Early Identification and Effective Intervention:

The Auditory-Verbal Approach

Kathryn Wilson, M.A., CCC-SLP, Cert.AVTSara Lake, B.A., J.D.February 20, 2004Washington, D.C

Presentation Topics Auditory-Verbal Philosophy Principles of the Auditory-Verbal Approach How A-VT Differs From Other Approaches,

Interventions, and Therapies Outcomes How to Access A-VT Services, Professional

Training & Certification Case Presentation

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.

Tori Fraternal twin Familial history of hearing loss Passed NHS Age at identification: 15 months First hearing aid fitting: 16 months Began AVT at 18 months Cochlear Implant at 4 years of age

Video: C.A. 8 yrs, 3 mo, 4 yrs post CI

Expected Results of NHS and Technological

Advances:

Average age of identification will decrease Greater access to information about all

communication approaches Number of families seeking A-VT will

increase Need for Certified Auditory-Verbal

Therapists will increase More children will develop spoken language

through the Auditory-Verbal approach

Principles of Auditory-Verbal Practice

Adapted from Pollack, D. (1985) & Ling, D. et.al (2003)

Aggressive Audiological Management

In an A-V approach: Pursuit of best amplification AVI Protocol for Audiological and

Hearing Aid Evaluation

Suggested Protocol for Audiological and Hearing Aid Evaluation Adapted from AVI, 2003

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

Appropriate Amplification Technology

Hearing Aids Cochlear Implants FM Systems

In an A-V approach Therapist must possess and apply in-

depth knowledge of speech acoustics

Favorable Auditory Learning Environments

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

“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

Integrating Talking and Listening into ALL Aspects of

Daily Life

In an A-V approach Audition is the primary sensory

modality Use of hearing for language acquisition is

unique to AVT Emphasis on auditory learning vs.

auditory training

Ongoing Assessment, Evaluation & Prognosis

In an A-V approach All therapy is DIAGNOSTIC An average or better than average

rate of progress is expected

Inclusion In Regular Schools

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

Parents and/or Principal Caregivers as Primary Teachers

In an A-V approach Parents actively participate in ALL

sessions The parent is the primary student

during therapy sessions The parent is the primary teacher in

day-to-day life

Integration of Speech, Language, Audition and Cognition

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 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

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) 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

How to Access A-V Services Auditory-Verbal International,Inc. (AVI)

A-V Therapy has been practiced by pioneers since the 1940s and 1950s

With more widespread early identification and improved technology, A-V Therapy is an option increasingly chosen by parents

Luetke-Stahlman & Moeller (1987) 90% of parents of children with hearing impairment are typically hearing individuals

How to Access A-V Services AVI is a worldwide membership

association and information clearinghouse regarding the Auditory-Verbal approach located in the Greater Washington, D.C. area

How to Access A-V Services AVI founded in 1987 by three

visionaries: Daniel Ling, Doreen Pollack & Helen Beebe who believed audition should be the primary sensory modality for the acquisition of language for most children with hearing impairment

How to Access A-V Services AVI offers a complete listing of all

Certified Auditory-Verbal Therapists as well as other practitioners in the approach; and

Information regarding the approach, membership & free literature as well as A-V publications

How to Access A-V Services

Through the AVI website, www.auditory-verbal.org

Or by contacting AVI at audiverb@aol.com or (703) 739-1049

Certification in A-V Therapy AVI administers an international

certification program in the A-V approach with certified professionals on 5 continents

Currently, Certified Auditory-Verbal Therapists in 33 of the United States

Certification in A-V Therapy International Certified Auditory-Verbal

Therapists are in Europe, China, the Middle East, the Far East and Latin America

Current certification standards and applications can be downloaded from the AVI website at: www.auditory-verbal.org/certification

Professional Training in A-VT Discipline of Auditory-Verbal Therapy

is a hybrid one; combines elements of audiology, speech-language pathology & education of the deaf

Also includes elements of other disciplines such as parent guidance, child development and technology

Approach also a highly practical one

Professional Training in A-VT

Proficiency in the approach involves both academic rigor and practical training

Professional Training in A-VT

Training Opportunities AVI Standardized Curriculum (2001)

& AVI Mentor Referral Service Refers professionals seeking A-V training to

certified professionals providing such training;

Part of mentorship can be accomplished through video observation and critique

Professional Training in A-VT

Auditory-Verbal Learning Institute (AVLI) Offering quality A-V Distance Education

products through an independent, yet AVI-affiliated institute

Products include CD-ROMs with lecture and A-V demonstrations, videos, parent kits and other A-V publications

Professional Training in A-VT

Auditory-Verbal Learning Institute (AVLI) 7205 N. Habana Ave. Tampa, FL

33614 Phone: (813) 932-5209 E-mail: clisenby@avli.org

Web: www.avli.org

Professional Training in A-VT AVI International Conferences

“Auditory-Verbal Techniques & Strategies: A

Professional Training” May 26, 2004 Como, Italy Cert.AVTs Judith Simser & Tina Olmstead Immediately prior to NHS2004

AVI Biennial International Conference Summer 2005 Toronto, Canada

Professional Training in A-VT Professional Training Weeks at

Auditory-Verbal Centers Auditory-Verbal Center of Atlanta (AVCA) Bolesta Center, Tampa, Florida Hear & Say Centre, Brisbane, Australia Learning to Listen Foundation, Toronto,

Canada

Professional Training in A-VT Auditory-Verbal specialization

at the Masters level (degree in audiology, SLP, education of the deaf) as part of the Ling Institute at the University of Ottawa in Canada

How to Access A-VT Services, Training & Certification Auditory-Verbal International, Inc.

2121 Eisenhower Avenue, Suite 402 Alexandria, VA 22314 USA (703) 739-1049 audiverb@aol.com

www.auditory-verbal.org

Case Presentation C.A. 17 months CI Age 6 months A-V Age: 11 months Age at Identification:

3 months Degree of H.L.

Profound Etiology: Genetic

Age at Implantation12 months

Hearing Aid UseConsistent use from 4 months of age

Device: Clarion Co-existing Conditions

None Educational Placement

At home with mother until age 5/mainstream kindergarten

Discussion The Principles of A-VT 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 two major differences in A-VT from other approaches.

Discussion Research supports the efficacy of the

Auditory-Verbal approach.

Information regarding the Auditory-Verbal approach, certification, and professional training is available through Auditory-Verbal International, Inc.

Conclusions Children identified early and

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

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

Questions?