Practical Auditory-Verbal Therapy Home
Lesson Plan For A Five-Year-Old
Lisa Katz, M.H.Sc., S-LP(C), Reg. CASLPO
Note that the following lesson can be found in Songs For Listening! Songs For Life! edited by Warren Estabrooks and Lois Birkenshaw Fleming (forward by Daniel Ling and CD vocals by Mary McCandless), which will be published by AGBell and available in late September 2002.
Lauren is four years and ten months old and has a profound, bilateral sensorineural hearing loss of unknown etiology. She was diagnosed at eighteen months of age, despite her parents’ suspicion of hearing difficulties at ten months. She was immediately fitted with bilateral behind-the-ear hearing aids and began auditory-verbal therapy.
During her first six months of therapy, Lauren made maximum use of her aided residual hearing. She heard differences in auditory patterns, and was able to detect low and mid-frequency speech sounds. Lauren learned many of the Learning to Listen Sounds as well as some stereotypical phrases such as “Oh, oh!” and “It’s all gone”. She was able to perform closed set selection tasks and was highly motivated to communicate by using words, phrases and gestures. Due to the profound nature of her hearing loss, she was not able to monitor her own speech and consequently her vocalizations were neutralized, pharyngeal and/or high pitched.
Lauren was two years and ten months of age when she received a Nucleus 24M cochlear implant, after which her listening and communication skills developed very well. She is now two years post activation of the cochlear implant and she receives auditory-verbal therapy once a week. Lauren is integrated in kindergarten at her local school where she is rather shy in the classroom but appears to have adjusted socially and, according to her itinerant teacher, is “coping well”.
Therapy begins as soon as I greet Lauren and her mother in the waiting room. I inquire if Lauren has recently had her hair cut and comment on the toy barn with which she is playing. On the way to the therapy room, I talk to her mother about events of the past week. At the table, I initiate a conversation about the weekend. Initially, Lauren is not forthcoming but she eventually becomes chatty. This conversation provides important diagnostic information about the current targets in audition, speech, language and cognition and helps to evaluate development toward the ultimate goal of conversational competence.
- To follow directions.
- To identify objects based on a related description.
- To extend auditory memory and sequencing to five items.
- To expose Lauren to rhyming words.
- To develop production of /l/ at the word level.
- To elicit production of /s/ in the final position in words.
- To sing songs with appropriate imitation of the suprasegmental features.
- To enhance voice melody.
- To develop use of regular past tense forms of verbs.
- To develop use of plurals.
- To develop language of description.
- To enhance the use of articles and conjunctions.
- To reinforce and expand counting.
- To learn letters of the alphabet.
- To continue the development of age-appropriate concepts.
- To request clarification.
- To respond appropriately to requests for clarification.
Scrumptious Scoops – The Six Sound Plus Test
Lauren is required to identify a sound produced from a distance (see Six Sound Song in Introduction). Ten small plastic cups are placed on the table. For each sound made by either mom or myself, Lauren will put a scoop of ice cream (made from different coloured balls of play dough) into a cup. Prior to giving her each “scoop”, I have her guess its colour by providing her with an association (e.g., This scoop is the same colour as the snow). We discuss favourite flavours and the word “scoop”.
- Visit an ice-cream store. Talk about the number of flavours available.
- Use the word “favourite” throughout the day. Lauren can survey friends and family members about their favourite flavours.
Sensational Sundaes – Listening for Critical Elements
I tell Lauren that we are going to make ice cream sundaes and show her a finished product. “Sundae” is a new word. I introduce all the materials: coloured pompoms for the various flavours of ice cream, small brown beads for chocolate sprinkles, brown confetti for nuts, red beads for cherries and coloured bowls. I begin by asking Lauren to prepare a sundae with three scoops of strawberry ice cream, chocolate sprinkles and two cherries. I add that I would like my sundae served in the blue bowl. We then switch roles for Lauren to place her order. When specifying her desired toppings, Lauren omits the /s/. We (acoustically) highlight /s/ or /z/ and expect production. Concepts such “some”, “or”, “a few” and “except” are incorporated in the activity.
- Make real ice cream sundaes at home. Talk about toppings. Have Lauren take orders from other family members and help prepare the treats.
- Provide opportunities to help Lauren develop her auditory memory skills in daily routines (E.g., Setting the table and cleaning up after dinner. Put away the water, pepper, napkins and put the salad dressing under the chair (sabotage)).
- Reinforce the concepts “some”, “a few” and “except”.
- Use the concept “or” by providing choices.
