Practical Auditory-Verbal Therapy Home
Lesson Plan for Babies
By Warren Estabrooks
The Lesson Plan
The following is an example of an auditory-verbal session that we follow in our clinic at NYGH. It might be adapted to a variety of home or private settings where the guiding principles of auditory-verbal therapy are followed. Lessons are meant to be flexible and adaptable. The best lessons are learned and reinforced in regular play and meaningful daily experiences. If the parent and the auditory-verbal therapist understand the basic foundations of language learning through listening and use their skills to develop them (Ling & Ling 1976; Pollack 1985; Northcott 1978), then the opportunities for spontaneous carry-over will be abundant. For each activity described in the following lesson plan, there are many suitable carry-over activities which parents and young children may find very enjoyable. For additional ideas, one might consult the nursery school or daycare teacher, the public librarian, the local Y.M.C.A. (which usually offers very good courses in parenting), religious school teacher, grandparents, and especially other parents! Most activities and songs in this lesson are based on the Learning to Listen Sounds and the songs from Hear & Listen! Talk & Sing! (Estabrooks & Birkenshaw-Fleming 1994).
Greetings usually take place in the waiting room. If it is relatively quiet, we sing one of the Hello Songs from Hear & Listen! Talk & Sing! We respect the presence of others in the waiting room, but usually everyone is interested in what’s going on. If the waiting room is noisy, we reserve this song until we are outside the clinic door. On the walk down the hallway from the waiting room to the clinic, we find out how things went at home this week. As this is an insightful time, we listen carefully to the parent and do not allow ourselves to become pre-occupied with other things.
As the parent holds the infant, we look at pictures on the wall and make one or two of the accompanying Learning to Listen sounds. The parent and therapist talk about all the toys before the child sees the stimuli. The baby or infant is encouraged to come “up, up, up” and sit “down, down, down” into the high chair. The parent sits beside the child or across from the child on the other side of the table. The therapist sits beside the child on the side of the ear with the most amplified hearing. A hearing aid check has already taken place by the parent just before the lesson, so the therapist does not do it again unless the parent cites difficulty.
Carry-over: Some parents put pictures of the Learning to Listen sounds around the house in places where the child can visit them readily … on the refrigerator, on the staircase and on the front door. This strategy may provide abundant opportunities to engage in auditory activities during high-chair time, on the way to bed, or on the way out to play.
The Party Noisemaker
In therapy, we are not as concerned about good eye contact as we are about good ear contact, so we focus attention through a sound stimulus, such as a party noisemaker, clacker, etc. We make the sound under the table or behind the child’s back and say “I hear that? Where is it?” Then we all look for the noisemaker and allow the child some time to play with it, as the parent responds to the sound by pointing to his or her ear and responding appropriately (“I heard that”).
Carry-over: The parent is asked to draw the child’s attention to all kinds of sounds around the home and in the community, by saying, “Listen! I hear!” and then finding the sound source with the child.
The therapist may say, “Listen, baby!” A(r) “That’s an airplane. It says a(r), it goes up, up, up in the sky. Listen!” The therapist waits and either makes the sound again or the parent repeats the sound. Sometimes we play with four or five different coloured airplanes and use a picture of an airplane. The parent may say, “Listen! I hear an airplane outside.” We pick the child up and look for an airplane in the sky above the hospital. The therapist directs the child to put the airplane into a colourful pail which signals the end of the play. When the airplane is in the bucket, we say, “All gone,” and make a natural gesture for “All gone, no more.” We also wave bye-bye to all the toys, as the child places the toy into the pail, and then prepare for the next activity by signalling the child to “Listen!” We do not show the toy before the cue to listen has occurred.
Carry-over: Take a trip to the airport; take a polaroid picture of an airplane; find a fair where the child can ride on an airplane ride. Listen and look for airplanes above the home.
The parent says, “Listen! I hear something!” The therapist says “bu, bu, bu,” pauses and says it again. The parent will say “I hear a bus! Where is it?” We all look under the table to find the bus. The child plays with the bus making it go back and forth on the table. We sing one of the bus songs. There is a short song for every Learning to Listen sound. After the child plays with the bus, we might put people in, and take them out, or push and pull it on a string. This is a good activity to develop “p, p, p, push”. We also talk about the wheels that go “round and round”. Then the bus goes in the pail.
Carry-over: Go for a ride on a bus. Play with a toy bus or make one out of cardboard boxes.
The therapist says. “I have something that goes round and round, round and round, round and round.” The parent repeats the same “round and round” sound. The therapist waits and then shows the child a circular gesture on the table with the index finger and presents a small spinning top. We have dozens of different tops which parents have collected from around the world. Sometimes we hide the toy in our hand and sometimes we hide it in a small box, a plastic egg or another container. Afterwards, the toy is placed into the pail.
