The short answer is YES.

 

SLP Services for Children with Hearing Loss

I value the work of speech-language pathologists. I am a speech-language pathologist (among a few other things) but I can tell you that my training as an SLP did not prepare me to provide high quality services to children with hearing loss. Why? Education of SLP’s – both academic and practicum – enables them to be generalists. They learn a little bit of a lot of things.

Many SLP’s do not have coursework on developing audition for children with hearing loss and most never have supervised practicum experience with children with hearing loss during school. I had some as an undergrad, but NONE in graduate school. I am certified as an SLP and licensed in two states. While I can legally provide a wide range of services I believe that it would be unethical of me to provide stuttering therapy, aphasia therapy or swallowing therapy. Even though I did some of that in grad school, I am not competent to provide these services now. This same criteria should be used when dealing with children with hearing loss.

 

School Services

Schools often state that their staff SLP’s are capable of providing any speech-language service that any child in their school district needs. Yesterday I attended an IEP meeting in which the school SLP told us her plan for managing a three year old with bilateral profound hearing loss who uses cochlear implants. She reported that she was very impressed that he could hear high frequency speech sounds when she evaluated him. When I told her that we expected children with cochlear implants to hear high frequency sounds she said she had not known that. But recognizing that she did not have the basic information about cochlear implants did not prevent her, and the special education director, from confirming that they could provide the services this child needed.

 

What is a LSLS?

Listening and spoken language specialists, are just that. They are specialists in developing skills for children with hearing loss. In order to obtain certification as a LSLS Cert AVT or LSLS Cert AVEd, candidates are required to first have a degree as an SLP, audiologist or teacher of the deaf. Then they need to be mentored for 3 years under the supervision of a person who is already certified. They need to have 900 hours of supervised practice and 80 hours of continuing education directly related to working with children with hearing loss and their families. This continuing education assures that they are current in their knowledge. Then they need to take a rigorous test assuring that the have current information about managing hearing and hearing loss in children. Once they are certified, they need to continue to obtain continuing education so that they remain current.

 

Evidenced Based Practice

Evidenced based practice is critical for evaluating any clinical issue. However, it is important to think about how we are organizing collecting data. It is important to realize that we cannot do double blind studies to evaluate LSLS practice or anything else. It would require that we randomly divide children into different groups without families having the option to choose which therapy method they wished to choose for their children. That is both unethical and illegal. When schools ask for this kind of information we should remind them that they do not have that information for almost anything else they do.

Evidence based practice should not be the only thing used to determine value of a treatment. Clinical expertise, scientific evidence, and family/caregiver perspectives are the three points that need to be reviewed to determine benefit. There are numerous studies which demonstrate the benefit of auditory verbal practice. A few are listed here.

 

Dettman et al., (2013). Communication outcomes for groups of children using cochlear implants enrolled in auditory-verbal, aural-oral, and bilingual-bicultural early intervention programs.  Otology Neurotology, 34(3), 451-459.

 

Dornan, D., Hickson, L., Murdoch, B., & Houston, T. (2007). Outcomes of an auditory-verbal program for children with hearing loss: A comparative study with a matched group of children with normal hearing. The Volta Review, 107, 37–54.

 

Dornan, D., Hickson, L., Murdoch, B., Houston, T., & Constantinescu, G. (2010). Is auditoryverbal therapy effective for children with hearing loss? The Volta Review, 110, 361–387.

 

Eriks-Brophy, A. (2004). Outcomes of auditory-verbal therapy: A review of the evidence and a call for action. The Volta Review, 104, 21–35.

 

Goldberg, D., & Flexer, C. (2001). Auditory-verbal graduates: Outcome survey of clinical efficacy. Journal of the American Academy of Audiology, 12, 406–414.

 

Marschark, M., Rhoten, C., & Fabich, M. (2007). Effects of cochlear implants on children’s reading and academic achievement. Journal of Deaf Studies and Deaf Education, 12, 269–282. doi:10.1093/deafed/enm013

 

Rhoades, E. A. (2006). Research outcomes of auditory-verbal intervention: Is the approach justified? Deafness and Education International, 8, 125–143. doi:10.1002/dei.197

 

Rhoades, E. A. (2001). Language progress with an auditory-verbal approach for young children with hearing loss. International Pediatrics, 16, 41–47.

 

Schachter, H. M., Clifford, T. J., Fitzpatrick, E., Eatmon, S., MacKay, M., Showler, A. Moher, D. (2002). Systematic Review of Interventions for Hearing Loss in Children. Ottawa, Ontario, Canada: Health Canada.

 

See more at: http://www.agbell.org/Document.aspx?id=2372#sthash.a61zKPej.dpuf

 

And www.HearingFirst/ConnecttheDots

 

 

I know of no studies comparing results of children who have received auditory verbal practice compared to children who received services from speech-language pathologists who are generalists. It would have to be a retrospective study because we cannot determine for parents how they should get therapy for their children. It should be sufficient to demonstrate the significant benefit children receive from auditory verbal practice.