- Highlight /s/ or /z/ in the final position of words in games and books.
A Delicious Dessert – Developing Language of Description
I use a deck of homemade cards to play a game of Go Fish. On each card is a picture of an ice cream cone. All combinations of flavours and cone colours are represented in the deck (e.g., chocolate ice cream in a yellow cone, vanilla ice cream in a pink cone). Lauren must be precise in conveying accurate descriptions. She must be able to identify and repair communication breakdowns as they occur and assume the perspective of her communication partner. The target in this game is the production of complete sentences including function words. When Lauren does not produce a complete sentence, we respond with “pardon me”. If she still is unable to clarify her message by using a full sentence, we model the desired production. We conclude the activity by having each player count the cards and then we compare and contrast the number of pairs we have with the number of individual cards. We discuss how we scored and who placed where.
- Enhance Lauren’s awareness that not following the rules of grammar may lead to miscommunication. If Lauren’s sentences are incomplete, respond with a puzzled expression or simply say, “Pardon me”.
- Encourage Lauren to request clarification by using phrases such as “Pardon me” or “What did you say?”
- Barrier games are excellent activities to improve descriptions and directions and to enhance expressive language.
A Tasty Treat – I Like Ice Cream
I sing the song “I Like Ice Cream” while snapping my fingers and clapping my hands alternately and Lauren and her mother join in. I then take out a set of cards depicting a variety of food items and select a card. I sing the song again, substituting the word, “ice cream” with the item depicted on the card and then place it face down on table. Lauren and her mother follow suit. We continue singing until five items have been presented. I then ask for Lauren to recall the items, verifying the responses by revealing the corresponding picture. If Lauren has difficulty remembering an item, I provide a brief description (e.g., It’s a fruit that a monkey likes to eat). She is also encouraged to remember the items in the order that they were presented and to sing the song. We sing the song several times.
- Singing songs is an excellent way to improve voice quality and refine the suprasegmentals of speech. The song is also useful for the expansion of auditory memory and the development of auditory sequencing. We rely on memory throughout the day – from remembering telephone numbers to recalling directions.
- Memory skills are important for success at school as children are typically required to store a substantial amount of auditory information prior to performing a specific task (e.g., “Before you turn to page five in your books, make sure that you have handed in your field trip money and you have thrown away all the scraps of paper from the art activity.”)
- Singing this song helps Lauren arrange items into categories. The category “food” can be subdivided into fruits and vegetables, snack foods, breakfast foods and so forth.
- The song can also be sung alphabetically or by phoneme. This is great way to incorporate speech targets (e.g., Lauren’s production of /l/).
- Take turns singing a total of five verses. Incorporate as many people as possible into the song.
- Try singing a few verses of the song without picture support.
- Avoid modeling the correct production while Lauren is singing. This interrupts the song. A better time to model and acoustically highlight the final /s/ or /z/ is when Lauren is recalling the items.
- Expect production of the conjunction “and” when Lauren is recalling the items.
- Until Lauren becomes familiar with the song and its tune, sing along with her and help her fill in the missing item. Clapping and/or snapping ones fingers reinforces the beat and rhythm of the song.
- Although this song can be used to introduce new vocabulary, Lauren’s inability to recall new word(s) may be due to a lack of familiarity with the vocabulary as opposed to a problem remembering the items.
A Decadent Delight – “Eighteen Flavours” Poem
I conclude the session by reading the poem “Eighteen Flavours” by Shel Silverstein. I pause after each line and prompt either Lauren or her mother to repeat. We talk about the meaning of new vocabulary words such as “luscious” and “scrumptious”. We also discuss the colours and ingredients (mocha contains chocolate, rocky road has marshmallows) of each flavour. I provide Lauren’s mother with a copy of the poem and indicate that Lauren could learn the rhyme, “I scream, you scream, we all scream for ice cream!”
- Read this poem at home and reinforce the new vocabulary.
- Discuss flavours and help Lauren recall the ones mentioned in the poem.
- Learn the ice cream rhyme.
Lauren’s lesson consisted of activities in which specific targets in audition, speech, language and cognition were incorporated. Important diagnostic information regarding performance in each of these areas was obtained, thereby helping to develop and refine targets for subsequent sessions. Ongoing parent guidance was provided during the session so that the skills and concepts demonstrated could be reinforced at home.
The song activity in the lesson was designed to extend auditory memory, evaluate Lauren’s ability to accurately arrange objects into categories and further develop the suprasegmental and prosodic features of speech inherent in song.