All You Ever Wanted to Know About Auditory-Verbal Therapy BUT Didn't Know Who to Ask! - Beth Walker, Kathryn Wilson


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All You Ever Wanted to Know About Auditory-Verbal Therapy BUT Didn't Know Who to Ask! - Beth Walker, Kathryn Wilson

  1. 1. 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. AVT Kathryn Wilson, M.A., CCC-SLP, Cert. AVT November 10, 2003
  2. 2. Agenda <ul><li>Auditory-Verbal Philosophy </li></ul><ul><li>Principles of the Auditory-Verbal Approach </li></ul><ul><li>How AVT differs from other approaches, interventions, and therapies </li></ul><ul><li>Outcomes </li></ul><ul><li>Cases </li></ul><ul><li>Resources </li></ul>
  3. 3. Auditory-Verbal Philosophy Auditory-Verbal International, Inc. Position Statement <ul><li>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. </li></ul>
  4. 4. <ul><li>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. </li></ul>
  5. 5. <ul><li>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. </li></ul>
  6. 6. <ul><li>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. </li></ul>
  7. 7. Principles of Auditory-Verbal Practice Adapted from Pollack, 1985
  8. 9. Principle 1 <ul><li>EARLY detection and identification of infants, toddlers and children who are deaf or hard of hearing. </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>Children may begin therapy as infants </li></ul></ul>
  9. 10. Areas Affected by the Child’s Hearing Impairment <ul><li>Parent-Child Relationship </li></ul><ul><li>Social, Emotional, and Cognitive Development </li></ul><ul><li>Critical Periods of Neurosensory Development </li></ul><ul><li>Acquisition and Use of Language </li></ul>
  10. 11. <ul><li>“At no time in a child’s life are the physical and acoustic conditions as favorable for listening as in early infancy.” </li></ul><ul><ul><ul><li>Daniel Ling, Ph.D </li></ul></ul></ul>
  11. 12. Principle 2 <ul><li>Aggressive audiological management </li></ul><ul><ul><li>In an A-V approach : </li></ul></ul><ul><ul><li>Pursuit of best amplification </li></ul></ul><ul><ul><li>Parents must be willing to make more trips to the audiologist </li></ul></ul><ul><ul><li>AVI Protocol for Audiological and Hearing Aid Evaluation </li></ul></ul>
  12. 13. Suggested Protocol for Audiological and Hearing Aid Evaluation Adapted from AVI, 1989 <ul><li>Audiological Test Procedures </li></ul><ul><li>Amplification Assessment </li></ul><ul><li>Sound Field Aided Response </li></ul><ul><li>Probe Microphone Measures </li></ul><ul><li>FM Systems </li></ul><ul><li>Frequency of Assessment </li></ul><ul><li>Reports </li></ul>
  13. 14. Frequency of Assessment <ul><li>Every 90 days once dx is confirmed and amplification fitted, until age 3. </li></ul><ul><li>Complete aided and unaided audiogram at least by age 2 </li></ul><ul><li>New earmolds—90 day intervals or sooner—until age 3-4 </li></ul><ul><li>Ages 4-6; assessment every 6 months </li></ul><ul><li>Age 6+; assessment and earmolds at 6-12 month intervals </li></ul><ul><li>Immediate evaluation if changes are suspected </li></ul>
  14. 15. Principle 3 <ul><li>Appropriate amplification technology to achieve maximum benefits of learning through listening </li></ul><ul><ul><li>Hearing Aids </li></ul></ul><ul><ul><li>Cochlear Implants </li></ul></ul><ul><ul><li>FM Systems </li></ul></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>Therapist must possess and apply in-depth knowledge of speech acoustics </li></ul></ul>
  15. 16. Principle 4 <ul><li>Favorable auditory learning environments for the acquisition of spoken language including individualized therapy </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>All therapy is one-to-one </li></ul></ul><ul><ul><li>Sessions are usually one time weekly for 1 hr. to 1 hr. 30 minutes. </li></ul></ul><ul><ul><li>Best conditions for verbal learning are provided </li></ul></ul>
