Parent Participation in Auditory Verbal Therapy

One of the hallmarks of Auditory Verbal Therapy is the belief that parents and caregivers are their children’s primary language teachers.  In fact, six of the ten Principles of LSLS Auditory Verbal Therapy begin with the words, “Guide and coach parents[…]“

Traditional stereotypes of “speech therapy” often involve parents browsing magazines in the waiting room while the clinician takes the child back to the room, performs some sort of unknown “magic” and spits the child back out at the end, perhaps with a worksheet or two (or a sticker… see my throughts on that HERE), but with little else in the way of parent participation.  This sets up the idea of “therapist as magician” and takes the responsibility for learning and teaching out of the parents’ hands.  In other clinics, parents have a front row seat in the observation room, where they can watch their child’s session behind a two-way mirror, but they’re still a part of the audience.  But in Auditory-Verbal Therapy, parents come to center stage to play a key role in the show.


WHY is parent participation such a crucial part of Auditory-Verbal Therapy?

  • One or two hours a week of therapy is simply NOT enough for a child to make progress toward listening and speaking skills that fall within the normal range.  If your child spends one hour a week working on these skills, it will take 23 years to make one year of progress.  The listening and spoken language approach is not a discrete event that happens from 9-10AM on Monday mornings… it is a LIFESTYLE.


  • Like children, adults learn by doing.  If you think that watching behind a window is enough to teach you what you need to know about implementing a therapy program at home, ask yourself this:  Would you watch a basketball game on TV and think it would be enough to make you a star player?


  • Your child needs to learn to communicate with you, not with me.  It is more important that your child learns the songs, rhymes, dialect, and vocabulary of your home.  I love talking to your child, but at the end of the day, my job is to help him participate fully in his natural environment, which is your family — not my therapy room.


  • AVT takes a developmental, not remedial approach.  The goal is for children with hearing loss to learn language in the same natural trajectory as children with typical hearing.  Children with typical hearing learn language through interaction with their parents.  Once our children with hearing loss have access to sound through technology, they can do the same.  Listening and Spoken Language Specialists guide and coach parents in ways to “supercharge” these everyday interactions to help children make up for lost time.


  • Quality parent-child interaction with books, toys, and routines of daily living is crucial for a child’s development in all areas (cognitive, linguistic, social-emotional).  In today’s world full of technological distractions, therapy should be an oasis in time to focus on what truly matters.


  • Hearing loss is a family affair.  While the child may be the one with the hearing loss, the experience of deafness affects the entire family.  Spending time together in therapy helps all family members process this experience with an professional who has experience helping families navigate the emotions and logistics of hearing loss across the lifespan.




But as great as that all sounds, I’ve heard every excuse and reason in the book for why parents can’t participate in therapy…


  • “My child behaves better without me.”  Whoa.  This is the #1 reason I hear from parents (and other clinicians who do not do parent participation sessions) as to why parents cannot participate in therapy.  To me, this is a big problem.  Yes, maybe your child does behave better without you… but what does that say?  To me, that says we have a behavior problem that we need to get under control as a team.  If your child can’t work and play with you for an hour in therapy, how on earth are you going to accomplish the home practice that must take place for your child to make progress?  Let’s problem solve as a team to come up with some positive behavior solutions so that child and parent can work together well in all situations.  Even if it takes a few sessions, it will be time well spent building a foundation for good behavior in therapy… and in life!


  • “I have other children to care for.”  Great!  Bring them in!  Integrating siblings into therapy may take some work on the part of the parent and therapist, but learning to listen and talk doesn’t happen in a bubble.  Parents often apologize for a sibling’s noise, or the need to feed a baby while participating in a session, or an older sibling’s desire to participate in “baby games,” and I tell them there’s no need to feel bad.  Flexibility is key, and siblings and extended family members can often add a lot to a therapy session (more people to play games, good practice conversing in groups, real-life examples for pronouns, etc.).


  • “I don’t speak English.”  That’s okay, your child needs to learn to talk to you more than he needs to learn to talk to me.  Listening and spoken language techniques work in all languages, and it’s important to me as the therapist that our sessions fit with your family, your culture, and your language.  I would love to learn about your family and how to make therapy work for you.


  • “I can’t make it to the session.”  For busy parents, this can be a huge sticking point.  Most brick-and-mortar therapy locations only operate within set hours.  With my teletherapy services, I am able to offer families the luxury of sessions on THEIR schedule, even if that means evening and weekend appointments!



So how can therapists successfully incorporate parents, caregivers, and family members into AVT sessions?


  • Include goals for parent education in your treatment goals and lesson plans. What strategies and techniques do you want parents to learn each session?  Both parent(s) and child(ren) should leave your session having learned something new.


  • Follow up!  If you introduce topics or ask parents to practice something at home but never discuss it again, the lesson becomes that home practice really not that important to you.  At the beginning of each session, I remind parents, “Last week, we talked about doing X, Y, and Z.  How did that go at home?”  Sure, parents can lie about it, but we all know how awful it feels to be caught unprepared.  That feeling goes a long way toward ensuring that parents hold up their end of the bargain next time.


  • Create a distraction-free zone.  From day one, I establish a strict no cell phones policy in the therapy room.  It’s sad but true, many parents can’t tear themselves away from texting their BFFs for long enough to focus on the their precious child’s developing brain.  I remind parents, “For this hour, NOTHING is as important as your child.”


  • Make therapy and embarrassment-free zone.  Depending on their personalities and/or cultural backgrounds, some parents may be very reluctant to do the moo-ing and woof woof-ing and singing that make up a fun AV session.  On day one, make it clear to parents that their full participation is vital to their child’s success, and set the example by being unafraid to ham it up yourself.  Remember, just like with children, tell — don’t ask — parents for what you need.  Instead of saying, “Do you want to sing Wheels on the Bus with me?” say, “Next, you and I will sing Wheels on the Bus and see if Jacob will vocalize in response to music.”


  • Provide labeled praise and specific feedback.  “Good job!” may sound nice, but it tells parents very little about what he did and how it’s helping.  “I like how you whispered to acoustically highlight the /t/ in “cat” ” tell a parent exactly what he did right, why it helped, and encourages him to do it again.  When parents need guidance, provide equally specific instructions as to what they might do.


  • Create a low barrier for entry.  Parents may come to the therapy table with limited English proficiency, literacy skills, or knowledge about parenting, child language, and play.  Instead of asking parents to read a book, ask them to “share” a book with their child, and model to them how talking about the pictures and asking questions can be just as valuable as the text itself.  Before asking parents to lead an activity, model it and give them chances for guided practice. A maxim for working with children is “teach, don’t test, ” and adults can benefit from that approach, too!


  • Help parents see their success — and their child’s.  Parents come to us at a vulnerable point in their lives, and they’re being asked to take on new roles — advocate, language facilitator, amateur audiologist — for which they are entirely unprepared.  Keep motivation high by giving parents simple tasks at which they can be successful, and see a real impact, in the first few therapy sessions.  Continue to reflect back on their growth as therapy progresses.  As children achieve success, help parents see their part in each achievement.  Success builds on success!

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