Auditory Verbal Therapy: Guide

Landscape of paediatric deafness

The number of children with permanent hearing loss in the UK under the age of five years has been estimated to be 7,2001,2 and around 90% of deaf* children are born to hearing parents^3,4. Without early intervention, many deaf children could be left without access to a rich language environment, whether spoken or signed (British Sign Language (BSL) or signed English). Whatever the communication approach chosen, early and effective intervention in the early years is the most important issue. All children have the right to develop language and communication so that they can achieve their potential in life. Access to their language and communication environment is key to this development. For children who are born deaf, especially into hearing families with no experience of hearing loss, skilled and sensitive early support is vital if they are to develop the language and communication skills they need to be ready to start school alongside their hearing peers. Parents** of deaf children should always be presented with clear information about these approaches so they are able to make an informed decision about which communication approach they would like for their child. The Auditory Verbal (AV) approach develops spoken language through listening and is an approach that equips parents and carers with the skills and strategies to support their child’s listening and spoken language development.

Children’s earliest experiences in life are foundational to brain development5. Research shows that language development before two years can predict educational outcomes^6,7. By the age of three and a half, the human brain has completed 85% of its physical growth, meaning the first three years of life are critical for developing spoken language through listening^8,9. For families wanting their children to communicate using spoken language, this represents a neurological emergency to access meaningful sound. It is essential to provide intervention as early in the child’s development as possible following the child’s identification, while also considering the preferences of the family¹⁰. In the UK there has been substantial investment in the Newborn Hearing Screening Programme (NHSP), with millions of babies having been assessed for hearing loss at birth since 2006. There have also been, and continues to be, significant advances in assistive hearing technologies (e.g., digital hearing aids, auditory implants and all other digital ancilliary aids). However, amplification alone does not allow for optimal spoken language development¹¹, nor does amplification alone support growth in other developmental areas such as social competence¹². The NHSP was introduced in the UK on the premise that outcomes for deaf children could be improved by early identification of hearing loss and effective early intervention^13,14. Effective early intervention is crucial if we are to benefit from this investment and technology. We now know that excellent outcomes for spoken language can be achieved if children with hearing loss are fitted expertly with the most appropriate technology and if their families are supported with effective early intervention¹⁵. Deafness is not a learning disability. Most children with hearing loss have the potential to reach the same educational outcomes as hearing children if they have appropriate support. However, if there is a language delay, this can affect both children’s literacy and numeracy. A study in 2017 funded by the Nuffield Foundation reported that 48% of oral children aged between 10 and 11 years were reading below age level¹⁶. Analysis of 2020’s GCSE results by the National Deaf Children’s Society shows that deaf pupils in England have now achieved an entire GCSE grade less than hearing peers for at least six years in a row. Just 35% of deaf children gained a grade 5 in key subjects English and Maths, compared to 56% of hearing children¹⁷. Similar analysis for Key Stage 2 results did not take place in 2020 or 2021, but in 2019 only 44% of deaf children achieved the expected standard for reading, writing and mathematics at Key Stage 2 compared to 74% of children with no identified Special Education Needs¹⁷.