Auditory-Verbal Education vs. Auditory-Verbal Therapy

People often think that there are no differences between Auditory-Verbal Therapy and Auditory-Verbal Education (Auditory-Oral); however, if people really understand the principals of both of the approaches, they will really notice considerable differences.  I am attaching a report written by a group of professionals explaining the differences between Auditory-Verbal Therapy and Auditory-Verbal Education, which was called Auditory-Oral when the article was written, and what exactly is Auditory-Verbal Therapy.

The Unique Principles of Auditory-Verbal Practice
Daniel Ling, O.C. Ph.D.,
Tina Novelli-Olmsted, M.Sc., Sylvia Rotfleisch M.Sc.,
and Judy Simser, O. Ont., B. Ed., Dip. Ed. Deaf


Introduction

The purpose of this paper is twofold: to present and discuss the 10 unique principles of auditory-verbal practice, and to show how these principles relate to the similarities and differences between auditory-oral and auditory-verbal programs. Professionals who work in both types of programs focus on spoken language development in children who are hearing-impaired.  However, as we shall show, auditory-oral and auditory-verbal programs are based on distinctly different philosophies and practices. These differences go far beyond the fact that auditory-verbal programs involve only individual children of all ages and their parents, while auditory-oral programs, especially those in self-contained special schools, generally involve groups of children from two or three years of age onwards. We shall show that there are many other important ways in which the philosophies underlying the different practices diverge. Auditory-verbal practice was initiated half way through the 20th century; auditory-oral programming has a longer tradition with deeper roots in history. The three authors of this paper are all active members of both Auditory-Verbal International, Inc. (AVI) and the A.G. Bell Association. We are all well qualified and experienced in both auditory-oral and auditory-verbal work with hearing-impaired children and their parents. We all hold that no one system of education is appropriate for all children. Nevertheless, for reasons given below, we suggest that parents who have the choice should first consider an auditory-verbal program. It is, for reasons given below, the most desirable first option for parents and their children following detection and diagnosis of deafness.

From as early as the 1950s it was clear that certain programs for developing spoken language and social skills among children who were hearing-impaired yielded better results than others. The poor levels of spoken language and low levels of academic achievement among school-leavers at that time commonly led to social problems and under-employment of hearing-impaired adults.  Among the several pioneers in the English-speaking world who developed new ways of overcoming the deficiencies of traditional forms of practice, the most widely recognized were Helen Beebe, Doreen Pollack and one of us (Daniel Ling). Their objective was to promote work under conditions that permitted children who were hearing-impaired to follow more normal paths of development. There were at least two forces driving them: profound dissatisfaction with the status quo and the development of wearable hearing aids. They insisted that children wear their hearing aids every waking moment of every day in order to optimize their hearing for their own and others’ speech. This was in contrast to many self-contained school programs that provided “auditory training” once or twice a week. (It was not for another thirty years or so that technological advances yielded much better hearing aids as well as cochlear implants.) These and an increasing number of forward-thinking colleagues became convinced that placing children in self-contained special schools unnecessarily was a serious impediment to their making optimal progress. This view was met with ridicule on one hand and with strong opposition on the other. For various reasons, not all easy to understand, it is still opposed by teachers in special school programs in spite of the outstanding success of auditory-verbal practice. The development of technology over the past few years has led to a vastly greater proportion of hearing impaired children who can now acquire much, if not all of their spoken language through the use of hearing aids and or cochlear implants. To be optimally effective these devices must be carefully selected, maintained and used under optimal conditions. We are clearly of the opinion that auditory-verbal programs best provide such conditions. Indeed there is a considerable body of experience and some research to support this statement. We have cited no references in this paper that support this statement because relevant documentation and further information is available on request from Auditory-Verbal International, Inc.® (http://www.auditory-verbal.org). More objective and detailed comparative studies are needed. Greater opportunity for such studies may result from the growth of newborn screening, which is likely to create a greater demand for auditory-verbal services, hence allowing an increased number of comparative research studies.

Teachers and clinicians who sought parental collaboration in the 1950s shocked the establishment. At this time, parents were generally expected to leave their children with a therapist or teacher behind closed doors; they were neither asked nor expected to participate in or learn from the therapy session but merely left to read or talk with others in the waiting rooms. Clinicians and educators in auditory-verbal programs deplore such procedures and, rather, encourage parent partnership from the outset. While several special schools have recently sought to make parents partners in their work, auditory-verbal practitioners have always expected parents and/or other caregivers to become the primary agents in the children’s acquisition of spoken language as part of their general development. Interaction with parents, family and others in their neighborhood provides a rich and stimulating linguistic environment. Home, particularly in the early years, offers more opportunities for individual attention, and a wider variety of ways for the child to absorb spoken language, particularly its semantic and pragmatic aspects, than a self-contained school. It permits the most highly significant person in a child’s life-usually the mother-to use the many more of the one-on¬-one interactions that occur naturally in the everyday life of the home. There is no better way than this to ensure that spoken language becomes an intrinsic part of the child’s developing personality.

