I always begin any introduction to Auditory Verbal strategies here because this strategy sets the foundation for all the work that comes next. Auditory First is an attitude as well as a set of conditions that will enable the child who is deaf or hard of hearing to have better access to speech and language. This strategy becomes a mindset or lifestyle that continues throughout the child’s day.

An Auditory First attitude is achieved when the following conditions are met:

Ideally a newly identified child should be seen every 4 to 6 weeks until a full audiogram is complete. From that point they should be seen every 3 months until the age of 3 when the child is typically seen every 6 months as recommended by the AG Bell Academy (Flexer, Madell & Hewitt, 2014.)
Child wears hearing technology ALL waking hours
Daily listening checks performed to assess the child’s current listening ability and to ensure equipment functions properly
Batteries are charged and backup batteries are available
Backup coils/wires are available for cochlear implant users
Magnet sites of cochlear implant users are checked regularly to ensure there is no irritation or swelling
Hearing equipment is listened to both with and without FM connection to check for clarity

The conditions listed above are prerequisites to ensure auditory access. However, it is also important to be mindful of how to present information to a child learning to listen and speak as the goal is to build auditory skills! This is the strategy that pairs with the mindset. Always think:

Was the child given the best opportunity for hearing sound before they were expected to respond?
Did the speaker avoid giving any visual information until the child had a chance to hear and process information?
Does the child’s behavior have anything to do with a change in their hearing?

SIDE NOTE: Some professionals still use the “hand cue” (page 287 in this sample, page 15 in the PDF) to ensure that they did not give the child visual information via speech reading. However, this technique is no longer recommended. A speech hoop would be an appropriate substitute but is better suited for initial instruction of a listening check and then faded over time in favor of different positioning or Visual Distraction Techniques. The “hand cue” is not part of natural communication so I encourage the use of other techniques.

(sources for speech hoops: source 1, source 2, source 3- use speaker fabric from an audio/automotive store rather than other dark fabric) The one pictured below I made in graduate school in 2010. It’s still going strong!

In the image above you will notice I am doing our daily listening checks in a preschool classroom using a speech hoop. Later, when the children learn this task and it’s expectations I can use a Visual Distraction Technique and change the distance at which I test each day. You will also notice that the student on the left has his cochlear implant magnet off. I test each piece of equipment individually and binaurally to monitor progress over time. I have caught many a dead battery through testing unilaterally, that I might not have noticed otherwise.

Back to ensuring auditory access. Access to sounds means a visual check of equipment as well as a thorough listening check. We can ensure equipment functions at the optimum by doing a visual “check” of equipment. Each child or adult has equipment unique to them so it is important to be familiar with different brands, know where/how to access their user manuals, or have access to an audiologist to perform troubleshooting. Here are the basis of a visual check:

Ear molds fit properly and are free of wax and moisture
Tubing is secure in ear mold
No visible cracks, pinches, or tears in cables of cochlear implants or tubing of hearing aids

Why is this strategy important? A child’s auditory system, in its earliest stages of development, depends on stimulation from an environment that is full of meaningful auditory input. A child who is deaf or hard of hearing who has early and consistent access to spoken language through audition will have better outcomes in auditory based communications. The children that have the earliest access to the speech signal through their amplification will have better outcomes in auditory based communication. (Sininger, Grimes, & Christensen, 2010).

For school based and clinical professionals, I propose taking this baseline further. We need to challenge the assumption that all that matters is how long the child has worn their hearing aids or cochlear implants. How often and for how long do they wear them? Are they well fitted/programmed? We can no longer rely on the “hearing age” data to predict or explain a child’s outcome. We need to look at the quantity and quality of their auditory experience with language. We need to consider the child’s critical period of neuroplasticity. The effect of experiences during the critical period will result in behavior which is reflective of the particular environment of the child. If the child does not have meaningful auditory exposure during the critical period, there may be a reduced effect on building auditory skills or, in some instances, no effect at all.

I will use the above image as an example. During our daily listening check, a child does not respond to the Ling 6 sounds as accurately as I have previously documented. Because Auditory First is an integrated part of our daily routine, I can prompt the child that we need to “take a closer look” and the child is able to bring me the troubleshooting box and hand me the hearing aid. She watches closely to begin to assume responsibility to checking the batteries and, in this case, removing wax from the ear mold. Oftentimes children who are deaf or hard of hearing display changes in behavior when their equipment does not function properly or when they may have wax, fluid, or developing/resolving ear infections. A person with an Auditory First attitude will be sensitive to these cues and take appropriate action. You will notice the FM system not in use at this time because I want to test the equipment’s function both with and without the assistive listening device.

This Auditory Verbal strategy helps build the following Listening and Spoken Language skills:

self-advocacy skills for hearing equipment- is it working or not, what tools to we need to troubleshoot?
attention to auditory signal first and foremost- using a speech hoop or visual distraction technique
a mindset of listening in the parent and child- parents need to be specifically coached
integration of listening into the child’s personality (Pollack et. al, 1997)- developing positive habits

Please leave a comment below to discus this strategy and describe how you use Auditory First in your practice or coach others to develop an Auditory First attitude!

Additionally, you can download an individual PDF of this strategy by filling out the form below or you can download the entire Auditory Verbal Strategies eBook by visiting the link in the navigation bar at the top of this page.