How to Grow a Young Child's Listening Brain

This text-based course is an edited transcript of the webinar, How to Grow a Young Child's Listening Brain, presented by Carol Flexer, PhD, CCC-A, LSLS Cert. AVT.

Learning Objectives

• Describe auditory brain development as the foundation for listening, language and literacy for all children.
• Explain why and how to deliver early language enrichment through listening.
• Describe practical strategies for activating and advancing listening, language and literacy development in infants, toddlers, and young children.

Introduction

I'm an audiologist so I certainly focus on children with hearing loss. However, working from a developmental perspective, as this talk does, all the information that applies to children with hearing loss and developing their listening capacity will also apply to all children. So we can certainly generalize the topics discussed during this course.

Desired Outcome

When we work with families we must begin with the critical question of what is the family's desired outcome? Their outcome includes their long-term goals for their children and what it takes to get there. The family's desired outcome guides our intervention, both ethically and legally. We want to ask families, "How do you want to communicate with your child?" "What language or languages do you know?" Research in early childhood development supports families using their home language at home because that is where they have the most information, the most knowledge, the most to say to their child and the most information to support that child's growing listening capacity. If the home language is different than the community or school language, we need to add that school language too as soon as possible.

Ninety-five percent of children with hearing loss are born to hearing and speaking families. Therefore, those families are going to be very interested in their child listening and talking in their language. Many families at home speak a language other than the community language, so likely they're going to be interested in their child's speaking and listening and reading several languages. The information in this course is designed for families who want listening, spoken language, and literacy outcomes for their child whether or not that child has a hearing loss. Our challenge as professionals is how do we take our knowledge of auditory brain development, that basic science knowledge and transform that information into a discussion about listening? 

The Auditory Brain

We are going to start by watching a video that was produced by the Developing Child Center at Harvard University. This center has an array of clips that are excellent about the developing child and about the child's brain.  Please watch the video as it will set the stage for this course.

As you can see from this video, the early weeks, months, and years of life are absolutely critical for creating the brain foundation upon which everything else happens. Early intervention providers have the responsibility and the privilege of creating the foundation for the rest of a child's life. What happens in that child's brain in those early weeks, months, and years is what sets the stage for that child's capacity for later learning in life.

References for Brain Research

The list below is a sample of references on basic brain research.

• Kral, A. (2013). Auditory critical periods: a review from system’s perspective. Neuroscience, 247, 117–33.
• Kral, A., Kronenberger, W.G., Pisoni, D.B., & O'Donoghue, G.M. (2016). Neurocognitive factors in sensory restoration of early deafness: A connectome model. The Lancet Neurology, 15(6), 610-621.
• Kral, A., & Lenarz, T. (2015). How the brain learns to listen: deafness and the bionic ear. E-Neuroform, 6(1), 21-28.
• Kral, A., Sharma, A. (2012). Developmental neuroplasticity after cochlear implantation. Trends in Neurosciences, 35(2), 111-122.
• Moon, C., Lagercrantz, H., & Kuhl, P.K. (2013) Language experienced in utero affects vowel perception after birth: A two-country study. Acta Pædiatrica, 102,156-160.

To summarize some of their studies, they found that the brain has to have access to intelligible speech during the early months and years of life. If that child has a hearing loss or no one is speaking to the child, the child isn't hearing auditory information. Whether not hearing is an anatomical hearing loss or an environmental lack of auditory stimulation, meaningful auditory information doesn't coordinate activity between the primary and secondary auditory cortex. Instead, the secondary auditory cortex gets co-opted for other functions such as vision, but the visual programming of the auditory cortex does not result in listening. So when auditory information isn't efficiently transmitted, we're looking at basic science from the primary to the secondary auditory cortex. Then that secondary auditory cortex cannot distribute that spoken language and other meaningful information to the rest of the brain that creates auditory meaning and auditory knowledge. That negative process is called downstream degradation. We want to avoid that. We want to link the auditory centers with the rest of the brain for cohesive, cognitive development.

