language growth with the auditory-verbal approach for children with significant hearing loss

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LANGUAGE GROWTH with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS Presentor: Ellen A. Rhoades, Ed.S., Cert. AVT, CED Auditory-Verbal Training & Consultation Services www.AuditoryVerbalTraining.com Presented at NHS 2000 International Conference on Newborn Hearing, Screening, Diagnosis & Intervention Milan, Italy October, 2000

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LANGUAGE GROWTH with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS. Presentor: Ellen A. Rhoades, Ed.S., Cert. AVT, CED Auditory-Verbal Training & Consultation Services www.AuditoryVerbalTraining.com. Presented at NHS 2000 - PowerPoint PPT Presentation

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Page 1: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

LANGUAGE GROWTH with the AUDITORY-VERBAL APPROACH for

CHILDREN with SIGNIFICANT HEARING LOSS

Presentor: Ellen A. Rhoades, Ed.S., Cert. AVT, CEDAuditory-Verbal Training & Consultation Services

www.AuditoryVerbalTraining.com

Presented at NHS 2000

International Conference on Newborn Hearing, Screening, Diagnosis & Intervention

Milan, ItalyOctober, 2000

Page 2: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

RESEARCH QUESTIONS

1. Regardless of intervention age, is the Auditory-Verbal Approach a viable communication option?

2. What rate of syntactical language growth is considered to be typical and therefore the potential standard?

3. Does the gap between CA and LA either narrow or close over time?

Page 3: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

No Pre-selection of Children or FamiliesNo Pre-selection of Children or Families• (5-yr Longitudinal Investigation in Nonprofit A-V Center)

• Typically, 1 or 2 center-based A-V sessions wkly• Children in A-V program from 1-4 years

• All communication options presented to parents prior to initiation of A-V services

Research Investigators:Ellen A. Rhoades, Ed.S., Cert. AVT, CED

Teresa H. Chisolm, Ph.D., CCC-A

Page 4: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

FAMILY DESCRIPTIONEducation: 23% (9) high school degrees 52% (21) college degrees 25% (10) post-bachelor degrees

100% normally hearing parent13% (5) some difficulty becoming monolingual13% (5) difficult family situations

Page 5: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

DESCRIPTION OF 40 CHILDREN

18 female & 22 male

• 25% (10) from TC programs• 32% (13) from A/O programs• 43% (17) started with A-V

Average age @ AVT initiation - 44 mo (range 4-100 mo)

Page 6: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

AGE OF IDENTIFICATION

37 mo3%

0-6 mo19%

7-12 mo11%

13-18 mo37%

19-24 mo 19%

25-36 mo11%

Average age ID - 17 mo (range 0-37 mo)

Page 7: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

AGE OF AMPLIFICATION

13-18 mo25%

19-24 mo20%25-36 mo

25%

37 mo5%

0-6 mo10%

7-12 mo15%

Average age amplification - 20 mo (range 3-40 mo)

Page 8: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Abnormal8%

Unknown43%

Genetic29%

Syndromic12%

Meningitic8%

ETIOLOGY

57% known etiologyIncidence of genetic deafness twice as high as reported in literature

Page 9: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

DURING STUDY 78% (31) SI referrals

18% (7) mild 33% (13) moderate 28% (11) severe

50% (20) OM referrals 35% (14) mild-moderate 15% (6) severe

15% (6) cognitively delayed 5% (2) medication - ADHD/bipolar disorder

30-42% of deaf children have additional handicaps, as reported in literature

Page 10: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

AUDIOLOGICAL DATA 33% HA users

mean unaided PTA 75 dB range 47-97 dB all but 2 w/ 30 dB (or better) aided PTA all fitted w/ high gain linear or programmable

38% CI users 7% (3) perilingually deafened 43 mo mean age implantation

30% HA to CI 47 mo mean age implantation

Page 11: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

ALL 27 CI USERS (68%)

severe-profound or profound deafness 15 N-22, 9 Clarion, 2 N-24 devices 3 N-22 devices failed, w/ 1 device failing over

period of 1½ years

PROSTHETIC DEVICE

HA-only33%

CI only37%

HA->CIboth30%

Page 12: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

TEST INSTRUMENTSReceptive & Expressive Language Age-Equivalencies

–Global (this study)»SICD-R (1-4 yrs)

»PLS-3 (1-7 yrs)

»OWLS (3-21 yrs)

–Specific»TEEM»TACL»PPVT-R

Page 13: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

ASSESSMENT INSTRUMENTS

• Standardized on normally hearing children

• Outcomes presented in age-equivalency scores

• Administration adhered to manual protocol

• Separate receptive & expressive language scores

Page 14: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

PROGRAM STATUS FOR 40 CHILDREN

Yrs A-V Intervention 1 2 3 4 %

• Relocated 0 2 1 0 7.5%• Referred 2 3 0 0 12.5%• Graduated 5 5 2 2 35.0%• Quit 1 3 0 0 10.0%• Continued 4 3 5 2 35.0%

Page 15: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

100% is Typical Rate of Growthfor Normally Hearing Children

AVERAGE GROWTH RATESAUDITORY VERBAL INTERVENTION RESULTS

STUDY OUTCOMESGlobal Language Measures

One Year of Progress per Year of Treatment is Considered the Norm

Page 16: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Years in Program

One Two Three Four

Perc

ent G

row

th

40

60

80

100

120

140

160

180

200

Receptive Expressive

n=40n=32

n=14

n=6

Years in ProgramOne Two Three Four

Perc

ent G

row

th

40

60

80

100

120

140

160

180

200Receptive Expressive

n=40

n=32

n=14

n=6

RATE OF SYNTACTICAL LANGUAGE GROWTH

Page 17: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

STATISTICAL ANALYSESLanguage age equivalency scores,

as a function of year in therapy, were subjected to repeated measures of covariance (ANCOVA)

with the actual number of months between test times as the covariate. The main effect of time was significant in each,

i.e., significant improvements in equivalent language ages were found as a function of each year in auditory-verbal therapy.

