9: Applying the Auditory Hierarchy

 

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episode 9: Applying the Auditory Hierarchy

Transcript

Intro: Welcome to the TOD Podcast, or as we like to say, the “TOD POD.” We chat about all things Deaf Education while you drive around. I’m Kimmy from The Hard of Hearing Teacher and I’m Deanna from Listening Fun, and let’s get started!

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D: So if you went to college or grad school for Deaf Education, you know the Auditory Hierarchy. It's detection, discrimination, identification, comprehension. It's also called Erber’s Hierarchy and it's a process of auditory habilitation or rehabilitation. It would be super great if we could put cochlear implants on a baby and have them automatically comprehend everything. But that's just not how it works. [laughs] Hearing people and their hearing babies also go through this hierarchy. It's just faster and more seamless because there isn't anything preventing them from accessing all the sounds needed to move up the hierarchy. The reason I wanted to talk about this today is because even though we can all rattle off this hierarchy, there's not that much that actually explains what you can actually do at each stage in your sessions to help your students.

K: I feel like practical tips that could be applied to school age students specifically would be really helpful. Sometimes I feel that there's a disconnect between what to do and how to do it.

D: Exactly. So what we're gonna do is go through each level and discuss what it means when a student is there and some activities you can do to practice on that level.

K: Sounds good.

D: Let's start with detection. Detection is being aware of the presence or absence of sounds. Sometimes you see on the on the auditory hierarchy depicted as an upside down triangle with detection at the bottom. That's because detection gives the listener the least amount of usable information. Detection doesn't tell you what the sound is, just that it happened. There's levels of detection. The most basic level is sound awareness - hearing environmental sounds like noisemakers or knocking on a door and speech sounds. On this level you want to work on the child making a conditioned response to sound. For very young children, this involves modeling a head turn response. Every time there's a sound in the environment, you coach the parent to turn their head to the sound, open their eyes and mouth wide, point to their ear, and say "I hear that!" and name the source of the sound. Since young children learn through modeling, when they hear a sound they will also turn to the sound and they may start pointing to their ear if they hear a sound. So you basically do what you would like the child to do as a the conditioned response to sound. If a child is around 2 or older you can teach them conditioned play. This is when you give them some type of toy like a ring stacker and they hold the ring up to their cheek or to their ear. You make a sound and when they hear the sound they put it on the stacker.

K: Detection is also more than just reacting to sounds. It's also being aware of sound starting and stopping. So with this, you can do dancing activities, like when the song stops the dancing stops. You can also do drawing activities where you sing, "color color color" and then you stop. And the coloring stops when your voice stops. You can do activities with a ball or with a car, where the toy is moving and your voice is on, like "vroom!" or "weee!" And when the item stops, the word stops. This is why people do "ahhhh" with the airplane and when the airplane stops, the sound stops. It all goes towards understanding that the sound is happening and these activities help pair the sound with something else that the child can perceive. This is less common with school aged children, unless you're working with a newly implanted student or a deaf plus with other disabilities kind of student. So let's move on to discrimination since that's more common to work on.

D: When people think of auditory discrimination, a lot of people think of minimal pairs - words that sound alike except for one sound like cat and bat, and this is word level auditory discrimination. But there's a lot that happens before this. The most basic level of auditory discrimination is pattern perception. Discriminating between the suprasegmentals of sound - intensity, pitch, duration. Duration being the important one here. The easiest form of auditory discrimination is hearing the difference between something like, "Aaaaahhhh" and "beep beep beep." The aaaahhh is long and durational and the beep beep beep is short and staccato. The listener does not have to actually be able to hear the difference in speech sounds themselves. They can discriminate based on duration alone. So if we're playing with an airplane and a car and I say "aaahhhh" and the child picks up the airplane, I know they can discriminate based on pattern perception.

D: This is why we do all of those learning to listen sounds associated with animals, vehicles, and actions. We want to make sure the students can detect all the speech sounds, which is why they span all those different sounds. But I also usually teach them in pairs so that I can move seamlessly into discrimination. So the airplane and the car. Maybe the cat and the dog like "meeeooww" versus "woof woof woof." And then sometimes like "oooooooopen" versus "close." It allows students to attach meaning to things faster and be able to follow simple directions faster because you're bringing down the audition skill to a very low level of pattern perception. This is what makes us different than most speech therapists. We know how to target foundational listening skills. It's not just about bringing the language level down. It's about bringing the listening level down as well. To a level where the student can participate even if they only have access at the suprasegmental level.

K: I liked that explanation, that was really clear. What are some other activities that you do when working on beginning discrimination skills?

D: Other activities for pattern perception are like the coloring, instead sometimes you say "color color" and sometimes you say "dot dot dot" and the student changes their coloring accordingly. Games with containers where the item goes like around the rim of the container, "around around around" versus "up up up up up" and then you drop it “iiiin”. Um, if there's any type of like door or box, you can do "knock knock knock" versus "ooooopen." So like sometimes you say knock knock knock and sometimes you say open and sometimes you do both. But if the student can do the right one then you know they have the pattern perception for that. Plus all of the play with animals and vehicles you just teach different learning to listen sounds of varying durations.

