Auditory verbal training originated in the mid-20th century as an approach to therapy for children with hearing loss. It focuses on developing listening and spoken language skills through the use of hearing technology and coaching parents to create an environment that supports listening and spoken language. Auditory verbal therapy follows 10 principles established by Auditory Verbal International, including early detection of hearing loss, maximizing acoustic stimulation through amplification, and integrating listening into all aspects of the child's daily activities and interactions without relying on sign language. The goal is for children to develop independent spoken language and communication skills to allow for integration into mainstream classrooms.

1. Auditory verbal training
WARIS ALI
M.PHIL(SCHOLAR)HEARING SCIENCES
IIRS-ISLAMABAD

2. What is AVT and where
did it originate?
 AVT was established as an approach to therapy
in the mid 20th century by pioneers Ling, Beebe,
and Pollack.
 Auditory Verbal International established ten
principles to guide the field and foster
understanding of Auditory Verbal Therapy.

3. First AVT Principle
 Supporting and promoting programs for the
early detection, identification, and diagnosis of
hearing loss and the auditory management of
infants, toddlers, and children identified along
with Auditory-Verbal Therapy.

4. Second AVT Principle
 Providing the earliest and most appropriate use of
medical and amplification technology to
achieve the maximum auditory stimulation
benefit.

5. Third AVT Principle
 Seeking to integrate listening as
well as maximal acoustic
stimulation into the child’s total
personality in response to the
environment by guiding/coaching
caregivers without the use of sign
language or emphasis on
speechreading.

6. Fourth AVT Principle
 Supporting the view that
communication is a social act, and
seeking to improve spoken
communication interaction within the
typical social dyad of infant/child with
hearing loss and primary caregiver’s
including use of the parents as primary
models for spoken language
development and implementing one-
on-one teaching.

7. Fifth AVT Principle
 Seeking to establish the child’s integrated
auditory system for the self-monitoring of
emerging speech.

8. Sixth AVT Principle
 Using natural sequential patterns of
auditory, perceptual, linguistic and
cognitive stimulation to encourage
the emergence of listening,
speech, and language abilities.

9. Seventh AVT Principle
 Guiding and coaching parents to create
environments that support listening/spoken
language through the child’s daily activities and
to integrate listening and spoken language in the
child’s life.

10. Eighth AVT Principle
 Guiding and coaching parents to help their child
self-monitor spoken language production.

11. Ninth AVT Principle
 Making ongoing informal/formal diagnostic
evaluation and prognosis of the development of
listening skills as an integral part of the
rehabilitative process.

12. Tenth AVT Principle
 Supporting the concepts of mainstreaming and
integration of children with hearing loss into
regular education classes with appropriate
support services and to the fullest extent possible.

13. Why does AVT work????
 Existing Evidence Supporting the AVT practice
 The majority of children with hearing loss have
useful residual hearing… a fact know for decades
( Bozold and Slebenmann, 1908, Goldstein, (1939);
Urbantschitsch, 1982).

14. Why AVT cont…
 When properly aided, children with hearing loss
can detect most if not all the speech spectrum
(Beebe, 1953;Goldstein, 1939; Johnson, 1976; Ling
and Ling, 1978; Pollack, 1970, 1985; Ross and
Calvort, 1984).

15. Cont….
 Once all available residual hearing is accessed
through amplification technology (eg. Binaural
hearing aids and acoustically tuned earmolds, FM
units, cochlear implants) in order to maximum
detection on the speech spectrum, then a child
will have the opportunity to develop language in
a natural way through the auditory modality.
 A child with a hearing loss need not
automatically be a visual learner.
 Hearing, rather than being a passive modality
that receives information, can be the active
agent of cognitive development (Boothroyd,
1982; Goldberg and Lebahn, 1990; Robertson and
Flexor, 1990; Ross and Calvert, 1984).