Page 18: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

N=40N=40

Receptive Language: 139%Expressive Language: 121%

Year 1

Page 19: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Year 2N=32N=32

Receptive Language: 124%Expressive Language: 115%

Page 20: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Year 3N=14N=14

Receptive Language: 86%Expressive Language: 94%

Page 21: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Year 4

N=6N=6

Receptive Language: 128% Expressive Language: 163%

Page 22: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Receptive Language

Chronological Age in Months40 50 60 70 80 90 100 110 120

Lang

uage

Age

in M

onth

s

102030405060708090

100110120

n = 40 \

n = 32 \

n = 14 \

n = 6 \

Receptive Language

RATES OF GROWTH PER YEAR

Page 23: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

WHY DOES RECEPTIVE LANGUAGE GROWTH SLOW DOWN IN THIRD YEAR?

Possible Explanation:Possible Explanation:

Perhaps there is a prolonged period of accommodation demonstrating discontinuity in language growth as postulated by J. Kagan.

This may be a time of internalization due to great structural alterations in the child’s linguistic knowledge.

Page 24: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Receptive Language

Chronological Age in Months40 60 80 100 120

Lang

uage

Age

in M

onth

s

10

20

30

40

50

60

70

80

90

100

110

120

n = 6 \

\n = 32

Expressive Language

n = 40 \

n = 14 \

RATES OF GROWTH PER YEAR

Page 25: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

WHY DOES EXPRESSIVE LANGUAGE GROWTH SPURT FORTH DURING THE FOURTH YEAR?

Possible Explanation:Possible Explanation:

The child, as a vessel, has built up a sufficient reservoir of receptive language skills.

The vessel runneth over.

Page 26: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

THE “GRADUATES”

SOME DIFFERENCES:SOME DIFFERENCES:

• 1/2 Hearing Aid Users• All but 1 had A-V services initiated after 3 yrs CA• 1 w/ significant family issues• 1 w/ TC background• 43% referred for SI issues• 36% referred for oral-motor issues

Page 27: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

Time

Pre-AV "Graduation"

Age

in M

onth

s

20

30

40

50

60

70

80

90

Chronological Receptive Expressive

Time Pre-AV "Graduation"

Age

in M

onth

s

20

30

40

50

60

70

80

90Chronological Receptive Expressive

PROFESSIONALLY RELEASED: THE “GRADUATES”n = 14n = 14

Page 28: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

STATISTICAL ANALYSISOver time, the rate of language growth for a-v children exceeded the expected rate of language growth for normally hearing children.

At the point of “graduation,” the differences between language ages and chronological ages were negligible.

This was confirmed by repeated measures analysis of variance.

Page 29: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

A BENCHMARK100% Average Rate of

Language Growth per year can be expected

for the Typical Child with Severe-Profound Deafness

with an Auditory-Verbal Approach

Page 30: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

The gap between LA and CA can be closed for at least

some children, regardless of prosthetic device used,

as a result of auditory-verbal therapy.

FINDING

Page 31: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

FINDING

Children with profound prelingual deafness CAN

acquire native communicative competence in spoken English,

regardless of hearing prosthesis (cochlear implant and/or hearing aid)

Page 32: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

RISK IS NOT DESTINY

Average age of AVT initiation - 44 months

While there is wide agreement that children who don’t receive appropriate auditory stimulation during their developmental prime time are at increased risk for language delays, we also must remember that children can thrive despite adverse conditions; they can develop or recover significant capacities even after critical periods have passed to sustain hope for every child.

The notion of a critical period for language development needs to be carefully qualified.

According to neuroscience/brain research, the window of opportunity for language development seems to be open from birth to about age 10.

Page 33: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS
Page 34: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

A systematically positivefamily-focused, child-driven,objective-oriented programthat is constructed on the

cognitively-orientedauditory comprehension-based model of a syntactical language “road map”

Page 35: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

ONGOING ANALYSESAre Audiological Factors Predictors of LanguageProgress? Age at ID of deafness Degree of unaided hearing loss Age at initial amplification Age at cochlear implantation Degree of aided hearing loss Use of prosthetic device (hearing aids & cochlear implants) Duration of implantation/effective amplification

Page 36: LANGUAGE GROWTH  with the AUDITORY-VERBAL APPROACH for CHILDREN with SIGNIFICANT HEARING LOSS

FUTURE ANALYSESAre these demographic factors predictors of language growth?

Age of AV intervention Age of amplification and/or implantation Parent education levels Family issues such as bilingualism, alcohol-abuse Child behavioral mgmt issue Child issues such as SI, oral-motor, cognitive delay Child’s gender Intervention history (communication mode): TC, A/O or A-V

Rate of specific language growth (TEEM, TACL, PPVT-R)?