Current Trends and Intervention techniques in Auditory Processing Disorders and Children - PowerPoint Presentation

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Current Trends and Intervention techniques in Auditory Processing Disorders and Children with cochlear implantsAuditory Processing DisorderTeam Evaluation and Management

Velvet Buehler, M.A. CCC-SLP/A

Clinical Professor

University of Tennessee Health Science Center

2014

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Disclosure StatementI have no relevant financial or nonfinancial relationships to disclose.

Velvet Buehler, M.A. CCC-SLP/A

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Overview of PresentationDefinition of APDAPD Team Members and their RolesAudiological

Assessment

Speech Language Assessment

Case Studies representing each Sub-Profile of APD

Test Findings

Classroom Accommodations

Direct Intervention

Compensatory Strategies

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Central Auditory Processing Defined (ASHA, 1993)

Difficulties with:

1- Sound Localization

2- Auditory Discrimination and Pattern Recognition

3- Temporal Resolution/Masking/Integration/Ordering

4- Auditory Performance with Degraded and Competing Signals

Observed

deficiency on one or more of

these areas resulting

from dysfunction of auditory processes as a result of a

neuro

-maturational delay , or it may be reflected by co-existing dysfunctions

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Auditory Processing Disorder Defined (Bruton Conf. 2000)AP is new label to emphasize the interactions of disorders at both peripheral and central sites

APD is a deficit in the processing of information that is specific to the auditory modality

The

deficit may be exacerbated in unfavorable acoustic environments and that may be associated with difficulties in listening, speech understanding, language development, and learning

APD is a complex and heterogeneous

Underlying APD is a deficit in one or more of the auditory processes listed in ASHA/1993 definition

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Central Auditory Nervous System

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Central Auditory Nervous System

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Auditory Processing is…How well we pay attention to, discriminate, associate

,

integrate

, and

organize

what we hear (

Ferre

)

Good

auditory processing skills are important for communicating with

others, for

learning new information

, and for

carrying out tasks in our daily lives

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Auditory Processing Skills:from ear to cortex (Ferre)

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Auditory Processing includes…“Bottom-Up” processesOccur in the auditory system prior to higher-order cognitive and linguistic operations at the cortical level“Top-Down” processesInfluenced by attention, memory and linguistic competence

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Auditory Processing Disorder Defined Katz: AP is not what we hear, but what we do with what we hear

Musiek

: AP is how well the ear talks to the brain and how well the brain understands what the ear tells it

Bellis

: APD is when the brain can’t hear

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Prevalence of (C)APD2-3% of children may evidence APDMale-female ratio is 2:1APD

characteristics may exist secondary to other disorders or co-occur

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(Central) Auditory Processing Disorder, ASHA, 2005(C) APD is a deficit in neural processing of auditory stimuli that is NOT due to higher order language, cognitive, or related factors.

However

, (C)APD may lead to or be associated with difficulties in higher order language, learning, and communication functions.

(

C)APD may co-exist with other disorders, but is NOT THE RESULT OF them.

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(C)APD, ASHA, 2005“Modality specificity” as a diagnostic criterion for (C)APD is not consistent with how processing actually occurs in the CNS. Few areas of the brain are solely responsible for a single sensory modality.

Individuals with (C)APD exhibit sensory processing deficits that are more pronounced in the auditory modality, and some “auditory-modality- specific” effects may be demonstrated.

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Overall performance for auditory functioning is poorWeaknesses in receptive and expressive language skills and literacyOften viewed as a behavior problem

History of chronic otitis media

Verbal IQ poorer than Performance or Motor skills sections of IQ evaluation

Fine/gross motor deficits

Not reaching academic potential

Characteristics observed in Auditory Processing Disorder

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APD: Possible Deficit AreasAuditory Memory and SequencingAuditory ClosureTemporal Patterning, IHT and Prosody

Phonological Awareness and Literacy

Auditory Figure Ground/Listening in Noise

Binaural Integration or Separation

Vocabulary, Syntax, Morphology

Meta-linguistics

Math

Poor Organization

Reduced Self-Esteem

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How does an APD negatively impact an individual? Perceiving similarities and differences in words

Hearing double consonant sounds in blends

Discriminating short vowels

Storing sounds in working memory to match to print

Segmenting words into syllables and sounds

Combining parts of word to make a whole

Phonetically blend unfamiliar words

Remembering sounds for printed letters

Remembering meta-linguistic labels

Relating visual components of words to their auditory counterparts

Detecting rhymes

Reading with correct prosody and rate

Recognizing emotional content and stress/rhythm changes in passages

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APD may cause deficits in…Meta-linguistics which involves the knowledge of the language of learning.

Meta-cognition

which involves the knowledge of the language of thinking.

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Meta-linguistics Letters make

sounds

letters

form

words

you can see

sounds

form

words

you can say

words

have

syllables

syllables

are made of

letters

letters

make

sounds

so you can say

syllables

Each

syllable

has a

first

,

last

, and sometimes

middle sound

.

Each

word

has a

first, last

, and sometimes

middle sound

.

Each

word

with more than one

syllable

has a

first, last

, and sometimes

middle syllable

.

Words

make

sentences

.

Sentences

make

paragraphs

.

Paragraphs

make

stories

.

“FIND THE LAST SOUND OF THE FIRST

WORD OF THE SECOND SENTENCE OF

THE LAST PARAGRAPH OF THE STORY.

WHAT LETTER MADE THAT SOUND?” (Lynne Harmon)

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APD may cause deficits in…Phonological Awareness which focuses on increasing awareness of phonemes, syllables and words in seven areas

Rhyming

Discrimination

Blending/Synthesis

Segmenting

Identification

Manipulation

Deletion

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Auditory Processing Disorder

Leads to deficits in

Literacy

Reading decoding

R

eading fluency

Reading comprehension

S

pelling

Written language skills

Narrative language skills

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APD may cause deficits in areas that impact LEARNING !If a child does not develop good listening skills, then learning is impacted.

If a child does not develop good reading skills, then learning is impacted.

“ Children who do not LISTEN and READ well are limiting their potential to continue to LEARN at the rate that other children do.”

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APD Team AssessmentHow do we determine the appropriate test battery to evaluate if we can OR cannot “listen”?Who

is on the

team?

Audiologist

Speech-Language Pathologist

P

sychologist

Special Educator

Classroom

Teacher

Oto

-Neurologist

OT/PT

Parents

Child

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Contribution of the Audiologist and the Speech PathologistASHA recommends that the final diagnosis be made by the audiologist as a result of a TEAM assessment

Team

management is also

recommended

Observe

behaviors and characteristics of APD

Understand APD and how it effects academics,

communication, literacy,

and social/emotional skills

Administer formal tests

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Contribution of the AudiologistMake the diagnosis of APDSpecify deficient auditory processesIdentify the specific sub-profile or type of APD

Make recommendations for management

ALDs

Compensatory strategies

Environmental and teacher modifications

Treatment areas related to auditory processes and sub-profile of APD

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APD Test Battery should answer these questions…Is the Central Auditory Nervous System functioning normally with language factors removed?Is there a neurologic basis for the problem…Can we determine a site of disorder?

