Tag Archives: Auditory-Verbal Therapy

It All Starts With Play…

Rebecca Siomra

Children need the freedom and time to play.
Play is not a luxury. Play is a necessity.
– Kay Redfield Jamison

When I came across this quote, it made me stop and think.

Play is a necessity. Interesting. Necessary for what? The importance of play for everyone has gotten a lot of attention in research and literature in recent years. In adults, play means something different to different people – playing hockey, painting a landscape, singing show tunes, training dogs, going for a morning run or even building a deck! In childhood, play has a very special and important role. Play affects just about every area of a child’s development, and impacts brain development. Play makes us feel good and it can motivate us and help us learn.  In discussing play in children, I’m not talking about the need for mountains of trendy, expensive toys or electronics, but just ‘play’, pure and simple.

Why would I care about play? I specialize in speech and language. Speech-Language Pathology isn’t only about talking and understanding, it’s about communicating and interacting with others, and those skills begin to develop from day one through daily routines, and through simple play.  The way we bounce, rock, tickle or sing to a baby are all early play activities. When we see how babies do (or don’t) respond to these activities, we start to know more about their personalities, or how they might be feeling that day. The way that we respond in turn helps that little one to learn that what they do (or don’t do) has an effect on others. They learn that making a noise or smiling will bring on another tickle, or round of ‘Twinkle Twinkle’, and so communication begins.

In my practice, the first step in a therapy program for a young child often starts with very simple interactions. I want the parents that I coach to really understand that play is a child’s work; encouraging play and joining in play is a parent’s work. Play allows a child to learn about themselves, their environment, other children, adults and how they should and should not behave with other people. In a wonderful coincidence, when we play with a child, we also learn about them and, if we’re lucky, about ourselves too.

I think it’s incredible that so many important
life-skills can be learned through play.

When we use the term ‘child’s play’, we usually mean something that is ‘easy to do’, or ‘without significant challenge’. I have the opportunity to work with very young children every day, and my experiences lead me question that generalization. A child’s play is fun, absolutely, but without challenge? I’m not so sure the little ones would agree with that!  Remember, this is their work, and they take it very seriously!

Boy working with building blocks

Watching a toddler tackle stacking blocks or a shape sorter for the first time, or try to sort out how to make a toy bus sing its song again, reminds me just how important it is to reset my perspective. So many skills are second nature to me as an adult, but are brand new to the children I work with. Every little step in developing early play skills requires patience… practice… learning. Think about it, when babies are really little, they learn to grasp something in their hand, then to lift it up, then their hand gets tired and, oops, it falls out.  Now what?

They try again, and again, and again. Perseverance is a life-skill; how amazing is it that it can begin to develop at such a tender age. As an adult, our role may be to stay close by and to let them keep trying, to allow them the opportunity to learn. Babies and young toddlers may dump anything and everything out of containers, but putting something back into a container requires hand-eye coordination and control of grasp and release. What happens when the task becomes too frustrating?

The child needs to figure out how to communicate so that someone will know to come and help; one more skill to add to the to-do list. Wow, this ‘child’s play’ stuff is a lot of work!  Fortunately, it’s also a lot of fun, which encourages these little ones to keep practicing.  They certainly are motivated to learn!

Over the years, I’ve collected charts and lists detailing developmental milestones. What I find fascinating is watching the points from those lists coming to life, first in what children do in their play, and then  in their everyday routines.

A baby who has been putting her fingers, then toys, in her mouth comes to realize that she can also put bits of cookie in her mouth – brilliant. One big step to independence!! The young toddler who has been playing peek-a-boo with his parents realizes that when they disappear around the corner to answer the phone they’re still there and will come back, and he doesn’t need to be sad – marvelous!

In Auditory Verbal Therapy, we coach parents to make ‘Learning to Listen Sounds’ for their babies while playing with toys, singing or looking at books. The big moment comes when, one day, that little one looks at the airplane and says ‘ahhhh’, without even realizing that she has learned how to attach a label to an object. Even more astonishing, all of that practice of making those funny sounds back and forth with any adult who will play, one day turns into first words!!

Play gives children a chance to practice what they are learning.
– Fred Rogers

Ah, those first sounds… first words. Music to every parent’s ears.  What comes next?  We want to hear those words again, and again of course! As adults, we can create endless opportunities for young children to practice new sounds and words through games or books.  We want them to feel confident and to want to try again. When we build all of this ‘work’ into play, a child will be motivated to keep trying, to keep learning.

The repetition of songs can help children learn about body parts, actions, animals or even what the parts of a bus do!  They learn how to listen and wait for the pause in a song when they can happily fill in the ‘E-I-E-I-O’ with gusto! They learn how to take turns by pushing a car or ball back and forth.  They learn how to ask for help by handing the container of bubbles to a parent while looking between the two expectantly. The countless rounds of peek-a-boo, driving that blue train around the track one… more… time. So many opportunities for children to learn from us, and all we have to do is have fun – really? Amazing!

As a Speech-Language Pathologist, I may guide a parent in how to adjust play routines, or the language they use, to match their baby’s learning needs, but it really still boils down to play.

Laying the ground-work for early play and communication development opens so many doors… like the one to the land of make-believe, but that’s a thought for another day!

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/it-all-starts-with-play), as being the originator of the content.

A Paradigm Shift in Practice

Becky Clem

Do you ever have someone inquire, “Why did you decide to become a Speech-Language Pathologist (SLP)/Audiologist (Aud.)/Teacher of Children with Hearing Loss/Deafness (TOD)?”  I love to share that my dad’s profession as a reconstructive and plastic surgeon led me to speech-language pathology.  His work with children with cleft lip and palate and his belief that SLPs played a critical role in his patients’ speech and language development influenced my career decision early in high school. I loved meeting his patients, learning about the surgeries, and seeing his beautiful reconstructive work on these small children. He frequently remarked that the SLP’s role was essential in helping these children have excellent speech and communication quality without social and emotional challenges.

Along my career journey, my passion for children with hearing loss and deafness developed.  My graduate school, Wichita State, required all SLP graduate students to take the maximum number of audiology courses possible. We did extensive hearing tests; used giant audiometers by today’s standards, made earmold impressions, debated the pros and cons of Aural-Oral and Total Communication at a monthly dinner, and fully integrated our thinking into the world of hearing.   One of my first clients was a homeless adult diagnosed with neurological deficits. As it turns out, he had an undiagnosed moderate to severe sensorineural hearing loss. Once fit with hearing aids, he began to explore the world of sound with joy and abundance.

Beginning the journey towards certification as a Listening and Spoken Language Specialist with Auditory-Verbal Therapy Certification was nothing less than an upheaval to everything I thought I knew about working with children with speech, language, and hearing disorders. From the beginning of my career, I wanted to work with children and only children in the field. In the field of LSL, the focus is guiding and coaching parents. LSL intervention was not taking the child to the therapy room for 30 minutes, 2 times a week, leaving the parent in the waiting room reading, watching TV or perusing the Internet! Parents would be in the sessions fully participating? How would I teach parents? Instead of using the SLP requisite mirror and photo cards for articulatory mouth positions, we would be teaching speech through listening only!  How was that possible?

