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/
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