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

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

WHAT IS A LISTENING AND SPOKEN

LANGUAGE SPECIALIST (LSLS)?

 Licensed audiologists, speech-language

pathologists, or educators of the deaf who
have attained high-level of specialty
education, experience, and certication.
LSLS work with infants and children who are
deaf or hard of hearing and their families
seeking a listening and spoken language
outcome.
Certication is delivered by AG Bell Academy

The LSLS Domains of Knowledge

Emergent
Literacy 6%

Hearing and
Hearing
Technology 12%

History, Education 6%
Philosophy, and
Professional
Issues 4%
Strategies for
Listening and
Spoken
Language
Development
18%
Parent Guidance,
Education and
Support 13%

Auditory
Functioning 16%

Child
Development 9%

Spoken
Language
Communication
16%

Dierences 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 dierences
Resulting in a single certication: the Listening
and Spoken Language Specialist Certication
(LSLS)

One cerScaSon, 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.

Who are LSLS?

6.9%

37.7%

Speech-Language
Pathologist
Audiologist

43.2%

Educator of the
Deaf

12.2%

School
Adminstrator
* Out of 547 Certied LSLS; some of our
professionals ll more than one role

Importance of LSLS
Communication Outcomes Selected by Families

6%

4% 1%

Listening and Spoken

Language

Total Communication
American Sign Language

89%

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

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 ndings. Volta
Voices 2007;14(6):38-40.

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,
$70,200 (7%)
medical costs and others

$61,100 (7%)

Total

$1,020,000

$919,000

95% condence 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.

Importance of LSLS
Education is expensive better
technology, better rehabilitation,
Earlier identication 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

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)

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

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)

LSLS

516
501
467

USA
448
437
379

717
678
640

WORLDWIDE
621
598
557

100

200
2014

300
2013

400
2012

2011

500
2010

2009

600

700

800

2014

StaSsScs
NaSonal 1 LSLs per 228 children with
hearing loss <17
States range from 0 LSLs to 1 LSLs per
about 1781 children < 17 (Louisiana)
Missouri has the lowest raSo 1/53
States with large populaSons have more
LSLs than states with small populaSons:
Not always the case

StaSsScs
US State

Number of
GDP per
2013
children <17
capita
LSLS 2014
PopulaPon
with hearing
rank
loss

Number of
children with
hearing loss
per LSL

South
Carolina

4,774,839

49

1727

11

157

Tennessee 6,495,978

38

2386

298

District of
Columbia

646,449

178

Missouri

6,044,171

35

2236

42

53

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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