One of the early intervention options for infants, toddlers, and young children who are fit with hearing aids or for those patients who receive unilateral or bilateral cochlear implants is the Auditory-Verbal Therapy (AVT) approach. AVT is an auditory-based teaching approach with significant family involvement. The goal of auditory-based teaching approaches for children with hearing loss, is to teach the family how their child can in fact “learn to listen”; and through learning to listen, develop spoken language.
The landscape of deafness continues to change, with truly exciting and limitless potential for newborns, infants, toddlers, and children who are deaf or hard of hearing. With the adoption of Universal Newborn Hearing Screening programs, hearing impairment is being identified at much younger ages. The prompt fitting of personal hearing aids and FM/IR systems and implementation of early intervention programs that emphasize the parents’ role as a child’s first and most important teacher (Pollack, 1970) have resulted in impressive outcomes for many children. And for children for whom personal hearing aids do not amplify the entire speech sound spectrum sufficiently, cochlear implants (CIs) have become an efficacious option, especially for the youngest patients we serve (Hammes, Novak, Rotz, Willis, Edmonson, & Thomas, 2002; Vohr, Jodoin-Krauzk, Tucker, Johnson, Topol, & Ahlgren, 2008).
As described by the Alexander Graham Bell Association for the Deaf and Hard of Hearing’s (AG Bell) Academy for Listening and Spoken Language (the “Academy”), “Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal therapy (AVT) promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational (professional) choices throughout life. Auditory-Verbal therapy must be conducted in adherence to all 10 Listening for Spoken Language (LSLS) Principles of Auditory-Verbal Therapy” (AG Bell Academy 2009a; 2009b).
Quite simply, “it’s all about learning to listen”! In teaching parents how to maximally stimulate their child through listening, children who are deaf or hard of hearing can learn to listen in order to develop spoken language.
The origins of the Auditory-Verbal approach have roots in the 1940s when the first hearing aids were developed. And 50 years prior to the development of hearing aids, Victor Urbantschitsch wrote Auditory Training for Deaf Mutism and Acquired Deafness (1895). Urbantschitsch described the auditory potential of most children who were deaf. As noted by Silverman (in the 1981 translation of the work from German) Urbantschitsch’s central argument was “that the education and ultimately the emotional and social adjustment of profoundly deaf children could be facilitated by methodical and persistent auditory training (exercises) that exploited any remnant of residual hearing by stimulating what he termed a dormant auditory sense” (p. viii). Similarly Max Goldstein, founder of the Central Institute for the Deaf in 1914, has been credited with founding the Acoustic Method (1939) and advancing the notion regarding the power of audition for persons who are deaf or hard of hearing.
The U.S. Auditory-Verbal pioneers, Helen Beebe and Doreen Pollack, exploited this belief that most “deaf” children had some remaining hearing that coupled with the advent of wearable hearing aids, allowed Auditory-Verbal teaching so that children who were deaf or hard of hearing could learn to listen, to process verbal language, and to talk.
Pollack initially outlined the guiding principles of auditory-verbal practice in her seminal book (1970). These principles have become the hallmark of the philosophy. Subsequent editions of the Pollack text (1997) continued to explain and explore the Auditory-Verbal approach, including the impact of the program with modern technology, such as improved hearing aids and cochlear implants (Pollack, Goldberg, & Caleffe-Schenck, 1997).
The 10 principles adapted from Pollack (1970) are as follows:
- Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal therapy.
- Recommend immediate assessment and use of appropriate state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.
- Guide and coach parents to help their child use hearing as the primary sensory modality in developing listening and spoken language.
- Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized Auditory-Verbal therapy.
- Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.
- Guide and coach parents to help their child integrate listening & spoken language into all aspects of the child’s life.
- Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication.
- Guide and coach parents to help their child self-monitor spoken language through listening.
- Administer on-going 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.
- Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards” (A.G. Bell Academy, 2009).
In the first principle “parents” also includes grandparents, relatives, guardians, and any other caregivers who interact with the child.
