Sarah Hogan, DPhil, Senior Auditory Verbal Therapist and Research Co-ordinator at AVUK

Today Auditory Verbal UK publishes its Position Paper highlighting the latest national and international research on Auditory Verbal therapy and paediatric deafness.

We have collated the latest evidence on how early interventions, hearing technology and social policy has advanced, adding to the growing evidence base for the effectiveness of the Auditory Verbal approach.

I am delighted to share this paper and highlight in this blog some of the key topics and most recent research, but it is also a moment of frustration, because, despite having one of the best newborn hearing screening programmes in the world, together with access to state of the art hearing technology, we are not yet seeing the gap close between the achievements of deaf children and those of their hearing peers. Plus, Auditory Verbal therapy is still not widely available through the NHS and public services as an option for families with deaf children.

Getting an equal start at school

We know that early intervention is vital to ensure deaf children have the same opportunities as their hearing peers, especially when it comes to educational outcomes. Whether a family want their deaf child to develop spoken language, use sign language, or both, they need access to support in the critical first few years of their lives. Research published this year showed that children enrolled in early intervention before they were 6 months old had consistently higher scores in emergent literacy components over time compared with children enrolled at or after age 6 months¹. However, without appropriate early intervention the development of a child’s literacy and numeracy can be affected.

Deaf children, in the majority of cases, are still not achieving the educational outcomes that we know are possible. Analysis by the National Deaf Children’s Society, released in 2022, of 2021’s GCSE results shows that deaf pupils in England have now achieved an entire GCSE grade less than hearing peers for at least seven years in a row. Just 38% of deaf children gained a grade 5 in key subjects English and Maths, compared to 52% of hearing children.

A systematic review published last year suggested there is strong evidence of the effectiveness of Auditory Verbal therapy for building language development of children with cochlear implants and on the development of all linguistic skills². And this year we shared our own research, Stepping Stones to Literacy, showing that deaf children who have benefitted from our specialist early intervention programme are attaining educational outcomes on a par with hearing children. These results show that over 80% of deaf children who have followed an Auditory Verbal approach at AVUK, are reaching or exceeding nationally expected standards at KS1 for Reading, and Mathematics. Over 75% are attaining or exceeding these standards for Speaking and Listening and for Grammar, Punctuation and Spelling.  

Use and effectiveness of telepractice

Telepractice became widely used for delivering Auditory Verbal therapy during the COVID-19 pandemic in 2020 and 2021, and we know it continues to work. Our own experience and research at AVUK, combined with additional international studies tells us that children with hearing loss who, together with their parents, receive telepractice sessions, perform at least as well in multiple measures of language outcomes as those who receive in-person sessions. This year we have continued to see families across the UK both in person (31%), via telepractice (52%) and as part of a blended programme of both in-person and telepractice sessions (17%).

Multilingual families

Many of the families we see at AVUK are bilingual, including Lola and Rafi who both feature in the Position Paper and speak English and French at home, and Lola is also speaking Spanish. This year, research conducted by Emily Wright from the University of Reading, in which some of our multilingual families participated, examined the beliefs of professionals on the ability of a deaf child to acquire two spoken languages and the advice professionals give to parents considering spoken language bilingualism for their deaf child. In an evolution of practice over the last decade, most participants believed deaf children can achieve spoken language bilingualism and would advise parents to speak in their home language, regardless of the parents’ English proficiency.

Policy and Funding across UK and the World

In November this year we heard that, following the successful government-funded 3-year pilot programme, Auditory Verbal therapy has now become part of the standard healthcare system in Denmark. Having worked with colleagues in Denmark on this programme and with AVUK having trained many of the Danish certified Auditory Verbal therapists, I’m delighted that all deaf children across Denmark will now have the option to access an Auditory Verbal programme. In line with other evidence on the effectiveness of Auditory Verbal therapy, evaluation of their study showed that 84% of the children acquired age-equivalent spoken language on a standardised assessment after 3 years of therapy³.

In the UK, deaf children continue to face the prospect of lower academic achievement, lower employment, are at higher risk of poor mental health, bullying and social exclusion, and currently, 92% of deaf children under the age of 5 do not have the option to access an Auditory Verbal programme. To increase access to this specialist support, there needs to be more practitioners trained in Auditory Verbal practice working in the NHS and local services who support deaf children across the UK. And to do this, we need investment.

The evidence and research in this latest Position Paper clearly demonstrates that deaf children in the UK could benefit greatly from an investment into making Auditory Verbal therapy more widely available in the critical first few years of a child’s life. We can and should raise the expectations of deaf children and unlock significant educational, social and economic benefits for the UK.

Read our 2022 Position Paper

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References

1. Meinzen-Derr, J., Altaye, M., Grove, W., Folger, A. T., & Wiley, S. (2022). Association of Age of Enrollment in Early Intervention with Emergent Literacy in Children Who Are Deaf or Hard of Hearing. Journal of Developmental & Behavioral Pediatrics, 43(2), 104-110
2. Binos, P., Nirgianaki, E., & Psillas, G. (2021). How effective is auditory–verbal therapy (AVT) for building language development of children with cochlear implants? A systematic review. Life, 11(3), 239.
3. Evaluation of the 3-year Auditory Verbal Therapy (AVT) program 2017-2021. Retrieved from: https://decibel.dk/evaluation-of-the-3-year-auditory-verbal-therapy-avt-program-2017-2021