Hearing Issues for Students with Deafblindness #4 This video is posted online with the following chapter markers: Chapter 1. Introduction - Chapter 2. Testing Deaf vs. Deafblind - Chapter 3. Why Do Informal Eval? - Chapter 4. Who Contributes to the IFHE? - Chapter 5. IFHE Draft Document - Chapter 6. Informal Evaluation - Hearing Issues for Students with Deafblindness #4 Transcript Music ] Chapter 1. Introduction [ Slide start: ] Chris: Okay. Hi, everybody. I hope you can hear me. We're going to be talking about functional hearing assessment. My name is Chris Montgomery. And my partner over here is Adam Graves. And we have a special guest with us today, Deanna Peterson, she's a teacher of the deafblind here at T-S-B-V-I and she's got some practical experience -- real world stuff to share with us as we go along. We're going to talk about functional hearing evaluation, as I mentioned. But specifically about -- it's called the I-F-H-E, Informal Functional Hearing Eval that we've been working to develop. It's definitely still in draft form, and we're going to ask you guys at the end if there are any takers on somebody who might want to maybe try it on, try it out on some of their students and give us some feedback. But we'll get more into that later. [ Slide end: ] [ Slide start: ] Up until this point, we've really been talking about the formal side of -- of audiological testing. Looking at going to see the audiologist, looking at the clinical side of things. As we look at that, if you guys will remember and hopefully you've been tuning in to us all along here, there are basically two kinds of formal audiological measures, and that would be behavioral -- that's when you take the student to the audiologist and they're in the audiology booth and you're testing with pure tones or with speech recognition, and the student would raise their hand or some other indication, whether they are hearing or not. And then the other one is physiological, that's the kind of testing that would be an Auditory Brainstem Response, ABR, Otoacoustic Emission, OAE or tympanic... I always have trouble... Adam: Tympanometry. Chris: Thank you. Adam: You're welcome. Chris: We're a team! [ Laughter ] But these things don't...don't require any sort of behavioral response. Actually, a lot of times with an ABR, a kid may be sedated so that they get more consistent results with that. Most audiological measure or real world audiological measure is going to be speech discrimination testing, which for a lot of our kids with deafblindness, it's going to be really hard, because a lot of them don't speak or use speech -- formal communication. [ Slide end: ] [ Slide start: ] Looking a little bit further at this formal audiological testing, audiologists need a really controlled clinical setting so that they have the same baseline to draw from over time. They're trying to keep things very consistent, it's more of a medical model. The formal testing or the informal testing should never -- we don't ever want to give the implication that the informal testing should be a replacement for the formal testing. But hopefully those -- the informal testing would give us more information for the audiologist down the road. A lot of our students who may not have a lot of formal language, it's through our observations and stuff that we can maybe say, hey, I think they heard this or something when they're in the audiological booth. [ Slide end: ] Chapter 2. Testing Deaf vs. Deafblind [ Slide start: ] Looking at some of the difference in testing of deaf versus deafblind, obviously a student who is deaf, they can see the sound sources. So as the door closes and makes that sound, you might be able to point to the door so that they can connect that visual with the auditory. And they're going to be, typically, easier to test in that behavioral assessment at the audiologist's office for that reason. Our students who are deafblind may not be able to make that visual connection of the sound and the sound source. And so they're going to have a lot more trouble connecting meaning to sound. Other things to consider with the deafblind student is: When is it cognition and when is it a hearing impairment? So some things that we'll be looking at and talking about are trying to separate, are they hearing it because of hearing impairment or is it a cognitive disability that we're looking at and these are -- really good things to look at, but also really hard questions to sometimes get answers for. [ Slide end: ] Chapter 3. Why Do Informal Eval? [ Slide start: ] Adam: We're going to talk about why we would do an Informal Functional Hearing Evaluation, some of this we have talked a little bit about before with -- in our past sessions with Lisa Sutherland, and a lot of it has to do with, as Chris said, it's just gathering information. And it can serve as a good first step for students who either haven't been tested yet, because there hasn't been -- nobody has noticed discrepancies between their hearing, their functional hearing, so maybe they haven't had a formal hearing test. But there's some questions as to whether or not they're actually hearing what's happening in their environment. And then, also, it's a good way to help guide the testing for the audiologist, that's information