Inge Kaltenbrunn

Speech Pathologist, LSLS Cert. AVT

ADVANCED SPOKEN

LANGUAGE DEVELOPMENT

IN CHILDREN WITH

HEARING LOSS

Learning outcomes

• To learn about spoken language development beyond

the preschool years in children with hearing loss

• To identify appropriate goals to support advanced

spoken language development

• To identify strategies to encourage narrative

development

• To understand the importance of comprehension and

use of non-literal language by children with hearing loss

Learning outcomes

• To identify strategies to encourage understanding and use of non-

literal language

• To learn about strategies to build and expand vocabulary in older

children with hearing loss

• To learn how modelling strategies can be used to develop meta-

cognitive skills in older children with hearing loss

• To learn about social communication skills that children with hearing

loss need to develop for social competence.

Spoken language development beyond

preschool

• Improvement in the ability to tell stories or relate personal experiences in an organized way

• Changes in ability to have a meaningful and effective conversation

• Ongoing growth in the understanding of words and the relationship between words, e.g. synonyms, antonyms

Spoken language development in older

children

• Development of non-literal language (idioms, humour and figurative language)

• Development of metalinguistic skills and awareness (learning to think about language)

• Reading with comprehension

• Using written text to learn

• Listening to learn in the classroom

Summary of goals: Advanced level

• Audition

• Speech perception

and production

• Vocabulary building

• Complex grammatical

structures

• Narrative skills

• Non-literal language

• Meta-cognitive skills

• Social communication

competence

Advanced spoken language learning

• Focus on “diagnostic teaching”

• Integrate targets into age appropriate activities

• Balance the challenge level of each goal, e.g. a

new language goal should be paired with an

established auditory goal and vice versa (Garber

& Nevins, 2009)

Example of integrated goals

• Cognitive target: Creative association

• Language targets: “would”; “if”

• Auditory target: Identifying an object by a

series of descriptors/critical elements

• “If I were this animal, I would be able to swim in

the water, but live on land”

From Garber & Nevins (2009)

Narrative development in children

with hearing loss

Features of stories

• All narratives have a hierarchical structure and

relay causally related events

• The demands of story telling is different than the

demands of conversation

• Narrative story telling requires the child to tell a

story containing specific story structures or

elements, also called “story grammar” (Pukulski

et al. 2003)

Story grammar

• Introduction of characters---Setting---Initiating

Event---Action---Consequence (Story Episode)--

-Internal Response (as in Table 1. SNAP Dragons Manual)

Development of narratives

• Children are ready for story telling from a very young age

(Linder, 1993)

• Children as young as 16 months of age recognize the

difference between stories and ordinary conversation

(Davidson (in Kephart, 2000))

• From 3 years of age, children begin to remember things

about self over long periods of time and develop inner

speech

What about narrative development in

children with hearing loss?

• Children with hearing loss aged 6-11 years using spoken

English showed (Jones et al. 2016):

• Equivalent performance to a hearing control group on narrative

macrostructure in a task that did not depend on their receptive

language skills

• Poorer performance on narrative microstructure than the hearing

group of children

• Less complete and/or relevant answers to inference questions that

assessed their understanding of the intentions and actions of the

story characters

• Expressive vocabulary strongly correlated with micro-level

narrative skills, but the relationship with macro-level narrative skills

was weaker.

Red flags in narrative development

• Short duration

• Minimal content

• Difficulty setting the scene

• Events are not well linked

• Lack of organization/coherence

• Irrelevant ideas are added

(Sperandio, 2014)

Encouraging story telling at home

• Parents should be encouraged to:

• Substitute 30 minutes of screen-time with

reading time every day (Sarant et al. 2014)

• Read aloud to the child everyday for at least 20

minutes (Flexer, 2014)

• Read text that is one level above the child’s

current language level (Flexer, 2014)

Encouraging story telling at home

• Parents should check the child’s comprehension periodically while they read, e.g.

- What is the name of the main character?

- Where and when is the story taking place?

- Who are you reading about in the current paragraph?

- What is the character doing?

- Why is the character doing this?

- What might happen next?

- How is the character feeling about the events?

- How might the story end?

- How did the story end?

