Auditory Verbal Therapy (AVT) is a highly specialist early parenting intervention to support deaf children aged 0 to 5 years. The intervention works with parents to help their child make best use of hearing technology and support listening and spoken language development through play-based therapy sessions.
It is delivered at Auditory Verbal UK (AVUK) centres, by Listening and Spoken Language Specialist certified Auditory Verbal practitioners who have undergone additional specialist training after qualification as speech and language therapists, teachers of the deaf, or audiologists.
The information above is as offered/supported by the intervention provider.
0 to 5 years old
Individual
Auditory Verbal Therapy (AVT) is a highly specialist early parenting intervention, which equips parents and carers with the skills to maximise their deaf child’s listening and spoken language. The intervention is designed for children with hearing loss between the ages of 0 and 5 years and aims to improve children’s listening and language skills, and academic outcomes.
AVT focuses on the development of spoken language through listening. Through play-based therapy sessions, parents/carers are coached and empowered with the tools to develop their child’s listening, talking, thinking and social skills from an early age. Parents are coached by a certified Auditory Verbal practitioner in play-based sessions with their child in how to develop their child’s listening so that listening becomes part of their personality.
Play activities are set at a cognitively appropriate level and may include activities such as instructional activities (e.g. making cupcakes) to develop auditory comprehension and auditory memory skills, role-play activities and storytelling (e.g. with dolls or toy people) to develop expressive language, social skills, and theory of mind. Parents are coached in how to frame these activities to allow their child to develop and improve their listening, thinking and spoken language skills. The intervention enables parents/carers to help their child to make the best possible use of their hearing technology (usually hearing aids or auditory implants).
AVT is delivered in between 40 to 60 fortnightly hour-long sessions, over a period of two to three years, by one practitioner to parents/caregivers. It is delivered by Listening and Spoken Language Specialist certified Auditory Verbal practitioners who have undergone additional specialist training after qualification as speech and language therapists, teachers of the deaf, or audiologists. In addition, a family support officer provides two parent consultation sessions per year, and additional support if required/requested, for each family on the intervention. It is delivered at Auditory Verbal UK (AVUK) centres.
0 to 5 years
Children aged 0 to 5 years who have hearing loss
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Deaf children can be deprived of auditory brain stimulation, and they can experience delays in spoken language.
Science-based assumption
Optimally functioning hearing technology and Auditory Verbal techniques protect deaf children from deprivation of auditory brain stimulation, underdeveloped listening behaviours and delays in spoken language.
Science-based assumption
Children aged 0 to 5 years who have hearing loss.
Intervention
The intervention coaches parents in Auditory Verbal techniques, such as checking and troubleshooting hearing technology, promoting listening behaviours with comprehension, and expression of spoken language, together with developing social skills and theory of mind.
Short-term
Deaf children are better able to develop listening and spoken language skills.
Medium-term
Existing language delays can be reduced, and deaf children can develop age-appropriate language.
Long-term
Children are better able to access a mainstream school curriculum, fulfil their educational potential, make and keep friends at school, and access equal opportunities in further education and employment.
Children aged between 0 and 5 years with hearing loss.
AVT is delivered in between 40 to 60 fortnightly hour-long sessions, over a period of two to three years, by one practitioner to parents/caregivers.
Parents are coached by a certified Auditory Verbal practitioner in play-based sessions with their child in how to develop their child’s listening, incorporating the child’s hearing technology if appropriate.
Play activities are set at a cognitively appropriate level and may include activities such as instructional activities (e.g. making cupcakes) to develop auditory comprehension and auditory memory skills, role-play activities and storytelling (e.g. with dolls or toy people) to develop expressive language, social skills, and theory of mind.
Parents are coached in how to frame these activities to allow their child to develop and improve their listening, thinking, and spoken language skills.
The practitioner who delivers this intervention is a Listening and Spoken Language Specialist (LSLS) certified Auditory Verbal practitioner.
In addition, a family support officer provides two parent consultation sessions per year, and additional support if required/requested, for each family on the intervention.
The Listening and Spoken Language Specialists have 124 hours of intervention training. Booster training of practitioners is recommended.
It is recommended that practitioners are supervised by one host-agency supervisor, who have received 124 hours of intervention training.
Intervention fidelity is maintained through the following processes:
Contact person: Rachel French
Organisation: Auditory Verbal UK
Email address: info@avuk.org
Website: https://www.avuk.org/
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
Auditory Verbal’s most rigorous evidence comes from two QEDs and a one-group pre–post study which were conducted in the UK, Israel, and Australia.
These studies identified statistically significant positive impact on a number of child outcomes, including improved maths grades, increased likelihood of high school graduation, and improved language and communication abilities.
While the reviewed studies are limited by methodological issues pertaining to the lack of a comparison group which has been sufficiently demonstrated to be equivalent to the treatment group, the intervention received a Level 2+ on the basis of the weight and context of evidence – in particular, the fact that a large number of studies have assessed the impact of Auditory Verbal and have consistently found large effects across different contexts/countries.
