Effects of Auditory Integration Training and Acoupedic Therapy on Word Recognition of Children with Hearing Impairment

Abstract

This study examined the effectiveness of auditory integration training and acoupedic therapy on word recognition among children with hearing impairment. Thirty three children between five and ten years old participated in this study. All the participants had Pre-Lingual and Post-Lingual hearing impairment with degree of hearing loss ranging from mild, moderate, severe to profound. All the children had their hearing loss confirmed through audiometric test and they were fitted with hearing aids. The instruments used consisted of Macro 53 brand of audiometer calibrated on ISO-13485:2008, word recognition test adapted from Betts (1946) with reliability of 0.89 for pre and post tests and case history of the participants. Data collected were coded and analysed using Analysis of Co-variance using SPSS version 17. The results revealed that Auditory Integration Training and Acoupedic therapy had significant effects on word recognition among the participants and that Auditory Integration Training was more effective on word recognition among children with hearing impairment. Also, there were significant main effects of degree and onset of hearing loss on participants' word recognition. It was recommended that early intervention in the form of Auditory Integration Training and Acoupedic Therapy should be adopted.

Full text

African Journal of Special and Inclusive Education Vol. 2 No. 1 (2017) 31-39
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Effects of Auditory Integration Training and Acoupedic Therapy on Word Recognition of Children with
Hearing Impairment
Ayo Osisanya
University of Ibadan
ayoosisanya@gmail.com
Samuel O. Adeniyi
University of Lagos
safeadeniyi@yahoo.com/soadeniyi@unilag.edu.ng
Folarin O. Olubukola
University of Ibadan
Abstract
This study examined the effectiveness of auditory integration training and acoupedic therapy on word
recognition among children with hearing impairment. Thirty three children between five and ten years old
participated in this study. All the participants had Pre-Lingual and Post-Lingual hearing impairment with
degree of hearing loss ranging from mild, moderate, severe to profound. All the children had their hearing loss
confirmed through audiometric test and they were fitted with hearing aids. The instruments used consisted of
Macro 53 brand of audiometer calibrated on ISO-13485:2008, word recognition test adapted from Betts (1946)
with reliability of 0.89 for pre and post tests and case history of the participants. Data collected were coded and
analysed using Analysis of Co-variance using SPSS version 17. The results revealed that Auditory Integration
Training and Acoupedic therapy had significant effects on word recognition among the participants and that
Auditory Integration Training was more effective on word recognition among children with hearing
impairment. Also, there were significant main effects of degree and onset of hearing loss on participants’ word
recognition. It was recommended that early intervention in the form of Auditory Integration Training and
Acoupedic Therapy should be adopted.
Introduction
Hearing and speaking are very vital to a
language-rich environment without which no man
can adjust to a speaking and hearing community.
The ability to acquire language and speak
effectively are dependent on the level and degree to
which the complicated hearing system can
successfully process acoustic information.
Obviously, verbal language development,
perception and effective usage are strongly related
to the pathologically free auditory sense organ
(Shojaei, Jafari & Gholami, 2016). The organ of
hearing is most needful for about 70% of daily
activities of men. Information is gathered and
adequate responses are made because one hears and
can interpret all auditory signals. Children generally
are born with inner capacity for language
development and acquisition of vocabulary with a
certain degree of variance due to level of
intelligence and some environmental factors (Deaf
Children Australia, 2012). However, the
development of qualitative speech rests
fundamentally on good sense of hearing. Therefore,
it is well-recognized that hearing is critical and
important to speech and language development,
communication, learning, and social activities
(World Health Organization, 2015; American
Speech-Learning-Hearing Association, 2015).
Sometimes, children and adults may lack the
development and production of qualitative speech
and language because of the degree of hearing loss
and pathology to the auditory system, which impede
processing of the surrounding information
adequately. Hearing loss is common and can affect
any age. Hearing loss, according to Majid and Saif (
2011) and the World Health Organization (2016), is
a loss of hearing in one or both ears ranging from
mild, moderate, severe to profound, causing
communication difficulty, social isolation, poor
language development, low self-esteem, and
academic underachievement, which leads to lower

