Recommendations and Resources to Support the Development of Academic, Verbal, and Cognitive Skills in Children with Hearing Loss

Recommendations for General Cognitive Functioning:

·     Student's FSIQ falls within the Borderline range, indicating potential difficulties in multiple areas of functioning.

·     Intervention strategies:

o  Pre-teaching and re-teaching lessons to provide her with additional exposure to new concepts, thereby aiding comprehension and recall.

o  Present new content through multiple modalities (e.g., visual, auditory) and use simple vocabulary and sentence structure.

o  Set small, measurable academic goals in each subject area and involve Student in creating rewards for meeting them.

o  Track her success using charts to provide a sense of accomplishment.

o  Consider an adaptive behavior assessment to identify goals in self-care, community interactions, and household chores.

o  Engage Student in hobbies and extracurricular activities to build success in multiple areas of functioning.

Recommendations for Verbal Skills:

·     Student's performance on the Verbal Comprehension Index (VCI) was significantly weaker compared to her peers, possibly due to bilingualism.

·     Verbal skill interventions:

o  Use dialogic reading to engage Student with child-specific questions that foster interest, comprehension, and critical thinking.

o  Enrich vocabulary by exposing Student to novel situations and encouraging her to ask about unfamiliar objects.

o  Keep a list of new words Student learns and review them periodically.

o  Encourage verbal discourse in a positive, open environment, asking open-ended questions and giving her time to respond.

o  Encourage Student to engage in age-appropriate conversations outside of school (e.g., ordering food at a restaurant).

o  Provide positive feedback during conversations, including reciprocal conversations and encouraging elaboration on her thoughts.

Recommendations for Fluid Reasoning Skills:

·     Student performed in the Average range on the Fluid Reasoning Index (FRI), making this a strength area for her.

·     Support for fluid reasoning:

o  Encourage Student to identify patterns and predict what comes next in sequences.

o  Help her group objects in different ways and explain her reasoning.

o  Engage in age-appropriate science experiments, where Student forms hypotheses and measures results.

o  Provide activities that are both at her skill level and appropriately challenging to promote further development.

Building Verbal Skills:

·     Family involvement:

o  Set aside time each evening for discussing the day’s events, minimizing distractions during the conversation.

o  Ask Student open-ended questions, avoid interrupting, and allow her time to respond fully.

o  Provide positive feedback when she engages in conversation.

o  Develop naming games where Student lists objects based on specific characteristics (e.g., "red," "round").

o  Use story-time activities where Student identifies changes in stories or completes unfinished stories.

·     Classroom support:

o  Reduce complexity in classroom discourse by controlling vocabulary, simplifying multi-step commands, and offering written support.

o  Organize new information into visual categories to help retain it more easy (e.g., using diagrams, graphs, or pictures).

o  Use visual support for lessons and text to reinforce learning.

Building Visual-Spatial and Fluid Reasoning Skills:

·     Family and teacher support:

o  Encourage Student to complete puzzles that involve matching shapes and colors.

o  Support her in identifying sequences of activities (e.g., performing and replicating actions).

o  Develop stories with Student as the central character, allowing to draw/select pictures to represent the sequence of events.

o  Ask Student to identify what happens before and after an event in a story to develop sequential reasoning.

Building Processing Speed and Working Memory Skills:

·        Memory strategies:

o  Use "chunking" techniques to help Student remember information. For example, group a phone number (555-5678) into chunks (5, 55, 56, 78).

o  Link new information to familiar concepts to improve memory retention and ease her ability to recall new facts.