This intervention has preliminary evidence of improving a child outcome, but we cannot be confident that the intervention caused the improvement.
| Identified in search | 20 |
| Studies reviewed | 2 |
| Meeting the L2 threshold | 2 |
| Meeting the L3 threshold | 0 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 18 |
| Study design | QED |
| Country | Israel |
| Sample characteristics | 52 young people with hearing loss, aged between 18 and 29 |
| Race, ethnicities, and nationalities | Not reported |
| Population risk factors | Young people with hearing loss, the majority with profound hearing loss and using a cochlear implant |
| Timing | Post-intervention |
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 2 |
| Citations | Goldblat, E. & Pinto, O. Y. (2017) Academic outcomes of adolescents and young adults with hearing loss who received auditory-verbal therapy. Deafness & Education International. 19 (3–4), 126–133. |
| Study design | Pre–post |
| Country | UK |
| Sample characteristics | 37 children with permanent hearing impairment |
| Race, ethnicities, and nationalities | Not reported |
| Population risk factors | All the subjects had permanent bilateral hearing loss and used hearing technology (hearing aids and/or cochlear implant system). 22 children (60%) had profound hearing loss, 10 (27%) had severe hearing loss, and 5 (13%) had moderate hearing loss in the better hearing ear. 12 children (32%) had difficulties in addition to hearing loss. 5 of the children were born prematurely and had developmental delay, 2 had long-term sensory integration difficulties (1 of whom also had a language disorder), 1 had motor difficulties and partial vocal fold paralysis, and 7 of the 12 children were diagnosed with sensory integration difficulty. |
| Timing | Baseline and then at six-month intervals, including after intervention completion |
| Child outcomes | Increased rate of language development (expressive and receptive language) (researcher administered test) |
| Other outcomes | None |
| Study rating | 2 |
| Citations | Hogan, S., Stokes, J., White, C., Tyszkiewicz, E. & Woolgar, A. (2008) An evaluation of auditory verbal therapy using the rate of early language development as an outcome measure. Deafness & Education International. 10 (3), 143–167. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Auditory Verbal UK (2016). Investing in a sound future for deaf children: A cost benefit analysis of auditory verbal therapy at Auditory verbal.
Constantinescu, G., Phillips, R. L., Davis, A., Dornan, D. & Hogan, A. (2015) Exploring the impact of spoken language on social inclusion for children with hearing loss in listening and spoken language early intervention. The Volta Review. 115 (2), 153–181.
Constantinescu, G., Waite, M., Dornan, D., Rushbrooke, E., Brown, J., Close, L. & McGovern, J. (2007). Outcomes of an Auditory-Verbal Therapy programme for young children with hearing loss. The Volta Review. 107 (1).
Constantinescu-Sharpe, G., Phillips, R. L., Davis, A., Dornan, D. & Hogan, A. (2017) Social inclusion for children with hearing loss in listening and spoken Language early intervention: An exploratory study. BMC Pediatrics. 17 (1), 74.
Dettman, S. J., Dowell, R. C., Choo, D., Arnott, W., Abrahams, Y., Davis, A., … & Briggs, R. J. (2016) Long-term communication outcomes for children receiving cochlear implants younger than 12 months: A multicenter study. Otology & Neurotology. 37 (2), e82–e95.
Dettman, S., Wall, E., Constantinescu, G. & Dowell, R. (2013) Communication outcomes for groups of children using cochlear implants enrolled in auditory-verbal, aural-oral, and bilingual-bicultural early intervention programs. Otology & Neurotology. 34 (3), b451–459.
Dornan, D., Hickson, L., Murdoch, B. & Houston, T. (2009) Longitudinal study of speech perception, speech, and language for children with hearing loss in an auditory-verbal therapy program. The Volta Review. 109 (2–3), 61–85.
Easterbrooks, S. R., O’Rourke, C. M. & Todd, N. W. (2000) Child and family factors associated with deaf children’s success in auditory verbal therapy. American Journal of Otology. 21 (3), 341–4.
First Voice. (2015). Sound outcomes: First Voice speech and language data.
Fulcher, A., Purcell, A. A., Baker, E. & Munro, N. (2012) Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age. International Journal of Pediatric Otorhinolaryngology. 76, 1785–1794.
Hitchins, A. R. & Hogan, S. C. (2018) Outcomes of early intervention for deaf children with additional needs following an Auditory Verbal approach to communication. International Journal of Pediatric Otorhinolaryngology. 115, 125–132.
Hogan, S. (2016). The Auditory Verbal Approach in the UK: A 10 year audit of outcomes for pre-school children in the UK. British Society of Audiology Annual Conference.
Hogan, S., Stokes, J. & Weller, I. (2010) Language outcomes for children of low-income families enrolled in Auditory Verbal Therapy. Deafness & Education International. 12 (4) 204–216.
Kaipa, R. & Danser, M, L. (2016) Efficacy of auditory-verbal therapy in children with hearing impairment: A systematic review from 1993 to 2015. International Journal of Pediatric Otorhinolaryngology. 86, 124–134.
Percy-Smith, L., Hallstrøm, M., Josvassen, J. L., Mikkelsen, J. H., Nissen, L., Dieleman, E. & Cayé-Thomasen, P. (2018) Differences and similarities in early vocabulary development between children with hearing aids and children with cochlear implant enrolled in 3-year auditory verbal intervention. International Journal of Pediatric Otorhinolaryngology. 108, 67–72.
Percy-Smith, L., Tønning, T. L., Josvassen, J. L., Mikkelsen, J. H., Nissen, L., Dieleman, E., & Cayé-Thomasen, P. (2017). Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants International. 19 (1), 38–45.
Percy-Smith, L., Tønning, T. L., Josvassen, J. L., Mikkelsen, J. H., Nissen, L., Dieleman, E., … & Cayé-Thomasen, P. (2018). Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants International. 19 (1), 38–45.
Rhoades, E. & Chisholm, T. (2000) Global language progress with an Auditory-Verbal approach for children who are deaf or hard of hearing. The Volta Review. 102, 5–24.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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