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job performance and fewer employment
opportunities in later life. Therefore, the presence of
hearing loss, even to a mild extent, has negative
effect on speech and language development in
children with hearing impairment and also delays
social, academic, and emotional abilities (Shojaei,
Jafari, & Gholami, 2016; Yuhan, 2013). According
to the World Health Organization (2016), about 360
million people, 5% of the world population, live
with substantial hearing loss and 32 million are
children, with the highest prevalence in low and
middle income countries. With this rate in the
developing world, the multiplying effects may be
catastrophic with immediate effect on economic
development.
While the most obvious impact of childhood
hearing loss is on language acquisition (World
Health Organization, 2016), the presence of hearing
loss at this critical period of language development
causes disorders in speech development, acoustic
processing and language synthetic representation,
morphology, and pragmatic application of language
(Shojaei, Jafari, & Gholami 2016; World Health
Organization, 2016). Whenever occasions like these
happen to adults or children, difficulties in
communication may result in feelings of anger,
stress, loneliness, and emotional and psychological
trauma, which may have profound consequences on
the total wellbeing of individuals.
Hearing loss or impairment occurs differently
and in varying degrees among people. Some
individuals experience hearing loss at birth. Hearing
loss of this type is called congenital loss while
others experience it after acquisition of meaningful
speech or later in life (i.e., adventitious or acquired).
These different kinds of losses occur in degrees
ranging from slight, mild, moderate, and severe to
profound as may be revealed by audiometric test.
The occurrence and prevalence of different kinds of
loss in whatever degree affect the total development
and wellbeing of the affected person.
Mild to moderate hearing loss corresponds with
an average hearing loss in the range of 21-70
decibels (Delage & Tuller, 2007). According to
Hillier (2012) and Delage and Tuller (2007), mild to
moderate sensorineural hearing loss has been
associated with deficiencies in frequency
discrimination and expressive language production,
which has both typical and atypical components.
Sometimes children with hearing loss attend regular
schools with some extra supports. This creates a
misconception concerning persons with mild to
moderate hearing loss because parents, educators,
and other professionals may conclude that
somebody with this hearing loss may not be
experiencing any major difficulties. Hence, this
assumption may cause deficiencies and delays in
the development of linguistic and social skills
(Briscoe & Bishop, 2001; Hillier, 2012). It must be
noted further that even minimal hearing loss places
children or any affected person at a disadvantage of
language development, learning problems, and
distortion of auditory information. Overall, the
adverse effect of hearing loss, whether congenital or
adventitious, mild or profound, is poor language
development, lack of auditory sensitivity, and
speech and language disorders, which may manifest
in distorted personality such as aggression and
somatization.
Studies by Gilbertson and Kamhi (1995),
Stelmachowicz, Pittman, Hoover and Lewis (2004)
and Hansson, Forsberg, Löfqvist, Mäki-Tokko and
Sahlen (2004) on language development of children
with mild-moderate hearing loss on learning words
revealed that a significant population of their
participants exhibited significantly poor
performance on most of the measures of
phonological processing and novel words learning
compared with those without hearing impairment.
By inference, if participants with mild to moderate
hearing loss demonstrated poor performance in
word recognition and learning, then individuals
with severe to profound hearing loss would perform
abysmally poorer in language learning. Therefore, if
speech and language are essential ingredients for
better life, identification of hearing loss and early
appropriate interventions are essential for normal
language acquisition in children with hearing
impairment who are lost in the world of language
(Ptok, 2011; Meinzan-Derr, Wiley & Choll, 2011).
Early identification of hearing loss and appropriate
interventions before the awareness of language can
increase the possibilities of normal speech and
language development in children with hearing
impairment (Olzinger, Felling & Bestel, 2011;
Pimperton & Kennedy, 2012). Early intervention
starts with hearing screening programmes for
infants and young children with the benefit of
identifying hearing loss at a very young age.
Research suggests that children, whether they are
born with or acquire deafness or hearing loss early
in life, who receive appropriate interventions within

