HI 3: Families Flashcards
Old policy + new
OLD
Distraction test, pre-2006
- sound made (e.g. rattle). look for response.
- done 6 mo post birth
- few reliably diagnosed before 2 years => huge impact on language
NEW
Newborn hearing screening programme (NHSP)
- 4-5 wks w/in birth
- objective
Tests in Newborn hearing screening programme (NHSP)
OTOACOUSTIC EMISSION SCREEN (AOE)
- sound presented thro ear canal via tube
- tests inner ear; HC sensitivity
- should result in echo generated
- AOE usually followed up by AABR
AUTOMATED AUDITORY BRAINSTEM RESPONSE
- various tones played thro ear canal
- electrodes on mastoid monitors brain’s response
Effects of pre lingual deafness on language development?
- prelingual deafness effects lang acq.
HERMAN ET AL - deaf children have
- smaller lexicons
- weaker connections btw word meanings
- lower reading vocab
- slower growth rate
- profit less from opp to acquire new words (convos)
- poor speech intell => phonological skills (important for lexical development)
- Poor lang =impacts=> working memory, ToM, social skills
- Non-verbal skills not usually impaired (compensatory strat)
Why is language important for brain development?
LANGUAGE STIMULATES BRAIN DEVELOPMENT
- FLEXER => hearing neccessary pre-quisite for developing spoken communication
- CAMPBELL => hearing speech stimulates specific regions of brain development but studies of deaf signers brains show similar levels of act when signing
- lack of stimulation at 2 yrs (critical period) = nueral degeneration
- children exp to sign lang from birth => better outcomes than deaf children in hearing fams (MAYBERRY)
IMPACT OF DEAFNESS OF LANGUAGE
Snowball effect of deafness
- delayed + degraded speech perception
- incomplete phonological representations, unintelligible speech
- Poor vocab + syntax, diff w compreh.
- limited social skills + interaction
- Delayed literacy skills + academic attainment + employability
GOES ON
Sign lang dev vs spoken. Best outcomes.
LEDERBERY ET AL - sign lang development parallels spoken.
- good models + early expos ess for cogn development, identity +mental health
- deaf children still gotta know some spoken words => comm w hearing ppl
- SINGING + ORAL BEST OUTCOME
- gr8st access to vocab
Cochlear implants - when offered? benefits?
- offered to profoundly deaf by age 3.
- SHARMA => Chw CIs @ 1 yrs gr8r nueroplasticity than hearing aid users
- ROBBINS => some CIs acq auditory skills same as hearing peers
CI cotreverdy
- fear it will eradicate Deaf culture + sign
- ethics of invasive surgery for non-life threatening condition — few deaf families would opt for it
- CIs dont make person hearing (still deaf)
- failures rarely reported
What 5 areas should intervention target acc to RCSLT?
- empowering parents by providing info + support w/in team
- est effective comm w/in family
- develop + monitor child’s comm skills
- Maximise use of residual hearing + speech
- Develop child’s self-esteem and identity
- SUPPORT AND INFORMATION
Early Support Programme – govt funded initiative. Prov parents w information:
- Professionals and services they may need, encounter, use. (charities, education, social se.)
- Info on hearing – hearing tests, aids and CIs, improving listening environm
- Infos on comm options + ways to support development
- Info on education
Coordinated services, key prof encountered: teacher of deaf, SLT, audiologist, docs, Deaf staff, volunt org
Role of Deaf staff – role model, facilitating interact, help w parent’s acceptance, promot sign comm, prov info on Deaf culture.
Helping to inform choices re comm opt: meeting w range of families, expl of interventions;implications;evidence, making changes to child comm plan, making arrangements w fam + local auth.
- EST EFFECTIVE COMMUNICATION
- PCI
Working on parent-child interaction as this is disrupted by childhood deafness due to mismatch of modalities. Early int => high quality interaction est
PCI:
- Parent filmed interacting w child. Watch video back with SLT + evaluate own interaction
- Focus on positives => change 1 thing
- Videos measure of before + after
- Interaction profile of parent – ability to gain child’s attention, linguistic input, consideration of child’s perspective
- EST EFFECTIVE COMMUNICATION
- Facilitating interaction: child needs…
- Full access to auditory and visual comm
- Attention strategies so child knows what comm is taking place
- Needs to switch attention from parent to referent (joint attention)
- Quality of comm important
Making communication accessible: Gaining eye contact, moving into LOV, facial exp + gesture; developing JA => gain att and present sign, point + child shifts gaze
Modifying content of parental language: parentese in speech and sign (access to app sign classes??), amount of lang (less + simple, few questions, more naming)
NDCS Family sign curriculum = aimed @ fams of deaf children who want to use BSL.
