Auditory Verbal Therapy
Auditory Verbal Therapy (AVT) is a highly specialist early intervention programme which equips parents and carers with the skills to maximise their deaf child’s listening and spoken language development with the aim of giving them the same opportunities and an equal start in life as hearing children. It is a targeted-indicated programme for children with hearing loss between the ages of 0-5 years. It is delivered at Auditory Verbal UK (AVUK) centres, and aims to improve children’s listening and language skills, and academic outcomes.
AV therapy focuses on the development of spoken language through listening. Through play-based therapy sessions, parents/carers are coached and empowered with the tools to develop their child’s listening, talking, thinking and social skills. Children are enrolled on the programme at less than five years of age to maximise the critical period in which 85% of the neural pathways for listening and spoken language are formed.
The programme enables parents/carers to help their child to make the best possible use of their hearing technology (usually hearing aids or auditory implants). It is delivered by Listening and Spoken Language Specialist certified Auditory Verbal practitioners who have undergone additional specialist training after qualification as speech and language therapists, teachers of the deaf or audiologists.
EIF Programme Assessment
Child outcomes
This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Enhancing school achievement & employment
Improved expressive and receptive language ability
based on study 1
Improved maths grades
based on study 2
Improved Hebrew grades
based on study 2
Improved literature grades
based on study 2
Improved English grades
based on study 2
Improved likelihood of high school graduation
based on study 2
Achieving similar rates of progress to typically hearing children in terms of auditory comprehension
based on study 3
Achieving similar rates of progress to typically hearing children in terms of oral expression
based on study 3
Achieving similar rates of progress to typically hearing children in terms of total language skills
based on study 3
Achieving similar rates of progress to typically hearing children in terms of speech skills
based on study 3
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Who is it for?
The best available evidence for this programme relates to the following age-groups:
Infants Toddlers Preschool
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
- Individual
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
- Home
- Primary school
- Out-patient health setting
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted indicated
Where has it been implemented?
- Australia
- Denmark
- Israel
- New Zealand
- United Kingdom
- United States
Ireland provision
Ireland evaluation
About the programme
What happens during the delivery?
How is it delivered?
- AVT at AVUK is delivered in between 40 to 60 fortnightly hour-long sessions, over a period of 2–3 years, by one practitioner to parents/caregivers.
What happens during the intervention?
- Parents are coached by a certified Auditory Verbal practitioner in play-based sessions with their child in how to develop their child’s listening so that listening becomes part of their personality.
- Play activities are set at a cognitively appropriate level and may include activities such as instructional activities (e.g. making cupcakes) to develop auditory comprehension and auditory memory skills, role play activities and storytelling (e.g. with dolls or toy people) to develop expressive language, social skills and theory of mind.
- Parents are coached in how to frame these activities to allow their child to develop and improve their listening, thinking and spoken language skills.
What are the implementation requirements?
Who can deliver it?
- The practitioner who delivers this programme is a Listening and Spoken Language Specialist (LSLS) certified Auditory Verbal practitioner, with NFQ-7/8 level qualifications.
- In addition, a family support officer provides two parent consultation sessions per year, and additional support if required/requested, for each family on the programme.
What are the training requirements?
- The Listening and Spoken Language Specialists have 124 hours of programme training. Booster training of practitioners is recommended.
How are the practitioners supervised?
- It is recommended that practitioners are supervised by one host-agency supervisor (qualified to NFQ-7/8 level), who have received 124 hours of programme training.
What are the systems for maintaining fidelity?
Programme fidelity is maintained through the following processes:
- Training manual
- Other online material
- Face-to-face training.
Is there a licensing requirement?
There is no licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- Optimally functioning hearing technology and Auditory Verbal techniques protect deaf children from deprivation of auditory brain stimulation, underdeveloped listening behaviours and delays in spoken language.
- The programme coaches parents in Auditory Verbal techniques, such as checking and troubleshooting hearing technology, promoting listening behaviours with comprehension and expression of spoken language, together with developing social skills and theory of mind.
- In the short term, deaf children are better able to develop listening and spoken language skills, therefore reducing any existing language delays and develop age-appropriate language.
- In the long term, children will be better able to access a mainstream school curriculum, fulfil their educational potential, make and keep friends at school and access equal opportunities in further education and employment.
Intended outcomes
- Active and healthy, physical and mental wellbeing
- Achieving in all areas of learning and development
Contact details
Rachel French
Auditory Verbal UK
info@avuk.org
About the evidence
Auditory Verbal’s most rigorous evidence comes from two QEDs and a one-group pre-post study which were conducted in the UK, Israel and Australia.
These studies identified statistically significant positive impact on a number of child outcomes.
While the reviewed studies are limited by methodological issues pertaining to the lack of a comparison group which has been sufficiently demonstrated to be equivalent to the treatment group, the programme received a level 2+ on the basis of the weight and context of evidence – in particular, the fact that a large number of studies have assessed the impact of Auditory Verbal and have consistently found large effects across different contexts/countries.