The principles promulgated at the outset of auditory-verbal practice have essentially been preserved to the present day. This speaks strongly for their validity. Many ideas that were then revolutionary are now widely accepted. A wide range of disciplines has influenced modern auditory-verbal work with children. We are living in a period of enormous growth, one in which more scientific work has been under¬taken during the past decade than in several previous centuries. The abundance of ideas stemming from diverse fields can do much to help current-day programs improve the services they offer. A contemporary example is the collaboration involving audiology and technology that is continuing to lead to the widespread screening of newborn infants to ensure the early detection of hearing problems. These screening programs have certainly attracted and sustained increasing numbers of auditory-verbal practitioners. Ongoing evaluation has shown that the need for remedial teaching can be vastly reduced by early auditory¬-verbal intervention. While both traditional and auditory-verbal practices have changed over time, largely due to the impact of technology, many philosophical distinctions between auditory-oral and auditory-verbal work still persist.

Auditory-Verbal and Auditory-Oral Programs: The Distinctions.

Professionals and parents with hearing-impaired children are often confused about the essential differences between auditory-verbal and auditory-oral practices. On a superficial level the two have much in common. Both aim to help children who are hearing-impaired develop spoken language as the most desirable means of living and learning in society at large. Both exclude the use of sign language. Both employ current technology and both follow a number of similar clinical and educational practices. But close examination shows that the differences between the two systems are substantial. The following comparisons are not to be taken as suggesting that any one type of program can be regarded as superior to any other for all children. We wish here only to make it clear that each offers advantages for some. Thus one or other type of program may serve some children more effectively than the other. It is also important to recognize that individuals in each type of program deserve equal respect and esteem. In the following paragraphs we strongly and clearly illustrate the nature of the differences between the two types of programs so that readers are better able to understand the nature of each.

•    Auditory-verbal practice involves the parents and child. The parents, often only the mothers, learn how to become the primary agents in their children’s program. Auditory-oral programs invite the parents to participate but involve the parents to a lesser extent. Teachers and clinicians may come and go: most parents are committed to their children for a lifetime!

•    Auditory-verbal practice first and foremost involves developmental work with individual children and prevention of communicative difficulties, whereas auditory-oral practice, particularly in school ages children, is geared more towards remedial work in groups. Teaching groups of children results in less attention to individual needs.

•    The acoustic conditions of the home are very favorable to auditory¬-verbal development but those of a classroom are less than optimal because ambient noise levels tend to be higher. Ambient noise degrades the speech signal. Speech should be at least 30 dB above ambient noise to ensure its optimal perception. This level is required for learning and understanding new material. Of course, when language has become well established, noise in familiar situations can be less damaging because children can often then predict much or most of what is being said from using the social and educational and linguistic cues all of which contribute to comprehension. A clear speech signal is crucial to learning.

•    Auditory-verbal practice involves children in abundant interactions with normally hearing peers. Auditory-oral programs in schools often admit a small number of normally hearing children to their special classes to ensure contact with hearing peers, but the tendency under these circumstances is for those children who are hearing impaired to communicate in some way with each other rather than with their hearing peers who thus fail to provide adequate models of normal behavior and normal speech. Auditory-verbal practice is to seek admission to regular neighborhood schools from the earliest possible stage. Auditory-oral programs keep the child in a special class until the child is “ready” for inclusion. Essentially, this difference arises because in auditory-verbal programs, inclusion in regular school programs is seen as a process rather than a product.

•    Auditory-verbal practitioners focus on the use of audition with minimal reference to visual or other sensory cues. This is because spoken language requires the production and perception of acoustic patterns. Indeed, audition is the only sense through which the acoustic patterns of spoken language can be fully perceived. This is why auditory-verbal programs emphasize the use of audition as the primary-and often only-sense modality to promote spoken language. Auditory skills have to be learned  and children function best under learning conditions that are familiar to them. Other things being equal, children from auditory-verbal programs therefore perform better on listening tests and speech evaluations than children who learn in auditory-oral programs. Their speech is of better quality and clarity because they receive optimal feedback on their own speech. In contrast auditory-oral programs make extensive use of vision. Indeed the use of visual cues is inherent in auditory-oral programs because the various differences among children in a group make it virtually impossible to teach a class without them. When extensive use is made of visual cues, children tend to develop less effective auditory processing skills and therefore poorer feedback on their own speech. It is only through the use of audition alone in speech communication that one can determine whether or not children can succeed in learning to hear others and to obtain feedback of their own speech production. If children mainly receive simultaneous exposure to auditory and visual stimuli and are then tested, the results cannot be a valid predictor of how the child will be able to function when visual cues are precluded. It follows that all other things being equal, children who are able to detect the whole range of speech sounds should, if possible, be placed in auditory-verbal programs at the earliest possible stage so that their potential for developing high levels of auditory comprehension and feedback on speech through hearing alone can be determined.

