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Facilitating spoken language development in the regular classroom. September 28 th & 29 th Winnipeg, MB Petra Smith M.Sc. Aud (C) Audiologist/Certified Auditory Verbal Therapist. AV PRINCIPLES AND THE AV SESSION.

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facilitating spoken language development in the regular classroom

Facilitating spoken language development in the regular classroom

September 28th & 29th

Winnipeg, MB

Petra Smith M.Sc. Aud (C)

Audiologist/Certified Auditory Verbal Therapist

av principles and the av session

AV PRINCIPLES AND THE AV SESSION

How the auditory verbal therapist works with the children, their families and other professionals

auditory verbal services in manitoba
Auditory Verbal Services in Manitoba:
  • Located at the Central Speech & Hearing Clinic
  • Audiology Services & Family Centered Intervention
  • AVT for families with children using hearing aids or cochlear implants
  • Cochlear Implant Candidacy Evaluations & Device Programming
  • Aural rehabilitation for older students & adults with cochlear implants
  • Professional Development & Mentoring
  • Education

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

auditory verbal therapy avt
Auditory Verbal Therapy (AVT)

Who can deliver AVT?

Auditory Verbal Therapists are practising professionals in Speech & language Therapy, Audiology, or Education of the Deaf who have received specialised training

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

auditory verbal therapist experience training
Auditory Verbal Therapist – experience & training
  • SPEECH LANGUAGE PATHOLOGIST
  • EDUCATOR of children who are deaf or hard of hearing
  • AUDIOLOGIST
  • Certified by A G Bell:

Listening and Spoken Language Specialist

www.agbellacademy.org

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

standardized curriculum for trainee therapists
Standardized Curriculum for Trainee Therapists:
  • History & Philosophy
  • Hearing & Audiology
  • Spoken Language Development
  • Parent Guidance
  • Cochlear Implants
  • Education in the mainstream
  • Auditory Verbal Practice

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

auditory verbal therapy avt1
Auditory Verbal Therapy (AVT)

What is AVT?

An individualised, auditory, developmental programme, implemented by the child’s family in close collaboration with a therapist, with the goal of achieving age appropriate spoken language ability, and full social participation throughout childhood and beyond.

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

auditory verbal therapy
Auditory Verbal Therapy..

…..is part of the Auditory Verbal Approach

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide9
THE AUDITORY VERBAL APPROACH“The auditory verbal approach is a mindset of expectations” (Pam Talbot, AVT)
  • Hearing and audiology
  • Parental involvement
  • Spoken Language Development
  • Education

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

ten principles of avt
Ten Principles of AVT
  • Adapted from the principles developed by Doreen Pollack, 1970
  • Adapted by the A G Bell Academy for Listening & Spoken Language, 2006

www.agbellacademy.org

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 1
AV Principle #1

“ Promote early diagnosis of hearing loss in newborns, infants, toddlers and children, followed by immediate audiologic management and auditory verbal therapy”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

hearing vs listening flexer 2005
Hearing vs Listening(Flexer, 2005)
  • Hearing is acoustic access to the brain. It includes improving the signal to noise ratio by managing the environment and utilizing hearing technology.
  • Listening is attending to acoustic events with intentionality.

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

hearing loss
Hearing loss
  • Hearing loss is not about the ears; it is about the brain.
  • Hearing aids, FM systems and cochlear implants are not about the ears; they are about the brain
  • (Flexer, 2005)

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

functional impact of hearing loss distance hearing
Functional impact of hearing loss:distance hearing

Flexer 1999

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

functional impact of hearing loss incidental learning
Functional impact of hearing loss: incidental learning

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

Flexer 1999

hearing loss auditory deprivation
Hearing loss = auditory deprivation

If caregivers want their child/ren to develop spoken language, early identification and optimal amplification =

“ a neurodevelopmental emergency”

(Flexer, 2005)

..due to the impact of auditory deprivation

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

neuroplasticity
Neuroplasticity
  • Greatest in the first three and a half years
  • The younger the infant, the greater the neuroplasticity
  • Rapid infant brain growth requires prompt intervention
  • No sound = reorganization of brain to receive other sensory information
  • No sound reduces auditory neural capacity

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

typical language development means
Typical Language Development Means..
  • Optimal use of the brain for skills human beings are pre-disposed to acquire – ie: spoken language
  • Best opportunity to achieve success in areas which must be taught – ie: reading

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

implications for intervention
Implications for Intervention

Developmental approach

…instead of….