Resources

Articles

1.       "Supporting Language Development in Children with Hearing Loss" (Hearing Health Foundation)
This article discusses strategies for supporting language development in children with hearing loss, with a focus on improving speech and language skills. Link: HearingHealth Foundation - Language Development

2.       "Strategies for Supporting Children with Limited Verbal Communication" (National Center on Deaf-Blindness)
This article provides strategies for improving communication skills in children with limited verbal abilities, including the use of gestures and alternative communication methods. Link: NCDB- Limited Verbal Communication Strategies

3.       "Improving Cognitive and Verbal Skills in Children with Hearing Loss" (American Speech-Language-Hearing Association) This article outlines strategies for improving both cognitive and verbal skills in children with hearing impairments. Link: ASHA -Cognitive and Verbal Skills

Books

1.       "The Handbook of Child Language" by Paul Fletcher and Brian MacWhinney
This comprehensive handbook covers various aspects of child language development, including cognitive and verbal skills. It’s useful for understanding language development delays and supporting children in these areas.

2.       "Building Early Literacy Skills: A Practical Guide for Parents and Teachers" by Marian R. Whitehead
This book offers practical strategies for supporting early literacy development in children, focusing on language acquisition, cognitive development, and verbal skills.

3.       "The Social Skills Guidebook" by Chris MacLeod
A great resource for parents and educators looking to help children develop stronger social skills. It includes strategies for improving peer interactions, verbal communication, and understanding social cues.

Video Playlists 

1.  “7 Tips to Help Late-Talking Toddlers from a Speech Therapist: Improving Speech and Language at Home.” This YouTube channel is dedicated to helping parents and educators support speech and language development in children, including those with language delays or hearing impairments. Link: https://youtu.be/6_8-fP2gqfI?si=f4cK5r7OFxKE7imL 
2.  “Cochlear Americas” (Cochlear Implant Videos) This side provides educational content for parents and professionals working with children who have cochlear implants, offering guidance on maximizing the benefits of cochlear implantation for speech and language development. Link: https://www.youtube.com/@CochlearAmericas/videos 
3.  “Speech Therapy Ideas” a side that offers practical therapy ideas for improving speech, language, and cognitive skills. This includes strategies for both expressive and receptive language, as well as cognitive development. Link: https://www.youtube.com/results?search_query=Speech+Therapy+Ideas+for+children+with+hearing+loss

Websites for Additional Support

1.       American Speech-Language-Hearing Association (ASHA)
ASHA offers a range of resources for supporting children with speech and language disorders, including those with hearing loss. Link: ASHA Website

2.       National Deaf Children's Society (NDCS)
The NDCS provides extensive resources on how to support children with hearing loss, including advice for parents, teachers, and professionals. Link: NDCS - Supporting Children withHearing Loss

3.       Cochlear Americas - Family Support Resources
Offers a variety of resources for parents and families of children with cochlear implants, with helpful tips on supporting communication and language development. Link: https://www.cochlear.com/us/en/professionals/resources-and-training/professional-education/school-resource-center

Sunshine Cottage Educational Products - CASLLS

The Cottage Acquisition Scales for Listening, Language, and Speech (CASLLS) is a comprehensive tool designed to monitor the progress of children who are deaf or hard of hearing, from preverbal stages to complex language structures. Developed by Sunshine Cottage School for Deaf Children, CASLLS is widely used by professionals to assess and guide language development.

Web Resources:

• Sunshine Cottage Educational Products: The official website offers detailed information about CASLLS, including purchasing options and related resources. You can explore their products here:

CASLLS Educational Products edproducts.sunshinecottage.org  

• Reading CASLLS Manual (PDF): This manual complements existing materials by providing a holistic tool to track development across all reading domains, aligning with CASLLS's framework. Access the manual here:

CASLLS Manual $30 to purchase edproducts.sunshinecottage.org

YouTube Resources:

• CASLLS: An Introduction: This video provides an overview of the CASLLS tool, its purpose, and how it can be implemented to support language development in children who are deaf or hard of hearing. https://youtu.be/bWYJLyTqrlw?si=UflDw1CSr74PfY7L
• Zoom Presentation https://youtu.be/U6OTTlAHRSY?si=I-CPg0DU1um8DPYU

For a more in-depth understanding and practical guidance, consider exploring webinars offered by Sunshine Cottage. They provide sessions such as "Discover the Basics in Implementing the CASLLS" and "Moving Beyond the Basics of the CASLLS," which can be found on their website.