that you can provide to them when you go in to have a formal evaluation, once you have those questions and have -- have gone through the evaluation and sort of filled in the information indicating why you think that student might not be hearing very well. You can then provide that to the audiologist so that when they are testing it, they can use that information as part of their testing. [ Slide end: ] [ Slide start: ] It also helps the team when creating instructional modifications and accommodations for a student who might be having difficulty in the classroom due to possible hearing difficulties. If you think that a student might not be hearing very well, but you're not sure whether or not it's due to a hearing loss or if it's because they just don't understand what's going on around them, doing a hearing evaluation can help you start to implement some instructional modifications that address the hearing part and if they respond to that, that might give you a better indication as to whether or not it's actually hearing or if it's cognition. Chris: Maybe, too, you would see like mom and dad are seeing different things at home than you are seeing at school. We will get into it a lot more in a second, but ‑‑ Adam: Right. And then -- yeah, that's a good point -- when there's discrepancies between what's happening in one environment and another environment, that's another good...time to do an Informal Functional Hearing Evaluation. It can also help provide information and make -- to help you make a decision as to whether or not the student would qualify as a student with deafblindness in order to receive services from a teacher of the deaf and hard of hearing or a teacher of the deafblind, if you have one. Those are the primary reasons why...why you would do a functional hearing evaluation and then while Deanna is here, I wanted to ask you, Deanna, you kind of began a process of doing a functional hearing evaluation on a student here, and I wanted to ask you what the impetus was for you to do it? It was to gather information, yes. But, you know, here at the School for the Blind, we're in a unique situation and we have a lot of people, not just myself, but a lot of people -- the speech pathologist, the behavior specialists -- who have years of experience with deafblind students. And this particular student, I think, most of us feel like we kind of -- kind of have a handle on what we think he can functionally hear and can't hear. But it's not really documented anywhere. It might -- there might be a little of that kind of information in the communication report, that the speech pathologist writes. I certainly put that kind of information in functional vision assessments, learning media assessments, and encourage other people to do that, because it needs to be noted somewhere. But in a real functional way, it doesn't get documented anywhere and -- and it's -- especially if the student does have a hearing impairment, it's -- it's something that most everybody who works with them has questions about. So it's a nice way to -- to summarize what you do know and I do think, although it's not providing this one, the first one, probably isn't going to provide a -- a lot of -- of novel information. I do feel like it helps me and the team come up with really good recommendations that -- that aren't already in place and it might help. I haven't gone over it yet with his family to see if it's -- if it's different information for them. But I like having a place to put all of that kind of information so people aren't, you know, rifling through all of the documents to try to get, you know, a couple of sentences about what's going on functionally with hearing. Chris: And I just wanted to add, too, because I really like what Deanna said. You know, when you are looking at the part -- the report from the audiologist, usually the audiologist, they're supposed to put recommendations. And those recommendations can sometimes amount to a couple of sentences that you can't really read. And while -- while I don't want to 'dis' audiologists because usually we get really good information in those recommendations, but this I think gives us more functional stuff and a lot more of it. And hopefully that would feedback into the audiologist so they would write even more recommendations of what they see, right? Deanna: Yes, and we are also really lucky, here at the School for the Blind, we have purchased our own sound booth, and we've been working with the same audiologist for at least -- at least as long as I've been here, 17 years. And she -- she understands our -- especially our multiply impaired students who...who can't raise a hand or push a button when they've heard the sound, and...and she really takes the feedback that we come in with -- sometimes it can be a hard sell, but she knows that we work with these students every day and -- and, you know, we see them using their residual hearing in a way that she's not able to do. And...we really -- because we are there, either myself is in the sound booth with the student or the teacher or the most familiar person is in there, helping determine what constitutes a response from that student, we do get better recommendations, because we have that relationship and because we are