The AV Approach: What is Auditory Verbal Therapy?
Click here to download a short summary of Auditory Verbal Therapy
"AVT has given my son a voice when there was silence. The method prises open doors that you didn't know were there, conventional speech and language therapy has not been as productive. AVT gives my son an enjoyable and positive approach to sound/language acquisition. Most of all AVT has given me hope rather than despair and can only be seen as a way forward in the great minefield of language acquisition." - Julie, mother of Arran, age 3
The short answer
Auditory Verbal Therapy is an individualised, auditory, developmental programme, implemented by the child's family in close collaboration with a therapist, with the goal of achieving age appropriate spoken language ability, and full social participation throughout childhood and beyond.
Auditory-Verbal practice is a parent centered approach to enabling children with hearing impairment to learn to talk through listening. It focuses on the use of SOUND (audition) as the primary channel for learning and gaining meaning from the environment. Parents are at the centre of this approach and take a full and active part in every session with the Auditory-Verbal therapist. In this way parents learn to provide the most productive and positive experiences to stimulate verbal communication.
This approach is distinctive in the way it maximises the child's use of hearing as the primary sense for developing spoken language. The Auditory-Verbal option is widely available in Australia, Canada and the USA and there is growing interest amongst families and professionals in the UK.
The vast majority of children born with hearing loss have some degree of hearing which can be improved by hearing aids and sometimes cochlear implants. These can maximise a child's access to sound so that listening, speaking and language skills can be developed to the fullest extent possible. Through the auditory-verbal approach the child develops a listening attitude so that actively attending to the sound around him becomes automatic. Hearing and listening become an integral part of communication, play, education and eventually work.
Three factors are critical to an effective outcome:
Early Diagnosis. It is vital that the hearing loss is identified early so that proper amplification can be fitted as quickly as possible.
Family Involvement. This is crucial at every stage to provide a supportive environment in which the child can develop the listening skills necessary to achieve natural speech and language.
A Partnership of Parent, Child and Professionals working together to reinforce the learning process.
Audiological Management [top of page]
Once the hearing loss has been confirmed the medical and audiological management are critical. The selection, modification and optimal maintenance of appropriate hearing aids are essential requirements of the Auditory-Verbal approach. Vigorous audiological management in conjunction with auditory-verbal practice leads to the development of spoken communication and/or provide some of the specific diagnostic information necessary in candidacy selection for cochlear implantation.
Who administers Auditory Verbal Therapy?[top of page]
Auditory Verbal Therapy should be administered by an LSLS Certified Auditory Verbal Therapist® or by another fully qualified professional in a related field who is training to become an LSLS Certified Auditory Verbal Therapist® under close supervision. The LSLS Certified Auditory Verbal Therapist® has cross-disciplinary skills drawn from three primary areas: audiology, speech and language therapy, and education of the deaf.
There are 12 LSLS Certified Auditory Verbal Therapists® working in the UK. Six are based at AVUK. You can Find a Cert AVT® here.
In order to became an LSLS CertAVT ® you need to be mentored by an LSLS CertAVT ® (www.agbellacademy.org/locate-therapist.htm), and meet the eligibility criteria set by the AGBell Academy (www.agbellacademy.org/certification_avt.htm). Auditory VerbalUK provides training and mentoring to professionals wishing to become LSLS CertAVTs through its training packages. For more information on training please see our Professional Training section or call AVUK on 01869 321492.
Learning to Listen the Auditory Verbal Way [top of page]
We have known for years that many children with hearing impairments have useful residual hearing. Now with the advent of new hearing aid and cochlear implant technology even more children can have access to spoken language. However, being able to make sense of the amplified sound goes much beyond merely detecting sound through hearing aids. Children with hearing impairment need help and encouragement to learn to listen. In the Auditory Verbal approach listening skills are organised on a hierarchy of auditory difficulty from detection to comprehension. Not all children require systematic introduction to auditory activities. However, children with severe and profound hearing impairment and those who are newly identified with mild and moderate losses do benefit from focussing on specific listening activities.
In the individual family sessions the Auditory Verbal therapist creates systematic and successful play where listening is the focus. This enables the therapist to know at which ages and stages the child is functioning in order to guide parents effectively through the overlapping developmental stages.
