Auditory-Verbal Therapist - Current & Past Questions

Current Question:

Q. What methods are used in the speech development of those children with cochlear implants?

A. There area as many methods to work on speech as there are therapists. I will answer this from an Auditory-Verbal standpoint which typically results in the natural development of natural voice quality and clear articulation. First I want to say that there are so many different types of children that there is no one way to work on speech. Some children have neurological problems that effect speech and require special treatment protocols. Many children have a variety of speech characteristics and disorders of production before they are implanted and special teaching techniques may be used to remediate them.

In the optimal course of speech development in the AV program, young children are provided with an input that replicates the speech mothers effortlessly use with children who have normal hearing. By talking to the newly hearing child using lots of vocal melody, repetition, and lenghtened vowels spoken in a sing-song fashion (ex., "byyyye byyyye"), the child's brain is stimulated much like that of a hearing infant's is and the natural stages of vocal play, babbling and jargon unfold. The mastery is in the type of input used for the child to hear: with the proper input, the normal stages of speech development unfold. In addition, we may use acoustic highlighting which increases the loudness and duration of a specific consonant that the child may not hear well: an example of this would be "sssssnake" to help the child hear the 's' sound. This allows the child to hear the sound in it's 'pure' form and then he can attempt to put it into a whole word or phrase. Another technique is to whisper the entire word so the loud vowel does not over power the weak consonants such as in the word "stop" where the loud /ah/ may take the child's attention away from the /s/, /t/, and /p/. Of course there are other techniques, but these are some commonly used.

The important principle of speech development in AV is to let the child have the time needed to proceed through the normal stages of speech and phonological development. If articulation intervention is done too soon, the natural flow of development can be arrested and the child may actually be taught to use 'deaf speech'. Stimulating hearing is the most powerful method of speech teaching. Allowing the child to go through the natural stages generally results in the most natural-sounding and intelligible speech.

Past Questions:

Q. What makes auditory verbal therapy different from the oral philosophy parents used with their children 50 years ago?

A. There are several significant differences I would like to address. 

(1) We can now diagnose deafness immediately after birth and begin intervention at that time. By fitting the infant with appropriate hearing aids and training the parents and extended family to stimulate the child's brain with hearing and spoken language, we can build sound into the child's earliest stages of brain development. In so doing, the infant can be stimulated to proceed through the approximate normal sequences of speech skill development and language acquisition. 

(2) The field of communication sciences enjoys a much greater understanding of the normal developmental processes of auditon, speech and language than we did a few generations ago. Our therapy and parent training procedures are more appropriate now than then and hence are far more successful.

(3) Current hearing technologies now allow nearly all infants with hearing impairment very good hearing sensitivity for hearing spoken language. If hearing aids are not adequate, the cochlear implant provides good hearing sensitivity throughout all the pitches needed to hear all of the speech sounds of English. 

(4) Certified Auditory-Verbal therapists are specialists in the preceding three areas and apply these to help parents raise their children as hearing-speaking members of society. Social and educational mainstreaming are the outcome for many children who are managed with today's knowledge and technology.

Q. I am a graduate student in deaf education and have been to several Auditory-Verbal Therapy (AV) workshops. I am currently a preschool special ed teacher w/ two hard of hearing children. Do you have suggestions for a basic book on AV principles to get me started in understanding the concepts?

A. Yes, there are some very good books to get you started. You can request a publications catalogue from Alexander Graham Bell Association for the Deaf and Hard of Hearing by sending an email to mailto:publications@agbell.org. In it you will find the classic AV books such as the "bible" of AV which is Doreen Pollack's book,
"Educational Audiology for Limited Hearing Infants and Preschoolers." Other good books are the ones by the following authors: Warren Estabrooks' "Cochlear Implants for Kids" and "Auditory-Verbal Therapy", Carol Flexer's "We Can Hear and Speak!". Other authors such as Elizabeth Cole and Daniel Ling have written excellent books. This should give you a good start. For a more extensive list, I have a reading list posted on my website, http://www.hearingimpaired.com. It's a few years old, but has a lot of important topics on it. 

Q. I have a 5 year old son who received a cochlear implant 1-1/2 years ago. He goes to Auditory Verbal therapy and we love it. He hears beautifully, speaks and sings. We are working on his voice quality as he sounds monotone. Any ideas for home practice??

A. Typically, melody and intonation come in over a period of time. One activity kids enjoy is to participate in lots of 'operettas' at home. Pick an activity your child enjoys (making cookies, reading a book, etc.) and take turns 'singing' all the lines. You sing a line either to a made up tune or to a familiar tune and ask your child to repeat each line after you. This will give him many opportunities to hear your melody and the same number of opportunities to practice his attempts. For example, while making cookies, sing to the tune of Jingle Bells: yum yum yum, yum yum yum, I want cookies now, mix and mix, stir and stir, I want cookies now. Get some sugar, crack an egg, stir it round and round, hurry up, bake them hot, I want cookies now! 

Q. I am a Speech Language Pathologist working in a medical setting.  I am very interested in learning about aural rehabilitation following cochlear implants on adults (ages 14+). Where and how would you suggest I begin?
 

A. This is an excellent question. First I suggest going to the Alexander Graham Bell Association for the Deaf and Hard of Hearing website (www.agbell.org). Their publications catalogue has many good resources. I suggest you order books by the authors Doreen Pollack and Warren Estabrooks: both have excellent books that are available. Also, videotapes and books by Daniel Ling are excellent. Several of these individuals have prepared other types of instructional materials. I also recommend joining Auditory-Verbal International (www.auditory-verbal.org) and A.G. Bell in order to receive their publications and stay informed of seminars and conferences you can attend.

 Q. Question: My daughter is 5 years old, has a severe-profound hearing loss and should attend Kindergarten next year. Currently she is enrolled in a hearing preschool as well as hearing impaired classroom. The K hearing impaired classroom will be over 1 hour away. How do I decide which school to send her to? There are no a/v therapists in our area. What is available for me to help her at home--are there any home-school programs or a/v programs for hearing impaired children?

A. These are excellent questions and many parents are in the same situation throughout the country. For resource materials, I suggest you go to www.agbell.org and locate their publications catalogue. Doreen Pollack's book is the classic in the field and has countless ideas for parents and professionals. Also the books by Warren Estabrooks are good. I never recommend placement in any program based on the child's age. It is always based on the child's receptive and expressive communication skills. It is important for a hearing impaired child to be in a highly verbally engaging environment with expectations and encouragement to listen and talk and interact with everyone.

Each child is so unique, I cannot recommend placement in this email format. A child needs to develop very good verbal skills in order to benefit from a regular school placement. In general, I recommend a placement that has the right attitude and philosophy of maximizing each child's communication skills. I am not typically concerned about a lot of academic skills in these early grades, but rather language development is priority. It might be helpful to locate a home school curriculum to teach your child at home, but always remember to focus on the language of the goals, not the specific goals themselves. Use the goals to embellish your child's language. Use the goals to stimulate your own thinking and build other language activities around them.

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