A complete set for progress monitoring CASLLES forms from preverbal to complex language structures, $240, edproducts.sunshinecottage.org  

CASLLS-Based Therapy Activities for Kindergarten – 5th Grade

Kindergarten – 1st Grade (Early Language Development)

1. Listening & Sound Awareness (Pre-Verbal – Single Word Level)

Activity: Sound Hunt

• Objective: Improve sound awareness and auditory discrimination.
• How to Play:
  • Play different environmental sounds (e.g., doorbell, dog barking, water running) and ask the child to guess or point to the corresponding picture/object.
  • Use real-life situations: “What do you hear? Listen… It’s a bird!”

Activity: Mystery Object Bag

• Objective: Strengthen auditory memory and vocabulary.
• How to Play:
  • Put common objects (ball, spoon, toy car) in a bag.
  • Describe one without showing it (“It’s round, you can throw it”).
  • Have the child guess before pulling it out.

2. Vocabulary & Sentence Expansion (Single Word – Combination Level)

Activity: Picture Walk Storytelling

• Objective: Encourage vocabulary and sentence development.
• How to Play:
  • Use a wordless picture book and describe each page (“Look! The boy is running.”).
  • Ask the child, “What do you see?” and expand on their response (“Yes! The big dog is jumping.”).

Activity: Speech Smash Mat (Themed Vocabulary)

• Objective: Help children practice category-based vocabulary and articulation.
• How to Play:
  • Print a themed smash mat (e.g., farm animals, foods).
  • Have the child name the object and use it in a short phrase before smashing (e.g., “Red apple”).

2nd – 3rd Grade (Expanding Language & Comprehension)

1. Following Multi-Step Directions (Combination – Complex Language Level)

Activity: Simon Says – Auditory Version

• Objective: Improve listening comprehension and ability to follow multi-step directions.
• How to Play:
  • Start with simple commands (“Touch your nose”).
  • Increase complexity (“First, clap your hands, then spin around.”).

Activity: Barrier Drawing Game

• Objective: Enhance auditory comprehension.
• How to Play:
  • The therapist describes a simple picture (“Draw a big sun in the sky”), and the child follows the instructions without seeing the therapist’s version.

2. Conversation & Social Skills (Complex Language Level)

Activity: Social Scenario Role-Play

• Objective: Improve problem-solving and conversational turn-taking.
• How to Play:
  • Present real-life situations (“Your friend is sad. What can you say?”).
  • Have the child role-play and practice responses using full sentences.

Activity: Guess the Feeling

• Objective: Develop emotional vocabulary and perspective-taking.
• How to Play:
  • Show pictures of people with different facial expressions.
  • Ask, “How do they feel? Why do you think that?”
  • Encourage full-sentence answers (“He is sad because he lost his toy.”).

4th – 5th Grade (Higher-Level Language & Critical Thinking)

1. Inferencing & Predicting (Complex Language Level)

Activity: What Happens Next?

• Objective: Develop inferencing skills using context clues.
• How to Play:
  • Show part of a picture or read the beginning of a story.
  • Ask, “What do you think will happen next? Why?”
  • Encourage children to justify their answers.

Activity: Hidden Meaning (Idioms & Figurative Language)

• Objective: Teach figurative language and comprehension beyond literal meanings.
• How to Play:
  • Introduce idioms (“Spill the beans”).
  • Have the child guess what it means and use it in a sentence.

2. Narrative Skills & Expanding Sentences

Activity: Story Cube Challenge

• Objective: Encourage storytelling with expanded sentences.
• How to Play:
  • Roll a story cube or pick random images.
  • Have the child create a story using the images (“First, the boy found a magic key…”).

Activity: Sentence Expansion Ladder

• Objective: Strengthen complex sentence formation.
• How to Play:
  • Start with a simple sentence: “The dog runs.”
  • Add details (“The big brown dog runs fast in the park.”).
  • Encourage the child to build on each sentence.

