A Longitudinal Study of Auditory-Verbal Effectiveness
Dimity Dornan, A.M., Ba.Sp.Th., F.S.P.A.A., LSLS Cert. AVT; Hear and Say Centre
Carol Flexer, Ph.D., CCC/A, LSLS Cert. AVT; University of Akron
Ethically and legally, the family’s desired outcome for their child guides us as professionals working with children with hearing loss. If the family chooses a listening and spoken language option, what data do we have to support this as a scientifically valid choice for families? Thanks to Dimity Dornan, Carol Flexer, and other scientists like them, we have more and more every day. This presentation summarized the results of a 4 year, 2 month longitudinal study conducted by Dimity Dornan and her colleagues focused on documenting the success of Auditory-Verbal intervention for children with hearing loss.
To begin, Dr. Flexer emphasized to the crowd that listening is not at all about the EARS… it’s all about the BRAIN. Auditory-Verbal Therapy, “[I]sn’t about tickling the ears, it’s about growing the brain.” Think about this: the human body is beautifully designed to give us just the right amount of sensory input. We have lids on our eyes, because we’re not meant to always see. Do we have lids on our ears? No. Auditory input, for children with typical hearing, is a 24/7 sensory experience. For children with hearing loss, then, if our goal is to capitalize on the auditory brain centers, we must advocate for early detection, identification, amplification, and stimulation if we are to build their listening brain. As an audiologist, Dr. Flexer also pointed out the unique audiologic management needed by the pediatric population, especially young infants. “Babies aren’t just short little eighty year olds,” she said, and thus we cannot treat them as such in our audiologic management – they need more frequent earmold impressions, more specific hearing aid adjustments, more vigilant speech perception testing if they are to have the best possible shot at developing listening and speaking skill on par with their hearing peers. Technology and opportunities for children with hearing loss today are far greater than in previous decades, but according to Dr. Flexer, if a clear auditory signal isn’t making it to the brain (via hearing aids, FM systems, Bahas, cochlear implants, or other technologies or combinations thereof), “You might as well be talking to the floor.” Auditory access is step one. With improved hearing capabilities, Dr. Flexer noted, “The days of in-your-face talking are over.” We can now expect children with hearing loss to gain the skills to hear in noise, follow multi-talker conversations, hear across distances, and even pick up incidental language (especially crucial for learning social skills and Theory of Mind). In conclusion, as anyone who has heard Dr. Flexer present before will know, “It’s all about the brain!”
Once children have achieved access to a clear sound signal, what evidence do we have to support Auditory-Verbal Therapy practices? Ms. Dornan compared nineteen children with a mean pure-tone average of 79.39dB (severe hearing loss) with nineteen language-age matched hearing peers over a period of fifty months (4 years, 2 months). In her study, the children’s receptive and expressive language, speech production, reading and math skills, and self-esteem were assessed at various intervals during the fifty month time period and the results were astounding. In language progress, receptive vocabulary, speech progress, reading skills, and math skills (yes… that’s ALL of the areas tested), there was no significant difference between the hearing and AVT groups of children. What’s more, the children in the AVT group had a mean age of identification of 23.5 months and mean age of cochlear implantation of 27.7 months (this was before Universal Newborn Hearing Screening in Australia) – ages that are on the older end for what we expect from today’s children, many of whom are identified at birth. The language and academic achievements of the children with hearing loss in the study were impressive, but what was most heartening was the measure of self-esteem. In this area, children with hearing loss scored equally to their hearing peers.
Though we use the same word – “deaf” to describe these children as we did for children with hearing loss decades ago, perhaps the time has come to change our mentality… and our vocabulary. The results of this study show that, over time, children enrolled in Auditory-Verbal Therapy programs are achieving stellar speech, language, academic, and social results on par with their hearing peers. Though much research remains to be done in this area (replicating the study in different AVT centers, different countries, etc.), the expectation of 12 months progress (or more) in 12 months time, and commensurate achievements for children with hearing loss and their hearing peers, is no longer a dream. Dr. Flexer and Ms. Dornan offered several explanations for why this is so: early auditory brain access, simultaneous education of the parents and child in Auditory-Verbal Therapy, and auditory brain growth through intense (but fun!) practice.
It’s a Small World After All
Lilian Flores, Ph.D., LSLS Cert. AVT
Teresa Caraway, Ph.D., CCC-SLP, LSLS Cert. AVT
Kathy Sussman, M.S.
