Auditory-verbal graduates: outcome survey of clinical efficacy.

This project is an update of an earlier study on American and Canadian graduates of auditory-verbal programs. Survey research was conducted to obtain information on a variety of topics. Overall, the current results again indicated that the majority of respondents were integrated into "regular" or "typical" learning and living environments. In view of the earlier identification of hearing loss and the early fitting of sensory aids and availability of cochlear implant technology, coupled with intervention that emphasizes auditory learning, it is suggested that today's infants have the potential to become independent, participating, and contributing citizens in mainstream society.

Otological and habilitative management of children with Down syndrome.

It has been well-established that children with Down syndrome experience a high incidence of persistent conductive hearing loss because of their predisposition to stenosis of the external auditory canal (EAC), cerumen impaction, serous otitis media (SOM), and cholesteatoma. Because this hearing problem may be a primary cause of the spoken communication skills in these children being far below their cognitive ability, assertive management is required. The authors present an aggressive multi-discipline treatment model that is instituted during the first year of life in an infant with Down syndrome. Reconstruction of the EAC, amplification technology, and speech/language intervention that emphasizes auditory-verbal (A/V) therapy are discussed. In a pilot study, we compared the language development of six infants with Down syndrome who received aggressive treatment during their first year of life (group A) to six infants who did not (group B). The results showed age-appropriate oral language development for the infants in group A.

Outcome survey of auditory-verbal graduates: study of clinical efficacy.

Audiologists must be knowledgeable about the efficacy of aural habilitation practices because we are often the first professionals to inform parents about their child's hearing impairment. The purpose of this investigation was to document the status of graduates of one aural habilitation option; auditory-verbal. A consumer survey was completed by graduates from auditory-verbal programs in the United States and Canada. Graduates were queried regarding degree and etiology of hearing loss, age of onset, amplification, and educational and employment history, among other topics. Results indicated that the majority of the respondents were integrated into regular learning and living environments.

Speech degradation as measured by the Rapid Speech Transmission Index (RASTI).

This study demonstrates degradation of a modulated speech-like signal in a typical listening environment as measured by the new Bruel and Kjaer Rapid Speech Transmission Index (RASTI) System. Thirty-four adults were seated in a typical college classroom. Measurements of the RASTI signal were made at 17 different seating locations. Results showed that the speech-like signal was substantially degraded, even at the front-row center seat. Loss of critical speech information was greater at less favorable locations. These results suggest that because hearing aids cannot amplify nonexistent speech information, the effects of distance must be considered when fitting amplification systems.

Audiological rehabilitation in the schools.

The audiologist is the professional best able to manage the complete hearing care of a child who experiences hearing loss of any degree. Even a "mild" hearing loss can sabotage the development of academic competencies, and there is a growing population of school children with mild-moderate hearing loss. Unfortunately, there are far too few audiologists employed in educational settings (approximately 700 nationally), with an average ratio of one audiologist for every 12,000 children; but some have 100,000 children to manage (Blair, Wilson-Vlotman, & Von Almen, 1989; Wilson-Vlotman & Blair, 1986). Audiological rehabilitation begins with an understanding of the realities of working in an educational setting, including legal requirements, the necessity of administrative support, the "failure model" of service delivery, and the importance of the IEP. FM equipment needs to be fit carefully, and used and maintained judiciously. Auditory skills training, integrated into the global learning environment of the child, offers a way to assist the child in learning to use the pivotal auditory modality. As audiologists become stronger advocates for the necessary use and enhancement of hearing, audiological rehabilitation will become more of a reality in school settings.

Distribution of auditory response behaviors in normal infants and profoundly multihandicapped children.

Responsiveness (yes/no decisions) to sound has been found to be similar for normal infants and profoundly multihandicapped children of comparable developmental ages (Flexer & Gans, 1985). The purpose of this investigation is to extend the comparison of these two groups by examining the distribution of their response behaviors to sound. Ten normal and 10 multihandicapped children were videotaped while various auditory signals were presented. Without knowledge of stimulus type, five judges listed the behaviors that occurred during 24 sound and 24 catch trials for each child. The behaviors were then evaluated as a function of the stimulus parameters of meaningfulness, bandwidth, and intensity. Results revealed that the profoundly multihandicapped children displayed relatively more reflexive than attentive type behaviors and exhibited fewer behaviors per response. The effects of stimulus-type on the numbers and distribution of responses are discussed.

Comparative evaluation of the auditory responsiveness of normal infants and profoundly multihandicapped children.

Responses to sound were observed in two groups of children. One was developmentally normal; the other was older but profoundly multihandicapped. The groups had developmental ages from 2 to 4 months, as assessed by the Kent Infant Developmental Scale (Katoff, Reuter, & Dunn, 1978). Stimuli were speech and random noise, both unfiltered and band-pass filtered at 2000 Hz, presented at 40, 60, and 80 dB HL. Responsiveness was determined from the confidence levels of observers' judgments of videotapes. Results showed that there were no significant differences between the subject groups. In both groups, however, responsiveness was dependent on hearing level and bandwidth but not on meaningfulness. The results support the practice of evaluating auditory responsiveness of multihandicapped children in relation to developmental age.

Auditory response behavior of severely and profoundly multiply handicapped children.

Severely and profoundly involved multiply handicapped children present special problems for the audiologist. Although a substantial amount of data is available on the behavioral responses of normal babies, there is a surprising dearth of similar information concerning handicapped children. In the present study, the responses of 31 severely and profoundly involved multiply handicapped children were studied by behavioral observation audiometry. Children's chronological age ranged from 7 to 153 months, while developmental age was estimated as 0 to 24 months. An experienced judge rated each of 9 specific behaviors either absent, strong, or weak on each trial. The stimulus types were a broadband noise, narrowband noises centered at .5 and at 2 kc/s, and speech either unfiltered or high-pass filtered at 1.2 kc/s, presented to S by a loudspeaker at 45 degrees azimuth, at 20, 40, 60, and 80 db re normal HTL. The interrelationships between stimulus variables, types of responses, and developmental level of the children were evaluated. Overall, the children responded differentially to the 5 stimulus types. Furthermore, the higher-functioning children responded much differently to the sounds than did the lower-functioning children. It was recommended that any behavioral technique be used together with objective tests in this most difficult population, and that testing be repeated over an extended period of time.

Observer bias in the hearing testing of profoundly involved multiply handicapped children.

Observer bias was investigated using 27 profoundly involved multiply handicapped children and behavioral observation audiometry. Two observers were in the room with the child, two others viewed via a video monitor, and each of the four observers had full knowledge of stimulus-type and intensity. Two additional observers viewed a videotape without being provided information about the stimuli. Results showed clear bias effects in 85% of the children. At low intensities, observers aware of stimulus events tended to score fewer responses than those judges unaware of stimulus intensity. At high levels, this trend was reversed. It is recommended that the estimation of hearing threshold in handicapped children be made by observers who do not have access to the sequence of stimulus presentations.