Guest Post: Auditory Verbal Therapy for the Deaf and Hard of Hearing

Gues Post on AVTAuditory Verbal Therapy (AVT) for the Deaf and Hard of Hearing


Wendy Visser, M.Ed, Dipl. Auditory Verbal Studies


 “Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012)(3,4) .

Over the last 10 years, early identification thru newborn screenings and improvements in technology, it is possible for most children who are deaf or hard of hearing to learn to listen and speak as well as their hearing peers. Children are being implanted as early as 2 months in Italy, 10-12 months in Canada, and 12 months in the United States (1).  The cochlea is fully formed in utero by 20 weeks.  This means that the fetus is able to hear for almost half of the pregnancy.  If the child is deaf, they have already lost almost 4.5 months of listening, at birth.  Once the cochlea is formed it does not change in size, so the surgery can be done as early as deemed possible in the country they live in (2).

It is important to start Auditory Verbal Therapy (AVT) as soon as possible, often before the surgery.   Any residual hearing can allow the child to begin to listen for auditory stimuli.  AVT is done with a therapist, the parent(s) and the child.  It is essential to continually develop listening opportunities during waking hours.  As the child grows they will learn to listen for particular sounds, their name and environmental sounds. Once they begin to babble and are capable to re-produce sounds, the children are taught to imitate sounds and recognize items that are age-appropriate to their hearing age.  A child’s hearing age is determined by the chronological age less the age of amplification, whether it be a CI or a hearing aid.  Family participation is a crucial part of AVT.  The therapist is only working with the child a few hours a week.  The therapist can provide coaching and guidance through activities and suggests ways to work on particular goals from the sessions. Typically, children who are implanted early and receive regular therapy and consistent work at home, can enter school with appropriate speech and listening skills as their hearing peers.

The Alexander Graham Bell Association for Listening and Spoken Language allows Speech Language Pathologists, Audiologists and Teachers of the Deaf and Hard of Hearing (with a Master’s degree) to find a mentor and prepare for the international qualification exam. The AG Bell Academy has designated two paths to certification for Auditory-Verbal practitioners: LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVT) and the LSLS Certified Auditory-Verbal Educator (LSLS Cert. AVEd). The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam.

There are various programs around North America that also provide training and mentorship such as the University of Ottawa, in Ontario, Canada and the John Tracy Clinic, in conjunction with St. Mary’s University, in California.  Once the practicum is complete, students are required to take the exam through AG Bell, to be fully certified as a LSLS AVT. (Listening and Spoken Language Specialist), Auditory Verbal Therapy.  There are only approximately 600 certified specialists, worldwide.

The Academy has endorsed a set of principles that delineate the practice of Auditory-Verbal Therapy:

The Principles of Auditory-Verbal Therapy: Defining Practice

  1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal Therapy;
  2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation;
  3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language;
  4. Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized Auditory-Verbal Therapy;
  5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities;
  6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life;
  7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication;
  8. Guide and coach parents to help their child self-monitor spoken language through listening;
  9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress, and to evaluate the effectiveness of the plans for the child and family; and
  10. Promote education in regular school with peers who have typical hearing and with appropriate services from early childhood onwards (3)

For more information, please see AG Bell’s website at

With the ongoing improvements in technology, another branch of AV therapy is expanding.  Teletherapy or telepractice is becoming an excellent option for students who live in remote areas or who do not have any local therapy. The session is done through the Internet on FaceTime, Skype or another video conferencing site.  The child and parent are provided with the needed materials and the therapist leads them through various language based activities that can be repeated or transferred to other like situations in their daily lives.  The challenge of this therapy, is the coaching aspect of the therapist as they are not there to demonstrate the activity.  It is seen as a very effective and respected form of therapy.  I am interested in learning more about the possibilities of teletherapy and telepractice and how I could integrate this into my own practice.

If you have any questions, please contact me.  If I do not know the answer, I am sure I can point you in the right direction.  It is a very rewarding field of study and I truly enjoy watching my students progress. Even the smallest achievement makes me so proud of the work the child and families do to improve their ability to learn to listen and use spoken language.



Wendy is located in Ottawa, Ontario, Canada  is beginning her 17th year as a teacher.  She completed her Master’s in Education and Teacher of the Deaf qualifications, in 2006.  Last year, she received my post-grad Diploma in Auditory Verbal Studies through the University of Ottawa.  Currently, Wendy provides (bilingual – French and English) private services to a small group of students on a 1:1 basis.  In addition, she is an Itinerant Resource Teacher at her local school board.  Her LSLS certification exam will be in 2014. You can find Wendy on Facebook and on TpT