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Working with Toddlers with Cochlear Implants
Reprinted with permission from the SPED (Special Education) Parent Newsletter at Lincoln Public Schools.
By Carole Curry and Carol Finn
There are few events more exciting or awe inspiring than seeing a toddler with a severe to profound hearing loss turn to the sound of someone clapping or imitate a speech sound that he has just heard. When the child with a Cochlear implant has his processor turned on for the first time, it is like witnessing a miracle! Initial reactions to sound at activation are varied. Some children smile, others fuss. Some children increase their vocalizations, others become very still. But once the excitement subsides and the tears of joy have dried, the hard work of teaching the child to listen begins.
We know that a recently activated child has much to learn in order to make sense of the sounds that he is being exposed to in his environment. We know that most hearing-impaired children are very strong visual learners and that information about their world and language has usually been acquired visually. But we also know that we expect the child with a Cochlear implant to become an auditory learner so he can hear speech, make sense of speech and environmental sounds, and use speech to communicate wants and needs. The challenge is to help the child move from being a visual learner to learning to use this new ability to detect and process sound.
When we have the opportunity to work with the child before implantation we use this time to teach awareness of sound, even if the child is not able to detect much sound with amplification. We provide opportunities to detect loud environmental sounds in the home. We encourage parents to point out sounds that occur and to let the child know that others hear the sounds, and to label the source of the sounds for the child.
It is very important to give the child as much language as possible before implantation. We use signs and natural gestures as well as speech. Some of the children have had very large sign vocabularies by the time they were implanted. Other children, because of their younger ages, have had a smaller vocabulary. Because we are working with visual learners, we do everything we can to give lots of visual information along with spoken words. We encourage parents to hold objects of interest up to their mouths to naturally draw attention to cues about mouth movements for sound. We acknowledge and make the child aware of when he uses his voice with others and give lots of positive reinforcement for using voice. We use lots of expression and animation when talking with the child to make the speaker's face and body language more interesting. We do the silly things that appeal to toddlers - blowing, giving kisses, patting mouth, doing raspberries, etc. to engage the child in some oral motor imitation, which will be necessary for speech. Above all, we try to make this as fun and natural as possible and look for ways that parents and caregivers can implement these strategies in their daily routines with the child.
After the Cochlear Implant (CI) has been activated, the focus of our teaching changes to auditory awareness and the ability to attend to various environmental and speech sounds. One of our first tasks is to teach the child to perform a "conditioned response" (a simple motor activity such as putting a peg in a pegboard or a ring on a stacker) when a sound is detected during a structured activity. The child then develops the ability to wait and listen until the sound occurs and is detected. We may use sound makers to start, but our next goal is for the child to perform the motor activity in response to the Ling 6 Sound Test. This gives parents and caregivers a systematic method for determining if the implant and current programs are functioning properly. Parents are encouraged to perform this task each day when the CI is turned on.
At this time, we also encourage parents to use some specific techniques, which will help the child move from visual to auditory processing. We use the "auditory sandwich" technique (presenting information auditory, pausing to wait for a response, then providing visual information in the form of a sign or natural gesture if the child doesn't understand, and finally, presenting the same words auditory again). We also use acoustic highlighting (rewording, rephrasing, pausing, waiting, whispering, signing and emphasizing specific pitch, intensity and/or duration cues) as we communicate verbally with the child.
During these early months after activation we also start working on sound-object association to help the child connect what he hears with what he is able to say. We pair toys (pictures for older students) with specific sounds. This gives the child opportunities to develop an association between sounds they are able to produce and objects that they play with on a regular basis.
Throughout all of these activities, our underlying goal is to provide optimal acquisition of spoken language through listening and to help these children be able to use verbal communication to express their intentions to their families, peers, and others in all environments.
Posted June 20th, 2007
By Carole Curry and Carol Finn
There are few events more exciting or awe inspiring than seeing a toddler with a severe to profound hearing loss turn to the sound of someone clapping or imitate a speech sound that he has just heard. When the child with a Cochlear implant has his processor turned on for the first time, it is like witnessing a miracle! Initial reactions to sound at activation are varied. Some children smile, others fuss. Some children increase their vocalizations, others become very still. But once the excitement subsides and the tears of joy have dried, the hard work of teaching the child to listen begins.
We know that a recently activated child has much to learn in order to make sense of the sounds that he is being exposed to in his environment. We know that most hearing-impaired children are very strong visual learners and that information about their world and language has usually been acquired visually. But we also know that we expect the child with a Cochlear implant to become an auditory learner so he can hear speech, make sense of speech and environmental sounds, and use speech to communicate wants and needs. The challenge is to help the child move from being a visual learner to learning to use this new ability to detect and process sound.
When we have the opportunity to work with the child before implantation we use this time to teach awareness of sound, even if the child is not able to detect much sound with amplification. We provide opportunities to detect loud environmental sounds in the home. We encourage parents to point out sounds that occur and to let the child know that others hear the sounds, and to label the source of the sounds for the child.
It is very important to give the child as much language as possible before implantation. We use signs and natural gestures as well as speech. Some of the children have had very large sign vocabularies by the time they were implanted. Other children, because of their younger ages, have had a smaller vocabulary. Because we are working with visual learners, we do everything we can to give lots of visual information along with spoken words. We encourage parents to hold objects of interest up to their mouths to naturally draw attention to cues about mouth movements for sound. We acknowledge and make the child aware of when he uses his voice with others and give lots of positive reinforcement for using voice. We use lots of expression and animation when talking with the child to make the speaker's face and body language more interesting. We do the silly things that appeal to toddlers - blowing, giving kisses, patting mouth, doing raspberries, etc. to engage the child in some oral motor imitation, which will be necessary for speech. Above all, we try to make this as fun and natural as possible and look for ways that parents and caregivers can implement these strategies in their daily routines with the child.
After the Cochlear Implant (CI) has been activated, the focus of our teaching changes to auditory awareness and the ability to attend to various environmental and speech sounds. One of our first tasks is to teach the child to perform a "conditioned response" (a simple motor activity such as putting a peg in a pegboard or a ring on a stacker) when a sound is detected during a structured activity. The child then develops the ability to wait and listen until the sound occurs and is detected. We may use sound makers to start, but our next goal is for the child to perform the motor activity in response to the Ling 6 Sound Test. This gives parents and caregivers a systematic method for determining if the implant and current programs are functioning properly. Parents are encouraged to perform this task each day when the CI is turned on.
At this time, we also encourage parents to use some specific techniques, which will help the child move from visual to auditory processing. We use the "auditory sandwich" technique (presenting information auditory, pausing to wait for a response, then providing visual information in the form of a sign or natural gesture if the child doesn't understand, and finally, presenting the same words auditory again). We also use acoustic highlighting (rewording, rephrasing, pausing, waiting, whispering, signing and emphasizing specific pitch, intensity and/or duration cues) as we communicate verbally with the child.
During these early months after activation we also start working on sound-object association to help the child connect what he hears with what he is able to say. We pair toys (pictures for older students) with specific sounds. This gives the child opportunities to develop an association between sounds they are able to produce and objects that they play with on a regular basis.
Throughout all of these activities, our underlying goal is to provide optimal acquisition of spoken language through listening and to help these children be able to use verbal communication to express their intentions to their families, peers, and others in all environments.
