FREQUENTLY ASKED QUESTIONS ABOUT THE AUDITORY,
SPEECH AND LANGUAGE DEVELOPMENT OF HEARING IMPAIRED CHILDREN
IN AN AUDITORY-VERBAL PROGRAM

By:  Rachel Reyes, M.Ed, Cert. AVT

Q:  When should my child begin therapy? Isn’t he/she too young or too old to undergo Auditory-Verbal Therapy?

A:  In a study by Yoshinaga-Itano et al. (1998), it was found that children identified with hearing loss by 6 months of age but have normal cognition and who received appropriate intervention had significantly better expressive and receptive language levels than those identified after 6 months.  Thus, it is believed that 6 months may be a critical age of identification for optimal language development to occur.

A hearing impaired child who is identified between 0-3 years old and immediately receives early and appropriate intervention is able to develop his/her auditory, speech and language skills during the linguistically formative years along with his normally hearing peers.  This is also a perfect time for parents and therapists to capitalize on the plasticity of the central auditory system.  Children in this age range who do not have any additional disorders have been known to develop their communication skills faster than older children.  This does not mean, however, that children who begin A-V Therapy at later than 3 years will no longer benefit. They are still expected to develop but the rate of progress may not be rapid because they may not have been receiving appropriate stimulation during the sensitive time for language learning.

Q:  When will my child start to talk?

A:  A child will learn to talk after he/she has first learned how to hear, to listen and to understand language.  Hence, a logically related question would be:  “When will my child begin to understand?”  According to Rhoades (2001), the answers to these questions depend upon many conditions including:
  • Child’s ability  to hear conversational speech consistently with an effective hearing aid or chochlear implant
  • The presence of an intact neurological system
  • And parents who diligently provide an excellent speech and language model (It is important to remember that a child will only use a language he experiences in his home environment.  A child will speak the way his/her family does)

Under these conditions, a baby will eventually learn to understand language and then to talk.  This is specifically true for those who started A-V Therapy at a very young age and who have minimal language delay.

What is important in the beginning is to consistently and appropriately feed meaningful and appropriate language to the child to help him/her develop a strong auditory image of the language spoken in his environment.  The child may not talk right away, but the child’s brain is able to store up the auditory experiences until he/she is ready to use them.  Child development studies show that babies start talking after a year of listening.  Therefore, a hearing impaired child is expected to talk at approximately 1 year after starting Auditory-Verbal Therapy.  However, this is a case-to-case basis as some children talk earlier and some much later.

When a child receives intervention at a later age, the question of when he/she will start to understand language and eventually talk will greatly depend on the chronological age (CA) and hearing age (HA), which is the time at which the child began to hear consistently with hearing aids and cochlear implant.  The greater the gap between a child’s CA and HA, the longer it will take for him/her to talk.

Q:  Why did my child babble or make sounds when he was a baby and then suddenly stopped after?

A:  Children with hearing impairment demonstrate the same language skills from birth to about 9 months as their normal-hearing peers.  They communicate through crying, laugh to indicate pleasure, and babble to stimulate themselves.

At about 6 months, a child with normal hearing begins to develop an auditory feedback mechanism, meaning he/she enjoys hearing his/her own voice, laughing aloud again and again, vocalizing and cooing and babbling.  These vocal behaviors are usually reinforced by adults who echo his/her laughter and imitate the sounds he/she makes.  As such, a normal-hearing child will continue to engage in babbling and vocal play until he/she learns the spoken language of the people of communicate with him/her.

According to Pollack (1997), a minimum amount of residual hearing in the bass part of the tone scale is sufficient to enable a profoundly deafened child to develop an auditory feedback mechanism.  But children who fail to develop such a mechanism will eventually stop making sounds.  Moreover, parents, upon being informed that their child is deaf, suddenly lose the motivation to talk to their child.  They become silent around the child, thinking that it is useless to talk to someone who cannot hear.  Therefore, the child will eventually stop making sounds as a reaction to the “silent treatment” he/she is getting from the adults.

Q:  How do I know what words to teach my child?

A:  There are no limits in the vocabulary used and taught in an approach such as the Auditory-Verbal Therapy, but a plan is necessary in the teaching situation.  Pollack (1997) suggests to teach functional words first.  These are the words a child needs to communicate in his everyday experiences.  Experience has shown that the words that are understood and said first by a child include bye-bye, no more, open, one more, up, etc.  These words can also be called “power words” as they can make things happen for a child.  For instance, when a child says “one more,” he/she gets another cookie; or when he/she says “up,”  Daddy lifts him/her up in the air.