Educational Conversations and Definitions

So how do we start as professionals when having a conversation with families and/or with colleagues? How do we connect the dots between hearing, brain plasticity, listening, talking, and literacy development?  Brain plasticity means the availability and malleability of the brain to grow and develop as a function of external stimulation. So, whatever information gets to the brain is how that brain will grow neurons and synapses. The brain always has some plasticity. The brain changes its structure in development as a function of information that's received. However, the maximum capacity for change and growth and connectivity is in those earliest weeks, months, and years. So as early intervention providers, we have the best opportunity to develop that child's brain because organically their brain is working right with us in growing and developing based on the information received. We have to talk about the terms we use in an intelligible way to families.

Sound

Sound is an event. For example, you don't "hear" mommy, that's a label. Mommy is a label. You hear mommy in action, walking, talking, and singing because an event creates vibrations. Vibrations are picked up by the "ear doorway" and are sent to the brain as energy for coding and then for perception as information. It isn't accurate to say, "I hear daddy." What would be accurate, for example, might be to say, "Oh, I just heard the door closing." An event. I'm assuming that's daddy because I expected him home at this point in time. I heard the event of the door and I made the link that that must be daddy causing that event to occur.

Language

What's language? Spoken language is an organized system of communication for the purpose of sharing information. It consists of sounds, words, and grammar used to express inner thought and emotions.  We place those on a loud speaker for others to have access to. Language also includes our facial expressions, gestures, and our body movements. 

Sensory Organs

How does instructional information get into the child's brain?  Our brain is completely encased in bone and has no access to the world. It lives in a skull.  Our amazing sensory organs of mouth, nose, eyes, ears, and skin assist in transferring the information from the environment into the brain. Our sensory structures are developed for the express purpose of capturing raw environmental data and transforming that raw data into chemoelectric and neuroelectric impulses that can be read in the brain.

Nose. The nose is the doorway to the brain for the sense of smell. The nose picks up olfactory molecules and changes those molecules into chemo and neuroelectric impulses that are sent to the brain to create meaning. Smelling occurs in the brain, not in the nose. For example, when we sniff and we smell the chocolate chip cookie. How do we know it's a cookie? The nose doesn't know it's a cookie. The nose just randomly picks up environmental olfactory data. The brain, by taking in this olfactory information and through exposure and experience and connecting that olfactory data to other parts of the brain, we come up with, oh, that's a cookie. A dirty diaper is another example.  Does the nose know that's a diaper? Of course not. The brain knows that's a diaper when those olfactory molecules are linked to the exposure and experience of diapers in the environment.

Eyes. The eyes are the portals to the brain for visual data. Seeing, however, doesn't occur in the eye. The eye picks up optic waves and transduces those waves to chemo and neuroelectric impulses that are red in the brain. Seeing occurs in the brain. So for example, if a child is born with congenital cataracts which are a covering of that eye doorway that prevents the brain from receiving visual information. If those cataracts aren't removed right away then that brain is not going to know if there's a delay in the activation of the visual center. We have to have those cataracts removed right away in order to activate the visual centers of the brain.

Ear.  The ear is the doorway to the brain for sound, for spoken language information, talking, and reading. Hearing doesn't occur in the ear. The vibratory data is picked up by the ear. The sense organs are portals to the brain for environmental information.  So what about hearing loss? Hearing loss is a doorway problem. Hearing loss, whether it's wax in the ears, fluid in the ears, or sensory neural hearing loss, there is some type and amount of obstruction in this ear doorway that prevents auditory data from the environment to reach the brain where learning the meaning of that auditory information occurs. Hearing aids and cochlear implants break through the doorway to allow access, stimulation, and development of auditory neural pathways.   The only purpose of those technologies and others such as a remote microphone or classroom audio distribution system is to capture auditory information from the environment to breach the doorway and to get that auditory information to the brain for learning. If that child has a doorway problem and they aren't wearing their technologies, their brain is being deprived of auditory information. We can think of those devices as brain access devices not as hearing aids or as ear devices. 

Hearing

Hearing can be defined as brain perception of auditory information. Hearing is a first order event for the development of language, spoken communication, literacy skills, and social-emotional connections because we have to get that information to the brain. Any time we use the word hearing we should think auditory brain development that uses a billion neurons with a quadrillion connections.

