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What is Auditory-Verbal Therapy?

Auditory-Verbal Therapy is a specialized type of therapy designed to teach a child to use the hearing provided by a hearing aid or a cochlear implant for understanding speech and learning to talk. The child is taught to develop hearing as an active sense so that listening becomes automatic and the child seeks out sounds in life. Hearing and active listening become an integral part of communication, recreation, socialization, education, and work.

  • The philosophy of Auditory-Verbal Therapy (AVT) is for deaf and hard of hearing children to grow up in a regular learning environment, enabling them to become independent, participating, and contributing citizens in the mainstream society.
  • AVT is a parent centered approach that encourages the use of naturalistic conversation and the use of spoken language to communicate.
  • AVT is an approach that emphasizes the use of residual hearing to help children learn to listen, process verbal language, and to speak.
  • AVT Maximizes the use of the child's aided residual hearing for the detection of sound.
  • The earliest possible identification of hearing loss with immediate fitting with amplification, as well as prompt intervention helps to reduce the extent of language delays commonly associated with hearing impairment.
  • AVT is based on teaching parents, during their child's individual therapy sessions to emphasize residual hearing and interact with their child using the auditory-verbal approach.
  • AVT encourages interaction and mainstreaming children from the beginning with normal-hearing peers.
    • Participation in playgroups, library story hours, and attendance in community schools can provide children highly motivating natural language models.
  • AVT teaches the child to develop self-monitoring skills.
    • The child learns to listen to his/her own voice as well as to others during natural conversations thereby promoting natural voice quality.
  • AVT follows a logical and critical set of guiding principles. The parent, therapist, and child engage in play activities that teach the child to his or her amplified residual hearing to learn auditory-verbal communication like children with normal hearing.

AVT is...

-Learning through listening

-High expectations for listening

-Providing clear speech

-Providing natural language

-Parents as teachers

-Individual therapy

-Conversation based

AVT is not...

-Learning through visual cues

-Expecting the child not to hear

-Speaking to loudly or softly

-Speaking with simple language

-Parents as observers

-Group instruction

-Drill based


Principles of Auditory-Verbal Therapy

  1. To detect hearing impairment as early as possible through screening programs, ideally in the newborn nursery and throughout childhood.
  2. To pursue prompt and aggressive audiological management and maintenance of appropriate aids (hearing aids, cochlear implants, etc.).
  3. To guide, counsel, and support parents and caregivers as the primary models for spoken language development and to help them understand the impact of deafness and hearing impairment on the entire family.
  4. To help children integrate listening into their development of communication and social skills.
  5. To support children's auditory-verbal development through one-on-one teaching.
  6. To help children monitor their own voices and the voices of others in order to enhance the intelligibility of their own speech.
  7. To use the developmental patterns of listening, language, speech, and cognition to stimulate natural communication.
  8. To continuously assess and evaluate children's development and, through diagnostic intervention, modify the program when needed.
  9. To provide support services to facilitate children's educational and social inclusion in regular education classes.
From the Auditory Verbal Position Statement

Interesting Facts

  1. 1.6% of the 39 million school age children in the U.S., 632,000 have a hearing loss.
  2. Hearing impairment is the #1 birth defect, but most hearing-impaired children have useful residual hearing.
  3. The majority of these children, if properly fitted with hearing technology, can detect most if not all of the speech spectrum.
  4. These children can learn to talk through listening, because they have been given access to spoken language.
  5. Listening is a major force in the development of a child's personal, social, and academic life.
  6. AVT can help these children develop conversational skills.
  7. In order to benefit from the "critical period" of development, then the identification of hearing loss, use of appropriate amplification and medical technology, and stimulation of hearing must occur as early as possible.
  8. If hearing is not accessed during the critical language learning years, a child's ability to use this information meaningfully will deteriorate.
  9. Current information about normal language development provides the framework and justification for the structure of Auditory-Verbal practice.
  10. As verbal language develops, reading skills can also develop.