Lic. Elisa Giraudo
Lic. Florencia Cornejo
The presenters for this session hailed from two US states, Mexico, and Argentina. All were brought together by their mutual commitment to provide superior listening and language services for children with hearing loss and their families. The presenters shared how collaboration, across countries and across languages, has been a mutually enriching experience for all of their programs. In today’s global society, the issues facing programs in Spanish-speaking countries are quickly becoming realities for programs in the United States, many of which have students whose parents come from around the globe and speak a variety of different languages. The presenters shared the results of a parent survey they conducted to highlight some of the main concerns facing these families: lack of interpreters for audiological appointments, concerns about teaching their children two oral languages, and problems with culture clashes (or misunderstandings) between parents and providers. The professionals emphasized the importance of conducting similar “family profile” surveys in our own practice, finding out the family dynamics and composition, parental education levels, perspectives and outlooks, daily social and play routines, traditions, and educational hopes for their child, as well as rhythms, songs, games, and first words from the family’s native language. In so doing, professionals can build cultural understanding while making the family, who may be intimidated by interacting with professionals in a language with which they are not wholly comfortable, feel like a respected member of the child’s educational team.
Some ideas and immediate proposals of the presenters included:
Take a family survey and analyze and apply the outcomes
Understand the cultural and social differences between the therapist’s culture and families’ cultures
Be empathetic – raising a child with hearing loss is difficult… raising a child with hearing loss outside your country, alone, and not understanding the language is even more difficult
Understand how the situation affects the family from a global perspective – not just the child-parent interactions, but interactions between parents, other siblings, extended family members, etc.
Confront your own stereotypes, biases, and assumptions that may get in the way of providing quality therapy
Help the family transfer language and speech production tasks into the activities of their daily life and in their own way
The presenters also discussed the idea that collaboration between professionals from the US and from Spanish speaking countries could indirectly benefit children of Spanish-speaking parents identified with hearing loss living in the USA. By learning from our colleagues in Central and South America, United States professionals can receive educational materials on hearing loss written in Spanish, and by supporting the professional development of Listening and Spoken Language Specialists in Spanish-speaking countries, we add to our collective knowledge base to serve Spanish-speaking children and their families, wherever they might reside.
With their successful collaboration as a model, the professionals from the US, Mexico, and Argentina encouraged other organizations to do the same, building mutually enriching relationships with listening and spoken language programs across the globe. As one presenter noted, “We may be different, but in terms of our commitment to the children and their families, we are all very much the same.”
Sound Beginnings: Coaching Families with LENA Feedback
Helen Morrison, Ph.D., CCC-A, LSLS Cert. AVT; Texas Christian University
Lisa Lopez, M.A., LSLS Cert. AVT; Sunshine Cottage School for Deaf Children
Adrienne Russell, M.Ed., LSLS Cert. AVEd; Sunshine Cottage School for Deaf Children
Donna Kramer. M.Ed.; Sunshine Cottage School for Deaf Children
Julie Sill, M.Ed.; Sunshine Cottage School for Deaf Children
The LENA, is a device smaller than a pack of cards, worn by a child for a period of time, that picks up audio recordings of the child’s environment and, when connected to a computer, can yield an incredible amount of information about the user’s auditory environment. Based on the research of Hart and Risley (1995), the more words a child hears before the age of three are highly correlated with language and academic outcomes later in life. Children from impoverished families entered school with a gap of 30 million words when compared to their peers who were children of professionals. The situation becomes all the more dire when we consider a child with hearing loss. How can professionals help parents, regardless of their socioeconomic level, optimize their meaningful language interactions with their child? These presenters sought to provide a solution to thei problem using the LENA system. The LENA’s Digital Language Processor collects information such as:
Adult-child conversational turns
Electronic signals (television, electronic toys, etc.)
This information can be used to guide and coach parents, and to empower parents to set their own goals for increasing their interactions with their child. When they analyzed LENA data from a test cohort of children, the presenters found that parent-child conversational turns were correlated with child vocalization. They found that parents engaged more with children who were more vocal – how can we coach parents of less-vocal children to talk, talk, talk to get their child to that high-vocal rate when a one-sided conversation is often frustrating and not very rewarding? The researchers shared several case studies to illustrate how LENA data can be used in parent coaching sessions to allow parents to take control of their interactions with their child and set their own communication goals. When goal-setting comes from the parent, follow-through is much more likely. Though this system is new, the presenters suggested a variety of uses for the LENA system, both for research and clinical practice.