Ways to Make Sure Your Child’s Therapy Keeps Pace with Classroom Demands


By Krystyann Krywko, Ed.D.

The beginning of each school year means new and often increased classroom demands. As children advance in school, parents need to understand the realities of what is happening in the classroom, so the supports are in place to preempt or overcome academic challenges. For parents of children with hearing loss in a mainstream educational setting, this means ensuring that therapy goals are intertwined with and responsive to the curriculum.

As children with hearing loss leave the comforts of their early intervention (EI) and preschool programs and head out into mainstream education settings, parents may be uncertain as to what skills and strategies their child needs to attain in therapy sessions in order to keep pace with changing classroom demands. “As classroom demands increase there is a need to use listening and language skills more effectively,” says Lois Heyman, director of the Shelley and Steven Einhorn Communication Center in New York City.

Research suggests that in a typical kindergarten classroom 50 percent to 70 percent of a child’s day is spent in listening mode. This expectation to sit and listen only increases as students move into higher grades. Learning can be extremely difficult if the student is unable to process the information because it is presented in a way that it is difficult for them to interpret. For children who are deaf and hard of hearing this means that if information is primarily delivered through lectures and classroom discussion then it takes an enormous amount of energy for them to learn the information presented.

“Educational demands on students seem to develop and change every few years,” says Amanda Eckert, a teacher of the deaf based in New York State, “particularly around grades four, eight and nine.” For example, third grade is where the demand for strong literacy skills increases, but it is in fourth grade where these skill are expected to be used to gain knowledge and information from texts, make connections to characters in stories, as well as make significant plot references. By the same token, middle school students are sometimes required to write down and capture information from class lectures, but it is in high school where they are expected to be completely independent and responsible for their own notes. If children’s listening skills do not keep pace with increased academic demands, then there is a greater chance that they will fall behind in the classroom.

What Skills Are Important to Build

When working with classroom teachers, speech-language pathologists and teachers of the deaf, it is helpful for parents to know the listening and language skills that these professionals should help children develop so that they can keep pace with the increased classroom demands during the school years.

Sound and Word Discrimination
Discrimination has to do with the ability to process the similarities and differences between two or more speech sounds. “Sound and word discrimination are the biggest need for a child who is deaf or hard of hearing as they move through school,” says Heyman. “As a greater demand is placed on listening, and auditory information comes at a faster pace, then when a word is misheard, the focus shifts from what the teacher is saying to trying to find the word that makes sense. This small pause in attention causes the child to fall further and further behind as the teacher continues to talk.”

For example, if a teacher says something like “The girl is in bed,” the child might hear “The girl is in dead”. He knows that doesn’t make sense, so he will hesitate and try to figure out what the actual word is that makes sense. While he is doing this, he will miss the information that follows until he figures out the misheard word.

It is important to focus on developing functional sound and word discrimination skills in realistic environments, which mimic the background noise and reverberation of the classroom. Discrimination goals are often easy to meet in the quiet of a therapy room, but moving sessions out into other spaces such as the cafeteria, playground or classroom where background noise is present helps to build auditory discrimination when listening in noise, adds variety to the listening challenges, and—most importantly—assists the student in transferring these skills to work in the classroom.

Auditory Memory
Auditory memory is the ability to absorb information that is presented verbally, process it, retain it, and then recall the information when needed (Stredler-Brown & Johnson, 2004). Children who are deaf and hard of hearing need to build this fundamental skill if they are to progress with their language development because it is a critical component of auditory comprehension.

Auditory memory plays an important part in classroom learning, as it is used to develop the memory and concept of words and phrases; the ability to sequence items and events; and the telling and retelling of stories. It also helps in answering questions about a familiar topic or a story. Without strong auditory memory skills it is difficult to learn from the conversations of others and from the time the teacher spends talking.

Developing a strong auditory memory is similar to building a strong muscle. “There is a progression of goals when working on auditory memory,” says Gerard Shine, a speech-language pathologist in Westchester County, New York. “Professionals working with children with hearing loss can start by first strengthening the skill in isolation and then move from using smaller units such as individual words and numbers before moving into sentences and longer strings of numbers, such as a telephone number.” The next step would be to work on improving auditory memory by working on restating and following multistep directions, and  keep progressing so that the child begins to feel more comfortable with larger chunks of information.

When working on improving auditory memory it helps to incorporate the skill into language comprehension goals. That way there are numerous opportunities both in the classroom and in therapy sessions for students to process information orally. The key is to build on the skill from the early years. “If students are not able to synthesize information presented orally at a young age,” says Eckert, “it will make those high school lectures that require note taking much more challenging.”