Describe the disordered listening processes and label a profile or type of APD

Lead to recommendations for other referrals/appropriate management related to environment, direct intervention, and compensatory strategies

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Differential DiagnosisThe APD test administration must make modifications for attention, articulation, memory, sensory and language deficits Notice “on again/off again”

behaviors

Do

not score items which are judged “inattentive

”

Do

not score items which are judged “misunderstood” or “too difficult” for level of

child

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Reason for VisitBackground HistoryChief ConcernsReview of Systems/ ExamsOtoscopyTympanometry and Acoustic ReflexesFisher’s Auditory Problems Checklist

Peripheral Hearing

Central Hearing

Assessment of Results

Plan/ Recommendations

Prognosis

The Typical APD Report

What does it mean?

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The Tests Typically Administered for Central Hearing by the AudiologistStaggered Spondaic Word Test (SSW)Dichotic Digits- Double Pairs Competing Sentences TestPitch Pattern Sequence Test (PPST)

CID-22 Speech in Noise Test

Time Compressed Sentences or Words

Low Pass Filtered Speech

Rapid Alternating Speech

Competing Environmental Sounds

Phonemic Synthesis

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Other Tests in APD BatteryComplete Audiologic

E

valuation

PIPB Rollover

Masking Level Differences

Acoustic Reflexes

Tympanometry

Oto

-acoustic Emissions

ABR/MLR/P300 Evoked Potentials

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Dichotic Listening

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Staggered Spondaic Word Test (SSW)Assesses dichotic listening Requires the auditory process of binaural integration when linguistic cues are presentBinaural Integration: the ability to understand and process two different messages presented simultaneously

Example: up stairs down town

RNC RC LC LNC

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Dichotic Digits- Double PairsAssesses dichotic listeningRequires the auditory process of binaural integration when linguistic cues are not presentBinaural Integration: the ability to understand and process two different messages presented simultaneously

Example: 1 4 (simultaneous)

6 5 (simultaneous)

LE RE

repeat all four numbers

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Competing Sentences Test (CST)Assesses dichotic listeningRequires the auditory process of binaural separationBinaural Separation: the ability to “selectively attend” and to understand one message presented while ignoring another message presented simultaneously

Example: It was a long ride by train. RE

I thought we would never get there. LE

Simultaneous

T

ell me the sentence you hear at the right ear/ left ear.

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Pitch Pattern Sequence Test (PPST)Assesses the auditory process of temporal patterning and inter-hemispheric transfer via the corpus callosumRequires pitch discrimination, memory, and sequencing to hum the three pitch sequence AND to label the three pitch sequence

Example: High

High

Low (binaural presentation)

1.Hum the three pitch sequence (

Rhemisphere

)

2.Label the three pitch sequence (

Lhemisphere

)

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Pitch Pattern/Duration Pattern Sequence Test

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CID-W22 Speech In Noise TestAssesses the auditory process of auditory figure groundAuditory figure ground: the ability to understand messages in the presence of background noise (+5db S/N ratio)

Example: Repeat these words (25 RE, then 25 LE)

Listen to the man and ignore the noise

Compare difference in ears

Compare difference in quie

t and in noise

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Time Compressed Sentences Assesses the process of auditory closure and overall temporal processing skillsAuditory Closure: the ability to “fill -in” the missing pieces of a compromised or degraded message

Example: Repeat sentences with 40 % time compression

Repeat sentences with 60% time compression

Do for each ear and

Compare difference between ears/ % correct

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Low Pass Filtered SpeechAssess the process of auditory closure and overall temporal processing skillsAuditory Closure: the ability to “fill-in” missing pieces of a compromised or degraded message

Example: Repeat words/ Say the word burn

Passed through a low pass filter

They sound “muffled”.

25 RE, 25 LE % correct

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Rapid Alternating Speech TestAssesses the process of binaural fusionBinaural fusion: the ability of the two ears to merge auditory input being rapidly alternating between the RE and the LE

Example: Repeat the sentence

The children came home late from school.

Rapidly alternating between ears

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Phonemic SynthesisListen, sequence and remember sounds discreetly presented and blend to make wordExample: m- i- l- k = milk

25 words increasing in number of sounds

% correct and analyze types of errors

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Competing Environmental SoundsDichotic task assessing Binaural IntegrationExample: hear two environmental sounds presented simultaneously to each ear and point to pictures representing the two sounds

Car horn (RE) and sneezing (LE)

get total % correct and % correct at each ear

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SAAT Use WIPI stimulus pictures (set of 8 on each page and some rhyme)Present 25 words while competing story is also being presented in background Score % correct

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Contribution of the Speech-Language PathologistUnderstand the audiologic test battery, auditory processes, types of APD and implications for treatment

Understand

, develop and implement effective treatment goals and

strategies

incorporating results of the

audiologic

evaluation AND the speech-language evaluation

Consult with teachers for carry-over into the classroom and identify weak academic areas

Consider results of other evaluations completed

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Contribution of the SLP:Assessment

Vocabulary

Critical thinking skills

Specific

word

finding

Oral

reading vs. Silent reading fluency

Reading comprehension

Paraphrasing, reasoning,

inferencing

Narrative language

Phonological Awareness

Phonetic Decoding

Short and long term

memory

Working memory and sustained memory

Sequencing

Organization

of thoughts

Lag time in response

Figurative/meta-linguistic/pragmatic

Length and

complexity

Spelling

Written language

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Additional Assessment Areas For SLP : Write Goals as needed! Auditory Memory/Sequencing/Reasoning : short term, long tern, sustained memory, working memory

Reading Comprehension

Reading Fluency

Written Language Skills

Spelling

Phonetic Decoding/Synthesis/Analysis/

Phonological Awareness

Auditory Cohesion

Receptive and Expressive Language

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School-Based Services for APDRules and RegulationsThe U.S Dept of Ed. Office of Special Education Programs: http://www2.ed.gov/about/offices/list/osers/osep/index.html

Follow your state’s Dept. of Educ. W

ebsite for current information

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Educational coverage - IEPSpeech or Language Impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or voice impairment that adversely affects a child’s educational performance.Speech

or Language Impairment include demonstration of impairments in the areas of language, articulation, voice, or fluency.

(1) Language Impairment – A significant deficiency not consistent with the

student’s chronological age in one or more of the following areas:

(a) a deficiency in receptive language skills to gain information;

(b) a deficiency in expressive language skills to communicate information;

(c) a deficiency in processing (auditory perception) skills to organize information

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Evaluation ProceduresEvaluation of Speech or Language Impairments shall include the following:a. Language Impairment – a significant deficiency in language shall be determined by:

(1) an analysis of receptive, expressive, and/or

composite test scores that fall at least 1.5 standard deviations below the mean of the language assessment instruments

administered; and

(2) a

minimum of two measures

shall be used, including

criterion-referenced and/or norm-referenced instruments

, functional communication analyses, and language samples. At least one standardized comprehensive measure of language ability shall be included in the evaluation process

.

Severe discrepancy between IQ and academic performance is no longer the sole criterion for eligibility.

