Written By Melissa Chaikof
The foundation of the Auditory-Verbal approach is that, with the use of hearing aids or a cochlear implant, hearing impaired children can learn to listen and understand spoken language in order to communicate through speech.
Parents are the major influence in a child’s life during the preschool period. They are the child’s primary and most effective teachers. Thus, the Auditory-Verbal approach is a parent-oriented approach. Parents are involved in their child’s therapy, and their Auditory-Verbal therapist teaches them how to teach speech and language to their child at home. Direct parent-child interaction is required through both structured listening sessions and ongoing language work incorporated into daily life. Parents and therapists develop a working partnership. Information and observations from the parents are important in planning the child’s language program.
Auditory-Verbal therapy progresses through four levels of auditory skills: detection, discrimination, identification, and comprehension. Detection, the beginning stage, is the ability to determine the presence or absence of sound. Discrimination is the ability to perceive differences between sounds. Identification is the ability to label what has been heard by repeating, by pointing to or picking up the object representing the word(s), sentence, or environmental sound perceived. Finally, comprehension is the ability to understand the meaning of connected language.
Auditory-Verbal International (AVI), a nonprofit organization that is now defunct, was dedicated to making available to every parent or caretaker of a hearing-impaired child the option of following the Auditory-Verbal approach. AVI has formulated nine basic principles of Auditory-Verbal therapy:
- Early detection and identification of hearing impairments in infants and toddlers
- Aggressive medical and audiological management, including selection, modification, and maintenance of appropriate hearing aids, cochlear implants, or other sensory aids
- Appropriate technology to achieve maximum benefits of learning spoken language through listening
- Favorable auditory learning environments for the acquisition of spoken language, including one-to-one teaching
- Affirmation of parents as the primary models in helping the child to learn to listen to his/her own voice, the voices of others, and the sounds of the environment
- Integrating listening into the child’s total personality so that listening becomes a way of life
- Ongoing assessment, evaluation, and prognosis of the child’s developing auditory, language, speech, and cognitive skills
- Full mainstreaming of the hearing impaired child into the regular educational system beginning at preschool
- Active participation of parents in order to improve spoken communication between the child and family members
Research indicates that a child cannot easily attend equally well to competing visual and auditory stimulation; one can attend to parts of each input but not to all of each. Many hearing impaired children have been taught to use their unimpaired visual sense at the expense of their impaired auditory sense. However, in the Auditory-Verbal approach, the primary input ,or means of language stimulation, is through hearing and not through seeing, i.e., lipreading, sign language, or finger spelling.
Never before in the history of deaf education has there been such access to hearing for children who are hearing impaired. With improved technology in hearing aids and with the availability of frequency transposition hearing aids and cochlear implants, the vast majority of these children can gain sufficient hearing potential to learn to listen and to develop spoken language. Technological and medical devices only give children access to hearing. Whether children learn to use this hearing depends on the therapy that they receive once they have been given this hearing potential. In the Auditory-Verbal approach, spoken language is developed through listening and, thus, is an ideal teaching method for the beginning auditory learner.
Beginning Auditory-Verbal therapy at as early an age as possible is essential as a child’s greatest facility for learning language occurs during the first two to three years of life. Therefore, in order to effectively learn spoken language, a child’s hearing must be stimulated and listening skills developed during this critical time. Studies of child development and neurophysiologic studies of neural plasticity in the human and other mammalian auditory systems confirm this concept.
What is a Certified Auditory-Verbal Therapist?
Auditory-Verbal therapists are professionals who have been trained at the Master’s level in one or more of the disciplines of speech pathology, audiology, or education of the deaf. Furthermore, they have had extensive experience working with children in an auditory-verbal approach and have passed an international exam on auditory-verbal. They recommend an Auditory-Verbal treatment plan as the first option for developing a speech, language, and educational program for hearing impaired children. Auditory-Verbal therapists seize the language of any life experience and promote and develop the use of sound for speaking and understanding spoken language. The guiding principle applied by an Auditory-Verbal therapist is that all therapeutic and educational decisions lead to the hearing-impaired child’s maximum participation in the hearing and speaking world.
The process of attaching meaning to sounds takes time, effort, patience, motivation, consistency, committment, faith, clear goals, and persistence. With young children, the attitudes and expectations of the adults interacting with the child, and also the environment in which the child lives, all have a direct impact on whether the child uses his/her hearing aids or cochlear implant and how effectively he/she uses them.
As an early implant user is often a strong visual learner, a hand cue will help in highlighting listening rather than lipreading. When a child is watching an adult’s face, it is necessary for the speaker to cover his/her own mouth to alert the child to listen. By then moving the speaker’s hand towards the child’s mouth, this serves as a cue for the child to imitate what he/she heard. Imitation should only be encouraged if a child begins to use meaningful sounds spontaneously. This imitation can also be used with parents as models to encourage their participation. Once a child relies on hearing, use of a hand cue will seldom be necessary to encourage listening or speech production.
In addition to the hand cue, techniques for working with the early listener include:
- Speak naturally to the child, speaking without exaggerated facial movements and without sign language.
- Use natural expressions appropriate to the child’s age and language level.
- Read familiar storybooks, recite familiar nursery rhymes, and sing familiar songs.Encourage the young child to use babbling and jargon as normal hearing infants do rather than pushing the child to imitate words.
- Be close to the child’s microphone of the cochlear implant or hearing aid of the child’s better ear.
Encourage listening by sitting beside the child and focusing on objects in front of the child.
- Minimize background noises, especially droning air conditioners, televisions, refrigerators, and radios.
Speak using “Motherese:” spoken language that is rich in suprasegmental (singsong) qualities, repetitive, and in short, meaningful two to three word phrases.
- Cue the child to listen throughout the day by pointing to your ear to alert the child to meaningful environmental sounds.
- Follow a child’s interest level in age and stage appropriate activities and experiences while working towards specific goals.
Mainstreaming, or full inclusion in a regular classroom, is one of the fundamental premises of Auditory-Verbal therapy. We speak as we hear. Children will imitate what they hear. Consequently, they need to be exposed to normal speech and language models. Hearing impaired children are never grouped in classes with other hearing impaired children so that the language models available to them are more natural and normal. Those children who are at least two years of age are enrolled in neighborhood preschool programs with normally hearing preschoolers. Because the hearing impaired child is learning how to function as a hearing child, the child learns to communicate effectively with normally hearing children. Normal speech and language models and higher expectation levels are provided in regular preschool and grade school programs. Integration leads to assimilation, and the hearing impaired child begins to function with relative comfort in our normally hearing community.