The brain needs to receive clear information to develop.  What comes out of the child is what went into their brain. In other words, the output is based on the input.  So for example, if a child is speaking Spanish, what went into their brain is Spanish. If what comes out is English, what went in, is English. If what comes out is clear speech, what went in? Clear speech. If what comes out is garbled speech, what went into that brain? Garbled speech. If that child is not speaking clearly, the very first thing we have to do is check their auditory input doorway. Is information getting clearly to the brain or is there a doorway problem? If we want to improve the spoken language output, we must first manage the input signal.

Human beings have eyelids that when we close them we shut out visual, optic information. However, humans do not have earlids organically which means the brains of people with a typical doorway receive auditory information 24 hours a day, seven days a week. That's how critical auditory enrichment and exposure is for neural health, for brain integration, and for brain health. Signal to noise ratio (SNR) is very important for brain intelligible speech. Speech has to be about 10 times louder than background noise in order to give the brain a clear auditory perception.

The meaning of sound occurs in the brain. We hear with the brain. The ears are just a way in. So what's the big deal? Human beings are loaded with auditory brain tissue, but children can't listen like adults because they have to develop and connect the auditory tissue in the brain with the rest of the brain. Those connections take time, practice and a lot of exposure. In fact, it takes about 15 years for the highest auditory centers of the brain to be complete even though the first few years are the most important for developing the foundational auditory connectivity. Also, children can't automatically complete unknown information like adults do. Children can't utilize auditory cognitive closure (complete a misheard word) unless he or she already knows what that word is. Therefore, a child needs to receive clear information and all infants and children need a quieter environment and a louder signal than adults need. 

Hearing vs. Listening

What's the difference between hearing and listening? Hearing is auditory access to the brain for the perception of auditory information. Hearing occurs in the brain. We have to improve the signal to noise ratio by managing the environment as noise is a problem. Listening is focusing the child's attention on auditory information. Neurologically, listening is intentionally activating the pre-frontal cortex. We have to first make sure the brain is receiving clear auditory information before we can teach the child to listen and focus on that information. We must know about the hearing thing before we can do the listening thing, and this is for all children.

Extrinsic vs. Intrinsic Redundancy

James Jerger is an audiologist and one of the founding fathers of audiology. He developed a key concept regarding the relationship of extrinsic to intrinsic redundancy. Extrinsic redundancy refers to the integrity of information from outside the person. It can also be called bottom-up sensory input. The input gets to the brain from the environment. On the other hand, intrinsic redundancy refers to the cognitive capacity, the internal knowledge, and attentional resources of the person. This is their top-down processing. Now there's an inverse relationship between these two that we have to consider for each child. Our job as those dedicated to early intervention is to grow that child's top-down cognitive reserve. We do that by strategically and knowingly enter enriched auditory information to the brain because children don't come to us with top-down ability. We grow their top-down internal capacity. That is our job.

So what are some ways that we can improve and enrich the extrinsic signal for the purpose of generating and growing this child's internal cognitive resources? One important way is how we talk to a child. We need to use clear speech. The speaker's use of clear speech can improve the listener speech discrimination by up to 40%. Another way is to slow down. Most adults speak faster than most children (and many aging persons) can process. We as adults often speak faster than 200 words a minute which is way too fast for children to process.  They can process about 124 words a minute. We should speak like Mr. Rogers. If you don't remember Mr. Rogers, you can Google him. Children loved him and you know why? They could understand him. He used nice, clear speech. He would speak slowly and he would pause. He would use very good suprasegmentals. You know, the motherese and parentese we use for young children, that's actually a very good thing. The brain loves that sing-song voice. I'll talk more about that in the segment that I'm doing on growing the music brain. Slow down, pause. Improve our intelligibility to improve the listener's perception and to grow and develop that child's intrinsic cognitive capacity.

Research: Language and Literacy Development

Auditory Stimulation

What impact does quality and quantity of speech by parents and caregivers to a child have on the child's development? In 1995, there was a case study done by Hart and Risley that showed how much auditory stimulation is needed for language and literacy development. This study looked at the meaningful differences and the everyday experiences of young American children. Hart and Risley found the number of words addressed to a child depended on their environment and the impact of those words on the child's intelligence and on their literacy. In these studies, the average words addressed to a child by the time they're age four in a professional family is approximately 45 million words. Obviously, these are not 45 million different words, but it's the repetitive content in a meaningful way. In working-class families by age four, children have heard about 26 million words and in poverty families, about 13 million words. Now, this doesn't mean that children are loved less or valued less in a working class or poverty family. It really has to do with knowing what it takes to develop that child's brain and knowing how to enrich the brain to develop the neural connections and a child's internal cognitive capacity.  You can read more about Hart and Risley's work here.