Encouraging story telling at home

• Parents should be encouraged to use visual

prompts or reminders to assist the child, if

needed

Encouraging story telling

• Build own story scripts by using the child’s favourite toys

or games. Create a story by adding on to the child’s play

(Sperandio, 2014)

• Expose the child to a range of different types of stories,

e.g. fairy tales and cultural stories

(www.worldoftales.com); popular stories adapted for

Australian culture (“Going On A Croc Hunt”) (Sperandio,

2014)

Encouraging story telling

• Tell a familiar story from another perspective, e.g. the

wolf in the story of the Three Little Pigs

• Use comic strips to learn sequencing a story (Garber &

Nevins, 2009)

• Make news newsworthy, e.g. My Best Day At Telecamp

• Utilize computer based products (Apps) to allow the child

to create and record their own stories, e.g.

www.storyplace.org; StoryMakerFree

Encouraging story telling

• Create “car” stories

• Participate in blank book story telling

• Create a bedtime story of the child’s actual day

• Play thinking games that involve classification, sorting

and sequencing to show the child how things relate to

each other

• Talk beyond what you can see when looking at pictures

Encouraging story telling

• Pretend often

• Prompt the child to relate events to others

• Wait for the child to finish telling the story

• Model and expand the child’s story, e.g. restate or reorganize the events shared by the child

Encouraging story telling

• Have the child retell a story in other formats, e.g.

using puppets

• Tell a story and have the child manipulate the

objects

• Compare a story to other stories

• Tell silly stories

• Retell longer stories seen in movies

Encouraging story telling

• Learn about popular movies, videogames and

toys in order to use the characters and themes

for the child to create their own stories, e.g.

FLOATZELF BIO

This lil' cloud's always got a

silver lining! Storm's sis is

full of bliss and always finds

the good in the bad. After

every storm (even her big

bro's), there's a rainbow!

ZELF POWER

Silver Linings

Non-literal language

Non-literal language “People say the

strangest things”

• “Time is just flying”

• “I got the thumbs up to continue with the project”

• “Pull your socks up and get the homework done”

• “She decided to run for president”

• “Warning: Repair crew ahead, please give them a brake!”

• “Last week at the beach, I saw a man eating fish”

• “Break a leg!”

Non-literal language: Jokes and riddles

• “Which vegetable has conversations with Jack?

Jack and the beans talk”

• “What time do ducks get up? At the quack of

dawn”

• “Knock-knock…Who’s

there?...Lena…Lena…who?...Lena little closer

and I’ll tell you”

• “I have legs but I can’t walk”

Non-literal language in written text

“Tonight was the night she had been waiting for. Princess

Penelope was head over heels for Prince Patrick and

she had finally persuaded her father to allow her to

attend the annual royal ball. Penelope had sprinted like a

cheetah all the way down to the royal dress shop to pick

out the perfect dress. After hours of searching her eyes

landed on the most beautiful dress ever made. The

dress was a sparkling ruby. Penelope thought that it

must be the colour of Dorothy’s slippers…”

Why is understanding and using non-

literal language important?

• The category of non-literal language includes

idiomatic expressions, humour and figurative

language (Garber & Nevins, 2009).

• There is a greater chance to misunderstand a

message if the words do not quite mean what

they say (Garber & Nevins, 2009)

• This is true when reading and when having a

conversation with family, friends or others

Use of non-literal language by children

with hearing loss

• Children with hearing loss do not have the same opportunity to overhear language, because of difficulty hearing in noise and over a distance

• Children with hearing loss may not be able to overhear small differences between speech sounds or stress or intonation cues that can be crucial to understanding a specific ambiguous word or phrase or sarcastic expression

• Children with hearing loss are therefore more at risk for having difficulty understanding and using non-literal language

Problems caused by poor understanding

of non-literal language

• Academic difficulties, e.g. understanding written text for learning; following directions in the classroom. Impacting on academic performance and literacy

• Personal and social difficulties, e.g. not understanding puns, slang, jokes, sarcasm, irony and idioms can lead to embarrassment and difficulty building relationships with peers (making friends)

• Job-related difficulties

• Loss of pleasure found in humour and word play based on language ambiguity, e.g. understanding a funny advertisement on television

What clues do we use to understand non-

literal language?

• Situational context

• Knowledge of the speaker’s knowledge

• Speaker’s body language, facial expressions and eye gaze

• Speaker’s tone of voice

What clues do we use to understand non-

literal language?

• Placement of stress cues in the expression

• Spelling of the word

• World knowledge and previous experiences

• Form of an utterance as it relates to the content

Use non-literal language naturally in authentic

conversations (Garber & Nevins, 2009)

• Don’t get stuck in a language rut

• Keep an ear out for slang and expressions used

by the child’s peers

Use non-literal language naturally in real

conversations

• Be aware that ambiguity is out there…then

problem solve:

- Search for contextual clues that may support the

intended meaning of a word, phrase or sentence

“Whiteboards are remarkable”

Use non-literal language naturally in real

conversations

• Fully discuss all possible explanations for each

ambiguous word/phrase/sentence

• Encourage the child to think aloud when attempting to

figure out problematic ambiguous material

• Ask the child to paraphrase what was actually said, e.g.

