Response by Ellen A. Rhoades, Ed.S., Cert. AVT
Since a beginning language age-equivalency was established when your
child first started auditory-verbal therapy, you can expect about 12
months progress in your child’s language growth for each 12 months of
therapy. If this is not achieved, then we must examine all possible
factors that may be negatively affecting your child’s communication
growth.
One of the most important factors is that of your child’s hearing
prosthesis. It is critical that your child be given the potential to
hear and listen with an effective, well-fit, and consistently worn
hearing device, regardless of whether it is a cochlear implant or
hearing aids. The ear molds must be securely fit and remade as often as
necessary. Ear infections must be medically managed so that they don’t
negatively affect your child’s use of hearing aids. The processor must
be programmed appropriately and frequently. Hearing equipment must be
well maintained and worn during all of your child’s waking hours. In
short, your child must have access to conversational speech at about
30-35 dB HL, i.e., you must enable your child to realize his/her
potential of hearing people talk with relative ease. It is this hearing
potential made available to your child that allows for good
auditory-verbal progress.
Another equally important factor is the neurological condition of
your child. Research
shows that many children with a hearing loss seem to have a sensorimotor
dysfunction of some kind, so it is important that a thorough evaluation
be given your child by a pediatric occupational therapist (OT). If any
sensory processing issues are noted, then it will be important to
provide appropriate follow-up therapy for your child, along with
auditory-verbal therapy. Because your child learns to understand our
world with whatever senses are available to him/her, good progress in
auditory-verbal communication skills is more likely when all the
needs of your child are met.
Still another very important factor is whether or not you have been
able to reinforce the listening, language, and speech activities
suggested by your therapist. Remember that the more time you devote to
the development of your child’s communication skills, the more likely it
is that your child will make progress. Your child should be bathed in
sound and in hearing our spoken language if adequate progress is to be
made. As your child is dressing, eating, bathing, and playing, you
should be talking about each experience. Your spoken words enable
auditory-verbal progress so that your child can become communicatively
competent.
Related to the issue of time that you spend with your child, is the
parenting issue as still another factor influencing your child’s
progress. This involves child behavioral management. It is important
that your child understands the rules of living at home and that your
child learns to comply with those rules. External discipline, but
without physical punishment, as well as having a daily routine are
important and directly relate to the internal discipline needed by your
child in order to become an effective listener.
Of course, there may also be some unforeseen conditions that could
very well affect your child’s progress in therapy, but these are
typically the most important issues. You or your child’s auditory-verbal
therapist should recognize when any of these potentially negative issues
are present, and steps should be taken to immediately remedy the
situation. For instance, if your know that your child is consistently
throwing temper tantrums, but you are at a loss as to how to remedy the
situation, then seek help, first by discussing possible solutions with
your auditory-verbal therapist.
It is very important that you and your auditory-verbal therapist
develop and maintain an openly caring, trustworthy, nonjudgmental, and
mutually respectful relationship. This is critical if your child is to
develop good communication skills as rapidly as possible. Because you
are in an active partnership with your auditory-verbal therapist,
communication between you and your therapist should be open at all
times. Therefore, being able to freely discuss all of your child’s needs
is of paramount importance.
Given that auditory-verbal therapy is of a diagnostic nature, all
potentially negative issues will likely be noted and addressed rather
quickly. Your auditory-verbal therapist will share concerns with you
when your child is not demonstrating progress as well as expected. Just
as you and your therapist should ask each other many questions in your
mutual quest to quicken your child’s progress, you and your therapist
must work together in problem-solving opportunities.
Your child will also be evaluated on at least a semi-annual basis by
the therapist. Such evaluations will note whether your child’s progress
is as reasonably expected. If progress is insufficient, then conditions
must change. There must be a re-examination of at least all the
above factors to determine what, if any, external conditions or
objectives need to be modified. Perhaps your child’s hearing aids are
not enough and cochlear implant surgery is imminent when your child
comes of age. Perhaps your child needs to be referred for a
developmental evaluation. Perhaps you and your child would benefit from
having a behavioral psychologist interact and counsel with you at home.
Perhaps your child’s sensory motor issues warrant some therapy from an
OT or other professional that you cannot yet access. Perhaps there were
some conditions in your home that need to be modified so that you and
other family members can better participate in developing your child’s
auditory-verbal skills, with everybody speaking the same language. There
are many possible factors that must be examined, monitored, and
re-evaluated.
While the auditory-verbal approach is an option that most children
with hearing loss can benefit from, it is recognized that another
approach may sometimes be better for individual children. For example,
the auditory-verbal option may not be the program of choice for some
children with severe auditory neuropathy, or for some that are unable to
process the spoken language. Therefore, if the child is using an
effective hearing prosthesis, it can be reasonably assumed that a child
should not remain in an auditory-verbal program for longer than 12-18
months without demonstrating at least some language progress. The most
important needs to be met are those of your child, and that is what
makes auditory-verbal therapy so unique.