Importance of Auditory-Verbal Therapy

  • When aided properly, children with even profound hearing losses can detect, most if not all, speech.
  • A child who has a hearing impairment need not automatically be a visual learner ( i.e. sign language), rather he/she can learn how to be an auditory learner.
  • Children learn language most effectively through consistent and continual, meaningful learning interactions in a supportive environment.
  • As verbal language develops, with audition, reading skills can also develop.
  • Parents in AVT programs do not need to learn sign language.
  • AVT uses and encourages the maximum use of hearing, and stresses listening rather than watching.
  • AVT uses a team approach to therapy that allows for a more complete education environment.

Why Should My Child Learn to Listen?

  • Children with normal hearing learn to readily detect sounds in their environment during infancy. They listen and learn that certain sounds have certain meanings. In this way, they learn to recognize, understand and speak words. This is auditory (listening) and verbal (speaking) communication. As they grow, they continue to build their vocabulary and language skills as they interact and communicate with others.
  • Children with hearing impairments can also communicate in this way, however, they need help to learn to detect and recognize sounds around them. They must be taught that listening is useful and necessary to verbally communicate.
  • Children with hearing impairments CAN LEARN TO LISTEN TOO!!

Terms You Will Hear Along the Way with AVT

  • Learning to Listen Sounds- The list of sounds that are used to represent objects. For instance, "aaah" represents an airplane and "moo" represents a cow. They are used with the beginning listener.
  • Ling 6 Sound Test- A test of listening that is done periodically throughout the day where the child which requires the child to respond to 6 sounds (ah, oo, ee, sh, s, and m) presented auditorally. The child completes an action or imitates the sound when heard. These sounds represent the sounds across the frequency range for speech.
  • Modeling- The verbal-visual demonstration of what you want the child to do, especially for imitation purposes. For instance, if you wanted the child to drop a block in a box upon hearing a sound, you the parent would model this for the child.
  • Suprasegmentals- The way in which we use vocal qualities such as stress, duration, pitch, and volume, to relay the meaning being said. Intonation. It is with these intonation/suprasegmental changes in our speech that we are able to make a question or a statement with the same words, ( i.e. You're going to the beach? Or You're going to the beach.)
  • Critical Elements- The parts of a message that contain the critical information in regard to comprehension of the message (i.e. Pick up the blue circle after the red square. This sequence has 5 critical elements)
  • Residual Hearing- The amount of hearing an individual has at various frequencies without his/her hearing aid/cochlear implant.
  • Hearing Age- The length of time the child has been receiving auditory input. (i.e. a 3 year old child who was born deaf, and received her cochlear implant at 2 years of age, as a hearing age of 1 year.)
  • Motherese - Speech used by parents/caregivers in talking with young children to help them in learning language.
  • Acoustic Highlighting- Techniques that can be used to make speech easier to hear.
  • The Hand Cue- is covering of the mouth (by hands, a toy, book, picture, etc.) during speaking when the child is looking directly at the face of the speaker.

Frequently Asked Questions

How is Auditory-Verbal Therapy different from other kinds of therapy?
Many therapists provide services to improve communication skills of children with hearing impairments. Some therapists teach American Sign Language, while others use total communication, cued speech, or techniques used in their community. Few professionals, approximately 205 in the world, are certified as Auditory Verbal therapists who are equipped for providing therapy sessions, parent training, and education services needed to maximize the child's use of hearing as a primary sense for speaking and learning at school.

Who provides Auditory Verbal services?
Certified Auditory-Verbal therapists are specially trained for this. Some therapists are not certified but do follow the principles of AVT and have received specialized training in its approach. Talking to a prospective therapist will let you know his or her beliefs and practices; meeting children and parents from various programs will help you assess the appropriateness of a program for your child.

