What is the Auditory-Verbal Approach?

On this page:

> How does the program work?

> The listening environment

> Parent Participation

> Auditory-Verbal Therapy techniques

> Variables affecting progress

> Conclusion

Auditory-Verbal Therapy focuses on learning through listening and speaking. It is a parent-based therapy where you, the parent/s, are educated to teach your child who has a hearing impairment to listen and to speak. The Auditory-Verbal Therapist works with you, to show you how to set up a listening, learning environment where your child can develop spoken language through using their aided hearing. Early diagnosis and optimal amplification are essential, as access to sound during infancy and early childhood is critical to enable the auditory brain centres to fully develop.

The Board of Directors of Auditory-Verbal International, Inc. (AVI) has adopted the following position statement:

The Auditory-Verbal philosophy is a logical and critical set of guiding principles. These principles are essential for children who are deaf or hard of hearing to learn to use their amplified residual hearing and/or a cochlear implant to listen, process verbal language and to speak.

The goal of Auditory-Verbal Therapy is that children who are deaf or hard of hearing grow up in regular learning and living environments enabling them to become independent, contributing citizens. Auditory-Verbal Therapy supports the right of children with all degrees of hearing impairment to develop the ability to listen and communicate using spoken language.

How does the Program work?
An Auditory-Verbal Therapy program is designed to meet the needs of the child and follows the natural progression of language development. It consists of one-to-one therapy with the therapist, child and parent/s. Activities are child orientated and reflect each child’s developmental level.

Auditory-Verbal Therapy sessions are always diagnostic. These sessions are used to evaluate the progress and skills of the child and the parents. The children learn to listen to their own voices, the voices of others and the sounds of their environment in order to communicate effectively through spoken language. Auditory-Verbal professionals advocate natural communication development in daily life, including participation in a typical school and in the community at large. (Pollack, 1985; Estabrooks & Samson, 1992; Estabrooks, 1994).

Individualised diagnostic therapy is necessary to determine whether the Auditory-Verbal Approach is appropriate for a particular child and family. This appropriateness, in turn, is dependent upon a number of variables. If at any time the family, in consultation with Hear and Say professionals, decides that they need to change to another program, they will be supported through this process.

"Sessions may be held in a variety of settings, including a hospital clinic, a private practice, or a school. Although much can be learned in these settings, they are a far cry from the natural learning environment of the child. To make the therapy environment more homelike, objects and toys found in the child’s home, as well as miniature versions of real objects, are used to stimulate spoken conversation through listening” (Simser, 1993).

Most Auditory-Verbal programs offer weekly therapy sessions, lasting for an hour or an hour and a half each. Active parent participation is a cornerstone of the Auditory-Verbal Therapy process. Through motivation and guidance, parents acquire the confidence to implement techniques and strategies to realize specific goals. The Auditory-Verbal Therapist demonstrates, guides and coaches the parent/s in order to help their child maximize the use of his/her auditory potential.

As a team, the Auditory-Verbal Therapist and the parents establish targets to be achieved at home. Targets for younger children may include: drawing attention to sounds in the environment, learning that sounds have meaning, babbling, learning early vocabulary, developing phrases or beginning small conversations. Targets for older children may include: story-telling, developing speech and auditory skills in the presence of noise or learning school-based subject material. These targets, which depend on the child’s developmental stage, hearing age and listening function, are incorporated in play, in ordinary daily routines, in structured activities, and in music (Estabrooks, Birkenshaw-Fleming, 1994).

The Listening Environment
Through the Auditory-Verbal approach, maximum use of hearing is developed in order to learn spoken language through listening rather than watching. Therefore therapy needs to be carried out in the best possible listening conditions to make information easy to hear and easy to learn. The acoustic environment is enhanced by:

parents and/or therapists sitting beside the child, on the side of the better ear (within earshot);
speaking close to the microphone of the child’s hearing aid(s) and/or cochlear implant(s);
speaking at normal volume;
minimizing background noise;
using speech which is repetitive and rich in melody, expression and rhythm; and
using acoustic highlighting techniques to enhance the audibility of spoken language (moving from most audible to least audible).

