Facilitating Auditory-Verbal Learning for Young Children

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Facilitating Auditory-Verbal Learning for Young
Children with Impaired Executive Functioning 
Presenter Ellen A. Rhoades, Ed.S., LSLS Cert.
AVT A.G. Bell Convention Short Course June 25,
2010 Orlando FL
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• SHORT COURSE OBJECTIVES
• I. Executive functioning (EF)
• A. executive functions
• B. dysfunctional executive processes
• C. data on children w/ HL learning differences
• (not learning rapidly via AV strategies)
• II. Rationale/neurobiological evidence
• Auditory-verbal learning
• motor learning
• C. rhythmic learning
• D. cross-modal learning
• E. synchronous learning
• III. Synchronous auditory-based cross-modal
  rhythms

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OVERALL GOAL Integrate these activities into
AV programs for young children (0-5 yr).
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Course Objective 1
EXECUTIVE FUNCTIONING
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THE THEORY THEORY
The child is a scientist his world theories are
continually revised.
Young children NEED to figure out what is going
on around them their EXPLANATORY DRIVE pushes
them to act in order to get them the info they
need. They must explore experiment they try to
figure out how we play games the meaning of
language.
Kids experiment. Their knowledge base
changes/expands to accommodate ongoing learning.
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NEUROBIOLOGICAL FINDINGS INFO PROCESSING
PERSPECTIVE ON LEARNING
Brain learns in computational manner based on
mini-steps, each influenced by genetic,
neurobiological, and environmental experiences.
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SYNCHRONY
(When parts simultaneously work together in
harmonious relationships)
NEURONS SHOULD FIRE IN SYNCHRONY (IN
UNISON) there is a 4-cycle per second rhythm in
the brain.
Synchrony is the emerging science of
spontaneous order the rhythmic interplay of
parts that unconsciously combine in patterns to
make up a greater whole embedded in the rules
of nature
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NEURAL SYNCHRONY THE FOUNDATION FOR LEARNING
Neurons fire or dont. Neurons that fire
together are wired together. Neural synchrony
occurs when neurons fire together at the same
time. Neural networks are established.
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SYNAPTIC STRENGTHENING
Neural networks process information. Those neural
networks that are consistently turned on over
time will be strengthened those rarely excited
may be dropped away.
("pruning streamlines the childs neural
processing, so that remaining networks operate
more quickly/efficiently.
Synaptic strengthening is the neural basis of
memory. Memory is synchronous synaptic activity.
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A NEURAL BASIS
Neurons Synaptic integrations Neural networks.
.
The establishment of a neural template for each
child has everything to do with auditory-verbal
development.
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Neural synchrony is needed for rapid
learning. Neural synchrony is the
neurobiological basis of attention. Neural
synchrony permits accurate perception and precise
movement. Synaptic strengthening is the
neurobiological basis of memory. Attention and
memory enable learning.
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Information is processed primarily via
prefrontal cortex (base of cognitive
control) by using goal-directed problem
solving skills. These skills constitute executi
ve functioning. (varied executive capacities)
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GOAL-DIRECTED PROBLEM SOLVING
Good executive capacities facilitate efficient
learning effective behavioral functioning.
(making rapid and flexible behavioral
adjustments) (responding appropriately to
varying demands of difft situations, e.g.,
multi-tasking)
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EXECUTIVE FUNCTIONS
Constellation of heterogeneous and interrelated
cognitive control skills essential for
coordinating thoughts actions so that effective
problem solving occurs. Set of processes
sub-serving purposeful goal-directed behaviors.
EFs interact with such fundamental brain
processes as sensory perception and language.
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EFs develop across childhood, from infancy
through adolescence becoming more complex as
children develop. Understanding EFs necessitate
task analysis.
Dawson Guares, 2009 Meltzer, 2009
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CENTRAL TO ALL COGNITIVE ACTIVITIES
ATTENTION WORKING MEMORY
Critical Executive Capacities The
neurobiological basis for learning
enables
enables
Attention
Memory
Learning
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RAPID CONSCIOUS LEARNING (OUTCOME OF ATTN
MEMORY)
We want the child to have automaticity in
learning.
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• ATTENTION
• DIFFT TYPES
• VISUAL
• COGNITIVE
• AUDITORY

