Facilitating spoken language development in the regular classroom

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Facilitating spoken language development in the
regular classroom

• September 28th 29th
• Winnipeg, MB
• Petra Smith M.Sc. Aud (C)
• Audiologist/Certified Auditory Verbal Therapist

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AV PRINCIPLES AND THE AV SESSION

• How the auditory verbal therapist works with the
  children, their families and other professionals

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Auditory Verbal Services in Manitoba

• Located at the Central Speech Hearing Clinic
• Audiology Services Family Centered Intervention
• AVT for families with children using hearing aids
  or cochlear implants
• Cochlear Implant Candidacy Evaluations Device
  Programming
• Aural rehabilitation for older students adults
  with cochlear implants
• Professional Development Mentoring
• Education

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Auditory Verbal Therapy (AVT)

• Who can deliver AVT?
• Auditory Verbal Therapists are practising
  professionals in Speech language Therapy,
  Audiology, or Education of the Deaf who have
  received specialised training

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Auditory Verbal Therapist experience training

• SPEECH LANGUAGE PATHOLOGIST
• EDUCATOR of children who are deaf or hard of
  hearing
• AUDIOLOGIST
• Certified by A G Bell
• Listening and Spoken Language Specialist
• www.agbellacademy.org

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Standardized Curriculum for Trainee Therapists

• History Philosophy
• Hearing Audiology
• Spoken Language Development
• Parent Guidance
• Cochlear Implants
• Education in the mainstream
• Auditory Verbal Practice

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Auditory Verbal Therapy (AVT)

• What is AVT?
• An individualised, auditory, developmental
  programme, implemented by the childs 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.

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Auditory Verbal Therapy..

• ..is part of the Auditory Verbal Approach

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THE AUDITORY VERBAL APPROACHThe auditory
verbal approach is a mindset of expectations
(Pam Talbot, AVT)

• Hearing and audiology
• Parental involvement
• Spoken Language Development
• Education

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Ten Principles of AVT

• Adapted from the principles developed by Doreen
  Pollack, 1970
• Adapted by the A G Bell Academy for Listening
  Spoken Language, 2006
• www.agbellacademy.org

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AV Principle 1

• Promote early diagnosis of hearing loss in
  newborns, infants, toddlers and children,
  followed by immediate audiologic management and
  auditory verbal therapy

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Hearing vs Listening(Flexer, 2005)

• Hearing is acoustic access to the brain. It
  includes improving the signal to noise ratio by
  managing the environment and utilizing hearing
  technology.
• Listening is attending to acoustic events with
  intentionality.

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Hearing loss

• Hearing loss is not about the ears it is about
  the brain.
• Hearing aids, FM systems and cochlear implants
  are not about the ears they are about the brain
• (Flexer, 2005)

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Functional impact of hearing lossdistance
hearing
Flexer 1999
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Functional impact of hearing loss incidental
learning
Flexer 1999
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Hearing loss auditory deprivation

• If caregivers want their child/ren to develop
  spoken language, early identification and optimal
  amplification
• a neurodevelopmental emergency
• (Flexer, 2005)
• ..due to the impact of auditory deprivation

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Neuroplasticity

• Greatest in the first three and a half years
• The younger the infant, the greater the
  neuroplasticity
• Rapid infant brain growth requires prompt
  intervention
• No sound reorganization of brain to receive
  other sensory information
• No sound reduces auditory neural capacity

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Typical Language Development Means..

• Optimal use of the brain for skills human beings
  are pre-disposed to acquire ie spoken language
• Best opportunity to achieve success in areas
  which must be taught ie reading

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Implications for Intervention

• Developmental approach
• instead of.
• Remedial approach

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GOAL

• Universal Newborn Hearing Screening

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Goal at identification

• Support families in making their decisions about
• Language of choice
• Communication approaches

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Communication Options
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Manual Oral

• Sign Spoken
• Language Language
• (ASL) (English/French etc)
• ?-------------------------------------------------
  --------------------?
• Bi-bi Auditory Verbal
• Signed Exact English Aural-oral
• Total Communication Cued Speech

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AV therapist offers

• Time to reflect, question, feel, grieve
• Information re
• Technology
• Hearing
• Spoken language development
• General developmental issues
• Action what to do!
• Contact with other families

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AV Principle 2

• Recommend immediate assessment and use of
  appropriate, state of the art hearing technology
  to obtain maximum benefits of auditory
  stimulation

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A good acoustic signal is needed for auditory
stimulation
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Amplification improves quantity and quality of
acoustic signal
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Good audiological support
Early identification of hearing loss Accurate
diagnosis Optimal amplification Early intervention
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Early amplification

• Research shows that children who are identified
  with a hearing loss by six months of age,
  provided with optimal amplification and family
  based intervention, have the potential of
  entering kindergarten on a par with hearing
  peers.
• Ref Yoshinaga Itano

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Amplification

• Hearing aids
• Cochlear implants
• All require optimal fitting to allow access to
  spoken language.

