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Trusting Your Ears: Improving Auditory Skills and Building Confidence in Children with Cochlear Implants

Young children with cochlear implants are in the process of not only learning how to hear, but also of trusting what they hear. Therefore, even if a child hears and understands your verbal direction, he or she might just respond by staring at you, due to issues with confidence. Engaging visually is much easier, safer, and avoids any embarrassment that can arise from potentially misinterpreting the auditory direction. Therefore, confidence is an important behavior to target within treatment. In order to boost both auditory skills and confidence in children with cochlear implants, music therapy is a great tool.

Here is are two examples of activities to target auditory skills, verbal communication, cognition, and confidence:

Music Therapist Treatment- Musical Obstacle Course : Begin by introducing the child to different sounds and instruments to create what’s known as sound-object associations. The therapist then stands behind the child while the child is facing maximally contrastive sounding instruments. For example, one melodic, one harmonic, & one percussion instrument. The therapist plays a sound on an instrument and the child must choose the correct instrument that produces the sound. Not only is the child identifying the sound just heard, but also using auditory memory because the child is remembering the sounds that each instrument produces. The child can verify the instrument by playing it, asking the therapist to play the sound again, and then determining if the sounds are the same. When the child answers correctly, the therapist and child play and sing a short song together using the instruments. The purpose of the short song is to reward the child for answering correctly and motivate the child to continue listening and working hard during the session. Increasing motivation helps to build confidence. Playing the instrument during the song reinforces the sound-object association.

MT Tip #1: Unless the child’s goal involves listening with noise, generally try to avoid playing an instrument and speaking at the same time. It is difficult for children with cochlear implants to auditorily discriminate between verbal directions and musical stimuli. However, that activity would be great to attempt after evaluating the child’s level of auditory comprehension in a quiet setting.

MT Tip #2: As the child progresses, the options can be more specific. For example, instead of one melodic, harmonic, & percussion instrument, the child may choose between three minimally contrastive sounding instruments. For examples, three melodic instruments, three harmonic instruments, or three percussion instruments.

Music Therapist & Speech-Language Pathologist Co-Treatment Session-Musical Obstacle Course: The instruments are placed thoughtfully on the table, chair, and even the floor. The music therapist can introduce the child to the names of each instrument and prompt the child to repeat the names to confirm that the child was listening. The music therapist can also test prerequisites by asking the child to name several of the instruments. The speech-language pathologist (SLP) then verbalizes to the child either a one-step, two-step, or multi-step direction. For example, “put the blue shaker on your head and play the drum that’s on the floor.” After providing the direction, a short, instrumental song can be played by the music therapist. The short song indicates the length of time in which the direction must be completed. Otherwise, the child may spend an excessive amount of time ruminating over what to do or being insecure about if they heard the direction correctly. The SLP can also switch roles with the child and listen for either a one-step, two-step, or multi-step direction verbalized by the child.

SLP Tip: Using instruments provides opportunities for language development. Therefore, take advantage of utilizing colors, spatial directions, and sizes when verbalizing simple or complex instructions to the child.

I hope this post helps you in your listening journey! For other listening activities and ideas specific to children, stay tuned to this website! For reading material as it pertains to adults, check out the chapter on Auditory Perception Training (APT) by Kathrin Mertel in the Handbook of Neurologic Music Therapy.