Family Role in The Therapy

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Family Role in the therapy

Important note to be given to the parent about AVT approach: This approach is very intense and requires involved and dedicated families for it to be successful. In order for AVT to work for you child it is up to you, as parents and caregivers, to be a strong advocate for him/her. It is essential that your child receive consistent audiological management, appropriate and consistent therapy, and adequate support in all environments with the expectation for your child to listen.

What the Speech-language pathologist and the parent should be doing.

A Parent’s Guide:

Normal Speech and Language Development

Encourage speech and language!

Talk naturally with the child, speaking without exaggerated facial (particularly mouth and tongue) movements and without the use of sign language.

Emphasize the sounds of speech used with your child in the way that mothers do with hearing infants who are learning to talk.

Understand normal child language and speech development

Take turns in therapy to give your child time to process what was said and time to respond.

Encourage the child to use babbling and jargon as normal hearing infants do.

Program management and Planning

Helps to understand the Auditory-Verbal goals and procedures

Emphasize that primary therapeutic goal is training the child to be aware of, attend to, and use sound.

Keep accurate notes and /or videotaped records of the child’s progress.

Use information about normal hearing children’s language and speech development when discussing the child’s progress.

Coordinate services with other professionals who may be involved with the child.

The Listening Environment

Speak close to the child’s hearing aid or cochlear implant microphone.

Speak in a quiet voice, at regular volume: raising the volume of your voice can often distort speech, making it more difficult to understand.

Use a slightly slower speaking rate.

Minimize all background noise; turn off window air conditioner units, fans, TV, radio’s, etc..

Use speech that is repetitive and rich in melody, expression, and rhythm.

What to expect from the child?

During the First Year

Follow simple one step commands

Develop object permanence; understand that an object continues to exist even when they can no longer see it.

Vocalizes when spoken to

Turns to localize where sound is coming from

Talks to mirrors and toys

Quiets when wearing hearing aids, and is noisy when they are off

Reacts to hearing a loud sound by smiling, quieting, or being still

Responds to noise-making toys

Responds to environmental sounds (doorbells, telephones, knocking, barking, etc.)

Responds to their name when called from a distance

Reacts when a noise suddenly stops

Indicates that they heard something, usually by pointing to ear, cochlear implant, hearing aids or looking puzzled.

Activities to encourage a Child’s Language Development

Talk to the child constantly, realizing that he/she can hear you

Respond to your child’s coos, gurgles, and babbling

Talk to the child as you care for him or her throughout the day (diapering, getting dressed, fixing meals, trips to stores)

Read colorful books to the child; talk about what is happing in the pictures.

Tell nursery rhymes and sing songs

Teach the child the names of everyday items and familiar people with a lot of repetition

Take the child with you to new places and situations

Play simple games with the child such as “peek-a-boo” and “pat-a-cake”

Cover their favorite toys (while they are watching) and wait for responses

Give the child toys that make different noises

More advanced expectations

Stop an activity in response to “no”
Identify and use words with different number of syllables
Match similar objects
Identify facial features (eyes, nose, mouth, hair)
Imitate a variety of speech babble

Activities to encourage the Child’s language

Reward and encourage early efforts at saying new words

Talk to the baby about everything you’re doing while you are with him/her

Talk about new situation before you go, while you are there, and again when you are home

Look at the child when he or she talks to you

Describe what your child is doing, feeling, hearing

Let the child listen to children’s tapes and CD’s

Praise your child’s efforts to communicate

Repeat new words over and over

Take the child on “listening walks”

Let the child tell you answers to simple questions

Read books every day, as parts of routines as well

Listen attentively when the child talks to you

Describe what you are doing, planning, thinking

Have the child deliver simple messages for you

Ask questions to get your child to think and talk

Show the child you understand what he or she says by answering, smiling, nodding your head

Expand what the child says, if he or she says, “more juice”, you say, “Alex wants more juice.”

