Making Connections Donna M Goione Merchant AuD CCCA FAAA Doctor of Audiology Assistant Professor Montclair State University NJ Certified Teacher of the DeafHearing Impaired NJ Certified Teacher of the Handicapped ID: 913832
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Slide1
Understanding and Managing Central Auditory Processing Disorders:Making Connections
Donna M. Goione Merchant,
Au.D
., CCC/A, FAAA
Doctor of Audiology
Assistant Professor, Montclair State University
NJ Certified Teacher of the Deaf/Hearing Impaired
NJ Certified Teacher of the Handicapped
Slide2“Central auditory processing [(C)AP] refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information… (C)APD refers to difficulties in the perceptual processing of auditory information in the central nervous system and the neurobiologic activity that underlies that processing and gives rise to electrophysiologic auditory potentials…(C) APD may co-exist with other disorders (e.g., attention-deficit/hyperactivity disorder (ADHD), language impairment, and learning disability…)”
www.asha.org/policy
The term “Auditory Processing (AP)” describes how information is processed after it leaves the peripheral auditory structures…
Slide3An APD refers to difficulties in the perceptual processing of auditory information in the central nervous system” (AAA, 2010).
It
is the result of the inefficient processing of what is heard that may be revealed in communication or academic difficulties (Katz, 2009).
http://www.edaud.org/position-stat/12-position-10-23-15.pdf
Slide4the ability to process language sounds rapidly (speed of processing)
the ability to recognize
incomplete
or unusual forms of a word (closure)
the ability to attend to one part of a sound pattern (auditory attention)the ability to understand speech in background noise (figure/ground)
Why is (Central) Auditory Processing Important?
In order to perceive speech for learning and communication
Slide5Court Ruling: August 12, 2012 U.S. Ninth Circuit Court of Appeals in E.M. v.
Pajaro
Valley Unified School District
Offered a legal definition of how auditory processing disorders are to be addressed in the school setting:
An auditory processing disorder (APD) is considered an eligible criterion for special education services under IDEA; 2004. Reliant on the individual’s needs, an APD shall be classified under speech or language impairment, specific learning disability, or other health impairment.The ruling also recognized that testing and diagnosis should be completed by an audiologist.
Slide6Behaviors Associated with CAPD
Pre-Schoo
l:
Difficulty localizing
Difficulty with rhyming sounds
Possible language delaysGeneral:Difficulty hearing in background noiseDifficulty following directionsDifficulty with retention Poor “listening” skills
Academic difficulties – low academic performance
Poor phonemic awareness/phonological skills
Possible behavior problems
Difficulty with note-taking
Slide7Academic Indicators
Phonics
Reading
Comprehension
Language ArtsTranscriptionWritten Language Skills
SpellingHandwriting Word Problems Sequencing and Organization
Slide8Learning Disabilities: Reading and Written Language Disorders
Reading Disorders:
1. Impairment with development of word
recognition
and reading comprehension
2. Omissions, distortions, and substitutions of words characteristic of oral reading errorsWriting Disorders: 1. Impairment
in the ability to composed written text
characterized
by spelling errors, within
sentences
, and/or
poor
paragraph organization
Phonological Awareness associated with dyslexia
1. Difficulty
processing speech and non-speech sounds
difficulty
with frequency, dichotic digits
Slide9How old can we test?Recommended by AAA and ASHA – age 7- Why? Under age 7 – increase in inconsistency and variability
Weaker reliability for test tasking Developmental and maturational influences
Normative data availability Under age 7 some tests (e.g.: Staggered Spondaic Word Test (SSW, Katz, 1962); SCAN-3:C Tests for Auditory Processing Disorders in Children (Keith, 2009)
Checklists for listening and communication
Indicators of “at-risk” – to be treated with direct intervention
Slide10Test Considerations
Developmental age
Cognitive Abilities
Language functioning level
MotivationAlertness during testingFatigue factorsNative LanguagePeripheral hearing sensitivity
Slide11Considerations before screening
(or diagnostic testing)
What evaluations have been completed so far to indicate evidence or indicators of CAPD? Multidisciplinary testing prior to referral – why?
Can the child participate in the evaluation? Complete the tasks and/or tolerate the testing?
