A dit B i D l tAuditory Brain Development: The Key to Listening, Language y g, g g
and Literacy
Carol Flexer, Ph.D., CCC-A; LSLS Cert. AVTDistinguished Professor EmeritusDistinguished Professor Emeritus
Northeast Ohio Au.D. Consortium (NOAC), and The University of Akron
lflwww.carolflexer.comJune 18, 2010
Family’s Desired Outcome The family’s desired outcome guides us –
ethically and legallyethically and legally. How does the family want their child
i t ?communicate? 95% of children with hearing loss are born
to hearing and speaking families. This session is all about the context of
early intervention if the family is interested in listening and talking for today’s child who is deaf or hard of hearing.
THEMES Because of technology and brain neuroplasticity,
the audiologist’s role has expanded in pediatricthe audiologist s role has expanded in pediatric sectors.
Because of technology and brain neuroplasticity,f gy p y,the landscape of deafness has changed.
Because of technology and brain neuroplasticity,today’s infants represent a completely new and different generation of children who are deaf.
We are in a position to provide to the world, a new and expanded vision of hope and possibility
di i iregarding intervention outcomes.
MAIN IDEAS Hearing is a first-order event for the development
of spoken communication and literacy skills. Anytime the word “hearing” is used, think
“auditory brain development”!! Acoustic accessibility of intelligible speech is
essential for brain growth. Signal-to-Noise Ratio is the key to hearing
intelligible speech.
Our early intervention programs must take into id ti th l i l d l t fconsideration the neurological development of
ALL children.
IT’S ALL ABOUTIT S ALL ABOUT THE BRAINTHE BRAIN
Hearing loss is not about the ears; it’s about the brain!about the brain!
Hearing aids, FM systems and cochlear implants are not about thecochlear implants are not about the
ears; they are about the brain! They are “Brain Access Tools”.They are Brain Access Tools .
NEW BRAIN RESEARCHNEW BRAIN RESEARCH
Basic neural research now provides dataBasic neural research now provides data that substantiates the necessity of accessing
and stimulating auditory brain centers.g yThere is a science behind our practice!
How Does the Auditory Brain Work?y
Important changes have been shown in the hi h di d h ihigher auditory centers due to hearing loss/deafness.
The auditory cortex is directly involved in speech perception and language processing in humans (Kretzmer ie al, 2004).
Normal maturation of central auditory ypathways is a precondition for the normal development of speech and language skills in p p g gchildren (Sharma et. Al, 2009).
Why Early ID and Amplification/Implantation, before age 2 is Critical (Robbins et al 2004)before age 2, is Critical (Robbins, et. al, 2004)
Skills mastered as close as possible to the time that a child is biologically intended to do so results in developmentalbiologically intended to do so, results in developmental synchrony.
Mastery of any developmental skill depends on cumulative i h d l d h f i i i f kill hpractice: the more delayed the age of acquisition of a skill, the
farther behind children are in the amount of cumulative practice they have had to perfect that skill. The same concept holds true for cumulative auditory practice.
Delayed auditory development leads to delayed language skills.
A cochlear implant can make oral proficiency in more than l ibl f li ll d fone language possible for prelingually deaf
children….provided we do what it takes.
Early Literacy Development – Janet Werker at UBC, Dev. Psy. 2007
Infants acquire native languages by listening, and start life being prepared to speakbeing prepared to speak.
At birth, infants prefer their mother’s speech, and songs and t i h d b f bi th d th t i t tstories heard before birth, and they can categorize content vs.
function words.
In the first 6 months, babies can discriminate many speech sounds, but by the end of the 1st year, there is a functional reorganization to language specific phonemes; infants become language specific listeners between 6 and 12 months of agelanguage specific listeners between 6 and 12 months of age.
This reorganization improves and tunes the phonetic t i i d f th i l d tt t thcategories required for their language, and attenuates those
distinctions not required.
Early Literacy Development – Janet Werker at UBC, Dev. Psy. 2007, y
Fetuses hear mostly the low frequency acoustic features of their mother’s speech in utero – so the acoustic focus is on rhythmic elementsrhythmic elements.
At birth, infants listen at multiple levels at the same time., p
They learn to distinguish rhythm, phonemes, and phonologic elements all at onceelements all at once.
Therefore, speak a bit slower and in complete sentences/phrases with a great deal of melody.
Infant speech perception acuity predicts their vocabulary Infant speech perception acuity predicts their vocabulary.
Early Literacy Development – Janet W k UBC D P 2007Werker at UBC, Dev. Psy. 2007
Infants use their phonetic categories to bootstrap learning dnew words.