Additional Free Resources for CASLLS-Based Activities

1. Hearing First – Listening & Language Learning Activities
   https://www.hearingfirst.org

2. Speech Therapy Store – Free Printable Speech & Listening Mats
   https://www.speechtherapystore.com

3. AG Bell Association – Auditory Verbal Therapy Resources
   https://www.agbell.org

4. Boom Learning – Digital Language & Listening Games
   https://www.boomlearning.com

5. LessonPix – Custom CASLLS-Based Materials
   https://www.lessonpix.com

Understanding the CASLLS - The Cottage Acquisition Scales for Listening, Language & Speech (CASLLS)

 The Cottage Acquisition Scales for Listening, Language & Speech (CASLLS) is a developmental tool used by speech therapists to assess and track the progress of children with hearing deficits. It is particularly useful for children with cochlear implants or hearing aids and follows a developmental sequence similar to that of typically developing children.

Understanding the CASLLS

CASLLS is structured into five levels:

1. Pre-verbal – Early listening behaviors and prelinguistic communication.
2. Presyllabic – Babbling and early sound play.
3. Single Word – First words and vocabulary expansion.
4. Combinations – Two-word combinations and simple sentences.
5. Complex Language – Advanced sentence structure and conversational skills.

This scale helps therapists determine where a child is in their listening, language, and speech development and plan interventions accordingly.

How to Use CASLLS with Kids with Hearing Deficits

1. Assessment & Baseline Development

• Begin by identifying the child’s current level using CASLLS checklists.
• Observe spontaneous speech, listening behaviors, and responses to sound cues.
• Use parent/caregiver input to supplement data on language use in natural environments.

2. Goal Setting

• Set individualized goals based on the child's current abilities.
• Example: If a child is at the single-word level, goals may include expanding vocabulary and introducing two-word combinations (e.g., “more cookie”).

3. Listening and Language Activities

• Pre-verbal stage: Encourage awareness of environmental sounds and vocal play through games like “What Do You Hear?” using auditory discrimination tasks.
• Single-word stage: Use visual and tactile cues to reinforce word meanings (e.g., pairing the word “ball” with the actual object).
• Combination stage: Model and expand language using simple carrier phrases (“Want ball?” → “Do you want the ball?”).
• Complex language stage: Focus on conversational turn-taking, storytelling, and answering wh-questions.

4. Integration with Auditory-Verbal Therapy (AVT)

• CASLLS aligns well with AVT principles, emphasizing listening-first strategies.
• Example: Instead of showing a child an object, say, “Find the apple” and encourage them to locate it by listening.

5. Progress Monitoring & Parent Coaching

• Regularly track the child’s progress along the CASLLS scale.
• Train parents to use targeted strategies at home, such as auditory sandwiching (saying a word, showing the object, then saying the word again).

Example Therapy Activities Using CASLLS

Activity: Sound Identification Game (Pre-verbal - Single Word Level)

• Objective: Improve sound awareness and early vocabulary.
• How to Play: Play recorded animal or environmental sounds and ask the child to point to or name the sound source.

Activity: Expanding Sentences with Visual Supports (Combination Level)

• Objective: Move from single words to two-word combinations.
• How to Play: Use picture cards with common objects (e.g., “dog”) and prompt the child to expand, “Big dog” or “Dog runs”.

Activity: Auditory Storytelling (Complex Language Level)

• Objective: Develop listening comprehension and expressive language.
• How to Play: Read a short story and ask inferential questions like “What do you think will happen next?”

Free & Paid Resources for CASLLS

1. Sunshine Cottage School for Deaf Children – Offers CASLLS materials and training.
   https://www.sunshinecottage.org

2. AG Bell Association for the Deaf and Hard of Hearing – Provides resources for auditory-verbal therapy.
   https://www.agbell.org

3. Listening and Spoken Language Knowledge Center – Offers speech therapy tools for children with hearing loss.
   https://www.hearingfirst.org

4. Advanced Bionics Listening Room – Free listening and language activities for children with cochlear implants.
   https://thelisteningroom.com

5. Boom Learning & Teachers Pay Teachers (TPT) – Download CASLLS-based speech therapy resources.
   https://www.boomlearning.com
   https://www.teacherspayteachers.com

Using Playmats & Smash Mats for Speech & Language Development

(For Children with Hearing Deficits, Hearing Aids, or Cochlear Implants)

What Are Playmats & Smash Mats?

