Effects of hearing loss on language acquisition - Helen Maiden - Exeter Deaf Academy Professionals' Open Day
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Empowering Deaf Young People in a Hearing World Gain insight into how Exeter Deaf Academy approaches language acquisition and development through the use of British Sign Language (BSL) and other communication methods.
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Effects of hearing loss on language acquisition - Helen Maiden - Exeter Deaf Academy Professionals' Open Day
- 1. Helen Maiden (Teacher of the Deaf) Educational Audiologist
- 2. Objectives of the session • To understand the effects of a hearing loss on Language Development • To have an understanding of the impact that different factors have on the development of language • To consider where the use of assistive listening devices/computer apps/vibrotactile devices may be of interest to you or your child.
- 3. Effects of a hearing loss on Language Development affects speech development slow development of speech and language poor performance at school difficulties with communication may miss out on employment opportunities
- 4. To be capable of good language output, you have to have adequate input, and for most languages (sign languages being the obvious exception), the input has to travel through the ears to get to the brain. Hearing loss in children results in limited access to the speech sounds, vocabulary, and grammatical structures of their language; if their hearing loss goes undiagnosed during the first few years of life, it can have a lasting negative effect on their speech and language development.
- 5. What are the impacting factors? When the hearing loss is diagnosed What the degree of the hearing loss is When the child has appropriate ‘aiding’ When aiding is consistent If there are additional processing difficulties additional language or special educational needs
- 6. Auditory neuropathy spectrum disorder ANSD is a ‘spectrum disorder’ damage to the hair cells inside the inner ear abnormal connections between the hair cells and auditory nerve damage to the auditory nerve itself
- 7. For the children and young people in our care to access the curriculum through the use of: • The most appropriate hearing technology • Ear moulds and hearing aids • Cochlear Implants • Assistive Listening Device – ALD (radio aid) Role of Audiology at the Deaf Academy
- 8. Why Early Intervention? • Education begins at birth • Stimulation and first hand experiences are vital for early development • Without experiences, children are unable to learn through imitation (watch, listen and copy) • Most incidental learning is through sensory or physical pathways
- 9. Early listening in good acoustic environment is crucial as the brain is at its most plastic Sound to Noise Ratio in most classrooms (and often at home!) - poor (+4dB to -20dB) Adults need at least 6dB, children need 15dB+ Children need the fullest possible access to the complete speech spectrum at all times 90% of what very young children know about the world they learn incidentally For deaf CYP opportunities for overhearing/incidental learning are limited or non existent Hearing - ‘Velcro’ for attention, spoken language, reading and academic competencies
- 10. Vocabulary A pupil’s level of vocabulary is the result of: opportunity a good acoustic environment for listening an existing network to which new knowledge is attached (eg. BSL, Cued Speech) Children with good vocabularies tend to be better readers and will therefore have access to learning more vocabulary in context Figurative language includes non-literal and idiomatic expressions May hinder understanding of story line or character development that may be crucial to reading with comprehension
- 13. Familiar sounds – normal hearing quiet LOUD Low High o o o ox x x x o x MILD MODERATE SEVERE PROFOUND
- 15. Typical audiogram examples Moderate hearing loss Profound hearing loss
- 16. Aided levels for a severe hearing loss
- 17. Average in better ear = 99 (115)
- 18. Average in better ear = 110 (117)
- 19. Average in better ear = 54 (113)
- 20. Average in better ear = 111 (112)
- 21. Average in better ear = 116 (117)
- 22. I a - - oi - - - o - e - - o - e - - ee - - The high frequency consonant sounds have been removed Try again! - - m g - - ng t - g - t s - m - sw - - ts The same sentence, but with the low frequency vowels removed and the consonants added
- 23. Vowels _U_ _ _ _ _U_ _ _ _ _A_ O_ _ _E _A_ _ _U_ _ _ _ _U_ _ _ _ _A_ A _ _EA_ _A_ _ • Consonants H_MPTY D_MPTY S_T _N TH_ W_LL H_MPTY D_MPTY H_D _ GR_ _T F_LL
- 24. We hear with THE BRAIN – the ears are just the way in. Hearing loss is not about the ears; it’s about THE BRAIN Any time the word ‘hearing’ is used think AUDITORY BRAIN DEVELOPMENT
- 25. Listening - not the same as hearing Listening is hearing plus the mental processes of interpreting and absorbing messages, storing and retrieving information. Listening is a learned behaviour "Learning to listen is a prerequisite to listening to learn" (Mayesky, 1986) Listening is the cornerstone of learning Children can not ‘listen’ the same as adults - children are learning language All children need a quieter environment and a more intense signal – i.e. the speaker’s voice
- 27. DISTANCE
- 28. Listen, what can you hear around you now? BACKGROUND NOISE
- 32. Amplification - Why Should We Care? Hearing aids are not cheap. Cochlear implants are even more expensive. Hearing aids aren’t like glasses. You need to be an informed user. There are a lot of misconceptions about hearing aids (and cochlear implants!) . As educationalist we have a responsibility - hearing better is UP TO YOU! Adapted from - Introduction to Hearing Aid Features adapted from Steve Barber, SHHH Wake Chapter
- 33. What Should We Care About? Highest Priority: Better access to sound High Priority: Learning to use the ‘aid’ appropriately Lowest Priority: How it looks (?) Adapted from - Introduction to Hearing Aid Features adapted from Steve Barber, SHHH Wake Chapter
- 34. Hearing aids
- 35. All Hearing ‘Aids’ are similar 1. Sound goes in the Microphone. 2. Sound gets amplified. 3. Sound comes out the Speaker into your Ear Adapted from - Introduction to Hearing Aid Features adapted from Steve Barber, SHHH Wake Chapter
- 36. Cochlear implants are similar too
- 38. All Hearing ‘Aids’ Are Different Style (Small is best?) Technology (Digital is only way to go?) Features (More is better?) Settings (an individuals ‘prescription’) Adapted from - Introduction to Hearing Aid Features adapted from Steve Barber, SHHH Wake Chapter
- 39. An audio demonstration • Lets listen to a hearing aid alone recorded through a coupler .... … and then with an radio aid to improve the quality of sound • Play demo • Which sound would you prefer?
