- words to talk about and ask for things.
- Uses k, g, f, t, d, and n sounds.
- Speech is understood by familiar listeners most of the time.
- Often asks for or directs attention to objects by naming them.
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3 - 4 Years
Hearing and Understanding
- Hears you when you call from another room.
- Hears television or radio at the same loudness level as other family members.
- Answers simple "who?", "what?", "where?", and "why?" questions.
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3 - 4 Years
Talking
- Talks about activities at school or at friends' homes.
- People outside of the family usually understand child's speech.
- Uses a lot of sentences that have 4 or more words.
- Usually talks easily without repeating syllables or words.
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4 - 5 Years
Hearing and Understanding
- Pays attention to a short story and answers simple questions about them.
- Hears and understands most of what is said at home and in school.
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4 - 5 Years
- Uses sentences that give lots of details ("The biggest peach is mine").
- Tells stories that stick to topic.
- Communicates easily with other children and adults.
- Says most sounds correctly except a few like l, s, r, v, z, ch, sh, th.
- Says rhyming words.
- Names some letters and numbers.
- Uses the same grammar as the rest of the family.
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Morphology
- Form
- Branch of linguistics that studies the structure of words
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Phonology
- Form
- Study of how sounds are organized and used in natural languages
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Pragmatics
- Use
- The study language as it is use in social contexts
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Semantics
- Content
- Meaning of words and language
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Syntax
- Form
- the arrangement of words and phrases to create well-formed sentences in a language.
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Hearing is the foundation to developing speech perception
- Yoshingaga-Itano, et al.
- Children w/ HL that received appropriate management by 6 months of age often developed age-appropriate speech by 5 years.
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Early Hearing Detection and Intervention (EHDI)
The goals for the EHDI Program are called “1-3-6”
- "1" - All infants are screened for hearing loss no later than 1month of age, preferably before hospital discharge.
- "3" - All infants who do not pass the screening will have a diagnostic audiologic evaluation no later than 3 months of age.
- "6" - All infants identified with a hearing loss receive appropriate early intervention services no later than 6months of age
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5 Factors Affecting Language Acquisition
Other Handicapping Conditions
40% of children with hearing loss have other special needs
- 10% Learning Disability
- 9.1% Cognitively Impaired
- 6.6% Attention Deficit
- 4.5% Visual impairment
- 3.2% Cerebral Palsy
- 2.0% Emotional disturbance
- 13.3% Other conditions
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Factors Affecting Language Acquisition
Predictors
- Degree of hearing loss
- Age
- Age of identification (before or after 6 months)
- Cognitive Status
- Other disabilities
- Client diversity
- Early intervention
- Availability of cochlear implants
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Language Characteristics of Preschool Children with Hearing Loss
- Parent- child interaction
- Less likely to use verbal praise, ask for opinions and suggestions and use questions
- More likely to use visual communication and tactile attention getting strategies
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Language Characteristics of School Aged Children with Hearing Loss
Form errors
- Shorter & simpler sentences
- Overuse of subject-verb-object pattern
- Incorrect usage of irregular verb tense
- Infrequency use of adverbs, auxiliaries and conjunctions
- Few compound sentences
- Inappropriately constructed sentences, non English word order
- “The dog bone he want”
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Language Characteristics of Children with Hearing Loss
Content errors
- Reduced expressive and receptive vocabulary
- Reduced ability to produce “Category” labels
- Reduced understanding of object-function
- Difficulty with multiple meaning of words
- Limited understanding figurative language
- Metaphors, idioms
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Language Characteristics of Children with Hearing Loss
Use errors
- Restricted range of communicative intent
- Limited knowledge and use of communication repair strategies
- Lack of knowledge regarding conversational rules such as changing the subject or closing conversations
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Language assessment Options
- Formal test (See table 6.2 on page 228): Tests normed on Children w/ HL
- Checklists and inventories
- Language samples and narratives
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Communication and Language Management
Treatment goals for language development
- Enhance parent-child communication
- Understand the increasingly complex concepts and discourse
- Acquisition of lexical and world knowledge
- Develop verbal reasoning (foundation for literacy)
- Enhance self expression
- Develop spoken, written and narrative skills
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Speech sound development
- Hearing is the foundation for speech sound development
- Fetus hears speech at 28 weeks gestation
- A child can discriminate the sounds of his native language at 6 months
- Normal hearing infants normally produce intelligible words around 12 months of age
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Speech sound development
Normal sequence of sound production
Crying and vegetative sounds --> cooing --> reduplicated babbling --> Variegated babbling --> first word
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Speech sound development
Infants with hearing loss
Cry, coo, squeal, growl and babble (same as hearing infants)!