There was a monumental paradigm shift in practice from my role as a speech-language pathologist to an LSL Cert. AVT speech-language pathologist. That shift changed my practice as an SLP for all my patients with communication disorders.

What did I learn along the way? I learned to:

  • Be open to learning something totally new and different. Learn with a clear mind and open heart.
  • Be willing to try new skills and methods even when they are not comfortable.
  • Be willing to have someone else evaluate your clinical skills. Be willing to have them evaluate and help immediately in the moment. As a clinical supervisor myself, it was rather humbling to have someone else evaluate my clinical skills in therapy sessions.
  • Be more concerned about learning and improving than what it might look like to the parent/family to have someone help you during the session.
  • Engage parents and family in therapy sessions, as full participants. The results in patient progress will be far beyond therapist-child only sessions.
  • Have the parent participate even in ‘the child does better without the parent’ situations.  How can we expect progress without the parents’ involvement in the session learning and practicing strategies?
  • Be willing to make mistakes. It’s okay!
  • Practice AVT strategies and techniques in as many situations as possible with children who have other types of communication issues.
  • Read current research about how we learn to talk by what we hear – not by what we see.
  • Ask questions of other disciplines who work with children with hearing loss.
  • Ask audiologists and TODs to teach you about what they do.
  • Be respectful of what others do in the profession of paediatric hearing loss.

A Paradigm Shift in Practice

What changed in my own practice as an SLP? I now try to practice by:

  • Involving all parents of my speech-language patients fully in therapy sessions had a dramatic impact on the child’s outcomes.
  • By teaching parents specific strategies for carry over and helping figure out ways to carry over in a functional way at home, results in faster discharge from therapy.
  • Growing my skill set to include how to teach to various adult learning styles.
  • Developing my skills in mentoring and coaching for parents and professionals could positively affect the outcomes for children with hearing loss.
  • Teaching children speech through listening instead of through vision and articulatory placement cues (exclusive of those children with motor speech disorders) leads to more natural sounds speech at discharge.
  • Evaluating suprasegmentals and vowels as part of articulation testing and conversation evaluation changed my starting point and goals for intervention.  Goals target errors in suprasegmentals and vowels before error consonants.
  • Being open to constant changes in the hearing technology field and learning how it could improve access to speech through listening for my patients.
  • Collaborating with other professionals within my own program and outside led to failures and successes. Learning from all encounters and using that information for future collaborations provided some key changes in my thinking and practices.
  • Partnering with families of children with speech, hearing, and language disorders is not exclusive to the field of LSL-AVT and paediatric hearing loss.  The principles especially related to “guide and coach parents” and “parents are the primary language model” became part of all my therapy sessions – became part of my professional personality and mission.
  • Parents want to be part of their child’s success. By guiding and coaching them to be their child’s primary language model and teacher at home and in the community, successful outcomes for children with communication disorders of any type are possible.

I am joyously passionate about pediatric speech-language pathology and pediatric hearing loss!  Speech-Language Pathology is a marvelous profession.  Megan Hodge, a speech-language pathologist at the University of Alberta has a perfect quote for my thoughts in closing:  “….a career in speech-language pathology challenges you to use your intellect (the talents of your mind) in combination with your humanity (the gifts in your heart) to do meaningful work that feeds your soul.”

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/a-paradigm-shift-in-practice), as being the originator of the content.

Listen to me now: A letter from the future

Mikaeel Valli

Dear Mom and Dad,

You are probably both wondering who this person is who is writing to you. It’s me, your son, Mikaeel writing this letter from the future as a 21 year old, but for now, you both know me as your young four year old, being raised beside my bustling older brother, Talib. Raising two young boys and balancing your work demands has, without a doubt, been keeping you both very busy. Raising us to adults as we are today, you both deserve a lot of credit for your hard work. Trust me, it will be worth it, though admittedly, we will have driven you nuts and given you splitting headaches many, many times.

I can only imagine how hard it was for you to learn that I have a severe to profound hearing loss. A deafening echo of ‘deaf’ must still be going through your minds and it has no doubt left you wondering what the future holds for me. Will I ever listen and communicate like any normalchild — especially like Talib? Even deeper echos running through your minds will probably be whether you will ever be able to communicate your thoughts to me or even for me to communicate my thoughts to you. The truth is, it will all happen! Rest assured that though it will be difficult in the beginning as you are now experiencing, over time I will gradually improve with my communication and listening skills to a point that these fears you are having will become non-existent.

As with many parents both of your minds must be racing as to what I  feel being that I am hard of hearing (HOH), especially once I reach an age of understanding. The reality is that I never felt any resentment over being HOH. I feel life is too short to dwell on things that cannot be changed. I believe we need to progress forward, focusing on the blessings we have, always being positive, no matter what. Rest assured that the cochlear implant has opened a tremendous floodgate of opportunities for me to such an extent that I don’t feel HOH (when wearing the cochlear implant, of course!). My listening and articulation capabilities are, at this point, very similar to individuals with typical hearing in many listening situations.

Currently, all you see is “little Mikaeel” being so quiet, and generally having a difficult time grasping the ability to learn to talk. You and your therapist wonder if I’ll ever talk myself out of my shell of shyness. Therapists and teachers have expressed concern and wonder if they are doing everything they can to help me. Both of you are convinced, however, that I just need more time. I want to assure you that you are absolutely right! There is a great misconception that upon cochlear implantation, recipients will automatically have the ability to hear and speak, but clearly you both understand that that’s not exactly accurate. It not only takes appropriate hearing technology and intervention, but time.  Along with the professionals, you have all done a tremendous job! Now, it’s time to wait for me to continue to learn, grow and express myself.

A young Mikaeel in an auditory-verbal therapy session with his auditory-verbal therapist

A young Mikaeel in an auditory-verbal therapy session with his auditory-verbal therapist

Dad, your determination to consistently take me to Auditory Verbal Therapy (AVT) sessions every Wednesday morning along with the time Mom takes to watch each of the taped AVT sessions along with your combined determination to enforce the lessons taught during those sessions will prove to be the recipe for my success. I certainly feel that, beside the decision for a cochlear implant, enrolling in AVT (and you both taking it seriously) are the best decisions that you both made. Without a shadow of doubt, I would never have achieved my current level of articulation and listening skills with it. The determination, love and work ethic you both possess is unmatched.

There is an expression that says, “No pressure. No diamond.” You both are placing a good amount of pressure on creating the conditions that will lead to the polishing of me — your diamond. Your tenacity of continual pressure for your children to attain their highest possibilities; having high expectations, will have diamonds descending onto your laps — guaranteed.

Continue going with the flow, even when the going gets tough. Many doors of opportunities will open up along the way for both Talib and I. These doors, however, will open when you least expect it. Talib will become a very confident young adult who will eventually meet a wonderful wife who brings a vibrant perspective to our family. He will earn great success in his career. I will mature quickly and, admittedly, I am very surprised at myself for this when I look back! You have encouraged me to focus and this has led me to pursue and develop my career from a relatively young age.