Study 1
| Citation: | Hogan et al., 2008 |
| Design: | Pre-post study |
| Country: | United Kingdom |
| Sample: | 37 children with permanent hearing impairment, who had attended AVT sessions at Auditory Verbal UK (AVUK). |
| Timing: | Post-test |
| Child outcomes: |
|
| Other outcomes: | |
| Study rating: | 2 |
Hogan, S., Stokes, J., White, C., Tyszkiewicz, E., & Woolgar, A. (2008). An evaluation of auditory verbal therapy using the rate of early language development as an outcome measure. Deafness & education international, 10(3), 143-167.
Available at
https://www.tandfonline.com/doi/abs/10.1179/146431508790559760
Study design and sample
The first study is a pre-post study.
Outcomes were assessed before the intervention was delivered, and at 6-month intervals over the course of treatment, including after completion of the intervention.
This study was conducted in the United Kingdom, with a sample of thirty seven children with permanent hearing-impairment, who had attended AVT sessions at Auditory Verbal UK (AVUK)
Measures
Expressive and receptive language ability was measured using the Pre-school Language Scale - 3 (direct assessment).
Findings
This study identified statistically significant positive impact on a number of child outcomes.
This includes children’s expressive and receptive language ability.
The conclusions that can be drawn from this study are limited by methodological issues pertaining to a lack of a comparison group, hence why a higher rating is not achieved.
Study 2
| Citation: | Goldblat & Pinto, 2017 |
| Design: | QED |
| Country: | Israel |
| Sample: | 52 young people with hearing loss, between 18 and 29 years old. |
| Timing: | Post-test |
| Child outcomes: |
|
| Other outcomes: | |
| Study rating: | 2 |
Goldblat, E., & Pinto, O. Y. (2017). Academic outcomes of adolescents and young adults with hearing loss who received auditory-verbal therapy. Deafness & Education International, 19(3-4), 126-133.
Available at
https://www.tandfonline.com/doi/abs/10.1080/14643154.2017.1393604
Study design and sample
The second study is a QED.
This study is a cross-sectional retrospective quasi-experimental study, comparing a group of children who received AVT for at least 3 years in early childhood, to a group of children with hearing loss who had not received AVT and were at least 18 years old.
Data on children was obtained from national records. Children in each group were matched in terms of year of birth, gender, residence, and income of parents.
This study was conducted in Israel with a sample of 52 young people with hearing loss, between 18 and 29 years old.
Measures
Math grades were measured using parent-reports of child grades.
Hebrew grades were measured using parent-reports of child grades.
Literature grades were measured using parent-reports of child grades.
English grades were measured using parent-reports of child grades.
Matriculation was measured using parent-reports.
Findings
This study identified statistically significant positive impact on a number of child outcomes.
This includes improved maths grades, Hebrew grades, literature grades, English grades and matriculation.
The conclusions that can be drawn from this study are limited by methodological issues pertaining to the lack of a comparison group which has been sufficiently demonstrated to be equivalent to the treatment group, hence why a higher rating is not achieved.
Study 3
| Citation: | Dornan et al., 2009 |
| Design: | QED |
| Country: | Australia |
| Sample: | 29 children with a range of hearing losses, amplified with hearing aids or cochlear implants. |
| Timing: | Post-test |
| Child outcomes: |
|
| Other outcomes: | |
| Study rating: | 2 |
Dornan, D., Hickson, L., Murdoch, B., & Houston, T. (2009). Longitudinal study of speech perception, speech, and language for children with hearing loss in an auditory-verbal therapy program. Volta, 109(2-3), 61-85.
Study design and sample
The third study is a QED.
This study is a repeated-measures, prospective quasi-experimental study, comparing a group of children who received AVT to a group of typically hearing children.
Typically hearing children were recruited by families and staff of the AVT programme, and were matched to children receiving treatment in terms of initial language age, receptive vocabulary, gender, and parent education level.
This study was conducted in Australia, with a sample of children between the ages of 2-6 years at the beginning of the programme. The AVT children had a range of sensorineural hearing losses, and used hearing aids and/or cochlear implants to access sound.
Measures
Speech perception was measured using the PLOTT measure; the Manchester Junior Words/Phonetically Balanced List for Kids Words measure; the Consonant-Nucleus-Consonant Words measure, and the Bench, Kowall, and Bamford Sentences measure (direct assessments).
Language was measured using the Preschool Language Scale – Fourth Edition and the Clinical Evaluation of Language Fundamentals measure (direct assessments).
Receptive vocabulary was measured using the Peabody Picture Vocabulary Test (direct assessment).
Speech was measured using the Goldman-Fristoe Test of Articulation, and Computer Aided Speech and Language Analysis (CASALA) (direct assessment).
Findings
The aim of the study is to investigate the extent to which children with hearing loss had improved outcomes over time, and the extent to which their rate of progress for speech and language skills was similar to that of children with typical hearing.
The study identified that rates of progress were similar between children with hearing loss receiving AVT, and typically hearing children, on auditory comprehension, oral expression, total language, and speech skills.
However, typically hearing children progressed as a better rate with respect to receptive vocabulary.
The conclusions that can be drawn from this study are limited by methodological issues pertaining to the lack of a comparison group which has been sufficiently demonstrated to be equivalent to the treatment group, hence why a higher rating is not achieved.