Where to begin?
In the case of hearing impairment an infant or young child typically requires direct intervention to develop auditory skills to the fullest potential. First child needs to learn to listen before they can use that listening to learn spoken language.
Step 1: Get access to sound across the speech frequency range.
FULL TIME ACCESS: Getting an infant to wear hearing aids isn’t as challenging as you’d first think. Getting a toddler to wear hearing aids is much more of a challenge. So, the earlier the easier and the earlier the better! The goal is ALL day use in a Listening and Spoken Language Habilitative Approach! Read about how every minute counts in a previous blog post of ours.
The Ling 6 sounds: These are sounds that span across the range of frequencies that we use to check detection of sounds. The sounds (m, ah, oo, e, sh, s) start at low frequency and progress up to the high frequencies of the speech signal.
At this early stage of auditory access the adults need to alert the child’s attention to all types of sounds. A baby doesn’t just know to turn in the direction of a sound. First he/she needs to learn that sounds come from something and sound carries meaning. Only then will a child begin to search for the source of a sound.
Step 2: Look for and train responses to sounds.
CONDITIONED RESPONSE: At this point we are trying to condition the child to show responses to sounds. When the baby is a bit older (between 1.5 to 2 years) we can begin some formal training to get him/her to drop a block in a bucket in response to someone saying each of the Ling 6 Sounds from behind him/her. This sound conditioning is important for getting accurate behavioral testing at the audiologist so we can insure the best settings on hearing aids or cochlear implants.
DETECTION: Once a child begins to show some awareness to sounds we know that they can detect the sound. However, this doesn’t give us any information about how clearly the sound is being perceived.
Step 3: Systematically begin comparing and contrasting sounds of different patterns.
IDENTIFICATION: Identification of sound is when a child begins to show a connection between a sound and an object, person or action. It does not yet mean that the child actually understands the meaning of the sound. It just means that he/she can make some connection. If a child can imitate a speech sound
LEARNING TO LISTEN SOUNDS: (aka “L2L Sounds”) are sounds that are associated with objects. These sounds typically contrast the duration, pitch and even the loudness of sounds to make them easier to recognize and process through listening than true words. Here are some examples:
- beep beep/car
- ruff ruff ruff/dog
- round and round/anything that turns or spins around
- bang bang bang/hammer
- tongue click/horse
PATTERN PERCEPTION: By using learning to listen sounds and making comparisons to the sound contrasts in our play the child begins to develop an awareness of sound patterns. Often a child can imitate the pattern (basic rhythm) of sound as a short short short sound vs. a long drawn out sound before any true word attempts.
Once pattern perception is developing we then begin to look for evidence that the child is noticing smaller parts of the speech signal. At this point vowels begin to sound more varied in the baby’s spontaneous vocalizations. Over time vowels begin to sound clearer and the child begins to imitate some sounds on command. Consonants develop over time as the child begins to listen to smaller and smaller sound differences.
Step 4: Develop longer attention to sound.
Once the child understands that sounds have meaning, alerting to sounds and his/her own name should be observed rather consistently. However, it’s possible to have great auditory alerting behavior without having sustained attention to sound. In order for comprehension so emerge at a good pace of development a child needs to learn to maintain attention to sound for increasing lengths.
AUDITORY ATTENTION: Auditory attention usually starts off only fleeting. It becomes the adult’s job to gradually but steadily increase the length of auditory attention. This would begin with only a learning to listen sound but then move to a phrase and then a few sentences. Auditory attention is critically important by the time the child reaches preschool. Children with typical hearing demonstrate a huge variability in this skill from one child to another. There’s no difference for children with hearing loss. Encouraging longer amounts of auditory attention can be done casually during daily interactions over time. For example, telling longer stories at bedtime, providing longer explanations of daily encounters, elaborating on a topic to have 3-4 sentences per turn in a conversation over dinner.
If you are looking for more information about hearing loss or resources for working with children who have hearing loss check out our storefront on
The next posts will continue in this series about early auditory and language development.
Stay connected by subscribing to get notified when new posts go up.