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six months of age can perform and develop
language at the same rate with their hearing
counterparts (World Health Organization, 2016).
With this great revelation, detection and early
rehabilitation of children with hearing loss become
imperative to help children with hearing impairment
to enjoy the same academic and social benefits
other children derive from the community.
For proper language development, reception and
perception of acoustic stimuli are essential
prerequisites for pre-lingual activities. This must
take the dimension that will make individuals with
hearing impairment to be familiar with sound and
language of their environment as early as possible.
In Nigeria, so many measures have been taken to
reduce incidences of hearing loss and also improve
language acquisition of children with hearing
impairment especially among the school-going age.
However, sad enough, the issues of training in
language acquisition at an early age have suffered
neglect. It is therefore expedient to develop or adopt
interventions that will help infants and children to
be familiar with sound and language to facilitate
proper and adequate language acquisition and use.
According to Northern and Down (2000), an
appropriate intervention programme must include
assessment of degree of hearing loss, hearing aid
description and fitting, auditory training, language
learning, and educational strategies. Therefore, it is
expedient to employ programmes or training that
will aid language acquisition and auditory
experience for children with hearing impairment as
early as possible. Auditory Integration Training and
Acoupedic Therapy would be expedient because of
their potential to aid language acquisition and
proficiency among children with hearing
impairment. Auditory training and language
development involve comprehensive programmes
that may take the forms of Auditory Integration
Training and Acoupedic Therapy. These
intervention strategies introduce children with
hearing impairment to sound and words, which aid
their language initiation.
Auditory Integration Training has received
popularity in advanced countries of the world
especially in Canada. Auditory Integration Training
is based on the concept that electronically
modulated or filtered music provided through
headphones reduces hypersensitivities to sound
(Baranck, 2002). Auditory Integration Training as
developed by French otolaryngologist, Guy Berad,
and based on the work of his predecessor, Alfred
Tomatis, typically entails 20 half-hours session of
listening to specially modulated music over a 10 to
20 day period. This intervention strategy has been
reported to be efficacious on a number of
participants with deficits in auditory processing
ability and other complicated behavioural problems
as documented by research.
Auditory Integration Training involves
systematic procedures, which have to do with the
ability of the child to recognize speech sound,
environmental sounds, and ability to discriminate
between and among the sounds with the use of
hearing aid. This training engages the child in how
to pronounce sound words. It also helps with the
formation of perfect auditory discrimination. The
child or groups of children under this training are
active participants. Gerth, Barton, Engler, Heller,
Freides, and Blalock (1994) evaluated the
effectiveness of Auditory Integration Training on 10
children with auditory-based learning deficit and
reported great improvement among the participants
despite the absence of a control group. Also, in
related studies as reported by Geffner, Lucker,
Gordon and Distasio (1994), Huskey, Barnett and
Cimorelli (1994), and Rudy, Morgan and Shepard
(1994) on the effects of Auditory Integration
Training on children with auditory processing
deficit and central auditory processing dysfunction,
the results revealed great improvement in word
recognition and attention spans of the participants.
Acoupedic Therapy is a technique of teaching
children with hearing impairment to speak and learn
by developing intelligible speech through the
maximum development of listening skills.
Acoupedic Therapy teaches children to process
language through amplified residual hearing and
stresses an oral approach that eliminates visual cues.
This approach is based on only the use of audition
and early amplification with hearing aids, which is
widely known as unisensory or auditory-verbal
method (Osisanya, 2012). Aucopedic Therapy is
anchored on the following principles namely: early
detection, early fitting with binaural hearing aid,
unisensory input, a normal learning environment,
the use of auditory feedback mechanism,
developmental language approach, parents as first
models of communication, and no grouping with
other children with hearing impairment. According
to Moores (1996), reading and writing are
discouraged in the early years because they act as

