Section 10 - Using Auditory Feedback in School Settings

Faulty aural-oral speech and language development in the preschool years is often the precursor of language-speech difficulties experienced in the school years. Children’s first exposure to the language around them focuses on the spoken word. How well the child experiences future academic success, particularly in reading and writing, is highly dependent on how he or she was exposed to, was able to hear, and was able to process spoken language. Hearing loss, central auditory problems, and poor language environment in the first few years of life can take an amazing toll on overall language development.

Many children in the school environment could profit from both sound amplification and an increased exposure to auditory feedback. The Kay Facilitator, Model 3500, offers the teacher and SLP an auditory feedback device that can enhance feedback (amplification, loop playback, and metronome pacing) as well as two modes that can degrade auditory feedback (delayed auditory feedback and masking). The versatility of the instrument allows the clinician or teacher to select the auditory feedback mode for the particular child. The instrument can be used in the classroom, in special training or resource rooms, or worn as a portable, assistive learning device.

The United States Department of Education (USDE) prepared a report (1) for Congress which was preparing authorization legislation for the Individuals with Disabilities Education Act (IDEA), citing the number of children with disabilities, ages 6-21. The USDE reported these figures for 1994-95:

2,513,977 children with specific learning disability

1,023,665 children with speech or language impairment

570,855 children with mental retardation

428,168 children with serious emotional disturbance

65,568 children with hearing impairments

312,935 children with other disabilities

4,915,168 total number of children with disabilities

Within each category of disability are many varied problems. For example, under learning disability we would include a range of problems such as dyslexia all the way to attention deficit disorders; speech or language impairment would include children with phonological problems, voice disorders, stuttering, and delayed language disorders. The "other disabilities" listing includes orthopedic impairment, visual impairment, autism, deaf/blindness, traumatic brain injury, and other childhood disabilities.

This USDE report (1) states further that 12% of children in elementary and secondary schools in the 1993-94 school year received special education services. Of that total number, 95% of the children are placed in regular school buildings where they receive services in regular classrooms (2). The regular classroom experience may be supplemented with special education services offered in separate resource or therapy rooms. Unfortunately, many school classrooms offer such poor acoustical environments that the child with a listening disability is further handicapped by the degraded speech signal he may be receiving (3). Berg and others (4) report that amplification systems are used by children with hearing loss as well as by some children with learning disabilities to improve their ability to listen within the classroom. The child who is easily distracted by competing stimuli in the classroom may often profit from the heightened focus given to hearing by wearing headphones and receiving real-time amplification. For other children, receiving enhanced auditory feedback in and out of the classroom has been found to improve overall communication effectiveness. Amplification and enhanced auditory feedback are often found facilitative to learning in the resource room and the special therapy room.

The Facilitator as an Evaluative Tool in the School

Each of the five components (amplification, loop playback, DAF, masking, and metronomic pacing) found on the Facilitator have had long histories of application in school settings. Because of the recent development of the Facilitator, the instrument per se has not had the extensive school application that each of its five components has had. Therefore, our description of application of enhanced or degraded auditory feedback in school settings is based on teaching and therapy experience using each of the five modes. The uniqueness of the Facilitator can be found in its housing of the five components that are available in the same instrument. The teacher, the special educator, or the SLP can each find use for the Facilitator, using one or more of the five feedback modes with a child with a particular learning disability or communication problem. And by merely turning the selector switch to another feedback mode, the instrument is immediately available with a different feedback component for a totally different problem with another child.

In testing the exceptional child, the auditory feedback offered by the Facilitator is added to what is already being done. If a child is being tested on reading skills, the influence of adding real-time amplification via headphones can be immediately determined. For example, some children with attention deficit disorders (ADD) might read better when given the additional auditory focus of real-time amplification. Or when the SLP is determining fluency in children who stutter, providing DAF while they are speaking might change fluency (facilitating better speech or making it worse). How particular children react to and use various forms of auditory feedback is highly individualized. If some form of auditory feedback is found to be facilitative to learning or communication, adding such a mode to the training process may result in improved learning and speaking outcomes.

Using Auditory Feedback with Particular Educational Disabilities

Within the school setting, there are particular children who might profit from one or more auditory feedback modes found on the Facilitator. Each of the five feedback modes have had long application with particular educational disabilities. Unfortunately, availability of auditory feedback equipment has often been limited. It is hoped, therefore, that having five auditory feedback modes in the same instrument will serve as a catalyst for increasing such feedback application in teaching and therapy, as well as increasing its use in research.

While the Facilitator offers enhanced real-time amplification, it is not designed to function as a hearing aid. Rather, its primary use in school settings would be in one-to-one training sessions with a teacher or SLP in a resource or therapy room. The instrument is designed for teacher-trainer microphone input through the instrument’s headphones worn by the child. All playback is via headphones as there is no external speaker. The child’s spoken response goes via his or her microphone through the instrument back to the teacher or clinician’s headset. The auditory feedback mode is selected by pressing the mode button to real-time feedback, loop replay feedback, DAF, masking, or metronomic pacing.