RTI offers a “response to intervention” model for eligibility: focused intervention services can be “early intervening services” before establishing special education eligibility.

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Areas to evaluate…Evaluation of language abilities shall include the following:(a) hearing screening;(b) receptive language: vocabulary, syntax, morphology;

(c) expressive language: mean length of utterance, syntax, semantics, pragmatics, morphology; and

(d) auditory perception: selective attention, discrimination, memory, sequencing, association, and integration

.

(3) documentation, including observation and/or assessment, of how Language Impairment adversely impacts his/her educational performance in his/her learning environment.

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Learning DisabilityEvaluation for Specific Learning Disabilities shall meet the following ……(6) evidence that, when provided scientifically-validated instruction and appropriate interventions and learning experiences, the child did not achieve at a proficiency level or rate consistent with State-approved grade level standards or with the child’s age, in

one or more of the following areas;

(a) oral expression,

(b)

listening comprehension

,

(c)

written expression

,

(d)

basic reading skills

,

(e)

reading fluency skills

,

(f)

reading comprehension

,

(g) mathematics calculation, and

(h)

mathematics problem solving

;

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Learning Disability(7) evidence that the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both

, relative to State-approved grade level standards, the child’s age, or intellectual development that is determined to be relevant to the identification of a Specific Learning Disability (as defined in the definition of Specific Learning Disabilities); and

(8) evidence that the child's learning problems are

not primarily due to

Visual Impairment,

Hearing Impairment

, Orthopedic Impairment; Mental Retardation; Emotional Disturbance; limited English proficiency; environmental or cultural factors; motivational factors; or situational trauma (i.e., temporary, sudden, or recent change in the child’s life);

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Learning Disabilityb. A child whose characteristics meet the definition of a child having a Specific Learning Disability may be identified as a child eligible for Special Education services if

…..

(3) documentation, including observation and/or assessment, of how Specific Learning Disabilities

adversely impacts the child’s educational performance in his/her learning environment.

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Evaluation TeamInformation shall be gathered from the following persons in the evaluation of a Specific Learning Disability:

(1) the parent;

(2) the child’s general education classroom teacher;

(3) a licensed special education teacher; a licensed school psychologist, licensed psychological examiner, licensed senior psychological examiner, or licensed psychologist;

(4) at least

one person qualified to conduct an individual diagnostic evaluation

{e.g., licensed special education teacher,

licensed speech-language teacher/pathologist

or licensed remedial reading teacher/specialist); and

(5)

other professional personnel

as indicated (e.g., Optometrist or

Ophthalmologist, ).

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Section 504Section 504 is a civil rights statute which provides that: “No otherwise qualified individual with handicaps in the United States...shall, solely by reason of his/her handicap, be excluded from the participation in, be denied the benefits of

, or be subjected to discrimination under any program or activity receiving federal financial assistance.”

(29 USC § 794)

Individualized instruction or direct intervention can be provided under Section 504(Specially Designed Instruction/ SDI)

Provides equal access to general education

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Classroom AccommodationsThe child’s student services plan may address…



Adaptive equipment and materials



Behavior management recommendations



Instructional modifications



At-risk program



Tutoring program



Counseling program



Testing modifications

ie

: allowing a student who has trouble writing to give his answers orally. Student is expected to know same material and answer the same questions as fully as other

students

, but doesn’t have to write his answers to show that he knows the information.

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504 EligibilityA student is eligible under §504 if the student:(

a) has a

physical

or mental impairment which

substantially limits one or more major life activities

;

(

b) has a record of such an impairment; or

(

c

) is regarded as having such an impairment.

34 CFR §104.3(j)(1).

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Major Life ActivitiesFunctions such as walking, seeing, hearing

,

speaking

, breathing,

learning

, working, caring for oneself, and performing manual tasks. The disability only needs to substantially limit one major life activity in order for the student to be eligible.

34 CFR §104.3(j).

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Direct Services under 504Instruction must be individually designed to meet the needs of the student as adequately as the needs of non-disabled students. 

Section 504 does not require LEAs to develop an IEP. It is recommended that the LEA document that the Section 504 review committee convened and

specify the agreed-upon services

in a document called a Student Services Plan.  

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Educational ServicesThe quality of educational services provided to students with disabilities under Section 504

must be equivalent to the services provided to non-disabled students

. Teachers must be trained in the instruction of persons with the disability in question and appropriate materials and equipment must be available.

Comment to 34 CFR 104.33(b).

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Specifically Designed InstructionSchema InductionDiscourse Cohesive DeviceContextual Derived Vocabulary BuildingPhonological Awareness

Semantic Network Expansion

Assertiveness Training

Self Instruction Training

Intensity, Frequency, Duration Discrimination

Auditory

Sequencint

Temporal

G

ap Detection

Phoneme and Phoneme to Grapheme Discrimination

Temporal Order Discrimination and Training

Pattern and Stress Recognition

Localization and Lateralization Training

Recognition of Auditory Information in Background Noise

Auditory Memory

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504: can include these and moreRedirectionVisual AidsPreferential SeatingFMPeer Note-taker

Preview or Provision of

ppt

or notes prior to class

Audio Recording device “

penscript

” for lectures

Audio Recording for books

Reduction of noise

Ear plugs

Quiet study area and test taking

Modifications on tests

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RTI Myths (LinguiSystems Guide to RTI (Judy Rudebusch,2007)Identify students for special educationTier 3 (individualized) is only for special education

It is a pre-referral intervention

Research is limited for reading

SLPs should not be involved with students through RTI

SLPs ROLE in RTI:

1:Program design

(language, literacy)

2:Collaboration

3:Serving Individual Students

(screen at risk students, determine referral, assess with norm and criterion referenced measures, determine duration, intensity, and type of service, provide intervention)

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Contribution of Other Team MembersPsychologist:Verbal

vs.

Performance IQ

L

earning style

A

ttention

L

earning disabilities

Hyperactivity

Emotional status

Speech of processing

Effects of medications

Impulsivity

ADHA or Autism Spectrum

Otoneuralogist

:

Dizziness

MRI to rule out retro-cochlear pathology

Special Educator/Teacher:

Complete checklists such as CHAPPS, Fisher’s Auditory Problems

Academic deficits

Occupational Therapist/Physical Therapist:

Auditory visual integration

Fine and gross motor skills

Sensory integration

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Audiological Tests Identify Deficits in Auditory ProcessesAnd Sub-Profiles of APD

Review of Auditory Processes Assessed during the APD evaluation

and Sub-Profiles of APD

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Auditory Processes and TestsBinaural Integration: Staggered Spondaic Word, Dichotic DigitsBinaural Separation:

Competing Sentences

Temporal Patterning/ IHT

: Pitch Pattern Sequence

Auditory Figure Ground:

CID W-22 in noise or SAAT

Auditory Closure:

Low Pass Filtered Speech, Time Compressed Sentences

Binaural Fusion:

Rapid Alternating Speech

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Types or Sub-classifications of Auditory Processing Disorders