Mom and Dad, always continue to work together as team of two in supporting each other, sharing comforting and reassuring thoughts with each other and always continue to ensure there is a line of communication between the two of you as well as with your children. Continue to strive to integrate your boys together and treat your journey with Mikaeel as a holistic package involving everyone in the family. One possible way is to incorporate Mikaeel into Talib’s activities and vice versa as much as possible. Consider bringing Talib along to a few of my AVT sessions. I bet Talib would find it a lot of fun to play with the abundance of colourful toys in the therapist’s room. It would certainly make Talib feel part of this journey to a greater level and would encourage me to mimic Talib, using him as my model. You could do the reinforcement of AVT lessons at home together with the two siblings as well. This will give prime opportunity in re-enforcing your conviction that everyone has a valuable role to play within the home and that everyone needs to feel included.

I know you both are very determined that Talib and I achieve an education and you are probably wondering how we both will do in school. Talib will become a proficient academic performer especially in high school where he will earn honor rolls throughout the four years. As for me, it will take time for me to gradually catch on, adjust to different listening situations and to effectively understand and communicate language properly in the earlier years of elementary mainstream school. But don’t worry. I will catch on, especially when I reach mainstream high school where I also will achieve honor rolls in all four years. I speculate that my continual exposure to children with typical hearing in my age group in mainstream elementary school was the driving force pushing me toward success. I believe that being assimilated has led to my ability to communicate effectively.

As I have already spilled the beans on your children’s school accomplishments, you are probably on the edge of your chair wondering what happens next after high school for both of us. Well, I have to say that patience is a virtue and that you will have to wait until prime time in about ten plus years! I just would like to let you know that as an adult, life is very positive and I am very happy just the way it is. This is thanks to the lessons and mindset that you instilled in us right from the very beginning. Your dedication has brought forth rewards that I think will surpass your wildest dreams.

You both are still probably wondering who I am and how I can say such decisive things. The reality is, once again, I am speaking from the future and you will be with this person through to the future and much further. I need to let you know that, along with the excellent family support received especially from your sister (in-law), Zainab and her family, you are both doing a fantastic job! All of you ought to be very proud of your accomplishments for molding Talib and I into our full potential in being happy and healthy.

Warmest regards from your old (and more behaved) son,


As an adult, whenever possible, Mikaeel enjoys spending time with Warren Estabrooks and Karen MacIver-Lux

As an adult, whenever possible, Mikaeel enjoys spending time with Warren Estabrooks and Karen MacIver-Lux

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/what-hearing-loss), as being the originator of the content.




Music and movement


As a speech-language pathologist who provides auditory-verbal therapy and a Kinderdance instructor, I have a strong belief in the importance of music and movement to support listening, speech, and language development in preschool children. I also like to incorporate early literacy skills into my Kinderdance classes and love to watch the children have fun while at the same time learning so many new skills- it flows so naturally from music! Learning to listen to the beat of the music can then be transferred into the beat of a rhyme or the syllables in a name. Adding fun rhymes to the warm-up part of class helps to build memory skills, introduce words that rhyme as well as new vocabulary and even the opportunity to practice articulation! Imagine how beneficial these activities would be for children with hearing loss…

Taking these ideas into an auditory-verbal (AV) session might seem a bit daunting if you have never thought about it before — I think that we all have our favourite songs for therapy sessions, but adding just a bit of movement opens up a whole new aspect of learning and mind-body awareness.

During my sessions I like to begin with a song (or two) to get the children in the mood for listening. I use the same songs for a number of sessions with my little ones so that they get used to the routine as well as the pattern and gestures of the songs. We sit on the mat stretching our legs out wide and facing each other to sing the “Itsy Bitsy Spider”, and make the most of stretching to complete all of the gestures. I find that this engages the children and they really get into the singing and hand movements. Because they must coordinate both mouth and body, I find that they don’t have time to even think of not joining in! After a few sessions, they know what to expect and as soon as they come in will go to the mat to begin – it is a fun and relaxing way to start therapy.

Another way that I like to use music and rhythm is with tapping sticks.
This is fun to do alone or with marching to stress the
beat of a nursery rhyme. Not only do the children love to march and tap,
they begin to ‘feel’ the words and relate them to a rhythm
that then reinforces the words that they are hearing.

They will sometimes learn bits and pieces of the words and it all comes out as a very disjointed rhyme but the bits are filled in as we continue to practice each week! I also use sticks to tap ‘high’ and ‘low’ parts of a song, using the sticks to indicate high notes as ‘tapping up’ and low notes as ‘tapping down’. This helps the children to pay attention to intonation by practicing listening carefully for the changes in the music- they need to pay close attention to when the notes go up and when they come down in order to know where to tap their sticks. It is quite a challenging exercise for them but they have a good time practicing and always love to be actively engaged in the songs. Involving the body as a whole engages the mind and adds to the sensory input for memory and motor skill development.

Glynnis music

Many researchers have looked at the impact of music on the developing mind- we have all heard about the Mozart Effect. You may have also heard about the enhanced listening skills that musicians have….these remind us how important it is to ensure that we are engaging the whole child in our therapy sessions; adding movement and songs stimulates both sides of the brain, adding language skills and memory to any activity. When the whole body is involved, studies have shown that better learning occurs! This is such a wonderful opportunity for children with hearing loss to also develop listening skills that will support their ability to discriminate – research tells us that trained musicians can distinguish between  individual notes within an orchestral piece of music; that is to say that they can ‘pull out’ one ‘voice’ within the piece – this carries over into their daily lives as they are also able to distinguish one person’s voice in a room full of speakers- a challenge for children with hearing loss.

Using music is such a fun and active way to help
develop this skill that doesn’t seem like therapy at all
(and is even fun for the therapist!)

Using shakers and sticks to tap out the rhythms of songs and rhymes while marching around the room, clapping to the beat of a favourite song while sitting on a mat on the floor or just closing your eyes and listening for the drum (or violins, or flute….) in a favourite piece of music all add a new dimension to the experience….one I hope you will consider when planning your next therapy session!

Wearing two (or more) hats!

Having been a paediatric nurse for over thirty years, I always felt that I had a good idea of how children grow and develop. Once I became a Speech-Language Pathologist, I added a new dimension to my assessment skills — how DO children learn speech and language? This has been a wonderful journey; one filled with challenges and the search for fun and interesting ways to encourage an area that I had for so long completely taken for granted. When I chose to make Auditory-Verbal Therapy (AVT) my area of interest, I decided that I would incorporate my other ‘hats’ into the bargain. When I am assessing a child my nursing hat slips on and I look at the general growth and development, how the child moves, social skills and even if there are any issues around eating! As a feeding therapist (yet another hat to be discussed in an upcoming blog!) I understand how the development of chewing and feeding skills are prerequisites for the development of speech. This was not apparent to me before becoming a Speech-Language Pathologist, but I can truly appreciate it now!

As is the case for all of us as therapists, many of the children who come for AVT also have medical challenges. It becomes a bit of a dilemma to fully understand what obstacles are present. This is where my nursing background is once again a definite benefit! Having the inside scoop, so to speak, helps me to plan my sessions and parent teaching in a way that is able to incorporate the whole child. Being able to appreciate what kinds of things might be interfering with the development of speech and language or their ability to listen gives me insight into how best to support them during this journey of AVT. It is always such a pleasure to be able to explain to parents how development is based on a building block system…it’s a matter of balance and support….you can’t skip a step without your whole tower falling down!

