slp auditory hearing loss therapy

Does It Make A Difference Who Does Therapy For Kids With Hearing Loss?

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:


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

About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 7 books, and written numerous books chapters and journal articles, and is a well known international lecturer.