Each October is Audiology Awareness Month, an ideal time to review one of the most critical concepts we use to guide children with hearing loss and their families: the hierarchy of auditory skill development, sometimes called the “listening ladder.”
What is Auditory Hierarchy?
The hierarchy of auditory skills, a concept coined by Dr. Norman Erber in the 1980s, consists of a series of skills that a child must master—in order—to learn to listen. Think of it as a ladder where each rung is an important milestone skill, and each skill forms the foundation for the next.
The four rungs on the ladder are detection, discrimination, identification and comprehension.
Skill 1: Detection
“We can’t expect a student to comprehend language before they’re able to detect it,” explains Katie Jennings, MED, teacher of the deaf. “To teach a listening skill, we always have to start with that bottom rung of the ladder.”
Katie uses a faucet as an example to help a child through the first stages of the process: “Let’s say… turning on the water draws [a] child’s attention. So, you could say, ‘Did you hear that noise? What was that? Oh, was that the water running? Do you want to touch it?’”
(For our purposes, Katie uses a faucet as an example, but she notes that these skills can be tied to any sound in the child’s environment—from a cell phone ringing to an adult talking. It’s important for families to be aware of these listening opportunities because so many sounds—traffic passing by, silverware moving in the drawer, a pet making noise—fill our auditory environment but are typically overlooked as unimportant. But to a child with hearing loss still developing these listening skills, they are vital clues to both the world around them and to cracking the language code!)
Skill 2: Discrimination
The next step is discrimination, meaning, the listener learns to differentiate one sound from another.
Katie suggests turning the water on and off to work on this skill, and with the faucet off, asking, “Did the water turn off?”
“What that does is help them hear the difference between what it sounds like when there is no sound and when there is sound,” she continues.
Skill 3: Identification
Next is identification, when the listener can successfully identify a sound and attach meaning to it.
In terms of the faucet example, identification would be a child learning the difference between water running versus a completely different sound, like a dog barking. Eventually, they’ll also be able to identify similar sounds, such as water running in the sink versus filling the tub.
Skill 4: Comprehension
The final step is comprehension. On this “rung” of the listening ladder, the listener can understand sounds and speech using only their listening skills. This stage is the end goal, when the listener now understands and follows simple directions, engages in back-and-forth conversation and more.
Once the child has reached comprehension, they’ll be able to communicate regarding that sound—asking and answering questions about it or following directions, such as “Don’t forget to turn off the water,” if they’ve been using the sink.
Is It Possible to Skip Steps?
It’s paramount for families, caregivers and hearing health providers to monitor how a child with hearing loss is moving through this auditory hierarchy. To be successful, the child has to must move through the steps in order—for example, they can’t successfully comprehend if they haven’t been able to first detect or identify a sound.
“If the child is stuck on something, or we keep practicing it, but they aren’t auditorily discriminating between similar sounds, or there is a sound that they are not detecting like high-frequency sounds, families should first reach out to the audiologist,” Katie says. “Because that tells us that the child doesn’t have enough access with their current mapping or their current programming on their hearing aids.”
That can happen if the child’s mapping/programming needs to be updated. Or perhaps there’s been a change in the level of hearing loss. “We have to work with our audiologists to successfully make it through the auditory hierarchy,” says Katie. “Otherwise, you know, the child might not have access to certain sounds, and they won’t be able to progress without full access.”
Tips and Strategies for Families
Katie notes that while the steps need to be taken in order, that doesn’t mean families won’t have times they need to go back and revisit some steps. For example, if a child has been speaking in sentences and then suddenly is struggling with some sounds or words, it’s probably time to go back to detection to see if they are having an issue such as difficulty hearing high-frequency sounds. “You can try an activity to target the plural /s/ sound by showing them a single cat and a group of cats and say, ‘Show me the cats,’ to see if they’re able to hear the ‘S’ sound at the end,” she explains.
Katie adds that issues like these often crop up after a child gets new programming for their cochlear implant or hearing aid—a normal and necessary result of maintaining hearing technology . “Any time there is some kind of change to their hearing, that can happen. Or sometimes they’re generally at the comprehension stage but still working on discrimination for words that sound very similar to each other.” In short, it’s normal for a child to need to go back to review skills or to take longer to get through the stages for certain skills. What parents and caregivers want to watch for is that the child doesn’t essentially get stuck at one stage and stop making progress.
For that reason, Katie said it’s key for families to understand the basic structure of the auditory hierarchy as well as where their child is on that ladder so they can meet the child where they are.
“You don’t want to talk over, or beyond, where your child is, but we also don’t want to focus on skills they’ve already mastered,” she continues. “So, working with a listening professional—an audiologist, speech language pathologist or teacher of the deaf—to identify where your child is and identify their specific needs is so important.”
‘A Lot of Language’
As important as the hearing professionals are to keeping a child with hearing loss on track on developing their listening skills, remember that children spend more time in their home environment.
One critical piece of advice for families: “The more they talk to their child with hearing loss, and the more they can point out different sounds and talk about them, the faster that child will progress through the listening ladder,” Katie says. “Sometimes when we think about spending time with our children we talk about ‘quality over quantity’ but with children who are hard of hearing, you have to do a bit of both. You want to have that quality time, but also make sure that child is also hearing a lot of language.”