Auditory-Verbal Therapy: Supporting Listening and Spoken Language in Young Children with Hearing Loss & Their Families

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Approximately 95% of parents of children with hearing loss are hearing themselves (Mitchell & Karchmer, 2004), and trends indicate that many parents are choosing spoken language as the primary mode of communication for their children with hearing loss. In fact, some states such as North Carolina, are reporting that parents are choosing spoken language options for their children with hearing loss more than 85% of the time (Alberg, Wilson & Roush, 2006), especially when they know spoken language is a viable outcome for their child. And, these parents are typically selecting approaches that support listening and spoken language, such as Auditory-Verbal Therapy, without initiating visual communication systems.

With early identification and the use of advanced hearing technology, children with even the most severe or profound hearing losses can access audition and follow an intervention approach focused on achieving typical developmental milestones in listening, speech, language, cognition, and conversational competence. Parents’ communication choices are based on their long-term desired outcomes for their child. Once those decisions are made, professionals providing early intervention and habilitative services should support the parents’ choices and provide the necessary support and intervention to ensure, to the greatest extent possible, that the child achieves those outcomes.

Definition of Auditory-Verbal Therapy

The Alexander Graham Bell (AG Bell) Academy for Listening and Spoken Language, which is based in Washington, DC, governs the certification of Listening and Spoken Language Specialists (LSLS), the practitioners qualified to provide Auditory-Verbal Therapy. The Academy defines the practice of Auditory-Verbal Therapy as:

“Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012).

The Principles of Auditory-Verbal Therapy: Defining Practice

The Academy has endorsed a set of principles that delineate the practice of Auditory-Verbal Therapy:

  1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal Therapy;
  2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation;
  3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language;
  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 Auditory-Verbal Therapy;
  5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities;
  6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life;
  7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication;
  8. Guide and coach parents to help their child self-monitor spoken language through listening;
  9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress, and to evaluate the effectiveness of the plans for the child and family; and
  10. Promote education in regular school with peers who have typical hearing and with appropriate services from early childhood onwards.

The Listening and Spoken Language Specialist (LSLS):

Two Paths to Certification

The AG Bell Academy has designated two paths to certification for Auditory-Verbal practitioners: LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVT) and the LSLS Certified Auditory-Verbal Educator (LSLS Cert. AVEd). The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families. For additional information about certification as a Listening and Spoken Language Specialist (LSLS), speech-language pathologists and audiologists should contact the AG Bell Academy at academy@agbell.org, visit the website ate www.agbellacademy.org, or call (202) 204-4700.

References

Alberg, J., Wilson, K., & Roush, J. (2006). Statewide collaboration in the delivery of EHDI services. The Volta Review, 106, 3, 259-274.

AG Bell Academy for Listening and Spoken Language (2012). 2012 certification handbook. Available at www.agbellacademy.org

Mitchell, R.E. & Karchmer, M.A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4, 2, 138-163.

 

Dr. K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT, is an Associate Professor in the School of Speech-Language Pathology and Audiology at The University of Akron. His primary areas of research include spoken language acquisition in children with hearing loss, strategies for enhancing parent engagement in the intervention process, Auditory-Verbal Therapy, and telepractice. He directs the Telepractice and eLearning Laboratory (TeLL), an initiative to evaluate clinical practices in the area of distance service delivery in Speech-Language Pathology.

 

Comments

  1. Such a time as this! Children with all degrees of hearing loss can learn spoken langauge through listening. Audiograms no longer have to determine outcomes – if we do what it takes: Early diagnosis of the hearing loss, aggressive audiological management, contemporary hearing technology, and auditory-verbal therapy. The importance of team has never been greater. Audiologists, Speech-Language Pathologists and Parents working together to support parents in reaching their desired outcome for their child. The sky truly is the limit!

  2. Early identification is key. Now through Universal Newborn Hearing Screening parents can learn early about their child’s hearing loss and have a follow up ABR to determine a diagnosis within weeks after birth. This allows them the opportunity to be fit with appropriate hearing technology and have early access to sound. Carol Flexer educates that “the ears are the way in” to giving the brain access to sound, to develop the auditory pathways, to develop spoken language. It is critical for professionals to lead parents in the direction to achieve their chosen outcomes for their child. Thank you Todd!

