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Auditory-to-Visual Communication Continuum

Speech-Language Pathologist/Auditory Consultant

​Does not require visual support for clarificationMostly Auditory:
Needs some visual support for
Equal need for
auditory and visual supports
Mostly Visual:
Understands some
spoken words/phrases​
Does not understand
spoken words/phrases​

Adaptation of McConkey Robbins, 2001; Nussbaum, Scott, Waddy-Smith, Koch, 2004

What is the A-to-V Communication Continuum?

Children who are deaf or hard of hearing communicate in a variety of ways. Some families choose to use hearing technology and have goals that their children will develop auditory and/or spoken language skills while others decide to use visual language for communication and have limited auditory access. The A-to-V Communication Continuum as described in this article is designed for use with children who have access to sound through technology and for those families who wish to develop auditory and/or spoken language skills.

The A-to-V Communication Continuum is a tool that can be used to describe a child’s ability to understand spoken language through listening and his/her needs for accompanying visual supports. The “A” stands for Auditory, meaning spoken language. The “V” stands for Visual. Visual supports can include use of American Sign Language (ASL) or signs used to support spoken language, in addition to visual supports such as Cued Speech, speech reading (lip reading), pictures, objects, written words, gestures, and facial expressions.

How can the A-to-V Communication Continuum be used?

The A-to-V Communication Continuum is NOT an evaluation tool but a tool for guiding discussions between families, educators, and clinical teams. It is a tool for helping parents understand their child’s auditory abilities and tracking skill development over time, resulting in information that can assist parents in selecting appropriate communication methods and educational placements. Educators may use the A-to-V Communication Continuum to create small groups of students for focused auditory teaching.

Why should the A-to-V Communication Continuum be used?

A child’s position on the A-to-V Communication Continuum is not necessarily static and the goal is not always to get to the “Big A” end of the continuum. A child who communicates using ASL with limited auditory access would be on the V end of the continuum, and his placement may not change. For a child developing auditory skills, placement on the A-to-V Communication Continuum might be better described as a zone of development or a range of abilities and needs for visual supports. Position on the A-to-V Communication Continuum may change over time as the child’s auditory skills grow, but may also vary by setting (home vs. school, noisy vs. quiet), content of conversation/instruction (routine vs. new vocabulary), and context (trip to the zoo vs. doctor visit). In familiar situations, a child may need Av (mostly auditory with some visual supports) to understand while needing AV (equal auditory and visual inputs) for learning new information. This child’s zone of development could be described as Av-AV. Describing a child’s zone of development allows the team to plan appropriate visual supports to aid the child’s communication across tasks and environments.

Once a child’s team has described a child’s zone of development using the A-to-V Communication Continuum, they are able to turn that information into a plan for their auditory expectations in addition to strategic use of visual supports for communication. The familiarity of the content being presented is one of the primary factors in determining where a child is performing on the A-to-V Communication Continuum.

Levels of Familiarity

New: Unfamiliar words or concepts that are being presented for the first time.
Review: Content that has been presented, but has not been firmly established.
Routine: Language of routines in the home and/or classroom.

Example: Child’s zone of development: A-AV. Take note of the level of visual supports needed when content is new (more visual) compared to when content is routine (more auditory).

A Av AV Va V
Review XX
Routine X ​X

See It in Action!

Take a look at how to use the A-to-V Communication Continuum as a conversation tool with a family. In this clip, notice how the parent-infant specialist invites the parents to share their perspectives first. She does not approach them as the “expert” by telling them where she placed their son on the A-to-V Communication Continuum. The discussion around the A-to-V Communication Continuum turns into a way to view long-term goals for their child’s education (mainstream Kindergarten). Additionally, the parent-infant specialist points out that placement on the continuum is not a judgment about the value of the A or V, but a way to determine the supports a child needs for successful communication.


Carotta, C., Koch Cline, M., & Brennan, K. (2012) Auditory Consultant Resource Network Handbook. Boys Town National Research Hospital: Omaha, NE.

McConkey Robbins, A. (2001). A sign of the times: Cochlear implants and total communication. Advanced Bionics Loud & Clear (4)2, 1-7.

Nussbaum, D., Scott, S., Waddy-Smith,B., & Koch, M. (2004). Spoken language and sign: Optimizing learning for children with cochlear implants. Paper presented at Laurent Clerc National Deaf Education Center, Washington, DC.

This information is from the Auditory Consultant Resource Network Handbook available for purchase from Boys Town National Research Hospital by contacting or calling (402) 452-5042.

Speech and Language;Childhood Deafness