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potential inhibitors to the development of oral skills.
Children with hearing impairment undergoing this
therapy only listen to the trainer on a one-on-one
basis. Group engagement is totally discouraged in
this approach. This method can only be effective in
training children with usable residual hearing but
may not work with children with severe to profound
hearing loss (Osisanya, 2012). Based on this
evidence, it appears Auditory Integration Training
and Aucopedic Therapy will aid development of
good listening skills and word recognition ability
among children with hearing impairment in Nigeria
though more research is still warranted. Therefore,
this study sought to explore the effectiveness of
Auditory Integration Training and Acoupedic
Therapy on word integration abilities of pupils
fitted with hearing aids. The study was guided by
the following research questions:
1. Does Auditory Integration Training and
Acoupedic Therapy have effect on word
recognition of children with hearing
impairment?
2. Does mild to severe hearing loss have
significant effects on word recognition of
children with hearing impairment?
3. Can onset of hearing loss significantly affect
word recognition of children with hearing
impairment?
Method
Participants and Sampling
The participants of the study consisted of 33
pupils with hearing impairment whose hearing loss
ranged from mild, moderate, severe to profound
hearing loss. The ages of the participants ranged
from five to ten years and they were already fitted
with hearing aids according to the degree of their
loss. The sample was purposefully selected based
on the pupils’ word recognition deficiencies and the
parental consent for the children to participate.
Design and Procedure
This study employed Pre-test Post-test, control
group quasi experimental research design. The
degree and onset of hearing loss was further
determined through case history and audiometric
examination. The participants were assessed by an
Audiologist in the department of Special Education
at the University of Ibadan using Micro 53 brand of
Audiometer. The degree of loss of each participant
was established. All participants were monolingual
and lived with their parents who were non-hearing
impaired. The brand of audiometer used for the
assessment of the participants’ level of hearing loss
was Micro53 calibrated on ISO-13485:2008. The
audiometer was in good condition before, during,
and after the assessment. The case histories of the
children were used to determine the actual age of
the children, onset of loss, and the status of the
parents. The word recognition test adapted from
Betts 1946 as used by Frye 2004 was used. The test
contains 10 words ranging from two to four letter
words with reliability of 0.89 using cronbach alpa.
Eleven children were assigned to each of the groups
with two experimental and one control groups. The
groups were pre-tested to ascertain the basis for
their word recognition disabilities. During the study,
the experimental groups were exposed to Auditory
Integration Training and Acoupedic Therapy while
the control group was taught with sign language and
facial cue for the eight weeks of the of the duration
of the study. After eight weeks of rigorous
activities, the three groups were post-tested to
determine the participants’ word recognition
abilities. Data collected were coded and analysed
using analysis of covariance with SPSS17 to test
significant effects of the treatments. The Duncan
post hoc analysis was further done to ascertain
significant difference between the treatments.
Results
Research Question 1
Does Auditory Integration Training and
Acoupedic Therapy have effect on word recognition
of children with hearing impairment? The result
from Table 1 showed that there was significant
main effect of treatment on participants’ word
recognition abilities (F(2, 30) = 138.59, P < 0.05, 72
= 0.32). This means that there was a significant
difference in the mean scores of the word
recognition abilities of the participants exposed to
Acoupedic Therapy and Auditory Integration
Training when compared with those in the control
group. Hence, research question one revealed
positive impact. It was therefore concluded that
Acoupedic Therapy and Auditory Integration
Training were effective in enhancing word

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Table 1
Summary of the Analysis of Co-Variance (ANCOVA) Posttest Word Recognition Abilities of Participants Based
on Degree of Hearing and Onset of Hearing Loss
Source
Type III sum
of squares
DF
Mean
square
F
Sig
Partial eta
squared
Corrected Model
.957a
2
0.479
9.392
0.001
0.385
Intercept
3.011
1
3.011
59.039
0.000
0.663
Protest
0.162
1
0.162
3.176
0.000
0.996
Trtgroup
14.135
2
7.068
138.588
0.001
0.321
Degree of HL
3.641
1
3.641
71.392
0.000
0.172
Onset of Loss
5.274
1
5.214
102.235
0.000
0.24
Trt group* DHL
1.52
2
0.76
14.902
0.000
0.503
Trt group* O of L
2.093
2
1.047
20.529
0.001
0.203
Error
1.528
30
0.051
Total
32.321
40
Corrected Total
2.485
45
R Squared = .385 (Adjusted R Squared = .344)
Table 2
Post-hoc Analysis Showing the Differences among the Treatment Groups
Trtgroup
N
Subset for alpha=0.05
1
2
3
Aucoupedics
II
15.420
AIT
II
18.032
Control
II
8.200
Sig.
1.000
1.000
1.000
Table 3
Post-hoc Analysis Table Showing the Significance Differences between the Treatment Groups
Variable
N
DF
Mean
Std Dev
T
P
Moderate, HL
9
16.21
7.52
31
8.73
0.027
Severe, HL
24
14.36
6.83

