Principles of Auditory Verbal Therapy

I’d like to share a little bit about the Principles of Auditory-Verbal Therapy.  These 10 guidelines are the standards for Listening and Spoken Language Specialists Certified Auditory-Verbal Therapists the world over.  The following are the principles (in bold) and my reflections on what they mean to me (in italics).  Please note that my reflections are just that — my reflections — and are by no means the definitive “answer” for what AVT is all about, or even ALL of my thoughts about AVT… just a short little “blurb” to put these principles into everyday language to help give you a better idea of what AVT really means!


Principles of LSLS Auditory-Verbal Therapy


1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal therapy.

The earlier, the better!  I fully support Universal Newborn Hearing Screening and believe that parents should receive accurate, unbiased information about their child’s hearing loss as soon as possible.  New technology, like OAEs and ABRs makes testing even the smallest infant’s hearing a possibility, so children should be identified and receive amplification and listening and spoken language services (if their parents so choose) within the first few months of life.


2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.

The brain can’t wait!  Access to amplification (first a hearing aid trial, then cochlear implants if necessary — or bone conduction aids or Baha for conductive hearing losses) is crucial to grow a child’s auditory brain.  Depriving the auditory cortex of stimulation when a child is young can permanently alter their neurodevelopmental pathways.  We must get children access to sound so that their brains can build the neural connections they need to process auditory information to the best extent possible.


3. Guide and coach parents¹ to help their child use hearing as the primary sensory modality in developing spoken language without the use of sign language or emphasis on lipreading.

Auditory-Verbal Therapy focuses on learning to LISTEN.  That means learning to understand sounds and spoken language without sign language and without formal lipreading/speechreading training.  By focusing on audition (hearing) only, without any type of visual aid, children become “listeners”.  Regardless of their degree of hearing loss, with appropriate amplification, even the “deafest of deaf” children CAN learn to understand speech through listening alone.


4. Guide and coach parents¹ to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized Auditory-Verbal therapy.

Parents are the key!  As a therapist, you may spend an hour (or less) per week with a child and parent in your therapy sessions.  Parents are with their children nearly all waking hours of their day!  Hearing children learn language from their parents in natural everyday interaction — deaf children can, too!  It may require a few special techniques, and that is why parent participation in AVT is crucial!  The LSLS Cert. AVT does interact with the child, but the main focus is on helping the parents, coaching them in the skills and techniques that help them make every day, every experience an opportunity for language learning with their child.


5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.

LSLS Cert. AVTs help parents structure everyday environments and interactions to set up situations for learning to listen and speak.  This may include helping the family identify “good” listening environments (close and quiet) and helping them help their child in more difficult situations (training the child to listen in noise, use of assistive listening devices like soundfield systems and FM).


6. Guide and coach parents¹ to help their child integrate listening and spoken language into all aspects of the child’s life.

AVT does not just happen for an hour or so a week and then you’re done with it until the next session.  Auditory-Verbal Therapy is NOT just therapy… it’s a LIFESTYLE.  LSLS Cert. AVTs help parents make every day a day to learn to listen.  Parents learn strategies like narrating everyday events to help build their child’s language skills in a variety of different situations and activities.


7. Guide and coach parents¹ to use natural developmental patterns of audition, speech, language, cognition, and communication.

One of the things I love most about AVT is its emphasis on developmental appropriateness.  Flashcards for preschoolers are not developmentally appropriate… nor are baby board books for a twelve year old.  Instead of taking a remedial approach to deaf education, the Auditory-Verbal approach seeks to follow developmental norms as closely as possible to help children, even though they have hearing loss, meet their speech, language, listening, and learning milestones on time.  This is why AVT for young children is play-based, focusing on toys, storybooks, and everyday activities in the life of a toddler.  Just because a child has a hearing loss doesn’t mean they aren’t still a CHILD and deserve to be treated as such.  When we “meet children where they’re at” it’s not only more fun for everyone involved, but by recognizing their unique needs at each age and stage of growth, we actually get better results!


8. Guide and coach parents¹ to help their child self-monitor spoken language through listening.

If you are hearing, think about how you learned to talk.  You listened!  Think about even now, as an adult, when you misspeak or mispronounce a word — how do you know you did so?  You listened!  Think about how your speech sounds when you have a stuffy nose, a cold, or just stepped off an airplane and your ears are plugged.  How do you know your voice sounds different?  You listened!  You heard yourself stumble over a word or phrase, and then corrected yourself and repeated it the right way.  It happens all the time, and we barely even realize we’re doing it.  This is why our speech sounds so natural — we are constantly monitoring and adjusting our voices based on the auditory feedback we hear from monitoring our own voice.  When deaf children have appropriate access to sound, the same self-monitoring is possible for them, too!  LSLS Cert. AVTs help develop this skill in children with hearing loss by focusing only LISTENING to speech — the therapist’s speech, the parent’s speech, but also the child’s own speech.  LSLS Cert. AVTs help parents carry this skill over into the home environment with strategies like “auditory sandwiching” or “auditory feedback loop” where parents repeat what the child says (and repeat it correctly, with emphasis, or acoustic highlighting, on missed sounds if the child made a mistake) to encourage the child to really listen to his or her own speech.  This is how a child, even with a profound hearing loss, can achieve a more natural, effortless vocal quality.


9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family.

Auditory-Verbal Therapy is diagnostic.  LSLS Cert. AVTs consult with parents to monitor the child’s ongoing progress and adapt lesson plans as necessary.  Many AVT sessions begin with parent and therapist chatting about the events of the week, noting any changes in the child’s listening, speech, or language skills.  We constantly monitor progress with both formal (standardized tests) and informal (the results of therapy, Ling 6 Sound Checks many times a day) tests.  If the child is doing well — great!  Where do we go next?  If the child is struggling — what can we as the adults in the situation change to give them a better shot at success?


10. Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards.

Mainstreaming is the goal!  Children with hearing loss CAN be educated with their hearing peers.  What I love about this is that the child with the hearing loss is not isolated from his/her siblings or neighborhood friends.  However the family was planning to educate their child before they found out he had a hearing loss, that’s how they should continue to plan to educate their child even though he has a hearing loss — whether it be public, private, parochial, or home schooling, the child who is D/HOH can be educated alongside hearing peers with minimal accommodation.

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