I have had a number of children come to me for AVT who also have other ‘challenges’ that have not been noticed. One little kiddie did not seem to be progressing in any of her development and her parents were quite concerned. After discussing her health history, it became clear that there were a few things that needed to be cleared up before we were going to make any progress with AVT! Because she had had some very serious issues with reflux, her attention after feeds was definitely not on listening and interacting! She seemed to be uninterested in her surroundings – so much so that her parents thought that there was a cognitive issue. After discussing the impact of reflux on attention to the outside world and the difficulty for the toddler in separating the discomfort inside from the activities on the outside – no matter how fun and exciting they were – it became clear that a discussion with the toddler’s medical team was in order otherwise we would not be able to make any headway with therapy. I also spoke with the child’s feeding therapist and Mum about feeding times related to therapy and we managed to find a window of good time to engage her when she was more comfortable. As time went by and her medications were changed, she outgrew the reflux and is now very engaged in therapy and progressing nicely. It was a real challenge to try to figure out what the issue was and then how best to help, but it all paid off in the end!

So you can see how as therapists, we must make it our business to ask the questions…not that we need to know the answers… but that we are looking at the whole child and what might be influencing progress….that we are aware of what other supports or services might be of benefit to the child or family and we remember that we are part of a team who can all help to build a supportive, positive environment for the children we see. This, then, allows us to support the families along their journey and help to ensure that the children have the opportunity to be the best they can be!


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/music-and-movement/), as being the originator of the content.

Letter to my 10 year old self

Jonathan Samson
Dear 10 year old Jonathan,

Hi kid, it’s me, or actually your 43 year-old self from your future. I’ve just finished working with your brother Noam on some exciting new investments that we’ve been following.

You don’t realize it yet, but with unwavering support from your family, you have set the groundwork for great things to come.

It all began with your parents making the BIG decision to provide you with powerful hearing devices (those clumsy body aids) and helping you learn to listen and talk the “auditory-verbal” way. That means no sign language and no emphasis on teaching lip-reading, although ultimately, your natural ability to lip-read expertly will come in handy!  Your parents’ decision had a huge impact on your life and I think you’ll be ecstatic with how you turned out.  I know I am.

Right now, however, you probably don’t think life is too great. You are 10 years old, just finishing up Grade 4 at Summit Heights and I know it has been an extremely difficult year for you on a personal level. The year started off with a teacher who enjoyed being difficult, which then spilled over to the kids in your class who treated you worse than ever.

Remember that day when you decided to bring your baseball bat to school to “get back” at Matt? That did NOT go over too well with the principal, did it? Luckily, nothing bad happened and he was very understanding.

Next time you have issues with any of the kids at school who are really bothering you, please tell your teachers and your parents. I know you like to keep things to yourself, but the teachers and principal can really help you. If you ever feel the urge to bring the bat to school to “get even” again, I strongly suggest that you leave it at home.  Go to the teachers and principal and have a chat with them. Believe me, it’s not the same as ratting the bullies out. The teachers and principals really CAN help smooth things out for everyone.

Please don’t worry what other people think of you,
otherwise you can’t be who you are. Consider your deafness
a good friendship gauge – it will show you down the road
who your true friends really are.

I know there are times when it seems so hard when kids are making fun of you both in front of you and behind your back, and picking on you on the way home from school. It also feels like your “friends” treat you one way in private but in public, they act in a totally different way. This must be somewhat confusing and unfair. Please don’t worry what other people think of you, otherwise you can’t be who you are. Consider your deafness a good friendship gauge – it will show you down the road who your true friends really are. Build upon those friendships and hang on to them, especially in times of change and uncertainty.

You have just replaced your clumsy body aids with new ear-level behind-the-ear hearing aids (BTEs).  Freedom at last!  Believe it or not, hearing devices will change even more. In another 16 years, a cool hearing device will literally change your life. In fact, it will blow your mind what you will achieve as a result. More on this later. This is what we call the suspense part of the story!

You have an itinerant teacher of the deaf who you really dislike. You may not know it now, but she is just fresh out of school and not all that experienced. You will only have her for another year. The lesson is that nothing is permanent and try to give people the benefit of the doubt. Difficult periods do pass.

Mom and Dad work hard day in and day out to improve your listening skills and speech pronunciation. So, next time you feel annoyed about your mom correcting your speech, especially in public, it is ok to calmly share your feelings with her that you would be more comfortable if she did it privately. However, just remember what I told you in this letter…that the unwavering support from your parents and family, have truly set the groundwork for things to come. Trust me, you owe your parents and family a HUGE thank you. Everything they do has a reason to it, and usually is for your benefit and Mom always means well.

Jonathan Sampson at that time

For many years you saw Louise Crawford at The Hospital for Sick Children to learn to listen and talk.  Two years ago, you “graduated” to The Learning To Listen Foundation at North York General Hospital where you now enjoy weekly auditory-verbal therapy sessions with Warren Estabrooks within spacious quarters.  Remember how your lessons with Warren and your mom were in the broom closet at the Metro School for the Deaf? All of this seems pretty routine and unremarkable to you, but believe me when I say, their unwavering support paid off. Your teachers and family will be there for you in the tough and good times ahead, so cherish and appreciate those bonds.

Your life has been somewhat a blend of optimism and “Teflon,” an amazing belief that everything leads to ultimate success. “Can’t” is not in your vocabulary. For some reason, you’ve never asked “Why am I deaf?” or “Why is this happening to me?”  Deafness has been a secondary issue, despite all the difficulties and obstacles. Hold onto this optimistic view that the glass is half full because this has been and will continue to be your survival tool.

In the years ahead, you will experience major changes to your life, which will open all kinds of doors. You will need to remember how important it is to adapt yourself to variabilities and to learn from these experiences. Use them as the springboard of opportunity to soar to extraordinary destinations in life.

I have two more pieces of advice, buddy. Be more social and try to overcome that fear and shyness. Put yourself out there more and trust yourself. It is worth it and really so important. Get more active and involved in sports. I know you think you suck at it, but you’ll get better and it is good for you in every aspect. You only woke up to this fact at the end of high school. University was such an enriching experience and it is too bad you didn’t do all of this earlier.

So what are these changes? End the suspense, you say?

Technology will explode like you would never believe. You will have surgery to receive a cochlear implant, which will allow you to hear far more than you ever believed possible.

Television programs and movies now have closed captioning or subtitles and you don’t have to bug your little brother and sister all the time to find out what’s going on.

The world has become a level playing field for you with the explosion of personal computing and mobile telephones.  No more relying on interpreting help on the phone. Nobody talks to each other anymore on the phone anyways – they now all type/text to each other!

You’re going to look like everyone else. Yes – you read that right. Half the population is going to be walking around with something resembling a hearing aid plugged onto their ear and no one will be any wiser nor stare any differently at you.

You have an unbelievable journey ahead of you.

Small successes line the road to big wins. So look for those small triumphs and just grab them and improve and improve upon them. Good luck!

From your older and somewhat wiser self,

P.S. You know that computer that your Dad just bought you – the Apple IIe? Go buy stock in Apple NOW. And hold on to it. Trust me on this one!

Samson Family


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/letter-to-ten-year-old-self/), as being the originator of the content.

What do parents value most about their experience with auditory-verbal therapy and education?