Parent Participation
The Auditory-Verbal approach embraces the view that children learn language most easily when actively engaged in relaxed, meaningful interactions with supportive parents and caregivers. (Kretschmer & Kretschmer, 1978; Ling, 1990; Ross, 1990; Estabrooks, 1994).

In Auditory-Verbal Therapy sessions, therefore, parents observe and actively participate to learn to:

model techniques for stimulating speech, language, and communication activities at home;
plan strategies to integrate listening, speech, language, and communication into daily routines and experiences;
communicate as partners in the therapy process;
inform the therapist of the child’s interests and abilities;
interpret the meaning of the child’s early communication;
develop appropriate behaviour management techniques;
record and discuss progress;
interpret short term and long term goals;
develop confidence in parent-child interactions;
make informed decisions; and
advocate on behalf of their child.

Auditory-Verbal Therapy Techniques
There are many techniques and strategies used by Auditory-Verbal Therapists to stimulate the development of spoken language through listening. These include:

providing acoustic highlighting such as whispering, singing, emphasizing elements of syntax and/or segmental and suprasegmental information;
asking the child "What did you hear?" as a precursor to repeating spoken stimuli;
encouraging and coaching the parent as the primary model for listening and talking;
moving closer to the microphone of the child’s hearing aid/s or cochlear implant/s;
re-wording, providing alternatives, repeating previously heard information;
waiting and/or pausing for responses;
putting spoken language immediately back into hearing if it has been necessary to use visual, tactile or kinaesthetic cues;
using the Hand Cue. This is a teaching technique which may be used when the child is a beginner listener, in order to cue the child to listen and also to elicit a verbal response from the child. It means “I talk - you talk”. It is used only when necessary and is phased out at the earliest opportunity when other techniques are substituted.

The Hand Cue consists of:

the therapist, parent or caregiver covering his/her mouth briefly, when the child is looking directly at the adult’s face. This encourages listening rather than lip-reading. When the child is playfully engaged and not looking, the Hand Cue is unnecessary.
the adult moving his/her hand toward the child, in a nurturing way, as a prompt for vocal imitation or as a signal for turn taking; and/or
the adult talking through a stuffed animal, a toy, a picture, or a book, placed in front of the speaker’s mouth.

The Hand Cue signals the child to listen intently, and is used to assist the child to integrate all five senses. The Hand Cue should be used only when necessary because some of its uses distort, smear or eliminate the sound arriving at the microphone. As children come to rely on hearing, the use of the Hand Cue is reduced (Estabrooks, 1994). Once the child has "integrated hearing into his or her personality" (Pollack 1985), the Hand Cue is rarely used.

Variables Affecting Progress
Each family and child is unique, with a specific living and learning style (Luterman, 1991). Listening and communication development vary from child to child and from family to family. Progress, of course, is dependent upon a number of variables, such as:

age at diagnosis;
cause of hearing impairment;
degree of hearing impairment;
effectiveness of the hearing aid/s or cochlear implant/s;
effectiveness of audiological management;
hearing potential of the child;
health of the child;
emotional state of the family;
level of participation of the family;
skills of the therapist;
skills of the parents or caregiver;
child’s learning style; and
child’s cognitive development.

Conclusion
Children who are deaf or hard of hearing need the same listening, speech, language, communication and cognitive foundations as children who can hear. These foundations are built through structured Auditory-Verbal Therapy sessions, daily activities and especially through play. Recent scientific advances in amplification and cochlear implant technology have provided great potential listening opportunities for children all over the world. The Auditory-Verbal Approach is a natural companion of such technology. As our special children walk the bridge into the new millennium, parents and professionals can rejoice in the mission of the Auditory-Verbal Approach as an "applied science with its objectively measured goals" (Ling 1994) and encourage a little hearing to go a long way.