NHS 2002NHS 2002

2nd International Conference on Newborn Hearing Screening, Diagnosis, and

Intervention

Como, ItalyMay 31, 2002

Progress in Specific Language Skills for Young Children in the Auditory-Verbal Approach

Ellen A. Rhoades, Ed.S. & Helen A. McCaffrey, Ph.D.

FOUR YEAR LONGITUDINAL STUDY

• Tertiary center-based A-V program

• No pre-selection of children or families

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

• Children typically received 1-2 weekly AVT sessions

• Children received A-V services over a 1 to 4 year period

To examine growth in lexical-semantic comprehensionlexical-semantic comprehensionas well as morpho-syntactical developmentmorpho-syntactical development

(both comprehension and production),particularly as it pertains to children with hearing loss

as a result of auditory-verbal intervention.

PURPOSE OF STUDY

TEST INSTRUMENTSReceptive & Expressive Language Age-Equivalencies

[Specific Language Measures with basal-ceiling ages noted]

TEEM (3 - 8 yrs) Test for Expressive Emergent Morphology

TACL (3 - 10 yrs) Test for Auditory Comprehension of Language

PPVT-R (2.6 - 90+ yrs) Peabody Picture Vocabulary Test

1. What are the rates of progress in lexical-semanticand morpho-syntactic language skills by children with hearing loss in an auditory-verbal program?

2. How does progress in such specified language skills compare to progress in global language skills as observed by Rhoades & Chisolm (2001)?

3. What are the relationships between chronological age and language-equivalent age as measured by testsof lexical-semantic and morpho-syntactic skills?

4. How do these specific language skills compare among children who were professionally released from auditory-verbal therapy and those who continued?

QUESTIONS

TestTime PPVT TACL TEEMEntry 32 32 17Year 1 22 21 11Year 2 10 10 2Year 3 9 8 1Year 4 4 4 0

NUMBER OF CHILDREN PARTICIPATING IN TESTING

AT EACH TEST PERIOD

FINDINGS OFRHOADES & McCAFFREY

1. Language growth in both lexical-semantic and morpho-syntactical domains were significant over each year of auditory-verbal intervention, and these data are consistent with the findings of improved global receptive and expressive language scores earlier obtained.

2. PPVT and TACL scores were submitted to a two-way repeated measures analyses of variance (ANOVA). Statistically significant growth in language occurred each year. TACL scores were significantly higher than PPVT as a result of the first year.

3. TACL, PPVT, TEEM scores subjected to correlational analysis. Correlation between CA and LA for each assessment gets stronger over time. The strongest correlation is during the last year of intervention.

MORE FINDINGS OFRHOADES & McCAFFREY, 2002

4. There is functional significance of language growth - unquestionably so that language improves as a result of the auditory verbal approach, since the growth rate exceeded that of normal maturation rate.

5. Formula to calculate rate of language growth:[(Score B - Score A)/M] x 100where A = age equivalent score at first evaluation B = age equivalent score at next evaluation M = number of months between evaluations

Rate of language growth evidenced by TACL and PPVT show PPVT growth is lower than TACL growth across all years of intervention. TACL scores exceeded growth rate of normal maturation.

STILL MORE FINDINGS OFRHOADES & McCAFFREY, 2002

6. CA-LA gap decreased over time as a result of AVT.

7. For those children who had AVT for 3+ years with both TACL and PPVT scores, CA and LA data were regressed for each child. Some reached or exceeded CA performance on the TACL, but none on the PPVT.

8. Professionally released children (n=14) all showed TACL scores to exceed CA, with PPVT scores reaching equivalence to CA. Similarly, data from this group were subjected to a repeated measures analysis of variance (ANOVA) and no significant differences were found between CA and LA. These data corroborate global language outcomes.

AVT= Auditory Verbal Therapy CA= Chronological Age LA = Language Age

AND MORE FROMRHOADES & McCAFFREY, 2002

9. For children who completed all 3 tests (n=9), mean language age-equivalencies for each test across time show that PPVT scores lagged behind TACL and TEEM, with the highest growth rate in TEEM scores.

10. Typically, most children obtained basal scores on the PPVT and TACL at the same time, but did not attain basal scores on the TEEM until a year later. Exceptions were those children given AVT as infants or those who experienced progressive deafness; they obtained basal scores on the TEEM at the same time as basal scores were obtained on the PPVT and TACL.