Katz / Buffalo Model

Decoding

Tolerance Fading Memory

Integration

Organization

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Bellis/ Ferre Sub-Profiles of APD

Primary Subtypes

Auditory Decoding Deficit

Dysfunction in the

left

hemisphere

Prosodic Deficit

Dysfunction in the

right

hemisphere

Integration Deficit

Dysfunction in inter-hemispheric pathways or

right

hemisphere

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Bellis/ Ferre Sub-Profiles of APD

Secondary Subtypes

Associative Deficit

Dysfunction in

left

associative cortex where acoustics and meaning/syntactic analysis occurs

Output-Organization Deficit

Dysfunction 1) in temporal-to-frontal and/or efferent system 2)with audition and higher-order abilities such as receptive language and executive function

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Primary Sub-Profiles:Auditory Decoding DeficitThe most auditory-modality specific

Site of dysfunction is the primary auditory cortex in the language dominant hemisphere (

left hemisphere)

Decreased intrinsic redundancy which is more pronounced in listening situations where extrinsic redundancy is reduced

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Primary Sub-ProfilesProsodic DeficitOften is the auditory piece of a larger, general central processing deficit arising from a dysfunction in the

right hemisphere

Auditory Processes impacted:

Poor Temporal Patterning skills

Poor Auditory Discrimination of non-speech stimuli and vowels

Poor Binaural Separation and/or Integration

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Primary Sub-ProfilesIntegration DeficitCharacterized by difficulty in tasks requiring inter-hemispheric transfer (right hemisphere or corpus callosum)

Symptoms may be within a single modality or may be multimodality because the corpus callosum is

is

a multimodal structure

The auditory symptoms may be the primary factor or just one manifestation of multimodality difficulties

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Secondary Sub-Profiles:Associative DeficitInability to apply the rules of language to incoming acoustic information (example: misunderstand passive voice, “the cat was chased by the dog”, compound sentences, and complex linguistic messages

Inability to attach linguistic meaning to phonemic units of speech

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Secondary Sub-Profiles:Output-Organization DeficitSymptoms can overlap with many other disorders so evidence of an auditory deficit must be confirmed

Inability to sequence, plan, and organize responses to auditory information or instructions

Receptive auditory skills are good, but the ability to act upon incoming auditory information is poor

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Successful Management

Direct Intervention

Environmental Modifications

Compensatory Strategies

Slide78

Team ManagementThree areas should be addressed based on the APD type/sub-profile, the deficient auditory processes, and the educational/communicative/ and social-emotional characteristics

Classroom/Environment/Teacher

modifications

Direct

Intervention/Remediation

Compensatory

Strategies

Slide79

Classroom/Environmental and Teacher AdaptationsChildren with APD are “high risk listeners” (Johnson, 1995)“high risk” category requires +12 to+20db signal to noise ratio

Children spend 45-65% of their day with primary focus on listening

Speech recognition in quiet is poor predictor of skills in noise

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Classroom AccommodationsPreferential seatingAssistive Listening Devices (D and O)Repetition (D)Rephrasing (P/A)Reduced elements (O)Slow clear speech

Attention-getting devices (touch, eye contact)

Chunking/phrasing

Obtain clarification

Multi-modality cues (not for I or O)

Written instructions

Assignment book

Pre-teach vocabulary

Recode info into picture (D, A, O not P and I)

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Classroom AccommodationsClear concise language with exaggerated expressions/prosody (P)Listening breaks (D)Positive reinforcementSubstitution of foreign languageQuiet study and test taking areas

Reduced or modified tests and assignments (un-timed, oral, grade for content not form, closed set not open ended questions, abbreviated assignments in subject area that is a strength, abbreviated reading

Peer buddy or note-taker

Slide82

Typical APD Treatment AreasAuditory MemoryAuditory DiscriminationAuditory Closure

Auditory Cohesion

Auditory Synthesis

Auditory Figure-Ground

Auditory Binaural Integration and Separation

Prosody Training

Temporal Patterning Training

Inter-Hemispheric Transfer Exercises

Slide83

Case Studies: Evaluation and Management

Slide84

Decoding DeficitCase Study: ONE

Slide85

APD Case Study: ONE12 year old in 6

th

grade

Reads at 2

nd

-3

rd

grade level

Difficulties listening in noise

Word attack skills depressed

Poor speller, can’t spell words the way they sound

Lower Verbal IQ

Complains of headaches

Poor vocabulary

Difficulties with Spanish

Good math computation

Poor note-taker

Says, “huh?”

frequently

Can’t spell words the way they

sound

Slide86

APD Case Study: ONEAPD Evaluation Results: SSW

:

poor bilaterally with right competing score poorer than left competing score

Dichotic

Digits: poor

bilaterally, right ear worse

Competing

S

entences

: poor bilaterally

Pitch

P

attern

: normal

Low

P

ass

F

iltered

S

peech

: poor

bilaterally

Time

C

ompressed

S

peech

: poor bilaterally

Speech-In-Noise

: poor bilaterally

Phonemic

Synthesis: OK, but

discrim

errors

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APD Case Study: ONEDeficient Processes: Auditory

Closure

Auditory-Figure

Ground

Binaural Separation

Binaural

Integration

Temporal Resolution

Possible

left auditory cortex/ left hemisphere site of dysfunction

Type

:

Auditory Decoding

Slide88

APD Decoding Case Study: ONEClassroom Accommodations:Assistive

listening device

Preferential seating

Use of multimodality cues

Repetition

Note-taker

Pre-teach new

information/vocabulary

Training for self-advocacy and dealing with adverse listening conditions

Avoid auditory fatigue/ give listening breaks

Frequent checks for comprehension

Slide89

APD Decoding Case Study: ONEDirect Intervention:

Auditory

Closure

Binaural

Integration/Separation with Dichotic

Listening

Auditory Figure Ground

Auditory Discrimination

Phonological Awareness

Reading Comprehension

Reading

Decoding and Spelling

Written Language and Narrative Language

Vocabulary Building

Slide90

APD Decoding Case Study: ONECompensatory Strategies:

Enhance

M

otivation/Avoid

F

atigue

Teach

Active

L

istening

T

echniques

(It’s Time to Listen Program)

Teach “Look

and

Listen” strategy

Provide Attribution Training

Teach Meta-linguistic, meta-cognitive, and meta-memory strategies

Teach

Schema

I

nduction

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Auditory Closure Activities (CAP Kit)Missing Word Exercises: begin with familiar and move to less predictable

Humpty Dumpty sat on a …….

Mary had a little ….

Name an animal that rhymes with house

When I am sleepy, I…..

Tom threw the …….

The water was so…,it took my breath away

Kim…..the ball with a bat

Slide92

Auditory Closure Activities (CAP Kit)Missing Syllable Exercises:He hit the nail with a …..There are twenty-six letters in the al-

pha

…

Sports: base….,

soc

…., ten…..

Hot…..,and …..plane with spondee words

Compart

…., ….

tiply

, to……row

Easiest in final position, then initial position

Most difficult in medial position

Slide93

Auditory Closure Activities (CAP Kit)Missing Phoneme ExercisesShould tape record and use context and category cues first

Final sounds are easiest , medial are hardest

Furniture: ta…l,

cou

…., …air

Parts of a flower:

ste

…,lea…

peta

….