there, you know, bringing information and asking questions. So it's a little bit unique for us. Adam: Yeah. But also, I think, you know...just to speak to your point about like bringing the recommendations to the audiologist, if you couldn't be there, having a comprehensive document describing, you know, what you see that -- the child hearing -- would help that audiologist even if you couldn't be there or the person who knows that child best couldn't be there. Deanna: It would, but I would recommend that -- I mean, we -- here, we send a lot of reports to a lot of different kinds of doctors. And the one -- the one common thing is that doctors are not going to read long reports. So we may want to think about..you know, something shorter and more compact and summarizing to send to the audiologist. Adam: And that -- well -- we can get into that a little bit later. [ Laughter ]. Because we do have something like that. [ Slide end: ] [ Slide start: ] But I'm going to keep moving here. And talk a little bit more about...the difference between cognition and hearing and the need to rule out whether the...difficulties that a student with deafblindness might have would be in cognition or hearing by using those recommendations to apply the -- to apply the instructional strategies that deal with hearing in order to rule those out. I just want to reiterate that's part of the purpose of providing this functional hearing. Once you apply some of those instructional strategies and you do find that -- that it is a hearing issue and not a cognitive issue, then you can start to -- to discuss the possibility of having that student be registered as deafblind in order to receive services. So if you have a student who isn't, you know, who has a visual impairment, but isn't registered as being deafblind or registered as eligible deafblind or having a hearing impairment, doing a functional hearing evaluation can help you make that determination, as you start to assemble the members of the team, such as a teacher of the deaf and hard of hearing, that you would need to then take the recommendations and do a little bit more evaluation, and do a formal hearing screening, if they haven't already had one. They can still be registered as deafblind, even if they haven't got a formal audiology report under section B. Chris: Yeah, that would be that suspected loss. They can be on the deafblind count for a year with the suspected loss. So while you guys are -- while the team is doing testing, while the teacher of the deafblind or the teacher of the deaf and hard of hearing can be formally on the team, that is an ARD process, though. So you have to go to ARD to make that call and also list that kid as being deafblind. If that happens, that can go for a year and that's when all of that audiological -- formal audiological testing can happen to see what the audiologists find to make that determination. [ Slide end: ] [ Slide start: ] Adam: There are some students for whom formal hearing assessment tools may be sufficient, particularly if you have a student who can fully participate in the process and who has the language and the cognitive ability to be able to understand the testing process. But even with some of those students, you might need some additional tools and this...evaluation can help you with that. Chris: And so Deanna, I just wonder, I have -- I have a second question for you. Are there any students that you work with, and you work with a pretty wide range of kids here, from our basic skills kids without much formal language all the way up to academic kids with deafblindness. And I wonder what your thoughts are on who would need or who may not need -- any specific situations that you have run into that... Deanna: Umm, I don't work with any students here at the School for the Blind who I would say it wouldn't be beneficial to do a functional hearing assessment on. But I could see, you know, out -- out there in the world, there probably are students who -- who are -- students who come to mind who might not need one would probably be academic students, who are really good communicators and the team doesn't have any questions. It seems like, if the team has any questions, then obviously that student is going to be a good candidate. Chris: I've gone to see kids who are academic and...lots of formal language, they can either speak, they can sign, they can read and write -- all of that kind of good stuff. And two of these kids had cochlear implants, one of them had a BAHA, a bone anchored hearing aid;according to their audiological reports with their devices they could hear speech, hear pretty well. And what we were seeing in the real world, sometimes they were, sometimes they were not hearing speech and they were missing things. So even for those kids where, you know, "Hmm, I'm not sure if this is quite lining up with what we're seeing in the classroom, we're seeing at home," with what the audiologist is seeing clinically. That might be a time where you would do something like this, too. And then if you're going back to the audiologist, that information might help them when they are reassessing, remapping those cochlear implants, and things like that. [ Slide end: ] Chapter 4. Who Contributes to the IFHE? [ Slide start: ] We mentioned