Three T's

The difference between having heard 45 million words and 13 million words was identified by Dr. Dana Suskind in 2015 as the 30 million word gap (Suskind, 2015). She developed a program based on research for building a child's brain by enriching them with an additional 30 million words by the time they are four years of age. This enrichment has to occur in the family. As professionals, we have a responsibility and a privilege of coaching families about how to grow their child's brain.

I highly recommend the book by Dana Suskind. One of the aspects of this book are the tips for family conversation and she calls it the three Ts. The first T is Tune in. Tune in to what the child is interested in. What are they doing? Follow the child's lead or get the child interested in what you're doing. Tune in to the child. The second T is Talk more. Talk to the child. Talk about what you're doing and what the child is doing. Have conversations and use rich and varied vocabulary with full sentences. The last T is Take turns. A conversation everyone gets to talk. You have a turn, the other person has a turn. You have a turn, the child has a turn. View the child as a conversational partner from day one. We start talking to newborns. We say things like the following:  "Hello darling, girl"  "You're mommy's baby." "Mommy loves her baby." "Hello, darling, girl." "Oh, my little girl." "Hi, dolly" "Hi". Then, we pause and wait and as that infant looks at you, that baby might coo, and then we say "I heard you, you were listening, Hi baby" Then we pause and the baby who's looking at us might coo again. That's called reciprocal babbling. Serve and return. Those are critical strategies for engaging a baby as a conversational partner. These are strategies that we coach families and engaging in from day one. We build on these three Ts all through the child's early life.

Bottom Line

The bottom line is infants must have very early brain access to intelligible speech and meaningful auditory information in order to fully develop and connect all auditory areas of the brain to organize that child's listening, their spoken language and their literacy capacity. Hearing is a stepping stone to cognition. What determines how smart a child is? What determines that? It's how much they know. The more you know the smarter you are. That's why enriching the child's brain with meaningful, developmentally appropriate information literally creates their ability to be smart. It creates their cognitive capacity. It builds their brain with knowledge and experience. That's a privilege that we have as parents and as early intervention providers in coaching patients, in growing their child's brain to make them smart, to give them the foundations for talking, reading, and learning.

Vocabulary 

Vocabulary is one of the biggest predictors of kindergarten success. Therefore early intervention isn't about the child as we've been discussing. It's about the family learning how to enrich and teach their child meaningful words. We don't teach words in isolation. We teach words within concepts and within grammatically correct sentences. Figure 1 is a summary of research about the number of English words that are understood by typically developing children. This is our target. The average child by age two understands receptively about 300 words. They might not speak them. Some children by age two understand 1,000 words while others are fewer.  This is an average, but see how rapidly the child's understanding of words develops. Nine hundred words by age three and by age five, 2500 words. Look what happens between age five and six. The typical child's knowledge of words, and it's not isolated poly parrot words, these are words as used within sentences to convey basic concepts going from age five at 2,500 words to 13,000 by age six. By age seven, 20,000 words are understood on average. We have to create that foundation in infancy.

Figure 1. Number of English words understood by typically developing children. 

Infant Spoken Language Development

The best predictor of that child's language competence is how much parents converse with their child. Some parents are natural talkers, enrichers, read alouders, and singers, who really can grow that child's brain. Other parents need a lot of help. I've never met a parent who wouldn't do all possible to help develop their child's brain. Many parents don't really know that they can develop their child's brain. In fact, they have the pivotal role in developing their child's brain with knowledge as the foundation for talking, reading, and learning. Some parents don't know that. It is up to us to provide that information. Parents need to speak the language or languages they know and then we add the community language right away. 

Ninety percent of what a very young child learns is learned incidentally (through conversations, overhearing others talk,) and not through direct instruction. It's through having these conversations. For example, "Oh kitty, would you like a glass of juice?" "I know you're thirsty, so here's your glass of juice." "Can I have a sip?" The parent wasn't thinking of teaching the words glass and juice when having that conversation. That information was incidentally provided through day-to-day conversation and routine that parent has as they engage their child.