Would the results of the CAPD testing add information to the child’s profile and change the program being provided?
Interventions different? Added? Are the areas already being addressed?
CAPD testing: starting point or not
?*
*Notation should be included in the CAP report when other testing could not be completed prior to auditory testing.
Slide12Assessment guidelines require that children:
•
H
ave
cognitive abilities to enable testing, •Have English as their primary language (or use assessments in the child’s primary language if other than English) •Have peripheral hearing within the normal range, and •Have intelligible speech.http://www.edaud.org/advocacy/16-advocacy-10-15.pdf
Slide13What skills are necessary to be tested?Cognitive concerns:Are there significant cognitive deficits?Test material demands on language, memory, and attention
Other global cognitive issues – Difficult to separate APD
ASD – Known that children with ASD can have difficulty receiving, filtering, organizing, and making use of sensory information. Etiology already established – testing to provide specific data on which auditory skills are most difficult with possible strategies
Slide14Comorbidity
CAPD
Attention & Cognitive
Disorders
Neurological Impairment
Neurobiological Disorders
Speech & Language
Disorders
Intelligence
Visual
Motoric
Developmental
Slide15Spectrum Disorders
Learning Disabilities
Neurological Impairments
Neurobiological Disorders
Seizure Disorders
Attention Deficit Hyperactivity DisorderTBISensory Processing DisorderSpecific-Language Impairment
Slide16Neurobiological, Neurodevelopmental, and Mental Health Disorders
Anxiety Disorders:
Inherited, stressful life events, family interactions patterns, childrearing practices, learning disorders
OCD
Depression and Bipolar Disorder
Tourette’s Disorder/Syndrome
Slide17CAPD is primarily an “input” disorder – deficit specific to the processing of acoustic input.
Language Processing Versus
Auditory Processing:
Slide18Differentiating auditory processing from language processing:
Must acknowledge the acoustic, phonemic, and linguistic roles from both a neurologically and behavioral standpoint.
Audiologists view N
europsychological/neurophysiological
Speech Pathologist view Behavioral/Functional
Slide19Language Processing Versus Auditory Processing:
Audiologist evaluates pitch and tone discrimination as part of CAP battery
SLP evaluates the ability to understand the words spoken
e.g.: Sarcasm
Slide20Richards and Goswami (2015) Auditory Processing in specific language impairment (SLI): Relations with the perception of lexical and phrasal stress.Investigated auditory processing abilities for discrimination of psychoacoustic tasks of amplitude rise time, frequency, duration, and intensity.
Collected data on performance of lexical and phrasal stress tasks.
Compared performance for 12 children diagnosed with SLI and 10 typically development controls – ages 8-12 years
SLI group scored significantly lower on sensitivity to rise time and sound frequency discrimination, along with linguistic stress tasks when compared to the controls
Hypothesis: poor auditory skills in rise time and frequency may relate to difficulty in processing stress patterns of speech having a negative impact on the development of language.
Slide21Can Auditory processing difficulties exist independently of language disorders/delays while still manifesting in a similar fashion?Research linked various AP skills to specific anatomical sites along the CANS
Barmiou
,
Musiek
, & Luxon, 2001; Kimura, 1961; Musiek, Kibbe, & Baran, 1984; and Musiek, et. al., 2005
Slide22Collaborative Approach
Educational Assessments
Intellectual Status Assessments
Multisensory Status: Visual, Motor, Neurological
Language Assessments
Familial Information
Slide23Referral Sources
Directly to the Audiologist
SLP to Audiologist
CST to SLP to Audiologist
CST to Audiologist
“Other” professional to Audiologist
Parent to Audiologist
Slide24Team Approach – why important, who is on the team?
Audiologist
Speech/Language Pathologist
Child Study Team Members:
Psychologist
Learning/Educational Consultant – LDT-C
Social Worker
Neurodevelopmental Pediatrician
Neurologist
Pediatrician
Other?
Why is this important?