Phonetic distinctions guide new word learning at 17 Phonetic distinctions guide new word learning at 17 months.
Listening experience in infancy is critical for adequate language development.
Phonetic categories > phonological processes > lexical-semantic use > reading and higher order language use.g g g g
THE EAR
THE BIG PICTURE: THE WORLD HAS CHANGED!
Who Moved my Cheese? by Spencer Johnson, M.D. – a book about change, g
We are an Information/Knowledge-based economy that demands high levels ofeconomy that demands high levels of spoken communication and literacy.
We are educating children to take charge in We are educating children to take charge in the world of 2030, 2040, and 2050….not in the world of 1970 or 1990 or even 2011the world of 1970 or 1990 or even 2011.
KEY STUDY BY HART ANDKEY STUDY BY HART AND RISLEY SHOWING HOW MUCH
AUDITORY STIMULATION ISAUDITORY STIMULATION IS ACTUALLY NEEDED
Meaningful Differences in theMeaningful Differences in the Everyday Experience of Young
American ChildrenAmerican Children
Therefore, early intervention is notTherefore, early intervention is not about the child, it is about the
f ilfamily.
Think of early intervention as “adult education”adult education .
Intervention Models
In today’s context, we all must use a bi i f d lcombination of models.
Ecological model – Typical social-g yplinguistic models with high expectationsexpectations.
Instructional intensity --- practice, practice, practice.
Families must be involved if sufficientFamilies must be involved if sufficient instructional intensity is to be obtained.
THE WORLD HAS CHANGED FORTHE WORLD HAS CHANGED FOR HEARING LOSS, TOO.
SPOKEN COMMUNICATION: PAST AND PRESENTAND PRESENT
(1) CD of possible auditory-oral outcomes before early identification, early
intervention, and cochlear implant technology – and (2) DVD of possible
auditory-verbal outcomes in this day andauditory-verbal outcomes in this day and age.
What Does “Deaf” Look Like in 2010?What Does Deaf Look Like in 2010?
Does 1970 “Deaf” Does 1970 Deaf look like 2010 “Deaf”?Deaf ?
We have used the same words forsame words for decades, but the context hascontext has changed, dramatically!dramatically!
Incidental Hearing_____________________________________Hearing is a distal sense
Hearing enables us to monitor what is happening in the environmentenvironment
Hearing enables us to learn casually, incidentally, and i lpassively
Hearing enables us to learn about our culture, about social conditions, about human interactions– by “over-hearing” the conversations and transactions of others.
We must extend a baby/child’s distance hearing as much as possible, as often as possible.
Why extend distance hearing?y g
Because the literature in developmental ppsychology tells us that about 90% of what very young children know about the world, y y g ,
they learn incidentally.
We can never teach 46 million words directly.y
Our children must be able to “overhear” conversations!
NEW PARADIGMS AS A RESULT OF EHDI PROGRAMSOF EHDI PROGRAMS
1. We can now implement a developmental rather than a remedial modela remedial model.
2. The focus is family-child with interventionist as coach, rather than teacher-child dyad; adult education.3 D f h i l i l f t i 3. Degree of hearing loss is no longer a factor in outcome; there is NO degree of hearing loss that precludes auditory access.4 The a diologist is a ke pla er the professional ho 4. The audiologist is a key player – the professional who makes auditory brain access possible.
5. An accessible auditory rather than a visual world is now possible for children with all degrees of hearingnow possible for children with all degrees of hearing loss – if we do what it takes.
6. 90% of children with hearing loss will be in general education classrooms if we do our job right during theeducation classrooms, if we do our job right during the birth-3 period.
The Bottom-Line Question ToThe Bottom Line Question To Ask Families Is: What is Your
Vision for your Child?
95% of children with hearing loss are born into hearing and speaking families; th i t t d i h i th i hildthey are interested in having their child
talk.
Once we know that listening and speaking are desired outcomes, the next
conversation is – what will it take?conversation is – what will it take?
What Does it Take to Have a Listening and Spoken Communication Outcome? Early identification and intervention to take y
advantage of neuroplasticity and developmental synchrony.
i il d ki d di l i Vigilant and kind audiologic management. Immediate auditory brain access via technology –
hearing aid loaner banks to preserve auditoryhearing aid loaner banks – to preserve auditory neural capacity.
Engage a professional who is highly qualified in g ge p o ess o w o s g y qu edthe development of listening and speaking, through techniques of parent coaching.
Employ strategies that “Grow the Baby’s Brain”.
