How long is a child (and family) expected to require auditory-verbal therapy?

Response written by Ellen A. Rhoades, Ed.S., Cert. AVT

Before beginning auditory-verbal therapy, a language baseline is established. To obtain this language baseline, your child will be evaluated with tests that were standardized on normally hearing children. This is so that your child’s language development can be compared to children who acquire speech and language in a normal fashion at a normal rate. The language skills of normally hearing children provide the ‘yardstick’ by which your auditory-verbal therapist will measure your child’s language progress. Therefore, an initial evaluation will at least determine your child’s language age-equivalency, both in understanding and in speaking language, before beginning therapy.

The newly identified baby with a hearing loss may not show any noticeable language delays at such an early point in time. However, this will likely not be the case with an older child, e.g., the two- to three-year-old preschooler recently identified as hearing impaired may demonstrate a language age-equivalency of as little as 0 to 8 months. The older your child at the time of the baseline evaluation, the more likely your child will show a language delay.

It is important that you understand what is meant by the "language gap." This gap is the difference between your child’s chronological age and his/her language age-equivalency as shown on the results of language tests. The typical preschool child who is first starting out with auditory-verbal therapy will have a language age that is much less than the chronological age. This gap between chronological age and language age is what must be closed as a result of therapy, i.e., your child’s language growth performance should progress until it is at least equivalent to the language level of normally hearing peers. One auditory-verbal goal of much importance is that of enabling your child to overcome the potentially devastating handicap of deafness, which is a language delay.

Thereafter, your child’s communication skills are evaluated at least once every twelve months. These annual tests serve many purposes, one of which is to determine your child’s rate of progress in developing speech and language. It is expected that, from one year to the next, test results will show approximately one year of language progress, i.e., 12 months growth in language for each 12 months of auditory-verbal therapy. If your child’s baseline test results show a "language gap," then a critical goal is to narrow the difference between your child’s chronological age and language age each year, so that the difference becomes less so with ongoing therapy. Moreover, it is hoped that the difference becomes obliterated, i.e., your child will talk like other children of his chronological age.

Research* shows that, 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. However, there may be some variation from this typical rate of progress, depending upon many factors. Two of the most important factors affecting your child’s progress include your child’s actual age and the age at which your child first began to hear well with either hearing aids or cochlear implant. If your child is older, then it is possible that the rate of language progress will not be as rapid since your child may not have been hearing until well past the most sensitive period for learning language. If your child does not have consistency in effective hearing with the use of a good hearing prosthesis, than language progress may be negatively affected.

Still other important factors, such as the neurological intactness of your child and appropriate follow-up therapy (for such potential neurological or sensory motor problems or other developmental delays), must be considered when measuring your child’s rate of progress in auditory-verbal therapy. Moreover, the critical factor of family involvement and active parent partnership plays a vital role in your child’s rate of language progress. Some parents devote the minimum one hour daily to "working" with their child, while others devote many hours each day to developing their child’s communication skills. Consequently, it cannot be safely assumed that every child will demonstrate 12 months of progress in communication skills for each 12 months of auditory-verbal therapy.

Research also shows that the average normally hearing four-year-old child has essentially acquired adult grammar, less the compound or complex types of sentences that are typically learned by seven years of age. Given this information, it can be assumed that when your child reaches the four- to four-and-a-half-year language age-equivalency, your child will understand and speak our language for all practical purposes. It can be assumed that the average two- to three-year old child, after four years of auditory-verbal intervention, will have developed the minimal language skills needed for first grade. So, at the very least, your child should receive therapy until this language level is demonstrated in annual evaluations. How quickly your child attains that level of communicative competency depends on some of the factors mentioned above.

Whether you and your child should continue with auditory-verbal therapy beyond attaining this four-year language level will depend on many additional factors. These include, but are not limited to, whether your child has yet begun to learn language independent of the therapist, whether your child is optimally using the implant or hearing aids and all other available accessories, the extent of your child’s speech intelligibility, and whether you and your family are demonstrating independence in thought and action. Perhaps you, your child, and your family are working well together and following up on therapy activities so effectively that all of you can be weaned from auditory-verbal therapy by decreasing the frequency of your sessions. Perhaps you and your child will just see the auditory-verbal therapist on a monthly or quarterly basis for monitoring purposes or for annual independent evaluations.

In summary, one child may demonstrate such rapid language growth that only one or two years of therapy are required whereas another child may require many years of auditory-verbal therapy. The older your child is when beginning therapy, the more likely that auditory-verbal intervention will be required for a longer period of time. Hence, there can be no straightforward answer to the above question. Much depends on you, your child and your family as well as any extenuating or unforeseen circumstances that might arise. Regardless, our common goal is that of enabling your child to become communicatively competent in as short a period of time as possible, so that your child can become assimilated into our hearing and speaking world.

*Rhoades, E.A. & Chisolm, T.H. (2001). Global Language Progress with an Auditory-Verbal Approach for Children Who Are Deaf or Hard of Hearing. The Volta Review, 102 (1).

Excerpt from 50 FAQs About AVT
(Ed. W. Estabrooks)
© 2001
Toronto, Canada: Learning To Listen Foundation