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Speech therapy for children with hearing problems is based on the Auditory Verbal Method.

It is a treatment method that aims to develop speech through listening, without the use of visual stimuli such as lip reading or the use of gestures or sign language. It focuses on early intervention and follows the stages of normal development of hearing, expression, speech, cognitive development and pragmatic use of speech. This method aims at the child’s integration into mainstream school, like children without hearing problems.

General principles of treatment

The child is encouraged to wear the cochlear implant at all times when he is awake, so that he has maximum exposure to auditory stimuli. In the early stages of therapy, we sit on the side of the cochlea and speak at close range. We minimize environmental noise, so that we have better access to the sound and the child can focus on the sound we want them to learn. Later, the child learns to listen at increasing distances and practices listening to environmental noise, television, and telephone conversations.

Speech is at a normal volume and we use a melodic voice. In this way, we focus on the suprasegmental elements of speech, which are pitch, duration, and intensity. It is important for the child to practice listening to suprasegmental elements early on so that they can speak with the appropriate rhythm, speed, timbre, and intonation.

We encourage parents to speak their native language and provide a rich language environment.

The reference point is the child’s auditory age, not the chronological age, so that we know what expectations we have from the child at any given time. The auditory age begins from the moment the child has systematic access to sound. When the child gets cochlear implants, their auditory age begins from their activation.

Aural education follows certain successive stages

In the first stage we expect reaction to sound. The child responds to environmental sounds, to ling sounds, perceives the presence and absence of sound and responds to his name. Indications that a child is reacting to sound are turning the head, blinking the eyes or stopping the activity he is doing.

Then the child distinguishes sounds, music from speech, distinguishes words based on the different number of syllables and the suprasegmental elements of speech (pitch, intensity, duration). Then the child recognizes the auditory stimulus, the sound or the word and can name them. Finally, the child understands the sounds and words, as well as their meaning. As the child grows, he understands simple and complex commands, has auditory memory, answers questions who – what – where – when, recalls information and can retell a story.

Strategies for developing auditory skills

1. Direct the child to listen. Once the child receives the cochlear implant, he does not react and does not yet recognize sounds or which sounds he should pay attention to. For this reason, we deliberately direct the child to listen. We point to our ear by saying “listen”.
2. Name sounds. Then we repeat the sound, name the object and identify the sound with the object. Our goal is for the child to recognize the sound and associate it with the object.
3. Hearing first: in order for the child to develop his auditory skills, we must provide auditory stimuli before visual ones. The child hears the sound or word and then sees the object. In this way, he focuses on auditory information and not on visual information.
4. Favourable environment: we minimize environmental noise, we go close to the child, we use a melodious voice, we make auditory emphasis and we repeat sounds and key words
5. We describe what the child does through daily routines, to identify what he hears with the object or action. We speak at a normal pace, pause and repeat, emphasizing the target word. We teach the use of objects and use familiar phrases and commands to enhance his auditory comprehension.
6. We encourage response: we pause and give the child time to process the auditory stimuli, we provide choices and we respect the rotation of the order.
7. “Auditory sandwich”: our goal is to provide auditory information to the child.However, when the child does not understand the speech and does not respond to what we say, we use visual aids, such as showing the object. Then we present the same information without visual aids so that it relies only on listening.
8. Associating activity with child’s experiences: e.g. we use the child’s name in a song or a story, we connect the book with the child’s experiences. This strategy attracts the child’s auditory attention.
9. We enrich the child’s linguistic expression: we provide the appropriate linguistic model, we add words and new information, we use synonyms and more complex syntactic structure
10. We provide elements to encourage word recall: we name the category, we suggest an opposite or synonymous word
11. “What did you hear?” Often children with hearing problems tend to answer a question we ask them by saying “what?”. Instead of immediately repeating the question, we can ask them “what did you hear.” In this way, we see which part of the utterance was not perceived acoustically. Also, the child learns to pay more attention to auditory information, to become a better listener and to have confidence in his auditory skills.

Play audiometry

The child is trained in play audiometry and learns to react to sounds. Play audiometry is necessary for the audiologist to be able to do the audiogram and the child can be trained from the age of 2 (depending on the time of implantation). The child holds a brick in his ear and every time he hears a

sound he throws the brick. The response to sounds can be done with musical instruments (beating a drum) and with the ling sounds (/m/, /a/, /u/, /i/, /s/). These sounds cover the entire spectrum of speech from the lowest to the highest frequencies. When the child reacts to these sounds, it means that he has access to all the sounds of speech.

What can parents do?

In the sessions, parents actively participate and are trained by the speech therapist to integrate the strategies they learned in the session into their daily lives. As long as the child is awake, it is important to create learning opportunities through daily routines. They are daily routines, such as feeding, diaper changing, dressing. Play routines that concern all play activities and Social routines that are the walks that parents take with their children and visits to friends or other family members.

It is essential that parents expose children to all environmental sounds inside and outside the home. In the early stages of treatment, we give parents listening lists, which include basic environmental sounds. Therefore, we know which sounds the child responds to and which ones he does not.

It is essential that parents read books to their children every day and establish a book reading routine. Play games that produce sound and listen to music and songs. Songs enhance parent-child interaction and develop prosody and suprasegmental elements.

Finally, children gain many experiences, as well as auditory and linguistic stimuli from the walks they take with their parents, such as in the park, at the beach, at the museum and in various stores. Parents can create a book of experiences where they record these experiences, including photos, drawings and mementos. They can refer to the book and discuss these experiences, which strengthens the child’s auditory comprehension and linguistic expression.

In conclusion, a child’s speech and language will develop when basic listening skills and speech comprehension have been established. Parents play a very important role in the education of children with cochlear implants, providing them with every opportunity to practice listening and speaking.