All You Ever Wanted to Know About Auditory-

Verbal Therapy BUT Didn't Know Who to Ask!

Beth Walker, M.Ed., C.E.D., Cert. AVTKathryn Wilson, M.A., CCC-SLP, Cert.

AVTNovember 10, 2003

Agenda Auditory-Verbal Philosophy Principles of the Auditory-Verbal

Approach How AVT differs from other

approaches, interventions, and therapies

Outcomes Cases Resources

Auditory-Verbal PhilosophyAuditory-Verbal International, Inc. Position

Statement

The Auditory-Verbal philosophy is a logical and critical set of guiding principles. These principles outline the essential requirements needed to realize the expectation that young children who are deaf or hard of hearing can be educated to use even minimal amounts of amplified residual hearing.

Use of amplified residual hearing in turn permits children who are deaf or hard of hearing to learn to listen, process verbal language, and to speak.

The goal of Auditory-Verbal practice is that children who are deaf or hard of hearing can grow up in regular learning and living environments enabling them to become independent, participating, and contributing citizens in mainstream society.

The Auditory-Verbal philosophy supports the basic human right that children with all degrees of hearing impairment deserve an opportunity to develop the ability to listen and to use verbal communication within their family and community constellations.

Principles of Auditory-Verbal Practice

Adapted from Pollack, 1985

Principle 1 EARLY detection

and identification of infants, toddlers and children who are deaf or hard of hearing.

In an A-V approach Children may

begin therapy as infants

Areas Affected by the Child’s Hearing

Impairment Parent-Child Relationship Social, Emotional, and Cognitive

Development Critical Periods of Neurosensory

Development Acquisition and Use of Language

“At no time in a child’s life are the physical and acoustic conditions as favorable for listening as in early infancy.”

Daniel Ling, Ph.D

Principle 2 Aggressive

audiological management

In an A-V approach:

Pursuit of best amplification

Parents must be willing to make more trips to the audiologist

AVI Protocol for Audiological and Hearing Aid Evaluation

Suggested Protocol for Audiological and Hearing Aid Evaluation Adapted from AVI, 1989

Audiological Test Procedures Amplification Assessment Sound Field Aided Response Probe Microphone Measures FM Systems Frequency of Assessment Reports

Frequency of Assessment Every 90 days once dx is confirmed and

amplification fitted, until age 3. Complete aided and unaided audiogram at

least by age 2 New earmolds—90 day intervals or sooner—

until age 3-4 Ages 4-6; assessment every 6 months Age 6+; assessment and earmolds at 6-12

month intervals Immediate evaluation if changes are

suspected

Principle 3 Appropriate

amplification technology to achieve maximum benefits of learning through listening Hearing Aids Cochlear Implants FM Systems

In an A-V approach Therapist must

possess and apply in-depth knowledge of speech acoustics

Principle 4 Favorable

auditory learning environments for the acquisition of spoken language including individualized therapy

In an A-V approach All therapy is one-

to-one Sessions are

usually one time weekly for 1 hr. to 1 hr. 30 minutes.

Best conditions for verbal learning are provided

Principle #5 Integrating

listening into the child’s entire being so listening becomes a way of life

In an A-V approach Residual hearing is

emphasized rather than visual cues

Emphasis on auditory learning vs. auditory training

Use of hearing for language acquisition is unique to AVT

Principle 6 Ongoing

assessment, evaluation and prognosis of the development of audition, speech, language and cognition which are integral to the Auditory-Verbal experience

In an A-V approach All therapy is

DIAGNOSTIC An average or

better than average rate of progress is expected

Principle 7 Integration and

mainstreaming of the children who are deaf or hard of hearing into regular education classes to the fullest extent possible with appropriate support services

In an A-V approach Mainstream education

is a critical component Parents and AVT work

in partnership to secure appropriate services and placement

Similar expectations are established for children who are deaf/hh and those with normal hearing

Principles 8 & 9 Active participation of

parents in order to improve spoken communication between the child and family members

