What is the evidence base for AVT?

Deaf children can learn to listen and speak – like their hearing peers.

There is a range of evidence that shows the significant benefits of AVT in the early years. These benefits are lifelong and are leading to improved outcomes and expectations for children with hearing loss. In the studies looking at the listening and spoken language progress of pre-school children, the majority of children following an Auditory Verbal approach developed age-appropriate listening and spoken language skills.

Evidence:

Auditory Verbal UK (2018) Raising the bar for deaf children with additional needs: a study of spoken language outcomes for children attending Auditory Verbal UK from 2007-2017. 

Percy-Smith, L. (2017) Auditory verbal habilitation is associated with improved outcome for children with cochlear implant.

  • This evidence has been used in getting the government in Denmark to offer all children with bilateral hearing loss (>40 PTA) 3 years of AVT.

  • See the report here. 

First Voice (2017). First Voice graduate outcomes outcomes report. 

  • These outcomes show that children in First Voice members’ early childhood intervention programmes regularly match or surpass their hearing peers, with over 70 per cent of children achieving age-appropriate results by the time they commence school

Goldblat, E., & Pinto, O. Y. (2017). Academic outcomes of adolescents and young adults with hearing loss who received auditory-verbal therapy. Deafness & Education International, 1-8.

  • Results indicate positive correlations between receiving AVT and academic variables. Significant differences were found between the study and control groups in all grades. These results suggest that AVT graduates outperform adolescents and young people with Hearing Loss who were not rehabilitated via this rehabilitative approach.

Hogan S. (2016) The Auditory Verbal Approach in the UK: A 10 year audit of outcomes for pre-school children in the UK Oral presentation to British Society of Audiology Annual Conference, Coventry, UK

  • Approximately 80% of the children who were on the Auditory Verbal programme at Auditory Verbal UK for two years or more graduated with age appropriate language (AAL) by five years of age. Of these children, 25% had challenges associated with their aetiology (eg. those associated with meningitis, cCMV, ANSD etc) in addition to their hearing loss.

  • A poster summarising the research is available here.

Auditory Verbal UK (2016) Cost Benefit Analysis. 

  • A cost benefit analysis of Auditory Verbal UK's early intervention programme, published in June 2016, can be found here. 

Kaipa, R., & Danser, M. L. (2016). Efficacy of auditory-verbal therapy in children with hearing impairment: A systematic review from 1993 to 2015. International Journal of Pediatric Otorhinolaryngology, 86, 124-134.

  • Several studies suggest that AVT can have a positive impact on developing speech and language skills in children with hearing loss. 

First Voice (2015). Sound Outcomes: First Voice speech and language data.

  • Out of 696 children with permanent hearing loss, 75% graduated from the programme with age-appropriate language.
  • When children with additional needs were not included in the analysis, the number of children with hearing loss who graduated with age appropriate language was 80.2%. Available here. 

Sharma, A, Campbell J, Cardon, G. (2015) Developmental and cross-modal plasticity in deafness: Evidence from the P1 and N1 event related potentials in cochlear implanted children. International Journal of Psychophysiology 95, 135-144.

  • There is a sensitive period during which the central auditory system remains maximally plastic. This means that effective early intervention needs to occur as early as possible and certainly within the first 3 and a half years.

Dornan D, Hickson L , Murdoch B , Houston T, and  Constantinescu G. (2010). Is Auditory-Verbal Therapy Effective for Children with Hearing Loss?  Volta Rev 110(3), 361–387

  • A longitudinal study reporting positive speech and language outcomes for 29 children with hearing loss in an Auditory Verbal programme compared with a matched control group with typical hearing. 
  • For speech, language and self-esteem, results showed no significant differences between the children with hearing loss and the children with typical hearing.

Hogan S, Stokes J and Weller I. (2010) Language Outcomes for Children of Low-Income Families Enrolled in Auditory Verbal Therapy. Deafness Educ Int. 12 (4) 204-216

  • Household income was not found to have an impact on the spoken language development of children with hearing impairment who participate in Auditory Verbal therapy programmes.
  • There was a highly significant increase in the rate of language development for the group of 12 children over the period of intervention, with 75% achieving age-appropriate language.

Hogan S, Stokes J, White C, Tyszkiewicz E, Woolgar A. (2008) An evaluation of Auditory Verbal Therapy using rate of early language development as an outcome measure. Deafness Educ Int. 10,143–167

  • Children acquired language at a much faster rate by the time they finished the study compared to when they started it.  This tells us that being on an Auditory Verbal programme at Auditory Verbal UK accelerated children’s language development.
  • A child with a hearing loss needs to have the right therapy for their spoken language to be accelerated through listening, as well as optimal hearing technology and early identification of hearing loss.
  • 80% of children who have graduated from AVUK’s Auditory Verbal therapy programme attend mainstream school.

Mitchell, R. E., & Karchmer, M. A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4(2), 138–163.

  • More than 90 percent of children with hearing loss are born to hearing parents.
  • Over 90 percent of these parents have been found not to learn sign language beyond the basic preschool level. If the parent communicated with their child through a language that they (the parent) only have a basic grasp of, then the child will not be exposed to the language of thinking and emotion and may miss the opportunity to develop theory of mind. 

Position papers:

Below are a number of Position Papers that summarise the wide range of evidence for Auditory Verbal therapy drawn from around the world:

UK A Sound Future: Raising Expectations for Children with Deafness (February 2018)

Australia  Hear and Say’s Position Paper on Listening First: The Changing Face of Hearing Loss (2015)

New Zealand  The Hearing House’s Position Paper on Early Intervention Services (2014)

Other useful reports and papers:

Hear and Say, Australia Publications.

First Voice, Australia Publications.

Decibels research project (Percy‐Smith et al.) Available here.