1. NHS 2002 2nd International Conference on Newborn Hearing Screening, Diagnosis, and Intervention Como, Italy May 31, 2002 Progress in Specific Language Skills for Young Children in the Auditory-Verbal Approach Ellen A. Rhoades, Ed.S. & Helen A. McCaffrey, Ph.D.

2. FOUR YEAR LONGITUDINAL STUDY Tertiary center-based A-V program No pre-selection of children or families All communication options presented to parents prior to initiation of A-V intervention services Children typically received 1-2 weekly AVT sessions Children received A-V services over a 1 to 4 year period

3. lexical-semantic comprehension To examine growth in lexical-semantic comprehension morpho-syntactical development as well as morpho-syntactical development (both comprehension and production), particularly as it pertains to children with hearing loss as a result of auditory-verbal intervention. PURPOSE OF STUDY TEST INSTRUMENTS Receptive & Expressive Language Age-Equivalencies [Specific Language Measures with basal-ceiling ages noted] TEEM (3 - 8 yrs) Test for Expressive Emergent Morphology TACL (3 - 10 yrs) Test for Auditory Comprehension of Language PPVT-R (2.6 - 90+ yrs) Peabody Picture Vocabulary Test

4. 1. What are the rates of progress in lexical-semantic and morpho-syntactic language skills by children with hearing loss in an auditory-verbal program? 2. How does progress in such specified language skills compare to progress in global language skills as observed by Rhoades & Chisolm (2001)? 3. What are the relationships between chronological age and language-equivalent age as measured by tests of lexical-semantic and morpho-syntactic skills? 4. How do these specific language skills compare among children who were professionally released from auditory-verbal therapy and those who continued? QUESTIONS

5. Test Time PPVT TACL TEEM Entry 32 32 17 Year 1 22 21 11 Year 2 10 10 2 Year 3 9 8 1 Year 4 4 4 0 NUMBER OF CHILDREN PARTICIPATING IN TESTING AT EACH TEST PERIOD

6. FINDINGS OF RHOADES & McCAFFREY 1. Language growth in both lexical-semantic and morpho-syntactical domains were significant over each year of auditory-verbal intervention, and these data are consistent with the findings of improved global receptive and expressive language scores earlier obtained. 2. PPVT and TACL scores were submitted to a two-way repeated measures analyses of variance (ANOVA). Statistically significant growth in language occurred each year. TACL scores were significantly higher than PPVT as a result of the first year. 3. TACL, PPVT, TEEM scores subjected to correlational analysis. Correlation between CA and LA for each assessment gets stronger over time. The strongest correlation is during the last year of intervention.

7. MORE FINDINGS OF RHOADES & McCAFFREY, 2002 4. There is functional significance of language growth - unquestionably so that language improves as a result of the auditory verbal approach, since the growth rate exceeded that of normal maturation rate. 5. Formula to calculate rate of language growth: [(Score B - Score A)/M] x 100 where A = age equivalent score at first evaluation B = age equivalent score at next evaluation M = number of months between evaluations Rate of language growth evidenced by TACL and PPVT show PPVT growth is lower than TACL growth across all years of intervention. TACL scores exceeded growth rate of normal maturation.

8. STILL MORE FINDINGS OF RHOADES & McCAFFREY, 2002 6. CA-LA gap decreased over time as a result of AVT. 7. For those children who had AVT for 3+ years with both TACL and PPVT scores, CA and LA data were regressed for each child. Some reached or exceeded CA performance on the TACL, but none on the PPVT. 8. Professionally released children (n=14) all showed TACL scores to exceed CA, with PPVT scores reaching equivalence to CA. Similarly, data from this group were subjected to a repeated measures analysis of variance (ANOVA) and no significant differences were found between CA and LA. These data corroborate global language outcomes. AVT= Auditory Verbal Therapy CA= Chronological Age LA = Language Age

9. AND MORE FROM RHOADES & McCAFFREY, 2002 9. For children who completed all 3 tests (n=9), mean language age-equivalencies for each test across time show that PPVT scores lagged behind TACL and TEEM, with the highest growth rate in TEEM scores. 10. Typically, most children obtained basal scores on the PPVT and TACL at the same time, but did not attain basal scores on the TEEM until a year later. Exceptions were those children given AVT as infants or those who experienced progressive deafness; they obtained basal scores on the TEEM at the same time as basal scores were obtained on the PPVT and TACL.

10. YearSourceDfFp 1Measure16.110.17* Time197.58<0.0001** Measure x Time11.3520.25 2Measure13.330.08 Time121.470.0002** Measure x Time10.720.41 3Measure11.370.26 Time138.01<0.0001** Measure x Time10.510.48 4Measure11.200.31 Time139.730.0007** Measure x Time10.760.42 *p<.05 **p<.001 SUMMARY OF REPEATED MEASURES ANALYSES OF VARIANCE OF EQUIVALENT LANGUAGE AGES

11. MEAN CA & LA FROM PPVT TESTING OVER 4 YR PERIOD OF A-V INTERVENTION

12. MEAN CA & LA FROM TACL TESTING OVER 4 YR PERIOD OF A-V INTERVENTION

13. MEAN CA & LA FROM TEEM TESTING OVER 4 YR PERIOD OF A-V INTERVENTION

14. CORRELATION BETWEEN LA & CA FOR EACH TEST GETS STRONGER OVER TIME CORRELATIONAL ANALYSIS

15. MEAN RATE OF LA GROWTH

16. RELATIONSHIP BETWN CA & LA IN 7 CHILDREN FROM TACL OVER 4 YR PERIOD

17. RELATIONSHIP BETWN CA & LA IN 7 CHILDREN FROM PPVT OVER 4 YR PERIOD

18. RELATIONSHIP BETWEEN CA & LA FROM TACL AND PPVT IN 2 GROUPS OF A-V ‘GRADUATES’

19. MEAN PPVT, TACL, & TEEM LA ACROSS 2 YRS OF A-V INTERVENTION

20. The auditory-verbal approach is a viable option toward enabling children with significant hearing loss to hear and speak. Implementation of this communication approach, when based on empirical evidence, can stimulate normal rates of language growth, in both the lexical-semantic and morpho-syntactical domains. Children who are hard of hearing and/or deaf, regardless of whether they are hearing aid or cochlear implant users, can become linguistic geniuses. Children with hearing loss can claim their birthright to function within normal limits in our hearing and speaking world....Ellen A. Rhoades & Helen A. McCaffrey, 2002

21. For further information on the Auditory-Verbal Approach, go to the web sitehttp://www.AuditoryVerbalTraining.com To contact the investigators by e-mail, go to:info@AuditoryVerbalTraining.com Progress in Specific Language Skills for Young Children in the Auditory-Verbal Approach by Ellen A. Rhoades, Ed.S., Cert. AVT & Helen A. McCaffrey, Ph.D., Cert. AVT