In the early stages parents learn how to help their child pay selective attention to sound rather than to visual information. Infants quickly learn to associate the loud clatter of a shaken plastic barrel with the idea that it contains something fun to play with. The child learns to respond to that sound by actively looking for the barrel. Such loud noises are quickly replaced by quieter noise makers until detection levels are reached.
Emphasis is placed on the child detecting and responding to voice. Parents are taught about how to highlight their voices so the child has the very best chance of detecting them. Once children discover that voice sounds come from the mouth they move on to ‘realise' that turn taking is a feature of communication. Thereafter we expect to see the child begin to associate a sound with its referent. In the early stages this is at the level of pattern recognition and gradually becomes refined to incorporate discrimination of speech sounds. ‘Learning to listen sounds' are quickly introduced and reinforced through singing, nursery stories/books and in everyday play and caregiving at home. Children with residual hearing across the speech frequencies have the potential first to detect, then to discriminate and eventually to identify the Ling sounds.
The development of auditory skills is fundamental to the development of receptive language. It is also crucial to the process of learning to talk. Normally hearing children begin this process in early infancy. Vocal play develops throughout the first year before the emergence of the first words. Hearing impaired children in the early stages of Auditory-Verbal therapy are encouraged to develop their vocal play through speech babble. Specific activities and techniques based on listening are employed to encourage infants to first play with the suprasegmantals of speech and then to practice their repertoire of speech sounds. During this early stage many opportunities are found to help children learn to use their voice intentionally. The next step is to associate and produce specific sound patterns in connection with objects e.g. brmmm when pushing a toy car and aaaah when waving an aeroplane in the air.
Auditory-Verbal practice encourages the maximum use of hearing in order to learn language through listening rather than watching. The way the child communicates in everyday environments will be both auditory and visual. The emphasis on listening during individual sessions enables the child to become a skilled listener. Then in the more difficult auditory conditions of everyday life s/he will be able to make optimal use of auditory cues in combination with all other visual cues available.
Most Auditory-Verbal programmes offer weekly sessions lasting for an hour or an hour and a half. Throughout parents acquire the confidence to try out techniques and strategies to reach specific goals in audition, speech, language, cognition and communication development. The success of Auditory-Verbal practice is in the way parents carry over these goals into their ordinary daily routines and play.
Quote from a mother of 3 ½ year old: "What is so great about AVT is that is fits into everything we do at home.”
Parent Participation [top of page]
Parents are right at the centre of each Auditory-Verbal session. Auditory-Verbal therapy gives parents confidence and the understanding of how they can help their child's communication development. The way parents do this varies from family to family but listening as an integral part of the child's life is the common goal. Some parents arrange special times when they focus exclusively on their hearing impaired child and work on specific objectives through play. Others get creative about using those spare moments between dropping off one child and picking up another.
Parents inform the Auditory-Verbal practioner of the child's interests and abilities and interpret the meaning of his/her early communication. Together we develop appropriate behaviour management techniques when delayed communication is causing frustration. We agree short and long term goals, discuss expectations and evaluate progress so that parents can make informed decisions and advocate on behalf of their child. Expectations are high for children in Auditory-Verbal programmes. Children need to acquire language at the same rate as their hearing peers so that the gap between their language age and chronological age does not widen.
Auditory-verbal professionals understand that no one approach can meet the needs of all children with hearing loss. It is cause for celebration when families do find an approach that meets their individual needs and wants.
Nicola is three and has had a cochlear implant for four months.
“Nicola was crying last night so I went in and put on her processor and she calmed down and so on and I only then realised that it was dark and we were doing it all by sound. She is great.”
Estabrookes, W.(1994) Auditory-Verbal therapy for parents and professionals. Washington, DC: A.G.Bell Association for the Deaf.
Estabrookes, W.(1998) Cochlear Implants for Kids. Washington, DC: A.G.Bell Association for the Deaf.
Flexer,C.(1999) Facilitating Hearing and Listening in Young Children. London: Singular Publishing Group.
Stokes, J.(1999) Ed. Hearing Impaired Infants; support in the first eighteen months. London : Whurr
We are committed to working with families of hearing-impaired children who wish their child to learn to listen and talk.