Remedial approach

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide20
GOAL:

Universal Newborn Hearing Screening

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

goal at identification
Goal – at identification
  • Support families in making their decisions about:
  • Language of choice
  • Communication approaches

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

communication options
Communication Options:

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

manual oral
Manual Oral

Sign Spoken

Language Language

(ASL) (English/French etc)

---------------------------------------------------------------------

Bi-bi Auditory Verbal

Signed Exact English Aural-oral

Total Communication Cued Speech

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av therapist offers
AV therapist offers
  • Time to reflect, question, feel, grieve
  • Information – re:
  • Technology
  • Hearing
  • Spoken language development
  • General developmental issues
  • Action – what to do!
  • Contact with other families

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 2
AV Principle # 2

“ Recommend immediate assessment and use of appropriate, state of the art hearing technology to obtain maximum benefits of auditory stimulation”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

a good acoustic signal is needed for auditory stimulation
A good acoustic signal is needed for auditory stimulation

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

amplification improves quantity and quality of acoustic signal
Amplification – improves quantity and quality of acoustic signal

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

good audiological support
Good audiological support

Early identification of hearing loss

Accurate diagnosis

Optimal amplification

Early intervention

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

early amplification
Early amplification
  • Research shows that children who are identified with a hearing loss by six months of age, provided with optimal amplification and family based intervention, have the potential of entering kindergarten on a par with hearing peers.

Ref: Yoshinaga Itano

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

amplification
Amplification

Hearing aids

Cochlear implants

All require optimal fitting to allow access to spoken language.

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

advanced bionics 90k implant
Advanced Bionics 90k Implant

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

speech processors from advanced bionics
Speech Processors from Advanced Bionics

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

wireless fm with iconnect earhook
Wireless FM with iConnect earhook

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

freedom speech processors from cochlear corporation
Freedom Speech Processors from Cochlear Corporation

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

microlink freedom for the bte
MicroLink Freedom for the BTE
  • Seamlessly integrated into the BTE case
  • FM receiver can be left in place all the time

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 3
AV Principle # 3

“ Guide & coach parents to help their child use hearing as the primary sense modality in developing spoken language without the use of sign language or emphasis on lipreading”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

a person who really listens
A person who really listens
  • Is motivated
  • Has time and opportunity
  • Is attentive

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

auditory skills development
Auditory Skills Development

The auditory verbal approach seeks to maximize the use of audition in the development of spoken language.

Levels of auditory skills:

detection -> discrimination -> COMPREHENSION

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av goals infants toddlers
AV Goals – infants & toddlers

Supporting families in hearing aid fitting and evaluation by:

  • Facilitating use of amplification all waking hours
  • Monitoring prelinguistic vocalizations
  • Collaborating with audiologists - comparing hearing tests with functional measures of benefit

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

assess monitor facilitate
Assess, monitor & facilitate:
  • Auditory development:

awareness of sound

attaching meaning to sound

vocalizations

  • Eye gaze & joint attention
  • Development of natural gesture
  • Play

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 4
AV Principle # 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 AV therapy.”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

parental involvement
Parental Involvement

Parents are the child’s:

  • Primary language models
  • First teacher
  • Playmate
  • Advocate

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

play as the engine of language development
Play as the engine of language development

“In the early stages it is the playful behaviours of the adult and the child that generate the language. By the time they are into fully fledged socio dramatic play, the language shapes reality.