We will now describe auditory feedback application to particular disability problems in the school setting:

Phonological Disability. More children suffer from phonologic delay and impairment than from any other speech or language impairment. This delay in articulatory skills is particularly in evidence in preschool and early primary school children. The younger child may not know the rules of phonology. Historically, the SLP would often focus on the particular speech-sound deficits and the position (frontal, medial, final) of the error within the word. Much of the speech therapy focus was given to practice in production of the correct sound. More recently, emphasis in therapy is given to improving the child’s phonologic process awareness. Process functions such as "stopping, gliding for liquids, cluster reduction, final consonant deletion, fronting, backing" are identified (5, p. 17). Emphasis in therapy is given to teaching the child awareness of those phonologic processes that have been identified as defective. Real-time amplification with the child wearing headsets, such as on the Facilitator, is an excellent therapy modality with some phonology authorities recommending that the child receive an auditory bombardment of models representing faulty and correct processing. Less emphasis is given to speech production.

Articulation Deficit. There are some children, usually older than the phonologic delay group described above, who display a persistent articulatory error. The error persists because of faulty production rather than from lack of awareness of phonologic process rules. The continuing frontal or lateral lisp is an example of such an articulation deficit. Such a lisp may well persist through high school or throughout life, if not corrected. Auditory modeling and loop feedback are often helpful in correcting such a lisp. Whatever methods the SLP may use to elicit an on-target production, that production once correct needs to be "captured" as a model and played back to the client. Loop playback permits comparison with the model and the struggling, new production. There are occasional clients who seemingly persist in their articulatory error because of faulty auditory feedback; such persons might profit from attempting to say target words with masking feedback preventing the auditory monitoring of what they are saying.

Learning Disability. As we read earlier in this manual, there are over two and a half million children in the United States with a diagnosis of "learning disability". The label covers a most heterogeneous group, with some children classified as having "minimal brain dysfunction syndrome" or having an attention deficit disorder, and so forth. Most children classified as learning disabled have demonstrated problems in acquiring academic skills, particularly in reading and writing, in the early primary grades. Many of them demonstrate faulty listening skills. Although many of these children demonstrate normal hearing acuity by the time they are in first grade, many of them demonstrate difficulty in listening and tracking what is said. Real-time amplification seems often to help them concentrate more on auditory verbal input.

Voice Disorders. Most school-age children with voice disorders have phonation problems related to vocal hyperfunction or excessive muscular tension. Vocal hyperfunction over time may lead to problems of vocal fold thickening or vocal nodules. Some children develop hoarseness or a complete absence of voice (aphonia) for no apparent organic reason. Auditory amplification coupled with loop auditory playback has long been found helpful in voice therapy for children with voice problems. Once the child is able to produce a target voice (a desired use of voice) that voice is repeated on loop playback for the child to hear again and attempt to match it. The child learns to listen critically to his voicing attempts. Some of the functional dysphonias and aphonia are often best treated with masking; as the child counts or reads aloud, masking noise is introduced. Under the masking condition, where the child cannot monitor auditorily how he or she is phonating, a good voice will often emerge. The good voice that appears under masking conditions is then recorded and used as the child’s model in subsequent voice therapy. On the Facilitator, real-time amplification, loop playback, and masking may be useful feedback modes to use with the schoolchild with a voice disorder.

Attention Deficit Disorders (ADD). Attention deficit disorders occur across the lifespan. When ADD is present in school children, it can present serious obstacles to learning. These children show continuous interference in age-appropriate attention span and excessive distractability, both of which contribute to interference in impulse control. Special educators have found that once distractability can be reduced, the child with ADD has a much better chance for achieving academic skills. Real-time amplification with the child wearing headphones has been found as one excellent way of reducing distractability. Oral reading with self-amplification can often keep the child longer at the reading task. Moderate masking of the real-time amplification while the child is reading sometimes can extend the reading task with less distractability. Some special educators have used the beats of a metronome to pace the child’s attention to the learning task. The three systems on the Facilitator (real-time amplification, masking, and metronomic pacing) may play a facilitative role in increasing the ADD-child’s auditory attention span, and at the same time decreasing distraction to other competing stimuli.

Stuttering. The delayed auditory feedback component on the Facilitator may play an important role in minimizing the symptoms of stuttering. In DAF, as the subjects speak, they hear via headphones a delay in milliseconds of what they just said. In the normal speaker, this delay will cause dysfluency, prolongation of vowels, and general breakdown in prosodic patterns of speech. In the stutterer, however, DAF often facilitates fluency. The longer the delay in milliseconds, the greater the slowing down of rate. Curlee and Perkins (6) reviewed earlier work using DAF with stutterers and found that varying the rate of DAF had direct influence on fluency. For example, a delay of 250 msec under DAF slowed speaking rate more than a 200 msec delay.