this a minute ago, but who is going to contribute to this informal hearing process evaluation? Obviously you want the whole team to do it, you don't want this to be one person. If you have a teacher of the deaf and hard of hearing, already on board on the team, bring them in. Obviously they, it would seem, would be a point person in this, maybe the speech pathologist, too. If you are lucky enough to have a teacher of the deafblind, there aren't many of us out there, but that would also be a person that could be a point in this. I definitely think that you would want a teacher of the visually impaired involved, because they're going to be able to be the springboard for, you know, the visual information that this student might be missing, and having those kind of connection problems with the -- with the hearing -- not seeing what they are hearing. Obviously the parents, we have already said that, but we've -- I think it would definitely be a thing you'd want to talk to parents, you know, what are we seeing at school, is it lining up with what you all see at home. And they might be able to even provide more information like about -- outside environments and things like that. And then, also, obviously don't forget the clinical, the formal hearing people and that would be your audiologists and otologic -- otological people. Your ENTs. Deanna: Chris, I just wanted to note, also, since it's not listed there because of Robbie's comment, O&M. I have countless -- countles...times have O&Ms stop by my classroom. They're a really great source for, "Hey, I'm really not sure, you know, if this kid is hearing traffic on this sound, where we need to be facing," and that happens a lot here. So that's ‑‑ Chris: I'm super glad you've brought that up. We even have an O&M in the room so it's double bad we didn't mention that. Deanna: Robbie...Robbie got us. [ Laughter ] She mentioned it. Thanks Robbie. Chris: That's all that environmental stuff. And that can be, you know, really different outside versus inside. So -- yeah. Don't forget those guys. [ Slide end: ] [ Slide start: ] Okay, where does the data come from? Obviously there's all the way up from formal testing and infant screening...medical reports, is the students or kids have had any stuff prior -- audiological visits or if they've seen an ENT for anything. We mentioned parents and team interviews. And then obviously all of that observation and diagnostic teaching. Deanna has talked a little bit about who's contributed here on her team, but do you have anything else that you would add to what you've already said? Deanna: Not -- nothing other than that -- I mean, like any other assessment, this wasn't a sit‑down get it done even with, you know, four or five other people in the room. It was a process. And it -- it required that, you know, we meet a number of times and... Chris: I think that's a real good point to. I don't think this is something -- and I don't think we've said it -- that you're going to go do in an hour chunk of time or something. It would seem to me this would be an ongoing process. This might be something that you do over multiple sessions. For any vision teachers out there, you know, functional vision. You don't come in and do that in a half hour shot. You know, you're going to look at your student -- you're going to look at your student over multiple sessions, multiple environments.And then, also, I think with this hearing thing, it might be something to kind of come back to every now and then and just kind of keep checking your results. And obviously if the student has a documented hearing impairment, and you're looking at their ARD paperwork and their F-I-E documentation, you would be looking at their otological and audiological, that's parts A and B. [ Slide end: ] Chapter 5. IFHE Draft Document [ Slide start: ] Adam: You have in your handout the -- the functional hearing assessment, and then the assessment -- or functional hearing evaluation and the assessment tool to help you fill that out and we'll -- we're going to start talking about that...right now. [ Slide end: ] [ Slide start: ] So the first step in doing a functional hearing evaluation is to -- to do interviews with people who work with the student. And then -- and also the parents. So everybody on the IEP team or the ARD team, and if you look on Page 6 of your packet, there are the questions there that you would ask or suggested questions that you could ask to help you gain information to fill out that part of the -- of the form. And then, also, part of the first step would be to review the existing documentation, which would include, you know, all of the -- all of the normal IEP paperwork, any sort of formal evaluations that the student already has, the eligibility statements. [ Slide end: ] [ Slide start: ] There's the A-I eligibility statement, which you may not have one for the student, that may be the reason that you are filling out this hearing evaluation is because you feel the student has a hearing impairment and you want to make sure that -- [Multiple voices] -- but it's not documented and so that's part of the process. [ Slide end: ] [ Slide start: ] You want to collect any information about their etiology, of course, because certain etiologies may have a tendency -- there may be certain etiologies in which students tend to have a hearing loss in combination with a vision loss. Even though, you know, the current documentation may not show a hearing loss. If they have an etiology that sometimes has those concomitant losses, it would be a good thing to document. Also a history of middle ear infections is important. As we talked about with Lisa, frequent ear infections...frequent ear infections can often lead to damage of the ear, which can lead to hearing loss. And then, of course, a history of hearing loss in the family is always a good thing to know, or, as well as, any history of the student coming in contact with ototoxic drugs. So those are all very important things to document. [ Slide end: ] [ Slide start: ] And then if you have reports from an ENT, or reports of testing with aids, if they are currently wearing any sort of hearing aids or assistive listening devices, you want the results of aided and unaided testing. The reason that we have prescribed listening devices in there is that -- and listening devices -- sorry. [ Laughter ] The difference again prescribed listening devices and listening devices that a child currently wears is that they may be -- just because they're prescribed an aid doesn't mean that they always wear it. So they may have an aid that's been prescribed to them, but they don't want to wear that, but they will wear something else. For example, they might not want to wear hearing aids, but they'll wear head phones in conjunction with an FM system. So you want to make note of that. And then...and then you also want to note any degree of hearing loss and what the implications of that would be. And that would be indicated on an audiological report. [ Slide end: ] [ Slide start: ] Chris: And Kate made a really good points, even though there may be audiological reports that the parent has, even the school, i mena, sometimes the ARD committee decides that we don't really need to reup any audiological information, and so you might have some really old reports, and things may have changed. Adam: Right. Yeah, hearing does tend to change as we discussed in some of our past sessions. Just because the audiological report says one thing, you know, that they have a mild loss, it doesn't necessarily mean that -- that they are always going to have a mild loss. Chris: And the thing about testing over time, maybe they went to the audiologist on a bad day. Adam: Right. Chris: Maybe there was gunk in their ear and, you know ‑‑ Adam: Right. Then that's why it's important to note the appearance of the ears, whether they have anything in their ears and the bio-behavioral state is of the student because, you know, definitely if they are -- if they are in a heightened emotional state it's going to be a lot more difficult to test them. Chris: Or if they're just back from lunch and they are tired, something like that. Adam: Right. Then there -- the speech and language reports and the communication reports, should also be included in any sort of -- of formal evaluations that you include in your informal functional hearing evaluation. Chris: I just want to add a little note to this, and I'd love to get Deanna to chime in, if she wants to, but...when I first started thinking about this, it was -- it was because I had done a functional vision, learning media assessment on a kid and it was a student with deafblindness and there wasn't really -- didn't feel like there was a good place to collect all of this information about hearing. You know, and like we've said, there's a speech report, there's -- there's -- if there's a documented hearing loss, there's information there, too. But where do we gather everything? Especially for the student with deafblindness, when you've got this combination of loss. And so it was kind of -- I wonder if we can make a document that -- we can have all of this information in one place and then hopefully this would take us to -- all the way to instructional strategies at some point or recommendations, whatever you want to call that, you know. I don't know if you have anything to add to that or not, either of you. But maybe ‑‑ Deanna: I do not, I agree. Chris: Maybe people out there have ideas on that. [ Laughter ] [ Slide end: ] [ Slide start: ] Our general premise number 2, any student with a hearing impairment may function differently in the real world than the results of the clinical testing might suggest. Students with deafblindness are particularly likely to demonstrate discrepancies between clinical hearing results and real world functioning because of gaps in concept development due to an increased lack of incidental learning. Again, can't see what you are hearing, there can be some definite gaps there, so those are a couple of our general premises. [ Slide end: ] [ Slide start: ] Moving on to Step 2 of this, and hopefully you guys are referencing -- because it feels a little odd to me that we've pulled this out into a PowerPoint -- but we hope that you're referencing the actual document as we're kind of going through it here. But this observational stuff -- Informal, unstructured observation. It's basically like simply watching the child and taking notes. What happens when they walk into the cafeteria and it's really noisy, or