Assessment Diagnosis Treatment and Controversies Defining Auditory Processing and APD Auditory processing may be described as the efficiency and effectiveness by which the central nervous system CNS utilizes auditory information ASHA 2005 ID: 774670
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Slide1
Auditory Processing Disorder
Assessment, Diagnosis, Treatment and Controversies
Slide2Defining Auditory Processing and APD
Auditory processing
may be described as the “efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information.” (ASHA 2005)
ASHA defines
Auditory Processing Disorder
as “a deficit in neural processing of auditory stimuli that is not due to higher order language, cognitive, or related factors” (2005).
Bellis adds that the disorder occurs
in the absence
of any documented “neuropathological condition” (2002).
Slide3Visual Processing
Image received Image perceived
Slide4General Characteristics and Symptoms
Auditory Processing Disorder can
occur with or without hearing loss
may run in families
affect a person’s ability to interact socially
affect children and adults with normal intelligence
Symptoms
E
xhibited by
Preschool Children
Demonstrate delayed speech and language abilities or articulation errors (Ex. Substituting d for g)
Have problems following directions at school or at home (Ex. “Find a book you want Mommy to read to you.”)
Ask for repetitions frequently such as “What?” or “Huh?”
Are more comfortable following daily routines once they have been practiced or learned rather than following verbal directions
Perform better with visual cues or models
(Bellis 2002)
Slide5Symptoms of APD
Symptoms Exhibited by
Elementary School Children:
Behave as if a hearing loss is present despite normal hearing
Exhibit articulation errors that are developmentally inappropriate
Poor social skills (making and keeping friends)
Express extreme frustration and often say, “I can’t do this!” or “I don’t understand”
Poor reading or spelling skills
Uses memorized phrases and sentences
Symptoms Exhibited by
Adults:
Inappropriate responses to “
wh
” questions
Poor expressive or receptive language
Difficulty with reading comprehension, spelling and vocabulary
Difficulty following long conversations
Difficulty following verbal
directions
especially when involving multi-step
directions
(Bellis 2002)
Slide6Referral
Audiologist should be contacted for a comprehensive hearing evaluation if some type of hearing or listening problem is suspected.
A
referral by physician is not necessary
for an Audiologist to assess hearing but it may be required by some insurance companies for reimbursement purposes.
(
DeBonis
2008)
Obtaining supplemental services at school
:
First someone raises a concern (parent, teacher, school psychologist) about the child’s academic or communicative performance
Based on the severity of the concern :
(1) the child may be referred for special education assessment (can’t occur without the parent’s permission)
(2) the teacher may implement some classroom and related modifications (which do not require special education classification)
(3) continue to keep a close watch on the child’s performance and reconvene at a later time to reconsider the need for special education referral
(Bellis 2002)
Slide7Prevalence
There are “no authorized estimates of the prevalence” of APD. (ASHA 2005)Chermak and Musiek (1997) estimated that APD occurs in 2 to 3% of children, with a 2-to-1 ratio between boys and girls.67% of ASHA certified SLPs who work in a school setting report regularly serving children with APD (ASHA 2005))
Slide8Areas of Deficiency
Auditory
Processing Disorder is
defined as
having a
deficiency
in one or more of the following
behaviors
:
Sound
Localization and Lateralization
refers
to
the ability
to know where a sound has occurred
in space
Auditory
Discrimination
refers
to the ability
to distinguish
one sound from
another
most
often used for distinguishing speech
sounds, such
as phoneme /p/ from phoneme /t/ as
in “hop” and
“hot
”
Sound/Symbol
Association
the
ability
to associate
a symbol
(a
letter) with a sound
(S with “
ssss
”).
Temporal Auditory Processing
the
ability
to integrate
a sequence of sounds into words
t
he ability to perceive
sounds
as separate
when they quickly follow one
another
Auditory
Figure Ground
refers
to the ability
to perceive
the main message when other sounds
are present (understanding
a conversation
in a movie theater)
(ASHA 2005)
Slide9Areas of Deficiency Cont.