Melanie Ribich short bio

I recently had the opportunity to read through 101 Frequently Asked Questions About Auditory-Verbal Practice edited by Warren Estabrooks. It was fascinating to me as a parent to read what professionals from around the world have to say on a wide variety of topics relating to Auditory-Verbal Practice.

One article that I found particularly interesting was the response to the question What do parents value most about their experience with auditory-verbal therapy and education?

In their response, Terri Cohen-Johnson and Marguerite Vasconcellos wrote that in general, parents value the umbrella of support that auditory-verbal practice provides.  Parents/caregivers appreciate:

  • the emotional support they receive from their child’s therapist,
  • the opportunities to observe, learn and practice the techniques and strategies that can help their child learn to listen and talk,
  • the boost in their confidence they experience as a result of being included as a key members of their child’s auditory-verbal team.

As a parent who also went through the auditory-verbal practice experience I wholeheartedly agree with this response and thought that I would share my personal experiences as they relate to this response found in 101 Frequently Asked Questions About Auditory-Verbal Practice.

We started working with our auditory-verbal therapist when our son Noah was four months old. At that time our family knew very little about hearing loss.  We found ourselves trying to balance the needs of all of our children — our two year old daughter, Noah and his twin brother — while dealing with the diagnosis of Noah’s hearing loss. I remember it as being an overwhelming and extremely exhausting period of time. My husband had gone back to work and I was home with the children.

I recall worrying: How I would manage Noah’s equipment? What about the constant ear mold fittings? How would I find childcare that would allow for all the audiology appointments? How was I to keep the hearing aids in his ears when he seemed to take them out fifty times a day? Why we were continuing to do therapy when it seemed like he wasn’t hearing a single sound we introduced to him?

Our auditory-verbal therapist began coming to our home every Friday morning and I had no choice but to show her who I truly was. There was often no time to clean up the dishes in the sink, put away the toys or even look presentable. It was a time when I felt had little control over what was happening in my life. After a number of weeks, I found myself beginning to look forward to those Friday mornings. I discovered that the therapist was helping me address the numerous worries and concerns I had.

Despite their best intentions, my friends did not truly understand what I was going through but our auditory-verbal therapist seemed to be empathetic. She was emotionally supportive in a way that no one else, at that time, was and that support encouraged me to go on.

The more I felt supported, the more eager I became to learn.

During those Friday morning sessions I learned there were specific things I could do for my child to help him learn to listen and talk. The therapist demonstrated these skills through play activities and then passed the activities over to me so that I could practice those skills with her support and guidance. Every time our therapist modelled a song in a session and then said, “your turn Mom”, was a way to push me to the forefront. It was uncomfortable at first, but the more I did it, the easier it became. That seemingly small part of a sixty minute session is the reason I am now comfortable in IEP meetings, know how to find the best people to work with my child and am unafraid to ask for whatever will help my child learn in his mainstream classroom.

Melanie, Noah and his teacher reviewing his progress in school.

Melanie, Noah and his first grade teacher reviewing his progress in school.

The more I learned from my auditory-verbal therapist, the more confident I became in my ability to manage everything from ensuring Noah’s hearing equipment was appropriately selected, fitted and maintained to navigating our insurance plan so Noah could benefit from the services/equipment he needed. I learned to create an ideal and positive listening environment in my home.  I gained confidence in managing Noah’s hearing needs.

Auditory-verbal therapy taught me that I was the case manager for my child. We have an entire team of people who work together for Noah. It used to be just Noah’s therapist and audiologist but now includes a teacher of the deaf, an educational audiologist, regular education teachers, and even our school principal. I believe that this group works best when the parent is the one who links them together. I know my child best and therefore I am truly the one who is going to do the best advocating.

Auditory-verbal therapy became a way of life, not an hour on a Friday morning. I was guided, coached and eventually expected to play the role of “therapist” for my child. And I did. Noah progressed and less than three years later was discharged from therapy.

Because I felt supported in the beginning,
I was perfectly set up to blossom into a parent who was empowered.

Being empowered, in my opinion, is the greatest gift that auditory-verbal therapy gave me as a parent.


101 Frequently Asked Questions About Auditory-Verbal Practice edited by Warren Estabrooks.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/what-parents-value-most-about-auditory-verbal-therapy), as being the originator of the content.

Common Myths about AVT (part 1 of series)

Karen MacIver-Lux


I once attended a conference of audiologists and while waiting for the shuttle bus to take me back to the hotel, an audiologist approached me to ask how I was enjoying the conference. After we had exchanged introductions and information about our practices, she asked a number of questions that we have decided to share in a series of blogs in the hope that we can dispel some of the misunderstandings about Auditory-Verbal Therapy. 

Question One:
“Why do you auditory-verbal therapists insist on covering your lips while speaking?  It’s so unnatural looking, don’t you think?”

Ah.  The hand cue.  Yes, it is unnatural looking.

Advances in hearing science and hearing technology over the past few decades have caused auditory-verbal therapists around the world to reconsider their use of the hand cue. Historically the hand cue has been used to prevent speechreading but in actual fact it makes it more difficult for children with hearing loss to hear the speech clearly.  In my opinion, it also sends a subliminal message to the child that we don’t trust that they are listening unless we cover our lips. If we don’t trust their listening, how can they learn to trust their own hearing and listening skills?  Auditory-verbal therapists are now using alternative techniques and strategies to encourage children to listen.  In the 101 FAQs about AVT (page 113), there is an excellent response regarding the use of the hand cue in Auditory-Verbal practice and alternative techniques that can be used to foster confidence in listening.

Question Two:
“I thought that if you cover your lips when you speak, then it’s called Auditory-Verbal Therapy!  I’m confused!”

There is a lot more to Auditory-Verbal Therapy than just encouraging children to listen.  In fact, in the auditory-verbal approach, the parent(s)/caregiver(s) are the primary clients, not the children.  In every session, the auditory-verbal therapist invites the parent(s)/ caregiver(s) to actively observe and participate during the process of:

  1. selecting and using techniques and strategies that are used to gain diagnostic information about the child’s current skills in areas of audition, speech, language, cognition and communication during the session and at home;
  2. selecting session targets and long term goals that are appropriate according to the child’s chronological age, hearing age, developmental age, culture and interests.  Parents learn to navigate and document their child’s acquisition of developmental milestones with their hearing technology;
  3. choosing which techniques and strategies work best in helping make spoken language and the sounds of the environment easier for the child to hear and process;
  4. reporting on the child’s current skills, strengths and challenges and advocating for additional supportive services when necessary; managing the child’s hearing health, use of and benefit from hearing technology, and accessibility to learning opportunities (within and outside an educational setting) that’s easy to hear;
  5. transferring the above learned skills to their children so they can take responsibility for their own hearing, listening and spoken communication skills, and their self advocacy during all life situations.

Question Three:
“Aren’t those who follow the auditory-verbal approach against American Sign Language (ASL), Cued Speech, and other intervention approaches that include the use of visual cues?”

Every child with hearing loss is unique so it is important that parents of children who have hearing loss have an abundance of options when it comes to choosing an intervention approach that best meets the needs of their child and the family.  It is absolutely crucial, that no matter the decision, the family’s choice is respected and supported by all professionals with whom the family comes in contact with.

