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Kathryn Wilson, M.A., CCC-SLP, Cert.AVT

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1 Kathryn Wilson, M.A., CCC-SLP, Cert.AVT
Early Identification and Effective Intervention: The Auditory-Verbal Approach Kathryn Wilson, M.A., CCC-SLP, Cert.AVT Sara Lake, B.A., J.D. February 20, 2004 Washington, D.C

2 Presentation Topics Auditory-Verbal Philosophy
Principles of the Auditory-Verbal Approach How A-VT Differs From Other Approaches, Interventions, and Therapies Outcomes How to Access A-VT Services, Professional Training & Certification Case Presentation

3 Auditory-Verbal Philosophy Auditory-Verbal International, Inc
Auditory-Verbal Philosophy Auditory-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.

4 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.

5 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.

6 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.

7 Tori Fraternal twin Familial history of hearing loss Passed NHS
Age at identification: 15 months First hearing aid fitting: 16 months Began AVT at 18 months Cochlear Implant at 4 years of age Video: C.A. 8 yrs, 3 mo, 4 yrs post CI

8 Expected Results of NHS and Technological Advances:
Average age of identification will decrease Greater access to information about all communication approaches Number of families seeking A-VT will increase Need for Certified Auditory-Verbal Therapists will increase More children will develop spoken language through the Auditory-Verbal approach

9 Principles of Auditory-Verbal Practice
Adapted from Pollack, D. (1985) & Ling, D. (2003)

10 Aggressive Audiological Management
In an A-V approach: Pursuit of best amplification AVI Protocol for Audiological and Hearing Aid Evaluation

11 Suggested Protocol for Audiological and Hearing Aid Evaluation Adapted from AVI, 2003
Audiological Test Procedures Amplification Assessment Sound Field Aided Response Probe Microphone Measures FM Systems Frequency of Assessment Reports

12 Appropriate Amplification Technology
Hearing Aids Cochlear Implants FM Systems In an A-V approach Therapist must possess and apply in-depth knowledge of speech acoustics

13 Favorable Auditory Learning Environments
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

14 “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

15 Integrating Talking and Listening into ALL Aspects of Daily Life
In an A-V approach Audition is the primary sensory modality Use of hearing for language acquisition is unique to AVT Emphasis on auditory learning vs. auditory training Audition is the primary sensory modality for learning spoken language In an A-V approach, the child is in touch with his world through all his senses. He is a 5-sensed person. Attention is not directed to lipreading or use of tactile cues in order to develop or enhance the child’s listening skills. Visual or tactile information is provided only after the child is given opportunities to process thru hearing. Emphasis on auditory learning…. Many of us have done Auditory training—specific exercises and activities designed to improve auditory skills—often taught in conjunction with other approaches In A-V listening is used all day everyday—not just during a training session Ling stated that the difference in auditory training and A-V is “teaching children to hear” vs “giving children reasons to learn to listen”—accomplished thru meaningful purposeful activities and life experiences.

16 Ongoing Assessment, Evaluation & Prognosis
In an A-V approach All therapy is DIAGNOSTIC An average or better than average rate of progress is expected

17 Inclusion In Regular Schools
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

18 Parents and/or Principal Caregivers as Primary Teachers
In an A-V approach 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

19 Integration of Speech, Language, Audition and Cognition
In an A-V approach The normal developmental sequence is followed Child’s hearing age serves as the baseline vs. chronological age

20 An Auditory-Verbal approach embraces ALL the Principles

21 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 At an early age, all were mainstreamed with hearing children.