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ATTENTION
We must attend to the task in order to find a
pattern. We must know a pattern in order to
recognize a problem.
Whether bottom-up or top-down, attention is
critical.
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AUDITORY ATTENTION
A child can discriminate sounds at
automatic, pre-attentive level yet perform
poorly on behavioral discrimination task (eg.,
non-responsive CI kid w/ Ling 6-Sd
test) Critical for processing info and for
establishing flexible, adaptive behavior.

• Auditory processing components include
• Arousal
• Orienting
• Selective attention
• Sustained attention

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SUSTAINED ATTENTION (COMPONENT OF AUDITORY
ATTENTION)
Gating out irrelevant stim is poor for typical
neonates, but improves significantly throughout
infancy and thereafter (maturational
changes) However, by adolescence, this ability
to maintain attnal focus deteriorates.
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The first step in learning a language is to
find it, and to find it, the baby must block out
the noise. C.D. Yang
What about the child whose hearing device works
against gating out irrelevant auditory
stimuli? What about the child who has access to
soft sound but does not yet have sustained
attention?
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NEUROLOGICAL BASIS FOR LEARNING
Attn enables memory
Memory enables learning
Automaticity in learning
Rapid Conscious Learning
Attention
Memory


Learning temporal binding of distributed neural
networks
Neural synchrony
Synaptic strengthening

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WORKING AUDITORY MEMORY

• A child is expected to
• hear the info
• listen to the info
• understand the info
• remember the info
• act on the info

GAIN, RETAIN, MAINTAIN
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WORKING MEMORY
A multi-component system, working memory is a
core cognitive process that involves both
short-term and long-term memory. Preserves
info while simultaneously processing the same or
other info performance is age-related and
patterned.
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WORKING MEMORY
Requires cognitive multi-tasking one must first
attend and then recall temporarily stored
information from the long-term memory bank
before developing relations between elements of
information and then spatially or verbally
manipulating the selected information. Involves
re-organizing known information in order to
achieve a goal, hence a cognitively loaded task.
Interacts with other executive processes.
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EXECUTIVE FUNCTIONS Attn Planning Organizing Pers
istence Strategizing Task initiation Working
memory Counterfactual thinking Monitoring and
evaluating Making judgments decisions Self-contr
ol (cognitive/emotional) Cognitive flexibility
(topic shifting) Coordination of affect and
cognition Rate of processing info
(spoken/printed)
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META-COGNITION (constellation of executive
processes)

• Thinking about thinking
• (awareness of self in learning process)
• Planning
• Reflection, self-evaluation
• Execution of goal-directed acts

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SELF-REGULATION (constellation of executive
processes)

• Ability to inhibit initial or habitual impulses,
• sometimes referred to as effortful self-control
• of action and emotion.
• Initiation and cessation of activities
• Postponement of action
• Resistance to temptation
• Generation of socially approved behaviors
• in absence of external monitors
• Affective, cognitive, behavioral self-regulation
• Cognitive flexibility

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In order to problem solve, the child must first
attend. Then the child must recognize that a
problem exists. A problem is recognized if
pattern perception has already occurred.
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INTEGRAL TO LEARNING
Brain growth rhythms Learning patterns Patterns
of listening, speaking, thinking Memory
patterns Movement patterns Emotional
patterns Social patterns
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PATTERNING

• The search for meaning occurs through
  patterning.
• A pattern is a configuration of relationships,
  a set or combination of things that seem to fit
  together.
• Whenever we try to figure out what something
  means, we search for patterns that make sense to
  us.
• Attentional and/or working memory dysfunction
  affects pattern recognition.