Sentences: I li……to

wat

….

tel

….vi…..

I gave an a…

orn

to the chip…

unk

.

She …

ashed

her …ace with soap and …

ater

.

Slide94

Binaural Integration Activities (CAP Kit)Listen to these letters, write the third oneDraw to directions, describe what is drawnPractice with singing, rhyming, and playing musical instruments

Sing and chant while moving (bouncing a ball, walking, rocking, drawing)

Grab Bag

Free choice: child feels with left hand and uses descriptive language to id what is felt

Directed Id: clinician names object and student feels with left hand to find and describes the object

Slide95

Binaural Separation/IntegrationDichotic Listening Training: intensity of signals presented to each of the two ears is varied systematically while children are instructed either to attend to both ears (integration) or attend to the target ear only (separation)

Recorded material is targeted toward the interests and language levels of the child

Manipulate the target-to-competition ratio

Readjust the target-to-competition ratio as needed

Complete training for 20-30 minutes daily/adapt for home use

Slide96

Dichotic Listening Training (DPT, Winget)Auditory training should include acoustically controlled tasks of sound intensity and sound localization. Intervention should incorporate a bottom-up approach (ASHA, 2005)

Binaural Listening:1-4 digit repetition in quiet and in noise

Monaural and Alternating Listening:1-4 digit repetition RE/LE in quiet and in noise

Listening Localization: close/far distance in steady and variable noise

Dichotic Listening: 1- 4 digit, phrase and sentence repetition in quiet and in noise

Slide97

Auditory Figure Ground ActivitiesPractice any targeted goal in the presence of background noise/competing speech Consider

the type of noise

Least challenge: predictable such as an AC or fan constant noise

Medium challenge: less predictable such as music, speech babble, or someone reading

Greatest challenge: playground or cafeteria noise

Signal to Noise Ratio

Easy: stimulus is louder than noise

Medium Difficulty: stimulus is equal to noise

Most Difficulty: stimulus is quieter than noise

Slide98

Auditory Discrimination Activities (Sloan)Phoneme Discrimination Training and Speech-to-Print Skills

Christine Sloan Treatment Program:

discriminate speech sounds correctly

help child know when they have perceived a sound incorrectly or are unsure

improve confidence and self-esteem

Slide99

Auditory Discrimination Activities (Sloan)Involves the presentation of minimal contrast phoneme pairs (t vs.d)

Phonemes are presented in isolation

Move to discrimination of minimal contrast pairs of phonemes in consonant-vowel and vowel-consonant syllables

Move to words of increasing complexity

Slide100

Auditory Discrimination Activities (Sloan)Speech to print skills are taught by sound analysis of nonsense words

Tach

…what is the middle sound? (A)

What is the last sound? (CH)

What is the first sound? (T)

How would you spell this/spelling rule?

Tatch

Real or nonsense? Define real words

Slide101

Processing Power (Ferre)Processing Power (

Ferre

) targets phoneme discrimination training along with a variety of additional auditory and language skills such as:

R

hyming

W

ord

A

ssociations

S

peech in

N

oise

Speech-Reading

Slide102

Auditory Discrimination Activities(CAP Kit)Perceive differences in sounds presented in words and sentences. Use real and non-real words.

Point to the words you hear me say. You can point to the different words or the same word twice. (cat/hat) (cat/cat)

Are these words same or different?(prize, price)

Is the first/last sound in these words the same or different?(mat/lot)

Is the first/last sound in these syllables the same or different? (am/

im

)

Slide103

Auditory Discrimination Activities (CAP Kit)Are the middle sounds same or different? (cat, cut)

Are these notes/tones the same or different?

Are these words the same loudness or different?

What begins with this sound /p/? (

pail,sail

, tail)

Listen for the long E and identify position in word. (ready, enough, neat)

Identify morphemes at end of verbs (plays, played, playing)

Slide104

Auditory Discrimination Activities (CAP Kit)Same or Different ProgressionLong vowels in words (plate, pleat) and in phrases (I want coke, I want cake)

Short Vowels in words (rat, rut) and in phrases

( I want cup, I want cap)

Word level final position sounds (price, prize)

Voiced

vs

Voiceless consonants (town, down)

Consonant Clusters (press, dress)

Slide105

Reading and Written Language InterventionUtilize programs which target phoneme discrimination, phonemic synthesis, segmentation, sound-symbol association, phonological manipulation, vocabulary

(top-down and bottom-up reading/writing strategies):

Lindamood

LiPs

Program

Wilson Program

Phonological Awareness Kits and Materials

Llindamood

Visualizing and Verbalizing

SPELL-Links to Reading and Writing

Lindamood

Vanilla Vocabulary

Lindamood

Seeing Stars

WKRP

Story Grammar Marker

Slide106

Story Grammar Marker (Maryellen Rooney Moreau and Holly Fidrych-Puzzo)

Re-tell or Generate a Story including:

Character

Setting

Initiating Event/Problem

Internal Response

Plan

Attempts to Solve Problem

Direct Consequence/ Lesson Learned

Resolution

Slide107

Visualizing and Verbalizing (Nanci Bell)Gestalt imagery is a primary factor basic to the process involved in oral and written language comprehension, language expression, and critical thinking

Sensory information connects us to language and thought

“I make the movies when I read”

Slide108

Visualizing and Verbalizing ComponentsExplanation of WHY we need to V/V

Picture to Picture

Word Imaging

Single Sentence Imaging

Sentence by Sentence Imaging

S by S with Higher Order Thinking Skills

s

ummarize, main idea, inference, conclude, predict, extend

Multiple

Sentence Imaging

Whole Paragraph Imaging

Paragraph by Paragraph Imaging

Whole Page Imaging

Chapter and Lecture Noting

Writing from V/V

Slide109

Visualizing and Verbalizing Present and teach use of structure words to aid in DETAILED visualizations and verbalizationsWhat Movement

Size Mood

Color Background

Number Perspective

Shape When

Where Sound

Slide110

The letters of language are like the stars in the universe ------- Parts of a whole.

“TEEOHEMOHDOUBLEAUROHDOUBLEYOU”

“How do you spell TOMORROW?”

Children need to learn to sound out words AND they need to “see the word in their heads” like in spelling bees!

Screening Test is the Symbol Imagery Test

Seeing Stars

(

Nanci

Bell)

Slide111

The ability to visualize letters in words: symbol imageryWhat do you see when I say the word FIP? Look away and try to image the word in your mindNow change FIP to FAP (you change the I to A)Now change FAP to FRAP (you see the R come after the A)

What do you see when I say ENOUGH?

Look away to see and hear me. What letters do you see? Try saying them backwards.

