Audiologic Rehabilitation for Children and Educational Audiology SPA 6581 – Spring 2015 Lecture Date: 03/16/15 AUDITORY VERBAL THERAPY

Audiologic Rehabilitation for Children and Educational AudiologySPA 6581 – Spring 2015Lecture Date: 03/16/15

AUDITORY VERBAL THERAPY

HTTP://WWW.UTDALLAS.EDU/~THIB/EARRINGFINAL/EARRINGWEB_FILES/FRAME.HTM

http://www.utdallas.edu/~thib/EARRINGFINAL/EARRINGWEB_files/frame.htm



Pollack, Goldberg, Caleff e-Schenck (1990)

Romanik, S. (1990)

Simser (1993)

Dickson, C. (1999)

Estabrooks (1998)

Cole and Flexer (2007)

Walker (1995, rev. 2010)

CURRENT MODELS OF AUDITORY LEARNING

Evaluations are done by many professionals AuD SLP MD Psychologist Genetics

Therapy is typically provided by SLPs but is also provided by audiologists, early interventionists, and deaf educators Therapist “fit” with patient depends on communication

mode chosen and therapist’s skill/knowledge base

WHO EVALUATES AND PROVIDES THERAPY?

Cochlear Implant Age = length of time since CI “hook- up.”

A-V Age = length of time enrolled in Auditory-Verbal Therapy

Language Age = level of understanding and use of language

IMPORTANT REVIEW OF TERMS

John is an 11 month old boy whose moderately severe bilateral hearing loss was diagnosed at two months of age. He began wearing hearing aids at 3 months of age and began AVT at the age of 5 months.

What is John’s hearing age? What is his program (AVT) age?

APPLICATION

Auditory processing, neuroplasticity of the auditory system and a critical period for development of an auditory function

Normal Auditory Development

Speech Acoustics

Auditory-Verbal Strategies & Techniques

Assessment of Listening Skills

KEEP IN MIND WHAT YOU NEED TO KNOW

There are many approaches to working with our patients

SLPs goals are to improve or facilitate communication whether it be in sign language, augmentative alternative communication (i.e. PECS, technological devices),or, ideally, spoken language

It is the role of the family or the patient to determine what mode of communication is best for them

WHAT TYPES OF THERAPY ARE OUT THERE?

Facilitates optimal acquisition of spoken language through listening by infants, toddlers, and children who are deaf or hard of hearing.

Auditory verbal education promotes early diagnosis and state-of –the-art audiologic management and technology.

Parents and caregivers are involved to the fullest extent possible in their child’s language development and education.

Auditory-verbal educators promote mainstream education for students who are deaf or hard of hearing by supporting the development of audition, spoken language and vocabulary, reading and written expression throughout the teaching of academic material.

AUDITORY VERBAL EDUCATION

Auditory verbal educators provide parental support, support services to mainstreamed students and intensive intervention for students in self-contained placements for children who are deaf or hard of hearing.

Auditory-Verbal Education focuses on teaching listening and talking to various sized instructional groups to prepare children to enter mainstream education when they have the skills to do so successfully.

A Listening and Spoken Language Educator (LSLS Cert. AVEd) teaches children with hearing loss to listen and talk exclusively though listening and spoken language instruction. The LSLS Cert. AVEd is guided by the Academy's Ten Principles of

LSLS Auditory-Verbal Education and adheres to a professional code.

AUDITORY-VERBAL EDUCATION…

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 will

have access to a full range of academic, social, and occupational choices.

AVT must be conducted in adherence to the “Principles of LSLS AVT.”

AUDITORY-VERBAL THERAPY

Certified by the AG Bell Academy for Listening and Spoken Language Listening and Spoken Language Specialist (LSLS)

Also can be certified as a LSLS – cert. AVEd (Auditory Verbal Educator)

There are many therapists who use the auditory verbal approach but are not offi cially certified

WHO PROVIDES AVT? CONTINUED…

WHAT DOES IT TAKE TO BECOME AN AVT?