Slide25Single test method
(The TAPS is NOT a diagnostic test for CAPD)
Minimal Screening Battery
Questionnaires
Screening protocols
Slide26SLP investigates how auditory deficits affect language skillsScreening tools:
Auditory Skills Assessment (
Geffner
& Goldman, 2010)
Differential Screening Test for Processing (Richard & Ferre, 2006)SCAN-3 for Children: Tests for Auditory Processing Disorders – Screening Subtests (Keith, 2009a, 2009b)
Slide27SCAN-3:C
Dichotic Listening
Monaural low redundancy-
AFC
ACTemporal Processing TaskDSTP – Differential Screening Test for Processing Auditory discrimination Dichotic processing Temporal processing
Screening/Packaged Batteries
Slide28Fishers Auditory Problems Checklist
Children’s Auditory Performance Scale (CHAPS)
Questions that address the ability to listen in a variety of acoustic environments, auditory attention, and auditory memory
S.I.F.T.E.R. Screening Inventory for Targeting Educational Risk
Questionnaires
Slide29ASHA 1996 and 2005:
Tasks need to include behavioral tasks
Use of –
Dichotic speech tasks
Monaural low-redundancy tasks Temporal Ordering tasks Binaural Interaction tasks
AAA 2010: Consensus Statement for a minimal
auditory battery
Use
of –
Dichotic Tasks
Frequency or Duration Pattern Sequence
Temporal Gap Detection
Slide30Auditory Mechanisms/Processes as stated in ASHA and AAA consensus statements:
Central
Auditory processes are the auditory system mechanisms and
processes responsible
for following behavioral phenomena
Sound localization and lateralizationAuditory discriminationAuditory pattern recognitionTemporal aspects of audition temporal resolution temporal masking temporal integration temporal orderingAuditory performance with competing acoustic signalsAuditory performance with degraded acoustic signals
Slide31Audiologic
Test Categories
Dichotic
Temporal Processing Tasks
Monaural Low-Redundancy Speech Tests
Binaural Interaction TestsElectrophysiological Measures
Slide32Interpretation
Goals:
Provide information about the presence or absence of a CAPD
Determine what specific auditory process/skill areas are
dysfunctional: Breaking down to specifics
Develop a CAPD Profile
Provide information to develop a comprehensive intervention plan
Determine site-of-lesion (if applicable
)
Why do we re-test?
Is the diagnosis “forever”?
Slide33Reporting versus Analyzing test results
Auditory Acoustic Processing
Auditory Language Processing
Compromised Auditory Processing
Auditory-Spoken Language Processing
Slide34Abnormal function in any one of the central auditory areas can lead to
a CAPD
, triggering language and learning difficulties
.
Slide35*Linguistic versus non-linguistic –importance of each type
Dichotic tests
Monaural Low Redundancy Speech tests
Temporal Processing Tests
Binaural Interaction Tests
Electrophysiologic al Assessment
Categories of Central Auditory Processing tests
Slide36Dichotic listening:Information presented to the left ear must cross to the right hemisphere and the CC in order to be perceived and labeled/used.
Information presented to the right ear is directly transmitted to the left hemisphere without the need for right hemisphere or interhemispheric processing
Slide37Binaural separation: The ability to separate a primary speaker from other speakers or noise; the ability to selectively attend to specific incoming auditory information and focus on a message, which has become difficult to follow due to competing noise. (Auditory performance with competing acoustic signal)
Slide38Binaural Integration deficits: The ability to simultaneously process two different messages when they are presented to each ear.
(Auditory Performance with competing signals)
Slide39Right Ear Advantage (REA)Ear asymmetry in which scores for the right ear are consistently higher than the scores for the left ear
REA is greater as linguistic content increased from CVs to sentences
REA is maintained on directed right and directed left listening instructions
Slide40Left Ear AdvantageAn
atypical Left Ear Advantage score
suggests there may be either right
hemisphere dominance for language or (more likely) an abnormal finding consistent with a neurologically-based language or learning disability
.This is a “rare finding” suggesting potential “neurologic abnormalities in the left cerebral hemisphere” (Keith, 2000).
Slide41Not widely used clinically
Not a dichotic listening task
Stimuli presented sequentially not simultaneously
Information to each ear is composed of a portion of the entire message.Primary responsibilities of auditory brainstem: Sound transmission Binaural integration of sound Control of reflexive behavior Localization and lateralization
Slide42Binaural Interaction:
The ability to take acoustic information from both ears in order to synthesize acoustic information that differs in time, intensity, or frequency between the two ears.