  16. 17. Principle #5 <ul><li>Integrating listening into the child’s entire being so listening becomes a way of life </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>Residual hearing is emphasized rather than visual cues </li></ul></ul><ul><ul><li>Emphasis on auditory learning vs. auditory training </li></ul></ul><ul><ul><li>Use of hearing for language acquisition is unique to AVT </li></ul></ul>
  17. 18. Principle 6 <ul><li>Ongoing assessment, evaluation and prognosis of the development of audition, speech, language and cognition which are integral to the Auditory-Verbal experience </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>All therapy is DIAGNOSTIC </li></ul></ul><ul><ul><li>An average or better than average rate of progress is expected </li></ul></ul>
  18. 19. Principle 7 <ul><li>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 </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>Mainstream education is a critical component </li></ul></ul><ul><ul><li>Parents and AVT work in partnership to secure appropriate services and placement </li></ul></ul><ul><ul><li>Similar expectations are established for children who are deaf/hh and those with normal hearing </li></ul></ul>
  19. 20. Principles 8 & 9 <ul><li>Active participation of parents in order to improve spoken communication between the child and family members </li></ul><ul><li>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 </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>Parents actively participate in ALL sessions </li></ul></ul><ul><ul><li>The parent is the primary student during tx sessions </li></ul></ul><ul><ul><li>The parent is the primary teacher in day-to-day life </li></ul></ul>
  20. 21. Principle 10 <ul><li>Integration of speech, language, audition and cognition in response to the psychological, social and educational needs of the child and family </li></ul><ul><li>In an A-V approach </li></ul><ul><ul><li>The normal developmental sequence is followed </li></ul></ul><ul><ul><li>Child’s hearing age serves as the baseline vs. chronological age </li></ul></ul>
  21. 22. <ul><li>An Auditory-Verbal approach embraces ALL the Principles </li></ul>
  22. 23. Outcomes in Auditory-Verbal Therapy <ul><li>Wray, Flexer & Saunders (1996) </li></ul><ul><ul><li>Followed 19 children, ranging in age from kindergarten through 10th grade. </li></ul></ul><ul><ul><ul><li>84% reading on grade level </li></ul></ul></ul><ul><ul><ul><li>44% reading above grade level </li></ul></ul></ul><ul><ul><ul><li>4 of the 19 were placed in gifted or honors classes </li></ul></ul></ul><ul><ul><ul><li>17 of the 19 were involved in activities related to school, home, or church settings. </li></ul></ul></ul><ul><ul><ul><li>18 of the 19 used a personal FM system at school. </li></ul></ul></ul><ul><ul><ul><li>At an early age, all were mainstreamed with hearing children. </li></ul></ul></ul>
  23. 24. Outcomes in Auditory-Verbal Therapy <ul><li>Robertson & Flexer (1998) </li></ul><ul><ul><li>Followed 54 school age children </li></ul></ul><ul><ul><ul><li>81% Mainstreamed totally in the regular school </li></ul></ul></ul><ul><ul><ul><li>19% Mainstreamed partially </li></ul></ul></ul><ul><ul><ul><li>43% Read better than average hearing child </li></ul></ul></ul><ul><ul><ul><li>43% Read on the same level as the average hearing child </li></ul></ul></ul><ul><ul><ul><li>9% Read below average </li></ul></ul></ul><ul><ul><ul><li>5% Did not provide reading skill information </li></ul></ul></ul>
  24. 25. Outcomes in Auditory-Verbal Therapy <ul><li>Robertson & Flexer (1998) </li></ul><ul><ul><li>43% Scored above grade average on standardized testing </li></ul></ul><ul><ul><li>30% Scored at grade level </li></ul></ul><ul><ul><li>27% scored below grade level </li></ul></ul>
