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Logo: Dr Helen Robinshaw | Supporting Familie with Deaf Infants and their Professionals

The Approach Evidence Based Practice

Evidence Based Practice

  • Objectivity
  • The most typical starting point
  • Beginning with auditory-verbal techniques
  • Auditory-oral and auditory-verbal techniques
  • Gestures and sign language
  • Comparing modes of communication



Based on the analysis of thousands of hours of video recorded interaction between babies and their parents, my doctoral and post-doctoral research detailed how both deaf and hearing infants use and develop, gestures and signs, and vocalizations and speech. 

I am in the unusual position of being both a researcher and an experienced specialist practitioner in the field of pre-school deafness.  I am therefore able to both share my objective research based knowledge and to apply it to individual families needs.  The application of my research findings in my practical work empowers families to use their own observations to help determine the most effective method of communication for their child.


The most typical starting point

90% of deaf babies are born to normally hearing parents, the large majority of whom would like their child to be able to communicate with them through listening and speech.  A high proportion of the remaining 10%, have deaf parents who also want their child to learn to listen.  We know that a child's first three years is a critical period for learning spoken language.  We know that although a child's ears may be impaired, the combination of good technology and good auditory stimulation enables us to bypass some of these problems and to continue to stimulate auditory brain development at the appropriate time.

We know too that children with both normal and impaired hearing will use gestures and sign language to great advantage when they have good sight and are surrounded by excellent role models. They will also undoubtably use visual information to support their understanding in noisy environments.  Whilst acknowledging that visual stimui are an important part of everyday life for young children, we perhaps need to create a more concerted focus on developing a child's listening skills.  By doing so at such a young age, one is making the most of the potential that the child still has, rather than writing it off and developing a way of compensating for the loss. In this way one keeps open the door to learning other spoken languages through listening, and if chosen, to learning signed languages at just a slightly later date.

The same principles apply to children with CMV (congenital cytomegalovirus) where often more than the auditory-neural connections in the brain need to be stimulated and developed.  cCMV is becoming more widely recognised and the impact of early intervention can be extremely beneficial.


Beginning with auditory-verbal techniques:

The significant improvements in early identification, amplification and implantation in the last decade or two enable us to access the brain; to develop auditory tissue and neural connections; to teach the child auditorily and "rewire" the brain during the critical period of language acquisition.  As a developmental psychologist using auditory-verbal techniques I guide and coach hearing and deaf parents in ways to develop good listening skills very early in the life of their deaf children.  The aim is for these children to become "listening children", so that they do not need to rely on visual stimuli or signs because they understand speech through listening alone.


Auditory-oral and auditory-verbal techniques

The auditory-oral communication approach differs from the auditory-verbal approach by supporting spoken communication with visual clues, such as lip reading, facial expression and natural gestures.  Whilst these are important features of all parent-infant interaction, there is a balance to be had between developing the the brains capacity strengthen the organization of visual-neural connections and auditory-neural connections.

Auditory-verbal practitioners aim to develop the auditory pathways in the brain as quickly and efficiently as possible.  Techniques are used to focus your child first and foremost on making the auditory patterns of communication meaningful rather than in compensating for weak auditory neural connections with visual cues.  The emphasis on listening in good acoustic environments enables your child to become a skilled listener.  Then in the more challenging conditions of everyday life your child will be able to make optimal use of auditory information in combination with all other visual cues available.


Gestures and sign language

My doctoral research and subsequent practical work also gave me a good understanding of the significant role of communicative gestures and signs in the language acquisition and development of both deaf and hearing infants.  I therefore also monitor your child's use of gestures and when appropriate, signs.  If deaf children have good eyesight and cognitive skills they will always be surrounded by visual clues to help them make sense of the world around them, to help them compensate for their impaired hearing.  Because the visual clues are easily accessible they will be used and relied upon more readily than information gained through listening alone.  So by modelling gestural or signed communication along side spoken communication, a child is unlikely to become such a good listener.  However for some deaf children this will be a more effective and appropriate method of communication in the longer term and early monitoring enables parents to make that decision based on hard evidence as soon as possible.


Comparing modes of communication

I also monitor both the gestural (visual-sign) and vocal (auditory-verbal) development of the child so that I may compare progress in both modes of communication. 

Where gestural communication accelerates beyond vocal communication we can be guided to re-evaluate the impact of the child's current amplification, refer on early for a cochlear implant or review the benefit of the current communication technique for that family. 

Where the child's progress is slower than expected in both the gestural and auditory modes of communication, we may begin to question the rate of the child's cognitive skills in general and question if other learning difficulties need attention.

The transition period from hearing aids to cochlear implants is another period when a comparison of gestural and vocal development can be very helpful.

Evidence based diagnostic assessment programmes allow me to share my knowledge with you, so that you fully understand how your child is making progress and can make informed choices that suit you, your child and your family life.