Hearing Loss in Children: The Kit & Caboodle

Children develop their speech vicariously by hearing others speak and imitating the sounds in their environment. Thus, a child who is hearing-impaired finds difficulty in their speech development. They cannot hear the all of the sounds in their environment, so they find difficulty understanding, communicating, and learning about the world.

The causes of hearing loss in children vary from genetics, infections, or even injury. Children could be born with hearing loss or acquire the loss during infancy or childhood. A hearing specialist or ENT doctor can possibly determine the significance of a child's hearing impairment and suggest the appropriate treatment.

(((((How We Hear)))))

I learned the function of the ears during Biopsychology at SUNY Buffalo (where I received straight A's). When I say "it's complicated," I truly mean it. I'll abridge the current and most widely accepted theory about how the outer/inner-ears take in sounds as well as how the brain processes them. Sound waves first hit the outer ear, continuing on through the ear canal causing the ear drum to vibrate. This vibration triggers the bones in the middle ear to move up and down, creating waves in the fluid of the inner ear, AKA the cochlea (pronounced kɒk.lɪə or coke-leah; coolest word EVER). The microscopic hair cells inside the cochlea (yes, there's microscopic hair inside your ear and no, do not apply Nair) bend and stimulate the auditory nerve, which then transmits this auditory information to the brain to be further processed. This all happens within fractions of a second. Any single breakdown in this system (ie: Nairing your cochlear hair) can result in hearing loss. In all seriousness, hearing impairment in a child can drastically hinder their speech development, emotional development, intellect, and life in general. Luckily, large strides have been made over the past few decades in treating and even fixing hearing impairment. But, before we get into that, let's talk about the different types of hearing loss.

(((((Types of Hearing Loss)))))

Conductive hearing loss constitutes a signal breakdown near the outer or middle ear. Temporary conditions such as fluid build up in the middle ear, ear infections, or wax build up in the ear canal can cause conductive hearing loss. Malformations of the ear or ear canal can also cause breakdown of auditory signals.

Sensorineural hearing loss can result from damage or malformation of the inner ear or cochlea. This type of hearing loss is typically permanent, and often medical or surgical treatment cannot fix the issue. Children who have sensorineural hearing loss can sometimes benefit from wearing hearing aids or cochlear implants that amplify auditory signals or bypass the damaged inner ear.

Mixed hearing loss is a combination of both conductive and sensorineural components of hearing loss.

(((((Severity of Hearing Loss)))))

To determine the severity of a child's hearing impairment, an audiologist creates a graph called an "audiogram". The severity of hearing loss can vary from mild, to moderate, to severe, to profound. An audiologist can create a measurement of a child's hearing loss on an audiogram by measuring a child's detection for sound at a slew of different pitches ("frequency") and loudness levels ("intensity"). The lines on an audiogram create a "shape" that represents the child's hearing loss. A flat shape indicates that the child hears at about the same intensity level across all frequencies. A sloping shape indicates a need for more intensity as sound movers across the different frequencies. A "cookie bite" shape refers to a hearing loss milder in the low and high frequencies, with a more significant loss in the middle frequencies.

(((((Treatment of Hearing Loss)))))

Regardless of the type and severity of a child's hearing loss, it CAN be managed. Professionals such as audiologists or otolaryngologists devote their careers to this. Amplification systems are constantly being improved upon, and medical or surgical treatments can sometimes help increase a child's hearing ability. Hearing is directly related to a child's development of speech, reading and writing. So parents who suspect a hearing impairment in their child should seek testing and treatment immediately. Difficulties with speech can be treated by a Speech-Language Pathologist.

 

Resources

National Institute on Deafness and Other Communication Disorders, NIDCD, from the National Institute of Health, http://www.nidcd.nih.gove/health/statistics/hearing.asp retrieved September 26, 2013.