  25. 26. Outcomes in Auditory-Verbal Therapy <ul><li>Goldberg & Flexer (2001) </li></ul><ul><ul><li>Surveyed 114 graduates of A-V programs in the U.S. & Canada </li></ul></ul><ul><ul><ul><li>94% had severe-to-profound or profound hearing loss </li></ul></ul></ul><ul><ul><ul><li>95% had hearing loss at birth or before 3 yrs. of age </li></ul></ul></ul>
  26. 27. Outcomes in Auditory-Verbal Therapy <ul><li>Goldberg & Flexer (2001) (n=114) </li></ul><ul><ul><li>Average age of respondent = 28.9 years (range: 18 - 56 years) </li></ul></ul><ul><ul><li>66% were aided within 3 months of identification; </li></ul></ul><ul><ul><li>82% were aided within 6 months of identification </li></ul></ul>
  27. 28. Outcomes in Auditory-Verbal Therapy <ul><li>Goldberg & Flexer (2001) (n=114) </li></ul><ul><ul><li>69% continue to use two hearing aids </li></ul></ul><ul><ul><li>All use hearing aids or a cochlear implant or both </li></ul></ul><ul><ul><li>1 had binaural cochlear implants </li></ul></ul>
  28. 29. Outcomes in Auditory-Verbal Therapy <ul><li>Goldberg & Flexer (2001) (n=114) </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><ul><li>86% mainstreamed in elementary school </li></ul></ul></ul><ul><ul><ul><li>86% mainstreamed in middle or high school </li></ul></ul></ul><ul><ul><ul><li>91% mainstreamed in their senior high school year </li></ul></ul></ul><ul><ul><ul><li>78% attended a typical college or university program </li></ul></ul></ul>
  29. 30. Outcomes in Auditory-Verbal Therapy <ul><li>Goldberg & Flexer (2001) (n=114) </li></ul><ul><ul><li>Telephone Communication </li></ul></ul><ul><ul><ul><li>78% reported making some use of voice telephone </li></ul></ul></ul><ul><ul><ul><li>62% reported using text telephones as well </li></ul></ul></ul><ul><ul><li>Employment History </li></ul></ul><ul><ul><ul><li>44% reported being students or homemakers </li></ul></ul></ul><ul><ul><ul><li>41% reported incomes above $20K </li></ul></ul></ul><ul><ul><ul><li>8% reported incomes above $50K </li></ul></ul></ul><ul><ul><ul><ul><li>Examples: teachers, attorney, physician, bank teller, janitor </li></ul></ul></ul></ul>
  30. 31. Outcomes in Auditory-Verbal Therapy <ul><li>Goldberg & Flexer (2001) (n=114) </li></ul><ul><ul><li>Overall Perceptions </li></ul></ul><ul><ul><ul><li>76% reported being in the ‘hearing’ world </li></ul></ul></ul><ul><ul><ul><li>21% reported being in the ‘hearing’ and ‘deaf’ worlds </li></ul></ul></ul><ul><ul><ul><li>1 respondent reported being entirely in the ‘deaf’ world </li></ul></ul></ul>
  31. 32. Discussion <ul><li>The Principles of AVT outline the essential components for young children to develop intelligible spoken language through listening. </li></ul><ul><li>The role of audition in processing spoken language and parents as primary models are 2 major differences in AVT from other approaches. </li></ul>
  32. 33. Discussion <ul><li>Expected results of NHS and technological advances: </li></ul><ul><ul><li>Average age of identification will decrease </li></ul></ul><ul><ul><li>Number of children under the age of two presenting for cochlear implant evaluations will increase </li></ul></ul><ul><ul><li>Number of families seeking AVT will increase </li></ul></ul><ul><ul><li>Need for Certified Auditory-Verbal Therapists will increase </li></ul></ul><ul><ul><li>More children will develop spoken language through the Auditory-Verbal approach </li></ul></ul>
  33. 34. Conclusions <ul><li>Children identified early and enrolled in Auditory-Verbal Therapy can acquire developmentally appropriate communication skills. </li></ul><ul><li>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. </li></ul>
  34. 35. Auditory-Verbal International, Inc. <ul><li>2121 Eisenhower Avenue #402 </li></ul><ul><li>Alexandria, VA 22314 </li></ul><ul><li>(703) 739-1049 Voice </li></ul><ul><li>(703) 739-0874 TDD </li></ul><ul><li> </li></ul>
  35. 36. Questions?