Informal auditory therapy: What's in the toy box?

Abstract

Figure: © iStockphoto.com/MagdalenaKucovaParents of patients often ask me, “Can you help him listen?” But recently I was asked this by a friend who is a parent of a boisterous 4-year-old. My friend had concerns about her son's hearing, but an audiologic assessment revealed normal peripheral activity. The mother, an informed, educated parent who is also an elementary school teacher, was aware of her son's predisposition to otitis media and the family history of dyslexia and ADHD. Her next few questions were not unexpected: “Does he have auditory processing problems?” “What can you do to help him?” “What can I do to help?” It is important to know the difference between hearing and listening. Hearing is the reception of an acoustic event. Listening is an active process involving the reception and utilization of acoustic information, and it incorporates auditory and language processing skills. Unfortunately, a diagnostic assessment for (central) auditory processing disorder, (C)APD, at an early age is not possible. Diagnostic assessment is usually not performed until a child is at least 7, and although some screening tests may be administered as early as 5, results should be interpreted with caution. Audiologists can implement early auditory training to improve listening comprehension and communication processing for children with predisposing risk factors for (C)APD. This includes localization and lateralization, sequencing of sounds, phoneme/syllable discrimination, auditory memory, and temporal processing. EDUTAINMENT Audiologists can use routine activities as part of auditory training and enrichment activities to engage a young child at risk for (C)APD. Reading to children is important; a child who can listen to a story and answer questions about it or retell the story is practicing active listening and improving his listening skills. Advise the reader to purposefully make errors, such as omitting pages or calling a character by the wrong name. If the child notices the error or can make appropriate corrections, he is actively listening. Family game night might be a clever marketing strategy from a board game company, but it can also be auditory training time. Musiek previously reported that the Simon Game can be used in informal temporal processing training.1 Ferre also provided a list of board games and activities targeting specific auditory processing skills that we have expanded to include the appropriate age for each game.2 (See Table 1.)Table 1: List of age-appropriate board games and activities targeting specific auditory processing skills.In 1983, the term edutainment (education through entertainment) was used to describe a package of software games that hold the attention of learners by engagement and interaction. Video games designed for educational purposes promote incidental learning because they are often built around rule-based strategies, logic, adaptability, and motivation, and they appeal to young children and their parents. Kuster also developed a list of free online listening activities useful for formal and informal auditory training.3 Dowell, Milligan, and Hurley also reported on video games that enhance auditory processing skills.4 (See Table 2.) As new games are introduced, other games are taken off the market. Clinicians should continually update their list of materials to be used in informal therapy.Table 2: Review of age-appropriate video games that enhance auditory processing.MUSICAL TRAINING Kraus and Chandrasekaran recently reviewed the benefits of formal music training as an enjoyable auditory training exercise.5 Music and speech share many of the same acoustical properties, such as pitch, timing, and timbre, to convey meaning. Musicians are trained to extract meaning from sound, and numerous anatomical and behavioral investigations have emphasized the superiority of a musician's brain. Musicians have an exceptional ability to hear in background noise, and are better able to discriminate timbre and pitch. Formal music training also aids cognitive skills; working memory and attention are important to extract meaning from sound. These same skills are needed for language processing. The Suzuki method is a popular musical training method for young children that involves listening to musical recordings daily. This ear training emphasizes the prosodic qualities—intonation, timing, and tone—and consists of playing music by ear first, with emphasis on tonality. Reading musical notation is taught at a later time, just as the developing child learns to speak and before reading skills develop. Hearing and listening are a child's first exposure to linguistic communication, and are essential for language acquisition and cognitive development. It is estimated that children spend approximately 50 percent of classroom time hearing or listening to instructions from their teacher, and approximately 45 percent of their time outside school hours is spent listening.6,7 Children with good listening skills are more successful in school, and good listening and auditory processing skills can be improved with informal training using everyday tools.