Oh, no. What happened?

Your car is broken?

Bbrrr. Uh, oh

Chapter 3:
Hearing Development

Although we often talk about hearing development,

speech development, and language development as

if your goal is for your child to catch up to his normalhearing peers. The tips below should help you think of

separate topics, they are all closely interrelated. Each

fun activities to do that, while still maintaining your

depends upon the other. All children develop listening skills

childs interest. They follow the Auditory Skills Checklist,

in a recognized sequence. For the purpose of this booklet,

a communication assessment available from MED-EL.

we want to keep in mind that we are working on the

development of listening skills in order to facilitate the

Although we talk about the various steps in auditory

development of speech and language skills. Therefore,

development as occurring in a particular order, children

when reading the following tips for developing better

dont necessarily spend a lot of time on one level before

listening skills, keep in mind that auditory development

moving to the next. Often it seems as though they are

in isolation is not really the goal the goal is the

developing detection, discrimination, and identification all

development of language.

at once. Feel free to try a variety of different activities

and games and follow their lead.

After a few months, babies with normal hearing will

develop the following skills: 1) they start to perceive
certain sounds (detection); 2) they start to perceive

Games to Stimulate Auditory Development

differences between sounds (discrimination); 3) they

Limiting background noise is important, especially during

start to recognize sounds (identification); and finally,

focused listening activities. You may find that your child is

they attach meaning to the sounds (interpretation or

more focused on sound when competing noise, such as

comprehension). A hearing child needs a minimum of 12

the radio or TV, is turned off and the environment is

to 24 months of listening practice to acquire these skills

relatively quiet. When your goal is for your child to

(Erber et al., 1976).

increase or develop listening or auditory skills the use of

visual cues should be minimized. Many parents find that

Depending on the age that your child has received his CI,

sitting beside their child during these learning activities

he may still be going through the normal preverbal

minimizes the visual cues and maximizes the childs

chronological age and stage. In this case, it is often very

dependence on listening alone for these focused

easy to take advantage of where he already is and

listening activities.

continue with hearing and speech development very

naturally. Youll find that our tips for stimulation in the
preverbal stage fit nicely with the early auditory and

Awareness to Sound

speech development tips described below. If your child has

Encourage your child to notice sounds. You can do this by

received his implant during or after the preverbal stage

reacting enthusiastically to every reaction your child has

(based on chronological age), you may find that you have

to sound. Cue your child to listen, then show him the

to deliberately re-create those situations in order to take

sound you both hear. Remember to label or tell the child

your child through those early developmental milestones

what the sound is. For example, Listen, I hear the

that are important for laying down the foundations of

telephone. Notice if your child indicates that he hears

later language development. The process should go quickly

your voice. Do his eyes widen or does he look at you?

18

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Get his attention or cue him that he hears your voice.

Experiment with sounds in and around the house,

Example, You heard Mommy, yes, Mommy is here.

so that your child has contact with as many different

Be sure to do the same thing with other family members.

sounds as possible. Make sure your child can see

Cue him when he hears Dad or his siblings.

and/or feel that there is something happening at the

moment he hears a sound. Look for a few toys that

Provide ample opportunities for your child to make

light up, vibrate, or move while they make a sound.

sounds by himself (using his own voice or other

When there are certain sounds in the environment

noisemakers and toys that make a sound). Most young

(someone rings the doorbell or the phone rings),

children love playing with the pots, pans, lids and

first draw the childs attention to this sound and then

wooden spoons found in your kitchen. Set aside a low

take him with you to the source of the sound (the front

cabinet that the child is allowed to pull open for playing

door, the phone). By frequently repeating this, your child

with these items when you are in the kitchen. Talk about

will start to see the connection between the sound, the

the sound they make. Is it loud, soft? This way the child

source of the sound and the meaning of that sound.

can learn about the sources of sound.

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Paying Attention to Sound

Now that your child is aware of more sounds, does he
attend to what he hears for a longer period of time?
Playing listening games is a fun way to increase the
attention to sound.
Act as if you are sleeping and wake up with a start
when your child calls out. Take turns and be sure to
talk: Wake up! Shhh!

