To Sign or Not to Sign Part 3: Auditory Verbal Therapy

June 11, 2009

By: Mark Dunning 

To sign or not to sign is still the question before us, only this time we'll look at not to sign. This is generally represented by the Auditory Verbal Therapy approach. As stated earlier, the technology today allows people with hearing loss access to more sound than at any point in history. While it is not a cure for hearing loss, it certainly can be considered a cure for the acquisition of spoken language. Children that use digital hearing aids and cochlear implants that get the right supports can learn to speak and understand spoken language at a level on par with hearing children.

One of the options for support of spoken language development is Auditory Verbal Therapy. Unlike Total Communication (see part 1), the AV approach discourages the use of sign language for children with hearing loss for whom the goal is spoken language acquisition. The idea is one of total immersion, no different than learning any other language. If you want to learn to speak French, the best way is to go to France and speak French. Well, if the goal is the acquisition of spoken language, the AV approach concludes, the best way to accomplish this is by focusing solely on the acquisition of that language and no others.

There are pretty obvious reasons why this approach would be a valuable management option for children with Usher who are at risk of losing their vision, but here they are in no particular order:


Most parents of children that are candidates to get the cochlear implant choose the cochlear implant
There are no hard figures on this, but discussions with a number of the leading institutions in the country lands the number of parents choosing cochlear implantation for their eligible child at somewhere between 95-99%. Parents that choose the cochlear implant are implicitly making the choice of spoken language, not ASL. Well, if spoken language is the goal for 95-99% of all cochlear implant candidate children, why even bother with sign?

Learning spoken language only reduces the stress on parents.
It takes a lot of effort for children with hearing loss to learn spoken language. There are speech therapy sessions to attend and mappings for implants and tunings for hearing aids and meetings with teachers. It can all be overwhelming for a parent. Most parents don't know sign language when they learn their child is deaf. So now they have to learn sign language and teach it to their child while still doing all the things necessary for a child to learn spoken language. It is a lot to ask of parents already fraying from the diagnosis.

Earlier mainstreaming leads to better socialization
One of the important tenets of auditory verbal therapy is early introduction in a mainstream environment. Again, this is the immersion approach. Children don't go to special schools or attend special classes. They do get external supports because, like all kids with hearing loss, spoken language acquisition is more difficult for them, but otherwise they are just like all the other kids. They play with the other kids, learn with the other kids, and most importantly, they socialize with the other kids.

Kids with Usher syndrome are at risk of losing their vision
This is the big one, the granddaddy that trumps all other arguments for the auditory verbal approach. Why teach a visual language to kids that are at risk of having too little usable vision in the future to use it?

There are more options for management of hearing loss in kids with Usher syndrome, but they are shades on the spectrum. We've covered the sign only approach (ASL), the voice only approach (AV), and the middle road (Total Communication). In the next post we'll sum up our discussion of management options and explain why on earth we had it in the first place.


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