Coaching parents of deaf children


This article has been reproduced with permission from RCSLT Winter 24/25 bulletin

Auditory Verbal therapist Catherine White shares her approach to supporting parents to help their children develop language skills.

When I first started out as an SLT, my mentor said: “Parents are critical to the success of therapy. What we do as therapists is just a drop in the ocean”. It always stuck with me, and 25 years on, it is still a foundational principle of the way I work. I first came across parent coaching when I trained as an Auditory Verbal (AV) therapist. AV therapy (AVT) is one of the early intervention approaches to developing spoken language in deaf children. Intervention can start as early as infancy and focuses on using listening as the primary modality for learning to talk. AV therapists coach parents to observe their child’s behaviours so they can decide which strategies or technique to use to maximise their child’s listening and spoken language development. Everything is embedded in play and activities of everyday living, like getting ready in the morning, participating in mealtime routines, helping with household chores.

Around 90% of deaf babies are born into families with no history of deafness (Mitchell, and Karchmer, 2004). Parents of newborns have many choices to make, but parents of deaf children have the added responsibility of choosing how to support their child’s communication.

Bea was only 16 months old when I first worked with her. I recently talked to her mum, Kate, about her experience of AVT. “It was excruciatingly tough to make decisions for Bea as a toddler. We wondered how we would parent a deaf child, whether she would ever hear our voices reading her a bedtime story and how she would communicate with her siblings, the wider family and, of course, the outside world. “Despite having hearing aids fitted at 10 weeks old and many lengthy hearing tests, we didn’t feel we knew whether Bea could hear us or not. The audiologist said that he thought we needed more help and recommended AVT. We embarked on a journey that changed our lives.”

One of the most important conversations I have with any family I meet is establishing what their long-term hope is for their child. Whether their desire is for their child to learn to listen and talk, sign or both, it is our responsibility to ensure that parents and caregivers are given access to all the information they need to make informed choices. Equally important is that families have access to professionals who are trained in these approaches, so they can access existing services. The NDCS website is an excellent place to signpost families at this stage.

For the vast majority of deaf children, learning to listen and talk is an achievable goal. International and national evidence shows around 80% of children following the AV approach achieve age-appropriate spoken language (Decibel, 2023; First Voice Sound

Outcomes, 2018-23; Hitchins and Hogan, 2018). Research also shows that AVT is eective in supporting children with additional and often complex needs, with one in two reaching age-appropriate language after attending a programme for at least two years, and all children doubling their rate of language progress on the programme (Hitchins and Hogan, 2018). Additionally, most deaf children achieved educational outcomes on a par with hearing children after completing an AV programme (Hogan, 2023).

The AV coaching approach

So how do we coach parents who have chosen an AV approach for their child? We first establish what residual hearing is available to the child so we can begin to stimulate the listening pathways of the brain. Then we can coach the parents with the strategies to help their child learn to listen and talk. Getting the best possible access to speech information through the child’s hearing devices is critical. This is done by checking their functional listening skills to see if their performance matches what their audiogram says they can hear. We do this by observing the child’s responses speech and  environmental sounds in a controlled environment. We use the Ling sound test to evaluate whether a child has sucient access to the speech frequencies required for understanding and developing speech intelligibly. This is then fed back to the parents, Teacher of the Deaf and audiologist so the necessary changes can be made.

Kate recalls: “I remember my therapist saying: ‘We’ll help you to make sure Bea has the right technology on her ears, then we can get to work’.” “Within 90 minutes of Bea’s first AV session she responded for the first time ever to her name. The verdict that day was that Bea could hear low frequency sounds, but she had no understanding at all that sound had a meaning. A plan was established to teach Bea how to attach meaning to sound and help her discover the power of her voice. Week after week, Bea began to understand sound, gather words and eventually began communicating with speech.”

Bea eventually went on to have a cochlear implant (CI) in one ear as it became clear that she wasn’t getting sucient access to sound through her hearing aids.

Coaching consists of joint planning, action/practice, feedback, reflection and observation (Rush and Sheldon, 2020). On one occasion, Kate indicated she would like Bea to understand Christmas. We discussed what Christmas meant for the family and how they celebrated it. We planned the session together identifying key goals, and then Kate invited Bea to play with her! As Kate and Bea played together, I coached Kate from the sidelines, drawing her attention to Bea’s responses and guiding her so she could give Bea the support she needed (What do you think she’s thinking? Can you give her the words for her thoughts? What do you notice? What piece of information is missing? Let’s try again!).

Coaching guides the parents to become excellent observers so they instinctively know when and how to use strategies and techniques in everyday interactions. The aim is always to demonstrate new learning within a session so that the parents are confident in how to consolidate them at home. Parents generate their ‘take home messages’ at the end of each session. These are key learnings or goals that they have gleaned from the session. We then discuss how to integrate them into their child’s daily routine. Bea graduated from her AV programme at age five with age-appropriate spoken language. She is now training to be a midwife. Bea’s family were the ones who did all the hard work. They were the ones running the marathon, I was simply the one coaching them.

Case study

Frances Clark, SLT and AV therapist, writes about her experience with Idrees. The biggest learning curves for me were developing listening in children, and coaching parents. I always thought that parents were very involved in my therapy sessions. They sat at the table, I gave them homework, they repeated what I did. However, learning to truly coach parents meant we were setting goals together, they were generating the take home messages using their own words, and expressing their opinions and relating everything to their own daily routines so that strategies could easily merge into their lives. I realised I had become a therapist who sees ‘families’ and not ‘children’, as the parents are the experts on their children and they are the people who ultimately make the change.

Despite training as both an audiologist and SLT as well as a long period working in a cochlear implant team, I had gaps in my knowledge on how to truly develop listening and what that meant. AVT enabled me to have a clear roadmap of how to develop the listening brain in partnership with parents.

One of the families I saw from infancy to graduation was that of Idrees, now aged eight. At the start of their programme Mum, Sabrina, told us that she wanted Idrees to be able to use the language they use at home. Idrees attended therapy from the age of eight months to three and a half years. He graduated with a spoken language age of four and a half years. There was a team around him that included his parents, the CI team, his SLT, Teacher of the Deaf, his school and myself as his AV therapist. Today Idrees is continues to challenge expectations of what deaf children can achieve,  recently achieving excellent results across the boards for his SATS, the best in his year group at a mainstream school. He is confident, happy and now also learning British Sign Language.

All deaf children have a right to access good quality, early intervention to support their language development, whether they wish to use sign language, spoken language or both.

At present, more than 90% of deaf babies who could benefit from AVT do not have access to it. Our hope is that all therapists working with families who want a listening and spoken language outcome for their deaf child would have access to training in the AV approach.

CATHERINE WHITE, Specialist SLT and Certified Auditory Verbal Therapist

FRANCES CLARK, SLT and Senior Auditory Verbal Therapist, and families from AVUK

Find out more

Visit the RCSLT guidance on deafness in children and adults rcslt.info/ deafnessguidance

Auditory Verbal Therapy avuk.org

REFERENCES

To see a full list of references visit: rcslt.org/references

BULLETIN WINTER 2024/25


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