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PREDICTION ANTICIPATION PATTERN
RECOGNITION
Pay attn to figure out something
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ABSOLUTE GIVENS
If the child does not perceive a pattern, the
child cannot anticipate! If the child does not
perceive a pattern, the child cannot predict! If
the child does not predict, the child cannot
effectively problem solve!
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LANGUAGE INNATELY DISCOVERABLE
Our brains are mapped to learn the
language experienced during our early years. Our
brains becomes neurally committed
The critical period for language learning depends
on experience time.
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How the young child processes information
affects the rapidity with which he
develops speech and language. The integrity
of his auditory-verbal development may be
compromised.
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Good EF processes facilitate rapid language
learning
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LANGUAGE LEARNING Children figure out
patterns. Based on those patterns, they
anticipate and predict. Language learning
involves problem solving. Language acquisition -
based on statistical learning the brain learns
in a computational manner influenced by
experiences (genetic, neurobiological,
environmental)
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FACILITATION CAN HAVE RECIPROCAL EFFECTS
Language
Executive Capacities
Language
Executive Capacities
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• EXECUTIVE CAPACITIES
• Needed for multi-tasking
• and other advanced cognitive tasks.
• Examples of multi-tasking
• listening while doing puzzle, taking notes.
• chanting while clapping, showering.
• watching TV while tying shoes, reading papers.
• singing a la ronde, while listening to another.
• talking while driving a toy or real car.
• thinking while drawing or writing.
• Executive deficits associated w/ LDs, ADHD.

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IB. DYSFUNCTIONAL EXECUTIVE PROCESSES
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Some children without diagnosed
atypicalities seem genetically predisposed to
certain executive dysfunctions, including
attentional working memory dysfunctions. Childr
en with hearing loss are no less immune to
executive dysfunctions. Perhaps they are more
at-risk for executive dysfunctions.
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There is evidence that the AV option provides
viable intervention for many children w/ HL.
Some children demonstrate rapid
progress. Rhoades, 2010
DILEMMA Some children w/ HL do not attain
typical rates of growth in listening and spoken
language.
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SPOKEN LANGUAGE DIFFERENCES Even w/ effective
hearing prostheses AV intervention, many
children w/ HL continue to struggle with dvlping
effective listening /or spoken
language. UNEXPLAINED VARIANCES (Musselman
Kircaali-Iftar, 1999)
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IC. CHILDREN w/ HL LEARNING DIFFERENCES
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MEDICAL-EDUCATIONAL DIFFERENCES
Up to 40 of children w/ HL also diagnosed w/
co-existing special needs LD, ADHD, ASD, CP, MD,
APD, ED, BD, AN/AD, blindness, Down/Usher et al
syndromes (Physical-Neurological-Developmental
Issues) Multiply Challenged Learners Children
w/ Complex Needs
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NEUROBIOLOGICAL DIFFERENCES
Unused sensory neurons are reorganized to
subserve another sensory system. Auditory
deprivation/stimulation results in cortical
re-organization. This affects how the brain
processes information and how the information is
acted upon. Hearing loss of any severity and
for any significant period of time implies
vulnerability for learning differences.
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LISTENING DIFFERENCES
Atypical access to sound/spoken language Atypical
auditory peripheral system Atypical central
auditory system Atypical auditory temporal
processing Atypical auditory evoked potentials
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COGNITIVE DIFFERENCES

• Some children with HL persistently demonstrate
  differences in executive capacities nonverbal
  tasks
• Delayed or different problem solving skills
• More concrete, literal
• Deficits in attn, working memory, impulse
  control, inhibition, cognitive flexibility,
  planning, verbal creativity

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SOFT NEUROLOGICAL DIFFERENCES
non-focal abnormalities often associated
with behavioral, motoric, and learning
difficulties difficult to diagnose possible
contributing factor for persistent communication
delays/disorders e.g., sensory processing
disorders.