“I ‘m ‘tending this is a snake. By the way it is a snake”

From Play by Catherine Garvey

Fontana/Open Books 1977

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

why individualized therapy
Why individualized therapy?

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

why do children need language
Why do children need language?
  • CONVERSATION
  • Social interaction
  • Problem solving and thinking
  • Negotiation and sharing
  • Story telling
  • Joint imaginary play

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

a conversation is
A CONVERSATION IS..

…A SERIES OF TURNS

…A SHARED ACTIVITY

…GOVERNED BY RULES WHICH ARE LEARNED IN INFANCY

…EASIER FOR ADULTS THAN FOR CHILDREN

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

conversation
CONVERSATION

“Informal exchange of ideas by spoken words”

Concise Oxford Dictionary 1982

so…one of our aims is:

..give the words to the child..

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

how hard can it be
How hard can it be?

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

a bad conversation
A bad conversation..

Think of someone you would gladly

cross the street to avoid, rather than

have a conversation with them.

Why would you rather avoid them?

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

a good conversation
A good conversation…

Now think of someone you enjoy having a conversation with. What do they do that makes it so worthwhile?

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

the rules of conversation
The rules of conversation:
  • Must initiate or respond when others initiate
  • Take turn at appropriate time
  • Give partner time to take a turn
  • Attend to speaker
  • Keep conversation going
  • Stay on topic
  • Send clear messages
  • Clear up misunderstandings
  • Start a new topic when needed

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide54

A..B..C...s

of

conversation....

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide55

A..ctive

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide56

B..alanced

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide57

C..ommon focus

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

the underpinning to conversation is equally shared participation
The underpinning to conversation is… …equally shared participation

Like a game of table tennis….

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide61

But…

What if one of the participants isn’t very competent?

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

conversations
Conversations

What can go wrong?

The rules of conversation are not observed due to:

DELAYED development

DISORDERED development

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide64

communication

breakdown

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

if left unattended can result in the child
If left unattended..can result in the child…
  • Not seeing the potential in toys
  • Not knowing how a sequence develops
  • Not understanding the joint goal
  • Finding sharing very hard
  • Experiencing more frustrations than enjoyable challenges
  • Other people don’t seem like play partners

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide66
The usual solutions adopted by adults

can feel very unsatisfactory, such as:

  • Doing all the talking
  • Asking a lot of questions and then answering them
  • Constantly offering new things to try and catch the child’s attention
  • Non-verbal games
  • Trying to direct the child’s behaviour
  • Describing and explaining the child

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

to avoid this families need
To avoid this families need:
  • Information – sensitive to adult learning styles, literacy levels etc
  • Demonstration – observation and participation
  • Experience – practice and feedback

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

take home messages for families
Take home messages for families:

Parents as play partners, and language models

Equal participation in conversation, even for the least skilled person

Viewing the child from the first session as a person with ideas and thoughts to express

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

dr edward zigler founder of head start
Dr Edward Zigler (Founder of Head Start)

“ Literacy begins with thousands of loving interactions with parents after an infant is born…it begins with sitting on a safe lap, hearing a familiar bedtime story”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 5
AV Principle # 5

“ Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

listening language and thinking
Listening, language and thinking

“ Listening is not a mechanical decoding skill. It is a complex and problematic aspect of communication and thinking….listening is thinking; as we listen we make all kinds of judgements and choices” (Haynes 2002).

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide72
So…..
  • The children need access to spoken language

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

enhancing listening
Enhancing listening

Can modify:

  • environment
  • acoustic signal
  • interactions

…..more later….

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 6
AV principle # 6

“ Guide & coach parents to help their child integrate listening and spoken language into all aspects of the child’s life”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

everyday life more resources for families
Everyday life – more resources for families ………

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

strategies for parents to try
Strategies for parents to try:

Adopt role as play partner – Having fun!

Equal participation in conversation.