Once the child can recognize about 5 sounds associated with an object (ex: beep-beep for a car or quack-quack for a duck) and has started producing a few functional words, it is time to teach him/her the first nouns.  Select a word that is motivating and interesting to a child.  Most little boys are fascinated by cars thus, for many of them “car” is the first noun that is learned.  It is also wise to teach one word for each routine for the day so he understands and uses a word that is used everyday.  Gradually, another word is added for that routine, and then another.  It is best to teach a new word for about 1 week at first, until the child realizes that everything has a name.  After this, it is no longer necessary to repeat one word many times.

The choice of words to teach will also depend on things such as the environment of the child, his/her interests, age, current happenings, and so on.

It has been said that deaf children must be taught on the average 5 new words a day from the beginning of 1st grade at 6 ?  years of age, in order to prepare them for high school.

Q:  How long should my child undergo Auditory-Verbal Therapy?  When is he/she going to be age appropriate?

A:  A child whose hearing loss has been identified early (3 years and below) and started appropriate intervention immediately will have a smaller language gap than a child who is diagnosed at a later age.  A language gap is the difference between a child’s chronological age and his/her language-age equivalency as obtained from the results of language tests.  This gap can be closed through an appropriate and systematic Auditory-Verbal Therapy program.

A child with normal hearing learns the basics of language between the ages of 4 and 5 years old.  Thus, it can be assumed that a hearing impaired child who acquires a language age of 4 to 5 years can already understand and speak the language of the community to which he belongs.

According to Rhoades (2001), the decision as to whether the parents and child should continue with Auditory-Verbal Therapy beyond attaining the 4-5 year language level will depend on some of the following factors:

  • Whether the child has begun to learn language independent of the therapists and parents;
  • Whether the child is optimally using the hearing aids, cochlear implant, and other listening devices;
  • The child’s speech intelligibility
  • Whether the family demonstrates independence and advocacy

When parents become so skilled such that they can follow up therapy activities so effectively, then the frequency of therapy sessions can be gradually decreased.  Probably they will see the Auditory-Verbal Therapist once a month or every quarter for monitoring purposes or for annual assessments.

Experience shows that rate of progress is usually a case to case basis.  Some children demonstrate rapid language growth that they will require Auditory-Verbal Therapy for only 1 to 2 years, whereas other children may need many more years of therapy.  Generally, the older the child is at the start of Auditory-Verbal Therapy, the more likely therapy will be needed for a longer period.

Q:  How do you lessen the language delay of my child? It is really possible to achieve more than a year’s growth in a year’s time?

A:  A hearing impaired child will require an appropriate and systematic Auditory-Verbal Therapy (AVT) program to facilitate their language development in order to lessen any language delays.  One of the principles of the Auditory-Verbal Practice is to encourage a developmental sequence in the acquisition of spoken language.  This is based on the fact that like their normally-hearing peers, hearing impaired children develop language in a natural sequential order.

Part of the job of an Auditory-Verbal Therapist is to design language goals that will facilitate the sequential development of a child’s language.  These goals are achieved through meaningful, pleasurable and age-appropriate therapy activities.  Parents, on the other hand, are expected to follow up on the goals at home.  They are expected to model techniques for stimulating speech and language and to plan strategies to integrate listening, speech, language and communication into daily routines and experiences.

According to Rhoades, barring any unforeseen complications, the average preschool child with a hearing loss demonstrates approximately 12 months of language growth as a result of 12 months of Auditory-Verbal Therapy.  Depending on many factors, however, there will be some variation from this typical rate of progress.  Two important factors are the child’s actual age and the age at which the child first began to hear well with hearing aids or cochlear implant.  If the child is older at the onset of therapy, the rate of progress may not be that fast.  but with a child who began therapy at an early age of 3 years and below a rapid progress can be expected.  And as he/she grows older and becomes more cognitively mature, the rate of language acquisition increases.  Thus, many of this children achieve a language growth of more than a year in a year’s time.


References:
Yoshinaga-Itano, C. et al, (2000).
Expressive vocabulary development of
infants and toddlers who are deaf or hard of hearing.
The Volta Review 100
(5), 1- 28.

Pollack, D. et al, (1997).
Educational audiology for the limited-hearing infant and preschooler.
An auditory-verbal program (3rd ed).
Springfield, II: Charles C. Thomas

Rhoades, E. (2000) 50 FAQs about auditory-verbal therapy.
Ontario, Canada:
Learning to Listen Foundation



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