The Development of Auditory Verbal Therapy (AVT) Program for Parents of Children with

Hearing Impairment
Ana Rafikayati (ana_rafika@yahoo.co.id)(Margorejo 3E no. 46 Surabaya 60238)
Lecturer, Special Education, University PGRI Adi Buana Surabaya , Indonesia
Abstract
As the main actors, parents must understand how to implement AVT correctly. Parents as person
who are always with the child also have to repeat the treatment at home in order to develop child's
language skills optimally. Nevertheless, many parents had difficulties in obtaining information and
references about how to carry out AVT independently at home. Although there have been AVT program
before, but the AVT programs were still written in English and some contents were not appropriate with
Indonesian culture.
This study aimed to describe the process of AVT program development, the result of AVT program
development and the feasibility of the AVT program for parents of children with hearing impairment.
This research used a qualitative approach with research and development (R & D) type by adapting
Thiagarajan development model or as known as the Four D models which is consisting of four stages: (1)
define, (2) design, (3) develop and (4) disseminate.
The process of AVT program development adapted 4D model by through in three stages, which are
(1) define, (2) design, and (3) develop. The result of AVT program development was a prototype that
includes several aspects: (1) the goals (competencies), the media, (3) the activities (games), and (4)
evaluation. This prototype program includes 8 goals of therapy with 3 games for each. This AVT program
is packaged in printed (book) A5 size with a thickness 70 sheets. Based on the data analysis, it is
gathered that the feasibility of the program are at 3.538 (decent) in content aspect, 4 (very decent) in
design aspect and 3,945 (decent) in parents perspective. Based on the results of the data analysis, it can be
concluded that the AVT program is deserves as a reference that can be used by parents in doing therapy
independently at home.
Key Words: Auditory Verbal Therapy (AVT) Program, Parents of Children with Hearing Impairment
Introduction
Recently, the developments of technology have supported the development of Hearing Aid such as
the digital hearing aid and Cochlear Implant (CI). Today children with hearing impairment have the
opportunity to develop their verbal language through listening. So, children with hearing impairment do
not need to automatically be a visual learner. When a child begins to use hearing aid or cochlear implant
as auditory access, Auditory Verbal approach will optimize their potential hearing to develop spoken
language (Lim & Simser, 2005).
Wu and Brown describes the important aspects that affect the success of AVT include early
identification, the participation of parents and the use of technology which is hearing aid or CI. As one of
the key determinants of success habilitation, parents are the main actors in the implementation of AVT.
This is in accordance with the opinion Estabrooks (1994: 20) explain that it is the duty of parents to
provide a spoken language interaction to the children because the parents are the one who always with the
children all the time. In addition, children with hearing impairment are easier learn the language if it is in
close activities with parents.
As the main actors, parents must understand how to do AVT correctly. Parents should not rely to the
therapy session that is only 1/3 hours per week. Parents as person who are always with the child also have
to repeat the treatment at home to develop a child's language skills optimally.
Nevertheless, in practice many parents are still experiencing difficulties in obtaining additional
information and references about how to carry out the AVT in doing repetition at home. It is happen
because the AVT habilitation is still relatively new so the information and references about AVT still
limited In Indonesia. AVT itself had just started implemented in Indonesia in 2000. Moreover, in
Indonesia AVT has been implemented only by the institutions in the big cities. There are only 4 AVT
center which are 2 in Jakarta and 2 in Surabaya (Nursimah, 2012). Whereas, shelter give an impact on the
easiness of getting information that is available through parental activities which are usually held
regularly by the institution of therapy in the big city.

Based on these problems, besides assisting during therapy session, parents also need additional
references to support their understanding and skills to be able to repeat the treatment at home
independently. One of the ways is through the activities plan that can be directly practiced or commonly
called program. Thus, parents can repeat the therapy independently at home.
Previously there has been AVT program that published by Cochlear (2010) and (2011). Even so, the
program was still in English so parents have difficulty in understanding it. This is in accordance with
Soemarmo in Arifatun (2012) which explain that in translation activity, people will face many difficulties,
such as difficulties in associating with meaning, such as the lexical meaning, grammatical meaning,
contextual or situational meaning, textual meaning, and sociocultural meaning.
In addition, because the programs were made by the experts from Australia, the content less
appropriate with Indonesian culture so it will occur misunderstanding if there is no modification. This is
in accordance with Peter (2009) which states that a cross-cultural interaction can lead to problems, such
us misunderstanding and difficult to understand the intentions correctly.
Based on these descriptions, it can be concluded that the needs in accessing AVT still not fulfilled
because the previous product which is from Cochlear have weaknesses in terms of language and culture.
By adapting existing products to be more appropriate with the habits and culture of Indonesian, this
research took "The Development of t Auditory Verbal Therapy Program (AVT) for Parents of Children
with Hearing impairment" as the title of this study.
Procedure
This study used a qualitative approach which was Research and Development type (R & D). The
duration of this study was 4 months in Aurica Foundation Surabaya. The subject research were 20 parents
of children with hearing impairment who has choosed AVT as the treatment for their children and their
children has used hearing aid or cochlear implant for 0 to 5 months.
The procedure used the model development by Thiagarajan et al (1974), known as the Four D
Models. The development consists of four stages of development, ie define, design, develop, and
disseminate. In this research, development steps only until the third stage due to the limitation of the
study period. More specifically, it can be seen in the figure 1.
Front-end analysis
Learner analysis
D
e
f
i
n
e

Task analysis
Concept analysis
Specifying instructional objectives

Constructing criterionreferenced tests

Media
selection

Format
selection

Initial design

D
e
s
i
g
n

D
e
v
Data
e
Draft
analysis II
Development test
l
final
o
Figure 1. Flow modification of 4D Model in developing AVT program (Thiagarajanpdkk, 1974)

Draft
II

Data
analysis I

1. Define
a. Front-end analysis

Expert appraisal
(content, design)

Draft
I

This stage has purpose to decide the basic problem and the reason why it needs development.
b. Learner analysis
In this stage, the things that to do were do observation, interview and find range of references
about learners characteristic.
c. Task analysis
At this stage, the thing that to do was identify the main skills that must be mastered child
through analyze AVT curriculum. The curriculum that is used is AVT curriculum by cochlear.
d. Concept analysis
At this stage, the thing that to do was identify the main concepts that must be mastered child
with the age of hearing 0 to 5 months then arrange it based on the hierarchy and break it down to be
smaller concepts.
e. Specifying instructional objectives
At this stage, the thing that to do was Specify the instructional objectives. Competencies in
AVT curriculum are changed to be more operational.
2. Design
a. Constructing criterion-referenced tests
At this age there was constructing criterion-referenced test to know how to measure the
success of therapy.
b. Media selection
At this age there was selecting media to support the therapy.
c. Format selection
The purpose of format selection in this study was to design or plan the content, choose the
activities and techniques.
d. Initial design
Initial design was the combination of all components. The result of initial design of this AVT
program is named Draft I.
3. Develop
a. Expert appraisal
1) Content, to see the suitability with curriculum and techniques.
2) Design, to see appearance of the product. It should be balance, interesting and communicative.
b. Developmental testing
At this stage there was test to the AVT program that has been validated by the experts before.
This product is tested to the children with hearing impairment parents. The children must have
hearing age 0 to 5 months and they do therapy at Aurica Foundation Surabaya.
Data was gathered by 2 Questionnaires. At first is questionnaire validation expert. Questionnaire
consisted of two types which are the content validation questionnaire filled out by expert content and
design validation questionnaire filled out by design experts. Second is parents questionnaire. This
questionnaire was given to the parents. Questionnaire validation expert and parent questionnaire in the
form of a Likert scale that has 5 scores ratings to evaluate this program. Score 5 for very good category, 4
score for good categories, 3 score for fair, score 2 for less and 1 for not good category.
AVT program is good if having good quality if it meets the following criteria.
1. Feasible according to experts (Content and Design)
Feasible criteria in this research are to look at the results of the analysis score instrument
validation expert. Data analysis techniques used in this research is the analysis data according to
Riyanto in Leksono et al (2010) as follows.
Feasibility = The sum score of items
Sum of items
Then an assessment in accordance with the eligibility criteria assessment which can be seen in
Table 1 as follows.