This is a family centered approach to supporting a child with a hearing loss. Our primary aim is to provide parents with the additional support they need to facilitate the child's development of spoken language.
The centre achieves its aim through an active partnership between its highly experienced Auditory-Verbal Therapists and parents. During the one-to-one sessions parents gain confidence in their ability to communicate successfully with the hearing-impaired child. Information is given in a clear and honest manner so parents are better equipped to make effective choices for their child.
Through the auditory verbal approach parents help their child to listen with their hearing aids or cochlear implants so that they can communicate and be fully integrated in their families, schools and community. This is the only programme of its kind in the UK.
The Centre is located in Oxfordshire, close to Bicester and the M40, with easy access to major routes to London and the North, and is well served by train and coach from London, Southampton and Birmingham.
How does AVT work? [top of page]
AVUK offers parents an opportunity to consult an experienced and independent hearing professional about their child with hearing impairment.
Following the diagnosis of a child's hearing loss parents can feel confused and powerless and often turn to professionals for a range of advice. At this difficult time the clarity and impartial advice offered by AVUK is especially valuable. It helps parents to understand the impact of hearing loss and explains the technical information which they have been given. Most importantly, it helps parents assess how the child's early speech and language development can best be encouraged.
The Auditory Verbal approach is both challenging and intensely rewarding. The families who attend the programme, the only one of its kind in the UK, believe it offers the best possible opportunity to meet successfully the challenges of life in the wider world.
The evidence base for this approach includes research on profoundly deaf graduates from Auditory Verbal programmes throughout North America. See professional training: references for some of this literature. American research* has found that the vast majority of subjects perceived themselves as fully integrated in the hearing community, went to their local schools, went on to higher education, did not need sign language, used the telephone to send and receive messages and pursued careers of their choice.
*Outcome Survey of Auditory-Verbal Graduates: Study of Clinical Efficacy. Goldberg, DM, Flexer, C. J Am Acad Audiol 4:189-200 (1993).
What can we achieve? [top of page]
Auditory Verbal Therapy is specifically designed to help parents with their hearing impaired babies and young children and, crucially, to ensure that these children achieve their maximum speech, language and auditory potential.
Support and guidance for families of newly diagnosed children.
Individual therapy tailored to each child and delivered by a CertAVT®.
Parental guidance on the best way to promote the child's use of residual hearing.
Liaison with other professionals involved in the child's health and education teams.
Intervention for both hearing aid and cochlear implant users.
Opportunities to meet other families of AVT children.
Programmes are individually designed to meet the needs of the child and the family. The setting of mutually agreed goals is an important feature but the key to success is our ability to be flexible to changing needs.
AVT sessions are available for all ages. The focus is on the development of speech and language through listening. Learning to listen requires a commitment to a lifestyle where maximum use is made of hearing. Children gradually acquire a hierarchy of listening skills as they progress through the auditory-verbal programme. We have high expectations for our hearing impaired children.
Who can benefit? [top of page]
AVT is most appropriate for infants and young children:
with a permanent hearing impairment
using conventional hearing aids and cochlear implants
from 3 months of age
It is crucial for us to work closely and co-operatively with the child's local health and education team. Parents value the support and guidance offered by AVUK as an additional, much needed service.
"Our daughter has finally started talking. We honestly believe she wouldn't be where she is today without the Auditory Verbal Programme." - David and Virginia Durham, parents of Petra, age 2. Read Petra's AV Story
"Our experience has been that AVT has been the most measured, constructive and, hence, the most rewarding method of teaching our child Cameron to speak." - Natalie and Ken Foan, Parents of Cameron, age 3
"The sessions with Jacqueline are full of fun, challenging, inspiring, and immensely rewarding. The emphasis on parental involvement has meant that I learn more about Vanessa and how best to help her than I do anywhere else." - Edith, Mother of Vanessa. Read Vanessa's AV story
Code of Practice
Please click here to download our Code of Practice (MSWord document)
What do we offer Professionals? [top of page]
Please visit the Professional Pages for details of the range of training oportunities and resources available.
- AVUK welcomes other professionals to come and find out more about AVT. Please contact firstname.lastname@example.org to arrange to visit us.
- AVUK works closely with AVSIG (Auditory Verbal Special Interest Group), registered with the Royal College of Speech and Language Therapists.