audiology midterm

Auditory Development - fully developed auditory system

At week 23, the fetus has a fully developed auditory system.

Four Auditory Assumptions

1. Humans decode auditory information and use it for meaningful communication.

2. Auditory development begins prenatally through embryonic fluid.

3. There is a critical period for auditory neural pathway development.

4. Infants have complex systems at birth and can analyze and categorize input, which is important for language development, bonding, and spatial awareness.

Language Is Caught, Not Taught

Language develops through the interaction of innate capability and incidental learning.

Hierarchy of Auditory Development

Detection → discrimination → identification → comprehension. Each step builds sequentially on the previous step.

Detection

Awareness of the presence or absence of sound, including sound localization.

Discrimination

Ability to determine whether two sounds are the same or different.

Identification

Ability to point to or identify a sound, including imitating it.

Comprehension

Understanding the meaning of auditory information.

LING 6 Test

Used to ensure access to a range of speech sounds and assess detection and discrimination.

LING 6 Test: what reliability is it testing?

Assesses how reliably the child responds to the speech-language pathologist (SLP).

LING 6 Test: Frequency Range

Tests sounds across 250–8000 Hz; formants are presented across a range.

LING 6 Test: Sounds

/ee/, /ah/, /oo/, /sh/, /s/, and /m/. Sometimes /th/ is included, but it is mostly present in English and is very high frequency, making it difficult to detect.

LING 6 Test: Silence

Silence is included so the child can detect the absence of sound; it also provides a control.

Ling-Madell-Hewitt (LMH) Test Battery (LING 10)

Adds /z/, /h/, /n/, and /dj/ to the Ling 6 sounds, providing a more comprehensive assessment of frequency and voicing.

Prosodic Cues and Linguistic Meaning

Energy, intensity, duration, and intonation of syllables help mark boundaries of syntax, semantics, and dialogue units.

Effects of Auditory Input on Language Learning (5)

Auditory input affects vocabulary acquisition, grammar, spelling, spoken language (speech), and phonological awareness.

Intrinsic Factors That Impact Listening (4)

Cognitive ability, comorbidity, learning style, and auditory processing.

Extrinsic Factors That Impact Listening (5)

Age of identification, consistent use of hearing assistive technology (HAT), amount and type of intervention, intervention intensity, and parental investment

Questionnaires

Provide parents and teachers with guidance on observing behaviors.

Inventories

Provide information about difficulties in specific listening conditions.

Assessments

Can use open-set or closed-set formats and progress from gross to fine distinctions, moving from maximal differences to minimal differences.

Open-Set Assessment

An assessment format in which the listener responds without a limited set of provided choices.

Closed-Set Assessment

An assessment format in which the listener chooses from a defined set of options.

Gross-to-Fine Assessment

Progresses from tasks with maximal differences to tasks with minimal differences.

Small-Set-to-Large-Set Assessment

Progresses from a few choices to many choices.

Cottage Acquisition Scales for Listening Language and Speech (CASLLS)

A criterion-referenced tool with levels including sounds and speech, pre-verbal, pre-sentence, simple sentence, and complex sentence.

CASLLS Levels

1. Sounds and speech. 2. Pre-verbal. 3. Pre-sentence. 4. Simple sentence. 5. Complex sentence.

Hearing Age

The time since hearing assistive technology was first turned on; it begins on the day the technology is activated.

Auditory Input and Speech/Language Development

Any disruption in auditory input can disrupt speech and language development.

Hearing Loss and Early Intervention

Legislation and early intervention services address the needs of young children who have hearing loss or are at risk of developmental delays.

1986 Public Law for Early Intervention

A new public law was passed to address service gaps for children under age 3 who were at risk or suspected of having developmental delays.

Individuals with Disabilities Education Act (IDEA)

Legislation that brought a major shift in public education and increased inclusion for individuals with learning and cognitive disabilities.

IDEA Part B

Addresses school-age children ages 3–21.

IDEA Part C

Addresses children under age 3 through early intervention (EI).

Who Qualifies for Early Intervention (3)

Children with an established condition;

a diagnosed physical or mental condition with a high probability of developmental delay;

or an existing developmental delay or risk of delay.

Developmental Targets of EI (5)

Social-emotional, physical, cognitive, adaptive, and communication development.

Natural Environment for EI Services

Services must be provided in the child's natural environment and be part of everyday routines.

Exception to Natural-Environment Services

A team may agree that objectives cannot be met in the natural environment; services may then occur in settings such as a hospital or developmental center.

Joint Committee on Infant Hearing (JCIH) with 2 responsibilities

A group involving doctors, nurses, and audiologists that has two main responsibilities:

making recommendations for early identification

and

establishing protocols for universal newborn hearing screening.

act that must be reauthorized every few years for EI

Early Hearing Detection and Identification (EHDI)

Language Acquisition Window

the period before 3 years for language acquisition

1-3-6 Rule

Screen by 1 month, evaluate by 3 months, and receive early intervention services by 6 months.

Screen by 1 Month

The first step of the 1-3-6 rule is newborn hearing screening by 1 month of age.