(Sound Localization & Lateralization)
Slide43Auditory Discrimination
The ability to identify differences between sounds
Broad Discrimination
Fine phonological differences
(canned vs can’t/ tamp vs damp)Effects: Word recognition, speech comprehension, distinguishing prosodic aspects
Slide44Older tests used to assess the CANS
Administered monaurally with degraded speech stimuli
Low pass filtering
Time compression – temporal Intensity – speech in noise ReverberationDegrading the signal reducing the redundancy of the signal Low redundancy – non-sense syllables High redundancy – sentences – more intelligible
Slide45Extrinsic Redundancy – arises from multiple and overlapping acoustic and linguistic cues inherent in speech /language (phonemic, prosodic, syntactic cues, etc.)
Intrinsic redundancy – Due to structure and physiology of CANS; multiple and parallel pathways transmitting information within the auditory system
Moderately sensitive to APD, provide information regarding functional deficits
Slide46Auditory
Closure
The ability to fill in missing components of speech messages when incomplete due to various acoustic distractions or disruptions.
Timing alterations of speech also require the auditory system to be able to “fill in” skipped or quickly blended sounds/words. (temporal aspects)
(Auditory performance with degraded acoustic signal &…)
Slide475
Masks some acoustic cues in speech or removes phonetic information which may affect phonemic processing: decoding problem related to auditory closure at a phonemic awareness level.
Auditory Figure-Ground
The ability to listen through background noise.
Slide48Temporal Aspects (Ordering and Resolution):Time-related cues in acoustic signalsSound order (past versus pats)
Voicing placement (time versus dime)
Prosodic elements
Where are you?
Where
are you?
Where
are
you?
Where are
you
?
Slide49Auditory Pattern Temporal Ordering
Being able to recognize acoustic contours of speech allows us to extract and use certain prosodic aspects of speech including rhythm, stress and intonation
e.g.: Where are you going?
Where are
you going? e.g.: Distinction between boost and boots depends on discrimination of consonant duration of temporal ordering of the final two consonants
Slide50Interpretation
Analysis of results intended to:
Identify the presence or absence of CAPD Identify underlying processes that may be disordered Determine site-of-lesion or site-of-dysfunction Develop intervention program in conjunction with academic and other measures(Bellis, 2003 & 2011)
Slide51Before we can create an effective intervention plan, we have to understand the problem and how the associated symptoms are supported.
What does it look like?
What does the diagnosis category really mean?
Do we need remediation therapy, classroom accommodations, or acoustic controls?
Slide52Most Commonly used Profile Models/Theories
Bellis/
Ferre
Buffalo
Model
Theories: the analysis of a set of facts in their relation to one another; abstract thought; speculation; the general or abstract principles of a body of fact, a science or an art (Merriam-Webster Dictionary)
Slide53Commonly used descriptive categories*
Auditory Decoding
Auditory Integration
Auditory
(Pattern) Temporal
ProcessingOrganizationAuditory MemoryAuditory Attention*Determined by the pattern of findings on a CAP evaluation
Slide54Auditory Decoding
Inefficient analysis/discrimination of fine differences within the speech spectrum
Language Deficits in vocabulary, grammar or semantics (or a combination
Deficits in spelling, sound blending, reading decoding or reading comprehension, especially with new material, when noise is present and/or when visual cues are limited
Listening difficulties: excessive auditory fatigue, decline of listening skills, mishearing information or mishearing
direction
Presents as if having a high frequency hearing loss; mishearing and substituting similar
sounds
Performs better in math than in reading
Slide55Auditory Integration
Difficulty with tasks requiring multi-modality input or output
Difficulty with reading, spelling and/or writing (poor sound-symbol association and sight-recognition skills)
Difficulty with symbolic
language
Difficulty with peer communication/interaction (secondary to poor syntactic, semantic, and pragmatic skills
)
Poor
music
skills
Slide56Auditory Integration
Poor
prosodic