With the application of the above-listed principles, parents can be become the most important “change agent” for their children, and in conjunction with today’s incredible “hearing sensory technology,” even children with severe and profound hearing loss can make use of auditory information to develop spoken language – through listening!
Because of the tremendous developments in the world of audiology, including Universal Newborn Hearing Screening (UNHS) programs; early identification of hearing loss with advanced electrophysiologic techniques; sophisticated hearing technology in the areas of amplification and cochlear implantation; and with increased efforts to provide evidence-based practice regarding the use one of the available modes of communication – auditory-verbal therapy/education -- has and will continue to dramatically change the landscape of deafness. The results include more and more children who are deaf or hard of hearing, developing spoken language through the auditory channel.
Auditory-based Therapy at Cleveland Clinic
Clinicians with AG Bell Academy for Listening and Spoken Language certification as LSLS Cert. AVT (Listening for Spoken Language Specialist: with the designation of Auditory-Verbal Therapy or Auditory-Verbal Education) are available for early intervention appointments with families interested in a listening and spoken language outcome for their child with hearing loss. Patients are first seen for a Communication Evaluation, and if interested, can be scheduled for Auditory-Verbal or Auditory-Based Therapy sessions. These 60 minute sessions include the patient and require the active participation of one or more family members in attendance. Families are “coached” in techniques to maximally stimulate a child’s hearing potential, and in so doing, the development of speech and language typically follows. A child-friendly space has been developed at Cleveland Clinic’s Head and Neck Institute, where each child enters a colorful “game-room” of stimulating toys, materials, and books – which are all utilized in teaching young children with hearing loss to develop spoken language skills and abilities.
Longitudinal outcome data from over 25 patients seen by our CCF LSLS Cert. AVT indicate that over 70% are achieving at or above their HEARING PEERS, in the areas of receptive vocabulary, expressive vocabulary, and morphology/syntax or the “grammar” skills and abilities.
Scheduling of Communication Evaluations (90 minutes), which may then lead to a recommendation for Auditory-Based Therapy (60 minute sessions; either weekly, every other week, or monthly) can be made at 216 445-7468.
LSLS Auditory-Verbal Therapy References
2007 Joint Committee on Infant Hearing (JCIH) Position Statement
Recommended Protocol for Audiological Assessment, Hearing Aid Evaluation and Cochlear Implant Monitoring
Existing Evidence that Supports the Rationale for LSLS Auditory-Verbal Therapy
How To Evaluate Your Child’s Auditory-Verbal Therapy
Locate a Listening and Spoken Language Specialist
AG Bell Association for the Deaf and Hard of Hearing (2009a). About the Academy. DC: Author.
AG Bell Association for the Deaf and Hard of Hearing (2009b). Principles of LSLS Auditory-Verbal Therapy. DC: Author.
Goldstein, M. (1939). The acoustic method. St. Louis: Laryngoscope Press.
Hammes, D., Novak, M. Rotz, L., Willis, M., Edmonson, D., & Thomas, J. (2002). Early identification and cochlear implantation: Critical factors for spoken language development. Annals of Otology, Rhinology, Laryngology, 111, Suppl. 189, 74-78.
Pollack, D. (1985). Educational audiology for the limited-hearing infant and preschooler (2nd Ed.). Springfield, IL: Charles C. Thomas Publishers.
Pollack, D., Goldberg, D., & Caleffe-Schenck, N. (1997). Educational audiology for the limited-hearing infant and preschooler: An auditory-verbal program. Springfield, IL: Charles C. Thomas Publishers.
Urbantschitsch, V. (1895). Auditory training for deaf mutism and acquired deafness (S.R. Silverman, Trans.). Washington, DC: Alexander Graham Bell Association for the Deaf (Original work published 1895).
Vohr, B., Jodoin-Krauzyk, J., Tucker, R., Johnson, M.J., Topol, D., & Ahlgren, M. (2008). Early language outcomes of early-identified infants with permanent hearing loss at 12 to 16 months of age. Pediatrics, 122(3), 535-544.