1. 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

2. 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?

3. No 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

5. 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)

6. AGE OF IDENTIFICATION 37 mo 3% 0-6 mo 19% 7-12 mo 11% 13-18 mo 37% 19-24 mo 19% 25-36 mo 11% Average age ID - 17 mo (range 0-37 mo)

7. AGE OF AMPLIFICATION 13-18 mo 25% 19-24 mo 20% 25-36 mo 25% 37 mo 5% 0-6 mo 10% 7-12 mo 15% Average age amplification - 20 mo (range 3-40 mo)

8. ETIOLOGY 57% known etiology Incidence of genetic deafness twice as high as reported in literature

9. 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

10. 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

11. 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

12. TEST INSTRUMENTS Receptive & 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

13. ASSESSMENT INSTRUMENTS Standardized on normally hearing children Outcomes presented in age-equivalency scores Administration adhered to manual protocol Separate receptive & expressive language scores

14. 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%

15. 100% is Typical Rate of Growth for Normally Hearing Children One Year of Progress per Year of Treatment is Considered the Norm 100% is Typical Rate of Growth for Normally Hearing Children One Year of Progress per Year of Treatment is Considered the Norm 100% is Typical Rate of Growth for Normally Hearing Children One Year of Progress per Year of Treatment is Considered the Norm

16. 100% is Typical Rate of Growth for Normally Hearing Children One Year of Progress per Year of Treatment is Considered the Norm 100% is Typical Rate of Growth for Normally Hearing Children One Year of Progress per Year of Treatment is Considered the Norm RATE OF SYNTACTICAL LANGUAGE GROWTH

17. STATISTICAL ANALYSES Language 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.

18. N=40 Receptive Language: 139% Expressive Language: 121% Year 1

19. Year 2 N=32 Receptive Language: 124% Expressive Language: 115%

20. Year 3 N=14 Receptive Language: 86% Expressive Language: 94%

21. Year 4 N=6 Receptive Language: 128% Expressive Language: 163%

22. RATES OF GROWTH PER YEAR

23. WHY DOES RECEPTIVE LANGUAGE GROWTH SLOW DOWN IN THIRD YEAR? 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.

24. RATES OF GROWTH PER YEAR

25. WHY DOES EXPRESSIVE LANGUAGE GROWTH SPURT FORTH DURING THE FOURTH YEAR? Possible Explanation: The child, as a vessel, has built up a sufficient reservoir of receptive language skills. The vessel runneth over.

26. THE “GRADUATES” 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

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

28. STATISTICAL ANALYSIS Over 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.

29. A BENCHMARK 100% Average Rate of Language Growth per year can be expected for the Typical Child with Severe-Profound Deafness with an Auditory-Verbal Approach

30. FINDING

31. Children with profound prelingual deafness CAN acquire native communicative competence in spoken English, regardless of hearing prosthesis (cochlear implant and/or hearing aid)

32. 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.

34. A systematically positive family-focused, child-driven, objective-oriented program that is constructed on the cognitively-oriented auditory comprehension-based model of a syntactical language “road map”