Table 1. Feasible criteria list

Score
Category

4.0 5.00
3.0 3.99
2.0 2.99
1.0 1.99
0.0 0.99

Very decent
Decent
Pretty decent
Less decent
Not decent

2. Feasible according to parents

These criteria are determined based on the results of a questionnaire given the parents. Data
analysis technique used is the analysis of the data according to Riyanto in Leksono et al (2010).
Because of the research subject numbers were 20, then it is needed to search the average value of the
results of the feasibility by the adaptation of the formula of Sugiyono (2013: 49).
Findings and Discussion
A. Stages Process of the Development
1. Define
a. Front-end analysis
In this study, the fundamental problem is the lack of references that can be used for
parents in doing AVT so that the parents cannot be involved in the habilitation AVT optimally.
b. Learner analysis
Based on observations, interviews are known that the characteristics of children with
hearing impairment with hearing age 0 to 5 months are as follows.
1) Sometimes prefer to use the sight in doing activities
2) Begin to adapt to the new sounds that they heard ( respond to the sound / look for the
source of the sound)
3) Do not understand the voice is heard
4) Do not understand the instructions (simple commands) without cue / gesture
c. Task analysis
In accordance with the results of the curriculum analysis AVT, obtained that competence
(ability) to be achieved at hearing age 0 to 5 are as follows.
1) Detect sounds
2) Discriminate sounds
3) Identify sounds
d. Concept analysis
Results of the concept analysis at this stage can be seen in Table 2 as follows.
Table 2. Competences.
Competency
Sub competency
1. Be aware to the sounds
2. Be able to detect Ling 6 sounds
3. Respond to his/her name when called
4. Discriminate long and short duration
5. Discriminate ling 6 sounds
6. Discriminate sounds through sound word a. Discriminate 2 sounds that extremely
(dog guk-guk, cow mu)
different
b.Discriminate 2 similar sounds
c. Discriminate 3 sounds
7. Discriminate simple phrase
through a. Discriminate 2 sounds that extremely
sound word (sleep sh, eat nyamdifferent
b.Discriminate 2 similar sounds
nyam)
c. Discriminate 3 sounds
8. Identify ling 6 sounds
e. Specifying instructional objectives
The goals of therapy that have to be achieved children with hearing age 0 to 5 months are
formulated to be operational sentences.

2. Design
a. Constructing criterion-referenced tests
The test assessed through observation by parents. Tests carried out in practice and assessed
through observation with Linkert scale.
b. Media selection
Considering the learning of languages beginning with daily activities of the child, then the
media selection in this program is quite easy to find and children often use it.
c. Format selection
The format selection of the activities can be seen in Table 3 as follows.
Table 3. Activities
Competency
Be aware to the sounds

Aactivity

Knocking door game

Hitting bucket game
ya aku dengar game
Be able to detect Ling 6 sounds
ya aku dengar game
Marble game
Puzzle game
Respond to his/her name when Calling name game
called
ya aku memanggilmu game
Calling child during everyday activities
Discriminate long and short Playing with plane & ship toys
duration
Drawing dotted lines
Playing with tempo
Discriminate ling 6 sounds
Playing with ball
Playing with building blocks
Sticking sticker on alphabet game
Discriminate sound word (noun)
Animals home game
Water gun game
Stamping pictures game
Discriminate sound word (simple Eat and drink game
phrase)
Cooking game
Household game
Identify ling 6 sounds
Throwing ball to the basket game
Playing with a stacking ring
Circle the alphabet game
d. Initial design
In this stage was the combination of all components
3. Develop
a. Expert appraisal
1) Content
Validation of these contents through a revision process 2 times. Then, expert filled in
the experts questionnaire. Based on the results, AVT obtained a total score of 46.
2) Design
This design validation through a revision process 1 times. Then, expert filled in the
experts questionnaire. Based on the results AVT obtained a total score of 52
b. Development test
Based on the recapitulation of the results of parents questionnaires from 20 subjects
research note that the results of scores are 38, 42, 48, 53, 36, 48, 43, 40, 45, 43, 44, 45, 41, 42,
39, 47, 49, 40, 43 and 4.

