Younger Is Better

Time is everything. There is extraordinary data which shows that the younger a child is the more cortical real estate they have. In other words, the work we do early has a critical effect of what happens to a child. We know experience changes our brains. The video BRAIN POWER:From Neurons to Networks helps describe What happens to the brain. When we say that a child is like a sponge, we mean that they can absorb so much – everything we expose them to builds their brains.


At birth, a child’s brain has about 100 billion neurons. In addition, they have synapses which make important connections within a child’s brain. In fact, a child’s brain has more connections than the entire internet. Adult brain have about 300 trillion links. Children’s brains have a quadrillion connections – more than the internet.


But connections are not present at birth. For a child who is receiving appropriate stimulation, 700-1000 new synapses or connections are developed ever second. In other words, every time you talk to the child, make eye contact, make a child laugh, you are growing their brain. The early years (birth to 5) are most critical because child’s brain makes as many connections as possible during that time and then prunes the ones it does not need. The connections we pay most attention do will be strengthened. Those we do not pay attention to will be pruned.


Brain Plasticity

Brain plasticity is greatest in early years and decreases with age. Babies brains need loving caring relationships to develop and grow. Early language skills are the foundation for literacy. The more words a child hears, the more words she will have at age 3. The Hart and Risley study demonstrate that fact. Children who heard about 30,000 words in a 14 hour day as babies had a vocabulary of 1,116 words at age 3 while children who heard only 8,624 words in a 14 hour day as babies had a vocabulary of 525 words at age 3.


Implications for children with hearing loss

The implications of this are really clear. We do not have time to waste. We need to provide auditory stimulation early and consistently if we expect a child to be able to listen and talk. You do not learn to be a tennis player by going to art school. You do not learn to listen and talk by learning sign language. Let me be clear. I am not saying that sign language will not build a child’s brain. It will build the visual connections but it will not build the auditory connections. If the goal of the family is to have a child use listening and spoken language, the child needs to be exposed to listening and to speech and language early. A child with typical hearing learns one new word every 90 minutes. If our children are going to do that we need to be sure that they have sufficient language exposure to be sure their brains are developing. Listening vocabulary results in speaking, reading and writing. The better you hear, the better you learn. Phonemic awareness is a critical part of literacy. The better a child’s listening skills, the better their phonemic awareness, and the better their reading and writing skills. Our goal is to have children reading at age level by grade 3.


What exactly do they need to hear?

They need to hear clear speech and a lot of it. Muddy In – Muddy Out. Years ago, one of my early supervisors had us try and draw the child’s audiogram before we tested a child, We needed to be able to hear what phonemes they were missing by listening to their speech. Muddy in – muddy out was very clear to me. And this skill has stood me in very good stead as a pediatric audiologist. It has helped be determine what I needed to do to adjust hearing aid and cochlea implant settings to improve perception.


What can we do to build listening skills

  1. Be sure technology is working and that a child is hearing well enough to develop the auditory brain.
  2. Encourage the child to listen. Don’t use visual cues first. Start with auditory – talk to the child, point to your ear and help him focus on what is being said.
  3. Point out sounds around you. “Did you hear the doorbell? Who is there? Let’s go look.”
  4. Listen listen listen. Remember the auditory sandwich. Start by saying it. Maybe say it again. If the child does not understand, use visual cues (maybe pointing or having them watch your face. Once they get the message remember to repeat it with just auditory access so the child builds the auditory – language connection
  5. Talk Talk Talk. Talk about everything that is happening in the child’s life. This will build theory of mind. ‘Uh oh, you dropped your ice cream. We made a mess. What can we do? We can’t eat it. I bet you are sad. Do you feel sad that your ice cream dropped?
  6. Give kids a turn. Don’t always lead the discussion. Don’t act like you know what your child is asking. If he just points to the frig. “Yes, yes that’s the frig”. You may know he wants juice but act like you do not. He has to give a little more if he is going to get the juice. Early on the word “juice” is enough. As his language grows, we expect “I want juice” or at least “want juice.” If we fill in the blanks for him, he does not have the need to build his skills.
  7. Expand language. If a child says “more juice” we say, “Do you want more juice? Okay.” Just pour a little so he has to ask for more. Build the need for him to use language.
  8. Read Read Read. A minimum of 10 books a day for starters. Use books, not just to read the words but to talk about what is happening. When you are reading a familiar book, ask what is going to happen next. Suggest a possible alternative. Maybe papa bear does not open the door. As kids get older and can read for themselves, parents should continue to read to and with their children. Discussing books is one of the most wonderful ways to build listening and literacy skills and to develop social skills.
  9. Try and keep the environment quiet. Turn off TV, radio, dishwasher. Work on language in the environment that will provide the easiest access. Your child with hearing loss will have the opportunity to build skills in noise. Unfortunately there is no choice about that, but to provide the best language learning, do it in quiet.


Time is critical. Build auditory brain skills early – before auditory connections are pruned and we cannot build the skills.





About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 7 books, and written numerous books chapters and journal articles, and is a well known international lecturer.