Why aren't Auditory-Verbal services offered at my child's school?
Compared to other communication and teaching methods for deaf children, Auditory-Verbal management is relatively new. However, interest in mainstreamed services and auditory learning environments for hearing impaired children is growing with the advent of hearing aids with built-in FM receivers, cochlear implants, and classroom amplification systems. Many teachers of the hearing impaired were trained before Auditory-Verbal management was understood and are unfamiliar with it. A critical role of the Auditory-Verbal therapist is to provide support services for school staff to meet the educational needs of each child. These can include classroom observations, in-services recommendations for language and curriculum modification, demonstration teaching sessions, etc.

Can Auditory-Verbal services be used in conjunction with other methods?
The Auditory-Verbal philosophy is a set of principles designed to be followed to achieve maximum use of hearing for learning. It does not use formalized visual communication systems such as sign language and cued speech. Research has shown that children who do not use sign language develop more sophisticated use of their hearing and speaking skills. Modifications to this approach are recommended on a case by case basis, taking the child, family, and community factors into account.

What age is best to begin Auditory-Verbal Therapy?
No infant is too young to work with. As soon as the infant has been fitted with hearing technology, therapy should begin. Because the human brain learns most rapidly in infancy, these important years should be capitalized on by starting therapy and parent training immediately.

How often should a child go to therapy?
In many cities, children receive one or two, hour-long sessions each week. Children and their parents participate in the sessions with the therapists. Families who are limited by distance may receive fewer sessions, such as every other week. The amount of therapy the child receives is not the main factor in a child's progress; rather it is the amount of time the parents spend engaging their child in verbal dialogue and language learning!

  • Is therapy covered by insurance?
    This often depends on the credentials of the therapist, the insurance policy, and the state where the policy is in effect. Some policies are more likely to pay for therapy with hearing aid users. Some will pay for therapy only to restore speech/language/hearing functions, which were lost through injury or illness; others pay if the child was born with a hearing loss.
  • What results can be achieved by using Auditory-Verbal Management?
    A generation of profoundly deaf graduates from Auditory-Verbal programs throughout North America have received careful study (Goldberg and Felxer ,1993). Even though the subjects were trained with hearing aids and did not have the advantage of cochlear implants, a vast majority are reported to have perceived themselves as fully integrated in the hearing community, received a mainstreamed education, did not use sign language, used the telephone to send and receive messages and pursued careers of their choice. Results of Auditory-Verbal training vary with the age of the child, presence of multiple disorders, parent participation, availability of appropriate services, type of educational programs, and other factors. The goal of Auditory-Verbal training is to maximize the child's use of hearing. Each child responds to this in a unique manner.

From Hear in Dallas, Co.

What is an Auditory Verbal Therapist?

  • Auditory-Verbal therapists are professionals who have been trained in one or more of the disciplines of speech pathology, audiology, and education of the deaf.
  • They recommend an Auditory-Verbal treatment plan as the first option for developing a speech, language, and education program for hearing-impaired children.
  • Auditory-Verbal therapists seize the auditory component of any life experience and promote and develop the use of sound for speaking and understanding spoken language.
  • Auditory-Verbal therapists have expertise in the use of acoustic emphasis of speech sounds and language patterns for the purpose of maximizing the hearing-impaired child's verbal development.
  • The guiding principle applied by an Auditory-Verbal therapist is that all therapeutic and education decisions lead to the hearing-impaired person's maximum participation in the hearing-speaking society.
From www.VoiceForDeafKids.com

AVT: The Listening Environment

  • Speak close to your child's hearing aid or cochlear implant microphone.
  • Speak in a quiet voice, at regular volume: raising the volume of your voice can often distort speech, making it more difficult to understand.
  • Use a slightly slower speaking rate.
  • Minimize all background noise; turn off window air conditioner units, fans, TV, radio's, etc..
  • Use speech that is repetitive and rich in melody, expression, and rhythm.
  • Use acoustic highlighting techniques to enhance the audibility of spoken language.