Carry-over: Go for a ride on a merry-go-round at a fair or in the local park. Point out wheels, weathervanes, fans or mobiles that turn or spin around.
The therapist says, “I have a train. It says choo – oo – oo. Here comes another part of it… and another part… and another part. Choo – oo – oo. Let’s go for a ride! It is going around and around.” As we sing a train song, the child plays with the train. After he or she puts the train into the pail, we wave bye-bye.
Carry-over: Go for a ride on a train or a subway. Encourage the infant watch a colourful mobile above his or her bed and listen to the associated sounds. Some parents have a mobile only of a train while other parents have mobiles made of several Learning to Listen toys. Combining many sounds into one activity is fun—Some parents put colourful wallpaper up in the infant’s room patterned with many of the Learning to Listen toys.
We now have five or six items in the pail. We replace the toys in their proper place by having the child retrieve the toys one at a time. We make each Learning to Listen sound again, play with it briefly, wave bye-bye, say “All gone” and then store it away.
At any time during the lesson, the therapist will incorporate a conditioning task where the parent models the desired activity for the child. Parents may hold a stacking ring or a plastic block to his or her ear, attentively anticipates a sound, and, upon hearing it, put the ring on the stacking toy, the block in the water, etc. We begin this activity with the sounds which are most audible and increase to more difficult sounds as conditioned responses improve. Such activities help in preparation for pure tone testing and can help us to check for hearing aid distortion.
The therapist will “blow raspberries” and say, “Brr Brr, Beep Beep! I hear the car! Listen, Mommy! Do you hear the car? Listen Mommy and Daddy, Do you hear the car? Brr, Brr, Beep Beep!” Then we wait and listen for the child to respond. We find the car and then everyone has a turn playing with it. This provides a chance to use some of the other Learning to Listen sounds such as “p, p, p, push,” “round and round,” “g, g, g, go,” “whee,” and phrases such as “bye bye,” “all gone,” ‘stop now,” etc. The therapist teaches the parent a variety of ways to incorporate several of the Learning to Listen Sounds in one activity with one toy. Then, into the pail it goes!
Carry-over: Babies and infants love to ride in cars. Go for a ride in the car often. Offer the child a ride in one of those mechanical cars at the supermarket or the carnival. Make a car out of a cardboard box and play actively in it with the child.
The therapist says, “I hear a bird,” and then whistles twice. There is a bird mobile hanging in the therapy room and we draw the child’s attention to this. Some children need direct instruction in localization skills. We do this in several ways with some of the Learning to Listen toys strategically placed so that the child needs to look up, down, or around to the stimulus in order to locate it. We have a number of toys which are battery operated and make the desired sound. We activate these periodically during the lesson and teach the child through modelling to locate them. The parent locates a large colourful picture of a bird on the walls and points it out to the child. The therapist may then present the child with a plastic egg in which there is a wind-up bird. We whistle twice or sing chirp chirp, chirp chirp. The child receives the egg, opens it and then plays with the toy. Then, the child places the bird in the pail.
Carry-over: Listen for the birds in the garden or park and point them out to the child. Visit the local pet store and listen to the birds as well as the sounds of other animals.
The therapist might introduce this activity as one of the Hear & Listen! Talk & Sing! songs about a dog, followed by playing with one of our clinics many dogs which can be wound up. This is an excellent opportunity to demonstrate the verbs walk, dance, bark, jump, roll-over, etc. After following a similar routine as with other toys, the therapist might present a dog puppet and the parent and child would act out a scene such as “pat, pat, pat the doggie,” “go to sleep doggie,” and “wake up, doggie.” Then the dog goes into the pail.
Carry-over: Play often with the family dog, including the pet in regular daily activities or take advantage of friends” pets. Buy a dog puppet (one of the Sesame Street dogs may be very useful) or stickers of dogs. Stickers and small pictures of all Learning to Listen toys are very popular and highly motivational.
All children enjoy rolling a ball! “Ball” is a highly-motivating word—it is an easy word to hear and say. In fact all of the early developing consonants “m,” “p,” “b,” “w,” and “h,” have associated toys, actions and activities. Playing with a ball helps to develop “r” as in “roll, roll the ball” or “p” as in “push, push the ball” or “b” or “ou” as in “bounce, bounce the ball.” We might play with a ball several times in one session. The parent is encouraged to follow the child’s lead at home and play with the ball for as long as the child is interested. In the clinic, we want to demonstrate as many ideas as possible for the carry-over of goals, so we try to get the ball into the pail after a short period of play.