skills
Difficulty listening in background noise or listening to multiple
speakersDifficulty
completing assignments in a timely
manner
Difficulty getting started on assignments, especially longer, multi-step assignments
Slide57Auditory Temporal Processing
Difficulty recognizing the cadence or flow of multiple acoustic cues in a stream of speech (acoustic contours or patterns)
Difficulty using salient features of a target signal to “get the message”; speech can be perceived as a “blur”
Difficulty perceiving and attaching meaning to timing cues in speech (
ie
: pacing and segmentation)
Difficulty sequencing critical elements within a message
Adverse effect on reading and spelling, listening in noise, direction-following, note-taking, auditory attention skills & processing speed
Slide58Auditory Temporal Processing
“flat” monotone readers
Difficulty
understanding sarcasm and/or using heteronyms
Difficulty
recognizing and using non-verbal, pragmatic language cues such as facial expressions, body language & gestures
Music-based skills may be compromised
Slide59Organization
Disorganized (poor note-taking skills & poor assignment completion skills)
Impulsive
Poor Planner
Difficulty with expressive language and word retrieval, including poor syntactic skills
Motor planning difficulties (articulation deficits, fine
nad
gross motor skills)
Difficulty following oral directions
Slide60Organization
Poor sequencing and follow through such as remembering assignments
Difficulty acting on incoming information
May demonstrate good reading comprehension but spelling and writing may be poor due to the multi-element nature of the task
Difficulty getting started
Difficulty with open ended tasks
May have difficulty hearing in noise but will still complain when it is quiet
Slide61Auditory Memory
Exhibit a tendency to forget earlier presented items and to retain what was heard most recently
Difficulty following and retaining conversation and instructions especially if the information is novel and if competing stimuli are present
Tend to exhibit reading comprehension problems
Possible spelling problems due to difficulties in retention of visual orthographic representation of words
Limited amount of information can be held at one time
Slide62Auditory Memory
Easily over-stimulated
Sensitive to loud sounds
Handwriting problems due to motor planning problems
Easily distracted
Adequate decoding skills
Spoken language is often “cluttered”
Weak receptive language skills
Difficulty making inferences
Slide63Auditory Attention
Difficulty choosing what to attend to (inability to correctly determine the target)
Distractibility (inability to selectively attend to a target)
Poor listening skills (inability to allocated attentional resources effectively)
Difficulty hearing in background noise (inability to block out competing stimuli while attending to a target)
Difficulty following oral instructions
Difficulty maintaining attention over time (limited attention span)
Slide64Auditory Attention
Difficulty attending to an intermittent target
Difficulty
following oral instructions
Difficulty maintaining attention over time (limited attention span)
Difficulty attending to an intermittent target
Slide65Secondary
Subprofiles
Specific to the Bellis/
Ferre
Model
That gray line between where auditory transitions to language processing and higher order cognitive realmsTop-down factors become contributory to the processing of auditory input
Indicated by specific patterns on an auditory test battery
Typically manifest as language disorders when tested by the SLP
Slide66Secondary
Subprofiles
Associative Deficit:
Inability to apply the rules of language to incoming acoustic information: especially with linguistically complex information
Sometimes referred to as “receptive childhood aphasia” (not commonly used anymore)
Lesions in the auditory association cortical areas
Receptive language deficits generally in vocabulary, semantics, and syntax
Slide67Secondary
Subprofiles
Output-Organizational Deficit:
Inability to plan, sequence and organize responses to auditory information or instructions
Difficulty hearing in noise
Poor organizational skills
Difficulty following directions
Reversals
Poor recall and word retrieval abilities
Slide68Auditory Phonological
Decoding
The ability to recognize and combine individual phonemes for reading fluency.