maybe it's not even that noisy, but maybe it's an echoy room. What happens in O&M when they're traveling outside? What changes are we seeing? Like Deanna said earlier, just having a place to write this stuff down, you know, you might have it in your head, but it's always helpful to write stuff down. And then our structured routines. And this would be looking -- using a structured routine, and you might even want to go as far as the context of a familiar routine, and using that as kind of your control, your controlled environment, so to speak. Things to start with, would obviously be -- time of day, doing it at the same time of day. You might use a consistent person -- I would -- use a consistent person, and then starting, like Adam said, to look at audiological information, if you have that. If you don't have it, what does it seem like the kid's hearing? Maybe using some different things with speech paired with movement or sign or symbols. And if you are in a controlled situation, like a functional routine, that you're doing all of the time, you can kind of add or subtract from that. So I'm -- I'm kind of thinking of...maybe the kid you're doing a grooming routine with and in there you are brushing teeth, and during that brushing teeth part you are saying, "Brush, brush, brush, brush." Maybe while you're signing it and saying it, maybe while you've got the actual object there of the tooth brush, you know, are you seeing any recognition over time? Maybe that student will start to make the sign or maybe when you hand them the tooth brush and you say, "Brush, brush, brush," they are putting it up -- maybe behavioral things. What are you kind of starting to notice anecdotally that you think the kid may be hearing. And then you have to, I think -- hopefully you've got that teacher of the deaf and hard of hearing that can kind of put that into a little more clinical sounds like, hey, I think that would be around a thousand hertz frequency, 300 hertz, you know, this is where it is in that speech banana kind of thing. Deanna, I'm going to ask you again, like if you specifically targeted any functional routines with the kids you're looking at to -- to do hearing, functional hearing evaluations with? Deanna: Well, the one that I did do it with -- I did target two routines and looked at them twice. Once informally, you know, just observing and noticing things and then...sitting down with both of the teachers ‑‑ Chris: What kinds of things did you look for, notice when you say noticing things. Deanna: I noticed for example that the student was constantly -- he has no vision -- he was constantly turning his head like this, and when he would hear something, he would stop. Always with his left ear, and that was documented but this -- this back and forth motion appeared to me not to be a stemming behavior, but a scanning behavior. Chris: Not visually scanning but auditorially scanning? Deanna: Right, yeah. That's one example. So, you know, the -- the next -- before I observed a second time, and I videotaped both times, so that I could go back and watch later ‑‑ Chris: That's a really good point. If you guys can videotape, because there might be stuff that you missed in the heat of the moment, but if you can go back and look at it on video ‑‑ Deanna: Look at it with other people. Adam: I was going to say that. If you include the team as you're looking at the videotape, you know, you are more likely to catch tiny little discrepancies or changes. Deanna: So before I did the second observation, I sat down with the teachers and talked about what I noticed and asked them to do a few things a little bit differently to help me determine if he was hearing things or if he was -- it's really, really difficult sometimes to determine is it -- is it -- even within a familiar routine, if a student is hearing something, and because it doesn't make sense for them, they're ignoring it, or because they're doing something they enjoy they're ignoring that other sound and it might be impossible to really -- to know in all situations. But definitely, it definitely helped to pinpoint -- at least even to document these are the things that we don't know the answers to. Chris: Yeah. I have the example of a student who -- their audiological information showed that they shouldn't be hearing this, because they had a high frequency loss, but any time that the microwave would come on -- in the classroom -- and that's a pretty high frequency sound, you know, it's probably mixed, but they would -- because they knew that sound was connected with food, they would turn around and actually -- they would look, find the microwave, you know, they would look at the microwave. So that was kind of interesting. Deanna: Yeah, that's a motivating sound. [ Laughter ] Adam: It is. Chris: The sound of money. [ Slide end: ] [ Slide start: ] Okay, so Deanna is done, she's leaving everybody. Deanna: Prompt you guys off camera. Chris: Thanks, Deanna, I appreciate your time. Deanna: You're welcome, bye. Adam: Bye. Chris: Other things during this general observation period, you know, we've talked about environments, are you indoor, outdoor, is the place carpeted, was there background noise, echo, adaptations for communication. So that would be things like, are you using