Using The Ling Six Sound Test With Children With Hearing Loss
The Ling Six Sound Test is a quick check of a child’s cochlear implant and/or hearing aid is functioning. It should be completed each morning when the child puts on their hearing device(s), and possibly throughout the day. The tool is named after and based off the work of Daniel Ling, an audiologist and pioneer in the field of auditory-verbal therapy.
The Ling Six Sound Test has several purposes. In their book titled "Auditory Verbal Therapy: Science, Research, and Practice", Estabrooks et al. provide some important reasons for utilizing the check. It can be used to help predict the child's speech recognition of various features and at varying distances. It can also help to determine how well a child is hearing speech using various technology, such as remote microphones. Lastly, the Ling Six can alert parents, teachers, and therapists that a child's hearing may have changed. If a change in audition can be detected early, the audiologist may be able to modify the device quickly, to ensure the child's access to sound is the best that it can be for that child. Every day counts! The six Ling sounds are "ah" (as in talk), "oo" as in hoop, "ee” as in keep, “m” as in me, ”s” as in soup, and “sh” as in shop. These six sounds are included because they span the range of frequencies of spoken language, which is from 250-8000 Hertz. For children who are utilizing hearing devices in order to acquire spoken language, the ability to consistently detect the spectrum of sounds is critical. In the picture below, the Ling Six Sounds are plotted on an audiogram. The light curved shape represents the range of sounds used in conversational speech. As you can see, the Ling Six Sounds are scattered around the borders of that shape.
When completing the Ling Six Sound Test, a parent/guardian, teacher, audiologist, or therapist produces a Ling sound and waits for the child to repeat it, indicating that the child is able to hear that sound. The remaining five sounds are completed in the same manner. It is important that the child cannot read the lips of the adult during the check, and that the adult not present the sounds in the same order or rhythm every time. It is also important for the adult to produce the sound at a normal conversational volume without over exaggerating the sound, so that the acoustic properties of the sounds are not distorted. For older or more experienced listeners, this routine check takes less than a minute. If suddenly a child isn’t able to detect and/or repeat the sounds during a daily check, troubleshooting and/or follow up audiological management should be considered.
The ultimate goal of The Ling Six Sound Test is for the child to repeat the sounds as stated above. However, young children that are new listeners are not yet able to complete the Ling Six Sound Test in this way. Initially, parents and professionals target inputting the sounds, or providing the young child many opportunities to hear the sounds being presented in a more varied and interesting way, to see if the child responds to the sounds. This is done by using the sounds with more intonation, or with a sing-song voice. A child may show detection of a sound by turning their head, widening their eyes, looking around, stopping what they're doing (such as playing or sucking on a pacifier), raising their eyebrows, or blinking their eyes. Parents or professionals often pair the sounds with toys that are natural representations of the sound during play. Some examples of object/sound pairs are shown below.
For example, you might be playing with toy foods and pretend to take a bite of a cupcake before saying a prolonged "mmmm" with more intonation than you’d use when having an older more experienced listener repeat “mm” during a brief sound check. Similarly, you may be playing baby dolls and put a baby doll to sleep while saying, “shhhh.” This allows the child to hear the sound and attach meaning to it. As you can see, the Ling Six Sounds can easily be integrated in to familiar routines and play-based activities for young children.
Once a child is consistently detecting the sounds, he or she is ready to begin discriminating between sounds. As previously mentioned, this can also be targeted during play-based language activities. During play with a train, motorcycle, and plane, you might make the “ooooo” sound, point to your ear and say, ”I heard that! What says ‘oooo’?” and see if the child is able to indicate the train by pointing to it or picking it up. As speech develops, the child may imitate approximations of the sounds and later be able to repeat them as part of the Ling Six Sound Test each day. For older children that are beginning to use hearing technology, you may target these skills with a more structured activity, such as conditioned play audiometry (the child does something like put a bear in a cup each time they hear a sound) or pointing to picture cards. Eventually, the Ling Six Sound Test is not a therapy activity, but rather a brief check when a child puts on their cochlear implant(s) and/or hearing aid(s).
The Ling Six Sound Test is a free, low-tech, and readily available screening method to quickly check the functioning of hearing devices. By teaching the set of sounds from a very early age, the Ling Six will become a familiar and established routine throughout childhood that confirms a hearing device is providing needed benefit to the user throughout their day.
Estabrooks, Warren; Morrison, Helen McCaffrey, & Maclver-Lux, Karen. Auditory Verbal Therapy: Science, Research, and Practice. Plural Publishing, Inc., 2020.
Click HERE to download FREE Ling Six picture cards!