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Auditory Verbal Therapy in Children
with Hearing Loss: We do not
have
Enough Specialists Habib Rizk MD,
Don Goldberg PhD**, Ted Meyer,
MD PhD
14th Annual Pediatric CI Symposium
ACIA Symposium Nashville, TN
DECEMBER 13th, 2014
Medical University of South Carolina
Department of Otolaryngology
** College of Wooster, Cleveland
Clinic
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Disclosures
• Don Goldberg: Immediate Past
President of the Alexander Graham
Bell AssociaSon for the Deaf
and Hard of Hearing
• Ted Meyer: President-‐Elect AG Bell
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WHAT IS A LISTENING AND SPOKEN
LANGUAGE SPECIALIST (LSLS)?
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• Licensed audiologists, speech-‐language
pathologists, or educators of the
deaf who have attained high-‐level
of specialty education, experience,
and certification.
• LSLS work with infants and
children who are deaf or hard
of hearing and their families
seeking a listening and spoken
language outcome.
• Certification is delivered by AG
Bell Academy
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Hearing and Hearing
Technology 12%
Auditory Functioning 16%
Spoken Language
Communication 16%
Child Development 9%
Parent Guidance, Education and Support 13%
Strategies for Listening and
Spoken Language
Development 18%
History, Philosophy, and
Professional Issues 4%
Education 6%
Emergent Literacy 6%
The LSLS Domains of Knowledge
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Differences between Auditory-‐Oral and
Auditory-‐Verbal Therapy
• Listening and Spoken Language
approaches were known as
Auditory-‐Verbal (A-‐V) and Auditory-‐Oral
(AO)
• AO focuses on speech and
provides the patient with visual
cues
• AV focuses on listening •
Evidence-‐based research found these
approaches
have more similarities than differences
• Resulting in a single
certification: the Listening
and Spoken Language Specialist
Certification (LSLS)
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One cerSficaSon, Two DesignaSons
• The LSLS Cert. AVT works
one-‐on-‐one with the child and
family in all intervention sessions.
• The LSLS Cert. AVEd involves
the family and also works
directly with the child in
individual or group/classroom settings.
Both have similar knowledge and
skills and
work on behalf of the child
and family.
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Who are LSLS?
37.7%
12.2%
43.2%
6.9%
Speech-‐Language Pathologist
Audiologist
Educator of the Deaf
School Adminstrator
* Out of 547 Certified LSLS;
some of our professionals fill
more than one role
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89%
6% 4%1%
Communication Outcomes Selected by
Families
Listening and Spoken LanguageTotal
Communication
American Sign Language
Cued Speech
Source: BEGINNINGS of North Carolina is a non-profit agency
providing an impartial approach to meeting the diverse needs of
families with children who are deaf or hard of hearing and the
professionals who serve them
Importance of LSLS
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• Total costs for special educaSon
programs for children with hearing
impairments was $11,006 per child
(2000 value)
• LifeSme educaSon cost (2007 value)
of hearing loss (moderate and
more severe): $115,600 per child
Grosse SD. EducaSon cost savings
from early detecSon of hearing
loss: New findings. Volta Voices
2007;14(6):38-‐40.
Importance of LSLS
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LifeSme Costs of Severe to
Profound Hearing Loss
Age of Onset
Component Prelingual (0-‐2) PrevocaSonal
(3-‐17)
Lost ProducSvity $433,400 (42%)
$444,300 (48%)
Special EducaSon $504,900 (50%)
$401,000 (44%)
VocaSonal RehabilitaSon $11,500 (1%)
$12,600 (1%)
AssisSve Devices, medical costs and
others
$70,200 (7%) $61,100 (7%)
Total $1,020,000 $919,000 95%
confidence interval $464,000 -‐
$1,733,000 $401,000 -‐ $1,623,000
Mohr PE, F. J., Dunbar JL,
McConkey-‐Robbins A, Niparko JK,
Ri?enhouse RK and Skinner M
(2000). "The Societal Costs of
Severe to Profound Hearing Loss
in the United States." InternaPonal
Journal of Technology Assessment in
Health Care 16(4): 1120-‐1135.
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Importance of LSLS
• Education is expensive – better
technology, better rehabilitation, …
• Earlier identification means Earlier
Intervention
• Will hopefully lead to less
lost revenue and more opportunities
for children with hearing loss
as adults
• And a cost savings in the
long run
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Methods • Databases reviewed for
demographic informaSon for new born
screening, prevalence of hearing
impairment…: – CDC-‐Early Hearing DetecSon
and IntervenSon databases
– NaSonal Health and NutriSon ExaminaSon
Surveys
– NaSonal Health Interview Surveys
– Gallaudet University Database
DEMOGRAPHICS OF CHILDREN WITH IMPAIRED
HEARING UP TO 2012 (2013
WAS STILL BEING PROCESSED)
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Methods
• AG Bell academy database was
reviewed for the number of LSLS
• The incidence staSsScs were used
as surrogates to esSmate: – PopulaSon
of preschool children and schoola
ge children needing LSLS
– Need for LSLS per state for
this populaSon
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Results
• 2012 NaSonal Early Hearing and
DetecSon Survey PUBLISHED September
2014: – 3.8 million children screened
(96.6%) – 6000 screened had HEARING
LOSS (1.6/1000) – 87.6% OF HEARING
IMPAIRED Children are referred to
Part C EI
• Only 83.1% were eligible (STATE
DEFINITIONS OF DEVELOPMENTAL DELAY)
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557
379
598
437
621
448
640
467
678
501
717
516
0 100 200 300 400 500
600 700 800
WORLDWIDE
USA
2014 2013 2012 2011 2010 2009
LSLS
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2014
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StaSsScs
• NaSonal – 1 LSLs per 228
children with hearing loss
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StaSsScs
US State 2013 PopulaPon
GDP per capita rank
Number of children
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Conclusions • Growth of LSLS numbers
over the past 5 years: Slow?
Steady?Adequate?
• Unequal distribuSon between states –
unequal distribuSon within counSes of
a state
• Need for more LSLS in all
of the 50 states plus DC
and territories
• Some states have tremendous needs
ADEQUATE REHABILITATION=BETTER OPPORTUNITIES
FOR THE CHILDREN=LOWER
ECONOMICAL BURDEN ON SOCIETY
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References • Eriks-‐Brophy A (2004).
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