Audiology - Chapter 16 Part 3
Principles of Auditory Verbal Therapy
Early Detection of Hearing Loss
First Principle: Detect hearing loss as early as possible.
Screening in the newborn nursery and throughout childhood.
Importance of follow-up visits after failing initial screening; referral to a pediatric audiologist.
Pursuit of prompt medical and audiologic management, including:
Selection, maintenance, and fitting of appropriate hearing aids.
Consideration of cochlear implants and FM systems.
Requirements for achieving early detection:
Ensure newborn hearing screening occurs.
Families must follow up on visits with appropriate professionals.
Connection to early intervention services is crucial.
Ongoing audiological management may require multiple visits to the pediatric audiologist.
Consistent use of hearing technology throughout waking hours is critical.
Guiding and Coaching Parents
Second Principle: Guide and coach parents to develop their child's spoken language using hearing as the primary modality without sign language.
Necessary elements to achieve this principle:
Regular auditory verbal sessions are essential, with the family prepared to learn and participate actively.
The whole family must support the use of listening in spoken language (auditory verbal approach).
Daily individual time with the child in a quiet environment helps reinforce learning across various domains, including social interactions and cognitive skills.
Parents need to maintain high expectations for their child’s listening and language development.
The role of parents as facilitators in their child's listening and spoken language development:
The therapeutic sessions focus on teaching the parents strategies to implement at home, rather than primarily working with the child directly.
Create supportive environments that facilitate listening through everyday activities.
Creating Supportive Environments
Parents should:
Control background noise in the home (e.g., minimizing TV and radio).
Dedicate time each day for talking and reading to the child.
Integrate speech and language goals into daily routines (e.g., during bath time, meal times).
Focus on auditory learning as opposed to merely auditory training.
Auditory learning aims to give the child a reason to listen through engaging activities.
Auditory training is non-language based and less effective in current practice.
Developmental Progress Monitoring
Establish a diagnostic assessment framework to:
Develop individualized auditory verbal treatment plans.
Regularly monitor child’s progress and evaluate the effectiveness of the therapy.
Importance of parental involvement in monitoring progress:
Might involve additional visits for formal diagnostics, sometimes impacted by insurance coverage.
Ongoing education is vital, promoting inclusion in regular schools with typical hearing peers, and ensuring necessary communication supports from early childhood onward.
Techniques and Strategies in Therapy
Important auditory verbal techniques and strategies include:
Acoustic highlighting: emphasizing important sounds or words in speech.
Establishing attention through visually engaging speech.
Expanding language by modeling phrases and responses.
Using questioning techniques: "What did you hear?" with appropriate wait time for responses.
Positional adjustments (e.g., moving closer) for better sound access.
Encouraging child-responsive listening through expectation cues.
Parental Involvement and Coaching
Role of Parents in Therapy:
Essential for the child’s progress as primary consumers of the therapy approach.
Parent Coaching Concept:
A mutual conversation framework, enhancing both parent and clinician skills.
Structured approach to develop family competencies and support child’s integration into home/community activities.
Empowerment through Coaching:
Supports families and educators in building confidence and competence.
Collaborative strategy encourages skill building by professionals and child’s known characteristics by parents.
Coaching Process Model (Rush & Sheldon)
Stages of Coaching:
Joint Planning: Collaborative planning of activities between parent and professional.
Observation: Professional observes the parent demonstrating skills.
Action: Practicing activities in real-life settings for refinement.
Reflection: Discuss what transpired during the actions; identifying comfort levels and understanding.
Feedback: Reciprocal feedback between parent and professional about actions and strategies.
Effective reflective questioning techniques:
Encourage open-ended questions that promote discussion and elaboration on strategies.
Strategies for Parent Engagement
Techniques for effective parent interaction include:
Show and Share: Parents demonstrate skills learned, initiating discussions about their experiences.
Best Drive Together: Professional first models then hands over to parent for practice in a structured manner.
Leading by Example: Involve the parent in modeling behaviors.
Guiding Experiments: Use open-ended statements to encourage prediction and engagement from the parent about outcomes.
News Commentator: Describe the parent’s actions to highlight effective practices during activities.
Secret Messages: Use nonverbal cues to encourage parent participation.
Fake Out: Deliberate errors to provoke communication challenges, teaching the necessity of correct auditory emphasis.
Technology and Results Overview
Historical context in technology going back twenty-five years shows notable outcomes from intervention practices of that time.
Highlights from past sessions show the effectiveness of auditory verbal therapy even with older cochlear implant technology.
Transitioning children like Kelly and Chase into mainstream education showcases the long-term success of such interventions.
Family-Centered Practices
Emphasizing parent involvement is crucial, with about 90% of families choosing listening and spoken language options when available.
Desired family outcomes should drive early intervention decisions and strategies.
Ensuring appropriate hearing technology is essential due to advancements in the field and to support successful outcomes.