Facilitating spoken language development in the regular classroom September 28 th & 29 th Winnipeg,...

Facilitating spoken language development in

the regular classroom

September 28th & 29th

Winnipeg, MB

Petra Smith M.Sc. Aud (C)

Audiologist/Certified Auditory Verbal Therapist

AV PRINCIPLES AND THE AV SESSION

How the auditory verbal therapist works with the children, their

families and other professionals

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

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


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


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


Standardized Curriculum for Trainee Therapists:

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


Auditory Verbal Therapy (AVT)

What is AVT?

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 Therapy..

…..is part of the Auditory Verbal Approach


THE AUDITORY VERBAL APPROACH

“The auditory verbal approach is a mindset of expectations” (Pam Talbot, AVT)

Hearing and audiology Parental involvement Spoken Language Development Education


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


AV Principle #1

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


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.


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)


Functional impact of hearing loss:distance hearing

Flexer 1999


Functional impact of hearing loss: incidental learning

Flexer 1999


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


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


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


Implications for Intervention

Developmental approach

…instead of….

Remedial approach


GOAL:

Universal Newborn Hearing Screening


Goal – at identification

Support families in making their decisions about:

Language of choice

Communication approaches


Communication Options:


Manual Oral

Sign SpokenLanguage Language(ASL) (English/French etc)

---------------------------------------------------------------------

Bi-bi Auditory Verbal

Signed Exact English Aural-oral

Total Communication Cued Speech


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


AV Principle # 2

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


A good acoustic signal is needed for auditory stimulation


Amplification – improves quantity and quality of acoustic signal


Good audiological support

Early identification of hearing loss

Accurate diagnosis

Optimal amplification

Early intervention


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


Amplification

Hearing aids

Cochlear implants

All require optimal fitting to allow access to spoken language.


Advanced Bionics 90k Implant


Speech Processors from Advanced Bionics


Wireless FM with iConnect earhook


Freedom Speech Processors from

Cochlear Corporation


MicroLink Freedom for the BTE

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


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”


Is motivated

Has time and opportunity

Is attentive

A person who really listens


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 -> discrimination -> COMPREHENSION


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


Assess, monitor & facilitate:

Auditory development: awareness of sound attaching meaning to sound vocalizations

Eye gaze & joint attention Development of natural gesture Play


AV Principle # 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 AV therapy.”


Parental Involvement

Parents are the child’s:

Primary language modelsFirst teacherPlaymateAdvocate


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


Why individualized therapy?


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

Why do children need language?


A CONVERSATION IS..

…A SERIES OF TURNS

…A SHARED ACTIVITY

…GOVERNED BY RULES WHICH ARE LEARNED IN INFANCY

…EASIER FOR ADULTS THAN FOR CHILDREN


CONVERSATION

“Informal exchange of ideas by spoken words”

Concise Oxford Dictionary 1982

so…one of our aims is:

..give the words to the child..


How hard can it be?


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?


A good conversation…

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


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


The underpinning to conversation is…

…equally shared participation

Like a game of table tennis….


But…

What if one of the participants isn’t very competent?


Conversations

What can go wrong?

The rules of conversation are not observed due to:

DELAYED development

DISORDERED development


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 don’t seem like play partners

If left unattended..can result in the child…


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 child’s attention Non-verbal games Trying to direct the child’s behaviour Describing and explaining the child


To avoid this families need:

• Information – sensitive to adult learning styles, literacy levels etc

• Demonstration – observation and participation

• Experience – practice and feedback


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


Dr Edward Zigler (Founder of Head Start)

“ Literacy begins with thousands of loving interactions with parents after an infant is born…it begins with sitting on a safe lap, hearing a familiar bedtime story”


AV Principle # 5

“ Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.”


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).


So…..

The children need access to spoken language


Enhancing listening

Can modify:

environment acoustic signal interactions

…..more later….


AV principle # 6

“ Guide & coach parents to help their child integrate listening and spoken language into all aspects of the child’s life”


Everyday life – more resources for families ………


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 child’s communicative attempts.


AV Principle # 7

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


AV Principle # 8

“ Guide & coach parents to help their child self-monitor spoken language through listening”

..auditory feedback loop


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


Early identification allows..

Less delay

More natural development

More acceptable speech patterns

Better literacy outcomes


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”


Spoken Language

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


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’


AV Principle # 10

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


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


Outcomes of the Auditory Verbal Approach


Outcomes

• Historical data suggests that only about 20% of children born with a profound hearing loss who used hearing aids (and not a cochlear implant), attained intelligible speech.

• Current data show that about 80% of children born with a profound hearing loss who have a cochlear implant between 2 & 4 years of age, attain intelligible speech (with appropriate intervention).


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.


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)


Geers et al – Findings:

All children showed strong language and literacy skills

>50% achieved grade level reading skills by grades 2 or 3

>50% fully mainstreamed Girls performed better on language measures Educational placement - important predictor Earlier implantation (<5) – better outcomes


Geers et al – Findings:

“ The dominant educational factor associated with high performance levels was the extent to which a child’s 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


AVT ..a therapy session..

60 to 90 minutes long – every weekListening gamesSongs and books – with actions and

propsCrafts, cooking and paintingPretend playLOTS of conversation……


MOTIVATION

GOALS

CONTENT

Therapy session framework


Organizing the session

Planning highlights specific target areas & skills in the therapist’s mind. 3 common strategies:

THEME based planning – activities with a common topic (less structure)

SKILL based planning (more structured)

ACTIVITY based planning (daily routines)

Facilitating spoken language development in the regular classroom September 28 th & 29 th Winnipeg,...

Documents

Transcript of Facilitating spoken language development in the regular classroom September 28 th & 29 th Winnipeg,...