• Playmats: Themed mats with pictures or interactive elements that encourage language learning through play.
• Smash Mats: Mats with pictures where children "smash" playdough, stickers, or small objects on targets as they practice words or sounds.

General Tips for Success

✅ Ensure Hearing Devices Are On & Functioning – Check that your child’s hearing aids or cochlear implants are working properly.
✅ Minimize Background Noise – Choose a quiet area to help your child focus on listening.
✅ Start With Visual Cues, Then Remove Them – Begin by letting your child see your mouth movements, then cover your lips to encourage pure listening.
✅ Use Visual & Tactile Cues – Point to pictures, use gestures, and encourage hands-on interaction.
✅ Encourage Listening First – Before giving visual support, ask them to try listening alone.
✅ Praise Effort, Not Just Accuracy – Reinforce attempts and progress, not just perfect speech.

1. Phonological Awareness (Rhyming, Syllables, Beginning Sounds)

🎯 Goal: Help your child recognize sounds, break down words, and understand rhymes.

Visual Activity: Rhyming Smash

🟢 Use a smash mat with pictures of rhyming words (e.g., cat, hat, bat).
🟢 Say two words aloud and ask, "Do these rhyme?"
🟢 If correct, let them smash playdough on the picture or place a sticker.
🟢 If incorrect, model the correct answer and have them repeat.

Auditory-Only Activity: “Mystery Rhyme” (Lips Covered)

🟢 Cover your mouth and say a word (e.g., “cat”).
🟢 Say another word (e.g., “bat”) and ask, “Do these words rhyme?”
🟢 Your child listens and responds by placing a token or smashing playdough on the correct answer.

Visual Activity: Syllable Clapping

🟢 Pick words from a playmat (e.g., elephant, tiger, apple).
🟢 Say the word and clap out syllables together.
🟢 Have your child place a token or jump for each syllable.

Auditory-Only Activity: “Guess the Word” (Lips Covered)

🟢 Cover your mouth and say a word syllable by syllable (e.g., “ba-na-na”).
🟢 Your child claps or jumps for each syllable and then guesses the word.

2. Articulation (Practicing Speech Sounds)

🎯 Goal: Improve speech clarity by targeting difficult sounds.

Visual Activity: Smash the Sound

🟢 Place pictures of words with the target sound on a smash mat (e.g., “S” words: sun, snake, sock).
🟢 Say the word and encourage your child to repeat after you.
🟢 If correct, they get to smash playdough on the word!
🟢 If they need help, give a model: “Try again, watch my mouth.”

Auditory-Only Activity: “Find the Sound” (Lips Covered)

🟢 Cover your mouth and say a word with the target sound (e.g., “sun” for /s/).
🟢 Your child listens and points to the correct picture on a playmat or smash mat.
🟢 If unsure, repeat with a slight pause between syllables (e.g., “s...un”).

3. Sound Discrimination (Hearing & Identifying Sounds)

🎯 Goal: Help your child recognize differences between similar sounds.

Visual Activity: Same or Different?

🟢 Say two words aloud (e.g., “bat” and “pat”).
🟢 Ask, “Are these the same or different?”
🟢 If correct, let them smash playdough on a picture.

Auditory-Only Activity: “Same or Different?” (Lips Covered)

🟢 Cover your mouth and say two words (e.g., “bat” and “pat”).
🟢 Your child listens and points to “same” or “different” on the smash mat.

Visual Activity: Loud vs. Quiet

🟢 Use a playmat with animals or objects.
🟢 Say a word loudly or softly, and have your child sort the words into "loud" or "quiet" categories.