Karen in therapy session

There are some auditory-verbal professionals who are proficient in sign language but the majority are not.  There are some children and parents who come to auditory-verbal therapy with some sign language skills, but most do not.

When families choose the auditory-verbal approach, they make a commitment to help their children learn spoken language through listening with appropriately fitted hearing technology by following the Ten Guiding Principles of Auditory-Verbal Practice, and engaging the guidance of an auditory-verbal professional.  Although the auditory-verbal professional would not provide sign language instruction, it does not mean that an auditory-verbal therapist would discourage a child from using sign language if that is indeed what the child currently uses to communicate.

Here’s an example of an Auditory-Verbal Therapy session I conducted with a child who was using sign language when I began seeing her.

Sally is a child with a bilateral profound hearing loss who at 18 months of age had developed age appropriate skills in sign language.  Sally’s parents made the decision to proceed with cochlear implantation, and just prior to activation of her cochlear implant, enrolled her into the auditory-verbal therapy program. At the time of Sally’s first auditory-verbal session, she had been listening with her cochlear implant for one week and her chronological age was 20 months.   After providing Sally’s mom with the session targets (a few of which are listed below), I proceeded to begin the Learning to Listen (LTL) Sounds lesson.

Audition: Show detection responses to all LTL sounds by stopping activity, turning head in the direction of the sound, and pointing to their ear (“I hear that!”)

Speech: Make approximations of the LTL sounds using vowel sounds and match suprasegmental features of speech.

Language: Follow simple directions such as “Wave bye bye!”

Cognition: Demonstrate evidence of associating the LTL sound with the object (sound-object association) and associate the LTL sound with the known sign.

Communication: Demonstrate appropriate eye contact with the speaker; make attempts to put verbal approximations or LTL sounds with natural or signed gestures.

While Sally was engaged in a quick cuddle with mom, I quickly placed a dog wind-up toy in a little box and shook it and waited.  Sally became quiet and looked at her mom.

After waiting a few seconds more, I shook the box again and waited.  Sally looked over in my direction where she saw the box.  I pointed to my ear and said, “Did you hear that Sally?”

Sally leaned over to take a closer look at the box and looked back at her mother and made the sign for box.  Mom nodded her head and said, “Yes! Karen has a box!”

I laughed and Sally looked over at me.  “Did you hear me laugh? Let’s listen to the box again.” And I shook the box.

Mom said, “I hear something in the box.  Karen, what is it?”

I replied, “It’s a dog! Do you know what the dog says?”

Mom replied by saying “Woof, woof” and then she waited.   Sally looked over at mom, smiled and mom exclaimed, “You heard the doggie!”

After waiting a few more seconds, I said, “woof, woof!”  Sally turned in my direction, and I smiled “I think you heard the dog again! Let’s open the box and see what’s inside!”

When we opened the box, Sally smiled and made the sign for the dog.  Mom replied, “Yes, it’s a dog!  You’re right!”

I then proceeded to guide the mom to make the sound for the dog, and look expectantly at Sally.

Sally repeated the sign for the dog and looked at me.  I smiled and said, “You have the dog!  Lucky girl!  Let’s play with the dog.”

Over the next few minutes we proceeded to take turns making the dog walk, bark, jump, run around and around.  After Mom and I barked a few times, Sally said “mm mm!”  Mom said, “Yeah, I heard your doggie go woof, woof!”

Once it appeared that Sally was becoming disinterested in the dog, I said, “Let’s put the doggie away in the bucket and bring out a new toy.  Wave bye-bye!”  We all took turns waving to the doggie and put the dog in the bucket.

The lesson continued with the rest of the LTL toys.  Throughout the session, we monitored Sally’s auditory responses to our voices, to the LTL sounds, and the spoken language we provided.  After following the same routine with five more toys, Sally began to show understand of the direction by waving every time someone said, “Wave bye-bye!” Mom and I discussed and recorded Sally’s auditory responses, signs, and spoken language attempts.  We then discussed ways that Mom could incorporate LTL sounds into the family’s daily routines.

Signs made by the children during auditory-verbal sessions are acknowledged and responded to by using spoken language, facial expressions and gestures.  At no point do I discourage a child from using sign language.  I demonstrate to the parent(s) and caregiver(s) the use of techniques and strategies that will support the development of spoken language primarily through hearing and listening with the children’s hearing technology and I quickly hand over the activities to the parents so they can practice while I coach on the sidelines.  After all, it is the parents who are their children’s primary spoken language models.

Auditory-verbal therapists are privileged to be members of a team of professionals supporting families who are helping their children with hearing loss reach their highest listening and spoken communication potential.  It is a truly privilege to be a part of this wonderful profession, and I endeavour serve all families and professionals with respect, integrity and kindness as their auditory-verbal therapist.


Resources: 101 FAQs About Auditory-Verbal Practice (Estabrooks, 2012): renowned experts in the field provide up-to-date information — current theory, practice, and evidence based outcomes. 101 FAQs offers knowledge, guidance and encouragement for speech-language pathologists, audiologists, teachers, doctors, schools, and parents.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/common-myths-about-avt-part-1), as being the originator of the content.

Do I need an AVT therapy room in my house?

Melanie Ribich short bio

Two of the questions I used to ask myself was, do I need to set up a therapy room in my house? How often do I need to sit down and do therapy with my child?

Elizabeth Rosenzweig of Cochlear Implant Online wrote, “in Auditory-Verbal Therapy, parents come to center stage to play a key role in the show.”

As a mom, I realize that active parent involvement in the therapy process is key to my son’s success and came to understand that was crucial for me to learn how to be my son’s pseudo therapist. Even with the best therapy, one hour once a week was not going to be enough for him to develop age-appropriate listening and spoken communication skills.

I have to admit, that although I loved the idea of being in charge
of my son’s progress, I was pretty worried during the early stages
of my son’s auditory-verbal intervention.

I learned that children with hearing loss need to hear a word or phrase three to four times more often than children with typical hearing before they master it receptively and expressively. I learned that 95% of a child’s receptive and expressive prowess is gained through overhearing adults engaged in conversational exchanges at extended distances.

Prior to cochlear implants, my son couldn’t hear a thing with his hearing aids. How was my son going to overhear my husband and I talk if he couldn’t hear? How was I going to do all that I needed to do, without replicating exactly what our therapist did with Noah every week when she came to our home?

AVT sessions do not consist of the therapist simply disseminating information, but rather, it’s an hour of therapist demonstration and parent practice with the purpose of enabling parents to feel confident using techniques and strategies that encourage the development of spoken language through listening. Auditory-verbal therapists understand that therapy is a process that does not end when their hour does. They guide and coach parents in creating and maximizing listening and spoken learning opportunities within their daily routines.

How was I ever going to find the time, resources,
and creativity to replicate what my therapist was able to do
every Friday morning in our living room? I felt that I had to
set aside specific time to “do therapy” with my son.

Or did I?

It wasn’t long before I learned that my world is my son’s oyster of listening and spoken language opportunities.

My auditory-verbal therapist emphasized that my son’s world (e.g. home, car, grocery store, apple orchard, etc.) is the most natural place for him to learn spoken language through listening.