Teaches signs + phrases meaningful to child.
- MONITOR COMMUNICATION
Early Support Developmental Journals:National monitoring protocol for deaf babies and children
Need to track areas potentially at risk due to deafness 0-3 years:
- comm, A+L, vocalising, social + emo dev, play, physical dev
- Each area divided into 11 baby (B) stages of development – early years have narrow ranges than later years, each stage has descriptors of what parent can expect.
- Encourages parents to obs child’s development.
Monitor early lexical development: MacArthur - Communicative Inventor ==> Parent report tool incl vocab checklist.
- MAXIMISING RESIDUAL HEARING AND SPEECH
describe continuum of auditory skills development
Easiest to hardest:
sound detection/awareness (presence/absence),
Discrimination (same/diff),
identification (labelling),
comprehension (understanding naming).
- MAXIMISING RESIDUAL HEARING AND SPEECH
How can residual hearing be maximised?
work on activities focusing on sound awareness and discrimination (minimal pairs etc).
- MAXIMISING RESIDUAL HEARING AND SPEECH
Describe Learning through listening
Yoshinaga-Itano –
Use of parent training that involves:
• Effective use of amplification
• Looking for/encouraging child’s response to environ sounds
• Child’s reaction to Ling sounds
• Encouraging adult imitation of child production + vice versa
Encouraging vocalisation and vocal play –
- Copying child sounds
- Playing w noise act toys
- Exposing to diff sounds
- Varying intonation patterns
- Singing – anticipating rhymes
- Books
- MAXIMISING RESIDUAL HEARING AND SPEECH
What asx monitors children’s hearing for speech?
Infant-toddler meaningful auditory integration scale (IT-MAIS), Zimmerman and Phillips
Structure of interviews to asx child’s spontaneous responses to sounds based on 3 criteria –
- Vocalisation behaviour
- Alerting to sounds
- Deriving meaning from sound
- MAXIMISING RESIDUAL HEARING AND SPEECH
Describe trajectory for speech production
Yoshinaga-Itano:
0-12 mo: All deaf children have similar vocal prod diff to age-matched hearing peers
1-2 yrs: Speech production differ by severity of HL. Less = more phonetic inventory + rising vocal inflection
2-5;06 yrs: Diff trajectory for profoundly deaf; speech prod depends on exp lang
3 years: ChwMILDHL sign. delayed in speech production
- MAXIMISING RESIDUAL HEARING AND SPEECH
Assessment to track speech in chwCIs
Profiles of Actual Speech Skills, P.A.S.S. (Osberger et al.):
- Assesses pre-speech vocalisations – designed to measure vocal changes in early months after Cis.
- Based on 6 min sample of spontaneous speech taken in play situation w child’s parent/caregiver
- Vocalisations classified by frequency of occurrences of each category is calculated
- Periodic reassessment enables monitoring of change
PASS CATEGORY + DESCRIPTION
SPEECH ==> Recognisable/reasonable approximation of phonemes of English. Describe broadly.
NON-SPEECH ==> Sounds don’t represent speech e.g. lip smacking, raspberries
SPEECH-LIKE ==> Utterances had vocalic, nasal quality, produced on a glottal fry
OTHER ==> Artic movements should be eliminated such as exaggerated jaw movements
Predicted outcomes for chwHL?
Outcomes for deaf children (Yoshinaga-Itano): The severity of a HL will impact the number of consonants in a child’s repertoire + exp lang vocab.
MODE OF COMMUNICATION (Yoshinaga-Itano??):
~ Chw mild HL – mainly use oral comm + more intelligible speech
~ Severe -prof deaf – if educated w sign + orally (bilingual), achieved intelligible speech
~ Prof deaf chwCIs – age of implantation important for transfer from sign to speech (18 mo = 100% VS 18-3- mo = 50%)
~ Parents changed comm strats during infant/toddler period
~ Est lang in sign is facilitated by subsequently by dev of spoken lan (piggy back effect)
Significant factors in optimising outcomes
children do well where: • Programmes are parent centred • Strong counselling component • Careful monitoring of child’s progress • Parent-professional partnership • Parents fully informed • Access to role models
