Auditory Verbal Therapy – Audio Description and Transcript
Parents and Whānau Hui – Growing and Learning Together with your Deaf
Child, brought to you by Ministry of Education, New Zealand Federation for
Deaf Children and Deaf Aotearoa New Zealand.
A presentation by Alexandra Crosbie, Habilitation Manager, The Hearing
House and Jill Mustard, Clinical Manager, Southern Cochlear Implant
Programme, on ‘Auditory Verbal Therapy’ held in a large seminar room at
Living Springs, Christchurch.
Interview with Alexandra and Jill discussing the purpose of the
presentation.
Alexandra: So our presentation today was ‘Why Auditory Verbal Therapy’
highlighting to the audience what auditory verbal therapy is about, how it works
and obviously strategies that they can take away and then utilise with their
children in the home.
Interview with Alexandra and Jill discussing the purpose of the
presentation.
Jill: Things like realising the effect of background noise on a child’s listening,
how they can improve the listening by coming closer to reduce those, using
acoustic highlighting to make listening easier for children and a range of
auditory verbal strategies were addressed.
Presentation by Alexandra and Jill.
Alexandra: So obviously what it is, it’s developing speech and language through
listening, so the big focus is on teaching your child to listen. Obviously it heavily
involves parental guidance but it also involves parental input. It’s about creating
a listening environment all the time, so not just some of the time. It’s 24 hours a
day, 7 days a week. We follow typical stages of listening, language and speech
and it requires things like early identification and diagnoses. It requires things
like obviously maximizing the auditory potential of the child whether that’s with
a cochlear implant or whether that’s with a hearing aid. Obviously we need
parents who are committed to following things up at home so you need to be
able to provide one to one time with your child and obviously audition is the
primary focus again so it’s that listening and it’s about the whole child, it’s not
just about parts of the child. It’s about cognition, it’s about the language, it’s
about the listening, it’s about the speech, it’s about the whole picture.
Jill: One of the techniques that we talk about in auditory verbal therapy is the
auditory feedback loop that we listen to. We all listen to what we are saying and
correct the words that we say or correct how we say it, how we’re saying what
we say through listening and that’s one of the things we use with children. We
help them monitor their own speech through listening and to make closer and
closer approximations to the adult model. Listening is the most reliable way of
getting speech information. Only thirty percent of what you say can be speech
read. Sounds like ‘ker’ and ‘ger’ are made at the back of your throat and can’t be
read at all. Other sounds look the same on your lips ‘llll’ ‘mmm’, ‘t’, they’re all
made at the same place so they look the same. Even ones like ‘p’, ‘b’, ‘m’, ‘pat’,
‘bat’, ‘mat’ you can hear the difference quite clearly. But if I just give you the lip
pattern, then you’re not really sure which of those three words I’ve actually said.
PowerPoint presentation on ‘AV Techniques…How are they different?’
 Acoustic Highlighting
 Auditory Sandwich
 Extend vocabulary
 Expanding on a child’s utterances
 Auditory feedback system
 Learning to listen, enabling listening for learning
Jill: And now we’ll look at some of the strategies that are specific to auditory
verbal therapy. So first of all for the children to understand that sound has
meaning, another thing that we’re really aware of in auditory verbal programme
is appropriate positioning so you sit on the side of the child’s best hearing. So if
the child’s got a unilateral loss you’ll be sitting on the side of the better ear. Also
being aware of the impact of background noise so if you want your voice to be
stronger than the background noise you come closer. Being aware of your
auditory environment too so like turning the television off if you’re not actually
listening to the TV so it’s not background noise when you’re trying to play and
talk with your child.
We encourage the use of ‘parentese’. So ‘parentese’ is the way that parents speak
to children to help them develop language. So, the way that parents speak to
hearing children even, with so much more pitch change and a slower rate. When
you say, “Uh oh, did you drop your banana? Oh dear.” And you’ve got more of this
slower rate and the up and downiness of language. We know that helps children
develop language so you encourage parents to use those kind of strategies with
deaf children who are just starting to learn language. So it’s a whole lot of
techniques and strategies that the therapist is aware of that they coach the
parents to use to make learning easier for their child.
