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Transcript of Facilitating spoken language development in the regular classroom September 28 th & 29 th Winnipeg,...
Facilitating spoken language development in
the regular classroom
September 28th & 29th
Winnipeg, MB
Petra Smith M.Sc. Aud (C)
Audiologist/Certified Auditory Verbal Therapist
AV PRINCIPLES AND THE AV SESSION
How the auditory verbal therapist works with the children, their
families and other professionals
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Auditory Verbal Services in Manitoba:
Located at the Central Speech & Hearing Clinic Audiology Services & Family Centered Intervention AVT for families with children using hearing aids or
cochlear implants Cochlear Implant Candidacy Evaluations & Device
Programming Aural rehabilitation for older students & adults with
cochlear implants Professional Development & Mentoring Education
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Auditory Verbal Therapy (AVT)
Who can deliver AVT?
Auditory Verbal Therapists are practising professionals in Speech & language Therapy, Audiology, or Education of the Deaf who have received specialised training
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Auditory Verbal Therapist – experience & training
SPEECH LANGUAGE PATHOLOGIST EDUCATOR of children who are deaf or hard of hearing AUDIOLOGIST
Certified by A G Bell:
Listening and Spoken Language Specialist
www.agbellacademy.org
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Standardized Curriculum for Trainee Therapists:
History & Philosophy Hearing & Audiology Spoken Language Development Parent Guidance Cochlear Implants Education in the mainstream Auditory Verbal Practice
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Auditory Verbal Therapy (AVT)
What is AVT?
An individualised, auditory, developmental programme, implemented by the child’s family in close collaboration with a therapist, with the goal of achieving age appropriate spoken language ability, and full social participation throughout childhood and beyond.
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Auditory Verbal Therapy..
…..is part of the Auditory Verbal Approach
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
THE AUDITORY VERBAL APPROACH
“The auditory verbal approach is a mindset of expectations” (Pam Talbot, AVT)
Hearing and audiology Parental involvement Spoken Language Development Education
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Ten Principles of AVT
Adapted from the principles developed by Doreen Pollack, 1970
Adapted by the A G Bell Academy for Listening & Spoken Language, 2006
www.agbellacademy.org
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle #1
“ Promote early diagnosis of hearing loss in newborns, infants, toddlers and children, followed by immediate audiologic management and auditory verbal therapy”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Hearing vs Listening(Flexer, 2005)
Hearing is acoustic access to the brain. It includes improving the signal to noise ratio by managing the environment and utilizing hearing technology.
Listening is attending to acoustic events with intentionality.
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Hearing loss
Hearing loss is not about the ears; it is about the brain.
Hearing aids, FM systems and cochlear implants are not about the ears; they are about the brain
(Flexer, 2005)
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Functional impact of hearing loss:distance hearing
Flexer 1999
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Functional impact of hearing loss: incidental learning
Flexer 1999
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Hearing loss = auditory deprivation
If caregivers want their child/ren to develop spoken language, early identification and optimal amplification =
“ a neurodevelopmental emergency” (Flexer, 2005)
..due to the impact of auditory deprivation
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Neuroplasticity
Greatest in the first three and a half years The younger the infant, the greater the
neuroplasticity Rapid infant brain growth requires prompt
intervention No sound = reorganization of brain to receive
other sensory information No sound reduces auditory neural capacity
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Typical Language Development Means..
Optimal use of the brain for skills human beings are pre-disposed to acquire – ie: spoken language
Best opportunity to achieve success in areas which must be taught – ie: reading
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Implications for Intervention
Developmental approach
…instead of….
Remedial approach
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Goal – at identification
Support families in making their decisions about:
Language of choice
Communication approaches
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Manual Oral
Sign SpokenLanguage Language(ASL) (English/French etc)
---------------------------------------------------------------------
Bi-bi Auditory Verbal
Signed Exact English Aural-oral
Total Communication Cued Speech
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV therapist offers
Time to reflect, question, feel, grieve Information – re: Technology Hearing Spoken language development General developmental issues Action – what to do! Contact with other families
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 2
“ Recommend immediate assessment and use of appropriate, state of the art hearing technology to obtain maximum benefits of auditory stimulation”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Amplification – improves quantity and quality of acoustic signal
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Good audiological support
Early identification of hearing loss
Accurate diagnosis
Optimal amplification
Early intervention
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Early amplification
Research shows that children who are identified with a hearing loss by six months of age, provided with optimal amplification and family based intervention, have the potential of entering kindergarten on a par with hearing peers.