Seeing Stars

Slide112

SPELL Links to Reading and Writing(Wasowicz,Apel,Masterson,Whitney)Spelling, reading, and writing activities that teach critical word study skills

Designed to improve spelling, reading decoding, fluency, vocabulary, comprehension, writing accuracy and organization

Spelling success includes

Phonological awareness (

relize

for realize)

Phonics (K is never spelled

ck,cc

at beginning of words)

Vocabulary( bare

vs

bear, question words start with WH)

Word parts (morphology, prefix, suffix, root words)

Mental images of words (MOIs: rope not

roap

)

Slide113

WKRP Reading By the Rules (Wisnia Kapp, Kravitz

-/

Zodda

)

Program involves these components:

Multimodality

Sound Symbol Association

Nonsense Word Reading

Vowel and Consonant Digraphs

Syllables and Sounds

Six Syllable Types

Slide114

Wilson Reading System/Areas Addressed:Phonemic SegmentationSound/Symbol RelationshipsDecodingEncoding (spelling)

Advanced Word Analysis

Vocabulary Development

Sight Word Instruction

Fluency/Comprehension/Visualization

Slide115

Lindamood Bell LiPsLindamood Phonemic Sequencing Program

Utilizes kinesthetic, visual, and auditory modalities to teach vowel and consonant discrimination/identification

Decoding and manipulation of nonsense and real words

Syllabification

Blending and segmenting

Multimodality

Screening

test is the LAC

Slide116

Teaches “feeling” the sounds in their mouths and that “ feeling” to track sounds in wordsAutomaticity with this task involves also “seeing” the corresponding letters in their minds…we image the letters (symbol imagery)Supports sight word recognition and improving spelling beyond the “phonetically correct representations”

LiPS

Program

Slide117

Vanilla Vocabulary(Nanci Bell)Develops vocabulary through imagery-Visualizing and Verbalizing

Verbalize and gesture the visualization

Verbalize own sentence and definition

Experience words in context of story

Slide118

Vocabulary Building Activities (DPT, Winget)Teach re-

auditorization

Teach contextual derivation of word meaning

Immediate provision of definition

Category

(what it belongs to)

Function (what it does/used for)

Form (how it looks, tastes, feels, smells)

Place (where it is found)

Materials/Parts (what it is made of)

Associations /Visualizations

Part of speech/antonyms/synonyms

Reinforcement of definition

Associations

Comparisons

Synonyms

Antonyms

Multiple meaning words

Similes

Slide119

Prosodic DeficitCase Study: TWO

Slide120

APD Case Study: TWO14 year old male with difficulties making and keeping friends, prefers adultsNormal academics but difficulty with geometryDifficulty following complex directions

Poor note-taking skills

Performance IQ is lower than Verbal IQ

Normal language skills /speaks in monotone

Poor musical abilities

Reads with flat affect

Teacher reports “bright but unmotivated”

OT at young age due to “tactile defensiveness” and visual perceptual deficits

ADD ruled out

Appears depressed

Slide121

APD Case Study: TWOAPD Evaluation Results:SSW and DD: left ear deficit

Competing Sentences: left ear deficit

PPS: poor humming and labeling

All other tests were normal

Slide122

APD Case Study: TWODeficient Processes: Temporal Patterning/Inter-hemispheric Transfer

Binaural

Separation

Binaural Integration

Type

:

Prosodic

Possible

Site of Dysfunction: right auditory cortex and associated areas

Slide123

APD Prosodic Case Study: TWOClassroom Accommodations:Animated

teacher placement

Preferential seating

Multimodality cues use of demonstrations and

examples

Avoid hints/tell exact meaning

Repetition

or rephrasing (with prosodic cues more perceptually salient)

Note-taker

Making frequent checks for comprehension

Un-timed

Tests

ALD

seldom indicated because difficulty is not related to the clarity of the acoustic signal

Slide124

APD Prosodic Case Study: TWODirect Intervention:Pragmatic Language Intervention

Reading Fluency Program/Sight Word Enhancement

Visualizing and Verbalizing Program

Prosody Training

Temporal Patterning Training

Inter-hemispheric Transfer Activities

Slide125

APD Prosodic Case Study: TWOCompensatory Strategies:

Teach

Schema Induction (to improve social situation interpretation)

Teach Active Listening Strategies

Attribution Training

Memory Enhancement Strategies

Dance, Drama or Music Lessons

Games such as “Bop IT”

Teach Key Word Extraction

Referral?

Counseling

Slide126

Prosody Training (CAP Kit)Identify how syllabic stress patterns change the meaning of wordsProject vs. pro

ject

Ob

ject vs. ob

ject

Sub

ject vs. sub

ject

Stressed syllable changes meaning

Steps

Teach definitions of both words

Have child point to the word you say

Embed word into a sentence and have the child determine which word was used based on stress and contextual cues

The

con

vict is a repeat offender.

Use sabotage to keep them on their toes

The con

vict

is a repeat offender

Slide127

Prosody Training (CAP Kit)Therapy tasksIdentify correct meaning based on subtle differences in stress, temporal and other prosodic cuesSentence pairs

You mean I scream vs. You mean ice cream

You have an ice chest vs. You have a nice chest

Stress word differences

You can’t go to the BALLGAME vs. YOU can’t go to the ballgame.

Key word extraction: listening for specific parts of speech or specific words within sentences or passages

Slide128

Prosody Training (CAP Kit)Therapy tasks continuedExaggerated intonation and prosody during readingPractice changing intonation and prosody based on emotions: how would you say this if you were happy vs. angry

Identify emotions of the speaker through listening alone

Slide129

Prosody TrainingKey word extraction: listen specifically for subjects, verbs, sounds, objects. Give a direction and ask “What was the action word?” “Who or what are you supposed to do?” “When?”

Identify pauses in connected discourse…determine if it is the end of a sentence, embedded clause, connective

Slide130

Prosody Training (DPT,Winget)Identify facial expression to match emotional content of message

Identify emotion words in sentences

Produce sentences with appropriate emotional intonation

Infer emotions based on situations described

Discriminating if emotional intonation is correct

Recognizing rising and falling intonation for sentences and questions

Produce rising and falling intonation for sentences and questions

Identify punctuation based on intonation

Discriminate syllable and word stress

Identify the word that is stressed in sentences and interpret meaning

Slide131

Temporal Patterning Training (CAP Kit)Nonverbal: imitate various rhythms, intensities and number of elements

identify same/ different patterns of knocks (auditory only stimuli)

Begin

with short patterns tapped or clapped presented in pairs (child tells same or different) or (child imitates the pattern exactly)

Patterns are altered in terms of speed, loudness, rhythm

Eventually add more elements up to 7-8

Slide132

Temporal Patterning Training (CAP Kit)Verbal: Imitate various pitches, durations and rhythms

Identify same/different patterns when two sentences are read with one or no words stressed more

Label various durations and pitches

Slide133

Temporal Patterning Training (CAP Kit)Auditory Sequential Tasks such as (

ball, shoe, tie: when did I say ball?)

(ta, da,

ga

: when did I say da?)

(tick, tack, tick: when was vowel different?)