(Word attack skills)
Lexical Decoding:The ability to understand a series of words that has been read. (Interpret meaning from written text, make inferences, and answer comprehensive questions regarding the information. Comprehensive Decoding.Buffalo Categories
Slide69Intervention:
Approach to Management
Having a plan
Understanding the diagnosis:
Process areas affected
Profile categories with implications
Interpret Reports/Findings From Collaborative
Design a management & intervention program
Slide70Direct Therapies
Functional Skill Development
Auditory Training
Cognitive, Metalinguistic, Metacognitive Skills & Strategies Improve learning and listening skills
Compensatory StrategiesClassroom Management Accommodations / ModificationsClassroom Acoustic Management/Environmental Acoustic and non-acoustic
Components of Intervention
Slide71Direct Remediation Intervention
Activities
to maximize neuroplasticity and improve performance by changing the way the brain processes auditory information
Activities
to help the child read and follow instruction better; function better in the classroom
Slide72Direct Remediation Techniques
Phonemic discrimination
Speech to print skills
Dichotic listening training
Localization/lateralization training
Enhancing perception of stressRhythm & intonational aspects of speechPerception of acoustic patternsMultimodality – interhemispheric stimulation
Slide73Lindamood
- Bell Programs
LIPS – (Auditory Discrimination In Depth (ADD)
Emphasizes importance of auditory perception & comparing phonemes in spoken syllables
Multisensory – based on their individual characteristics that can be heard, seen & felt through oral-motor actionsOrton-Gillingham- Structured, sequential & cumulative Multisensory – language based Students write letters & words with fingers
Wilson Reading ProgramFundations Reading Program
Bottom-up Management/Therapies
Slide74Auditory Training
Goal: re-wiring, re-organization, potential activation of neurons and neural connections previously in a state of rest
Based on neural plasticity
:
Developmental
Compensatory
Learning
related
Educational Goal: Improve listening, comprehension, spoken language processing, & educational achievement
Acoustically controlled
Intensive Schedule
Targets specific stimuli
Slide75Auditory
Intervention
Auditory Discrimination – Improve the listener’s ability to discriminate, identify, and recognize fine and /or rapidly changing acoustic cues
One of the most basic fundamental
auditory
processes
Critical to discriminate acoustic stimuli
e.g.: speech segments and/or phonemes
Auditory Closure
Vocabulary Building – larger vocabulary base, when confronted with unfamiliar or
misperceived word
Pre-teaching/Introduction of Words
Slide76Auditory
Intervention
Temporal Processing Skills
Sound
Pattern training – Identifying/mimicking
patterns with
differing durations/frequencies
Prosody
training -
Attention
to stress & prosody while
reading/listening to poetry
Duration
discrimination
training – timing between word/boundaries
Sequencing tasks
Heteronym
differentiation
Identify word boundaries via temporal cueing
Reading poetry
Follow auditory directives
Slide77Auditory Intervention
Binaural Separation; Binaural Integration/Summation; Interhemispheric
Transfer (Integration skills)
DIID
– Dichotic Interaural Intensity Difference (Corpus Callosum involvement) Directing Stimuli to stronger ear at reduced levelEar plugs? Speech recognition in noiseIntensity altered dichotic listeningListen to intensity imbalance stereo musicAuditory vigilance training
Verbal identification through tactile cues of objects held in left handDescribe picture while drawingLeft-sided motor response to verbal command
Slide78Auditory
Intervention
Auditory Vigilance – ability for a listener to remain attentive to auditory stimuli over a sustained period of
time.
Increase/improve awareness to acoustic stimuli
Use
of multi-step or complex auditory directives
Work on listening to instructions
fully then perform task
Providing target words, sounds, categories or
ideas randomly
scattered throughout increasingly
longer
passages
read aloud.
Auditory Memory Enhancement (AME
) - develop
an ability to listen for general concepts (hear, process, recall) rather than trying to recall larger amounts of detail all at once
Sketching
Rehearsal strategies
Using
imagery and tag words to emphasize language and
transitions
Slide79Decoding
Phonemic/Phonologic Awareness
Answers from a CAP Report - Questions to ask
Is it the acoustic code?
Onset/Offset- Start/Stop of sound? Word? Is it the language portion (tagging of the phoneme on the acoustic segment?)Is it difficulty with phonics or the process? (Difficulty with rapidly perceiving sounds in words?)
Is it difficulty with the Lexicon?
What about English as a second language? Impact?
Slide80Discrimination Training
Auditory Training exercises/Auditory timing – e.g.: tapping out
Phonological Segmentation
Phonological Blending
Rhyming: phoneme, syllable, word
Word attack skills (for the teacher)
Vocabulary building
Auditory Decoding Intervention
Slide81Slide82Slide83The Environment: Impact of Noise
Type of Noise
Loudness of the noise relative to the target
Task demands
Even minor changes in the environment can diminish the auditory pattern over timeClassroom Acoustic Evaluation
Slide84Classroom Acoustic Make-Up
Decoding
: Signal-to-noise improvement a primary consideration
Integration & Prosodic
: Bothered by noise as a function of task demands (e.g.: test taking, increased multisensory demands). Random noise – Alter task demands in this case, remove from environment, frequent breaks, extend test/project completion time, reduced assignment size
Slide85Classroom Acoustic Make-Up
Organization
: Difficulty filtering out any kind of distractions – visual and/or auditory – Reduce chaotic or over-stimulating environments. Noise desensitization activities to improve tolerance and filtering.