Ref: Yoshinaga Itano
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Amplification
Hearing aids
Cochlear implants
All require optimal fitting to allow access to spoken language.
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
MicroLink Freedom for the BTE
Seamlessly integrated into the BTE case FM receiver can be left in place all the time
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 3
“ Guide & coach parents to help their child use hearing as the primary sense modality in developing spoken language without the use of sign language or emphasis on lipreading”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Is motivated
Has time and opportunity
Is attentive
A person who really listens
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Auditory Skills Development
The auditory verbal approach seeks to maximize the use of audition in the development of spoken language.
Levels of auditory skills:
detection -> discrimination -> COMPREHENSION
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Goals – infants & toddlers
Supporting families in hearing aid fitting and evaluation by:
Facilitating use of amplification all waking hours
Monitoring prelinguistic vocalizations Collaborating with audiologists -
comparing hearing tests with functional measures of benefit
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Assess, monitor & facilitate:
Auditory development: awareness of sound attaching meaning to sound vocalizations
Eye gaze & joint attention Development of natural gesture Play
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 4
“ Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized AV therapy.”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Parental Involvement
Parents are the child’s:
Primary language modelsFirst teacherPlaymateAdvocate
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Play as the engine of language development
“In the early stages it is the playful behaviours of the adult and the child that generate the language. By the time they are into fully fledged socio dramatic play, the language shapes reality.
“I ‘m ‘tending this is a snake. By the way it is a snake”
From Play by Catherine Garvey
Fontana/Open Books 1977
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
CONVERSATION Social interaction Problem solving and thinking Negotiation and sharing Story telling Joint imaginary play
Why do children need language?
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
A CONVERSATION IS..
…A SERIES OF TURNS
…A SHARED ACTIVITY
…GOVERNED BY RULES WHICH ARE LEARNED IN INFANCY
…EASIER FOR ADULTS THAN FOR CHILDREN
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
CONVERSATION
“Informal exchange of ideas by spoken words”
Concise Oxford Dictionary 1982
so…one of our aims is:
..give the words to the child..
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
A bad conversation..
Think of someone you would gladly
cross the street to avoid, rather than
have a conversation with them.
Why would you rather avoid them?
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
A good conversation…
Now think of someone you enjoy having a conversation with. What do they do that makes it so worthwhile?
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
The rules of conversation:
Must initiate or respond when others initiate Take turn at appropriate time Give partner time to take a turn Attend to speaker Keep conversation going Stay on topic Send clear messages Clear up misunderstandings Start a new topic when needed
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
The underpinning to conversation is…
…equally shared participation
Like a game of table tennis….
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
But…
What if one of the participants isn’t very competent?
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Conversations
What can go wrong?
The rules of conversation are not observed due to:
DELAYED development
DISORDERED development
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Not seeing the potential in toys Not knowing how a sequence develops Not understanding the joint goal Finding sharing very hard Experiencing more frustrations than
enjoyable challenges Other people don’t seem like play partners
If left unattended..can result in the child…
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
The usual solutions adopted by adults
can feel very unsatisfactory, such as:
Doing all the talking Asking a lot of questions and then answering
them Constantly offering new things to try and
catch the child’s attention Non-verbal games Trying to direct the child’s behaviour Describing and explaining the child
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
To avoid this families need:
• Information – sensitive to adult learning styles, literacy levels etc
• Demonstration – observation and participation
• Experience – practice and feedback
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Take home messages for families:
Parents as play partners, and language models
Equal participation in conversation, even for the least skilled person
Viewing the child from the first session as a person with ideas and thoughts to
express
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Dr Edward Zigler (Founder of Head Start)
“ Literacy begins with thousands of loving interactions with parents after an infant is born…it begins with sitting on a safe lap, hearing a familiar bedtime story”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 5
“ Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Listening, language and thinking
“ Listening is not a mechanical decoding skill. It is a complex and problematic aspect of communication and thinking….listening is thinking; as we listen we make all kinds of judgements and choices” (Haynes 2002).