Noticing when Sound Stops and Starts

Rock or sway to the rhythm of the music you play for
your child. Stop moving when the music stops.
This will stimulate the child to also take note of the
musics beginning and end.
Jog in place or dance as long as the music is playing,
and stand still or go and sit on the floor when the
music stops. Add language to the activity: Uh oh, the

Go and stand behind a door together and wait until

music stopped! What happened? Its all gone.

someone knocks on the door; you may only open

Get two identical empty containers such as small film

the door when you have heard the knocking.

Introduce finger plays and simple songs such as Itsy
Bitsy Spider. Young children love these games and
it will hold your childs attention to music longer.
Join your child in games when he is making sounds
with different items around the house. Playing
together will increase his attention to sound.
Walk in place or march to a rhythm; sway or move to
the beat while your child bangs a drum; Have your

canisters or small Tupperware. Leave one empty

and put a few coins in the other. Shake each one
separately. See if your child notices that one makes
a noise and the other does not. Then open the
canisters and show them to your child so that he can
make the link between sound/no sound and the
content. Add language to this activity as well.
Make animal and vehicle sounds with your voice.
Have the child move the toy along with your voice.

child do the same while you bang on the drum.

Have the child stop moving the toy when your voice

Searching for the Source of Sound

Good job, the car stopped.

stops. Be sure to use real words, too. For example,

Once your child is aware of sounds, he may search for
sound but not be able to locate the source.

Identifying a Sound Source

Children with bilateral implants may locate the sound

Your child may now be able to turn to the source of

more easily than children with unilateral hearing.

the sound or find the sound that he hears.

Point out the sound, label the sound, or take the

child to the source of the sound.
Play games to encourage the child to find the sound
source. Play hide and seek. Have a sibling or other
adult hide and make a sound or call the childs name.
At first, you may need to help your child find the
source of the sound. This can become a fun turntaking game as well.
Arrange to have someone knock on the door or
ring the doorbell. Cue the child to listen. Say,
What do I hear? or Listen, someone is at the door.
Who is it? Go to the door.

20

Reinforce this skill by commenting on the source of

the sound your child identifies. For example your
child may turn to your voice, and you can say, Good
job, you heard Mommy.
Encourage your child to tell you what he heard, by
pointing or saying I heard the _______. Or, I heard
that.
Play a calling game where siblings take turns
responding appropriately when their name is called.
Have your child find the sibling that is calling his name.

Oink, oink

Imitating Sounds or Speech

You have been working on sound imitation and turn
taking with your child. Now you want your child to
able to imitate babbling or other speech-like sounds
either as a long or short string of syllables.
Sitting in front of a mirror and making long versus short
strings of syllables can be a fun way to encourage the
child to imitate your syllables. Pick sounds that the child
is already capable of producing, such as babababa vs.
ba or mamama vs. ma. Mixing in a few funny faces
always helps to keep the child interested.
Put a piece of paper and marker, crayon or finger paints

Imitating the Volume of Sound or Speech

on the table. Pair the action of drawing along with long

Children that develop this skill are better able to modify

vs. short strings of syllables. You make the sounds then

the intensity of their own voices for appropriate

encourage your child to imitate.

situations. Most children, whether they have normal

Take turns. Have the child produce long vs. short

syllables and you imitate the sound. This encourages
understanding of this task.
Use toys to make sounds for your child to imitate.
For example, push a car along with imitation of
beep-beep-beep vs. beep.

hearing or are deaf and use a CI tend to be too loud

in some situations. Many parents want to teach them
to use a quiet or inside voice when the situation calls
for moderation.
Play a wake-up game. Use a loud voice to wake up a
doll or stuffed animal vs. a quiet voice when the doll is
sleeping. This is a great game when your child is playing

Imitating the Pitch of a Sound or Speech

with stuffed animals, dolls or when playing house.

You will want your child to be able to imitate or use vocal

Remember to use language to describe what you will do

inflection for common utterances, such as falling pitch in

and what is happening.

uh oh, or to imitate rising inflection for a question such

as more?
Use a strategy called acoustic highlighting by overemphasizing your modeling of these pitch changes.
You can also use a little sing song in your voice.
Sometimes, swaying slightly or using gestures helps

Repeat some of your childs favorite games from the

previous activities using imitation of a quiet vs. loud voice.
Take turns playing a drum or banging on a pot, with
loud vs. quiet sounds. This can be helpful to teach the
loud vs. quiet concept.
Use finger puppets. Assign the lion to be the loud

your child get the feel for this. Many young children

puppet and a snake to be the quiet puppet. The

using a CI are able to use appropriate voice inflection

lion has a loud roar, while the snake sound is quiet,

fairly easily. Children enjoy playing around with

different pitch changes of common phrases like uh-oh,
oh no, more please in a fun and silly manner.