Word sequences can be used

(which of these words is different “tick

tick

tack”

Sentences can be used where one word is stressed more than another

(You ARE going home, YOU are going home, You are going HOME)

Slide134

Inter-hemispheric Exercises (CAP Kit)Key factors in these activities are that a single or double transfer across the corpus callosum must occur and the exercises provide opportunity for repetition so as to stimulate the corpus callosum efficiently

Appropriate for home-based therapy

Slide135

Inter-hemispheric Exercises (CAP Kit)Motor-to-Verbal TransfersChildren find objects with the left hand and are instructed to label them verbally in terms of shape, size, texture, etc.

Verbal-to-Motor Transfers

Children are instructed to find a particular object or shape with the left hand from a grab bag or behind a screen where they cannot see the objects

Slide136

Inter-hemispheric ExercisesMusic Therapy: musical instruments that require coordinated movements of the hands such as the piano with bimanual coordinationSinging Therapy: requires both linguistic output (left hemisphere) and melodic expression (right hemisphere), listen to songs and answer questions about lyric

Slide137

Inter-hemispheric ExercisesDance Therapy: requires listening and doing with bipedal coordination

Video games requiring visual and auditory vigilance and bimanual coordination

Drawing pictures from verbal directions or describe pictures they have drawn

Extracurricular sports

Slide138

Integration DeficitCase Study: THREE

Slide139

APD Case Study: THREE9 year old male in 3rd grade

History of chronic ear infections

Dx

of ADD in first grade takes Adderall daily

Resource for reading/spelling

Speech therapy twice weekly at school

Can’t ignore low intensity intermittent and constant noise

Slide140

APD Case Study: THREECan’t follow multi step commands at home or at schoolDoes well in math, but not with word problems

Struggles with reading, can’t find place on page, fair comprehension when read to but can’t read independently

Can’t write on lines easily

Poor self starter “watch and wait”

Difficulties with transitions

“I don’t get it” Memorizes spelling words, but forgets what he has memorized easily

Poor word attack/encoding and decoding skills

Vocabulary is reported to be age appropriate, therapy at school targets auditory memory skills

Slide141

APD Case Study: THREEAPD Test Results:SCAN C:

FW

= SS 12

AFG= SS 11

CW= SS 9

CS =SS 8

composite= SS 100

Slide142

APD Case Study: THREEAPD Test Results:SSW

= 80%RC, 30%LC sig. L/H ear effect=TFM Type ,Type A pattern

, two

reversals

DD= 85%RE, 60%LE

PPS= 0% label,100% hum

CS= 70%RE, 0%LE

Time

Compressed Speech=85%RE,75%LE

Speech-In-Noise=

normal

Phonemic

Synthesis= Abnormal, errors included forgetting the first sound of words /

aper

/ instead of /paper/ and /boat/ instead of /coat/. He also reduced blends /rain/ instead of /train/

Slide143

APD Case Study: THREEDeficient auditory processes:

Binaural

Integration and Separation

Auditory

Closure

Inter-hemispheric

Transfer/Temporal Patterning

Poor

auditory attention for instructions, details, concepts, reasoning and reading comprehension

Slide144

APD Case Study: THREEAPD Type= Auditory Integration DeficitDifficulty

with receptive and expressive language, syntax

, visual-motor

integration, writing, difficulty recognizing patterns or wholes necessary for word recognition and spelling, difficulty using symbols, space and visual imagery, difficulty with rhythm and prosody, poor phonics and reading skills, don’t get the “big picture”

Slide145

APD Case Study: THREEFurther Speech-Language assessment results:PPVT III: SS 81 /10

th

percentile

EVT: SS 79 / 8

th

percentile

CELF-3

results ranged from SS of 3-7 with percentiles ranging from

1st-16

th

O

verall

R

eceptive :2

nd

percentile

O

verall Expressive:1

st

percentile

T

otal language:1

st

percentile

Slide146

APD Integration Case Study: THREEClassroom Accommodations

Preferential

seating

Break information and directions into small

parts

Provide “how to” information

Repeat, don’t rephrase

Un-timed tests in quiet

room

Abbreviated assignments or more time

Note-taking assistance

Avoid multi-modality presentation

Hands-on experiential environment

Provide multi-modal inputs one at a

time

ALD may not be indicated in order to “get the big picture”

Slide147

APD Integration Case Study: THREEDirect InterventionSpeech-Language

T

reatment

to address possible receptive/expressive language

delays

Vocabulary Building

Auditory Memory and Sequencing Activities

Key Word Extraction for

Sustained

A

ttention

Dichotic Listening and Localization

Training

Speech in Noise Training

Slide148

APD Integration Case Study: THREEDirect Intervention:Auditory

Closure Activities

Auditory Cohesion Goals

Temporal Patterning Training

Prosody Training

Inter-hemispheric Transfer Exercises

Phonetic Discrimination/Decoding/Synthesis Training

Slide149

APD Integration Case Study: THREECompensatory Strategies:Provide

education about nature of

difficulties/Attribution training

Teach recognition of difficult listening situations and problem solve

Teach meta-memory

devices

Formal and content schema induction

Teach

“look or listen”, “look then listen”

Slide150

APD Integration Case Study: THREEOther Management Recommendations:May

benefit from dance and/or music lessons, juggling, karate, or

gymnastics

Games

: Bop It, Simon

Says

Activities

that start with WHOLE and teach PART TO WHOLE skills such as puzzles or building

models

Pairing

speech with

music

Slide151

Auditory Cohesion ActivitiesName category for lists presented auditory only (divergent naming)Apple, banana, orange= fruits

Produce items in named category (convergent naming)

Tell me five fruits.

Identify two characteristics of two items read aloud which are similar or different and explain why (cookies/cake)

Slide152

Auditory Cohesion ActivitiesCompose paired combinations and explain why they are paired

Identify suitable endings or next turn to conversational dialogue

Solve verbal math problems

The boy picked five apples and the girl picked three more than him. How many did they pick together?

Identify suitable title for mini-stories read aloud

Slide153

Auditory Cohesion ActivitiesRepeat and complete analogiesApple is to red, as banana is to…..

Repeat riddles or inferences and solve problems explaining “why?”

Complete “IF….then” statements

If you’re a girl, tell me the days of the week. If not, tell me the months of the year

Answer Auditory Reasoning Questions

Respond to True/False statements and explain “Why?”

Slide154

Auditory Cohesion ActivitiesIdentify and compose absurd sentences and explain why they are absurdThe waitress said he forgot our order.

I use a shovel to eat soup and ice cream.

Identify logical reactions to problem-solving choices and explain “Why?”

Is

J

uly colder than December? Why?

Slide155

Auditory SynthesisTherapy exercises are meant to help the student become more aware of word segments, sound components and sound discrimination and help the student gain fluency with combining sounds into words.Identifying number of syllables

How many syllables are in the word “tornado”

Identifying the initial sounds

Which of these words start with /s/: side, hide, wide

Discriminating sounds

Which word begins with a different sound: fish, wish, fast

Blending compound words

Down-stairs= downstairs

Slide156

Auditory SynthesisBlending syllablesWa-ter=waterBlending phonemes/r/-/o/-/z/ =

rose

Riddles

I’m thinking of an animal. It has an /a/ sound. It begins with /f/ and ends with /

ks

/. What is it?