Distortion Product Otoacoustic Emissions (DPOAE)

A hearing screening method classified as electroacoustic.

Auditory Brainstem Response (ABR)

A hearing screening method classified as electrophysiological.

Automated Auditory Brainstem Response (AABR)

An automated form of auditory brainstem response used in newborn hearing screening.

Failed Newborn Hearing Screen

If either or both ears fail screening, rescreen within 1 month.

Hearing Screening

An indirect measure of auditory sensitivity.

Evaluate by 3 Months

JCIH encourages striving for evaluation by 2 months.

prosodic cues (4)

Energy, intensity, duration, intonation of syllables

Diagnostic Hearing Evaluation

Confirms the presence or absence of hearing loss.

Functional Auditory Assessment

Assesses how a child uses and responds to auditory information functionally.

Receive EI Services by 6 Months

JCIH encourages striving to begin services by 3 months.

Establish a Medical Home

Provide a team approach to intervention and care.

Lost to Follow-Up percentage

35.9% of children

Listening and Spoken Language Certification

additional training for children with hearing loss who want to use speech

Unbiased Counseling

Counseling should provide information without favoring one option over another.

Accurate Counseling

Counseling should provide correct and reliable information.

Choice-Driven Counseling

Counseling should support informed family choice.

Culturally Responsive Counseling

Counseling should respect the family's culture and needs.

Early Intervention Team

May include the parent, service coordinator, speech-language pathologist (SLP), audiologist, Certified Teacher of the Deaf, developmental psychologist, and social worker.

Service Coordinator

Ensures that early intervention services are provided.

EI Program Considerations (4)

Include amplification, the communication model chosen by the family, a natural communication environment, and parental consent and involvement.

when does transitional evaluation occur?

at least 3 months before child’s third bday to determine if they can move from Part C to Part B

Communication Model

Selected according to the family's choice.

Natural Communication Environment

Communication and intervention occur in settings that support natural everyday interactions.

Parental Consent and Involvement

Family consent and participation are considerations in early intervention planning.

Battelle Developmental Inventory, Third Edition

A developmental evaluation tool used in New Jersey, according to the notes.

Annual Reassessment

The same tool, the Battelle Developmental Inventory, Third Edition, is used for annual reassessment.

EI Eligibility Criteria

Services are determined by the state; 33% delay in one area or a 25% delay in at least two areas.

Teacher of the Deaf (TOD)

the Teacher of the Deaf goes in first.

At-Risk Children and EI

States determine whether children considered at risk are included in early intervention services.

Writing EI Outcomes and Goals

Goals should be meaningful, functional, measurable, and attainable within 3–6 months.

syndromes contribute to what percent of genetic hearing loss?

30%

Congenital Hearing Loss

Hearing loss present at birth

Usher's Syndrome

gait, associated with hearing loss

syndromes associated with hearing loss (6)

ASD, cerebral palsy, Down syndrome, congenital hearing loss, and Usher's syndrome, other disabilities

Transition Planning Conference/Identification Meeting

A meeting addressing the transition from IDEA Part C early intervention to Part B services when the child is eligible.

Transition from Part C to Part B

Eligible children transition from Part C early intervention services to Part B services.

Transitional Evaluation

Conducted at least 3 months, or 90 days, before the child's third birthday.

Initial IEP Meeting

Conducted when a child qualifies for continued services through an Individualized Education Program (IEP).

Hierarchy of Listening Skills goals

Goals should target multiple dimensions at once

Auditory Function Dimension of Listening

Includes awareness, discrimination, patterning, identification, and comprehension.

Meaningful Input Dimension of Listening

Progresses through sounds, words, phrases, sentences, and conversation.

Situational Context Dimension of Listening

Can be structured, routine-based, or naturalistic.

Listening and Spoken Language Certification

Additional training for professionals working with children with hearing loss who want to use speech.

Auditory-Verbal Therapy (AVT)

An approach associated with a medical setting

Auditory-Verbal Education (AVEd)

An approach associated with a school setting

3 dimensions in hierarchy of listening skills

auditory function, meaningful input, and situational context.

when should referral be initiated?

within 2 days of hearing loss confirmation

characteristics of counseling (4)

unbiased, accurate, choice driven, culturally responsive

analog hearing aids

amplification only

digital hearing aid

more precise in amplification, can tailor better to individual hearing loss

frequency following response

an auditory evoked potential that measures the brain’s ability to synchronize neural activity with a sound stimulus

frequency following response & AI

allows the hearing aid to capture details of sound, learning the specific details of an individual’s speech patterns

hearing aids regulated through…

FDA

medical eval requirement for hearing aid

doctor’s clearance that a person has been medically evaluated and considered a candidate for a hearing aid, may be waived if a person if under 18

FDA OTC Hearing Aid Act of 2017

commercially available hearing aids for adults over 18 with perceived mild to moderate hearing impairment

60/60 rule

candidate if PTA is above 60 dB HL AND their unaided word recognition is less than 60%

changes to cochlear implant candidacy

can be approved for 9 month olds, 60-60 rule, asymmetric HL, unilateral HL