22

perhaps just sssss. Then model what each puppet

will do. Take turns being different puppets and making
loud vs. quiet sounds.

ures in
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Working with Simple Phrases or Directions

Now you want to offer the opportunity for your child to
respond to simple phrases or predictable directions.
There are many games, play time and daily living
activities that can facilitate your childs ability to follow
directions. Remember to follow your childs lead when
you pick your activities.
For younger children who enjoy dumping and pouring,
you can put blocks in a box, toys in the dump truck, or
toys in the sand box. You give the directions during play.
Modifying his Utterance to More Closely Match an
Adult Model with Hearing Alone

Be sure to take turns and have your child tell you

what to do sometimes.

Once your child begins to use words, phrases and

Put farm animals in a barn or wagon.

sentences, you will want him to be able to improve his

Put zoo animals in a cage, box, or fence enclosure.

accuracy of speech production to match the adult

Have your child find different trucks, cars, or airplanes

model. Parents of children who have normal hearing

frequently correct speech production or grammar by
reflecting back to the child the correct pronunciation
or structure.
Your child may say, Look at the tat! You then say,
Yes I see the cat. Try to emphasize the word cat.
Over time your child will begin to correct himself.
Try using a technique called a forced alternative
during snack time, meal time, and play time. Instead of
giving him a global choice, such as What do you
want? you give the child a choice of two. Ask the
child, Do you want apples or cheese for snack? This
strategy allows the child not only to focus on the adult
model but also to produce the word right after hearing
a model. If your child repeats back teese for cheese,
you then say, Good, here is your cheese. Use
acoustic highlighting (extra emphasis on the word
cheese). Then enjoy your snack.

to push, or put under a box or table.

Find the pictures in the book when reading a story.
Include actions as well as objects. For example, show
me the one that is walking (running, jumping, etc.)
Have the child help fold clothes, put clothes away, or
take clothes out of the dryer. It can be fun to do these
tasks together.
Have the child find apples, crackers or other familiar
items when you are at the grocery store.
Have the child follow directions when he helps set the
table for dinner.
Play games such as Simon Says where the child will
need to follow the directions. Take turns and let the
child be Simon.
Hide some objects under containers and then uncover
the objects as you name each of the hidden toys. Then
cover the toys again and ask the child to find certain
objects.

23

Remembering and Repeating More Elaborate Utterances

At first, your child may make sounds that follow the

As your child becomes a more sophisticated listener,

intonation of the song or rhyme but words may not be

he will be able to handle comprehension of longer

identifiable. Later, your child may imitate actions and then

utterances. The ability to follow these types of utterances

some of the key words. Finally, your child will be able to

helps children to be more successful as they enter

sing along with the song or rhyme. Repetition is good.

into the preschool setting. Any of the activities above can

But add new songs, rhymes and finger plays as your childs

be used with changes made to the complexity

skills improve and he begins singing or saying the words.

of your directions. For example: if your child wants to help

These activities help increase auditory memory

sort the laundry, you can use this situation to

for increasingly longer strings of information.

introduce a lot of everyday language. For example, you

can say, We are going to sort the clothes. Lets put all the

Working Deliberately in Background Noise

socks together. Please hand me Daddys big white socks.

Although background noise creates a difficult listening

You can also have the child find the big blue airplane vs.

situation, it is important to practice listening sometimes

the little red airplane.

in a noisy environment. The world is a noisy place and

in order for your child to do the best he can in a bad

Nursery Rhymes or Songs

acoustic environment, you need to practice in those

It is important to continue to use songs, rhymes and

situations occasionally. Take your listening activity to a

finger plays with your child. Your child will most likely

noisy area occasionally or turn on the radio. Its important

follow a sequence of skills during these activities.

to use a quiet environment most of the time, however.

24