16. Cont…
 In order to benefit from the “critical
periods” of neurological and
linguistic development, then the
identification of hearing loss, use of
appropriate amplification and
medical technology, and
stimulation of hearing must occur
as early as possible (Clapton, and
Winfield, 1976; Johnson and
Newport, 1989; Lenneberg, 1967;
Marler, 1970; Newport, 1990).

17. Cont….
 If hearing is not accessed during
the critical language years, a
child’s ability to use acoustic input
meaningfully will deteriorate due to
physiological (retrograde
deterioration of auditory
pathways), and psychosocial
(attention, practice, learning)
factors (Evans, Webster, and
Cullen, 1983; Merzenich and Kass,
1982; Patchett, 1977; Robertson
and Irvine, 1989; Webster, 1983).

18. Cont….
 Current information about normal
language development provides the
framework and justification for the
structure of Auditory-Verbal practice.
That is infants/toddlers/children learn
language most efficiently through
consistent and continual meaningful
interactions in a supportive
environment with significant
caretakers (Kretschmer and Kretscher,
1978; Lennenberg, 1967; Leonard,
1991; Ling, 1989; MacDonald and
Gillette, 1989; Menyuk, 1977; Ross,
1990).

19. Cont…
 As verbal language develops through the
auditory input of information, reading skills also
develop (Geers and Moog, 1989; Ling 1989,
Robertson and Flexor, 1990).

20. Rationale Cont…
 Parents in Auditory-Verbal programs do
not have to learn sign language or Cued
Speech. More than 90% of parents with
children with hearing loss have normal
hearing (Moores, 1987). Studies have
shown that over 90% of parents with
normal hearing do not learn sign
language beyond the basic preschool
level of competency (Luetke-Stahlman
and Moeller, 1987). Auditory-Verbal
Practice requires that caregivers interact
with a child through spoken language
and create a listening environment which
helps a child to learn.

21. Cont…

If a severe or profound hearing loss automatically
makes an individual neurologically and
functionally “different” from people with normal
hearing (Furth, 1964; Myklebust and Brutton, 1953),
then the Auditory-Verbal philosophy would not be
tenable.
 The fact is however, that outcome studies show
that individuals who have, since early childhood,
been taught through the active use of amplified
residual hearing, are indeed independent,
speaking, and contributing members of
mainstream society (Goldberg and Flexer, 1991;
Ling, 1989, Yoshinaga-Itano and Pollack, 1988).

22. Language,
Cognitive,
and Audition
Evaluations

23. Expectations
for a Child
with a
Hearing Loss

24. Chronological Age vs.
Cochlear Age
 Chronological age begins at birth
 Cochlear age begins when the implant is
activated
 Cochlear age used as tool
 Speech and language
expectations/development should be based on
cochlear age

25. Progression of
Development
 Normal speech and language development can
be expected on a delayed time scale
 Speech and language goals should follow the
natural progression of normal speech and
language development

26. Auditory Expectations with
AVT & CA @ 12 months
 Respond to a variety of environmental and
speech sounds at various distances
 Imitate vowels and some consonants
 Imitate motions of nursery rhymes
 Identify nursery rhymes when sung

27. AVT & CA @ 12 months
cont.
 Respond to familiar phrases
 Identify and imitate learning to listen sounds

28. Auditory Expectations with
AVT & CA @ 24 months
 Identify a picture that is part of a simple story
 Identify an object with descriptors
 Recall 3 critical elements
 Answer questions about a picture, book, or set of
objects

29. Auditory Expectations with
AVT & CA @ 36 months
 Answer questions & recall details about a story
with the topic revealed
 Answer questions without pictures
 Recall four critical elements
 Answer questions about a familiar topic

30. Auditory Expectations with
AVT & CA @ 48 months
 Repeat easy sentences
 Process information (by live voice or on tape) at
sentence and conversation level with
background noise
 Follow a conversation with an unrevealed topic

