language growth with the auditory-verbal approach for children with significant hearing loss...
TRANSCRIPT
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
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?
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
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
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)
AGE OF IDENTIFICATION
37 mo3%
0-6 mo
19%
7-12 mo11%
13-18 mo37%
19-24 mo 19%
25-36 mo
11%
Average age ID - 17 mo (range 0-37 mo)
AGE OF AMPLIFICATION
13-18 mo
25%
19-24 mo20%25-36 mo
25%
37 mo5%
0-6 mo10%
7-12 mo
15%
Average age amplification - 20 mo (range 3-40 mo)
Abnormal8%
Unknown43%
Genetic29%
Syndromic12%
Meningitic8%
ETIOLOGY
57% known etiologyIncidence of genetic deafness twice as high as reported in literature
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
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
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%
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
ASSESSMENT INSTRUMENTS
• Standardized on normally hearing children
• Outcomes presented in age-equivalency scores
• Administration adhered to manual protocol
• Separate receptive & expressive language scores
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%
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
Years in Program
One Two Three Four
Pe
rce
nt
Gro
wth
40
60
80
100
120
140
160
180
200
Receptive Expressive
n=40
n=32
n=14
n=6
Years in Program
One Two Three Four
Pe
rce
nt
Gro
wth
40
60
80
100
120
140
160
180
200Receptive Expressive
n=40
n=32
n=14
n=6
RATE OF SYNTACTICAL LANGUAGE GROWTH
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.
N=40N=40
Receptive Language: 139%
Expressive Language: 121%
Year 1
Year 2
N=32N=32
Receptive Language: 124%
Expressive Language: 115%
Year 3
N=14N=14
Receptive Language: 86%
Expressive Language: 94%
Year 4
N=6N=6
Receptive Language: 128%
Expressive Language: 163%
Receptive Language
Chronological Age in Months
40 50 60 70 80 90 100 110 120
La
ng
ua
ge
Ag
e i
n M
on
ths
10
20
30
40
50
60
70
80
90
100
110
120
n = 40 \
n = 32 \
n = 14 \
n = 6 \
Receptive Language
RATES OF GROWTH PER YEAR
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.
Receptive Language
Chronological Age in Months
40 60 80 100 120
La
ng
ua
ge
Ag
e i
n M
on
ths
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
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.
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
Time
Pre-AV "Graduation"
Ag
e in
Mo
nth
s
20
30
40
50
60
70
80
90
Chronological Receptive Expressive
Time
Pre-AV "Graduation"
Ag
e i
n M
on
ths
20
30
40
50
60
70
80
90Chronological
Receptive
Expressive
PROFESSIONALLY RELEASED: THE “GRADUATES”n = 14n = 14
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.
A BENCHMARK
100% Average Rate of Language Growth per year
can be expectedfor the Typical Child with
Severe-Profound Deafnesswith an Auditory-Verbal Approach
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
FINDING
Children with profound prelingual deafness CAN
acquire native communicative competence in spoken English,
regardless of hearing prosthesis
(cochlear implant and/or hearing aid)
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.
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”
ONGOING ANALYSES
Are 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
FUTURE ANALYSES
Are 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)?