Six Principles of Language Learning

Roberta Golinkoff is an amazing researcher, scientist, linguist, and psychologist at the University of Delaware.  In 2017, she mentioned the six principles of language learning through listening. All of the below are learned through listening and focuses on the child's auditory brain.

1. Children learn what they hear most. Frequency matters. 
2. Interactive and responsive environments build language learning. Children learn in social situations. They learn in social, emotional, connective interactions with people who love them.
3. Children learn words for things and events that interest them. They learn about words and things that capture their attention.
4. They learn in meaningful contexts as opposed to those devoid of meaningful engagement. 
5. Vocabulary and grammatical development are reciprocal processes. Do not speak in single words. Speak in phrases or complete sentences.
6. Children need to hear diverse words and language structures. Don't say the same thing the same way all the time. Use different words and different language structures.

You can read more about Dr. Golinkoff's work at her website, www.roberta-golinoff.com

Tips on "Growing" a Child's Auditory Brain

Enrich that brain with diversity because it's all about the brain. It's not about the ears. The ears don't learn anything. The ears are receivers. All of our sense organs are amazing structures. I don't mean to diminish the amazing capacity our sense organs have for capturing raw environmental data. They are brilliant structures, but they don't know a thing. The ear doesn't know anything about what the sound means. The ear captures the raw vibrations and sends them to the brain where the knowledge of the meaning of the sound occurs.

I use the "brain" word al the time when speaking with families about growing their child's brain, enriching their brain, and creating a world where that brain can develop. Always consider what the status is of that child's auditory brain. Where has that brain been? What does that brain know? Does the child know words? Have they been exposed to knowledge and experience? Have they been read aloud to? Has someone been singing to them to grow this amazing singing brain?  Has that brain been enriched? Has that brain been deprived? If the child has a doorway problem, have they been wearing hearing aids or is that brain being deprived of auditory information because the family thinks the hearing aids are about ears instead of about the brain? Do you think that any family would not put on hearing aids or implants if they knew that not wearing the technology would deprive that child's brain? Well conversely wearing the technology, the hearing aids or the implants, was enriching their child's brain. Who wouldn't want to do that? What parent wouldn't want to enrich and grow their child's brain with knowledge?

What are some tips then that we can offer for families about growing their auditory brain for listening, for learning, for reading? You can offer tips on apps electronically or on paper, but I highly recommend every tip is preceded with, "This is one way to grow your child's brain for knowledge, for learning, and for growing".  As professionals, we recognize how critical parent engagement is. The majority of learning happens at home and continues to happen at home. Data show that only 13.36% of waking hours by age 18 are spent in school. Those of us who work in schools want to make sure that we really do not squander that 13.36 % of waking hours. We want to use those hours to the max, but we have to engage parents from the very beginning to really develop that child's brain.

Human beings are naturally designed to listen and talk if we do what it takes to activate and develop the brain early with auditory information. The brain is set up to hear provided we activate those auditory centers with auditory information early.  It's critical that we get to that brain early to naturally develop the auditory centers for listening, language, reading, and learning.

Experience Books

The first tip is to have the family make an experience book. An experience book can be paper, it can be electronic, it may be one page every day, and /or one item beginning in infancy. It is something to talk about. I have families who have closets full of experience books. Figure 2 is an example. It says Wednesday I used a yarn to tie daddy. A little stick figure, one sentence. Figure 3 states, "I called daddy mommy, it's a slip of the tongue." You see how you can sit down and have a lovely conversation even when you take both sides of the conversation as one does when you're talking to babies. Another example can be seen in Figure 4, Daddy helped me open a can of carrots. Now, if you want to use apps you can actually take pictures and insert a picture in the electronic experience books or print out the picture and paste it into a paper experience book. Figure 5 is "My mommy dragged herself out of bed in the morning," which of course is figurative language. Encourage families to have experience books as a way to enrich their child. 

Figure 2. Yarn to tie daddy.

Figure 3. Slip of the tongue.

Figure 4. Can of carrots.

Figure 5. Mommy dragged herself out of bed in the morning.

Always Explain

So as we make other suggestions to families it's very important to emphasize the brain Why? First of all, how do these recommendations relate to the family's desired outcome of listening and spoken language development? Second, how are these recommendations supported by basic science? What is the reason for recommendations? Give people a reason and provide examples.