1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiological 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 listening and spoken language.

PRINCIPLES OF LSLS AUDITORY- VERBAL PRACTICE...

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 parents1 to use natural developmental patterns of audition, speech, language, cognition, and communication.

8. Guide and coach parents1 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 eff ectiveness of the plans for the child and family.

10. Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards.


Think about the 2 year old and the hours that professionals have vs. parents 1 hour of therapy x 48 weeks a year = 48 hours 11 waking hours per day x 7 days a week = 77 hours x 52

weeks a year = 4, 015 hours

Think about the 9 year old who has the language of the typical 4 year old. Parent sessions are not typically done in public school

settings...a MUST for children with educationally significant language delays.

GUIDING AND COACHING PARENTS = EFFICIENCY

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

Parent participation and parent involvement in all aspects of the child’s habilitation

IN AN AUDITORY-VERBAL APPROACH

80 hours of CEUs in the area of AVT

Minimum of 750 supervised therapy clock hours over a three to five year period

Minimum of observation 10 hours of at least two diff erent LSLS Cert AVTs

Work with a LSLS-certified mentor for three to five years

Written examination after all of the above has been completed

WHAT ARE THE REQUIREMENTS?

CRITICAL AREAS TO ASSESS

The speech and language assessment should include the “evaluation of the client’s speech perception abilities, understanding and use of spoken language, written and signed language as appropriate, voice skills, speech production and overall intelligibility, preferred method of communication, and any communication tactics used (Cooper, & Craddock, 2006).”

I would argue that it should include a few more areas to round out the assessment of “form, content, and use,” including: audition skills, pragmatic, and social skills. Others you would include?

Case History Informal audiological assessmentQuestionnaires regarding auditory behaviorSpeech perception testingClinical and behavioral observationsStandardized and criteria based speech and/or

articulation assessmentsStandardized language assessmentsSign language tests (if needed)

OVERVIEW OF THE SPEECH LANGUAGE EVALUATION

SLE PRIORITIES AND PROTOCOLS

Each center will develop their own protocols for evaluations. These should be evidence-based, and need to be flexible enough to adapt with changing criteria and/or technology.

Examples of protocols for the SLE: USC protocol: page 1, page 2 UNC protocol: page 1, page 2, page 3, page 4 AVT protocol recommendations – A.G. Bell

Other Considerations: What about the patients who don’t fit into the

predetermined general protocol?

USC SLE PROTOCOL – PAGE 1

USC SLE PROTOCOL – PAGE 2

UNC SLE PROTOCOL PG. 1

UNC SLE PROTOCOL PG. 2

UNC SLE RECOMMENDATIONS PG. 1 AND 2

UNC SLE RECOMMENDATIONS PG. 3 AND 4

Case History Pregnancy, labor, delivery history Medical history Surgical history Hearing history, amplification history Developmental milestone acquisition Communication mode Educational history Concerns regarding speech and language development

THE SPEECH LANGUAGE EVALUATION

CASE HISTORY EXAMPLE QUESTIONS

Did the pregnancy progress to full term?

Were there associated complications?

Was there perinatal infection, such as _____________?

Did the child spend time in the neonatal intensive care unit (NICU)?

Were high oxygen concentrations needed?

Were there blood transfusions?

CASE HISTORY CONSIDERATIONS

The SLP may identify a patient in need of further evaluation, and may be the initial point of referral to the CI team. Audiological

Were they appropriate? Were they timely?

Need to know the results for NBHS, recommendations for appropriate management Were the appropriate referrals made? Were recommendations followed? Results of testing? (ABR…) Others?

Have they seen an ENT?

