There are many ways to provide high quality services in keeping with the Principles of Auditory Verbal Therapy, and this is just one example of a sixty-minute session (times are approximate and, obviously, will vary from session to session – they are more for organization than exact measures).
:00-:05 Check in with caregiver(s) and child. How was the past week? Did the child do, say, or hear anything new or particularly notable? I also use this time to remind the parent of what the goals were for the past week and to see how home practice went (“Last week, we talked about using the noun modifiers “dirty” and “clean.” How did Susie do with that at home this week?”). This is very important to me, because it reinforces the idea that PARENTS are their children’s primary teachers, and that I will be holding them accountable for working with their child at home. Sure, a parent could just lie and say, “Oh, yeah, it went perfectly,” but a) that’s easy to see through, b) we all know how awful it feels to be put on the spot and be found wanting and have to lie – hopefully that feeling will motivate the parent not to have it happen again and c) the child’s performance in therapy will reflect whether or not skills have been practiced at home during the week. I encourage parents to use their child’s Experience Book to record their observations of their child’s behavior, things the child said, or other milestones during the week to help them remember talking points for therapy.
:05-:10 Equipment and Ling Six Sound Check. This time is used for troubleshooting the child’s HA(s), CI(s), or Baha, to ensure that they have optimal access to sound. A Ling Six Sound Check provides behavioral verification of equipment function. As the child masters the Ling Six Sound Check presented from a close distance and without background noise, distance is increased and background noise (white noise, music, multitalker babble – YouTube is a great source for this from “sound effects” – type videos) to more closely replicate the listening environment of the real world. This is a great time for the therapist to help the parents connect the child’s performance on auditory tasks to his speech and language skills as well as any audiological needs (e.g. if the child is not demonstrating detection of /s/, is it time for a new CI MAP or for a child who is a hearing aid user to consider CI candidacy?).
:10-:50 Let’s play! The majority of the session is spent having fun and working on therapy objectives. The activities and goals vary from child to child, but each session should target goals in the domains of:
Audition: working through Erber’s Hierarchy of auditory skill development, auditory memory, etc. Again, these tasks begin in close, quiet environments, and later are moved to greater distances and greater background noise as the child’s listening skills develop.
Speech: working on the production and articulation of developmentally-appropriate phonemes (speech sounds) and syllable shapes through LISTENING first (no, “Look at my lips,” here, thank you very much!).
Language: working on increasing vocabulary, as well as the linguistic structures (syntax) that the child can understand (receptive language) and use (expressive language).
Communication: working on pragmatic and social language – asking questions, understanding slang and figures of speech, self-advocacy skills, etc.
Cognition: paying attention to the development of the whole child and cognitive/academic skills that are developmentally-appropriate for him.
Some therapists like to plan a separate activity for each of these domains. This usually does not work well for me, as I prefer to plan longer activities that incorporate goals from a variety of areas. It varies between professionals. For me, the “activities” section of the session ALWAYS includes shared reading of a book, and usually includes some sort of craft or take-home activity to reinforce goals throughout the week. There are many different ways to structure this part of the session, but a few things should be consistent between any professionals using an Auditory-Verbal Therapy model:
The goals of each activity should be introduced and explained to the caregiver before the activity begins
The therapist should model the activity for the parent, and then quickly turn the activity over for the caregiver to lead in working with his/her child
Caregivers should be active participants in the session and given opportunities to practice new skills and ask questions
All skills are taught with an emphasis on listening – audition first!
:50-:60 Wrap-up. The therapist discusses with the caregiver (and child, if they’re old enough), the goals and objectives that were targeted during the session, and how the child did. The therapist works with the parent and child to create a new page in the child’s Experience Book about what happened during the session, and records goals and activities for the parent and child to work on at home during the time between sessions. Parents (and children) are given time to ask any questions, and the session wraps up.
Elizabeth A. Rosenzweig 