Affirmation of parents as primary models in helping the child learn to listen to his or her own voice, the voice of others, and the sounds of the environment

In an A-V approach Parents actively

participate in ALL sessions

The parent is the primary student during tx sessions

The parent is the primary teacher in day-to-day life

Principle 10 Integration of

speech, language, audition and cognition in response to the psychological, social and educational needs of the child and family

In an A-V approach The normal

developmental sequence is followed

Child’s hearing age serves as the baseline vs. chronological age

An Auditory-Verbal approach embraces ALL the Principles

Outcomes in Auditory-Verbal Therapy

Wray, Flexer & Saunders (1996) Followed 19 children, ranging in age from

kindergarten through 10th grade. 84% reading on grade level 44% reading above grade level 4 of the 19 were placed in gifted or honors classes 17 of the 19 were involved in activities related to

school, home, or church settings. 18 of the 19 used a personal FM system at school. At an early age, all were mainstreamed with hearing

children.

Outcomes in Auditory-Verbal Therapy

Robertson & Flexer (1998) Followed 54 school age children

81% Mainstreamed totally in the regular school

19% Mainstreamed partially 43% Read better than average hearing child 43% Read on the same level as the average

hearing child 9% Read below average 5% Did not provide reading skill information

Outcomes in Auditory-Verbal Therapy

Robertson & Flexer (1998) 43% Scored above grade average on

standardized testing

30% Scored at grade level

27% scored below grade level

Outcomes in Auditory-Verbal Therapy

Goldberg & Flexer (2001) Surveyed 114 graduates of A-V

programs in the U.S. & Canada 94% had severe-to-profound or profound

hearing loss

95% had hearing loss at birth or before 3 yrs. of age

Outcomes in Auditory-Verbal Therapy

Goldberg & Flexer (2001) (n=114) Average age of respondent = 28.9

years (range: 18 - 56 years)

66% were aided within 3 months of identification;

82% were aided within 6 months of identification

Outcomes in Auditory-Verbal Therapy

Goldberg & Flexer (2001) (n=114) 69% continue to use two hearing aids

All use hearing aids or a cochlear implant or both

1 had binaural cochlear implants

Outcomes in Auditory-Verbal Therapy

Goldberg & Flexer (2001) (n=114) Education

86% mainstreamed in elementary school 86% mainstreamed in middle or high

school 91% mainstreamed in their senior high

school year 78% attended a typical college or

university program

Outcomes in Auditory-Verbal Therapy

Goldberg & Flexer (2001) (n=114) Telephone Communication

78% reported making some use of voice telephone

62% reported using text telephones as well Employment History

44% reported being students or homemakers 41% reported incomes above $20K 8% reported incomes above $50K

Examples: teachers, attorney, physician, bank teller, janitor

Outcomes in Auditory-Verbal Therapy

Goldberg & Flexer (2001) (n=114) Overall Perceptions

76% reported being in the ‘hearing’ world 21% reported being in the ‘hearing’ and

‘deaf’ worlds 1 respondent reported being entirely in

the ‘deaf’ world

Discussion The Principles of AVT outline the

essential components for young children to develop intelligible spoken language through listening.

The role of audition in processing spoken language and parents as primary models are 2 major differences in AVT from other approaches.

Discussion Expected results of NHS and

technological advances: Average age of identification will decrease Number of children under the age of two

presenting for cochlear implant evaluations will increase

Number of families seeking AVT will increase Need for Certified Auditory-Verbal

Therapists will increase More children will develop spoken language

through the Auditory-Verbal approach

Conclusions Children identified early and

enrolled in Auditory-Verbal Therapy can acquire developmentally appropriate communication skills.

Auditory-Verbal Therapy is an appropriate intervention for newly identified infants, toddlers, and children whose parents have chosen spoken language as the desired communication outcome.

Auditory-Verbal International, Inc.

2121 Eisenhower Avenue #402Alexandria, VA 22314(703) 739-1049 Voice(703) 739-0874 TDDhttp://www.auditory-verbal.org/

Questions?