Vocabulary Development
When children are exposed to a greater number of words, they have a greater tendency to be strong communicators and readers because there is a “Matthew effect” in vocabulary development in which students with good vocabularies grow even stronger in the number of words they know (Hart & Risley, 1995). Children who are deaf and hard of hearing need three times the exposure to new words and concepts as compared to their peers with typical hearing, simply because hearing loss reduces auditory access and incidental learning (Flexer, 2009).

This reduced auditory access means that a child who is deaf or hard of hearing needs extra exposure to new words and concepts before they are able to identify and understand them when they teacher speaks. “Handing a vocabulary list to an itinerant teacher and having them introduce the word and definition won’t help the child be able to identify the word,” says Heyman. “This way of doing therapy works for a child who has language delays, but not a child who is deaf or hard of hearing.”

Instead, Heyman suggests using Erber’s (1982) four stages of auditory skill development to approach vocabulary building for a child with hearing loss. These four stages are: detection (a child can hear the sounds); discrimination (a child can discriminate between the sounds); identification (a child can identify different sounds); and comprehension (a child is taught the meaning of the sounds). This approach allows for different access points for a child who is deaf or hard of hearing to process auditory information.

Theory of Mind

Theory of Mind has to do with the ability to understand others’ perspectives, beliefs, desires and intentions. Having a well developed Theory of Mind helps an individual to understand such social occurrences as surprises, secrets, mistakes, lies and tricks (Flexer, 2009). In a classroom setting, Theory of Mind is necessary for the development of social skills, emotional understanding, collaborative learning in the classroom, and understanding the actions and thoughts of others, whether they are classroom friends or characters in a book.

Research has shown that children who are deaf and hard of hearing can have significant delays in their understanding of Theory of Mind (Schick, B., de Villiers, J., de Villiers, P., & Hoffmeister, B., 2002). The main reason for this is because language is indispensable for the development of Theory of Mind and reduced access to language can impact the development of this ability (Farrar & Maag, 2002). However, exposing children to descriptive language that helps to explain Theory of Mind and involving them in situations, whether through the use of story or role play, can help them to more fully develop the language to understand the perspectives of others.

Theory of Mind can be a difficult concept for professionals to focus on in developing intervention goals, but language goals can be used to reach the same result. “I have found the best way is to first work on rules of conversation,” says Shine, “and to help students understand that in order to have a positive social interaction there are rules of conversation that need to be followed.” Providing the language needed to express a state of mind or an opinion is also helpful for students to begin to understand the perspectives of others. Words like “he thought” and “he believed” give students a framework for moving toward the  understanding that others have different thoughts, beliefs and ideas.  Whole class or small group discussions can also be used to talk about the past, the future, emotions and misunderstandings, as this provides opportunities to share viewpoints in a structured environment.

Staying on Track

So how can parents be sure that their child’s listening skills are growing along with the academic demands of the classroom? “Parents need to be aware of what their child’s goals are and the purpose for each goal,” says Lana Eggleston, a speech-language pathologist at Arkansas Children’s Hospital, EARS Outreach program. “Call a meeting if you don’t know the information, don’t be afraid. What is difficult is for parents to wait for their annual review to find out that their child is not making any progress.”

Determining why your child is not making progress is a little like putting together pieces of a puzzle. Keeping the lines of communication open between child, parent, teacher, speech-language pathologists, teachers of the deaf, and other listening and spoken language professionals can make sure that everyone is aware of the goals and expectations so that they are truly meeting the needs of your child as academic demands and challenges increase.

Schick, B., de Villiers, J., de Villiers, P., & Hoffmeister, B. (2002). Theory of Mind: Language and Cognition in Deaf Children. ASHA Leader, December 3. Retrieved from http://www.asha.org/Publications/leader/2002/021203/f021203.htm 

Erber, N. (1982). Auditory Training. Washington, DC: Alexander Graham Bell Association for the Deaf and Hard of Hearing.

Farrar, M. J., & Maag, L. (2002). Early language development and the emergence of a theory of mind. First Language, 22, 197–213.

Flexer, C. (2009). Theory of Mind Development and Distance Hearing. Online presentation. Retrieved from http://www.audiologyonline.com/audiology-ceus/course/theory-mind-development-and-distance-14990

Hart, B., & Risley, T. R. (1995). Meaningful Differences in the Everyday Experiences of Young American Children. Baltimore, MD: Paul H. Brookes Publishing.

Stredler-Brown, A. & Johnson, C.D. (2001, 2003, 2004). Functional auditory performance indicators: An integrated approach to auditory skill development. Retrieved from http://arlenestredlerbrown.org/docs/FAPI-old.pdf

Source: Volta Voices (2014), Volume 21, Issue 4