The approach to auditory rehabilitation between adults and children is different. For children, this type of service could be more considered "habilitative" compared to "rehabilitative." ""Rehabilitation" focuses on restoring a skill that is lost. In children, a skill may not be there in the first place, so it has to be taught..."[24] In trying to find specific services for children all depend on the child's stage in development. The age of the child; the age of onset of the hearing loss; the age when the hearing loss was identified; how severe the loss is and what type of hearing loss is present; what the extent of the hearing loss; and when the child was introduced to amplification devices all dictate what services will be needed during the child's development.
Communication modalities also influence what aural rehabilitation plan will be put into place for the child. As listed on Communication Options, there are many different language modalities used. This will impact the plan and how the parents interact with the child during therapy and at home. Having an onset hearing loss during childhood can be very debilitating for the child as they move into the speech and language developmental years.
In this type of training, activities that help increase awareness of sound, identifying sounds, sound discrimination, and attaching meanings to sound is focused on. This helps the child learn to distinguish one word from another using whatever residual hearing they have. Auditory perception also includes training in how to use hearing with assistive hearing devices and how to handle easy/difficult listening situations.
This involves developing skills in language understanding (reception) and language usage (expressive), all according to what developmental expectations the child is supposed to be hitting. This is where auditory perception can be more complex, focusing on concepts, vocabulary, word knowledge, what type of language to use in different social situations, narrative skills, how to express themselves through writing, understanding rules of grammar, among others.
This section of auditory perception training dives into deeper how to use visual cues that can help perceive a message meaning. This is done by focusing on the speaker's facial expression, body language, and the context/environment that the conversation is taking place in.
This most so involves getting the child to understand their specific hearing loss and how to build skills around it. Understanding that the child needs to develop assertiveness skills for different listening situations, handling communication breakdowns, and how to modify situations that make communication difficult will help push the child into situations and skills that will help them develop at a more "normal" rate.
Developing skills to help with the production of speech sounds by putting themselves into conversations and situations that will expose the child to use their expressive and receptive skills is another subset of auditory perception. In this type of training, the focus is on how the child produces speech sounds, what their voice quality sounds like, how quickly or slowly they speak, how well they can control their respiration, loudness, and their understanding of speech rhythms.
With children being fitted with hearing devices at younger ages, care and adjustment must be done by the family/caregivers. The children need to be a participant in the hearing aid care and management as much as possible. Through their developmental stages, they aim to be able to adjust their hearing aids on their own, clean them, troubleshoot the hearing aid, and eventually build up to being responsible for making appointments with their service providers.
The beginning of assessments starts with identifying what the patient is dealing with, whether this be tinnitus, Auditory Processing Disorder, or other types of hearing disabilities. The clinician in charge will ask questions regarding how the hearing loss is effecting communication, activities, participation, interactions with communication partners, and the overall quality of life. An assessment can be a one-time-thing or an ongoing process. The timing and frequency of testing depends on how the client's needs continue to evolve, their goals, and frequency of their device use during daily living.
Within the scope of audiologic rehab, there are three types of counseling:
Informational counseling - focuses on providing education to the person diagnosed with the hearing loss along with their family members/significant others. This helps those involved get a grasp on the disorder, what symptoms can appear because of it, prevention and wellness, and the rationale for specific treatment interventions.
Personal adjustment counseling - has a broad focus on the individuals psychological, social, and emotional understanding and acceptance of the hearing loss/related disorder.
Support groups - gives the individual a sense of community, a place to practice speech in noise, training with conversational partners, work on auditory stimulus and comprehension, and a place to discuss other concerns.
In the focus of the AR plan, it is important to inform and understand that children, students, and older adults have a battle with the environment around them. Understanding that those receiving services may need technology or techniques that help them in environmental factors they often struggle in. Finding the specific hearing needs that need to be met and supporting them through it will help the individual grow in language and communication skills.
Modifying seating arrangements within a classroom, office space, religious setting, etc., by reducing the distance from the listener and speaker will provide a bit of clarity to the individual with a hearing loss. Installing carpet, noise-reducing wall accessories, and limiting the amount of sound within rooms can help significantly as well. Making sure a room is well lit and the speaker is easily seen can help those training in speechreading be able to use their visual and auditory skills to stay focused on what is being said. Having rooms with visual alert systems can help get the attention of someone with a hearing loss without having to touch them. All of these are good examples of what can be done to help reduce distractions for an individual with a hearing loss.
Training covers a large variety of areas to help focus on maximizing communication skills in environments relevant to the person receiving services. These types of training services include family and significant others. Auditory training is a training technique used to enhance the individuals ability to interpret auditory experiences by figuring out ways to utilize the residual hearing of the individual. This approach can either be synthetic, analytic, or a combination of both.
Synthetic Approach
This approach focuses on the overall meaning of discourse (top-down processing, which "refers to the perception that is driven by cognition".[25])
Instead of focusing on the small details of speech, this approach focuses on segments of speech, words, phrases, sentences, or conversations.
Includes all areas of auditory comprehension
Pulls on the focus of analytic targets to use as functional practice that helps with addressing the use of strategies in real-world situations.
Analytic Approach
Uses the smallest linguistic features of acoustic cues (bottom-up processing, which refers to "processing sensory information as it is coming in".[25])
Uses phonemes or syllables as a main focus
Uses tasks progressing from easy to difficult to help train an individual how to be prepared for both quiet and noisy environments
Pragmatic Approach
Trains the listener to control their communication variables. This can include things like level of speech, signal-to-noise ratio, and the context or complexity of a message.