31. AVT & CA @ 48 months
cont.
 Retell a story recalling many details in the correct
sequence
Expectations taken from the Auditory Learning
Guide (ALG) developed by Beth Walker, 1995

32. Lesson Plans
and
Treatment
Goals

33. Sample Lesson Plan
GOAL ACTIVITY
PROCEDURE
Sample target items
Materials
Rationale
Supporting
Research
STRATEGIES
(To promote auditory
learning)
HOME
IDEAS
EVAL/NEXT GOALS
Audition:
Speech:
Language &
Cognition:
Other:

34. Audition Goals & Activities
 Detect/identify sounds of the Ling 6/7 Sound Test
“s” “m” “oo” “ee” “ah” “sh” “fff”
 Fish in a fish bowl with water
 Seeds in a flower pot
 Animals in sand
 Cars down a ramp

35. Audition Goals & Activities
Learning to Listen Sounds
Cow moo moo Snake ssssss
Ice cream mmmmm Airplane ahhhh
Car beep beep Toothbrush chchchch
Rabbit hop hop Monkey eeeee
Bus bubu Fish shshshsh
Truck honk honk Ball bounce bounce

36. Audition Goals & Activities
 Identify/imitate approximations of Learning to
Listen to Sounds
 Grab bag, surprise box
 Open the “presents”
 Guessing game with cups

37. Audition Goals & Activities
 Follow directions by recalling three critical
elements
 Barrier game
 Coloring activity
 Feed the people
 Build a castle

38. Auditory Strategies
 Move closer to the implant
 Vary the prosody and intonation
 Sing a song
 Put the key word at the end of the
phrase
 Pause before saying the key word
 Whisper voiceless sounds
 Prolong fricatives and nasals /hausssss/
 Repeat stops /kkkkeik/

39. Auditory Strategies
 Vary the number of syllables
 Decrease background noise
 Ask “what did you hear?”
 Auditory sandwich technique
 Present two choices
 Use the parent as a model

40. Speech Goals & Activities
 Imitate consonants varying by manner
with the same vowels
ex: ssss vs tutu mmm vs bubu
 Microphone
 Basketball, bowling, soccer
 Balloon toss
 Marbles
 Make a puzzle

41. Speech Goals & Activities
 Produce /m/ in the initial position of words
 /m/ magnets
 Hide /m/ objects in rice, beans, or sand
 Make a book

42. Language Goals and
Activities
A Review: Normal Language Development Checklist
6 Months
 Repeats self-produced sounds
 Imitates sounds
 Vocalizes to others
 Uses about 12 different phonemes

43. Language Goals and
Activities
1 Year Old
Vocabulary
 Turns to name
 Jabbers Loudly
 Waves “bye bye” upon request
 Plays “peek-a-boo”
 Often over-generalizes meaning
(ball, dog)

44. Language Goals and
Activities
2 Year Old
 Jargon almost completely
dropped out
 Pronouns are used often and
correctly
 Vocabulary may have grown from
50-200 words
 Average sentence length 2.5
words

45. Language Goals and
Activities
2 Year Old
Vocabulary
 Understands 300-600 words
 Points to five body parts on command
 Responds to y/n questions appropriately
 Knows and uses prepositions “in” and
“on”
 Names and produces sounds of
common animals
 Follows simple directions

46. Language Goals And
Activities
2 Year Old
Grammar
 Speaks in 2-3 word utterances
 25% of two-word combo’s consist
of noun + verb (Open-Pivot)
construction (Daddy go)
 Asks “What’s that?”
 Uses rising intonation with other
questions

47. Language Goals and
Activities
3 Year Old
 Talking in multi-word utterances
 Vocabulary is extensive and long
 Comprehensive of more complex
directions
 Concrete in regard to subjects
they can discuss
 The “why” question phenomenon

48. Language Goals and
Activities
3 Year Old
Vocabulary/Concepts
 Understand the meaning of “Who?”,
“Why?” and “How many?”
 Able to answer AGENT + ACTION?’s
 Knows own gender
 Understands basic adjectives “big” and
“little”
 Counts up to 3 but only understand
concept of “one”.
 Follows 2-4 part commands

