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LESSON 76

Auditory skills hierarchy

Year 1
Spring semester
Speech and Language Development
Speech and language
Duration: 10:02

In this lesson we look at Erber's auditory skills hierarchy: detection, discrimination, identification and comprehension. We discuss sample activities for each level, ways to adjust difficulty, and how the levels are used in rehabilitation goals.

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Hello, and welcome to the AIHEAR Audiology Academy.
In this lesson we will learn the levels of auditory skills from detection to comprehension, known as the auditory skills hierarchy.
We will see sample activities for each level and how these levels are used in rehabilitation goals.
Hearing a sound is necessary for understanding it, but it is not enough.
Children who have just begun receiving sound through hearing aids or implants learn, step by step, to make sense of what they hear.
Norman Erber described this process in levels in his book on auditory training, published in nineteen eighty two.
These levels are detection, discrimination, identification and comprehension; difficulty increases at each level.
The levels are not a rigid ladder; a child may be at a higher level for one skill and at a lower level for another.
The hierarchy is used not only with children but also with adults who regain sound through an implant or hearing aid.
Detection is perceiving whether a sound is present or not.
Discrimination is being able to say whether two sounds are the same or different.
Identification is naming, repeating or pointing to the sound or word heard from a set of choices.
Comprehension is grasping the meaning of what is heard and responding to it appropriately.
Each level builds on the one before: an undetected sound cannot be discriminated, and undiscriminated sounds cannot be identified.
But comprehension does not require every sound to be identified one by one; context and grammar can fill the gaps.
At the detection level, the child is only expected to respond to the presence of sound.
The child is taught to drop a block into a box on hearing the sound; this is called a conditioned response.
This follows the same logic as play audiometry in audiology; threshold measurement is in fact a detection task.
With the Ling six sounds, you can quickly check each day whether the child detects speech sounds from low to high frequencies.
Games such as dancing while music plays and stopping when it ends also build attention to the presence and absence of sound.
Drawing attention to everyday sounds such as the doorbell, the phone or a dog barking is also a natural part of this level.
At the discrimination level, the child decides whether two sounds are the same or different.
Work starts with sounds that are very different from each other.
For example, a long sound and a short sound, a loud and a soft sound, or one syllable and three syllables are compared.
An airplane is a long aaa, a bee is a choppy bzz bzz; the sounds differ in duration and rhythm.
As the child progresses, the differences are made finer: first different vowels, then syllables differing in only one consonant.
Discrimination does not require knowing the name of the sound; perceiving the difference is enough.
At the identification level, the child chooses the sound or word heard from a given set of choices; this is called a closed set.
For example, with three pictures in front of them, the child points to the picture of the word heard or repeats the word.
If the choices are few and different, the task is easy; words with different syllable counts, such as banana and ball, are an example.
As the choices grow in number and become more alike, the task gets harder, as with cat and hat.
When the child is asked to say what they heard without choices, the task moves to an open set and takes its hardest form.
Word recognition tests in speech audiometry also measure this level.
At the comprehension level, the child is expected to act on the meaning of what is heard; repeating it is not enough.
Carrying out a direction such as bring your shoes is an example of this level.
Answering questions such as how old is this or what color is this in a meaningful way also shows comprehension.
At the highest level, the child listens to a story, answers questions and joins in conversation.
Comprehension also draws on grammar and context, so the child can understand a sentence without identifying every sound.
The same skills are then practiced in noise, at a distance and without seeing the speaker's face.
Let us follow the levels through a single word: ball.
At the detection level, the child only shows that a sound was heard; in discrimination, says ball and a long airplane sound are different.
At the identification level, the child points to the ball among three pictures or repeats the word.
At the comprehension level, when told put the ball in the basket, the child picks up the ball and puts it in the basket.
As the levels progress, the same word becomes part of a harder task.
So it is possible to work on many levels with the same toys and pictures, just by changing the task.
At each level, difficulty can be adjusted in several ways; the first is the stimulus: sounds, syllables, words, sentences and conversation.
The second is set size: we move from a closed set with few choices toward an open set.
The third is the setting: work starts in a quiet room, and background noise is added later.
The fourth is distance: the speaker stands close at first, then further away.
The fifth is visual cues: at first the face is visible, then only hearing is used.
The sixth is context: we move from a familiar topic to unexpected and new topics.
Erber suggests thinking of the levels and stimulus types together as a grid; each cell can be a separate training goal.
At the start of rehabilitation, we assess which level the child is at for each skill.
A goal names the level, stimulus and conditions; for example, identification in quiet, without lipreading, from three choices.
When the goal counts as achieved is written in advance as a measurable success criterion.
Once a goal is achieved, one of the conditions is made harder, so progress continues in small, trackable steps.
In the auditory sandwich, often used in auditory-verbal practice, speech is first given through listening alone.
If the child does not understand, visual support is added, and then the speech is presented again through listening alone.
If a child no longer detects sounds they detected before, first check that the hearing aid or implant is working and worn correctly.
If the child keeps confusing certain sounds, we check whether those sounds are really audible with the device.
For example, if s and sh are confused, audibility in the high frequencies and the device settings can be reviewed.
So device fitting and auditory training are not separate; they are two processes run together by the same team.
By turning daily routines into listening opportunities, the family becomes the most important partner in training.
The family's observations at home, such as which sounds the child turns to, also help show which level the child is at.
A tip from the clinic: if a child detects two sounds but cannot tell them apart, do not assume the problem is just a lack of training.
First use the Ling sounds and a device check to see whether those sounds are audible enough with the device.
If audibility is insufficient, the fitting is reviewed before training and, if needed, verified with real-ear measurement.
If audibility is sufficient, that sound pair is addressed with targeted work at the discrimination level.
Erber's hierarchy consists of the levels of detection, discrimination, identification and comprehension.
At the identification level, we move from a closed set toward an open set.
At each level, difficulty is adjusted through the stimulus, set size, setting, distance, visual cues and context.
Rehabilitation goals are written in a measurable way for each level and are followed together with the device fitting.
Test yourself: a child points to the picture of the word they heard among three pictures. Which level are they working at?
The correct answer is C: identification.
The child finds the word heard among a set of choices; this is a closed-set identification task.
In the next lesson we will see why these skills need to be gained early in life: critical periods and neuroplasticity.
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Prerequisites

LESSON 75 Language milestones

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