•    To obtain auditory-verbal certification from Auditory-Verbal International, Inc.® candidates must already be qualified in education, ideology and/or speech-language pathology. They must then undergo further extensive specialist training and pass demanding examinations. This is essential because effective auditory-verbal practice requires an extensive knowledge pertinent to, as well as beyond, all three disciplines. Professionals having knowledge of only one of them are unlikely to work as efficiently. In contrast, profes¬sionals engaged in auditory-oral work have usually received training in one of the three disciplines. Moreover, specialist university programs in which these auditory-oral teachers train for their work have different traditions and foci. At this time, for example, most university based teacher training programs have opted to train professionals in all currently used communication methodologies used with hearing-impaired children, including the use of sign. Some of their graduates have little or no background in speech science and strategies that lead to good speech production, yet are qualified to work in any educational setting. Hence the standards and specialist knowledge of teachers in auditory-oral programs may differ greatly not only from those of auditory-verbal programs but also from one clinical or educational setting to another. These differences between the two types of programs are much larger than those reflecting the aptitudes and abilities that exist among personnel in the two types of program. The notion that one should focus on similarities among practices rather than on their differences can therefore be seen as unrealistic.

Many teachers in special schools have not received the training that allows them to make the utmost use of residual hearing, and applicable technological developments have overtaken them. The main problems with auditory-oral work, however, do not stem from the teachers, but from the system itself, because most of the difficulties that we have discussed above are inherent in such provision. Special schools are often the most satisfactory arrangement for administrators at all levels simply because they may not be aware of modern developments nor the changes in their particular school systems that are required to incorporate them. It is also expedient for them to resist change and refuse to support other types of special clinical and educational programs.

Teachers involved in special schools face many problems that are not necessarily of their own making. True, some adhere to the traditional philosophy that they work in the best possible system, and are threatened by alternatives or reject them without due consideration. The sense that a given philosophy is superior and should prevail against all others seems often to derive from the programs in which clinicians and teachers were enrolled for professional preparation. These tend to follow traditional paths. It should be recognized that the best schools and systems are those which are most advantageous to the children. We should rejoice that alternative types of programs exist, give each its due and recognize that differences exist. Seeking to hide vital differences by not referring to them or by using vague coverall terms such as “auditory-based pro¬grams” can only lead to substandard programming.

Most of our colleagues in special schools do excellent work in spite of the constraints imposed by the nature of auditory-oral provision. Thus in stressing differences, we do not imply that equally able professionals and parents engaged in the two types of program should not enjoy parity of esteem. Those in auditory-oral programs have to deal effectively and simultaneously with children who have a wide variety of problems. Indeed, some of their work is concerned with children who have good auditory-verbal potential but whose parents have chosen an auditory-oral setting for some special reason, including receiving misinformation following diagnosis, insufficient knowledge of auditory-verbal programs and inability either to locate them or, in the absence of insurance coverage, afford their cost.

Improvements in the range and quality of services require mutual respect and healthy collaboration between colleagues engaged in various forms of practice. This is rarely seen. Its rarity clearly indicates that many professionals and administrators disregard the problems of diversity in the field, prefer to dismiss the validity of other philosophies and are ready to engage in turf wars about children’s placement. Such attitudes may serve to preserve or increase enrollment in particular types of programs but does nothing to ensure that the needs of individual parents and their children are optimally met.

The Unique Principles of Auditory-Verbal Practice

The ten distinct principles underlying auditory-verbal practice as approved by Auditory-Verbal International, Inc. (AVI) are unique to AVI and part of the organization’s charter. They are presented without further discussion because the practices and philosophies on which they are based have been discussed in some detail above. Principles that are unique to auditory-verbal practice include the following:
a.    Using audition as the primary sensory modality in developing speech perception and spoken language communication.
b.    Ensuring, through the guidance by qualified auditory-verbal practitioners, that parents and/or principal caregivers become the primary agents of children’s spoken language development.
c.    Preventing or reducing children’s unnecessary reliance on lip¬-reading, this in order to develop or enhance listening skills.
d.    Using the proprioceptive senses as a supplement to audition in speech acquisition.
e.    Integrating talking and listening skills into all aspects of children’s lives and personalities.
f.    The practitioner’s consistent use of clearly produced, normal speech patterns under acoustic conditions that provide signal to noise ratios on the order of 30 dB, this to ensure spoken language presented to children is both optimally salient and can carry the various acoustic cues that enhance the children’s own spoken language communica¬tion.
g.    “Fostering extensive interactions in the regular educational environ¬ment with normally hearing peers.”
h.    Inclusion in regular neighborhood schools from early childhood onwards, rather than attendance in self-contained special schools.
i.    Daily interaction with hearing peers in order that they may learn normal patterns of speech, language and social behavior.
j.    Participation to the fullest possible extent in normal family life.
Concluding Remarks.
It is hoped that the views expressed in this paper well play a signifi¬cant role in:
1.    achieving wider understanding of Auditory-Verbal International, Inc.® and its members’ work;
2.    promoting better access to auditory-verbal practice for more children;
3.    creating more widespread recognition that many children’s lives could be profoundly changed for the better if auditory-verbal programming was considered as the most desirable first option;
4.    leading to a significant growth in personnel engaged in this work;
5.    stimulating advocates of auditory-oral programs to define their principles and how their application effectively ensures attention to the children’s and parents’ individual needs; and
6.    encouraging independent research of the type that is needed to more adequately compare the effectiveness of both types of programs.