Critical Keys to a Successful Spoken Language Outcome:g g
Access the Auditory CentersAccess the Auditory Centers of the Brain as Early as Possible;
Then, Practice, Practice, Practice Li i d T lkiListening and Talking
How Much Practice is Needed?How Much Practice is Needed?
Malcolm Gladwell: 10 000 hours Malcolm Gladwell: 10,000 hours 46 million words heard by age 4 Children with hearing loss require
three times the exposure to learn newthree times the exposure to learn new words and concepts due to the reduced acoustic bandwidth caused by theacoustic bandwidth caused by the hearing loss.
HOW TO “GROW” YOURHOW TO GROW YOUR BABY/CHILD’S BRAIN
Information for families of children with hearing problems of any type and degree
i l di il l h i lincluding unilateral hearing loss, “minimal” hearing loss and auditory
processing difficultiesprocessing difficulties
Work in Harmony with OurWork in Harmony with Our Organic Design
Human beings d i dare designed to
listen and talk….if we do what it takes!what it takes!
Family Factors that Influence Spoken L d T M OLanguage and ToM Outcomes
Parent Involvement in early interventionParent Involvement in early intervention programs is critical for future educational success.success.
Impact Belief: refers to one’s belief to perform a particular task successfully toperform a particular task successfully, to persist until the outcome is achieved, and to ultimately make a differenceultimately make a difference.
Maternal Linguistic Input (both quantity and q alit ) at a le el appropriate for theand quality) at a level appropriate for the child.
FOR PARENTS: HOW TO GROWFOR PARENTS: HOW TO GROW AUDITORY BRAIN CENTERS
Above all, love, play, and have fun with your child!
hild i h i id hl Once your child receives a hearing aid or cochlear implant, make sure he/she wears it every waking hour (at least 12 hours/day). The auditory brainhour (at least 12 hours/day). The auditory brain centers need consistent access to clear, complete sound in order to develop.
Check your child’s technology regularly. Equipment malfunctions, often. Without auditory access talk to the flooraccess, talk to the floor.
FOR PARENTS: HOW TO GROW AUDITORY BRAIN CENTERSAUDITORY BRAIN CENTERS
Minimize background noise. Turn off the T VT.V.
Sing to your child! Fill their days with all kinds of music and songskinds of music and songs.
Speak slowly, clearly and in full sentences with lots of melody. Stay close!y y
Focus your child on listening. Call attention to sounds around the room. Point to your
U li t i d h “ h dear. Use listening words such as “you heard that”, and “you were listening”.
Emphasize sound before vision for Emphasize sound before vision for auditory enrichment.
FOR PARENTS: HOW TO GROW AUDITORY BRAIN CENTERS
Read, Read, Read aloud every day. Try forRead, Read, Read aloud every day. Try for 10 books per day.
Name objects in the environment as you Name objects in the environment as you encounter them in daily routines.T lk b t d d ib h thi d Talk about and describe how things sound, look, and feel.
Compare how objects or actions are similar and different in size, shape, smell, color, or texture.
FOR PARENTS: HOW TO GROW AUDITORY BRAIN CENTERST lk b t h bj t l t d Y Talk about where objects are located. You will use many prepositions such as in, on,
d b hi d b id t t b tunder, behind, beside, next to, between. Prepositions are the bridge between concrete
d b t t thi kiand abstract thinking. Describe sequences. Talk about the steps
involved in activities as you are doing the activity. Sequencing is necessary for organization.
GENERAL REFERENCESGENERAL REFERENCES Cole, E., & Flexer, C. (2007). Children with
Hearing Loss: Developing Listening andHearing Loss: Developing Listening and Talking, Birth to Six. San Diego: Plural Publishing.M d ll J & Fl C (2008) P di t i Madell, J., & Flexer, C. (2008). Pediatric Audiology: Diagnosis, Technology, and Management. New York: Thieme Medical P bli hPublishers.
Robertson, L. (2009). Literacy and Deafness: Listening and Spoken Language. San Diego:Listening and Spoken Language. San Diego: Plural Publishing.
Archives of Otolaryngology – Head and Neck Surgery May 2004Surgery. May 2004.
BRAIN BRAIN BRAIN!!!BRAIN, BRAIN, BRAIN!!!
The purpose of hearing aids, cochlear implants personal-worn FMimplants, personal worn FM,
classroom FM and IR systems, and auditory-based intervention is toauditory based intervention is to
access, grow and develop auditory brain centers as the foundation forbrain centers as the foundation for
literacy.