B. Product Development (AVT Program)

This program is adapted from AVT program that existed before which is the AVT program from
Cochlear (2010) entitled "sound foundation for babies" for infants or early age. The product in this
study which is AVT program aims to help parents of children with hearing impairment that have
children with hearing age 0 to 5 month (after using hearing aid or Cochlear Implant). AVT program
was produced in book with A5 size and 70 sheets thickness.
This program is produced in book because book is more comfortable to read than soft file (can be
read with the computer) form. This is because the soft book file has weaknesses. Eyes will get tired
easier if read too long in the computer. So that the reader is less comfortable in reading product. This
is in accordance with Hendratman (2013) which states that the weakness of the e-book, among others,
the eyes are tired because of the screen / monitor gadget emits light, the eyes will feel dry and tired.
In addition, there is a big obstacle in the spread of information in Indonesia. This is in accordance
with Arthur (2013) which states that there is a heavy imbalance between the conditions in the big city
and in small village especially in the city that is out of Java island like in Papua. Communities in the
city can operate and utilize the gadget as a source of information. Meanwhile, people in the village
still cannot operate a computer and struggling with Wifi.
By paying attention to these reasons, the AVT program is packaged in printed form which is book
because it is more commonly used and everybody can use it as a source of information.
AVT programs produced with A5 size with the aim of practicality. With its small size, this AVT
program can be taken anywhere because it does not take place and enough to put in a handbag for
mother. AVT program consists of (1) the goals (competencies), (2) the media, (3) the activities
(games), and (4) evaluation. Based on the contents of the program, it can be concluded that this
program has been completed. This is in accordance with SAQA in Nur'aini which states that programs
include four things: (1) objectives, (2) processes, (3) evaluation and (4) media.
AVT program has been adapted to the international AVT curriculum which has been standardized.
It is has been accordance with the language development of children with hearing impairment. Based
on this, the program has been adapted to the needs of the child in understanding the language. This is
in accordance with Mc Kay (2010) in the journal entitled "Improving Classroom Teaching" states that
a good learning plan is a plan that adapts to the needs of children.
AVT program is designed for parents, so the language that is used is a simple language that is
easily understood. In addition, the steps of the implementation are described in detail in order to
avoid error interpretation in reading the program. This is in accordance with the opinion Keraf (1984:
36) states that a sentence is effective if (1) accurately represents the idea of the author, (2) capable to
causing the same idea in mind, between readers and author.
C. Feasibility Program Product AVT
1. Feasibility according to Experts
a. Content Expert
After the questionnaire is filled by a content expert then do the data analysis. The data
analysis is as follows.
Feasibility = (6x3) + (7x4)
13
= 46
13
= 3,538
Then carried interpretation of the results through the list of eligibility criteria. Based on
the list of criteria it can be concluded that the results of the validation obtain the value of
3.538, it is mean that this program is decent.

b. Design expert
The data analysis of the design is as follows.
Feasibility = (13x4)
13
= 52
13
=4
Based on the list of eligibility criteria, it can be concluded that the results of the design
validation AVT program to obtain a value of 4, it is mean that the program is very decent.
2. Feasibility according to Parents
Data analysis was carried out and then averaged. The average score on the analysis of
parents is 3.945. Based on the list of eligibility criteria, it can be concluded that the program is
decent.
Conclusions
1. The process of development is adapted 4D models that have four stages: (1) define, (2) design, (3)
develop and (4) disseminate. In its implementation, this study only through to stage.
2. Result of development is AVT program prototype that includes several aspects: (1) the goals
(competencies), (2) the media, (3) the activities (games), and (4) evaluation. This program contains
eight goals of therapy with 3 game activities for each. AVT program is packed in print (book) with A5
size with a thickness of 70 sheets.
3. Based on the data analysis, it is gathered that the feasibility of the program are at 3.538 (decent) in
content aspect, 4 (very decent) in design aspect and 3,945 (decent) in parents perspective. Based on
the results of the data analysis, it can be concluded that the AVT program is deserves as a reference
that can be used by parents in doing therapy independently at home.
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Bio-Data
Ana Rafikayati born in Bojonegoro on 16 December 1988. In 2011, she
graduated from the Department of Special Education, State University of Surabaya
UNESA. She continued her master degree in the same university in 2012 and she
graduated from there in 2014. She has range of experiences as a teacher and
consultant of children with special needs especially for children with hearing
impairment since 2011. She started to be a special education lecturer in 2015 in
University PGRI Adi Buana Surabaya. She joined range of project about special
education such as the development of recorded book and orientation mobile skill of
children with visual impairment in 2010, the development of communication method for children with
special needs in 2012 and 2013, the development of post school transition for children with special needs
1n 2014. Besides that, she also conducted some researches along 2010 to 2015, such as: gap analysis
about the implementation of inclusive education, developing Auditory Verbal Therapy program for
parents of children with hearing impairment, study about literacy skill of children with hearing
impairment, qualitative study about PKH (Program Keluarga Harapan) program for people and children
with disabilities and study about the epidemiology of children with visual impairment.