Tolerance-Fading
Memory
refers
to weak short –term memory
when information is presented
audibly in the presence of distractible sounds
Sound
Blending
ability
to blend
individual speech
sounds together into a meaningful word
(c-a-t
ca
t)
Auditory
Closure
ability
to
perceive information
in which some of the information
is missing (“it is raining and I ____ my umbrella”)
Decoding
problems
are related to difficulties
with phonics
may spell
words phonetically, spell inconsistently,
have reading
problems, confuse similar sounding
words
(ASHA 2005)
Slide10Diagnosis of APD
Diagnosis is
also
very difficult due to the fact that
no two individuals will exhibit the same symptoms or behaviors
.
APD can be formally diagnosed
only by an Audiologist
.
(ASHA 2005)
Initially, an Audiologist should rule out hearing loss as a primary cause of the symptoms exhibited.
Factors that may help to determine if an APD assessment is necessary:
A child must be at least seven years old before a behavioral central
a
uditory evaluation can be completed.
Hearing loss
Significant cognitive or language delays related to mental retardation, AD/HD, and/or Autism
(Bellis 2002)
Slide11Diagnosis
The following factors
influence behavioral testing performance
and should be considered when choosing the assessment battery:
C
hronological
and developmental
age
C
ognitive abilities (attention, memory, education)
Linguistic
, cultural, and social
background
Medications
Motivation
D
ecision processes
M
otor skills
(
DeBonis
2008)
The Audiologist will take a complete history
and a
variety of auditory processes will be assessed such as:
dichotic listening (listening to a different signal in each ear simultaneously)
perception of distorted speech (which may consist of filtered speech or very rapid time-compressed speech)
p
erception of nonverbal auditory stimuli (tone patterns)
temporal auditory processing (sequencing
and patterns, gap
detection)
(ASHA 2005)
APD
screening can be conducted
by audiologists
, SLPs,
and psychologists
,
using
a variety of measures
that evaluate
auditory-related skills
.
Other tests that are not administered in a sound booth should not be considered diagnostic tests for APD, however, they may be used to provide valuable information about the individuals overall listening and comprehension abilities.
(Bellis 2002)
Slide12Assessment Tools
A complete battery of testing may include the following:IQ tests – WPPSI (preschool), WISC (6-16), WAIS (16+)Academic tests – Woodcock JohnsonAuditory Processing tests – SCAN-C & SCAN-AAuditory Skills Assessment (ASA) Test of Auditory Processing Skills (TAPS)Parent & teacher questionnaires – BehavioralAssessment Scale for Children (BASC) Conner’s Comprehensive Behavior Rating Scales
Slide13Assessment Tools
Auditory Skills Assessement (ASA)Screen children as young as 3.6 years oldMeasures auditory and phonological processing skillsSpeech discrimination in noiseSound blendingRhymingSound discriminationSound patterningUsed as a preliminary assessment of skills as well as for a re-evaluation tool to measure the success of interventionsTest of Auditory Processing Skills (TAPS)Measures of various aspects of auditory processing as well as language processingPhonological processing (decoding and encoding)Auditory closureShort-term auditory memory for contextual and noncontextual informationLanguage comprehension and making inferences
Slide14Types of APD
There is no one universally accepted theoretical model of APD!
The Buffalo Model – Dr. Jack Katz
Looks at the relationship between patterns of performance on specific tests of auditory processing and learning difficulties in children.
Decoding
Tolerance-Fading Memory
Integration
Organization
(
Masters,
Stecker
& Katz, 1998)
Dartmouth Medical School – Dr.
Frankl
Musiek
Divided auditory processing deficits into subgroups on the basis of underlying brain-based etiologies
.
Bellis
/
Ferre
Model
The model is based on both the underlying neurophysiology and the relationship among different types of APD and language, learning and communication difficulties.
(Bellis 2002)
Slide15Bellis/Ferre Model
Three primary subtypes:
Auditory decoding deficit
D
ifficulty with speech in noise, speech
discrimination, sound blending, retention of
phonemes, reading, speech to print may be poor.
Integration deficit
D
ifficulty with multimodality tasks that require
inter-hemispheric transfer of information.
Prosodic deficit
Difficulty with humor, multiple meanings and
utilizing information in
suprasegmentals
of speech.