tactile sign language, body gestures or big movements or anything like that. And then maybe familiar versus unfamiliar environmental sounds. Adam had a really good example of a kiddo that he just saw that there's lots of background noise in the house, but when the kiddo heard the garage door shut, they could pick that out of all of that soup of all of the background noise, and they knew dad was home and they perked up and got real happy about that. But so those would be some things to be noting as you go along here. [ Slide end: ] Chapter 6. Informal Evaluation [ Slide start: ] I'm going to step out a little bit of the assessment itself and just try to make a point to you guys that -- that when we're assessing, it's really good to be aware of what approach we are using -- we would recommend a multi‑sensory approach. Again, that's that thing where you are pairing that sensory information, whether it's movement, gesture, whether it's tactile, with the voice or with the sound. And within that context, it might be too much to give all of that information to a kid at one time, so you might need to give the sound, then stop, and then make the gesture or make the movement, if that's what you are pairing it with. So that you are not overwhelming them with too much stuff all at one time. We're kind of calling it the sandwich approach. So you are sandwiching that sensory information. Just putting a small pause in between. That stimulus. [ Slide end: ] [ Slide start: ] Adam: Okay. So -- so I -- this is just the draft of the -- of the informal hearing assessment. And the -- the questions to look at. So -- so we're just going to kind of fly through this because you already have this in your handout. Under the section that says procedure, all of these are listed under that. So we're just going to go over them really quickly. Just so that you get a general idea of what you are looking for. But if you need to go, you know, more in‑depth, you have that in your handouts. So when you are actually doing the -- the assessment or the evaluation, you have all of the questions that you need to be referencing. So the first thing to -- to consider is the state of the student. You know, we talked about their physical state as well as, you know, are -- do they do better in the mornings or in the afternoon, that sort of a thing. Did they seem sick when you were doing the evaluation. Those are all important factors to take into consideration. [ Slide start: ] [ Slide end: ] The general functioning and awareness and that is just an overall making note of -- of how the student shows awareness of varying sensory information and particularly of -- particularly auditory information. And how they show that they are aware and what the motor behaviors are that indicate that. Or it could be vocalizations, as well. [ Slide end: ] [ Slide start: ] And then, also, sound as meaning. Does the child attend to -- to sounds and do they understand the origin of sound, what the sounds mean? Do they show recognition of specific sounds? And how do they show that and how do they show the anticipation of specific sounds? And what sort of sounds should they respond to? Is it high frequencies, low frequencies, you know, male versus female, that sort of a thing. Chris: Mom versus dad. [ Slide end: ] [ Slide start: ] Adam: Right. Auditory patterning. This is -- we're looking for different types of responses. Do they -- do they respond better to the initiation of a sound or the cessation of a sound. Some kids prefer or respond better once the sound has ended, they will make a gesture to try and make the sound continue. Chris: Kind of like that air conditioner that's been running all day and it turns off, and you go, "Oh, my God, that was freezing." Adam: Exactly. Then, you know, do they show preferences for certain types of sounds or patterns of sounds? [ Slide end: ] [ Slide start: ] Let's see ... then, also, continuing with auditory patterns, do they indicate that they understand the direction from which a sound is coming? Do they respond better from sounds that are coming from above or below, left or right? Those are all things that you need to be looking for and, again, that's kind of outlined in the procedures here. [ Slide end: ] [ Slide start: ] And do they -- do they understand when an adult mimics their vocal patterns? Do they stop to listen for an adult's response? Or do they try to mimic your vocal patterns, if you make a specific sound that is within their repertoire of sounds, do they recognize it as being similar to their sounds and try to repeat it back to you? [ Slide end: ] [ Slide start: ] And do they startle to sound? Do they use -- is sound a calming mechanism for them? Do they use certain noises to help them regulate? These are all things that we're looking for. [ Slide end: ] [ Slide start: ] And then at -- do they enjoy making sounds on their own? Do they vocalize a lot? Are there certain vocalizations that they tend to make more than others? You know, you have a child that makes a lot of -- sounds like mmm's and, you know, low sounds like that, they may be -- may be able to hear low frequency sounds better than high frequency. Chris: You would try to mimic that probably, right? Adam: Right, yeah. So then do they respond to it