Associative
: Background noise not necessarily a factor – it’s the language. Possibly due to signal’s linguistic clarity not acoustic clarity.
Slide86Environmental Considerations
Provide structure and demonstrate an organized work area
Reduce visual distractions in the classrooms
Seat the student close to the teacher
Strategic seating with flexibilitySeat away from windows or doorwaysProvide an unobstructed view of the chalkboard, teacher, movie/TV screenKeep extra supplies of classroom materials on handMaintain adequate space between desks
Slide87Classroom Acoustic Considerations
Acoustic Enhancement
FM/DM
Listening
Systems* Personal
versus CADS Group Sound Field Infrared SystemsOther Modifications:Carpeting rooms, curtains, drapes,Acoustic ceiling tiles, baffles within listening spaceEliminate open classroom, damping highly reflective surfaces.
*
An FM/DM system alone will NOT remediate a CAPD issue.
Not all CAPD issues benefit from amplification
Slide88Games
Auditory Discrimination
Rhyming Games
A Rhyme in Time
Telephone GameLocalization Games: Key Game Marco Polo Blind Mans Bluff
Temporal patterning Mad Gab Bop It Bop It Extreme Simon Simon 2 Tongue Twisters Dr. Suess Books
Temporal Patterning cont’d
Poems
Nursery Rhymes aloud
Singing Songs (e.g. BINGO)
Patterning Skills
Simon Says
Scrabble
Upwords
Boggle
Dominoes
Rummikub
Phonological Awareness
Syllable tap out
Slide89Games
Auditory Attention
Simon Says
Battleship
Telephone Game TwisterAuditory Vigilance Musical Chairs Duck Duck Goose Bop It Brain Warp
Simon Says Red light-Green light
Cross Hemisphere
Sports – Karate
Dance
Playing an instrument
Tossing a ball hand to hand
Interactive Video Games
Donkey Kong Jungle Beat
Mario Mix Dance Revolution
Name That Tune
Feely Bag
Enhance Visual Skills
Charades
Read My Lips
Pictionary
Cranium Series
Slide90Speech and Language Assessments
Temporal Resolution:
Comprehensive Test of Phonological Processing
Phonological Awareness Test
Reading Inventory of Phonological AwarenessLindamood Auditory Conceptualization TestLexical Decoding:Phonological Awareness Test Knowledge of Word Meaning:
Receptive One-Word Picture Vocab TestPeabody Picture Vocabulary Test -4
Slide91Semantic Knowledge
The Language Processing Test 3 – Elementary
Word Test 2 – Elementary
Clinical Evaluation of Language Fundamentals -4
Comprehensive Assessment of Spoken Language (CASL) Word Retrieval Test of Word Findings-2/Test of Word Retrieval Efficiency/Test of Word Finding in DiscourseMorphological and Syntactical KnowledgeClinical Evaluation of Language Fundamentals – 4/5
Test of Language Development Primary 3Comprehensive Assessment of Spoken Language
Slide92Integration – Possible assessments to examine related measures include evaluating socio-pragmatic skills (turn-taking, individual’s conversational style, inference/deductive reasoning
)
Test of Pragmatic Language-2
Test of Problems Solving -3
Test of Auditory Processing SkillsTest of Narrative LanguageQualitative Reading Inventory 3 ( assesses both explicit and implicit knowledge about a story)Sequencing/OrganizationTest of Narrative LanguageThe Token Test Detroit Test of Learning Disabilities (Word Sequencing subtest)
Lindamood Auditory Conceptualization test #3
Slide93How do we know intervention is working?
Educational performance
Behavioral speech perception testing
Functional assessment/Questionnaire observations
SIFTER LIFE CHAPSRe-Evaluation
Slide94Specific Learning Disability
:
“a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations”.