Having fun listening.

Encouraging turn taking.

Engaging in joint attention.

Commenting & expanding

Interpreting child’s communicative attempts.

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 7
AV Principle # 7

“ Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition and communication”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 8
AV Principle # 8

“ Guide & coach parents to help their child self-monitor spoken language through listening”

..auditory feedback loop

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

audition speech acoustics
AUDITION & SPEECH ACOUSTICS

Factors affecting speech intelligibility:

  • timing of onset of deafness
  • nature & extent of hearing loss
  • type & appropriateness of amplification
  • speech perception
  • communication option chosen for the individual child
  • other challenges

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

early identification allows
Early identification allows..
  • Less delay
  • More natural development
  • More acceptable speech patterns
  • Better literacy outcomes

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 9
AV Principle # 9

“ Administer ongoing formal and informal diagnostic assessments to develop individualized AV treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the families”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

spoken language
Spoken Language

Follow developmental sequence in:

  • RECEPTIVE LANGUAGE
  • EXPRESSIVE LANGUAGE
  • PRAGMATICS
  • PHONOLOGY
  • COGNITION

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av therapist will
AV Therapist will:
  • Follow typical developmental milestones
  • Use criterion referenced and standardized tests developed for typically hearing children
  • apply the formula for calculating ‘hearing age’

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

av principle 10
AV Principle # 10

“ Promote education in regular classrooms with typical hearing peers and with appropriate support services from early childhood onwards”

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

avt in school av goals the curriculum
AVT in school – AV goals & the curriculum
  • IEP Team involvement
  • Collaboration with classroom teachers, resource teachers, SLPs etc
  • Training for EAs
  • Ongoing therapy sessions as needed
  • Regular assessment & monitoring

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

outcomes of the auditory verbal approach
Outcomes of the Auditory Verbal Approach

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

early intervention outcomes
Early intervention outcomes
  • Emerging data are showing that over 90% of children born with a profound hearing loss who obtain a cochlear implant before 18 months, attain intelligible speech.
  • This outcome is based on consistent use of the device and placement in regular classrooms.
  • Extra auditory stimulation is also necessary.

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

geers et al 2003
Geers et al (2003)
  • N – 181
  • Children received implant before 5 years
  • 4 year longitudinal study
  • Looked at variables influencing outcomes

(eg: gender; age at onset; etiology; age at implant; residual hearing; educational placement; type of intervention; commuication mode)

  • Outcomes measured by assessments normed on hearing population (speech perception; speech production; spoken language; total language; reading)

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

geers et al findings
Geers et al – Findings:
  • All children showed strong language and literacy skills
  • >50% achieved grade level reading skills by grades 2 or 3
  • >50% fully mainstreamed
  • Girls performed better on language measures
  • Educational placement - important predictor
  • Earlier implantation (<5) – better outcomes

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

geers et al findings1
Geers et al – Findings:

“ The dominant educational factor associated with high performance levels was the extent to which a child’s classroom communication mode emphasized speech and auditory skills development” (Moog & Geers 2003 p124s)

REF: Ear & Hearing Vol. 24 # 1 Special Supplement Eds: Geers, A E & Iler Kirk, K

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

avt a therapy session
AVT ..a therapy session..
  • 60 to 90 minutes long – every week
  • Listening games
  • Songs and books – with actions and props
  • Crafts, cooking and painting
  • Pretend play
  • LOTS of conversation……

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

therapy session framework
Therapy session framework

MOTIVATION

GOALS

CONTENT

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

organizing the session
Organizing the session

Planning highlights specific target areas & skills in the therapist’s mind. 3 common strategies:

THEME based planning – activities with a common topic (less structure)

SKILL based planning (more structured)

ACTIVITY based planning (daily routines)

Petra Smith M.Sc. Aud (C) Sept 28/29 2009

slide95

Who is the client?

Petra Smith M.Sc. Aud (C) Sept 28/29 2009