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SENSORY PROCESSING DISORDERS
70-78 of children w/ HL in AV intervention
programs are identified w/ sensory integration
dysfunctions.
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VESTIBULAR DISORDERS
30-70 of children w/ HL have vestibular/balance
disorders.
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MOTORIC DYSFUNCTIONS

• Observed in some children w/ HL
• Motor control deficits
• Motor planning deficits
• Visual-motor differences
• Motor perceptual deficits
• Movement coordination disorder

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VISUAL DIFFERENCES

• Differences in
• visual attn
• visual-motor integration
• visual spatial memory
• peripheral distractions
• visual temporal processing

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NEURODEVELOPMENTAL WARNING SIGNS IN BABIES
When month-by-month developmental milestones are
delayed or seem dysfunctional.
Hypotonia, hypertonia? (muscle tone - resistance
of muscle to stretching)
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RED-FLAGS

• the child w/ syndromic deafness
• the child born prematurely
• the child w/ birth trauma
• the child w/ atypical reflex history
• the child w/ atypical postnatal conditions
• the child w/ delayed developmental milestones
• the child w/ a bacterial or viral cause of
  deafness
• (CMV, rubella, meningitis)
• the child w/ a history of repeated OME

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AND

• the child w/ APD or PDD
• the child w/ AN/AD
• the child w/ difficulties in memory, following
  directions
• the child w/ difficulty completing activity
  within specified period of time
• the child w/ difficulty speaking rhythmically
• the child who cannot seem to keep a consistent
  beat
• the child who seems unable to independently
  develop problem-solving strategies, e.g., putting
  together puzzles
• the child who has difficulty independently
  figuring out word meaning
• the child w/ difficulty catching or throwing
• the child struggling in AVT, in spite of
  consistent use of effective hearing prostheses

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• LEARNING DIFFERENCES
• IRRESPECTIVE OF HL SEVERITY
• Auditory temporal processing differences
• Cognitive delays or executive differences
• Adversely affected by noisy environs
• Language delays or disorders
• Academic or social difficulties

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NEURAL DYS-SYNCHRONY
For some people, the clock gets out of
whack very early in development. Though they
appear to make up for the loss of synchrony and
progress through life normally, their ability to
function easily and fluently in specific areas
may be impaired. The brain and the body do not
always work in perfect unison.
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Diagnosing these soft signs can be very
difficult to distinguish from the typical
language deficits often experienced by young
children w/ HL. Why wait until the children are
older for explanatory factors? ASSUME
DIFFERENTIAL LEARNING. ASSUME DYSFUNCTIONAL
EXECUTIVE PROCESSES.
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Course Objective 2
NEUROBIOLOGICAL EVIDENCE FOR LEARNING
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NEUROBIOLOGICAL AXIOM When one part of a brain
is impacted, all parts of that brain are
impacted. THE INTERCONNECTEDNESS OF BEING
The body, brain, and mind form a single
interactive unity in which everything is
interconnected in multiple ways the unity of
being.
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BRAIN ORGANIZATION
Language is too complex to be broken down into
discrete cortical areas. Language is likely
located all over the brain, with extensive cross
talk between areas.
When one part of the unity is dysfunctional, it
influences how other parts function. We cannot
isolate one part and fix it without
influencing many other parts.
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IIA. AUDITORY-VERBAL LEARNING
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AUDITORY LEARNING (listening as an active
process)
Focused listening alters the brains neural
activity (physiological plasticity). Auditory
experiences change the central auditory system
new neural patterns are established. Auditory
learning includes enhancement of both top-down
cognitive processing and bottom-up sensory
processing
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Listening can be enhanced.
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VERBAL LEARNING (spoken language knowledge
use)
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Spoken language can be enhanced.
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IIB. MOTOR LEARNING
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MOVEMENT MATTERS
Action gives rise to dvlpmtl change. Exercise
causes neuron formation (neurogenesis). Movement
the door to learning facilitates attn memory
dvlpmt. (beyond the speech act)
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MOVEMENT
Motor repetitions are building blocks for
learning this must be practiced and integrated
w/ other systems. Movemt is young childs main
vocabulary. As the body goes, so goes the
brain. The body grows the brain.
The physical body is at the very core of
learning. Give the child a daily sensory
diet. HOOK UP THE BRAIN TO THE MUSCLES. (movemt
beyond the speech act)
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MOTOR LEARNING

