Written by Karen Anderson, 2002. Design by Oticon, 2007 ELF – Early Listening Function Discovery tool for parents and caregivers of infants and toddlers (4 months to 3 years) ELF - Early Listening Function User’s Manual This manual is for pediatric audiologists and early intervention service providers who are working with families of infants and toddlers with hearing impairment. The Early Listening Function instrument has been designed to obtain an indication of the functional use of hearing in very young children. 2 Written by Karen Anderson, 2002. Design by Oticon, 2007 ELF - Early Listening Function The ELF has three primary purposes: 1. Parent involvement and hearing loss, the ELF can assist the empowerment parents in recognizing the limita- With universal newborn hearing tions of the hearing loss, which may screening, infants with hearing loss motivate them to consider amplifi ca- are being identifi ed in the fi rst month tion use seriously. Children with the of life and parents are typically not best language outcomes are those prepared for the diagnosis of hearing who have parents that are intimately loss in their newborn.The adjustment involved in all areas of early interven- to having a child with hearing loss tion and hearing loss management. and the eventual acceptance of the As the child’s pediatric audiologist, hearing loss as an integral feature you have entered into a partnership of the child’s life comes with the to manage the child’s hearing needs understanding of how the hearing as they grow and develop throughout loss may aff ect the child. Gaining the childhood. parents’ involvement and participa- tion in the discovery process of how the child functions auditorily can be 2. Estimating amplifi cation very benefi cial to the adjustment and benefi t acceptance process of the parents. Although diagnostic procedures are It also establishes a partnership improving for young infants, there between the parents and audiologist remains a degree of uncertainty about as the team who identifi es the child’s the exact hearing thresholds of most hearing abilities and current limita- infants at the time they are fi t with tions and growth (change) over time. their fi rst hearing instruments. The Through this participation, parents range of technologies available to au- are empowered to be involved in diologists to choose from when fi tting observing their child’s hearing be- young children has also increased. havior. This can then lead to a deeper Real-Ear-to-Coupler Diff erence (RECD) appreciation of the nature of commu- measures provide targets for hear- nication and to readiness to become ing aid fi tting. With involvement and informed about eff ective parent-child careful observation by the parents interaction strategies and techniques and daily caregivers of the child, to facilitate auditory development. useful information can be gathered For children with mild or unilateral that can develop confi dence in the 3 Written by Karen Anderson, 2002. Design by Oticon, 2007 ELF - Early Listening Function optimal adjustment of the hearing child during communication and how instruments for daily use. The ELF can the listening bubble may aff ect the also be useful in determining if a per- child’s responses to auditory stimuli, sonal FM system would be of benefi t may assist in realistic step-by-step as the ELF activities raise the aware- auditory skills goal setting. ness of the parents about the daily Although the ELF listening activi- situations and listening conditions ties are detection activities, other would benefi t from FM system use. activities encouraging identifi cation, The ELF can also be used as a pretest discrimination, and comprehen- and posttest for comparing hearing sion of sound can be introduced in instruments or FM system benefi t. the same manner (close, far, quiet, typical,noisy) once the parent has become accustomed to the struc- 3. Tracking improvements in ture of presenting the ELF listening auditory development activities. Knowing the child’s typical Understanding the eff ect of hearing auditory behavior can also help the loss on communication access in parent in detecting possible changes daily situation by the parents and in hearing status due to otitis media caregivers can only support the even- with eff usion or hearing loss progres- tual communication outcomes of the sion. Finally, hearing loss is invisible child with hearing loss. Development and is diffi cult to explain in a clearly- of verbal language depends on con- understood manner. The structure of sistent communication access. For the ELF may provide parents a clear parents that choose an auditoryoral and meaningful way to describe their or auditory-verbal communication op- child’s hearing impairment to family tion for their child, a strong focus on and friends so that they may respond auditory development is necessary. knowledgably to a comment like “I’ve Like any other developing part of the seen the baby hear and don’t think body, the auditory system de-velops he needs the hearing aids.” as it is stimulated consistently over time. The ELF can assist parents and early interventionists in tracking a child’s functional use of early audi- tory skills in the home. Recognizing the importance of proximity to the 4 Written by Karen Anderson, 2002. Design by Oticon, 2007 ELF - Early Listening Function Appropriate Use of the ELF Audiologist or early interventionist should discuss these points with parents prior to giving them the ELF The premise of the ELF is to identify if Listening Activities a child is able to detect certain types The child must not be able to see of sounds from diff erent distances the person making the sounds, their in both quiet and noise. Infants shadow, or be able to detect the like to listen to sounds and voices, sound by feeling their breath, air however, the behavioral response moving, or other vibrations. when a 1-month old perceives sound will be somewhat diff erent than an These listening activities are not older infant. In order for the ELF to “calibrated” sounds. However, it is provide appropriate results, parents important that the parent or car- need to have a clear idea of what the egiver attempt to use the same sound activities are, how to do them, and intensity during all presentations. For what responses to expect. Discuss example, if a child responded to a this information with the parents to whisper at 3 feet but not at 6 feet, the prevent their possible frustration or parent should not make the whisper misunderstanding of what they have louder to obtain a response at 6 feet. observed. Some parents may need to Only if the child responded more than have their early intervention services once out of several presentations provider assist them in doing the ELF at 6 feet would the parent mark the listening activities and observing the response as a ‘maybe.’ child’s behavior. The ELF responses should be shared with the early inter- A radio set on a talk station or the vention team to enhance the child’s television on in the background program. Also, discuss with the par- would be appropriate when present- ents if they or you will be expected to ing listening activities in noise. Try to complete one or both of the ELF score have this background noise on in the sheets. Not all families, audiologists, same room or an adjoining room with or early interventionists will want to the door open when presenting the track performance over time. There- listening activities. The point is to see fore, the audiologist needs to tailor if the child who responds in quiet can ELF score sheet use for the individual also respond when noise is present. familiy. 5 Written by Karen Anderson, 2002. Design by Oticon, 2007 ELF - Early Listening Function The signal to noise ratio is expected • Saying ‚sss-shh, sss-shh, sss-shh‘ to be typical for the home, rather than rather than‚ shoe-buh‘ in number 9. a calibrated stimulus. Responses to the ELF listening activities will be In discussing the activities with the most pronounced for children who parents, if the parents do not feel have a fl at confi guration of hearing comfortable with any of the listen- loss or at least a mild degree of hear- ing activities, discuss with them ing loss across all speech frequencies. what a suitable replacement activity with quiet, typical, loud, or high or Children who have normal hearing low frequency characteristics might through the low frequencies may be from their own environment. have robust responses to most or all The activities should be easy to do of the listed ELF listening activities. and easy to repeat over time. For an The audiologist or early intervention- example of rough use of frequency ist working with the parents must range, ‘buh buh buh’ is considered a be aware of this potential and may lower frequency speech stimulus and choose to not use the ELF if there is ‘ship ship ship’ a higher frequency an island of normal or minimal hear- speech stimulus.The phrase ‘shoe- ing loss. Alternatively, the audiolo- ba, shoe-ba, shoe-ba’ is considered gist or early interventionist may work to have both low and high frequency with the family to include or replace elements. some of the existing items with high frequency listening activities such as: Caution the parents to hit the frying pan or do a loud door knock from • Quiet ‚tsk, tsk, tsk‘ sound in number a distance fi rst. These loud sounds 3 rather than quiet clucking tongue should be presented close to the baby’s head only when more distant • Mommy saing ‚sss, sss, sss‘ responses were not observed, espe- quietly in number 4 rather than cially when amplifi cation is worn.