CDO 431 Exam Review 2.2

  1. 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
  2. Birth - 3 Months
    • Makes pleasure sounds (cooing, gooing)
    • Cries differently for different needs
    • Smiles when sees you
  3. 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
  4. 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
  5. 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.
  6. 1 - 2 Years
    • 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.
  7. 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
  8. 2 - 3 Years
    • 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.
  9. 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.
  10. 3 - 4 Years
    • 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.
  11. 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.
  12. 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.
  13. Morphology
    • Form
    • Branch of linguistics that studies the structure of words
  14. Phonology
    • Form
    • Study of how sounds are organized and used in natural languages
  15. Pragmatics
    • Use
    • The study language as it is use in social contexts
  16. Semantics
    • Content
    • Meaning of words and language
  17. Syntax
    • Form
    • the arrangement of words and phrases to create well-formed sentences in a language.
  18. 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.
  19. 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
  20. 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
  21. Factors Affecting Language Acquisition
    • 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
  22. 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
  23. 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”
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. Speech sound development
    Normal sequence of sound production
    Crying and vegetative sounds --> cooing --> reduplicated babbling --> Variegated babbling --> first word
  30. Speech sound development
    Infants with hearing loss
    Cry, coo, squeal, growl and babble (same as hearing infants)!
  31. 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
  32. 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
  33. 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)


    Pitch and intensity
  34. Speech Assessment for children with Hearing Loss
    • Measurement of articulation and phonology
    •   Standard articulation and phonology tests
    • Speech intelligibility measures-Percent intelligible word scores and intelligibility ratings
  35. 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
  36. 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.
  37. Reactions to the Diagnosis of Hearing loss
    Family Concerns
    • The Grief Cycle (based on Kubler-Ross, 1969)
    • Shock
    • Anger
    • Denial
    • Depression
    • Acceptance (resignation)
  38. 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
  39. 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
  40. Growing up with Hearing loss
    • More self-conscious
    • Peer relationships
    • Conformity
    • Need to advocate for themselves more
  41. 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)
  42. 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
  43. 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
  44. Psychoemotional Concerns for Individual
    Psychoemotional Reactions
    Acquired Hearing loss
    • The grief cycle
    • Conversational exclusion
    •   Paranoia
  45. 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
  46. Counseling Basics
    Types of Counseling
    • Psychotherapy
    • Counseling
    • Nonprofessional counseling
    • One-way direction counseling
    • Two-way direction counseling
  47. 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.
  48. 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.
  49. Nonprofessional counseling
    • Boundaries must clarify the roles of individuals
    • Know when to refer

    • Informational counseling
    • Personal adjustment and support
  50. One-way direction counseling
    • Content counseling or informational counseling
    • Professional talks while patient listens
    • Little time of the patient to talk about concerns
  51. Two-way direction counseling
    Allows the patient to talk more and the counselor to talk less
  52. 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
  53. 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)
  54. 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!
  55. 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)
  56. 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”
Card Set
CDO 431 Exam Review 2.2
Audiological Rehabilitation