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Table 4
Post-hoc Analysis Showing the Difference in Pre and Post Ls in Response to Word Recognition Abilities
Variable
N
DF
Mean
SD
T
p
Pre Lingual
19
11.87
6.99
31
7.56
0.042
Post Lingual
14
13.74
8.24
recognition abilities of pupils fitted with hearing
aids. However, to ascertain the direction of the
differences and determine the magnitude of the
mean scores of the participants in each of the
experimental groups, Duncan Post-hoc analysis was
calculated and the results are presented in Table 2.
According to results presented in Table 2, there was
a significant difference in the post-hoc test mean
scores of word recognition abilities in Acoupedic
Therapy and Auditory integration training between
the experimental and control groups. Participants in
the Auditory integration training group (X
̅=18.03)
benefitted from the treatment better than those in
the Acoupedic Therapy (X
̅=15.42) and control
(X
̅=8.200) groups.
Research Question 2
Does mild to severe hearing loss have significant
effects on word recognition of children with hearing
impairment? The result from Table 1 showed that
degree of hearing loss (DHL) had effect on
participants’ word recognition abilities (F(2,30)=
71.39, P < 0.05, n2 = 0.17). This implies that there
was a significant difference in the mean scores of
word recognition abilities of participants with mild
and severe hearing loss when compared to each
other. However, to determine the magnitude of the
mean scores of participants with mild hearing loss
and severe hearing loss with respect to the treatment
protocols, the Duncan Post-hoc analysis was
calculated and the results are presented in Table 3.
The results in Table 3 revealed that the mean post-
hoc score of the participants with mild hearing loss
was 16.21 with a Standard Deviation score of 9.52
compared to participants with severe hearing loss
having the mean scores of 14.36 and a Standard
Deviation value of 9.83. This implies that
participants with mild hearing loss benefitted from
the treatment more than those with severe hearing
loss
Research Question 3
Can onset of hearing loss significantly affect
word recognition of children with hearing
impairment? The result from Table 1 showed that
there was effect of onset of loss on participants’
words recognition abilities (F(2, 30) = 102.24, p <
0.05, n2= 0.24). This means there was a significant
difference in the mean scores of word recognition
abilities of participants with Pre-lingual and post
lingual hearing impairment when compared with
each other. However, to determine the magnitude of
the mean scores of the participants with respect to
the treatment protocol, the Duncan post-hoc
analysis was calculated and presented in Table 4.
The result in Table 4 showed that the mean post-hoc
score of the participants with Pre-Lingual hearing
loss was 11.87 with a Standard Deviation score of
6.99 compared to participants with Post Lingual
hearing loss, having the mean scores of 13.74 and a
Standard Deviation value of 8.24. This means that
participants with Post Lingual hearing loss
benefitted from the treatment more than those with
Pre-Lingual hearing loss.
Discussion
The results revealed that there was significant
main effects of treatments on participants’ word
recognition abilities. This indicates that Auditory
Integration Training and Aucoupedic Therapy were
significantly effective on improving the word
recognition abilities of children with hearing
impairment. The result indicated that using
Auditory Integration Training and Acoupedic
Therapy as an early intervention strategy with
appropriate hearing aids for children with hearing
impairment will help them to develop language
appropriately like their hearing counterparts. The
result corroborated previous research (i.e., Gerthet
et al., 1994; Geffner et al., 1994; Huskey, et al.,