when you mimic that sound, yeah. And also do they vocalize when -- when they are -- if they have amplification, if they have a, you know, a hearing aid or a cochlear implant, do they start to vocalize more or less when the amplification is turned on. Chris: So many kids when I have seen, when they put their hearing aids in they start to ooohh, you know, or something like that. Adam: Right. So we are at five minutes. Chris: I'm going to answer a question that just came up on the line here. Susan asked about if anybody is using digital sound meter levels out there, and I think that's a really good question. If you don't -- not many people have digital sound meters anymore. But this would be -- this would be a device that you could use to -- to tell you how loud something is basically. It reads in decibels. They are downloadable, you can go on, if you have got a smart phone, how do I get this -- yeah, somewhere in there. There's all kinds of stuff that you can download to your smart phone that's weighted, they say it's weighted, but basically it's adjusted to the microphone in your smart phone. These things work pretty well. I think you can probably find some for free. If not five bucks, you know, so anyway just wanted to answer you that. [ Slide end: ] [ Slide start: ] This auditory -- auditory discrimination -- common things that I see are maybe a kiddo can -- can really responds a lot more to dad's deeper voice than mom's higher pitched noise, or male versus female voices. Again, I think it's really that familiar versus unfamiliar sound source. You need to take that into context. If a student hears the microwave and looks towards it or moves towards it, obviously, you know, they've attached some meaning to that, but they're also hearing it. Just really things like that to kind of keep -- keep in your mind. [ Slide end: ] [ Slide start: ] And that -- then it's this auditory memory, too, this would be even kind of a higher level thing. So -- do they demonstrate any kind of memory of a sound over a period of time? You know, again I think Adam's example of the garage door opening when dad comes home, man, that's a really great thing because that doesn't happen every minute of every day. But, boy, the kiddo really knew what that sound was about. Again, repeating those -- the vocal sequences or sounds. I used to have a student that I would pair a deep hug with while I gave him a squeeze and after a while he had a -- a mild hearing loss, I think it was. He started when I would do that, he would start to get the hu, hu, start to repeat that back to me. That's getting a little bit into like auditory training stuff, but those would be things that you could kind of work with, that deep pressure or tactile stuff with your vocalization. [ Slide end: ] [ Slide start: ] And then this is where our I-F-H-E kind of starts to stop, is when we get into linguistic auditory processing. But it's -- it is really -- we're working with speech all this while, I think a lot of the time, along with environmental sounds and things like that. We're not saying don't use speech. But when we really start to get a lot of communication back through speech, this is where we're kind of leveling out, and it might be time to look for something, look at something like the FAPE or other functional auditory measures. [ Slide end: ] [ Slide start: ] We talked about this a little bit before. But this is really, hopefully, all of this is going to lead up into being able to come up with some instructional strategies, things that you can give the team that everybody can be working on and everybody kind of knows the situation. And, again, also hopefully this will give you information to work with the audiologist in the clinical setting. [ Slide end: ] [ Slide start: ] As we mentioned before, this is really a draft thing that we've been trying to put together and it's -- we've tapped into Jim Durkel's brain and Adam and I and Kate have all been trying to think about it, and this is what we've come up with so far, but it is pretty much a draft and anybody who thinks they might want to try this because we've -- that's the next thing, we really need people to see if this is viable. We'd love to hear from you. You have our email addresses, you know where we live. [ Slide end: ] [ Slide start: ] Adam: And the tool is all -- it's all in there. [ Slide end: ] [ Slide start: ] There's -- if you look at the Informal Functional Hearing Evaluation that's in your handouts -- that will give you the instructions on how to -- how to write your recommendations and then there's also included in it, this one, which is the Record of Informal Functional Hearing Evaluation and this sheet will help you kind of record your observations and make comments about how the student responds. Try this with one of your students. Use these tools and let us know of any changes that you think would be important to ‑‑ [ Slide end: ] [ Slide start: ] Chris: How did this work for you, did it work, was it ridiculous, did it give you good information? Kate put up the little caveat or comment up there, if anybody knows any teachers of the deaf and hard of hearing, we would love to have them and absolutely speech pathologists, too. Thank you. Adam: Thanks, everyone. [ Slide end: ] Music ]