Carry-over: Attend a kindergym or tots play group where many balls are used. Go to McDonald’s or a similar restaurant where the child can play in the ball room. Have an age-appropriate ball at home as many concepts can be developed by playing with it.
The parent says, “Here comes a rabbit. It goes hop hop hop, hop hop hop.” We continue to point to our ear. We wait, and anticipate a sound from the child, and then we try to locate the toy. The child then has the opportunity to play with it. In our clinic, we have a life-like, battery-operated rabbit, whose ears go up and down as it hops. One father simply made a pair of rabbit ears, put them on, and hopped around. He also spontaneously included a song and dance called “The Bunny Hop” which became a clinic standard. We also might read Pat the Bunny or a book about rabbits. After the activity, the child puts the bunny into the pail.
Carry-over: Make a visit to a farm to see real rabbits. Purchase a toy farm set containing a rabbit. This is a valuable resource and it usually contains many of the Learning to Listen toys. A stuffed animal will help you to talk about many body parts as well as “hop hop hop.” Make some long ears and dress-up like a bunny with the child.
The clown says “Ha ha ha!” A clown sits on the window sill of the hospital clinic. Originally intended as a doorbell for a child’s room, when its nose is pushed, the clown lights up and plays a cheerful song. We have found toys to be a very motivating reinforcer for speech babble (Pollack, 1985). A duck, a yo yo, pop-up toys, and bears are all used to develop various stages of auditory and speech development. As soon as the baby begins to babble a specific phoneme we introduce a highly-motivating word such as a “bye-bye,” “m, m, m, more,” “night night.”
Carry-over: Make a visit to a local circus or carnival to see clowns. Purchase a clown puppet or jack-in-the box which may double as a music box.
The Learning to Listen Bag
Next, we take many toys out of the Learning to Listen bag (like Santa’s sack). This bag contains many Learning to Listen toys and furry animals. We say “moo” for a cow, “baa” for a sheep and “roar!” for a lion. Sometimes the Learning to Listen Bag contains all the animals and props for Old McDonald’s Farm and we spend a few minutes acting out the story using the associated props. We always make the sound before we share the toy, and then sing an appropriate song. Subsequent activities may include a repetition of some of the above toys and activities, plus:
- Bubbles (Blow) (p, p, p pop) This is a particularly good activity for the older toddler who may vocalize babble or certainly giggle when presented with bubbles. Initially, the therapist or parent will have to blow and the child will enjoy running after the bubbles. We are delighted the first time a child blows bubbles. Blowing is a pre-requisite skill for speech, as well as sucking and chewing.
- Toy Baby (Mama) We feed the baby doll and give it food (Mmmm); wipe doll’s face (Wipe, wipe, wipe); hug and talk to doll (Ah baby); change doll’s diaper (Pee oo); put doll to bed (night night).
- Horse (neigh neigh) We also use tongue clacking with this animal. This is a helpful pre-speech behaviour which needs developing.
- Cat (Meow) We may pat a cat and feed it milk or we might put on some paper whiskers and act like a cat. Parents often point these animals out to children and we encourage them to put a big picture of a cat in the child’s diary.
- Slide (Whee) We have found this to be a very motivating toy as a reinforcer for speech babble and use it to introduce words such as a “bye bye,” “m, m, m, more,” “night night.” Even whispered sounds such as “p, p, p” and “h, h, h” when amplified may be quite audible to a baby who is hearing-impaired.
Carry-over: There are many types of home that help children learn to listen to all of these sounds. The ones mentioned in this lesson are only some of the activities possible. Parent-sharing groups are excellent for gathering new ideas. Expensive toys are not needed, and hand-me-downs are very welcome. Not only other parents have great ideas about carry-over activities but so do grandparents!
The Final Story
Although one or two short stories may be told during the lesson, our therapists and parents like to finish the therapy session as quietly as possible. In the early stages of therapy, we may act out a very short story with props or puppets. As the attention span of the child increases, we can tell longer stories, such as the perennial favorite Are You My Mother? by P.D. Eastman.
The Parent Book
Throughout the lesson, the therapist will answer the parents” questions, but a few minutes are spent at the conclusion of the lesson to ensure that the parent is absolutely certain of what he or she needs to develop at home in the areas of speech, language, cognitive and communication development. We review the notes the parent has made during the session and discuss any other concerns. Occasionally, the parent may wait until the last moment to tell the therapist about big concerns. We make time for this by ensuring adequate time between the sessions of each of the children attending therapy. From time to time, however, the auditory-verbal therapist is made aware of serious concerns that are in the domain of social work. Most auditory-verbal therapists know very well when special counselling is necessary and it is our professional practice to refer the parent(s) to the appropriate member of the team.
Practical Auditory-Verbal Therapy Home