49. Language Goals and
Activities
3 Year Old
Grammar
 Speaks in 3-4 word sentences
 Articles “a” “the” and copula/auxiliary “is”
are beginning to be included.
 Use of word tense are present
 Use of pronouns “I”, “me”, “you”, “my”,
“mine”
 Yes/no questions are developed “Is this a
horse?”
 Over generalizes grammar rules

50. Language Goals and
Activities
4 Year Old
 Begin to play with words
 Elaborates simple responses into long narratives
 Comments with approval on his/her own
behavior and criticizes that of others

51. Language Goals and
Activities
4 Year Old
Vocabulary/Concepts
 Identifying and Expressing understanding
of colors
 Counts to ten by rote, understands
concept of 3.
 Can perform simple analogies “fire is hot,
ice cream is ____”
 Understands basic prepositions
 Understands adjectives of size and
quantity:

52. Language Goals and
Activities
4 Year old
Grammar
 4-5 word sentences, on average.
 Sentences are complete
 Grammatical overgeneralizations
continue
 Uses third person singular
 Use of conjunctions
 Modal verbs

53. Language Goals and
Activities
5 Year old
 Has a sense of social standards
and limitations. (pragmatically
appropriate given then situations)
 Mastered number concepts thru 10
 Can name and describe use and
function of everyday objects
 Grammatical and articulatory
errors are eliminated

54. Language Goals and
Activities
5 Year old
Vocabulary Concepts
 Can group objects by category
 Aware of the function of senses (eyes,
ears, nose, mouth)
 Understands prepositions “behind” and
ahead of”
 Understands “first” and “last”
 Understands the concept of time

55. Language Goals and
Activities
5 Year old
Grammar
 Sentences are from 5-6 words in
length
 Can understand almost any type
of sentence spoken
 Speaks in grammatically complete,
correct sentences.
 Begins to develop metalinguistic
awareness

56. Language Goals and
Activities
6 Year Old
 Sentence Length- 6-7 words
 Vocabulary -5000-6000 words
 Number concepts- rote counting up to 30
 Asks meaning of words
 Complete analogies

57. Language Goals and
Activities
Bloom and Lahey Overview
 Phases
 Content Categories

58. Language Goals and
Activities
HOW DO I TEACH LANGUAGE?....
Language Teaching Hierarchy

59. Language Goals and
Activities
Language Temptations:
**** Reminders:
Do's
 Remember Children need opportunities to
communicate
 Deal with the child in a sensitive way
 Be aware of the child’s message
 Plan activities that mean something to the child
through his or her daily activities
 Involve other people in the interaction
 Remember having fun is a part
 Allow wait time … typically 10-15 seconds; for those
significantly impaired up to 30 seconds

60. Language Goals and
Activities
Don’t ’s
 Don’t rush the child’s attempts to communicate
 Don’t overload the child’s ability to see, hear,
and move.
 Don’t set the child up to fail
 Don’t waste valuable time doing things with child
that will not help him or her in life
 Don’t assume you know what the child is trying to
communicate
Expectations taken from Wetherby and Prizant 1989
Communicative Temptations and Pamela Talbot
2002 Topics in Auditory Verbal Therapy
See Communicative Temptations Handout

61. Language Goals and
Activities
Handouts: See sampling of activities following
phases 1-3 content categories of Bloom and
Lahey.
Note: Each activity can be modified to
accommodate learners at varying phases of
Bloom and Lahey.

62. Auditory Strategies
 Ask the child what did they hear; not are
you listening???
 Use the hand cue
 Move in closer
 Repeat whole phrase
 Acoustically highlight; not over-articulate
 Rephrase
 Whisper the key sound
 Model on the parent first

63. THNKS FOR YOUR
UN-DIVIDED ATTENTION