I was reminded that my husband, my daughter and Noah’s twin brother are Noah’s primary spoken language models. I learned that we, as a family unit, know my son’s skills and interest the best.

The Auditory-verbal therapist taught me how to elicit a response from Noah. I learned to wait, pause and to allow him time for him to process the information he heard and to answer for himself. The therapist guided me though typical developmental norms in listening and spoken language and with her help I learned what Noah needed to learn each week. It was up to me to teach him what he needed to learn.

I quickly learned that it’s not practical or convenient (nor is it natural) to have a specific time during each day to “do therapy.” I learned that I didn’t need a therapy room in my house. I learned that every waking hour consists of golden opportunities that will enable my son to develop listening and spoken communication skills. Every hour of every day in the life of our family became the “real therapy session” as opposed to the therapy session in the therapist’s office or our living room.

The “real therapy session” involved anything and everything.
My husband and I could do it any time, any place. It was easy to
involve our other children in the activities we planned.
We quickly saw that all three of our children benefitted, not just Noah.

When my boys were very little I used to walk them around our neighbourhood and narrate as I walked. I would comment on the trees, the weather, the birds, cars, airplanes, anything I saw that I could talk about and point out to them. When the weather was cold, I took them to a local mall and did the same thing. I became very good at narrating while I folded laundry and cleaned the kitchen. Narrating mundane tasks is therapy. It is real life language. Any opportunity to hear rich language was one I took advantage of.

We went to the library almost every day. I found that the more books that I read, the better Noah’s attention span became. Initially, Noah was only able to listen for just a minute or two. Now at six years of age, he is a bookworm whose appetite for listening to a story seems endless.

Not only did children’s books provide the perfect opportunity for
grandparents and other family members to bond together with Noah,
but they also served as conversational starters.

Reading another copy of the book that was introduced by our therapist during her therapy session was also something I did repeatedly. For example, Noah and I read “The Carrot Seed” at home after it was introduced during a therapy session. We then bought carrot seeds and planted them in our garden and watched them grow. We bought carrots at the grocery store and peeled and chopped them in the kitchen. We ate carrots for lunch and dinner. We even baked with carrots. The therapy session was the springboard to the real language experience that happened in Noah’s everyday environment.

I learned to make homemade “experience books” which became great conversational starters. They weren’t anything fancy as I’m far from being a crafty mom, but they were quickly assembled books that contained stories, drawings about events, photos and things that were of high interest to Noah. Repeated exposure to the experience books not only helped my son to improve his speech clarity, expressive language, early literacy skills, but they also gave my extended family members a chance to understand his early communication and literacy attempts.

Noah's AVT space

Grocery shopping and cooking were full of listening and language learning opportunities. I had to shop and cook anyway! It was tailored to any topic or session target being worked on and was modified at varying ages and stages. When my kids were in high chairs, I used to narrate while cooking. When they were a little older, I would have them find certain foods (colours, shapes, food groups, etc) at the grocery store or the kitchen cupboard. I had Noah and his siblings measure, sort, and put ingredients together. The possibilities are endless when it comes to food and language!

Even today at six years old, Noah is always my first child to ask to help me in the kitchen. But now he is the one narrating to me. He is the one reading the recipe aloud step by step. He is the one commenting on how delicious the ingredients smell, describing how a particular food feels in his hands, how excited he is to taste the final result, and making suggestions of what we should cook next time.

Developing skills that will help integrate listening into the
personality of a child with hearing loss does not happen solely
in a therapy session. It does not require a therapy room in the house,
fancy equipment or a even crafty mom.

I have learned that what is required is an open mind and heart, a willingness to explore the world through your child’s eyes and ears with your knowledge and skills learned from the weekly auditory-verbal therapy sessions.

Resources: Cochlear Implants Online


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/do-i-need-an-a…om-in-my-house), as being the originator of the content.

Importance of Relationship between Audiologists and AVTs

Stacey Lim bio


No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.

-John Donne

Although it goes without saying that an auditory-verbal therapist (AVT) and the family are integral components of a child’s spoken language development, the Audiologist also plays an important role.  Audiologists fulfill the auditory needs of the child by providing ongoing audiological assessments, ensuring the use of appropriate hearing aids and/or cochlear implants and FM systems.  These fall within the scope of audiology practice, as well as the guiding principles of auditory-verbal therapy.

Working with an auditory-verbal family and AVT requires the
development of a symbiotic relationship that promotes
the child’s spoken language development.

As an auditory-verbal graduate, I have been fortunate to benefit from the relationship between my Audiologist and my AVTs, who worked closely with each other and with my parents to create the best kind of opportunities for me to learn spoken language.   As an Audiologist, I have been fortunate to have been in environments where the development of a relationship with Speech-language pathologists and AVTs not only is possible, but also encouraged. As a graduate audiology student, I had the opportunity to work closely with the AV clinic at my graduate institution.

First, in the therapy sessions with my fellow speech-language pathology classmates, I was also providing auditory-verbal/auditory-based habilitation, with a stronger focus on auditory skills development.

Second, during my audiology practicum clinic assignments, we shared information from the sessions with the child’s AV clinicians.  If the child’s graduate SLP clinician was available to come to the audiological evaluation, it was not just welcome, but also encouraged.  Through this relationship and inclusion in each other’s professional domains, we could see the relationship between access to sound and language/speech development.

It is these personal and professional experiences that lead me to the conclusion that having an Audiologist on the AV team is highly beneficial.


One of the key relationships in auditory-verbal practice is the one developed between the Audiologist and the AVT. The AVT will see the child on a very regular, frequent basis, such as weekly or even more, while the Audiologist may only see the child once a year or several times a year. The AVT can closely monitor the child’s auditory development and any changes in the child’s listening abilities during the AV sessions. If the AVT notices a change in the child’s perception of sound or speech production, one of the potential causes of this change in speech production or perception could be a change in auditory access.  Ideally, the AVT would recommend that the family make an appointment with the child’s Audiologist.

Prior to the child’s audiological appointment, the AVT can provide the Audiologist with a list of phonemes or sounds that are being misinterpreted or are no longer being produced clearly.  Armed with this information, the Audiologist can check the child’s hearing aids, reprogram them, or if the child is a cochlear implant user, re-map the child. All these would go toward the goal of ensuring that the child has full access to those phonemes.

Further, to ensure that the AVT and child’s caregivers know what access the child has to sound, the Audiologist can provide these partners in the child’s auditory development with the results of the audiological evaluation, hearing aid programming sessions, or cochlear implant mapping session.

By sharing this information with each other, the AVT and the Audiologist ensure that the child’s auditory skills and language development will continue to grow.

Not only do the Audiologist’s roles include the optimization of auditory devices and ongoing assessments, but also includes working with the family and the AVT to promote emerging auditory skills that carry-over into daily life. For example, telephone usage is one of the most challenging activities for individuals with hearing loss. In addition, ensuring that the child’s hearing aids or cochlear implant devices are compatible with the chosen telephone option, the Audiologist can work with the family and AVT to select appropriate telephone accessories, such as amplifiers or cords that connect the phone to the hearing aid/cochlear implant, etc. The Audiologist and AVT can also work together to ensure that these telephone accessories are appropriate and that the child’s hearing devices are effective for telephone use. The AVT could, for example, incorporate telephone practice into the auditory-verbal session, and provide the Audiologist with information about how the child was able to communicate on the telephone.