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Speech characteristics
Prelingual mild to moderately severe hearing loss
- Intelligible speech
- Misarticulation of single consonants
- Problems with affricates, fricatives and blends
- Common error types
- Assessment: standard articulation tests and phonological analysis tests
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Speech characteristics
Prelingual severe to profound range
Two key points:
- Even with the best hearing aid technology development of intelligible speech in children with a prelingual severe to profound hearing loss is challenging
- Speech intervention should focus on establishing overall communication competence
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Speech characteristics
Prelingual severe to profound range
- Articulation
- Distortions, omission, substitutions common with all phonemes
- Consonant errors especially fricatives and affricates
- Vowel difficulties
Suprasegmental (duration, fundamental frequency changes w/in a single utterance, breathing pauses/difficulties, rate)
Resonance/Nasality
Pitch and intensity
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Speech Assessment for children with Hearing Loss
Measurement
- Measurement of articulation and phonology
- Standard articulation and phonology tests
- Speech intelligibility measures-Percent intelligible word scores and intelligibility ratings
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Speech Training-Children with Hearing Loss
Management key points
- 1. Integrate auditory with speech goals
- 2. Use dialog format instead or tutorial format
- 3. Use bridging activities to promote “real-world” carryover
- 4. Practice communicative sabotage
- 5. Use contrast in perception and production
- 6. Select speech goals that enhance comm. competence
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Speech Training-Professional Issue
When working on speech development with children w/HL remember:
- 1. Auditory feedback may not be sufficient. Consider visual, tactile or kinesthetic cues.
- 2. Know the child's hearing loss w/ and w/o amplification. (familiar sounds audio)
- 3. Don’t forget coarticulation. Speech sounds change when paired with different speech sounds.
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Reactions to the Diagnosis of Hearing loss
Family Concerns
- The Grief Cycle (based on Kubler-Ross, 1969)
- Shock
- Anger
- Denial
- Depression
- Acceptance (resignation)
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Growing up with Hearing loss
- Poor Self-Concept
- Study by Capelli
- Cosmetic issues
- The Hearing aid effect
- Emotional Development
- Missing out on conversations
- Aren’t exposed to vocabulary
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Growing up with Hearing loss
Social Competence includes:
- Ability to think independently
- Capacity for self-direction and self control
- Understanding feelings, needs of self and others
- Flexibility
- Ability to tolerate frustration
- Ability to rely on and be relied on by others
- Ability to maintain healthy relationships
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Growing up with Hearing loss
Adolescence
- More self-conscious
- Peer relationships
- Conformity
- Need to advocate for themselves more
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Acquired Hearing loss (adults)
Self-Concept in adults
- Denial- average of 7 years before doing seeking help.
- Only 25% follow-up on hearing aid recommendations.
Dismiss the problem as the fault of others
The hearing aid effect (Doggett et al. 1998)
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Late onset deafness
- Caught between the hearing world and the deaf world
- Communication becomes cumbersome and is avoided
- Depression & anxiety common
- Treatment is crucial, to reduce the negative impact caused by the HL
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Psychoemotional Concerns for Family
Acquired Hearing loss and the Family
- Family Members:
- Take on the stress
- Are often blamed (mumbling)
- They may talk around the patient in order to reduce the effort and stress
- Be responsible for “hearing” for the family member
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Psychoemotional Concerns for Individual
Psychoemotional Reactions
Acquired Hearing loss
- The grief cycle
- Conversational exclusion
- Paranoia
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Psychoemotional Concerns for Individual Psychoemotional Reactions Acquired Hearing loss
Other psychoemotional reactions to hearing loss
- Alienated
- Cheated
- Enraged
- Vulnerable
- Bitter
- Drained
- Impatient
- Disturbed
- Hopeless
- Overwhelmed
- Anxious
- Depressed
- Guilty
- Nervous
- Annoyed
- Confused
- Fearful
- Lonely
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Counseling Basics
Types of Counseling
- Psychotherapy
- Counseling
- Nonprofessional counseling
- One-way direction counseling
- Two-way direction counseling
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Psychotherapy
helps the patient to explore unconscious behavior patterns in order to alter ways by analyzing ones responses. Looks to change a person or behaviors.
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Counseling
helps people develop here-and-now strategies for coping with life, decision making and current problems. Looks to support personal adjustments to a specific situation.
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Nonprofessional counseling
- Boundaries must clarify the roles of individuals
- Know when to refer
- Informational counseling
- Personal adjustment and support
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One-way direction counseling
- Content counseling or informational counseling
- Professional talks while patient listens
- Little time of the patient to talk about concerns
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Two-way direction counseling
Allows the patient to talk more and the counselor to talk less
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The Counseling Process
- 1. Help patients tell their story
- 2. Help patients clarify their problems
- 3. Help patients take responsibility for their listening problems
- 4. Help patients establish their goals
- 5. Develop an action plan
- 6. Implement the plan
- 7. Conduct ongoing evaluation
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Allowing patients to speak uninterrupted at the beginning of an appointment adds very little time to the overall appointment.
Just two minutes of uninterrupted listening is enough time to allow 80% of
patients the time to express their story. (Langewitz et al. 2002)
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The Counseling Process
1. Help patients tell their story
- Each patient’s story is unique
- Patient response: “No one understands how hard this is for me.”
- “Most people with hearing loss experience these difficulties” vs. “You are having a rough time right now”
Don’t be a terminator!
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The Counseling Process
2. Help patients clarify their problems
- Use self-assessments or questionnaires
- Abbreviated profile of hearing Aid benefit (APHAB)
- Client Oriented Scale of Improvement (COSI)
- Self-Assessment of Communication (SAC)
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The Counseling Process
3. Help patients take responsibility for their listening problems
- Patient must accept responsibility in order to commit
- Let patient choose goals
- Substituting “and” for “but”
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