  3. Many thanks to my colleague, Todd Houston. There is no limit to the potential of children who are born deaf or hard of hearing or who acquire hearing loss in the early years of life. More than just early identification, it is the deep understanding that parents and practitioners work in partnership with one another to help the parents realize the dreams they have for their children. Why would any of compromise when so much is possible? Practitioners are learning to become adult educators, for if we are truly to coach and guide, then we need to understand the playbook and be the cheerleaders on the side. Six of the principles of Auditory-Verbal Practice begin with the words “Coach and guide”, so practitioners have a new role to play in learning how to exert just enough pressure to yield diamonds.

  4. I am finding that as we educate the parents and caregivers, we need to also educate professionals. I spent hours on the phone this morning doing just that. Our efforts will benefit many!

  5. Anabel Vielman says:

    My daughter who has bilateral hearing loss is going to therapists who are certified and it is amazing to see her pick up speech. She is a parrot right now and it is very exciting and funny to watch her vocabulary grow. I recommend AV therapy to all who have children with hearing loss.

  6. I have been preaching this to my students in my graduate and undergraduate Aural Rehab classes this semester. Hearing along speech understanding is the gateway to learning. It starts with educating society as a whole not just parents, caregivers, or students.

  7. Dr.Chester Charles II,Au.D/ Adjunct professor says:

    I have been preaching this to my students in my graduate and undergraduate Aural Rehab classes this semester. Hearing along speech understanding is the gateway to learning. It starts with educating society as a whole not just parents, caregivers, or students.

  8. Esther F. Coffin Miller, MSA, CCC-A says:

    I support anything that promotes age appropriate language acquisition and comprehension. Having worked with generations of deaf and hard of hearing children, teens, and adults I know how crucial parental involvement is to language and communication development. We need not avoid “visual” communication along with this. Speech-reading, gestures, signs, graphic displays are “normal” parts of language and can only expand the learner’s and society’s repetoire. This does not detract from or harm the development of oral/aural skills and can provide support in a variety of less than desireable auditory environments.

  9. I HAVE A 14 Y/O SON WHO WAS DIAGNOSED WITH BILATERAL SENSORINEURAL HEARING IMPAIRMENT WHEN HE WAS AROUND 2 YEARS OF AGE. HE IS ALSO DIAGNOSED WITH AUTISM. HE HAS VERY LIMITED VERBAL OUTPUT AND MOST OF THEM ARE NOT CLEAR. I WANT TO KNOW IF AVT IS AN APPROPIATE THERAPY FOR HIM. HIS BEEN USING HIS HEARING AIDES SINCE 3 YEARS OLD. HE IS RESPONDING TO PROMPT THERAPY AND AS HE MATURES HE IS ABLE TO FUNCTION MORE AND BETTER. PLEASE LET ME KNOW, THANK YOU.

  10. K. Todd Houston says:

    Eloisa –

    Thank you for posting. It would be difficult to state specifically if AVT is appropriate for your son, but I’ve worked with several children with hearing loss who also had a diagnosis of autism. In those cases, AVT did help them integrate auditory information and increase their auditory processing and spoken language. In your situation, using prompts may be the most appropriate technique for your son as you continue to incorporate auditory learning and spoken language strategies with him. As with any approach (or combination of approaches), if you don’t see progress, find one that does facilitate communication. Good luck!

  11. Speech and language therapy after fitting the hearing aid as early as possible should be given under the guidance of qualified speech language therapist.the begining starts from use of hearing aid with auditory training,speech reading,and language training which includes speech and written language.

  12. Samantha says:

    Yes I have a 4 yr old who lost her hearing over the past 3 yrs , just recieved her choler implant in april 2012, seeing how we live in nc, we have choosen to do all her care at UNC HOSPITALS which is about 5-6 hrs one way for us they are now telling us that we need this kind of speech, language therpey, have sugested 2 people who would be willing to do it however said people wont return my calls , our local town, doctors have no clue where to refeer me to and i am loosing my mind cuz my child needs services, their are none !!!