- 40. Education strategies try using some at home Contextual clues Normal patterns of speech Rhythm and Intonation Normal Lip Patterns Attention to Listening Conditions Attention to Lighting Conditions Carry out daily Listening Checks Know the limitations of personal amplification devices Rephrase rather than repeat Allow time to respond
- 41. Before identify key concepts or think which aspects might be hard for the HI child if possible pre-tutor new words/concepts use extra resources, particularly visual, to support understanding check appropriateness of written language
- 42. During encourage a quiet environment identify speakers; only one talking at a time get attention of child before giving instructions focusing child back to the speaker as appropriate lip-reading involves a lot of guesswork so try to provide a context try not to sit with your back to the window use visual aids paraphrase or simplify others’ contributions check understanding, do not presume that the child has the general knowledge required
- 43. After summarise, review, repeat main points of session be aware that child may need extra clarification ensure child has understood instructions feedback areas of success and concern to school reinforce vocabulary
- 44. Daily monitoring •Ling 6 sounds •These pictures linked to THRASS and cued speech •Use in pairs or all together •Know what you are using them for - detection or discrimination?
- 45. Any Questions?
Editor's Notes
- Filtered speech - pens/pencils needed Audiograms Listening and ‘hearing’ Understanding spoken language The environment Assistive devices - personal FM/soundfield Strategies
- Hearing plays a massive part in the development of language and speech and a loss of hearing or a hearing impairment can have massive implications for speech development. A lack of hearing affects speech and development in four major ways, these are: It causes slow development of speech and language Slow language development leads to poor performance at school as it makes learning more difficult: children struggle to increase their vocabulary, communicate their ideas and join in with class discussions. A hearing impairment may also make it more difficult to grasp new subjects, especially with subjects like English grammar Difficulties with communication and language can lead to people becoming isolated and frustrated Speech problems may cause problems with choosing careers: many careers depend heavily on successful oral communication so people with speech problems may miss out on employment opportunities
- Auditory neuropathy spectrum disorder (ANSD) is a type of hearing impairment caused by sounds not travelling to the brain effectively Ear - internal The ear consists of three parts, the outer ear, the middle ear and the inner ear. Sound waves enter the ear canal and cause the eardrum to vibrate. The sound then passes through the middle ear via the three small bones of hearing (ossicles) on to the inner ear, which is filled with fluid. The movement of the fluid in the cochlea stimulates the hair cells inside it to trigger a nerve impulse, which is carried to the brain by the auditory nerve. The brain then interprets these nerve impulses as sound. ANSD occurs due to damage to the hair cells inside the inner ear, abnormal connections between the hair cells and auditory nerve, damage to the auditory nerve itself or a combination of all three. This means that sounds are not transmitted to the brain through the auditory nerve as they should, causing hearing loss and difficulty interpreting sounds. ANSD is a ‘spectrum disorder’, which means that the symptoms experienced vary from mild to severe. They may also vary over time, improving on some days or worsening on others. What causes auditory neuropathy spectrum disorder? Doctors are not sure exactly what causes auditory neuropathy spectrum disorder (ANSD) but think it may be linked to premature birth and/or low birthweight. Some cases seem to run in families so there may also be a genetic component, that is, a faulty gene is passed on from parent to child. ANSD also appears alongside other conditions, such as Friedrich’s Ataxia. What are the signs and symptoms of auditory neuropathy spectrum disorder? Children with auditory neuropathy spectrum disorder (ANSD) hear sounds differently, so all sounds may sound similar – like a television that has lost its signal – or they may sound distorted. This causes problems understanding speech, which in turn, leads to difficulty developing speech.