Sample case history for children with hearing loss: http://www.asha.org/docs/html/GL2004-00002-F1.html

Informal audiological assessment Depends on access to sound

Cochlear Implant – unilateral, bilateral, length of implantation, frequency use, how bonded to the device is the patient

Hearing aids – unilateral, bilateral, power aid, benefit from aid/aids

Behavioral responses to noise makers and/or speech


Informal audiological assessment continued Ling 6 sound test – detection

Informal VRA Conditioned play

Ling 6 sound test – identification Imitation using hand cue Imitation without any cueing (usually older children and/or

adults)


Questionnaires regarding auditory behavior Infant Toddler – Meaningful Auditory Integration Scale (IT-

MAIS) and Meaningful Auditory Integration Scale (MAIS) Can be administered by AuD or SLP The IT-MAIS is -for children 4 and younger and the MAIS is for

children 5 years and older IT-MAIS was derived from the MAIS


IT-MAIS and MAIS continued… Both contain 10 questions with answers on a scale of 0 – 4 Caregiver interview designed to assess a child’s spontaneous

responses to sound in his/her everyday situations Assesses 3 main areas

Vocal behavior Alerting to sound Deriving meaning from sound


LittlEars a parent questionnaire that evaluates all types of auditory

behavior which are observable as a reaction to acoustic stimuli

35 questions Hierarchically structured as to follow the auditory

development of children from newborn hearing screening to 24 months of age or hearing impaired children with cochlear implants or hearing aids with a hearing age of 24 months


Speech Perception Testing Different from the testing done in the audio booth Loudness of stumuli is not controlled or set at specific

decibel level when completed by SLP Done auditory only but visual cues can be given after pt is

unable to answer correctly Helpful information can be gleaned when a pt can only answer

correctly with visual cues


Speech Perception Testing Early Speech Perception Test (ESP)

Can be done by AuD or SLP Two versions

Low-Verbal Standard

Closed Set Hierarchically structured

Pattern Perception Spondees Monosyllabic words


Speech Perception Testing ESP Low Verbal Version

Toys that correspond to the target words Example for the “Pattern Perception” subtest would be a toy ball, an airplane,

hamburger Set of 4 toys out on the table at a time

ESP Standard Version Colored pictures that correspond to the target words

Set of 12 pictures per card 1 card for each subtest


Auditory Perception Test for the Hearing Impaired (APT-HI) identifies specific auditory perception and processing

deficits across the continuum of listening from awareness to open-set comprehension

Used with children 3 yrs or older


Clinical and behavioral observations Social skills – dependent on age

Eye contact, awareness of environment, communicative intent, joint communication, initiation of communication

Mode of communication Nonverbal

Sign language, gestures, gestures + vocalizations, home signs, activating others, AAC

Verbal


Clinical and behavioral observations continued… Attention and/or behavioral concerns

Communication frustration vs. true behavioral concerns Family dynamics

Family’s expectations for child and understanding of the implant process and time requirements involved


Standardized and criteria based speech and/or articulation assessments Goldman Fristoe Test of Articulation – 2 (GFTA-2)

Standardized articulation assessment Requires child to label pictures and sometimes may not be

appropriate for children with delayed language skills Assesses a child’s production of all English consonants in most

contexts (initial, medial, final, blend)


Speech assessments continued… Identifying Early Phonological Needs in Hearing Impaired

Children (IEPN-HI) Not standardized Assesses most phonemes in most contexts, including vowels Assesses child’s production of phonemes based on manner,

place, voicing


What’s the manner, place, and voicing for these phonemes? /G/ /M/ /S/

What’s the frequency information for these sounds?

QUICK LITTLE SPEECH QUIZ!