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Enhancing listening
Can modify:
environment acoustic signal interactions
…..more later….
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV principle # 6
“ Guide & coach parents to help their child integrate listening and spoken language into all aspects of the child’s life”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Strategies for parents to try:
Adopt role as play partner – Having fun! Equal participation in conversation.
Having fun listening. Encouraging turn taking.
Engaging in joint attention.Commenting & expanding
Interpreting child’s communicative attempts.
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 7
“ Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition and communication”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 8
“ Guide & coach parents to help their child self-monitor spoken language through listening”
..auditory feedback loop
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AUDITION & SPEECH ACOUSTICS
Factors affecting speech intelligibility:
timing of onset of deafness
nature & extent of hearing loss
type & appropriateness of amplification
speech perception
communication option chosen for the individual child
other challenges
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Early identification allows..
Less delay
More natural development
More acceptable speech patterns
Better literacy outcomes
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 9
“ Administer ongoing formal and informal diagnostic assessments to develop individualized AV treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the families”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Spoken Language
Follow developmental sequence in: RECEPTIVE LANGUAGE EXPRESSIVE LANGUAGE PRAGMATICS PHONOLOGY COGNITION
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Therapist will:
Follow typical developmental milestones Use criterion referenced and
standardized tests developed for typically hearing children
apply the formula for calculating ‘hearing age’
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AV Principle # 10
“ Promote education in regular classrooms with typical hearing peers and with appropriate support services from early childhood onwards”
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AVT in school – AV goals & the curriculum
IEP Team involvement Collaboration with classroom teachers,
resource teachers, SLPs etc Training for EAs Ongoing therapy sessions as needed Regular assessment & monitoring
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Outcomes
• Historical data suggests that only about 20% of children born with a profound hearing loss who used hearing aids (and not a cochlear implant), attained intelligible speech.
• Current data show that about 80% of children born with a profound hearing loss who have a cochlear implant between 2 & 4 years of age, attain intelligible speech (with appropriate intervention).
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Early intervention outcomes
Emerging data are showing that over 90% of children born with a profound hearing loss who obtain a cochlear implant before 18 months, attain intelligible speech.
This outcome is based on consistent use of the device and placement in regular classrooms.
Extra auditory stimulation is also necessary.
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Geers et al (2003)
N – 181 Children received implant before 5 years 4 year longitudinal study Looked at variables influencing outcomes(eg: gender; age at onset; etiology; age at implant; residual hearing;
educational placement; type of intervention; commuication mode)
Outcomes measured by assessments normed on hearing population (speech perception; speech production; spoken language; total language; reading)
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Geers et al – Findings:
All children showed strong language and literacy skills
>50% achieved grade level reading skills by grades 2 or 3
>50% fully mainstreamed Girls performed better on language measures Educational placement - important predictor Earlier implantation (<5) – better outcomes
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Geers et al – Findings:
“ The dominant educational factor associated with high performance levels was the extent to which a child’s classroom communication mode emphasized speech and auditory skills development” (Moog & Geers 2003 p124s)
REF: Ear & Hearing Vol. 24 # 1 Special Supplement Eds: Geers, A E & Iler Kirk, K
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
AVT ..a therapy session..
60 to 90 minutes long – every weekListening gamesSongs and books – with actions and
propsCrafts, cooking and paintingPretend playLOTS of conversation……
Petra Smith M.Sc. Aud (C) Sept 28/29 2009
Organizing the session
Planning highlights specific target areas & skills in the therapist’s mind. 3 common strategies:
THEME based planning – activities with a common topic (less structure)
SKILL based planning (more structured)
ACTIVITY based planning (daily routines)