Other communication methods:

	Sign Language	Auditory-Verbal	Cued Speech	Oral Auditory-Oral	Total Communication
Definition	A manual language that is distinct from spoken English (ASL is not based on English grammar/syntax). Extensively used within and among the deaf community. English is taught as a second language.	A program emphasizing auditory skills. Teaches a child to develop listening skills through one-on-one therapy that focuses attention on use of remaining hearing (with the aid of amplification). Since this method strives to make the most of a child’s listening abilities, no manual communication is used and the child is discouraged from relying on visual cues.	A visual communication system of eight handshapes (cues) that represent different sounds of speech. These cues are used while talking to make the spoken language clear through vision. This system allows the child to distinguish sounds that look the same on the lips.	Program that teaches a child to make maximum use of his/her remaining hearing through amplification (hearing aids, cochlear implant, FM system). This program also stresses the use of speech reading to aid the child’s communication. Use of any form of manual communication (sign language) is not encouraged although natural gestures may be supported.	Philosophy of using every and all means to communicate with deaf children. The child is exposed to a formal sign-language system (based on English), finger spelling (manual alphabet), natural gestures, speech reading, body language, oral speech and use of amplification. The idea is to communicate and teach vocabulary and language in any manner that works.
Primary Goals	To be the deaf child’s primary language and allow him/her to communicate before learning to speak or even if the child never learns to speak effectively. Since SL is commonly referred to as "the language of the deaf", it prepares the child for social access to the deaf community.	To develop speech, primarily through the use of aided hearing alone, and communication skills necessary for integration into the hearing community.	To develop speech and communication skills necessary for integration into the hearing community.	To develop speech and communication skills necessary for integration into the hearing community.	To provide an easy, least restrictive communication method between the deaf child and his/her family, teachers and schoolmates. The child’s simultaneous use of speech and sign language is encouraged as is use of all other visual and contextual cues.
Language Development (Receptive)	Language is developed through the use of SL. English is taught as a second language after the child has mastered SL.	Child learns to speak through the early, consistent and successful use of a personal amplification system (hearing aids, cochlear implant, FM system).	Child learns to speak through the use of amplification, speech reading and use of "cues" which represent different sounds.	Child learns to speak through a combination of early, consistent and successful use of amplification and speech reading.	Language (be it spoken or sign or a combination of the two) is dev-eloped through exposure to oral speech, a formal sign language system, speech reading and the use of an amplification system.
Expressive Language	SL is child’s primary expressive language in addition to written English.	Spoken and written English.	Spoken English (sometimes with the use of cues) and written English.	Spoken and written English.	Spoken English and/or sign language and finger spelling and written English.
Hearing	Use of amplification is not a requirement for success with SL.	Early, consistent and successful use of amplification (hearing aids, cochlear implant, FM system) is critical to this approach.	Use of amplification is strongly encouraged to maximize the use of remaining hearing.	Early and consistent use of amplification (hearing aids, cochlear implant, FM system) is critical to this method.	Use of a personal amplification system (hearing aids, cochlear implant, FM system) is strongly encouraged to allow child to make the most of his/her remaining hearing.
Family Responsibility	Child must have access to deaf and/or hearing adults who are fluent in SL in order to develop this as a primary language. If the parents choose this method they will need to become fluent to communicate with their child fully.	Since the family is primarily responsible for the child’s language development, parents are expected to incorporate on-going training into the child’s daily routine and play activities. They must provide a language-rich environment, make hearing a meaningful part of all the child’s experiences and ensure full-time use of amplification.	Parents are the primary teachers of cued speech to their child. They are expected to cue at all times while they speak; consequently, at least one parent and preferably both must learn to cue fluently for the child to develop age-appropriate speech & language.	Since the family is primarily responsible for the child’s language development, parents are expected to incorporate training and practice sessions (learned from therapists) into the child’s daily routine and play activities. In addition, the family is responsible for ensuring consistent use of amplification.	At least one, but preferably all family members, should learn the chosen sign language system in order for the child to develop age-appropriate language and communicate fully with his/her family. It should be noted that a parent’s acquisition of sign vocabulary and language is a long term, on-going process. As the child’s expressive sign language broadens and becomes more complex, so too should the parents’ in order to provide the child with a stimulating language learning environment. The family is also responsible for encouraging consistent use of amplification.
Parent Training	If parents are not deaf, intensive SL training and education about deaf culture is desired in order for the family to become proficient in the language.	Parents need to be highly involved with child’s teacher and/or therapists (speech, auditory-verbal, etc.) in order to learn training methods and carry them over to the home environment.	Cued speech can be learned through classes taught by trained teachers or therapists. A significant amount of time must be spent using and practicing cues to become proficient.	Parents need to be highly involved with child’s teacher and/or therapists (speech, aural habilitation, etc) to carry over training activities to the home and create an optimal "oral" learning environment. These training activities would emphasize development of listening, speech reading and speech skills.	Parents must consistently sign while they speak to their child (simultaneous communication). Sign language courses are routinely offered through the community, local colleges, adult education, etc. Additionally, many books and videos are widely available. To become fluent, signing must be used consistently and become a routine part of your communication.