Standardized language assessments Consider child’s age and language abilities Consider communication mode to determine appropriate

test Spoken language vs Sign language

Overall language tests Vocabulary tests


Infants and Toddlers Most often assessment is completed via parent

questionnaire and clinical observations Clinician’s must use their knowledge of development and

clinical instinct to sometimes accurately score these, as parents may under or over-estimate a child’s abilities Birth to Three Developmental Assessment and Inventory Scale Receptive Expressive Emergent Language Test -3 rd Edition

(REEL-3)


Preschool overall language tests Preschool Language Scale – 5 th Edition (PLS-5) Clinical Evaluation of Language Fundamentals – Preschool

3rd Edition (CELF-P3) Oral and Written Language Scales – 2 (OWLS-2)


School age overall language tests Oral and Written Language Scales -2 (OWLS-2) Clinical Evaluation of Language Fundamentals -4 th Edition

(CELF-4) Test of Language Development – 4 th Edition (TOLD -4)

Primary and Intermediate Editions


Vocabulary testing Different from language in that it does not involve syntax,

semantics, morphology Receptive and expressive vocabulary testing Completed via picture labeling or identifying


Vocabulary testing continued… Receptive One-Word Picture Vocabulary Test (ROWPVT) and

Expressive One-Word Picture Vocabulary Test (EOWPVT) Peabody Picture Vocabulary Test (PPVT) and Expressive

Vocabulary Test (EVT)Sign language vocabulary test

Carolina Picture Vocabulary Test (CPVT)


Impressions and Recommendations are clearly stated in reports so that it can be understood and implemented in various environments (private therapist, school therapist, school teacher, home, etc)

Recommendations for CI candidacy, strength of candidacy, and why

Recommendations for possible change in amplifi cation

Recommendations for educational placement, school accommodations (preferred seating, FM system)

Recommendations include speech, language and auditory goals

Further testing if needed (i.e. psychoeducational)


Therapy is key!

GETTING DOWN TO WORK!

Positioning to Maximize Auditory Input

Attention Getters

Helps for PROCESSING through Audition

IF you must…

Helps for Confident Listening

Other Strategies

AUDITORY-VERBAL STRATEGIES AND TECHNIQUES

Optimal distance is Within 6 inches of the HA microphone Within 6 inches of the CI microphone

Where should you be seated, etc.

POSITIONING TO MAXIMIZE AUDITORY INPUT

The Environment Quiet room High chair, little chairs and little table, or we play on the

floor Therapist sits on the side of the child, with the therapist’s

chair slightly behind the child’s chair and directs the child’s attention in front using toys or redirection cues

Minimize distraction (toys, noise, etc…)

AUDITORY BASED THERAPY

Attention Getters

The “Listen!” Cue Audition FIRST

Not show and tell but Tell and Show

Why hearing first?Sing What You

Say/Parentese Get Closer

Helps for PROCESSING through Audition

CLEAR SpeechSpeak at a slightly

slower rate of speech

Acoustic Highlighting: more to less

Lowlighting/Whispering: Why?

A-V STRATEGIES

MORE AUDIBLE(for a beginning child)

PROGRESSING TO

LESS HIGHLIGHTING(for a child who is listening

well)

No background noise Increased background noise

6” from hearing aid or cochlear implant

Increased distance from hearing aid or cochlear implant

Slightly slower rate Normal rateIncreased pitch variation (sing what you say)

Normal rhythm

Clearer enunciation (use of “clear” speech)

Less clear and/or unfamiliar voice

Increased repetition No repetitionGreater acoustic contrast (vowel variation, rhythm contrast, number of syllables)

Less varied (minimal pairs, same syllables, similar rhythm)

Simpler language with shorter phrases

Complex sentences

Emphasis on key words No emphasis on key wordsEmphasis on unaccentuated words (prepositions, articles, verb tenses, pronouns)

No emphasis

Word position in sentence:End of sentence

Middle of sentence

Beginning of sentence

Closed set Open set


WAIT Time + Expectant Look The younger the child, the more wait time needed The Expectant Look says...

Repetition: Why?

Pause before challenging word/s

Word position in sentence

Give a choice

What DID you hear?

AV-STRATEGIES HELPS FOR PROCESSING

AV-Strategies IF you must...