Other Tips for Parents

1. Love, play and have fun with your child.  
2. Minimize background noise. Turn off the TV. If you're not watching TV together as an enrichment experience, turn it off. The brain is developed best in quiet.
3. Sing. Fill a child's days with all kinds of music and songs. Singing is a powerful way to not only have fun with the child but to grow their brain.
4. Let's enhance that extrinsic redundancy. Slow down. Now, of course, we want our children to be able to process rapid, blurry, slurred speech because that will happen to them out there in the world. But the way that a child learns to handle unclear speech that is spoken to them is by having a strong intrinsic cognitive platform. The stronger their brain, the more their brain can rush to the rescue to help out when the extrinsic information is reduced and is muddied. Speak slower, clearly, in full sentences with correct grammar.
5. Focus on listening. Focus that child's brain on listening. Call their attention to auditory information. For example, "Susie, listen, I hear the phone." "Listen, I hear you chewing that crunchy pretzel". "Can you hear that pretzel?" "Listen, mommy's singing." Call the child's attention to auditory information. When the child indicates they heard something by looking for it, reinforce it. "Oh Johnny, you heard that, wow, good listening." "I like it when you listen." What we need to do rather than just say "good boy or good" is we identify what it is that we're reinforcing. If we're reinforcing listening, label it, "wow, you heard that spoon drop". "You were listening, good listening." Reinforce listening to all children, not only in children who have doorway problems or hearing loss.
6. Read daily, at least 10 baby books a day. We should be reading chapter books to children by age four. They could be chapter books that a six or seven-year-old could be reading themselves, but a four-year-old can certainly understand the book as we read aloud to them even though they're not yet able to read that book for themselves. Chapter books have continuity. You have to enhance auditory memory, auditory sequencing, auditory attention.
7. Name objects in the environment not as a label but as an inclusion in an activity.
8. Talk about, describe how things sound, look and feel as the child is attending to that activity, to that event, to that object.
9. Compare how objects or actions are similar or different in size, shape, smell. There is so much to talk about in this world. It's such an amazing world. There's so much to say. There's so much to notice. There's so much to be curious about. There's so much to talk about. All these wonderful thoughts that we have in our minds, let's put them on a loud speaker and share them with our children.
10. Talk about where objects are located. You need to use many prepositions such as in, on, under, behind, beside, next to, and between. By the age of four children should know all their prepositions. You can not do much of anything without a preposition. For example, the teacher says in pre-school, "Johnny, come into the room. Why don't you hang your coat on the hook? Put your boots under your coat. Why don't you sit down at your desk? Open up your desk. What's inside of your desk? Why don't you take out your crayons?" Prepositions in English are what we call non-salient morphological markers which means we don't stress them. We tend to blur them. For example, we might say, "your shoes are in the closet." "Why don't you look in the closet?" We need to do what's called acoustically highlighting to get the brain to have a clear perception of the words and of the prepositions that we're trying to have that brain develop a synapse for. So for example, to teach prepositions we might say something like, "oh Johnny, your shoes are in in in in the closet. Let's look in in the closet." Now you're not always going to talk that way, but to initially get the brain programmed around words that we tend to not emphasize, it's important to do that type of acoustic highlighting.
11. Describe sequences. Talk about the steps involved in activities as you are doing the activity.  Sequencing is necessary for organization.  Everything has a sequence. You can't get dressed, brush your teeth or get on a bus for example, without a sequence. What can you do without putting things in order with a first, next and last? Sequencing involves auditory memory which is based on listening. So we coach families to sequence even from the beginning when changing a diaper. For example, first, my brain smells a dirty diaper. Next, I've got to take it off and clean you up. Last, I put on a clean diaper and give you a kiss. So we coach families to speak in sequences and to call out sequences to help the child learn to organize the events that occur in the routines of daily living.

There is so much that we can do to develop a child's brain, to grow their intellect, and to develop their listening as the foundation for talking, reading, and learning. We have a wonderful vital role in developing a child's brain. 

Additional References

Suskind, D. (2015). Thirty million words: Building a child's brain. NY: Dutton/Penguin Random House.

Further references are listed within the course and may be found in the handout.