Lisa Katz, M.H.Sc., S-LP (C), Reg. CASLPO, LSLS Cert AVT®
Maria Emilia De Melo, M.Fga., S-LP, Aud (C), Reg. CASLPO, LSLS Cert AVT®
Toronto Public Health/ Toronto Preschool Speech & Language Services/ Infant Hearing Program, Toronto, Canada
Simultaneous bilateral cochlear implants are now routinely provided to young children with severe to profound hearing loss in Toronto, Canada. Bilateral stimulation enables these children to establish binaural processing and hear with greater ease (Papsin and Gordon, 2008). When this technology is coupled with early identification and auditory-verbal intervention, children have optimal chances of benefiting from the sensitive periods of neurological and linguistic development. As a result, they can achieve their maximum potential in the development of spoken language.
Auditory-Verbal Therapy (AVT) is an individualized therapy program that facilitates optimal acquisition of spoken language through listening by infants and young children who are deaf or hard of hearing. AVT promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and hearing technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. AVT must be conducted in adherence with all ten principles of the approach
(definition adopted by the AG Bell Academy for Listening and Spoken Language®, July 26,
2007 http://www.agbellacademy.org/AuditoryVerbalTherapy.htm).
The Toronto Infant Hearing Program (IHP) provides the opportunity for all newborn babies to have their hearing screened. If the infant is diagnosed with a permanent hearing loss, various services are provided to the family, for example, audiologic management and family support.
The family support worker (FSW) makes referrals to services for growth and development and communication supports and services. Depending on the family’s needs and expectations for their child, the FSW refers the family to either a visually based or an auditory based approach.
The following case study serves as an illustration of what nowadays is considered to be a fairly common profile of a child enrolled in the
Toronto IHP. That is, the child presents with a congenital severe to profound hearing loss, the hearing loss is identified through newborn hearing screening and the diagnosis is confirmed shortly after birth. In addition, the child’s first pair of hearing aids is obtained shortly after diagnosis, therapy begins early and the child receives simultaneous bilateral cochlear implants by twelve months of age.
The child described below was enrolled in auditory-verbal therapy and received services from a speech-language pathologist who is also Listening and Spoken Language Specialist (LSLS) certified auditory-verbal therapist and has extensive experience working with infants and children who are deaf or hard of hearing. As a result of her progress, she has recently been discharged from receiving weekly therapy services and is currently being monitored.
• Performs auditory-cognitive tasks
• Understands and uses early spatial, quantity, and quality concepts (e.g., up, one, big)
• Takes turns appropriately
• Has an age appropriate attention span
• Exhibits good eye contact
• Understands primary speaker in the presence of background noise or a competing message
• Identifies hummed songs
• Overhears conversation
• Localizes and identifies sounds at all angles and from a distance
• Uses appropriate suprasegmental features of speech (e.g., exclamation, question, and negation)
• Sings known songs and recites nursery rhymes
• Produces age appropriate speech sounds. Produces word endings spontaneously (e. g., tru ck , cry ing , and we t )
• Spontaneously produces fiveword approximations with different semantic relations
(e.g., “Do you want some milk?”)
• Answers and asks age appropriate “Wh-” questions
(e.g., What, Where, and Who).
• Follows two-step related commands
• Complies for the duration of the therapy session (1 hour)
1. Promote early diagnosis of hearing loss in newborns, infants, toddlers and children, followed by immediate audiologic management and Auditory-Verbal Therapy.
2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.
3. Guide and coach parents 1 to help their child use hearing as the primary sensory modality in developing spoken language without the use of sign language or emphasis on lip reading.
4. Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active, consistent participation in individualized
Auditory-Verbal Therapy.
5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.
6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life.
7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition and communication.
8. Guide and coach parents to help their child self monitor spoken language through listening.
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.
10. Promote education in regular classrooms with typical hearing peers and with appropriate support services from early childhood onwards.