D: Once a student has pattern perception I usually move on to the actual names of items. So instead of saying, "Where's the cow? Moooo!" I just say, "where's the cow?" Can they hear the difference between cow, horse, chicken, etc. Now if you look at the auditory learning guide on the right hand side it breaks down auditory discrimination into like teeny tiny steps. And unless you're doing remedial cochlear implant rehabilitation, you really don't need to break it down that small into steps - unless the child is making errors which we'll talk about in a second. But as a general overview, it's easier to hear the difference between words with different number of syllables. It's still really just pattern perception so “cat” and “chicken” sound different. And then words with the same number of syllables but different sounds, so maybe “horse” and “cat”. And then words with some of the same sounds, like “cat” and “cow”. And then minimal pairs being the hardest, “sheep” and “jeep”. Here's where this comes into play for itinerants. If a child is making a speech error, we need to determine if one, they can hear that sound and two, can they discriminate that sound from other sounds. So for example, I had a child who had a lot of final consonant deletions and this child was old enough that it wasn't developmentally appropriate anymore. My first question was can they detect the final sound in words, the final consonant? We did some activities where some of the words had a final sound and some did not like “go” versus “goat”, or “no” versus “nose”. And they were able to identify the correct picture. And then I tried discrimination, can they hear the difference when the sounds differ by like manner, place, or voicing? Is there a pattern? So for some examples, for voicing, maybe “cap” versus “cab”. /p/ and /b/ are both stops but /p/ is unvoiced and /b/ is voiced. Can they discriminate the final constant differing by place? So maybe “mud” versus “mug”. /d/ and /g/ are both stops. They're both voiced but the place of articulation is different. Now you don't have to remember the places of articulation. It's just helpful to notice if there's any patterns to what a child is able to discriminate.

D: If they are having trouble discriminating between sounds that differ in voicing or manner, that's something you can tell the audiologist and they can adjust their programming. Voicing, manner, and place cues all occur at different frequencies and the audiologist may be able to use this information to adjust the child's map or programming. But I just wanted you to have some background info on why being detailed in practicing auditory discrimination can be helpful when a student makes speech errors because it helps you determine if it's an access issue or maybe the student just needs more listening practice or maybe they discriminate all that sounds fine and it's a speech or articulation issue. With the student I mentioned who was dropping all the final consonants, they were able to do all these auditory discrimination tasks. So I was able to go to the speech path and tell her that he c-could detect and discriminate final sounds and that that it was probably a speech-related error, and not a hearing related error. I have two auditory discrimination resources in my store that break down word level auditory discrimination for this type of practice and we'll link them in the show notes.

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D: This episode is brought to you by the Listen and Color Bundle from Listening Fun. Teach vocabulary in context with no prep. Includes all the language targets you need: context clues, multiple meaning words, synonyms and antonyms, inferences, and analogies. You read a sentence aloud, discuss the vocabulary target with your student, they color the corresponding picture on the page. It’s print and go for you and engaging for your student! Link in the show notes and at listentotodpod.com . Now back to the show!

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D: With older children other common auditory discrimination errors are with high frequency sounds, like /s/ as in “snake”, /f/ as in “fox”, /th/ as in “thank you”. One way you can help with auditory discrimination is to practice on the syllable level and give their brains lots of opportunities to hear that consonant with different vowels. The repetition will build up that neural connection in their brain. So what I do is I write the letter and then I draw 3 lines coming off of it that go to different vowels and then the student traces with their finger or a marker as we say the different sounds. So maybe like "say see soo" and then we'll do the same thing with 'f' "fay fee foo." And then I start mixing them up so they have to practice listening to how they sound different from each other. So I'll say, "say" and they'll trace from the 's' to the 'a' and then I'll say, "fee" and they'll trace from the 'f' to the 'e' And you make it harder by combining syllables. Sometimes we just do the listening practice and sometimes we do the discriminating practice. I'll talk you through a real example.

D: I was talking and I said the word “thigh”, as in like the part of your leg and the students said back to me “die”. They didn't hear that initial 'th' correctly so we went back one step to practice. I wrote 'th' on the paper and then some lines going to other vowels including 'i' because that was the vowel in the original word. So we practiced "thay thigh thee" a bunch of times. And then we also practiced in multiple syllables like "thay thee thigh thay" and their brain got lots of practice hearing that /th/ sound with different vowels. And then we did a quick practice of discriminating “thigh” versus “die”, “thigh” versus “my”, “thigh” versus “sigh”, to really make sure that it was good. Another activity for practicing auditory discrimination is doing tongue twisters. You can practice the tongue twister and then change one of the sounds and see if the student can hear the difference. Sometimes you say it correctly and the student gives you a thumbs up. Or you make a mistake on purpose and the student has to correct you. So as an example, Kimmy can you please read this tongue twister?

K: Susan's sock shop has surely stopped selling.

D: Thumbs up. Now swap out one of the 's's with an 'f' and we'll see if we can auditorily discriminate.

K: Susan's sock shop has surely stopped felling.

D: So I would do a thumbs down because you said “felling” instead of “selling”. And this is like a fun auditory discrimination task that is challenging but also entertaining and you can do it with whatever sounds the child needs practice with. I also like to play games with nonsense words, people's names, unfamiliar places, brand names, anything like that to force the kids to really listen to the words and not just rely on context.

D: These are some of the ways that I teach auditory discrimination instead of just testing it. However, it's very important to keep in mind that you can't out-therapy poor access. And you always need to check that they have access to the sounds. If I notice any of the same type of errors repeating, I am contacting that audiologist like pronto. So that was a long time on auditory discrimination, but now we can move on to identification.

K: In moving from discrimination to identification, it's important to note what the difference is. They're similar and can be worked on together but they're also separate. How I think about this is, discrimination has to happen between things, there has to be at least two options like, can you tell that these two words are the same or not the same? You can't discriminate between one item. Identification on the other hand is being able to complete a task with only one auditory input or item. It can be more, but it CAN be done with just one item. An example would be repeating a word or if I say “cat” and they point to a cat, I know that they can identify that word.

D: Exactly. Identification is knowing that a sound goes with a thing. Imitating falls under identification. If I say the word “cat” and the student repeats back to me the word “cat”, they have identified that word. A lot of times students move between discrimination and identification pretty seamlessly. I don't spend a lot of time worrying about if it's discrimination or identification. If they can hear the difference between the words and they know the words go with things, I'm moving on to comprehension. Comprehension is using sounds in language, like following directions, answering questions, having conversations. The difference between identification and comprehension is actually pretty interesting for TODs, I think, to be familiar with. Many of us have had or seen students where they repeat everything they hear or they repeat the last word or phrase that someone says. If I say like, "do you want a cookie?" they say “cookie” not “yes”. Now I'm not talking about kids with autism and echolalia, that's something a little different. I'm talking about kids with hearing loss who are using their cognitive energy to listen, and they have audition skills on the identification level, but they're not comprehending. They're hearing the words that you are saying, they are imitating the words back to you, but they are not comprehending the language that you're saying because they're not on the comprehension level and they're not using it correctly in context. Some people may hear a child like this and think they can listen and speak fine since their pronunciation is good and they're saying all types of words, but what they're really doing is parroting, imitating without comprehension. And this is a problem because it's not functional. Their brain is spending all its cognitive energy on processing the sound and identifying what you're saying that there's not enough brain power left over for comprehension.

K: This happens to me ALL the time. I know when listening fatigue hits me because I'll hear the words someone is saying, but it takes me an extended period of time to comprehend. Like my brain needs to recharge from between hearing them say the words and processing them. So this is very important to know because hearing what someone is saying is not the same as understanding it and as someone gets more fatigued this gets harder and harder to do.

D: Exactly. So when we get a young student who is parroting frequently, how do we get out of that? We have to strengthen their listening skills. We have them slow down and we play games that discourage imitation and promote thinking. So for example, maybe a puzzle. I will pick a piece and purposely put the piece on the wrong spot and say, "does it go here?" and then immediately model, "Nooo! Does it go here? Nooo. Does it go here? Yes!" Then I'll grab another piece and I'll ask them, "Does it go here?" and some kids will just say "here!" like they'll just repeat. I can give them a look and pause and they may say no or maybe I model it for them. But this game, like repeating the last word, is not appropriate. It doesn't make sense. It's not going to get them to the next step of the game so they'll learn pretty quickly that they're supposed to say yes or no and eventually they'll figure out which one it is. But it's one of those things that helps them get out of the habit of just repeating the last word that you say. Other things that work well for this type of game are shape sorters and color sorting games.

K: It's also helpful to remember that when it comes to these levels, it's very fluid and we're often working on several levels at once. So like I can work on comprehending directions and word level auditory discrimination with the same student. It's helpful to have an idea of what the foundational listening skills are, so that we're prepared to work with newer listeners when they pop up on our caseload.

D: Yes, and when I do in-services I usually show a slide of Erber's Hierarchy and very briefly explain it, like much more briefly than I explained it here, just to show teachers two main things. One, a kid turning to their name is potentially just detection and tells me very little about their actual listening abilities. And two, when you stress a child with hearing loss's cognitive load by making it harder to listen, like not using their accommodations, you reduce their ability to comprehend the material. The harder they have to work to listen the less brain energy they have to understand what you are teaching them. I usually compare it to students reading aloud and using all their brain energy on fluency and having nothing left over for comprehension. It's like that but with listening and comprehension.

K: That's a really good example. So this episode really got into the nitty-gritty of the listening hierarchy but we're hoping that you learned something new and found this episode helpful with all of the tips for how to implement that in your practice. We’d love if you could share it with a friend or share about our show on social media. A full transcript and show notes are available at listentotodpod.com and we'll see you next time.

Both: Bye!

LSLDeanna