Year SourceDf F p1 Measure 1 6.11 0.17*

Time 1 97.58 <0.0001**Measure x Time 1 1.352 0.25

2 Measure 1 3.33 0.08Time 1 21.47 0.0002**Measure x Time 1 0.72 0.41

3 Measure 1 1.37 0.26Time 1 38.01 <0.0001**Measure x Time 1 0.51 0.48

4 Measure 1 1.20 0.31Time 1 39.73 0.0007**Measure x Time 1 0.76 0.42

*p<.05**p<.001

SUMMARY OF REPEATED MEASURES ANALYSES OF VARIANCE OF EQUIVALENT LANGUAGE AGES

30

40

50

60

70

80

90

100

110

120

Chronological Age in Months

PPVT

Year 4(n=4)

Year 3(n=9)

Year 2(n=10)

Year 1(n=22)

MEAN CA & LA FROM PPVT TESTING OVER 4 YR PERIOD OF A-V INTERVENTION

30

40

50

60

70

80

90

100

110

120

Chronological Age in Months

TACL

Year 4(n=4)

Year 3(n=8)

Year 2(n=10)

Year 1(n=21)

MEAN CA & LA FROM TACL TESTING OVER 4 YR PERIOD OF A-V INTERVENTION

30

40

50

60

70

80

90

100

110

120

Chronological Age in Months

TEEM

Year 3(n=1)

Year 2(n=2)

Year 1(n=11)

MEAN CA & LA FROM TEEM TESTING OVER 4 YR PERIOD OF A-V INTERVENTION

0.0

0.2

0.4

0.6

0.8

1.0

1 2 3 4 5

Test Session

TEEM

TACL

PPVT

CORRELATION BETWEENLA & CA FOR EACH TEST GETS

STRONGER OVER TIME

CORRELATIONALANALYSIS

0

25

50

75

100

125

150

1 2 3 4

Years in Program

TACL

PPVT

MaturationRate

n=22

n=21

n=10

n=9

n=8

n=4

n=4

n=10

MEAN RATEOF LA

GROWTH

20

40

60

80

100

120

140

20 40 60 80 100 120 140

Chronological Age in Months

y = 1.053x - 24.021

y = 1.535x - 33.586

y = 1.399x - 70.825

y = 0.923x - 27.311

y = 0.851x - 23.634

y = 1.025x - 47.502

y = 1.389x - 32.210

TACL

Normal trajectoryy = 1.0x

RELATIONSHIP BETWN CA & LAIN 7 CHILDREN FROM TACL

OVER 4 YR PERIOD

20

40

60

80

100

120

140

20 40 60 80 100 120 140

Chronological Age in Months

y = 0.617x - 0.751

y = 1.101x - 12.875

y = 0.471x + 6.659

y = 0.751x - 18.711

y = 0.730x - 19.890

y = 0.618x - 14.872

y = 1.184x - 33.287

PPVT

Normal trajectoryy = 1.0x

RELATIONSHIP BETWN CA & LAIN 7 CHILDREN FROM PPVT

OVER 4 YR PERIOD

0

10

20

30

40

50

60

70

80

90

Pre-AV Graduation 1 Graduation 2

Time

PPVT

Chronological Age

TACL

n = 9

n = 5

RELATIONSHIP BETWEEN CA & LA FROM TACL AND PPVT IN 2 GROUPS

OF A-V ‘GRADUATES’

0

20

40

60

80

Measure

Year 2

Year 1

n = 9

MEAN PPVT, TACL, & TEEMLA ACROSS 2 YRS OF A-V INTERVENTION

The auditory-verbal approach is a viable option toward enabling children with significant hearing loss to hear and speak.

Implementation of this communication approach, when based on empirical evidence, can stimulate normal rates of language growth, in both the lexical-semantic and morpho-syntactical domains.

Children who are hard of hearing and/or deaf, regardless of whether they are hearing aid or cochlear implant users, can become linguistic geniuses.

Children with hearing loss can claim their birthright to function within normal limits in our hearing and speaking world.

...Ellen A. Rhoades & Helen A. McCaffrey, 2002

For further information on the Auditory-Verbal Approach, go to the web site

http://http://www.AuditoryVerbalTraining.comwww.AuditoryVerbalTraining.com

To contact the investigators by e-mail, go to:

info@AuditoryVerbalTraining.cominfo@AuditoryVerbalTraining.com

Progress in Specific Language Skills for Young Children

in the Auditory-Verbal Approachby

Ellen A. Rhoades, Ed.S., Cert. AVT&

Helen A. McCaffrey, Ph.D., Cert. AVT