A-V-A Sandwich or “Put it back into hearing” Give visual context for

auditory input Point to the

picture/object Natural gesture Facial expression

Adjust set size

Helps for Confi dent Listening

ModelingConverse slightly

above child’s linguistic level

Diagnostic Teaching, NOT testing

Known →unknown, audible →less audible

A-V STRATEGIES

The absent-minded therapist

Let child be the teacher

OTHER A-V STRATEGIES

Framework for the development of an auditory function

Based on the work of Simser, Romanik & Foreworks Curriculum

Comprehensive chart

Not an exhaustive list

AUDITORY LEARNING GUIDE BETH WALKER, 1995, REV. 2010

Establishing Goals

Planning therapy sessions

Documenting progress

Parent Education

Professional collaboration

THE ALG IS USEFUL FOR...

Therapist’s skill level/experience

Residual hearing/aided thresholds

Age at implantation Perception vs. production

ALG: CONSIDERATIONS

DETECTION ONLY, “LOW LEVEL”

Begins with detection of ANY speech sound

Quickly progresses to detection of all sounds

Close range to distance

Includes detection of wide variety of environmental sounds at various distances

Some children, with optimal amplification, may complete work on all steps in one week

ALG: SOUND AWARENESS

Conditioned Response Exposure/Modeling at 16 months Most children consistent: ~24 months Audiological Evaluations

More effi cient More reliable More thorough

Ling 6 Sound Check Daily checks help monitor:

Amplification Middle Ear Status

ALG: SOUND AWARENESS

Examples: Alternating vowels (dee-mo)

Identification of consonants varying in manner of production (ma-ma-boo-boo)

ALG: PHONEME LEVEL

Connected spoken language

Conversational context: Discourse Dialogue

Combine with Sentence and Word Level

ALG: DISCOURSE LEVEL

Develops auditory memoryMUST give child a communicative reason to respond

Use imitation as a strategy After step 3? 6?, “work” at this level is often unnecessary “Stimulus-response” context

ALG: SENTENCE LEVEL

Examples of Critical Elements One: Where’s the kittycat? Two: I need a red ball. Look under the table. Three: Mommy wants two pretzels. Four: Color the big star yellow and orange.

ALG: CRITICAL ELEMENTS

Word Level Perception of individual words Progression:

Acoustic features of the target Word placement

In the context of phrases or sentences

ALG: WORD LEVEL

Word Level Vocabulary Development Program- (NOT “skill-based”

exercises with single words) 1.Learning to Listen sounds 2.Power Word list 3.Lexicon One 4.“Theme-based” units, Children’s Literature Units (Ling Basic

Vocabulary & Language Guide)

ALG: WORD LEVEL

https://sites.google.com/site/rudhhvideo/home/grace-id-by-description

FUN WEBSITE



Learning to Listen Sounds: Content Suprasegmental features Early developing vowels Early developing consonants.

LEARNING TO LISTEN SOUNDS: CONTENT

Learning to Listen Sounds Sound/object associations More auditorily interesting and diverse in suprasegmentals

for the beginning listener What are suprasegmentals?

Used at the beginning to teach that speech is meaningful Helps the beginning listener learn how to discriminate

between sounds “ahhhhh” for the airplane vs “puh-puh-puh-puh” for the boat


Learning to Listen Sounds Lings 6 Sounds are incorporated in the Learning to Listen

Sounds “Ahhh” for an airplane “Mmm” for a cookie “Shhh” for a baby “Sssss” for a snake “Eeee” for a police car or elephant “Ooo” for a ghost


Considerations Age Experience listening Selection of sounds Auditory Access

Suprasegmentals Child must be able to imitate sounds that vary in duration,

intensity, and pitch. Let’s name sounds with:

Long duration Brief interrupted duration Loud intensity Quiet intensity High pitch Low pitch Varied pitch

LEARNING TO LISTEN SOUNDS: CRITERIA FOR MASTERY

Child must be able to imitate two back vowels, two mid-vowels and at least one front vowel. Let’s identify:

Back vowels Mid vowels Front vowels

Child must be able to imitate a nasal, fricative, and plosive.