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1994; Rudy et al., 1994) that reported positive
impact of Auditory Integration Training in
improving auditory processing deficit, attention
deficit, and language development difficulty
experienced by children with hearing impairment.
The finding of Ugwuanyi and Adaka (2015) on the
effectiveness of Auditory Integration Training on
reading comprehension of children with hearing
impairment in Enugu State, Nigeria, is a welcome
development. The finding of this current study
revealed that Auditory Integration Training
improved the reading comprehension of the
participants within eight weeks of intensive
training. The implication of this result is that
locally, alternative strategies to improve language
acquisition of children with hearing loss have
started evolving and gaining recognition. The
effectiveness of Acoupedic Therapy on word
recognition abilities of children with hearing
impairment as revealed by this study is also another
breakthrough as its effectiveness can be highly felt
by children with usable or residual hearing as noted
by (Osisanya, 2012) though there is paucity of
research documenting the use of Acoupedic
Therapy locally. This means that if the two
approaches are effectively used by specialists,
language acquisition will be easy for children with
congenital and most profound hearing loss in
Nigeria where some of the affected children have
been facing language development difficulty.
Furthermore, the post-hoc analysis reveals that
Auditory Integration Training was more effective as
the Auditory Integration Training group (X
̅=18.03)
benefitted from the treatments compared to those in
Acoupedic Therapy (X
̅=15.42) and control
(X
̅=8.200) groups. The effectiveness of Auditory
Integration Training can be linked to the fact that
the trainees under the instruction of Auditory
Integration Training were actively involved in the
process of auditory and word initiation. The result is
in line with previous research (e.g., Huskey et al.,
1994; Rudy et al., 1994; Yencer, 1996; Zollweg,
Vance & Palm, 1997) reporting the efficacy of
Auditory Integration Training in word recognition
and attention span of their participants. Therefore,
the popularity of Auditory Integration Training is
based on the history of its effectiveness in
improving language development and reducing
attention deficit of pupils with hearing impairment.
Therefore, it will be of immense benefit for children
with hearing loss in Nigeria if this intervention
strategy is adopted early enough and implemented
by professionals. Language development, which has
become an onerous task for children with deafness
will become an easy and attainable task and will
give them the opportunity to be functional members
of the society at an early age.
The results also revealed that degree of hearing
loss has significant effect on word recognition of
children with hearing impairment. Participants with
mild and moderate hearing loss benefitted from the
treatment than those with severe hearing loss as
reflected in Table 3. The significant effects of
treatments on participants with mild-moderate
hearing loss can be attributed to the influence of
residual hearing, which could have affected their
word recognition abilities. This finding is in line
with Hansson et al.’s (2004) study of the word
learning abilities of children with mild-moderate
and severe hearing loss and language impairment
using Gilbertson and Kalmi’s (1995) method. Their
results revealed that children with mild and
moderate hearing loss performed better than
children with severe language impairment on word
learning, sentence comprehension, and reading
accuracy. This can be linked to efficient use of their
residual hearing fitted with hearing aids.
Finally, the results indicated that the onset of
hearing loss has significant effect (Pre and Post
Lingual hearing loss) on participants’ word
recognition abilities with the participants having
post lingual hearing loss demonstrating
improvement in word recognition abilities
compared to participants with pre-lingual hearing
loss. The gain derived from the treatment could be a
result of initial gains of language before the onset of
their hearing impairment. This means that children
with adventitious hearing loss of mild to moderate
degree can be helped to improve their hearing and
speaking well with early detection and intervention
by the use of Auditory Integration Training and
Acoupedics Therapy. The two interventions can be
another breakthrough in language training and
acquisition among children with hearing
impairment in Nigeria.
Recommendations and Conclusion
This study explored the effectiveness of
Auditory Integration Training and Acoupedic
Therapy on the word recognition abilities of
children with hearing impairment. The study is

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important because of language deficit experienced
by children with hearing impairment though many
strategies and efforts have been employed to
improve language development among children
with hearing impairment in Nigeria. Auditory
Integration Training and Acoupedic Therapy were
employed as intervention strategies for eight weeks
on two experimental groups. The intervention
proved very effective on word recognition among
participants with hearing impairment. Therefore,
early identification and intervention in form of
Auditory Integration Training and Acoupedics
Therapy will help children with hearing impairment
to develop language efficiently if the approaches are
appropriately employed.
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