Frances Clark discusses the Auditory Verbal approach, a method of learning to speak through listening.
What is Auditory Verbal Therapy?
90% of deaf children are born to hearing parents, many of whom will be unfamiliar with the options available to their children in terms of learning language.
Auditory Verbal Therapy is a specialist therapy for children who are deaf. It focuses on early intervention through coaching parents to use techniques and strategies to support the development of their child’s language through listening.
In order for deaf children to listen, they require optimum technology such as hearing aids or cochlear implants. They also need the technology to stimulate the listening part of the brain, the auditory cortex. Owing to neuroplasticity, the auditory cortex requires stimulation early in a child’s life, ideally before the age of three and a half, otherwise this part of the brain may be used for other senses. Then it can become difficult for a child to rely on their listening alone, without the need for additional input such as lip-reading, sign, gesture or pictures. Auditory Verbal therapists work to ensure optimum technology is provided and that parents are given strategies to stimulate listening and therefore the listening brain. As a result, children with hearing loss are better able to develop listening and spoken language skills, with the aim of giving them the same opportunities and an equal start in life as hearing children.
A typical Auditory Verbal Therapy session looks and feels like play! The child is engaged in an age-appropriate activity such as bathing a doll, making cupcakes or designing a dinosaur park in small world play. Parents are taught how to integrate techniques into their everyday lives which is where the real learning happens. Auditory Verbal Therapy enables parents to help their child make the best possible use of their hearing technology (hearing aids or cochlear implants) by equipping them to check and troubleshoot in collaboration with their audiology team. This ensures that the child has full access to the speech spectrum and can therefore learn language through listening.
How does Auditory Verbal Therapy differ from other types of speech and language therapy?
AVT concentrates on developing the auditory cortex rather than relying solely or partly on visual cues and therefore therapy is delivered primarily through listening.
Parents/caregivers are coached in the use of Auditory Verbal strategies and techniques in everyday activities and play so that every opportunity is used to develop their child’s listening brain and spoken language skills.
AVT is an early intervention programme. By working intensively with the child in their first few years they should require much less additional support for the rest of their life.
AVT aims to develop the child’s social skills and theory of mind (the ability to understand that their mind differs from another’s). This prepares them to make and keep friends at school.
Is it effective?
Research from Australia and the USA indicates that children who have received a programme of AVT, develop spoken language commensurate with their aged match hearing peers and progress at the same rate for listening, spoken language, self-esteem, literacy and numeracy.
Research from Denmark demonstrated that children receiving Auditory Verbal Therapy had advanced spoken language skills compared to other children who received standard early intervention and AVT improved outcomes for children with cochlear implants.
Another study compared Auditory Verbal Therapy to Oral Communication (OC) and Total Communication (TC) approaches for developing language. The results indicated that significantly greater numbers of children in the AV group obtained standard scores within normal limits than children in the OC and TC groups.
Auditory Verbal UK belongs to First Voice which is a consortium of Early Intervention Centres from Australia, UK, New Zealand and South Africa. The outcomes for these centres were collated in 2018 and the results indicated that 86% of children with hearing loss and no additional difficulties, achieved a spoken language score within or above the range for typically hearing children.
In the UK, approximately 80% of all children who spent at least two years on the programme achieved age appropriate language. On average, the children who had additional needs as well as deafness, doubled their rate of language development, and one in two children reached age-appropriate spoken language at the end of their programme. For children, both with and without additional needs, the earlier they accessed the programme, the better the prognosis for language development. It has also been found that 97% of deaf children without additional needs reached at least age appropriate spoken language at the end of a programme of Auditory Verbal Therapy.
During lockdown in 2020, all therapy was moved to tele-therapy which was delivered via Zoom. The effectiveness of tele-practice was measured and the children showed no difference in their rate of language development on a formal assessment. Prior to lockdown, 60% of parents were unsure of the effectiveness of tele-therapy whereas during lockdown, after receiving it, 10% of parents were unsure of the effectiveness.
The success of AVT via tele-therapy is largely because of the coaching nature. It is what the parents DO that matters, the therapist coaches them on how to integrate AVT into their everyday lives.
How can it be accessed?
Families can self-refer by contacting firstname.lastname@example.org or call 01869 325000.
“AVUK was a safe and welcoming environment where we could share our concerns with people who knew what Rafi was going through and were best positioned to help him. It gave us support, it gave us answers and it gave us techniques that we could apply every day to support our child.”
Kenza and Antoine, Rafi’s parents
Frances Clark, Senior Auditory Verbal Therapist and clinical lead for the AVT UK London centre.