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Advanced Bionics 90k Implant
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Speech Processors from Advanced Bionics
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Wireless FM with iConnect earhook
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Freedom Speech Processors from Cochlear
Corporation
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MicroLink Freedom for the BTE

• Seamlessly integrated into the BTE case
• FM receiver can be left in place all the time

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AV Principle 3

• Guide coach parents to help their child use
  hearing as the primary sense modality in
  developing spoken language without the use of
  sign language or emphasis on lipreading

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A person who really listens

• Is motivated
• Has time and opportunity
• Is attentive

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Auditory Skills Development

• The auditory verbal approach seeks to maximize
  the use of audition in the development of spoken
  language.
• Levels of auditory skills
• detection -gt discrimination -gt COMPREHENSION

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AV Goals infants toddlers

• Supporting families in hearing aid fitting and
  evaluation by
• Facilitating use of amplification all waking
  hours
• Monitoring prelinguistic vocalizations
• Collaborating with audiologists - comparing
  hearing tests with functional measures of
  benefit

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Assess, monitor facilitate

• Auditory development
• awareness of sound
• attaching meaning to sound
• vocalizations
• Eye gaze joint attention
• Development of natural gesture
• Play

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AV Principle 4

• Guide and coach parents to become the primary
  facilitators of their childs listening and
  spoken language development through active
  consistent participation in individualized AV
  therapy.

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Parental Involvement

• Parents are the childs
• Primary language models
• First teacher
• Playmate
• Advocate

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Play as the engine of language development

• In the early stages it is the playful
  behaviours of the adult and the child that
  generate the language. By the time they are into
  fully fledged socio dramatic play, the language
  shapes reality.
• I m tending this is a snake. By the way it is
  a snake
• From Play by Catherine Garvey
• Fontana/Open Books 1977

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Why individualized therapy?
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Why do children need language?

• CONVERSATION
• Social interaction
• Problem solving and thinking
• Negotiation and sharing
• Story telling
• Joint imaginary play

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A CONVERSATION IS..

• A SERIES OF TURNS
• A SHARED ACTIVITY
• GOVERNED BY RULES WHICH ARE LEARNED IN INFANCY
• EASIER FOR ADULTS THAN FOR CHILDREN

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CONVERSATION

• Informal exchange of ideas by spoken words
• Concise Oxford Dictionary 1982
• soone of our aims is
• ..give the words to the child..

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How hard can it be?
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A bad conversation..

• Think of someone you would gladly
• cross the street to avoid, rather than
• have a conversation with them.
• Why would you rather avoid them?

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A good conversation

• Now think of someone you enjoy having a
  conversation with. What do they do that makes it
  so worthwhile?

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The rules of conversation

• Must initiate or respond when others initiate
• Take turn at appropriate time
• Give partner time to take a turn
• Attend to speaker
• Keep conversation going
• Stay on topic
• Send clear messages
• Clear up misunderstandings
• Start a new topic when needed

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A..B..C...s of conversation....
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A..ctive
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B..alanced
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C..ommon focus
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The underpinning to conversation is equally
shared participation

• Like a game of table tennis.

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But What if one of the participants isnt very
competent?
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Conversations

• What can go wrong?
• The rules of conversation are not observed due
  to
• DELAYED development
• DISORDERED development

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communication breakdown
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If left unattended..can result in the child

• Not seeing the potential in toys
• Not knowing how a sequence develops
• Not understanding the joint goal
• Finding sharing very hard
• Experiencing more frustrations than enjoyable
  challenges
• Other people dont seem like play partners

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• The usual solutions adopted by adults
• can feel very unsatisfactory, such as
• Doing all the talking
• Asking a lot of questions and then answering them
• Constantly offering new things to try and catch
  the childs attention
• Non-verbal games
• Trying to direct the childs behaviour
• Describing and explaining the child

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To avoid this families need

• Information sensitive to adult learning
  styles, literacy levels etc
• Demonstration observation and participation
• Experience practice and feedback

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Take home messages for families

• Parents as play partners, and language models
• Equal participation in conversation, even for the
  least skilled person
• Viewing the child from the first session as a
  person with ideas and thoughts to express

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Dr Edward Zigler (Founder of Head Start)

• Literacy begins with thousands of loving
  interactions with parents after an infant is
  bornit begins with sitting on a safe lap,
  hearing a familiar bedtime story

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AV Principle 5

• Guide and coach parents to create environments
  that support listening for the acquisition of
  spoken language throughout the childs daily
  activities.