(Adapted from the principles originally developed by Doreen Pollack, 1970)
1 The term “parents” also includes grandparents, relatives, guardians, and any caregivers that interact with the child.
*Adapted from the principles of Auditory-verbal Practice. © 2006 A.G. Bell Academy for Listening and Spoken Language®.
A child’s auditory-verbal progress depends upon a number of variables, such as:
• Timing of hearing impairment
• Age at diagnosis
• Cause, type, and degree of hearing impairment
• Use of hearing aids prior to cochlear implantation
• Chronological age at cochlear implantation
• Effectiveness of the hearing technology
•
•
•
•
•
•
•
Effectiveness of audiological management
Auditory potential of the child
Skills and knowledge of the therapist
Skills of the parents or caregivers
Child’s learning style and intelligence
Emotional state of the family
Level of participation of the family
Chronological age
Gestational age
Age at diagnosis
2 years
40 weeks
2 months
Etiology
Degree/Type
Unknown
Bilateral profound sensorineural
Age received hearing aids 2 months
Age started Auditory-Verbal Therapy 4 months
Age at implantation 10 months
Hearing technology
Bilateral Nucleus Freedom cochlear implants simultaneously implanted
c c c c c c c
Jerry Northern and Marion Downs, From Hearing in Children, (5th Edition, pg. 18),
Lippincott Williams and Wilkins, Baltimore, MD, 2002.
PLS- 4 Test Scores
Standard
Scores
150
145
140
135
130
125
120
115
110
105
100
95
60
55
50
90
85
80
75
70
65
-
-
-
-
-
-
-
-
-
-
AC Score EC Score
- -
-
-
-
-
-
-
-
-
-
-
X
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
TOTAL
Score
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
X – January 6, 2009
X – June 10, 2008
X – October 2, 2007
• “AVT has not only provided me with ongoing guidance regarding the management of my child’s hearing loss, but also with support in all areas of my child’s development.”
• “My therapist has empowered me to advocate for my child and to feel positive about her future.”
• “AVT makes sense as it follows the typical sequence of child development and is carried out in daily situations.”
• “AVT has taught me all that I know, from the basics about hearing technology and selecting appropriate toys to achieving my child’s communication potential.”
• “AVT has provided me with support and guidance regarding my concerns.”
• “The biggest challenge is to educate people about deafness and to enable them to understand the fact that our kids have the potential to learn to listen and talk.”
• “Finding a childcare that does not underestimate my child’s potential.”
• “Keeping the cochlear implants on was my biggest challenge. As a baby, she would take them off and put them in her mouth. Now we are over that and the problem is different…..We both get frustrated when we have to take them off to swim, bath or play on the slide.”
• “I worry about acceptance when he is older. Others accepting him and he being comfortable with his difference.”
With the advent of newborn hearing screening and state-of-the-art hearing technology, children who are deaf or hard of hearing and their families can benefit from auditory-verbal therapy more than ever. Early diagnosis and intervention enable children to access speech and environmental sounds, helping to stimulate central auditory pathways which are highly plastic in the first years of life. As illustrated in the case study, auditory-verbal therapy combined with early simultaneous bilateral cochlear implantation has facilitated the closure of the gap between the child’s hearing age and chronological age.
201-225 Duncan Mill Road
Toronto, Ontario, Canada
M3B 3K9
(416) 338-8255
(416) 338-8511
(416) 338-0025 www.tpsls.on.ca
tpsls@toronto.ca
Infant Hearing Program
Speech & Language Program
Blind–Low Vision
Early Intervention Program
The authors wish to recognize the support of the Ministry of Children and Youth Services of Ontario and the support of the team members of the Toronto
Public Health: screeners, support assistants, data entry professionals, program evaluator, and managers. Thank you for your contribution and support.
We dedicate this presentation to the families and their children and to the early childhood professionals in Toronto and the Greater Toronto Area.
Funded by Toronto Public Health, City of Toronto
Project: Presentation Poster
Client Contact: Lisa Katz (647.212.8710)
Communication Coord:
Designer: Hassan Akbar
Pauline Jackson
Version: 1/5 2/5 3/5 4/5 5/5
Revision meeting date: