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Facilitating spoken language development in the regular classroom

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Title: Facilitating spoken language development in the regular classroom


1
Facilitating spoken language development in the
regular classroom
  • September 28th 29th
  • Winnipeg, MB
  • Petra Smith M.Sc. Aud (C)
  • Audiologist/Certified Auditory Verbal Therapist

2
AV PRINCIPLES AND THE AV SESSION
  • How the auditory verbal therapist works with the
    children, their families and other professionals

3
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

4
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

5
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

6
Standardized Curriculum for Trainee Therapists
  • History Philosophy
  • Hearing Audiology
  • Spoken Language Development
  • Parent Guidance
  • Cochlear Implants
  • Education in the mainstream
  • Auditory Verbal Practice

7
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.

8
Auditory Verbal Therapy..
  • ..is part of the Auditory Verbal Approach

9
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

10
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

11
AV Principle 1
  • Promote early diagnosis of hearing loss in
    newborns, infants, toddlers and children,
    followed by immediate audiologic management and
    auditory verbal therapy

12
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.

13
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)

14
Functional impact of hearing loss distance
hearing
Flexer 1999
15
Functional impact of hearing loss incidental
learning
Flexer 1999
16
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

17
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

18
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

19
Implications for Intervention
  • Developmental approach
  • instead of.
  • Remedial approach

20
GOAL
  • Universal Newborn Hearing Screening

21
Goal at identification
  • Support families in making their decisions about
  • Language of choice
  • Communication approaches

22
Communication Options
23
Manual Oral
  • Sign Spoken
  • Language Language
  • (ASL) (English/French etc)
  • ?-------------------------------------------------
    --------------------?
  • Bi-bi Auditory Verbal
  • Signed Exact English Aural-oral
  • Total Communication Cued Speech

24
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

25
AV Principle 2
  • Recommend immediate assessment and use of
    appropriate, state of the art hearing technology
    to obtain maximum benefits of auditory
    stimulation

26
A good acoustic signal is needed for auditory
stimulation
27
Amplification improves quantity and quality of
acoustic signal
28
Good audiological support
Early identification of hearing loss Accurate
diagnosis Optimal amplification Early intervention
29
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

30
Amplification
  • Hearing aids
  • Cochlear implants
  • All require optimal fitting to allow access to
    spoken language.

31
Advanced Bionics 90k Implant
32
Speech Processors from Advanced Bionics
33
Wireless FM with iConnect earhook
34
Freedom Speech Processors from Cochlear
Corporation
35
MicroLink Freedom for the BTE
  • Seamlessly integrated into the BTE case
  • FM receiver can be left in place all the time

36
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

37
A person who really listens
  • Is motivated
  • Has time and opportunity
  • Is attentive

38
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

39
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

40
Assess, monitor facilitate
  • Auditory development
  • awareness of sound
  • attaching meaning to sound
  • vocalizations
  • Eye gaze joint attention
  • Development of natural gesture
  • Play

41
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.

42
Parental Involvement
  • Parents are the childs
  • Primary language models
  • First teacher
  • Playmate
  • Advocate

43
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

44
Why individualized therapy?
45
Why do children need language?
  • CONVERSATION
  • Social interaction
  • Problem solving and thinking
  • Negotiation and sharing
  • Story telling
  • Joint imaginary play

46
A CONVERSATION IS..
  • A SERIES OF TURNS
  • A SHARED ACTIVITY
  • GOVERNED BY RULES WHICH ARE LEARNED IN INFANCY
  • EASIER FOR ADULTS THAN FOR CHILDREN

47
CONVERSATION
  • Informal exchange of ideas by spoken words
  • Concise Oxford Dictionary 1982
  • soone of our aims is
  • ..give the words to the child..

48
How hard can it be?
49
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?

50
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51
A good conversation
  • Now think of someone you enjoy having a
    conversation with. What do they do that makes it
    so worthwhile?

52
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53
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

54
A..B..C...s of conversation....
55
A..ctive
56
B..alanced
57
C..ommon focus
58
The underpinning to conversation is equally
shared participation
  • Like a game of table tennis.

59
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60
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61
But What if one of the participants isnt very
competent?
62
Conversations
  • What can go wrong?
  • The rules of conversation are not observed due
    to
  • DELAYED development
  • DISORDERED development

63
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64
communication breakdown
65
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

66
  • 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

67
To avoid this families need
  • Information sensitive to adult learning
    styles, literacy levels etc
  • Demonstration observation and participation
  • Experience practice and feedback

68
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

69
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

70
AV Principle 5
  • Guide and coach parents to create environments
    that support listening for the acquisition of
    spoken language throughout the childs daily
    activities.

71
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).

72
So..
  • The children need access to spoken language

73
Enhancing listening
  • Can modify
  • environment
  • acoustic signal
  • interactions
  • ..more later.

74
AV principle 6
  • Guide coach parents to help their child
    integrate listening and spoken language into all
    aspects of the childs life

75
Everyday life more resources for families
76
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.

77
AV Principle 7
  • Guide and coach parents to use natural
    developmental patterns of audition, speech,
    language, cognition and communication

78
AV Principle 8
  • Guide coach parents to help their child
    self-monitor spoken language through listening
  • ..auditory feedback loop

79
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

80
Early identification allows..
  • Less delay
  • More natural development
  • More acceptable speech patterns
  • Better literacy outcomes

81
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

82
Spoken Language
  • Follow developmental sequence in
  • RECEPTIVE LANGUAGE
  • EXPRESSIVE LANGUAGE
  • PRAGMATICS
  • PHONOLOGY
  • COGNITION

83
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

84
AV Principle 10
  • Promote education in regular classrooms with
    typical hearing peers and with appropriate
    support services from early childhood onwards

85
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

86
Outcomes of the Auditory Verbal Approach
87
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88
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.

89
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)

90
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

91
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

92
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

93
Therapy session framework
  • MOTIVATION
  • GOALS
  • CONTENT

94
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)

95
Who is the client?
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