The slower speaking rate seems to have an immediate effect of decreasing stuttering and increasing speech fluency. The Facilitator offers a wide range of DAF, from .050 msecs to 0.5 msecs, with the SLP able to change the DAF in 10 msec increments. Also, we have found the metronome useful in decreasing speaking rate with some stutterers, i.e., asking the client to match his or her speaking rate to the beats of the metronome (maybe one word per beat or two words per beat). On the Facilitator, the metronomic pacer has a range of 50 to 150 beats per minute; the SLP can adjust the metronome faster or slower to determine the optimal speaking rate for the child. If either a particular DAF rate or metronome rate is found helpful in maintaining fluency, the child may profit from wearing the Facilitator with headphones as a portable, assistive device out of the clinic room, at home, in play situations, and in the classroom.

Motor Speech Difficulties. Some children lack the muscle control required for normal speech. Many times there is an associated feeding problem related to the lack of fine oral motor skills. These motor speech problems in medical settings are classified as dysarthrias. Such children at school generally require individualized speech therapy in the resource or therapy room. While training emphasis is given to developing better postural tone and more efficient motor patterns (such as increasing mouth closure), attention must also be given to controlling the distractability that can arise from faulty motor movements and competing tactile and visual stimuli. Many of these children profit from extensive use of auditory feedback in their speech training and in the various facets of their academic programs. Wearing headphones with real-time amplification permits listening to the amplified speech of others as well as to their own speech. Loop playback, learning to listen critically to what and how they are saying something, can play an important role. Using music, melodic intonation therapy, and developing an awareness of the prosodic aspects of what they say can all be useful parts of speech therapy for the child with motor speech difficulties. Also, the use of a metronome in therapy, beating out the accents of the spoken language, can often be helpful. The child with dysarthria or motor speech problems may find the Facilitator helpful with its real-time amplification, loop playback, and metronome features.

Auditory Processing Difficulties. Some children with learning disabilities seem to have their biggest learning problem in auditory processing. Although they may have normal hearing acuity, they may have difficulty processing the sounds of spoken language into the correct word order that will facilitate meaning. Similar to what many people experience learning a new second language, the normal spoken rate of that language is too fast for the novice listener to understand what is being said. To help correct this listening problem in school-age children, there are a number of commercial auditory processing programs (7,8) available, including audio cassettes, work sheets, and progressively more difficult listening tasks; most of these programs require real-time amplification. Headset amplification appears to help the child focus on the auditory verbal input. Listening to loop playback, hearing again what was just said, can be helpful in improving auditory processing skills; for example, we would give a spoken instruction and then repeat it as needed on loop playback. Learning to listen under difficult conditions, such as adding moderate masking noise to real-time amplification, is a good method for increasing attention span while listening to speech. The real-time amplification, loop playback, and masking features on the Facilitator would each be found useful in working with children with auditory processing difficulties.

Using the Facilitator in School Settings

As we have seen, there are many school-age children who profit from auditory feedback: in the classroom, in the resource or therapy room, and in out-of-school situations. Each of the five auditory feedback modes on the Facilitator have had long use in school settings, both for children with learning disability and those with communication disorders. For the first time, however, the Facilitator is a training/therapy device that provides these five auditory feedback modes in one instrument: real-time amplification, loop playback, delayed auditory feedback, masking, and metronomic pacing. It is hoped that with the ready availability of different feedback modes in the one instrument that auditory feedback will play a greater training role for those children who can profit from it. The versatility of the Facilitator permits its use as a plugged-in training/therapy instrument within the school as well as a portable, battery-powered assistive device in out-of-school situations.

(1) United States Department of Education (1996). Eighteenth Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Washington, DC: USDE.

(2) Peters-Johnson, C. (1997). Action: School services. Language, Speech, and Hearing Services in Schools, 28: 184-189.

(3) Nabelek, A. and Letowski, T. (1985). Vowel confusions of hearing-impaired listeners under reverberant and nonreverberant conditions. J. of Speech and Hearing Disorders, 50: 126-131.

(4) Berg, F.S., Blair, J.C., and Benson, P.V. (1996). Classroom acoustics: The problem, impact, and solution. Language, Speech and Hearing Services in Schools, 27: 16-22.

(5) Bernthal, J.E. and Bankson, N.W. (1984). Phonologic disorders: An overview. Speech Disorders in Children, ed. By J. Costello. San Diego, CA: College-Hill Press.

(6) Curlee, R.F. and Perkins, W.H. (1973). Effectiveness of a DAF conditioning program for adolescent and adult stutterers. Behavior Research and Therapy, 11: 395-401.

(7) Sanders, J.F. (1996). Perceive and Respond Auditory Program, 2nd Ed. Oceanside, CA: Academic Communication Associates.

(8) Willette, R., Peckins, I., and Galofaro, B. (1997). Auditory Perception Training. Austin, TX: Pro-Ed.

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