• linked to body rhythms/internal timing
• associated with motor competence/coordination
• generates sustains neuronal growth
• enhances vestibular functioning
• improves rate of learning
• Motor coordination associated with
• some executive capacities, working memory,
  spatial
• learning, processing speed, perception of aud
  rhythms
• social academic functioning
• spoken language

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COMMON KNOWLEDGE
Dont containerize the infant/toddler. Child
needs room to explore move. Get him out of
the bouncing seat, stroller, swing, infant seat,
playpen. Encourage physical play.
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BODY-BASED INTERVENTION
Movement facilitates A calm alert state
whereby the child is attentive and able to
self-regulate. State of readiness for learning
and social engagement.
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Movement can be enhanced.
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IIC. RHYTHMIC LEARNING
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RHYTHMICITY OF LIFE
We are conceived in repetitive rhythm. We are
slaves to the rhythms of life.
Internal Rhythmic Awareness
SYNCHRONY BETWEEN RHYTHMIC CYCLES CHARACTERIZES
OUR BIRTH AND OUR GROWTH
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BRAIN RHYTHMS Connection between rhythmicity
and brain function Rhythms assist the neural
networks in developing automaticity and
flexibility. Timing is critical for neuronal
dvlpmt. Brain rhythms provide the temporal
framework for all human behavior.
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RHYTHMIC LEARNING
(recurring at regular intervals
timing) temporal processing temporal
dynamics temporal coordination temporal
resolution perceptual timing temporal binding
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TIMING

• Rhythmicity is an essential element of
• auditory attention
• memory systems
• spoken language
• motoric functioning
• executive functioning
• sensorimotor functioning
• academic learning
• perceptual expertise/integration
• auditory-verbal development
• social interactions
• memory systems

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ARRHYTHMIC CHILDREN (lacking a steady rhythm
irregular beat)
Atypical rhythmic motor responses ADHD,
LD Dysfluent speech some kids w/ HL Strong
evidence for substantial benefits of rhythmic
stimuli in therapeutic intervention for kids w/
motor dysfunctions.
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Rhythmicity can be enhanced.
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IID. CROSS-MODAL LEARNING
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LANGUAGE-ACTION SYNCHRONY
Say what you do at the time you do it. Say what
the child does at the time he does it. Say
appropriate sd/word at time of movemt. (recommend
ed A-V strategy)
TALK THE WALK. WALK THE TALK.
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INTERSENSORY REDUNDANCY
Amodal information (e.g., texture, rhythm,
tempo, intensity) not specific to one sensory
modality Obtaining synchronous
information from more than one sense promotes
further differentiation of event
properties. Perceptual sensitivity to amodal
information occurs during early
infancy, subsequently impacting on unimodal
learning attnal selectivity.
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MULTISENSORY CONVERGENCE
Multi-modal information (multiple sensory
modalities) Infant integrates
info facilitates auditory processing
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ALL GROWTH IS INTERRELATED Language should not
be considered in isolation. Each aspect of the
childs development affects other aspects of his
development. When everything works
well, language develops as rapidly as possible.
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CROSS-MODAL LEARNING
INTEGRATION the act of combining into an
integral whole. SYNERGISTIC neurons work
together, so that the total effect is greater
than the sum of the two (or more). Synergistic
Integration Sensory systems should work
synergistically.
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AUDITORY-MOTOR LEARNING
Motion is the childs first language. Sensation
is his second.