    I just dont know what to do we only moved here to make sure she got the best and now I have failed as a mother cuz now she needs more and I cannot give her this >!
    any one please let me know asap if you know some one who would be willing to do services with my child via skype or if you know anyone who services eastern nc ( cherokee, brysoncity, whittier, sylva, andrews, ect )

    I just want my baby to have a chance at speech like her sisters please help!

    • K. Todd Houston says:

      Samantha:

      Thank you for your comment. First, having lived in western NC before, I commend you for living in such a beautiful area! More importantly, it sounds like there may be limited choices of service providers near you. My suggestion is to contact the pediatric cochlear implant team at UNC as they do have a very positive reputation. I’m sure they will work with you to identify someone who can work with you and your daughter. If someone isn’t returning your calls, then UNC should be aware. They can work with you to identify another service provider. Good luck to you and your family!

  13. Mary-Kathleen Young says:

    I am wondering when it is appropriate to discharge a student from AVT. I have a 10 year old who has a sensori-neural hearing loss. She has received AVT and sp/lang. therapy. Receptive and expressive language is “within normal limits” but she does present with gaps in her vocabulary based on observation. Is sp/lang. therapy enough at this point? What criteria is used for discharging a child/individual, especially when sp/lang. therapy is ongoing?

    Thank you, Mary

    • Todd Houston says:

      Mary-Kathleen:

      Discharge guidelines may vary a bit from practitioner to practitioner. My own view is that once the child is functioning within typical limits in listening, speech and language, I may transition the child to getting supplemental speech-language services from a licensed SLP. In other words, my view is that they may not need Auditory-Verbal Therapy but there might be a few articulation or language issues that can be addressed by another professional. Discuss the situation with your AVT provider and perhaps develop a transition plan. Good luck!

  14. Esmaela Diann says:

    Good day! I am Esmaela Diann Mascardo from the Philippines. I have a younger sister named Keith, who just turned 13 last January 5, 2013. She has a speech problem. She cannot talk or converse like other normal kids (at her age) do. She has an inborn cleft palate, which was treated (through surgery) when she was still 5 or 6 years old. The doctor said that she will be recovering and that gradually will be able to talk. Unfortunately, until now, nothing is changed. By the way, she isn’t totally deaf and mute. She is very eager to learn to talk. She opens her mouth and force herself but unfortunately, there is no sound. But because of her eagerness to talk, she tends to speak with us in sign language sometimes. On the other hand, she can utter some easy words — two syllable words like mama, papa, dada. She’s supposedly in 5th or 6th grade now, but with her condition, she even does not finish pre-school. It really hurts me as a sister. Every time she speaks/talks to me or even by just seeing her, seems that my heart breaks into tiny pieces. My mother always cry especially when she hears or sees other children boo or tease her. But because we do not have enough money to hire a speech therapist, we do not know what to do to help her. What would I do? As a teacher, I want to touch and make a difference in her life, and as a sister, I do want to help her and make her feel and know that she has a normal life like other children do. How can I treat her condition? Can she still talk normally? Will there be any chance for us to have a normal and a happy conversation? How can I help my sister? Please do help me. I would forever be grateful and indebted to you. Thank you very much.

  15. MESaucedo says:

    any recommendations for pediatric audiologist, speech therapist and pediatrician in Bakersfield CA

  16. Marcia Zegar says:

    Application of technology advancements during the last 10+ years along with neurological studies demonstrate the significant need for “2013” understanding of the implications of hearing loss — social, emotional, cognitive, academic, spatial, pragmatic, behavior . . . Educational training too often provides only an introduction to the drastic impact of hearing loss on global human development from birth. I greatly appreciate the leaders in our field who encourage ALL of us to create family/professional partnerships in learning and dedication to coach and guide all children with hearing loss to meet their true potential — as individuals — not based on audiometric levels of ‘hearing’.

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