Auditory-Only Activity: “Quiet or Loud?” (Lips Covered)

🟢 Cover your mouth and say words in different volumes (loud/soft).
🟢 Your child sorts them into “loud” or “quiet” by placing tokens on a playmat.

4. Receptive Language (Following Directions, Understanding Words)

🎯 Goal: Strengthen listening and comprehension.

Visual Activity: Follow the Path

🟢 Use a playmat with a road, maze, or themed scene.
🟢 Give directions like, “Drive the car to the red house” or “Put the ball next to the tree.”

Auditory-Only Activity: “Follow the Clue” (Lips Covered)

🟢 Cover your mouth and give a one-step direction (e.g., “Touch the dog.”).
🟢 If correct, increase to two-step (e.g., “First, find the apple, then touch the car.”).

5. Expressive Language (Expanding Words & Sentences)

🎯 Goal: Encourage your child to use more words and sentences.

Visual Activity: What’s Happening?

🟢 Use a scene playmat (e.g., a zoo, a park).
🟢 Ask WH-questions: “What is the boy doing?” or “Where is the cat?”
🟢 Encourage full sentences instead of one-word answers.

Auditory-Only Activity: “Tell Me More” (Lips Covered)

🟢 Ask your child a WH-question (e.g., “What do you see on the mat?”).
🟢 Encourage them to describe it using at least two words (e.g., “big house”).

Making It Fun & Engaging!

🎉 Use Rewards: Give small rewards or high-fives for participation.
🎉 Switch It Up: Try different themes (farm, ocean, transportation).
🎉 Take Turns: Let your child "be the teacher" and give you directions!
🎉 Use Everyday Items: Apply these skills during play with toys, books, or meals.

By incorporating both visual and auditory-only exercises, you can help your child with hearing deficits maximize his listening, speaking, and language skills in a fun and interactive way! 🚀

Instrucion How to Use Playmats or Smash Mats for Speech and Language Development

What You’ll Need:

✅ A playmat or smash mat with pictures (these can be themed, like animals, food, or emotions)
✅ Small objects, stickers, a dry-erase marker, or playdough (optional, depending on your activity)
✅ Your child’s preferred reinforcer (snack, toy, bubbles, etc., if needed for motivation)

Step-by-Step Instructions:

1. Introduce the Playmat/Smash Mat

🗣 Say: “Look! We have a fun mat with pictures on it! Let’s play together.”
👀 Show your child the mat and talk about what’s on it. If it has animals, name a few: “Here’s a dog! Here’s a cat!”

2. Choose a Target Skill

Decide what you want to work on based on your child’s level:
🔹 For Labeling Vocabulary: Ask, “What’s this?” and help them name the pictures.
🔹 For Imitation: Model the word and encourage your child to repeat it.
🔹 For Expanding Sentences: Add words (e.g., “Big dog!” or “The dog is running!”).
🔹 For Making Choices: Let them pick between two pictures (“Do you want the apple or banana?”).
🔹 For Using AAC/GoTalk: Help them find the correct button or picture to match the mat.

3. Make It Fun with Actions!

Depending on the type of mat, encourage interaction:
🎯 Smash Mat (for playdough, stickers, or smashing objects)

• Say a word, then squish playdough or place a sticker on the picture.
• Example: “Say ‘apple’—smash the apple!”
  🎲 Playmat (for movement or placing objects)
• Place small toys or tokens on the pictures when your child names them.
• Example: “Put the car on the road!”

4. Keep It Interactive

✔️ Use gestures, facial expressions, and sound effects to keep your child engaged.
✔️ If they struggle, model the correct response and encourage them to try again.
✔️ Praise all efforts! “Great try!” or “You said ‘cat’—awesome!”

5. Wrap Up and Reinforce Learning

🎉 Dear Parent! Celebrate your child's effort by playing with a favorite toy or giving a high-five.
🔄 Review the words one last time: “Wow, we talked about so many animals today! We saw a dog, a cat, and a bird!”