- Filtered speech - pens/pencils needed Audiograms Listening and ‘hearing’ Understanding spoken language The environment Assistive devices - personal FM/soundfield Strategies
- Encourage a quiet working environment Speak clearly and at normal rate of utterance Lip-reading – some pupils get some additional information, make sure they can see your face Use visual aids as much as possible to support what you are saying– pictures, objects, key words Get attention of the pupil before giving instructions When talking to the pupil try not to cover your face, turn away from them, or walk around the room Don’t stand with your back to window Identify the speakers: only one talking at a time Paraphrase or simplify other pupils contributions
- Once a child has broken the code of reading, the challenge is to read with comprehension A child who independently constructs meaning from text can be said to be reading with comprehension Reading researchers have discovered that children read better when they have prior knowledge about a topic Idioms are expressions that would have different meanings if you took the words apart. The individual words in the idiom don’t usually help you make sense of it; you just have to know what it means Children with well developed “schema” can fill in missing information with their own experiences this can be problematic if child substitutes his/her own experiences regardless of the text In order to infer something from a story, a reader must “read between the lines”
- All sounds can be plotted on an audiogram. Frequency is shown along the horizontal scale are Hertz, from left to right - a low pitch to a high pitch. Numbers down the side indicate how loud a sound is (the higher the number the louder the sound)
- low frequencies on the left – power of speech (vowel sounds) high frequencies on the right – intelligibility of speech (consonant sounds) Low frequency, louder sounds are often felt – vibrotactile Range of hearing needed for speech is between 250 Hz and 4000Hz. Human ear can hear from 20-20,000, animals can hear a much wider range of sounds – the dog whistle
- The audiologist uses an audiometer to test hearing, and plots the results on a graph called an audiogram DEMO diagram shows the levels of hearing loss from mild to profound. Average loss Mild 20-40dB Moderate 40-70 Severe 70-90 Profound > 90
- Typical example of severe hl
- The aim is to give enough gain to bring levels up to within the area of the speech banana. Green line shows the aided level for this person. In a profound loss there may not be enough gain to bring levels up in all frequencies. …………..?
- College - JBurgess
- Complex Needs - MDawson
- School SWoodruff
- College DFreeman
- School JCaulfield
- Hearing is a sense most people are born with, but listening is a learned behavior (Machado, 1990). Listening skills do not develop automatically. "Effective listening is a communication skill that must be taught to and nurtured among our students," says Grunkemeyer (1992). As educators and caregivers, we can provide many opportunities to promote listening skills in our classroom. Most homes are auditory-verbal environments At school, 70% of the school day is verbal instruction/information 90% of what very young children know about the world they learn incidentally Hearing is a physical process ‘Hearing’ must be made available before ‘Listening’ can be taught
- Sound looses energy as it travels A teacher’s voice typically measures 60-65 dB at a distance of 1m The teacher’s voice is reduced by 6dB each time that distance is doubled That’s a reduction of at least 12dB at the back of the class, >24dB in the hall
- You need to know how to use the aid hospitals will give the information to parents but the individual needs to know too – our role
- Sound goes in the Microphone. Sound gets changed according to the programming The signal is transmitted from the coil across the skin to the internal receiver– electrical signal
- What happens with a cochlear implant? Different way of hearing
- Visual learners – easily distracted Contextual clues - Normal patterns of speech - Rhythm and Intonation - Normal Lip Patterns - Attention to Listening Conditions - Attention to Lighting Conditions - Carry out daily Listening Checks - Know the limitations of the Hearing Aid - Use clear speech with normal rhythm and intonation - Rephrase rather than repeat - Allow time to respond - Social……
- Eg. before a doctors/dentist appointment, family meeting or social situation of some kind Not down any concepts that are hard for your pupil to feedback to teacher, AOHI and parents. Monitor progress Extra resources could include – books, videos, computer programmes, flash cards, lists of key vocabulary Think about layout of worksheets, if they are consistently not appropriate feed this back to ATOHI Work towards any IEP targets during lesson if appropriate. Monitor progress against set targets
- Working environment – be aware of other pupils and background noise created. Encourage peers to work quietly, no tapping of pencils or rocking on chairs! Small acoustic treatments could include putting felt on the bottom of pencil pots, covering hard display tables with soft furnishings. Make a note of key words during lesson that may be difficult to lip read – particularly if they are unfamiliar to the pupil
- Extra clarification – make a note somewhere of concepts that pupil struggled with and if possible find time to over main points of lesson Homework, often given out during packing away time so pupil will not always hear instructions. New vocabulary – write in home/school book or have some other way of keeping a record of vocabulary and definitions