Child must demonstrate spontaneous use AND identify Learning to Listen Sounds in a set of 10-12

LEARNING TO LISTEN SOUNDS: CRITERIA FOR MASTERY CONTINUED

MoreUpMama, Daddy GoStopBye-byeNoAll gone Hot/cold Mine/me Off /on Look BlowGo away MoveOpen

POWER WORDS

First 30-60 words that young children acquire.

Need a core vocabulary before child can produce two-word combinations

First Lexicon includes nouns, pronouns, adjectives, verbs, position/location words and words to indicate denial and rejection

FIRST LEXICON

DELAYED AND REMEDIAL LEARNERS CAN “CATCH UP” WITH FOCUSED LANGUAGE

INTERVENTION THAT FOLLOWS A DEVELOPMENTAL SEQUENCE

A typical session will address the following: Device check Auditory goals Language goals

Receptive and Expressive Speech/Articulation goals Parent education, home carry-over program, goals for the

week

Almost all therapy is play based…you can’t make an impact if they’re not engaged!


Device check A MUST at the beginning of each session

Parents don’t always do this and if a child is not bonded to his/her device, the child may not know if batteries are dead. (E.F.)

Bilateral - must check each device independently

Microphone check via monitor headphones for CI and listening stethoscope for hearing aids Typically done if there are concerns


Device check cont… How is it done?

Ling 6 sounds –method chosen depends on child’s age and length of time with device Conditioned play Informal VRA Imitation

What happens if it doesn’t go well? Troubleshoot – listen to microphone, determine if it is equipment

issue or a hearing issue


Conditioned play Many MANY hearing impaired children do not have this skill It is a learned skill Children who receive auditory based therapy or AVT learn

this skill almost immediately, as it allows for more accurate programming of their device/s and allows audiologists to obtain more reliable information in the audio booth

Audiologists LOVE SLPs for this!!


Areas typically covered: Communication

Auditory Learning/Audiological Management

Language Development

Speech Development

Development of Inner Discipline/Behavior Management

Cognition/Pre-Academic skills/Pre-Literacy

A-V: PLANNING THEPARENT PARTICIPATION SESSION

1. Greeting & Review---Sessions begin with asking parent(s) specifi c questions about child’s progress and quality and quantity of home carry-over since the last session.

2. Goal 1 & ActivityState the goal to the parent - be brief - use parent friendly language - refer to the source of the goal - tell why this goal is important

3. Goal 1—(continued) Model the strategies you want the parent to learn. State the strategies that you want the parent to practice.

FORMAT FOR A PARENT PARTICIPATION SESSION

4. Guided Practice Therapist takes two or three turns, then turns the activity

over to the parent Therapist takes a turn, parent takes a turn, therapist takes

another turn, parent Therapist uses target strategies in a play activity one day,

parent does it the next Give feedback- find something positive and “shape” the

behavior from there 5. Independent Practice

Parent practices strategies until he/she is comfortable without prompting

6. Encourage positive self-evaluation


7. Repeat #2-3-5 for each goal and activity.

8. Closure (2-3 mins.) If the parent has not yet recorded the goals and strategies,

now is the time to do this. Let’s think of some ways we can encourage the parent to

record the information in writing.

9. Have the parent tell you what he will be working on this week. “Why don’t you tell me what you’ll be working on this week so

I can check to make sure I’ve made myself clear.” “I want to check to make sure I’ve stated our goals clearly. Tell

me your understanding of what you will work on this week with Julie.”


