Listen Up: Pay Attention to Hearing and Develop Listening Skills

Authors: Kate Moss Hurst, Consultant for the Texas Deafblind Project

Keywords: listening skills, expanded core curriculum, sensory efficiency, audition, audiologist, Informal Functional Hearing Evaluation, Texas Deafblind Project, Teacher of the Deaf and Hard of Hearing, FM system

The term expanded core curriculum (ECC) is used to define concepts and skills that often require specialized instruction with students who are blind or visually impaired in order to compensate for decreased opportunities to learn incidentally by observing others. In addition to the general education core curriculum taught to all students, those who have visual impairments also need evaluation and recommended instruction in the ECC starting at birth. One area of the ECC is Sensory Efficiency Skills. Sensory efficiency includes instruction in the use of vision, hearing, touch, smell, and taste. It also addresses the development of the proprioceptive, kinesthetic, and vestibular systems (What is the ECC?). Learning to use their senses efficiently enables students with visual impairments to access and participate in activities in school, home, and community environments.

When vision is impacted, the child’s other distance sense, hearing, becomes even more important. Even mild hearing loss can have a significant impact on learning. When a child is deafblind, learning to use any functional hearing is critical. Children with any type of sensory loss can benefit from learning to use available functional hearing for a variety of reasons. These include:

• to help alert to, attend to, and identify sounds related to specific locations, objects, and people;
• to localize sound sources to aid in finding things in the environment and to be safer when traveling or moving about at home, school, and community;
• to supplement information received from other senses including sight, touch, taste, smell, and proprioception that might aid in concept development;
• to improve language and speech development, communication, and literacy skills;
• to improve the quality of interactions with people and the environment.

This is why it is very important to thoroughly assess the functional hearing of any child who is visually impaired. Even mild hearing loss such as those caused by fluid in the middle ear can have a great impact on speech and language development. Recent research also indicates that children with cortical visual impairment (CVI) may have a greater risk of auditory processing issues since many of the causes of CVI are also things that cause central auditory processing disorder (CAPD)(Bennett, 2022). 

Anything that can be done to improve functional hearing is important for these individuals. Depending on the degree of hearing loss, amplification devices or cochlear implants may be needed as determined by a medical professional. For any child, creating hearing-friendly learning environments and teaching listening skills is very important.

Assess the child’s functional hearing

Specially designed instruction is driven by meaningful evaluation. There are many formal assessment tools that are used by audiologists to determine the degree of hearing loss a person might experience. Some of these are specifically designed for use with children, even infants. While some require the child to be able to interact with the audiologist, others, such as an auditory brainstem response (ABR) or the type of hearing screening done on infants in the hospital, require no interaction with the child. Even so, some children who are very fragile may require sedation to have these tests done. This is something that family members may be unwilling to do for health reasons.

There are also more informal evaluation tools available to the layperson to learn how a child uses his/her hearing functionally. One such tool is the Informal Functional Hearing Evaluation (IFHE) developed by the Texas Deafblind Project. The IFHE is meant to guide the teacher of the deaf and hard of hearing (TDHH), the teacher of students who are visually impaired (TSVI), and the teacher of students who are deafblind (TDB) in determining the impact of a potential hearing loss on educational functioning for students with visual impairments and multiple disabilities (Graves & Montgomery, 2017). This publication is free to download from the National Center on Deaf-Blindness (NCDB).

Evaluate the listening environment

Many times, it is harder for individuals with hearing loss to hear because of the amount of auditory clutter in the environment. For example, many classrooms and homes have music or a television continually playing in the background. There are some simple things that can reduce the clutter and improve the listening environment, such as positioning the child as close as possible to the instructional sound source. For a student with a hearing aid or cochlear implant, it is important to ensure that these devices are working properly and adjusted for the learning situation. For example, during an orientation and mobility lesson, the student needs to be able to hear environmental sounds readily both as cues to the environment and for safety reasons. 

In many situations where instruction is being provided by a teacher, an FM (frequency-modulated) device or personal amplification for the teacher may help focus the child’s attention on the teacher’s voice. This strategy has also proven helpful for students with attention deficit disorder and autism (Bennett, 2023; ASHA, 2023; Schafer, E.C., et al 2014).