• Dvlpmtl domains involve more than one sensory
  system.
• Speech perception typically involves
  integration of
• auditory-motoric-visual processes.
• When motion sensation are integrated,
  spoken
• language-reading-writing develop fluently.
• Cross-modal learning typically improves with age.
• Cross-modal learning can strengthen a sensory
  deficit.

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MOVEMENT LANGUAGE
Neural underpinnings link lang to action
MNS (mirror neurons fire when we watch others
actions) Motor dvlpmt spoken lang
acquisition entwined processes sharing common
cortical systems. Action gives rise to dvlpmtl
change. Integral to brain functioning is
coordination dynamics. Sound/aud perception
movemt can be bound into single coherent
unit. Movement facilitates more rapid A-V
growth. Action-oriented language is
king. Language is body-based. Movement helps
unlock A-V potential.
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SOME CROSS-MODAL TREATMENT APPROACHES
NeuroNet
Integrated Listening Systems
Interactive Metronome
CROSS PERCEPTUAL TRAINING
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Cross-modal integration should be
enhanced. Integrated rhythms/synchronicity should
occur. Attn, working memory, self-regulation,
meta-cognition (executive processes) should be
facilitated. The child should become an
independent learner the child should learn how
to learn. Language patterns/rules should be
discovered by the child.
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IIE. SYNCHRONICITY IN LEARNING
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SYNCHRONIZATION (ON-THE-BEAT COORDINATION)
Synchrony simultaneous occurrence e.g., neuronal
firing e.g., movement w/ sound. (of a temporal
nature that has to do with patterning)
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RATIONALE SYNCHRONOUS CROSS-MODAL LEARNING
the more synchronized the neuronal networks
across sensory modalities, the more advantageous
it is for selective attn, memory formation,
decision-making spoken language bodily
movemt can be bound into a single coherent unit,
just as motor dvlpmt spoken language
acquisition are entwined processes in the sharing
of common cortical systems
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Cross-modal synchrony can be enhanced.
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Evidence strongly suggests that auditory-based
repetitive, rhythmic cross-modal learning can
facilitate automaticity flexibility in the
learning process.
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COGNITIVELY-LOADED ACTIVITIES Thinking while lis
tening, talking, and moving rhythmically synchrono
usly
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REPETITIVERHYTHMICSYNCHRONOUS MULTI-TASKING
ACROSS DIVERSE FAMILIES DIVERSE
CONTEXTS DIVERSE LANGUAGES
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PROGRAM RESOURCES
2010 lack of controlled studies, but much
anecdotal evidence coupled with case studies
exists. All observe significant improvmts in attn
learning. All involve synchronous aud-based
cross-modal rhythms. Similar findings reported
by following programs
NeuroNet (relies on childs hearing
prosthesis) Integrated Listening Systems
(Tomatis/music/sd equipmt) Interactive Metronome
(sd equipmt)
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Course Objective 3
SYNCHRONOUS CROSS-MODAL AUDITORY
RHYTHMIC ACTIVITIES
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SHORT COURSE GOAL Integrate these
activities into an auditory-verbal program for
young children (0-5 yr).
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Special thanks to Nancy Rowe, founder of
NeuroNet, for enlightening me to the
neurosciences and the need for children to
develop integrated auditory-motor
rhythms. Contact Ellen A. Rhoades
via www.AuditoryVerbalTraining.com
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SELECTED REFERENCES Dawson, P. Guare, R.
(2009). Smart but scattered. NY Guilford.
Dawson, P., Guare, R. (2003). Executive
skills in children and adolescents A practical
guide to assessment and intervention. NY
Guilford. Edwards, L., Crocker, S. (2008).
Psychological processes in deaf children with
complex needs. London Jessica Kingsley. Meltzer,
L. (2009). Executive functions in education. NY
Guilford. (MORE TO BE ADDED)