Auditory Verbal therapy and outcomes

The term Auditory Verbal therapy was coined by the Alexander Graham (AG) Bell Association for the Deaf in the 1970s in the United States23. A systematic review published in 202124 and 202325 suggests that there is strong evidence of the effectiveness of Auditory Verbal therapy on the development of all linguistic skills. One specific study in 2021 found that good attendance at Auditory Verbal therapy sessions was a factor that led to better spoken language outcomes 26


There is strong evidence of the effectiveness of Auditory Verbal therapy on the development of all linguistic skills




Optimal development of speech and language skills is preceded by developing optimal listening skills. Listening is dependent upon the stimulation and development of the auditory cortex in the brain. Throughout the first three years of life, children generally receive this stimulation in the form of interactions with their parents and this allows them to start learning language27. We now know there is a sensitive period during which the central auditory system remains maximally plastic. An effective early intervention programme, comprising optimally fitted hearing technology (i.e. hearing aids or implantable hearing technology, such as cochlear implants) together with effective early support for communication needs to be in place as early as possible and ideally within the first three and a half years in order to optimally support the brain development required for listening and spoken language development28. Research has shown that children who receive a cochlear implant below the age of 2 years old obtain higher mean receptive and expressive language scores than children implanted over the age of 2 years29.



Overwhelming evidence


The evidence base for the effectiveness of the Auditory Verbal approach is growing with more research being published every year. Outcomes for a group of more than 200 children who have followed either an Auditory Verbal, a total communication or an oral (listening with an intentional support of lipreading) approach has found that children following an Auditory Verbal approach outperform children who have followed an oral or total communication approach on a number of measures including speech-language, speech intelligibility and literacy30. A further analysis of a greater number of Auditory Verbal interventions has been conducted to highlight both their effectiveness and to direct future research31. Other research, albeit more limited, has also indicated that there are benefits of choosing an Auditory Verbal approach, even after the optimal intervention age. For example, late identified children have shown social interaction skills comparable to their hearing peers after Auditory Verbal intervention32. In the UK, the Early Intervention Foundation has independently assessed the evidence from the research base and included Auditory Verbal therapy in its guidebook for commissioners of Early Intervention programmes33


Deaf children following an Auditory Verbal approach outperform children who have followed an oral or total communication approach


Research from the US and Australia shows that children in an Auditory Verbal therapy programme develop spoken language in line with their hearing peers34,35,36,37, and progress at the same rate for listening, spoken language38, self-esteem, reading and mathematics as a matched group of children with normal hearing39. First Voice, a consortium of Australasian Early Intervention Centres (of which Auditory Verbal UK is an international member) collate and publish spoken language outcomes for graduates of Auditory Verbal programmes. The First Voice consortium has published the Sound Outcomes report for 2021 in which data was pooled over five Auditory Verbal programmes. Reporting on 186 children with hearing loss who graduated from First Voice centres in 2021, 83% of graduate children with hearing loss alone (i.e. without additional difficulties) achieved a standard score within or above the average range for typically hearing children40. The report also details a cost benefit analysis from 2019: the benefit to cost ratio for the community investment was approximately 4:1, a figure replicating Auditory Verbal UK’s own cost benefit analysis in 201641.

In 2022, the Danish government announced that AV therapy would be included as part of the care pathway for all children up to five years of age with permanent hearing loss. This followed a government funded project to investigate the effectiveness of the AV approach in a national intervention study for the families of children with a permanent hearing loss aged from birth to five years. Aiming for the goal of age-appropriate speech-language skills, the evaluation reports that 84% of the children achieved age-appropriate spoken language after three years of AV therapy. The figure was previously only 30%42.


Recent research (2018) investigating the early reading development of children with cochlear implants who have followed an Auditory Verbal approach has found that phonological awareness, the awareness of the sound structure of language, is a significant factor in reading development43. A 2020 study from the USA found that children with hearing loss aged from 5 to 9 years, who used a listening and spoken language approach, demonstrated reading skills within the average range for typically-hearing individuals through the use of hearing technology and appropriate intervention44. Regarding further chronological development of reading, research from Israel has shown that Auditory Verbal therapy graduates outperform adolescents and young people with hearing loss who were not rehabilitated via this approach, in Hebrew and Literature grades45.


Outcomes in the UK


80% of all deaf children who spend at least two years on our programme at Auditory Verbal UK achieve age-appropriate language



In the UK, approximately 80% of all deaf children who spend at least two years on our programme at Auditory Verbal UK achieve age appropriate language46 and most attend mainstream school47. On average, deaf children with additional needs double their rate of language development whilst on the Auditory Verbal UK programme, and one in two children reach age-appropriate spoken language at the end of their programme46. This suggests that Auditory Verbal therapy continues to be an effective intervention even if a child has additional needs. For children both with and without additional needs, the earlier they start the programme, the better the prognosis for language development46,48. The target-focussed, collaborative approach adopted by Auditory Verbal practitioners49 influences the outcomes for families of children who have hearing loss alone and of those who have additional challenges50. The holistic approach of Auditory Verbal intervention promotes best outcomes through transdisciplinary working.


In AVUK’s 2018 study, it was shown that 97% of deaf children without additional needs reached at least age-appropriate spoken language at the end of their Auditory Verbal therapy  programme46.



Educational outcomes


Evidence of the literacy outcomes attained by deaf children in the UK whose families had chosen a listening and spoken language approach and accessed Auditory Verbal therapy  t were collated by AVUK in 2022. The research shows that most deaf children following the Auditory Verbal therapy programme are attaining educational outcomes on a par with hearing children. 


Over 80% of deaf children who have followed an Auditory Verbal approach, are reaching or exceeding nationally expected standards at Key Stage 1 for Reading, and Mathematics. Over 75% are attaining or exceeding these standards for Speaking and Listening and for Grammar, Punctuation and Spelling. At Key Stage 2, the percentages of children reaching or exceeding nationally expected standards were 81% and 78% for Reading and Mathematics, respectively. The percentages of children reaching or exceeding nationally expected standards for Grammar, Punctuation and Spelling was over 75% and 76% for Science51.


By considering these outcomes in light of the national attainment figures for, first, children with no special educational needs [figure 1] and, second, all deaf children [figure 2], we see that the percentage of graduates from AVUK achieving competency as measured by the national SATs is at a level at least equivalent to their hearing peers. This data includes data of children with additional needs.


 Key stage oneKey stage two

Nasir’s story

Abdul and Shamaila, Nasir’s parents, found out their son was deaf just before he turned one. There were desperate for more support as they were unsure what the future would hold for Nasir. They found AVUK through their Teacher of the Deaf and signed up for our Auditory Verbal therapy programme where Nasir learnt to listen and speak. Now, aged 17, Nasir is thriving, studying Business Studies at college. 

“Auditory Verbal therapy has given Nasir the ability to express himself amongst his family and peers. When we think back to those early days of anxiety and worry about Nasir’s future, we wish we could go back and tell ourselves that it was going to be alright.” – Nasir’s parents, Abdul and Shamaila

Nasir and therapist Susie Burden