Consider placing tennis balls or felt pads on chairs and desks to reduce noise when moving them. Close doors to hallways, find or create quiet places for instruction, or use study carrels to reduce distracting sounds. Sit the child away from noisy air conditioners or other environmental sound sources and place them closer to the instructional sound source, such as the teacher’s voice or an alternative communication device. Add soft materials like carpet, draperies, padded room dividers, and other sound-absorbing materials to reduce echoes and environmental sounds. Survey the environment at both home and at school to see what things can be modified to reduce auditory clutter and improve the listening environment (Nationwide Children’s Hospital, 2023).

Work on listening skills

There are a variety of auditory training curricula used in schools for children who are deaf or hard of hearing. A student with a visual impairment can benefit from auditory training regardless of their hearing status. A speech-language pathologist (SLP) or teacher of the deaf and hard of hearing (TDHH) can determine which curriculum might be appropriate for a child at any developmental age.

 Typically, a listening program will start with basic awareness of sound. First, determine if the child alerts to any specific sound. This will provide information on what the child can hear, and what type of hearing issues the child might be experiencing, if any. For example, does the child consistently hear higher-frequency sounds like the voice of another child? Does the child respond to both loud sounds and soft sounds? Does the child startle to sudden, unexpected sounds? Then, systematically call the child’s attention to environmental sounds and human voices. It is easy to play games where a sound is made and watch for the child to respond in some way. Initially, the child may startle or become quiet when a sound is made. Later, the child can learn to raise a hand or put a block in a container to indicate when a sound is heard. This skill is valuable for behavioral hearing testing.

Once the child is aware of sounds, teach the child that sounds have meaning and are associated with specific objects, people, and events. Identifying sounds is an important skill. At first, it may just be identifying the human voice versus an environmental sound, like the door closing or a drum banging. When the child hears a sound, does he know what made the sound? For children who are blind, visually impaired, or deafblind, hearing may need to be supported with touch. Does the child know that the dog made the barking sound or that it was a car that made the honking sound? When mom or dad speak, does the child know who is speaking? Children need opportunities to explore the sounds that various objects, animals, and people make.

Where is the sound coming from? How can a child find it? Sound localization is very important for safe travel and discovering things of interest in the environment. This skill may not be easy for a child using hearing aids unless the audiologist who fits the aid is made aware of the importance of localizing sound for a child with visual impairments (Sound Travels, 2020).

Learning about suprasegmental aspects of speech is also valuable. This includes features of speech, such as pitch, intensity (volume), duration, and rhythm patterns as well as specific speech sounds. For some children, these are the features of sound they pay attention to most. For example, they may recognize their name by the rhythm made when you say it. They may mimic sounds that have interesting pitch changes but pay no attention to the actual words. Build on how the child already plays with sound by joining in or giving him/her more interesting sounds to mimic. There are many fun and easy listening games to play with children to improve their attention to sounds in the environment.    

How to help build skills

Every child is different in his or her ability to make use of auditory information. Early intervention related to the use of hearing is very important and can make a big difference for any child. As the child gets older, more advanced listening skills can be taught for travel (by an orientation and mobility instructor) or for using audition (listening) as a literacy source. The suggestions below may not apply to all children, but will certainly not harm any child.

