Incorporating Lessons from

Neurodevelopment to Inform Clinical

Practice: Optimizing Language & Listening

Outcomes

Amy Szarkowski1,2,Denise Fournier Eng1, Elizabeth Erickson O’Neill1, Sue Mumby Gibbons1, Jennifer Harris1, Jennifer Johnston1, Greg Licameli1,3

¹Department of Otolaryngology and Communication Enhancement - Boston Children’s Hospital

2 Department of Psychiatry - Harvard Medical School

3 Department of Otolaryngology - Harvard Medical School

Hearing aids and cochlear implants work so

well for so many. Yet, sometimes, they

don’t….

2

How to help children to

bridge the gap between

ability to access sound

and making sense of what

they hear?

How can professionals use science to inform practice?

3

Fostering Better

Outcomes

Fostering Better

Outcomes

Speech-Language Pathology

AudiologyAudiology

Neuropsych&

Development

Neuropsych&

Development

LinguisticsLinguistics

MedicineMedicine

Many approaches to promoting

language and listening are successful.

4

How do we understand children for whom

“traditional methods” have not worked?

IQIQCognitive ability – innate & enriched

EQEQEmotional

intelligence & motivation

X factors

X factors

Caregiver involvement; SES; additional disabilities

5

The Need for

Discrete Auditory Skills

Awareness of “needing to listen”

Detecting presence or

absence of sound

Identification of specific frequencies

(Ling sounds)

Discrimination of similar-sounding

phonemes

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Is listening � language analogous to crawling � walking?

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Iverson, Journal of Child Language, (2010)

Challenging the “Listening Hierarchy”

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ComprehensionComprehension

Identification/ImitationIdentification/Imitation

DiscriminationDiscrimination

DetectionDetection

Estabrooks & Marlow (2000)

Looping Back AroundResponsiveness

Accessibility

Communication

Language

Listening

Comprehension

Meaningful Exchange

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ListeningComprehension

Increase ability to

express wants and needs

Increase ability to

comment on present events

Visual attention

Looking and pointing

Vocalization

Increase

variety of vowel

and consonant

sounds in

vocal play

Babbling in sign

language

Sign and spoken

approximations

of words

Combining words

(spoken or signed)

Sound

exploration

Establish and expand

response to sound

Communication

Build a strong

base of language

and world

knowledge

Begin to

link

sound and

meaning

A Model for

Aural Habilitation/Communication Therapy for

Deaf and Hard of Hearing Infants

and Toddlers

Turn-taking

Pretend

Play

Increase ability to

comment on events removed

from the present

11

shrdocs.

com

Schema of Meaning

Brains rapidly draw from a wide range of

information to understand

– What was stated previously

– Who is the speaker

– Expectations about directions of conversation

– Without context, more difficult to “detect”(Van Berkum, Current Dir Psych Science, 2009)

12

Early Life Experiences Shape

Brain ArchitectureNeural Circuitry

• Exposure

• Experience• Connections

Developmental Plasticity

• Sensitive periods

• Critical periods• Entrenchment

• Enhancement & inactivity

Behavioral Manifestations

• Reflects brain � shaped by experience

• “Alternative pathways” & multi-sensory integration

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Fox, Levitt & Nelson, Child Dev (2010)

The Brain Expects LanguageExperience-expectant

mechanisms

Features of the environment expected

for humans:

- Adequate nutrition

- Access to a caregiver

- Sensory stimulation

- Language input

Experience-dependent

mechanisms

Features of the environment unique

to the individual:

- Access to food

- Quality of caregiver

- Variable sensory input

- Quality & quantity of access to

language

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Nelson, Child Dev Perspec, (2007)

Reduced Early Language

Impacts Neuropsychological Functioning

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Graphic from:

brighthubeducation.com

� �

�

�

�

Mayberry, Handbk of

Neuropsych, (2002)

Social Neuroscience:

The Brain Requires Interaction

Attachment & caring relationship (oxytocin)Attachment & caring

relationship (oxytocin)

Empathy (arousal, emotion understanding,

motivation, top-down regulation)

Empathy (arousal, emotion understanding,

motivation, top-down regulation)

Prosocial behaviors (responses to stress)Prosocial behaviors

(responses to stress)

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Cacioppo & Decety, Ann NY Acad Sci (2011)

Functional Neuroanatomy:

Auditory Perception to Comprehension

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Friederici, Trends in Cog

Sciences, 2012

What the Brain Does -

SimultaneouslyBottom-up, input-driven processes proceeding from the auditory cortex to the anterior superior temporal cortex and from there to the prefrontal cortex, as well as top-down, controlled and predictive processes from the prefrontal cortex back to the temporal cortex are proposed to constitute the cortical language circuit

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(Friederici, Trends in Cog Neuroscience, 2012)

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Interventions &

Supports

Need to Address

How the Brain

Works

Considerations for Professionals

Meaningful CommunicationMeaningful Communication

The “Languaging

Brain”

The “Languaging

Brain”

Top-down & Bottom-up

approaches

Top-down & Bottom-up

approaches

Critical & Sensitive Periods

Critical & Sensitive Periods

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Questions?

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Amy.Szarkowski@childrens.harvard.edu

References• Cacioppo, J.T. & Decety, J. (2011). Challenges and opportunities in social neuroscience. Annals of the New York

Academy Sciences, 1224, 1, 162-173.

• Estabrooks, W. & Marlow, J. (2000) The Baby is Listening. Washington DC: Alexander Graham Bell Association, p.

22 -25. Modified from Erber (1982) and Estabrooks (1994, 1998, 2000).

• Fox, S.E., Levitt, P., Nelson, C.A. (2010). How the timing and quality of early experiences influence the

development of brain architecture. Child Development, 81, 1, 28-40.

• Friederici, A.D. (2012). The cortical language circuit: From auditory perception to sentence comprehension. Trends

in Cognitive Science, 16, 5.

• Iverson, J.M. (2010). Developing language in a developing body: the relationship between motor development and

language development. Journal of Child Language, 37, 2, 229-261.

• Kuhl, P.K. (2007). Is speech learning ‘gated’ by the social brain? Developmental Science, 10, 1, 110-120.

• Kuhl, P.K. (2010). Brain mechanisms in early language acquisition. Neuron, 67, 712-727.

• Mayberry, R. (2002) Cognitive Development in Deaf Children. Handbook of Neuropsychology. In S.J. Segalowitz

and I. Rapin (Eds). Handbook of Neuropsychology, 2nd Edition, Vol. 8, Part II

• Nelson, C.A. (2007). A neurobiological perspective on early human deprivation. Child Development Perspectives,

1, 1, 13-18.

• Van Berkum (2009). Current Directions in Psychological Science

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