Last five minutes of weekly sessions (child plays independently)

At a separate time from weekly session (child is not with parent)

Use Parent Information Session Topics handout to insure all necessary info is covered

Use handouts, videos, audios, books, other parents, websites as resources

PARENT INFORMATION SESSIONS

Communication Options/The Auditory-Verbal Approach

Communication

Audiological Management/Hearing Aids/Cochlear Implants

Behavior Management/Development of Inner Discipline/Eff ective Parenting

Speech Development

Language Development

Speech Development

Auditory Development

Literacy

Child Development

PARENT CURRICULUM

Expertise in the Auditory-Verbal approach

Skills in teaching parents Question: “Am I skilled in teaching adults?” Areas where we need more training:

Providing clear information Coaching Providing specific feedback

Open to feedback from and dialogue with parents

EFFECTIVE PARENT COACHING AND GUIDANCE REQUIRES....

What do you know about adult learning from your own experience?

Think of something you learned as an adult that you are good at - how did you become competent?

Think of an unsuccessful learning experience - what went wrong?

ADULT LEARNERS

Characteristics of Adult Learners Seek education that relates or applies directly to their

perceived needs Goal oriented

Learning must make sense Self-directed

Learn best in a democratic, participatory and collaborative environment.

“Adults respond most favorably when they are actively involved in designing and implementing their own learning.”-Lowy, 1983

WHAT DO WE KNOW ABOUT THE CHARACTERISTICS OF ADULT LEARNERS FROM THE LITERATURE?

Adults vary in their confidence level, intellectual ability, education level, personality, and cognitive learning style.

They learn at diff erent rates and in diff erent ways: Right brain vs. Left brain (Rose and Nicholls, 1997) Visual vs. Auditory vs. Tactile/Kinesthetic (Brandler and

Grider) Reflective, Creative, Practical and Conceptual Thinkers

CHARACTERISTICS OF ADULT LEARNING

Parents need… Coaching and guidance that is relevant and clear to help

them meet their goals Working knowledge of the stages in listening, language,

speech and cognition and strategies and techniques that promote the auditory learning of the child’s goals

Practice and repetition Reinforcement Intervention that fits their learning style Active, consistent participation To be shown respect. Practitioners are open to feedback

from parents

APPLICATION TO A-V PRACTICE

As adults who are goal oriented and seek education that relates or applies directly to their perceived needs parents will work toward weekly goals when they are CLEAR

about what those goals are. As adults who are self-directed

parents will use hierarchies of normal development to select goals WITH the therapist.

As adults who learn best in a democratic, participatory and collaborative environment parents feel their abilities are valued when the professional

provides feedback by pointing out a parent’s strength and then shaping the behavior from that point.

parents feel empowered to disagree with the professional. parents will ask questions when they don’t understand.

FAMILY-PROFESSIONAL PARTNERSHIPS

As adults who vary in their confidence level, intellectual ability, education level, personality, and cognitive learning style parents will grow in their capacity to be the child’s primary teacher if the professional does not feel that he/she must always be

the one with the answers. parents are guided to discover answers to questions. If the professional asks questions to highlight the parents’

knowledge.

FAMILY-PROFESSIONAL PARTNERSHIPS

Poor planning and organization Parents who are not given ample opportunity to practice during

the session will fi nd it diffi cult/impossible to integrate new strategies and techniques during daily activities

Unclear statements from the teacher about what parents need to do

Activities and materials are not age/stage appropriate Emphasis on testing vs. teaching Too much time devoted to counseling/talking with parent—not

enough time spent on weekly goals Parents who chose this approach because someone “convinced”

them A-V was right for their child may resist participating in sessions or home follow through

No occupying toys Interruptions—deliveries, neighbors, phone, siblings Child is not ready for the session when therapist arrives

OBSTACLES TO SUCCESSFUL PARENT PARTICIPATION SESSIONS

Documents

Audiologic Rehabilitation for Children and Educational Audiology SPA 6581 – Spring 2015 Lecture Date: 03/16/15 AUDITORY VERBAL THERAPY