• Get the child’s attention before speaking and, when possible, get within three feet of the child. If the child is deafblind, let him/her place a hand on your throat or lean against your body to feel the vibration. 
• Let the child get close to or touch the source of various sounds. In the classroom, this might mean sitting near the teacher or intervener as much as possible. It might also mean giving extra time for the child to tactually explore objects that make various sounds.
• Turn off competing sounds, such as music and television in the background.
• If the child has some usable vision, face the child and speak clearly, using visual or tactile cues in addition to speech, if needed. For a child who is deafblind, this generally means letting them touch your mouth, jaws, and throat. 
• When speaking to the child, slow down, raise the sound level, and enunciate clearly.
• Use short, simple phrases and comment on what the child is doing. Target vocabulary and use consistent words and phrases in routines to make it easier for the child to figure out what is being said.
• Play games frequently that involve listening skills such as sing-alongs, dancing to music, finding the object that is making noise, vocal play involving pitch, intensity, and/or rhythm, 1-2-3 “Go” and “Stop”, etc. 
• Call attention to sounds in general, but also specific sounds in words and the spelling of words when reading. 
• Allow the child to feel your lips and jaw movements when you make a specific consonant or vowel sound. 
• Read to or with the child or explore experience books together, explaining pictures and objects and asking questions.
• If the child does not understand what you say, patiently repeat words, phrases, or questions.
• If further assistance in the classroom is necessary, use a microphone or sound field amplification system to focus the child’s auditory attention on the teacher’s voice. Consult with your TDHH or SLP (note that a sound field device can benefit all children in the classroom).

Conclusion

All children with visual impairments need to be able to use their hearing to the greatest degree possible. Even children who have significant hearing loss benefit greatly from auditory training. Some children, including those children who have auditory processing issues, may need systematic instruction in how to “listen” and make use of what they hear in order to improve their access to instruction. Don’t assume that just because a child responds to some sounds they have the ability to utilize and make sense of what they hear. 

Keep regular checks on hearing, especially if the child seems delayed in speaking or paying attention to instruction. Limit auditory clutter and distractions as much as possible. Let the child get “hands-on” with sound sources so the sound becomes meaningful. Give the child plenty of opportunities to explore and experiment with sound including the sound of his/her own voice. Provide specific auditory training if needed, especially if the child uses a cochlear implant or hearing aid. 

Though every child may not develop speech or have the ability to travel independently, they can benefit from learning to get the most out of their available hearing. It is important to help them to “listen up”.

References and Resources

American Academy of Otolaryngology-Head and Neck Surgery. (n.d.). Strategies for improving the listening and learning environment. ENT health. https://www.enthealth.org/be_ent_smart/strategies-for-improving-the-listening-and-learning-environment/ 

American Speech and Hearing Association (ASHA). (n.d.). Child aural/audiologic rehabilitation.  https://www.asha.org/public/hearing/child-aural-rehabilitation/.

Barclay, L. (2011). Learning to listen, listening to learn. ‎American Printing House for the Blind.

Bennett, Rachel, (2023). CVI and central auditory processing disorder (CAPD). CVI Now. Perkins School for the Blind. https://www.perkins.org/resource/cvi-and-central-auditory-processing-disorder-capd/ 

Clason, D. (2023). Understanding autism, hearing loss and auditory processing disorder: 

Symptoms can overlap, making diagnosis tricky in kids. Healthy Hearing.  https://www.healthyhearing.com/report/52743-Autism-spectrum-disorder-and-your-child-s-hearing-health 

Graves, A. and Montgomery, C. (2017). Informal functional hearing evaluation. National Center on Deaf-Blindness. https://www.nationaldb.org/media/doc/IFHEFunctionalEvaluation_ae.pdf 

Nationwide Children’s Hospital. (2023). Creating a listening environment for children with hearing loss. Retrieved from  file:///C:/Users/adkinsa/Downloads/speech-pathology-listening-environment%20(1).pdf      

Schafer E.C., Traber J., Layden P., Amin A., Sanders K., Bryant D., Baldus N. (2014). Use of wireless technology for children with auditory processing disorders, attention-deficit hyperactivity disorder, and language disorders. Seminars in Hearing, 35(3):193-205.

Shapiro, Z. (2021). Is auditory training helpful with hearing loss management? Audiology Island. https://audiologyisland.com/blog/auditory-training-for-hearing-loss 

Tabb, C. (n.d.). Activities to develop auditory skills. Paths to Literacy https://www.pathstoliteracy.org/activities-develop-auditory-skills/

Texas Deafblind Project. (2021). Sound travels. Texas School for the Blind & Visually Impaired. https://txdeafblindproject.org/wp-content/uploads/2021/09/SoundTravelsFinal9.18.21.pdf 

What is the ECC? (2014). Austin, TX: https://www.tsbvi.edu/programs/ecc