 

I don’t want an obstetrician fixing my broken leg, or an ENT delivering my baby. Yes, they are both legally able to do that but we have specialists for a reason. We have Listening and Spoken Language Specialists because they are specifically trained to assist children with hearing loss and their families in maximizing performance. Shouldn’t that be enough?

 

*image courtesy afmil

I apologize for missing the last blog. I was in Mexico City and the earthquake happened. Internet was very intermittent, I could connect with my phone sometimes but not with the computer, and the chaos took over.

I was there to speak at a conference run by the Aurea Auditory Verbal Center. I had arrived a day early and went to the Frieda Kahlo Museum/Home the morning of the earthquake so I was not in the middle of the city when it hit. I returned to the hotel to find that it was badly damaged. Fernanda Hinojosa, who directs the Aurea Center, came to get me and Joan Hewitt who was also presenting and took us to her home which was in an undamaged area. It was amazingly kind of her and helped us manage a very difficult situation.

People were flying in from all over Latin America for the conference. Flights were diverted and people who live in Mexico could not get into the city, so the conference had to be cancelled. But we were there and Fernanda and the others who work at the Aurea Center really wanted us to share what had come to share. So it was decided that we would still do the presentations, but we would videotape them and at some time in the future the Center would figure out how to distribute them.

Learning in a new community

Every time I visit a new community I learn something. Sometimes it is about community, sometimes about how services are provided, often about culture. So here is what I learned in Mexico: there are no audiologists in Mexico. As in a few other countries, there are audiology physicians. These are physicians trained in ENT but they evaluate hearing and program cochlear implants. They do not do surgery. Interestingly enough, they do not dispense hearing aids. Hearing aids are dispensed by hearing aid dealers in the community. The audiology physicians in Mexico believe that only physicians can be audiologists. There are people in Mexico who have graduate degrees in audiology from other countries but the audiology-physicians insist they are not audiologists and should not be seeing patients. In fact, they feel so strongly about this that their professional/licensing group informed the audiology physicians in the community that they could not attend the conference because we (Joan and I) were not really audiologists since we were not physicians. Some of the audiology physicians in the community asked if they could have vacation days on the conference days in order to attend the conference and were told that they could not. (I guess we were a little threatening!!) In addition to not supporting non-physician audiologists, the group does not support children with hearing loss receiving therapy from non-physicians, even though they are not providing the therapy!

How do we learn?

What I learn about audiology is not limited to what I learn from other audiologists, but also from  linguists, speech-language pathologists, listening and spoken language specialists, brain researchers, otolaryngologists, neurologists, pediatricians, geneticists, teachers, parents etc. Certainly as a person working with children, I need a wide knowledge base to do what I do well. The idea that someone would feel that they cannot learn something from someone who has different training then they do is unfortunate. The fact that they do not recognize that other countries may have a different and legitimate degree structure is confusing. And a little frightening.

What do children with hearing loss need to succeed?

It takes a village for a child with hearing loss to succeed. For success, these children need language at age level, literacy at age level, and social skills at age level. How do they achieve this? Early identification, early and appropriately fit technology, intensive language stimulation, preferably through audition. Parents are the best language models for their children. They are with them full time. Therapy, even one hour a day, does not provide the intensive language that all children need. So, therapy really should be directed to helping parents and other caregivers understand how to be excellent language models. How to talk, talk, talk. How to expand on a child’s language, and how to read, read, read, because reading has been shown to provide the best discussions and language expansion.

The children

Joan and I got to spend a wonderful day in the clinic working with children and their families who had children with complicated issues or who wanted second opinions. I love being in a center and working with families. I saw six children, and loved every minute. Joan did cochlear implant programming and I assessed children. We were able to counsel families and help direct them. I was able to help the family of a child with a unilateral hearing loss understand what he was missing and why he needed technology on the opposite ear. I was able to demonstrate FM benefit for a family who thought the cochlear implant alone was enough – 30% improvement in speech perception. I was able to test a four-month old using behavioral observation and confirm to the mother that hearing was normal. And, most importantly, I could demonstrate these test methods to other clinicians in the community, who can use them now.

 

The materials we developed

It was certainly a disappointment that the conference had to be cancelled but the audiology-physicians who were not allowed by their employers to attend, are now saying that this worked out for them because, once the material is translated, they will be able to watch and learn in private at home on the internet. The Aurea Centre is also planning on using the material to generally provide audiology information to others in Spanish speaking countries who do not have access to books and journals for learning about managing hearing loss in children. Materials in audiology and auditory-verbal therapy are not available in Spanish so these kinds of presentations are very valuable to them. I think we sometimes forget how lucky we, who are fluent speaking and reading English, are and how much material we have at our fingertips. I was reminded about that on this trip. And, while the earthquake disrupted my life for a few days, it will take a long time for Mexico City to recover. In spite of the chaos, the people there were kind and generous in caring for us in the midst of a crisis. I will always be grateful.