Super Duper Handy Handouts!. "Hearing Loss in Children" by Susie Lorraine, M.A., CCC-SLP

P.R.O.M.P.T. Therapy: Who, What, & Why?

PROMPT stands for Prompts for Restructuring Oral-Muscular Phonetic Targets. The technique utilizes tactile-kinesthetic (a fancy word for "learning through doing") articulatory cues on one's jaw, face, and under the chin to develop OR restructure speech production.
Many therapists at Suffolk Center for Speech are trained in PROMPT therapy, versed in manually guiding children in articulating specific sounds or words. PROMPT, for many children, can be boring and unengaging. But we know how to make it fun. Our therapeutic platform for children is heavily focused on motivating and rewarding. Many parents of patients tell us their children "can't wait for speech."

During PROMPT, a clinician will use their hands to cue and stimulate articulatory movement in the patient's mouth area, and simultaneously, discourage unnecassary movements to eliminate them. This type of therapy addresses cognitive, social, pragmatic, behavioral, sensory motor and physical domains. Each individual is evaluated for his/her strengths and weaknesses. Strengths are utilized to improve the clients communication skills with a focus on dimishing weaknesses. PROMPT therapy may be different for individual patients in terms of how a clinican helps the patient improve motor control, cognitive skills, and social interactions. At Suffolk Center for Speech, our main objective in PROMPT therapy is to improve functional, interactive, and verbal communication of young ones. PROMPT therapy is not for everybody.

Who Can Benefit?

Children and adults who suffer from Apraxia of Speech, Developmental Delays, Dysarthria, Phonological Disorders, Autism Spectrum Disorders, and Hearing Impairments can all benefit from PROMPT therapy.



What Does A PROMPT Session With A Child Involve?

A therapist will initially evaluate a child's degree of focus during the communication process. If a child is having difficulty paying attention to the therapist, maintaining eye contact, and/or generally focusing, a therapist will implement strategies to help the child "be present". The therapist may attempt to slow down the child's rate of speech, and prompt the child to use vowel sounds. Once the child begins to imitate or initiate vowel sounds for the purpose of communication, Parameter PROMPTS (processes that facilitate jaw/facial control and a degree of articulatory movements) are provided. These will shape speech production for a child in need. It won't happen overnight, but PROMPT is an extremely effective approach to teaching a child to proper communication skills(physically and verbally). Therapy structure will shift from focus and attention to functional speech exercises.
 

Can Parents Carryover PROMPT Therapy Goals At Home? 

They sure can. In fact, parental involvement is critical to the success of PROMPT therapy. Parents are NOT encouraged to attempt to imitate PROMPT training. PROMPT therapy is a specialty that requires in-depth training, and incorrect emulation can interfere with PROMPT therapy goals. Parents are encouraged to talk with their children about what he/she did during therapy: to ask them questions about it. This will help the child remember what he/she has learned during therapy (how to articulate certain sounds or vowels, or how not to). Parents are also encouraged to read stories that contains words that force out the articulators the child is finding difficulty with in a fun and engaging environment (particular to the child). If the child is still pronouncing sounds wrongly, inform them subtly. Make it fun for the child to learn correct pronunciations by playing games that include well rehearsed words or phrases. A fun and natural environment is important for the child to rehearse pronunciation; otherwise, they may not bring what they've learned at Speech Therapy home or to school. It's extremely important that parents acquire a solid rapport with their child's speech-language pathologist, so that strengths and weaknesses can be discussed as well as ways to foster successful therapy (homework, if you will). A skilled therapist will give ideas to a parent regarding situations and scenarios where a child may experience most effective practice.
 

PROMPT Trained and PROMPT Certified:
What's the Difference? 

A PROMPT-trained therapist is allowed to practice PROMPT therapy on patients in need, and are completely qualified as well. The only difference between a PROMPT-trained therapist and a PROMPT-certified therapist is a video project, which is extremely costly to the therapist. Other than that, there is no difference.