22 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

23 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

24 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

25 How to Access A-V Services
Auditory-Verbal International,Inc. (AVI) A-V Therapy has been practiced by pioneers since the 1940s and 1950s With more widespread early identification and improved technology, A-V Therapy is an option increasingly chosen by parents Luetke-Stahlman & Moeller (1987) % of parents of children with hearing impairment are typically hearing individuals

26 How to Access A-V Services
AVI is a worldwide membership association and information clearinghouse regarding the Auditory-Verbal approach located in the Greater Washington, D.C. area

27 How to Access A-V Services
AVI founded in 1987 by three visionaries: Daniel Ling, Doreen Pollack & Helen Beebe who believed audition should be the primary sensory modality for the acquisition of language for most children with hearing impairment

28 How to Access A-V Services
AVI offers a complete listing of all Certified Auditory-Verbal Therapists as well as other practitioners in the approach; and Information regarding the approach, membership & free literature as well as A-V publications

29 How to Access A-V Services
Through the AVI website, Or by contacting AVI at or (703)

30 Certification in A-V Therapy
AVI administers an international certification program in the A-V approach with certified professionals on 5 continents Currently, Certified Auditory-Verbal Therapists in 33 of the United States

31 Certification in A-V Therapy
International Certified Auditory-Verbal Therapists are in Europe, China, the Middle East, the Far East and Latin America Current certification standards and applications can be downloaded from the AVI website at:

32 Professional Training in A-VT
Discipline of Auditory-Verbal Therapy is a hybrid one; combines elements of audiology, speech-language pathology & education of the deaf Also includes elements of other disciplines such as parent guidance, child development and technology Approach also a highly practical one

33 Professional Training in A-VT
Proficiency in the approach involves both academic rigor and practical training

34 Professional Training in A-VT
Training Opportunities AVI Standardized Curriculum (2001) & AVI Mentor Referral Service Refers professionals seeking A-V training to certified professionals providing such training; Part of mentorship can be accomplished through video observation and critique

35 Professional Training in A-VT
Auditory-Verbal Learning Institute (AVLI) Offering quality A-V Distance Education products through an independent, yet AVI-affiliated institute Products include CD-ROMs with lecture and A-V demonstrations, videos, parent kits and other A-V publications

36 Professional Training in A-VT
Auditory-Verbal Learning Institute (AVLI) 7205 N. Habana Ave.  Tampa, FL Phone: (813) Web:

37 Professional Training in A-VT
AVI International Conferences “Auditory-Verbal Techniques & Strategies: A Professional Training” May 26, 2004  Como, Italy Cert.AVTs Judith Simser & Tina Olmstead Immediately prior to NHS2004 AVI Biennial International Conference Summer Toronto, Canada

38 Professional Training in A-VT
Professional Training Weeks at Auditory-Verbal Centers Auditory-Verbal Center of Atlanta (AVCA) Bolesta Center, Tampa, Florida Hear & Say Centre, Brisbane, Australia Learning to Listen Foundation, Toronto, Canada

39 Professional Training in A-VT
Auditory-Verbal specialization at the Masters level (degree in audiology, SLP, education of the deaf) as part of the Ling Institute at the University of Ottawa in Canada

40 How to Access A-VT Services, Training & Certification
Auditory-Verbal International, Inc. Eisenhower Avenue, Suite Alexandria, VA USA (703) 

41 Case Presentation C.A. 17 months CI Age 6 months A-V Age: 11 months
Age at Identification: 3 months Degree of H.L. Profound Etiology: Genetic Age at Implantation 12 months Hearing Aid Use Consistent use from 4 months of age Device: Clarion Co-existing Conditions None Educational Placement At home with mother until age 5/mainstream kindergarten

42 Discussion The Principles of A-VT 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 two major differences in A-VT from other approaches.

43 Discussion Research supports the efficacy of the Auditory-Verbal approach. Information regarding the Auditory-Verbal approach, certification, and professional training is available through Auditory-Verbal International, Inc.

44 Conclusions Children identified early and enrolled in Auditory-Verbal Therapy can acquire developmentally appropriate communication skills. Auditory-Verbal Therapy is an effective intervention for newly identified infants, toddlers, and children whose parents have chosen spoken language as the desired communication outcome.

45 Questions?

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