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Hearing impairment is called the invisible disability but it impacts on every facet of life for a child and their family. Considering the wide ranging impacts of hearing impairment on young children, early identification and intervention during the critical early learning years, has been proven to be crucial to the child’s development of speech and language. With the recent scientific advances in amplification and cochlear implant technology, Children who are born with hearing loss in early childhood, have unprecedented potential, like never before, to develop listening skills, develop intelligible spoken language, and enjoy the social and academic standards commensurate with peers with typical hearing. Most of these children can learn to listen to their own voices, listen to the voices of others and listen to the sounds of life. With this new population of babies and young children, we can work from a developmental and preventive prospective rather than from a remedial and corrective one.
To foster this potential, most parents make an educated choice from a variety of communication approaches, to help their young children, to satisfy their family goals, and to embrace their culture. Auditory verbal therapy (AVT),a listening and spoken language (LSL) approach , is one such choice.
Crucial to effective early intervention is effective audiologic management. Once a child’s hearing loss is identified, they need to be fitted with appropriate hearing aids as soon as possible so that they can access their residual hearing with the right hearing device. Then the child needs to learn to listen and make use of the hearing signals that they receive. Simply providing hearing devices does not mean the sound will be perceived or interpreted. The child needs to learn to listen and understand through these devices. They need to learn that sound has meaning and is related to all that is going on around them. It is important to remember that access to sound does not automatically mean that speech and language will develop. Appropriate teaching is essential. “Technology and medical devices only give children access to hearing. Whether the children learn to use this hearing depends on the therapy that they receive, once they have been given this hearing potential” Judith Simser. Thus, “AVT is natural companion of such technology”.
Estabrooks, Maclver-Lux, & Rhoades, 2016 described AVT, as an evidence-based and evidence informed early intervention approach for infants, toddlers, and young children who are deaf or hard of hearing and their families, respects parents as the primary agents of change and primary case managers in the lives of their children. In AVT the Auditory-Verbal practitioner and the parents apply specific creative evidence-based strategies in order to promote the optimal and efficient acquisition of spoken language developed primarily through listening. Listening, therefore, becomes a major force in nurturing the child’s personal, social, and academic life.
The Goals for Auditory Verbal Therapy are set in four areas of development such as; audition language, speech and cognition. AVT emphasises the development of listening and language through natural play, singing, daily routines as well as structured therapy activities. AVT focuses on rigorous application of techniques, strategies conditions and procedures that promote optimal acquisition of spoken language through listening. It is an individualized and tailored to the specific needs of the child and the family. The child’s auditory abilities develop because emphasis is placed on listening throughout all the child’s waking hours, “so that listening becomes an integral part of his/her personality (Cole et al, 2005). Zahra Jeddi , Zahra Jafari, Masoud Motasaddi Zarandy, Aziz Kassani, in their study in 2014 concluded cochlear implantation and aural rehabilitation result in accelerated rates of cognition, social communication, and motor skill development in deaf children.
Principles of auditory verbal therapy
1)Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiological management and Auditory-Verbal Therapy.
2) Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.
3) Guide and coach parents to help their child use hearing as the primary sensory modality in developing listening and spoken language.
4) Guide and coach parents to become the primary facilitators of their child's listening and spoken language development through active consistent participation in individualised Auditory-Verbal therapy. 5) Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child's daily activities.
6) Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child's life.
7) Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication.
8) Guide and coach parents to help their child self-monitor spoken language through listening.
9) Administer ongoing formal and informal diagnostic assessments to develop individualised Auditory-Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family.
10) Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards.
*Adapted from the AG Bell Academy for Listening and Spoken Language, July 30, 2014
Parent as primary model of speech and language development
The role of the family in early intervention is essential to establish the child’s preverbal skills, and for the parents and family to accept the hearing impairment. The parents become confident in their role as the primary language model and facilitator. All these necessary elements of effective early intervention are found in AVT. Learning to listen occurs only when children seek to extract meaning from the acoustic events surrounding them all day and everyday.
It is documented that maternal engagement in early communication reflect greater scores of parent–child interactions, which is associated with increased development in spoken language skills and it is stressed that spoken language exposure and mentoring of caregivers provide the context for language learning (Niparko et al., 2010). It is, furthermore, documented that early intervention with fitting of hearing aid by 3 months and enrolment in family-centred auditory verbal intervention by 6 months allow children to close the language gap and develop age equivalent language already at 3 years of age (Fulcher et al., 2012). This finding emphasizes that habilitation involving parents, impacts a broad spectrum of parameters and not only listening, spoken language and social well-being of the children, but also matters regarding parental concern.
At Bangalore Cochlear Implant Institute, A team Audiologists and speech language pathologists provide integrated auditory verbal therapy and extensive rehabilitation program that provide support and aftercare to the recipients and their family members. For any information connect with us through info@bciinstitute.net. Ph: +91 6366888883