Two secondary subtypes:
Associative deficit
May
demonstrate receptive language difficulties, can not apply rules of language to incoming auditory information
Output-Organization
Difficulty
in sequencing, planning and organizing responses
.
(Bellis 2002)
Slide16Management: Environmental Modifications
Management of APD should incorporate three primary principles and all are necessary for interventions to be effective:
Environmental modifications
Remediation techniques (direct therapy)
Compensatory strategies
Environmental Modifications:
Classroom Accommodations
Preferential Seating
Pre-teaching of new material
Frequently check for understanding
Rephrase
vs
Repeat
Provide a note taker
Use visual cues and modeling procedures
Amplification
Personal FM systems
Access
to word processors and other
technology
(Bellis 2002)
Slide17Management: Direct Therapy
Phonological Awareness Activities:
Discriminating between speech sounds that are similar (pop/top)
Discriminating between vowels (a in cat vs. e in egg)
Segmenting words (CAT=C…A…T)
Blending sounds into words (C…A…T=CAT)
Before Therapy:
Twhnkke
,
tvinjle
kitsle
rtaq
.
Hov I wnnddr wgat wou zre.
After Therapy: Twinkle, twinkle little star. How I wonder what you are.
Auditory
Closure
Activities
:
Using contextual cues to fill in the missing pieces (Jack and Jill went up the ___)
Noise is added to make activities more
challenging.
Before Therapy: O
ing ol was a ry o
ol
After Therapy: Old
King Cole was a merry old soul
Selective Attention and Localization
Activities
:
Training in
d
ichotic listening
(Bellis 2002)
Slide18Management: Direct Therapy
Temporal Patterning Training:Typically nonverbal exercises that address rhythm (clapping, tapping on the table)Prosody Training:Exercises to teach interpretation of nonlinguistic cues (tone of voice)Computer-Based Therapy Programs:Fast ForwardEarobicsAuditory Integration Therapy (Bellis 2002)
Slide19Management: Compensatory Strategies
It is important to become an ACTIVE LISTENER!The Whole Body Listening ApproachSit or stand up straight so that the body is alertLean the upper body slightly or the head toward the speakerKeep your eyes on the speakerEliminate unnecessary movementMetacognitive and Metalinguistic StrategiesSelf-instructionSelf-regulationUsing context cluesDrawing inferencesRephrasing information
Slide20Areas of Concern
Many clinicians are still skeptical about the existence of APD and point
out
three big areas of concern.
(1) Disorders
such as Autism Spectrum Disorders, Attention Deficit
Hyperactivity Disorder
(ADHD), language impairments and learning disabilities produce similar behaviors
associated
with APD.
Skeptical clinicians have deemed the auditory deficits a function of these broader
disorders
.
(2) It
is often difficult to diagnosis a problem if the problem can’t be
seen.
N
o
two individuals will exhibit the same symptoms or
behaviors
no audiological assessments
or medical physiologic tests
that
adequately differentiate APD from other
disorders
Physiologic
tests such as brain scans,
electrophysiology
and magnetic resonance imaging (MRI) often fail to reveal any obvious structural or
functional
damage
(3) Finally
, an individual’s motivation to participate in APD screening may lead to problems making an accurate diagnosis.
Slide21References
American
Speech-Language-Hearing Association (1996). Central auditory processing:
Current status
of
research
and implications for clinical practice.
American Journal of Audiology
, 5 (2),
41-54
.
American
Speech-Language Hearing Association (2005). (Central) Auditory Processing
Disorders [Technical
Report]. Retrieved from www.asha.org/policy.
American
Speech-Language-Hearing Association. (2005).
(Central) Auditory Processing Disorders—The
Role
of the Audiologist
[Position Statement]. Retrieved from www.asha.org/policy.
Bellis, T. (2002).
When The Brain Can’t Hear: Unraveling The Mystery of Auditory
Processing
Disorder
.
New
York, NY: Simon & Schuster.
DeBonis
, David A., et. al (2008). Auditory Processing Disorders: An Update for Speech-Language
Pathologists
.
American Journal of Speech-Language Pathology
, 17, 4–18.
Slide22THANK YOU!
Jennifer
Saliba