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Listening, language and thinking

• Listening is not a mechanical decoding skill.
  It is a complex and problematic aspect of
  communication and thinking.listening is
  thinking as we listen we make all kinds of
  judgements and choices (Haynes 2002).

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So..

• The children need access to spoken language

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Enhancing listening

• Can modify
• environment
• acoustic signal
• interactions
• ..more later.

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AV principle 6

• Guide coach parents to help their child
  integrate listening and spoken language into all
  aspects of the childs life

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Everyday life more resources for families
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Strategies for parents to try

• Adopt role as play partner Having fun!
• Equal participation in conversation.
• Having fun listening.
• Encouraging turn taking.
• Engaging in joint attention.
• Commenting expanding
• Interpreting childs communicative attempts.

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AV Principle 7

• Guide and coach parents to use natural
  developmental patterns of audition, speech,
  language, cognition and communication

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AV Principle 8

• Guide coach parents to help their child
  self-monitor spoken language through listening
• ..auditory feedback loop

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AUDITION SPEECH ACOUSTICS

• Factors affecting speech intelligibility
• timing of onset of deafness
• nature extent of hearing loss
• type appropriateness of amplification
• speech perception
• communication option chosen for the individual
  child
• other challenges

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Early identification allows..

• Less delay
• More natural development
• More acceptable speech patterns
• Better literacy outcomes

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AV Principle 9

• Administer ongoing formal and informal
  diagnostic assessments to develop individualized
  AV treatment plans, to monitor progress and to
  evaluate the effectiveness of the plans for the
  families

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Spoken Language

• Follow developmental sequence in
• RECEPTIVE LANGUAGE
• EXPRESSIVE LANGUAGE
• PRAGMATICS
• PHONOLOGY
• COGNITION

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AV Therapist will

• Follow typical developmental milestones
• Use criterion referenced and standardized tests
  developed for typically hearing children
• apply the formula for calculating hearing age

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AV Principle 10

• Promote education in regular classrooms with
  typical hearing peers and with appropriate
  support services from early childhood onwards

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AVT in school AV goals the curriculum

• IEP Team involvement
• Collaboration with classroom teachers, resource
  teachers, SLPs etc
• Training for EAs
• Ongoing therapy sessions as needed
• Regular assessment monitoring

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Outcomes of the Auditory Verbal Approach
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Early intervention outcomes

• Emerging data are showing that over 90 of
  children born with a profound hearing loss who
  obtain a cochlear implant before 18 months,
  attain intelligible speech.
• This outcome is based on consistent use of the
  device and placement in regular classrooms.
• Extra auditory stimulation is also necessary.

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Geers et al (2003)

• N 181
• Children received implant before 5 years
• 4 year longitudinal study
• Looked at variables influencing outcomes
• (eg gender age at onset etiology age at
  implant residual hearing educational placement
  type of intervention commuication mode)
• Outcomes measured by assessments normed on
  hearing population (speech perception speech
  production spoken language total language
  reading)

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Geers et al Findings

• All children showed strong language and literacy
  skills
• gt50 achieved grade level reading skills by
  grades 2 or 3
• gt50 fully mainstreamed
• Girls performed better on language measures
• Educational placement - important predictor
• Earlier implantation (lt5) better outcomes

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Geers et al Findings

• The dominant educational factor associated with
  high performance levels was the extent to which a
  childs classroom communication mode emphasized
  speech and auditory skills development (Moog
  Geers 2003 p124s)
• REF Ear Hearing Vol. 24 1 Special
  Supplement Eds Geers, A E Iler Kirk, K

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AVT ..a therapy session..

• 60 to 90 minutes long every week
• Listening games
• Songs and books with actions and props
• Crafts, cooking and painting
• Pretend play
• LOTS of conversation

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Therapy session framework

• MOTIVATION
• GOALS
• CONTENT

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Organizing the session

• Planning highlights specific target areas
  skills in the therapists mind. 3 common
  strategies
• THEME based planning activities with a common
  topic (less structure)
• SKILL based planning (more structured)
• ACTIVITY based planning (daily routines)

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Who is the client?