Working together, the Audiologist and AVT become partners and
combine technology and practice to maximize the child’s

listening abilities in different situations.

This is by no means the only way that Audiologists and AVTs can have a relationship that fosters the child’s development.

One of the other principles of auditory-verbal practice is also mainstreaming in a regular education classroom.  Again, providing appropriate auditory access to educational material is important for language learning, as well as expanding world knowledge. The Audiologist can work with the auditory-verbal family to ensure that appropriate assistive technology (e.g., FM systems) are being used in the classroom.

Moreover, the Audiologist can work with the child’s school to make sure that the FM system is being used correctly by their teachers. The Audiologist can also provide in-service training to educate the child’s teachers about hearing aids, cochlear implants, FM systems, and the importance of auditory access in the educational environment, as well as be a part of the child’s IEP team.

As a guide through the child’s landscape of listening, the Audiologist can work with both the family and the AVT to navigate the intricacies of auditory skills, auditory perception, and hearing technologies.

Working closely with the AVT and the child’s caregivers allows the
Audiologists to see the child’s developmental milestones,

as well as the needs of both the child and the family.

Because hearing and auditory access are such critical components of auditory-verbal practice, the Audiologist is a part of the “continent” of auditory-verbal life.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/relationship-between-audiologist-and-avt), as being the originator of the content.


Raising an Auditory-Verbal Therapist

Karen  MacIver-Lux

From an early age, I knew I was a privileged little girl.

My idea of privilege, however, had nothing to do with money, popularity, or good looks. For me, it was being able to hear with easy-to-hide hearing aids, and not having to wear eye-glasses like my best friend did.

That and being able to hear and speak English, which was downright difficult to learn with a bilateral severe to profound hearing loss with ’70’s hearing technology.

It took my mother, and a small village of trusted professionals to raise me to be the joyful listener and speaker that I am.

Once I grew up I became determined to “give back”, ultimately studying to become an audiologist and training to be an LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVTTM).

Over the years, I have adopted a number of practices that continue to help me in my endeavours to be the best AVT that I can be. The following tips are a few that I share with budding auditory-verbal therapists:

Adopt the 'Yes We Can' philosophyWhat made learning to speak difficult was not only the limitations of the ’70’s hearing technology, but also the many well-meaning professionals who categorically told my mother that I’d never learn to talk, never go to school, and would never get a job.

Luckily for me, if you want my mom to do something, just tell her she can’t do it, and she will do it just to prove you wrong.  Despite her determined “yes we can” philosophy, it was extremely disheartening to hear the negativity over and over again.  What did it accomplish other than to create days and nights of tears and anxiety?  Nothing.

During my years in practice I have observed that parents want and need to feel encouraged in order to see the value of consistent hearing technology use and weekly auditory-verbal therapy sessions. They are, after all, my primary clients.

“Clinical positivity” (reporting positive aspects of clinical findings and observations) is what breeds encouragement and plants the seeds of success.

Some examples of “clinical positivity” include:

  • explaining to the parents what their child with hearing loss CAN hear at time of diagnosis,
  • pointing out those occasions when their child showed positive outcomes in areas of audition, speech, language, cognition and communication,
  • being positive and when in doubt, use expressions like, “I don’t know, but let’s try!”

Learn to ListenYes, as a therapist I, too, need to learn to listen—not only to the children, but more importantly, their parents/caregivers.  When a parent/caregiver begins talking, I have learned to become quiet, lean in, wait (even when there is a pregnant pause), and most of all, maintain eye contact.

Therapy session

When parents speak out of frustration or anger, I try to listen and resist the urge to defend, explain and justify.  I focus on being an active and compassionate listener. Summarizing what I heard can be very helpful to them and to me.  I respond carefully to their concerns or issues once I am sure of their perspective. I try to put myself in the parents’ shoes and imagine what it must feel like raising a child while feeling uncertain of what the future holds.

I have been guilty of “listening” to parents while putting away toys, wiping the table, or writing notes in my chart.

Please don’t do this.  Parents look forward to having the opportunity to share their progress and their child with you, not the back of your head.

Keep your mentor closeI am fortunate to have a mentor to turn to for honest feedback, support, and professional guidance.

I don’t always like what I hear, but I’ve learned through experience to listen carefully to what he says, not to take criticism or constructive feedback personally, and when I disagree, to go ahead and try what he suggested because it usually ends up being the best advice.  He has earned my trust.

Find a mentor that you admire and trust—a good mentor who takes the time to listen to your stories of challenges and successes, a person who will support and encourage you in your growth as a career professional.

Don't Forget the Child’s Eye View (and Smell)

As a child I endured many years of therapy in a room with grey walls devoid of pictures, cabinets full of toys and treasures hiding behind locked doors, a tiny table and uncomfortable chairs that were either too small or big, and a room so big that the sound reverberated. I vowed that my therapy room (and sound booth) would be a cozy play-land with lots of bright colours, interesting toys, inviting books and pictures to look at.  I want the children and their families to see, hear, feel, love, and eagerly anticipate the meaningful auditory and spoken language opportunities I create for them.

Imagine that you are a child who cannot hear.  Stuff your ears with earplugs and get on your knees and crawl into your therapy room.  What does it look like?  What does it sound like? Is your therapy room warm and inviting?  Would you want to spend time in this room every week for three to five years?

I suggest refraining from drinking coffee, smoking, or eating strong-smelling foods before conducting a therapy session.

Pay attention to personal hygiene (which includes perfume).  As much as I hate to say it, there is nothing worse than sitting for an hour with a therapist who has a pungent smell.

Pay attention to the child’s personal space. I hated it when my therapists tapped me on the shoulder or hands, so I make a conscious effort not to do the same. If I need to be closer than 8 inches to the microphone of the child’s technology in order for the child to detect the entire speech spectrum, then I know I’m too close for the child’s comfort. The child will feel that you are breathing down their neck.

All of these are enough to turn a child who loves to please into a child who refuses to cooperate!

Remember the ‘Two Weeks and Then Move On’ Rule

I’ll never forget the day I started seeing a client who my mentor had been teaching.  I remember feeling so nervous!  How was I ever going to do therapy as well as my mentor did?

He made the sessions look so easy to do!  When it was my turn in the hot seat, I found myself stressing over which techniques and strategies to use and generally, making a big mess of things.

“Rome wasn’t built in a day” I reminded myself, deciding to focus on one technique—study it and practice it for two weeks.

If I mastered the use of the technique during therapy sessions, great!  If I didn’t, it was time for me to move on to another technique.  I would come back to the un-mastered technique some other time.  I even involved the parents in the process of helping me learn and use the techniques and strategies and we had fun learning together and laughing at our mistakes.

Unlike learning to acquire listening and spoken language skills, learning the tricks of the auditory-verbal trade is a career-long process— a process that is bound to be frustrating yet very rewarding at the same time.

To those of you who are budding AVTs, welcome to the world of auditory-verbal practice!  For those of us who are seasoned auditory-verbal therapists, we owe it to the children to find ways to raise the bar in auditory-verbal practice.


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/raising-an-auditory-verbal-therapist), as being the originator of the content.