“When John was away at school, he grew another foot.”

“When John was away at school, he grew a foot taller”

Use non-literal language naturally in real

conversations

• Discuss definitions of new or unfamiliar words as they

occur

• Search for visual clues, e.g. story situation, facial

expressions, gestures, eye gaze, etc.

• Emphasize the words that may be causing the ambiguity

in order to highlight them for the child

• Contrast literal and figurative meanings

• Make use of idiom or proverb dictionaries

Use non-literal language naturally in real

conversations

• Increase the child’s world knowledge, e.g.

classic literature; popular fiction; classic and

popular films; classic and popular games and

board games; music genres; a variety of direct

experiences (museums or other places of

interest; special interest clubs; sports;

opportunities for social interaction)

• Use role play, if needed

Strategies for vocabulary building

• NEW-Familiar-NEW strategy (Garber, 2011)

• Use a word that is new to the child

• In the next sentence, follow up with a known

word that means the same thing

• In another phrase, go back to the new word

Strategies for vocabulary expansion

• NEW-Explain-CONNECT strategy (Garber,

2011)

• Use a new word

• In the next sentence, explain it

• Then connect it to something that the child has

experienced directly

Developing meta-cognitive skills

Strategies to model for developing meta-cognitive

skills (Garber, 2010 from Duncan, 2007):

• How to think and remember

• Rehearsal: repetition, highlighting important facts,

physical cues

• Elaboration: creating mental images, paraphrasing

• Organization: grouping, classifying, identifying main

ideas

Towards social communication

competence

• Self-advocacy (Lucker & Molloy, 2014)

• Topic maintenance

• Topic shift

• Role shift

• Communication repair strategies, e.g. asking for specific

clarification; summarizing

• Child’s own strategies for successful communication

(Lucker & Molloy, 2014)

Resources for spoken language in older

children with hearing loss

• LEAPing on with language. Rehabilitation section on

www.cochlear.com.au

• Garber, A.S. & Nevins, M.E. Cochlear HOPE Tips: Ideas

for the elementary aged child. AudiologyOnline webinar.

www.audiologyonline.com

• Garber, A.S. Listen and Think II: Take it to another level.

Cochlear HOPE AudiologyOnline webinar.

www.audiologyonline.com.

Resources for spoken language in older

children with hearing loss

• Garber, A.S. Project ‘Versatile Vocabulary’.

Cochlear HOPE AudiologyOnline webinar.

www.audiologyonline.com.

• Black Sheep Press resources: Black Sheep

Press-language support for learning and life.

www.blacksheeppress.co.uk.

References

• Berndsen, M.A. (2001). Developing conversation

narrative skills in children with hearing impairment. The

Auricle, Early Winter edition, 12-15.

• Flexer, C. (2014). The auditory basis of literacy. RIDBC

Renwick Centre workshop event. Sydney, Australia.

• Garber, A.S. & Nevins, M.E. (2009). Cochlear HOPE

Tips: Ideas for the elementary aged child.

AudiologyOnline webinar. www.audiologyonline.com

References

• Garber, A.S. (2010). Listen and Think II: Take it to

another level. Cochlear HOPE AudiologyOnline webinar.

www.audiologyonline.com.

• Garber, A.S. Project ‘Versatile Vocabulary’. Cochlear

HOPE AudiologyOnline webinar.

www.audiologyonline.com.

References

• Jones, A.C., Toscano, E., Marshall, C.R., Atkinson, J.R.,

Denmark, T., Herman, R., & Morgan, G. (2016).

Narrative skills in deaf children who use spoken English:

dissociations between macro and microstructural

devices. Research in Developmental Disabilities, 59,

268-282.

• Lloyd-Richmond, H. & Starczewski, H. (2002). SNAP

DRAGONS-Stories/Narratives Assessment Procedure

Manual. Nottingham Cochlear Implant Programme,

Nottingham, England.

References

• Lucker, J.R. & Molloy, A.T. (2014). Overcoming

challenges with group conversations. Volta Voices

Nov/Dec 2014, 22-24. AG Bell Association for the Deaf

and Hard of Hearing.

www.listeningandspokenlanguage.org.

• Pakulski, L.A., Kaderavek, J.N., & Repphun, S. (2003).

Narrative story structure in response to a role play task:

A case study. Volta Voices, Jan/Feb 2003, 29-31.

References

• Sarant, J., Harris, D., Bennet, L. & Bant, S. (2014).

Bilateral versus unilateral cochlear implants in children: a

study of spoken language outcomes. Ear & Hearing,

35(4): 396-409.

• Sperandio, D. (2014). Rehabilitation for children with

hearing implants. MED-EL workshop. Sydney, Australia.

Thank you for watching!