Initial sound extraction and blending:

Tom is powerful=tip

Slide157

Associative DeficitCase Study: FOUR

Slide158

APD Case Study: FOUR9 year old in speech treatment for receptive language delay in areas of vocabulary, syntax

Early

grades were good, began having difficulty in fourth grade

P

oor

social language skills

Slide159

APD Case Study: FOURAPD results: bilateral deficits on Dichotic Digits and Competing Sentences, all other test results were normal

Deficits

in binaural separation and integration, may be result of more generalized left-hemisphere dysfunction

Type

=

Associative

Slide160

APD Associative Case Study: FOURClassroom Accommodations:Focus on “rules”Use multi-modality cues

Rephrase information and repeat with smaller linguistic

units

Comprehension checks: ask for paraphrase not repetition of what was heard

Pre-teach new

information

Use organizational aids

Allow for foreign language substitution or modifications

Use multiple choice or closed set tests

Slide161

APD Associative Case Study: FOURDirect Intervention:

Speech

language treatment to include receptive vocabulary, syntax and pragmatic language goals

Teach paraphrasing and

inferencing

skills

Teach contextual derivation of word meaning

Teach rules of language

Teach discourse cohesion (conversational competence)

Teach meta-linguistic vocabulary

Slide162

APD Associative Case Study: FOURCompensatory Strategies:Teach Meta-memory Strategies (They expend so much energy trying to comprehend the message, there is little energy left to remember the message)

Training in the Rules of Language

Formal and Content Schema Induction

Slide163

Meta-Memory Strategies

Chunking (breaking down long messages or lists into smaller components and grouping similar concepts/objects together

Elaboration (use analogies and acronyms)

Recoding the information into a pictorial representation (visualize/imagery)

Set task to music or motion

Verbal rehearsal and re-

auditorization

Slide164

Meta-Memory Strategies (HELP for Memory)Selecting and Prioritizing Information to Remember

Coding and Grouping items for recall

Pairing items, categorizing, grouping by whole/part

Using Aids to Remember

Memory pegs, chunking words and number and information in paragraphs, using word lists in sentences, acronyms, rhymes, catch phrases, pictures and imaging, notes, outlines, mapping, webbing, time lines

Applying Memory Techniques

Selecting appropriate strategy to recall information, identifying number of steps in sequence, following sequential directions with and without pictures and symbols

Slide165

Compensatory StrategiesTraining in the Rules of Language

Use and meaning of tag words(first, last, before, after, next)

Use and meaning of discourse cohesion devices (pronouns/ additives such as and, however, although/ causal terms such as because, therefore)

Teach meaning of metalinguistic vocabulary: sentence, word, syllable, sound, etc.

Slide166

Compensatory StrategiesFormal Schema Induction: training to recognize and interpret discourse cohesion devices/make predictions

Teach tag words (first, last, before, after)

Adversative terms (but, although, however)

Referents (pronouns)

Additives (and)

Causal terms (because, therefore)

Slide167

Compensatory StrategiesContent or Contextual Schema Induction: teach how scripts based on context and experience assist us in interpreting the message

Restaurant (how many? Do you have a reservation?)

When message does not fit situation, ask for repetition/clarification

Slide168

Output organization deficitCase Study: FIVE

Slide169

APD Case Study: FIVE9 year old with average gradesDisorganized

Doesn’t complete assignments

Impulsive

Poor planner

Difficulty following oral directions

Word-finding problems

Poor sequencing abilities

Good reader but has reversals on spelling and in math

History of articulation deficits

“I heard it but I can’t remember it”

Poor handwriting

Slide170

APD Case Study: FIVEAPD Evaluation Results

Phonemic

Synthesis: normal until words contained five sounds

Speech in Noise: below expected scores for each ear

Dichotic Digits: poor (usually reported 3 of 4 digits)

SSW: significant number of

reversals

LPFS: normal result

PPS: normal result

CST: normal result with errors being omission of some words at the end of the sentence

Slide171

APD Case Study: FIVEType: Output Organization Deficit

Deficit in temporal-to-frontal and/or efferent system

Deficient Processes:

Auditory-figure-ground

Auditory memory

Auditory synthesis

Auditory sequencing

Slide172

APD Output Organization Case Study: FIVEClassroom Accommodations:

Recommend

highly structured, rule-based classroom

Use an assignment book checked by teacher

Provide written instructions

Preferential seating

Trial use of ALD

Rephrasing using smaller linguistic units

Avoid auditory fatigue

Use positive reinforcement

Slide173

APD Output OrganizationCase Study: FIVEDirect Intervention:

Auditory

Memory

Activities/Speech In Noise Training

immediate

and delayed

responses

varying

degrees of noise/speech competition

Auditory Sequencing Activities

Assess Expressive Language and target deficit areas

Assess

Sensory

I

ntegration

and

Fine

M

otor

S

kills

(OT

)

Assess for ADD/ADHD

Slide174

APD Output OrganizationCase Study: FIVECompensatory Strategies:Teach

R

ules

in

Organization

Teach “It’s Time to Listen”

/ Active Listening

S

trategies

Teach

Meta-Memory

S

trategies

Teach

Study

and

Test

T

aking

S

kills

Teach

Note-taking

and

Outlining Skills

Slide175

Auditory Memory ActivitiesTeach the ability to recall informationTeach the ability to recall information in sequential order (more difficult)

Words, numbers, words (related and unrelated), letters, sentences, paragraphs

Slide176

Auditory Memory ActivitiesRepeat numbers and wordsforward and backward(facilitates working memory)

Repeat sentences of increasing length and complexity

Follow directions with increasing number of steps and complexity

Sequence and paraphrase or interpret directions of increasing length and complexity

Answer comprehension questions about sentences or short passages read to them

Do the above with immediate and delayed recall to increase short term and sustained memory

Slide177

Auditory Memory ActivitiesTeach Compensatory StrategiesP

rovide immediate (short term) and delayed recall (sustained attention) for tasks

Provide visual cues and then remove them

Build on sequences just repeated (John….John is a…..John is a cute….John is a cute boy)

Teach

Reauditorization

or

Subvocalization

Teach chunking, memory pegs, chaining, use of rhythm (81927 becomes 819-27)

Slide178

Auditory Memory ActivitiesTeach Compensatory StrategiesVisualization and Imagery

See the picture in your mind

See the word or number in your mind

What color are the words or numbers

Sky write

Trace it on table or floor

Pretend to type it

Pretend to see yourself following the direction: make a movie in your mind

Slide179

Active Listening Strategy/SLANTS Sit upL Lean forwardA Activate thinking and focus on topic

N Note key information

T Track the talker

Ellis(1991) SLANT a starter strategy

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What Have I Learned?I can define APD.

I can name APD team members

and

describe their roles.

I can identify Sub-Profiles of APD based on test findings and case history.

I can recognize the appropriate classroom accommodations that are most appropriate for each Sub-Profile of APD.

I can provide direct intervention that is most appropriate for each Sub-Profile of APD.

I can recommend compensatory strategies that are most appropriate for each Sub-Profile of APD.

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ReferencesIncluded on short handout uploaded to ASHA Program Planner