Using a wait time. When your child is learning to speak you don’t just want to
totally flood them with language. You also need to give them an opportunity to
talk, an opportunity and an expectation for them to talk, so you can do that with
your pacing of language, you have a turn in conversation, all of that ‘parentese’
cue and wait expectantly for the child to tell you something back. Whether it’s
just one word or a sentence or something, so that they learn that conversation is
a two-way thing.
Most children when they’re around 18 months - 2 years of age, they imitate what
a parent says just as a natural course of events. So usually they imitate the last
word of something that you’ve said. So if you said, ‘okay, let’s get ready, we’re
going to the car.’ They’ll say, ‘car’ and then they’re doing that so they’re listening
to themselves and then they make a closer and closer approximation to the adult
model.
Here are another range of techniques that we use. Acoustic highlighting is one of
them, so we know that stress is one way of highlighting what you’re saying. ‘Go
and get your… pyjamas.’ So you’ll put the stress on the word that you really want
them to hear and remember. A little pause before the most important thing is
another acoustic highlighting strategy, because it makes that word stick out a
little bit more. Not just, ‘go and get you pyjamas. Go and get your…pyjamas.’ It
makes it, that’s the bit I have to listen to. Knowing that it’s easier to hear and
remember the last word of a sentence rather than the word that’s in the middle
of the sentence. So, putting the key words at the end.
An auditory sandwich is another one, so that if you say something like, ‘what do
you want on your sandwich? Do you want jam or marmite?’ And you think,
you’ve said and they haven’t quite heard it or understood it, so that’s the first
layer of the sandwich, using their listening. The next layer of the sandwich is if
they haven’t got it you add something to help them get the cue, so maybe you add
pointing or a gesture or showing them or taking them or adding lip reading. So,
‘do you want jam or marmite?’ Okay, they’ve understood, they’ve chosen. So the
next layer is putting it back into listening again, so, ‘do you want jam or
marmite?’ So now that they know what you’ve said they can have a listen to,
what does that sound like again? So it’s listening, another supportive technique
and then back into listening again.
Always being aware of extending the child’s vocabulary. Expanding on the child’s
utterance. So, if a child gives you a two word sentence, which they’re likely to do
when they’re around two years of age. If they say, ‘Daddy car,’ you can say, ‘that’s
right, Daddy’s gone in the car, he’s gone to work, he’ll be back home later. So
expending on the child’s concept.
The auditory feedback system, which is monitoring what they say, making an
ever increasing approximation to an adult model. And we want to teach them to
listen so that they can use listening for learning.
Question from a parent.
Parent: We found at creche, if there was too much background noise going off,
he’d pretty much tell the teachers to take the microphone away. Is it best they
have it on all the time or just or do you say, like for story time, that’s when you
wear it? Or is it better to have it going all the time?
Response from Alexandra.
Alexandra: I would say to a parent it’s typically when there is focused listening
occurring. So that could be small group work, it could be mat time, it could be
story time. But if he’s outside playing and the teacher’s still got the FM system
on, if she’s having a conversation with another child, he’s hearing that. Yeah. it’s
actually about when he needs it, so I would be saying group time, mat time, but
not when he’s doing free play.
Interview with Alexandra and Jill discussing the session.
Alexandra: The session today was enjoyable. There were questions that were
challenging, but also brought food for thought to families. Ultimately for me, it’s
about bringing information to parents, so that they can actually make a choice
for themselves and work with that.
Jill: Most children will have the ability to listen and speak and if you practice that
a little bit, using some strategies, that helps them listen when listening
conditions aren’t so good.
PowerPoint on Top Tips for ‘Auditory Verbal Therapy’.
Top Tips:
 With current technologies most children can hear and learn to listen
and speak.
 Consistent use of hearing aids/cochlear implants is important for
listening and spoken language development.
 Expect your child to listen. Coming closer helps your child focus.
 In the early stages of language development use a more ‘sing song’
voice and pause to encourage your child’s language.
 Children need to be immersed in the language(s) used at home to
develop their proficiency.
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for Deaf Children logo.