Archive for March, 2009

Why Choose the Auditory-Verbal Approach?

Tuesday, March 24th, 2009

So much of medicine is based on “best practices.” What works best for the largest number of typical cases, what have studies shown, etc. Why is AV a great first option for parents when they find out that their baby or child is deaf?

Amy: I think it’s because we know that learning to speak and hear is an integral way of being a part of the ENTIRE community. This is the first reason. If we didn’t care about that, then it wouldn’t matter what language, right?!?

Melissa: I also think that it is the language of our families. Even if Elliot and I had learned sign language, would it have been realistic to have expected both sets of grandparents, aunts, uncles and cousins to also have become fluent in sign? We live far from family, and so the cousins did not grow up being a significant part of each other’s lives, but, when they did get together they connected immediately as if they got together more frequently, and my girls were always an integral part of this interaction, something that would not have been possible if they couldn’t communicate with their cousins.

I often hear older deaf adults talk about how they felt isolated from their families and never felt a part of it. I didn’t want this for my children.

Amy: So, even if we lived many years ago and could not do AV, we may have chosen lipreading and oral methods because it was that important to us. Would we have signed, also? I have wondered that. I know that ASL is hard to learn, as hard as learning any foreign language as an adult. Would I have learned it fast enough to speak and teach in complex language to my children? I have often heard the stories of families who DID learn to sign, but only at a rudimentary level. Their kids were still isolated, and outside the immediate family it was rare to hear of people becoming fluent for the sake of a grandchild or buddy.

But today, we have extremely high functioning cochlear implants. I don’t think those who began the acoupedic methods ever envisioned how far we would have come– and how fast. No doubt they would be amazed at how quickly a child can learn to listen and speak. And how easily! If parents choose cochlear implants, the most commonsense approach is to use the new auditory skills. Why get one, otherwise? The goals of parents who get cochlear implants for young children are hoping that their child will hear and speak, and Auditory Verbal Therapy is the most likely way that this can be accomplished.

Melissa: I agree. Given today’s technologies and the successes widely experienced with these technologies, AV should be the first option for most parents if their goal is for their deaf child to learn to hear and speak. Provided the parents are committed to the time commitment and hard work early on, their children will reap the rewards.

What Is the Auditory-Verbal Approach?

Tuesday, March 3rd, 2009

Auditory-Verbal does not simply mean auditory and verbal.  Rather, it is the name of a well- defined approach that focuses on optimizing children’s hearing so that they can learn language auditorally rather than visually.  It is also a parent-centered approach because parents are their children’s primary language role models during the critical early language learning years.



Principles of LSLS 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 parents¹ to help their child use hearing as the primary sensory modality in developing spoken language without the use of sign language or emphasis on lipreading.

4. Guide and coach parents¹ 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 parents¹ to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.

6. Guide and coach parents¹ 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 effectiveness 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.

*An Auditory-Verbal Practice requires all 10 principles.

¹The term “parents” also includes grandparents, relatives, guardians, and any caregivers who interact with the child.

(Adapted from the Principles originally developed by Doreen Pollack, 1970)
Adopted by the AG Bell Academy for Listening and Spoken Language®, July 26, 2007.


Amy: I think most people have an idea of “oral education of the deaf” that comes from things like movies, books or TV.  We have all seen various shows with people teaching lip-reading, using hands on throats and lips, etc.  We hear laborious stories of parents spending hours teaching the production of one single sound.   For many years, without good amplification, oral education required things which were not primarily auditory in nature.  One of the biggest difference I see between oral education and Auditory Verbal therapy, specifically, is the fact that it is based on the child’s audition (not their mouth).  Contrary to what people might think, it was not utilizing cochlear implants in the early days, but hearing aid technology and residual hearing.  Even today, it continues to be based on the auditory access present in any particular child.   When audition is present, the spoken language will naturally follow.

The other main difference which I believe is of utmost importance is the fact that parents or primary caregiver are the key players of this game.  They are recognized as the person most often with the child, the person who is the most involved, and who can make the most language difference for the child.  I don’t ascribe to the “more is better” philosophy when it comes to actual time in a therapist’s office.  I DO ascribe to the “more is better” philosophy of quality time with one’s parent!  For my kids, this meant talking all the time, reading all the time, spending every possible moment communicating about our daily lives.  I hear about orally educated kids who go every day to therapy!  But what happens in the hours when they are with their parent?  To me, that is the most important question.  I don’t enjoy the driving, the waiting rooms, the scheduling… if I can do it at home– that’s the best place to be.  My Auditory Verbal therapists taught me how to do the work at home.  The weekly sessions (for a brief couple of years) were parent training for me!

Mainstreaming is the 3rd major difference.  While I homeschool, it IS mainstreaming for my child because I homeschooled his brothers before him, and have no doubt that he will re-enter a brick & mortar school (as regular schools are called) when the time is right.  He mainstreamed for preschool without an ounce of difficulty.  Being in a typical listening environment, whether it’s in the classroom, in a sport, in the arts or any facet of education… is part of real life!  It prepares kids for living in a world which is based on listening and talking.  When we go to religious education or track practice, I want to know that my child can hear the teacher and coach, knows how to speak clearly, and can advocate for whatever he needs.  Mainstreaming gives that experience.

Melissa: One of the greatest benefits of mainstreaming that I have seen my girls experience firsthand is the ease with which they learn language naturally from their peers, both through conversations and overhearing, including idiomatic expressions and expressions that are current to their generation.  I remember Rachel learning, “Sure!” in preschool, saying it with the same intonation as her normally hearing peers, and Jessica coming out with, “Awesome!” and “Whatever!”  Because they learned to hear, they have been able to pick up spoken language naturally from their peers. 

Then, there are those moments of overhearing that we wish they didn’t have!  Anyone who has driven in Atlanta traffic knows that it can be a frustrating experience.  Between carpooling her older siblings and driving to oral motor therapy in a heavily trafficked area, Jessica, who was always sitting right behind me in the car, heard my too frequently expressed complaints.  One day, when she was four years old, she reached up onto the counter only to find an empty plate, which led her to exclaim, “There are no more blueberries, dammit!”

The other advantage to mainstreaming is that I knew my girls were learning grade level material alongside their peers.  When Rachel was a baby, and we visited a high school class at an oral school, I became concerned because the material was clearly at a lower level than a regular tenth grade.  By attending our neighborhood high school, I knew that she was learning at grade level and even above in honors and AP courses.


Amy: Oh, the easy acquisition of phrases we wish to avoid.  Sigh!  We know that well.  Currently one phrase is “Oh my God.”  We discourage that phrase in our family but Oliver heard someone say it… whether it was other kids in the neighborhood or TV or his brothers, I can’t say!  But we have tried to replace it with “Oh my goodness.”  So now he frequently discusses this, saying “you don’t say Oh my God, you say Oh my goodness.”    In November I sent Melissa the following email: “Ollie just said to Alex: “Get your butt down here!”  UH OH…”

Elliot took the CRCT last spring with his peers from across the state, as part of the Georgia Virtual Academy (a public school).  The state testing was administered in a large room by a teacher who spoke much of the details of the information, since first graders need instructions read to them.  We could have requested accommodations, but we knew they weren’t necessary.  He sat in the front row, but he told me when I picked him up that he could hear everything.  Test results confirmed that he not only did, but that he could easily exceed all standards for 1st grade curriculum.  Historically, the non-mainstreamed kids in deaf education in our state have had difficulty with the state testing, even when it is administered with accommodations.