Auditory Processing Disorder - PowerPoint Presentation

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Auditory Processing Disorder

Assessment, Diagnosis, Treatment and Controversies

Defining Auditory Processing and APD

Auditory processing

may be described as the “efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information.” (ASHA 2005)

ASHA defines

Auditory Processing Disorder

as “a deficit in neural processing of auditory stimuli that is not due to higher order language, cognitive, or related factors” (2005).

Bellis adds that the disorder occurs

in the absence

of any documented “neuropathological condition” (2002).

Visual Processing

Image received Image perceived

General Characteristics and Symptoms

Auditory Processing Disorder can

occur with or without hearing loss

may run in families

affect a person’s ability to interact socially

affect children and adults with normal intelligence

Symptoms

E

xhibited by

Preschool Children

Demonstrate delayed speech and language abilities or articulation errors (Ex. Substituting d for g)

Have problems following directions at school or at home (Ex. “Find a book you want Mommy to read to you.”)

Ask for repetitions frequently such as “What?” or “Huh?”

Are more comfortable following daily routines once they have been practiced or learned rather than following verbal directions

Perform better with visual cues or models

(Bellis 2002)

Symptoms of APD

Symptoms Exhibited by

Elementary School Children:

Behave as if a hearing loss is present despite normal hearing

Exhibit articulation errors that are developmentally inappropriate

Poor social skills (making and keeping friends)

Express extreme frustration and often say, “I can’t do this!” or “I don’t understand”

Poor reading or spelling skills

Uses memorized phrases and sentences

Symptoms Exhibited by

Adults:

Inappropriate responses to “

wh

” questions

Poor expressive or receptive language

Difficulty with reading comprehension, spelling and vocabulary

Difficulty following long conversations

Difficulty following verbal

directions

especially when involving multi-step

directions

(Bellis 2002)

Referral

Audiologist should be contacted for a comprehensive hearing evaluation if some type of hearing or listening problem is suspected.

A

referral by physician is not necessary

for an Audiologist to assess hearing but it may be required by some insurance companies for reimbursement purposes.

(

DeBonis

2008)

Obtaining supplemental services at school

:

First someone raises a concern (parent, teacher, school psychologist) about the child’s academic or communicative performance

Based on the severity of the concern :

(1) the child may be referred for special education assessment (can’t occur without the parent’s permission)

(2) the teacher may implement some classroom and related modifications (which do not require special education classification)

(3) continue to keep a close watch on the child’s performance and reconvene at a later time to reconsider the need for special education referral

(Bellis 2002)

Prevalence

There are “no authorized estimates of the prevalence” of APD. (ASHA 2005)Chermak and Musiek (1997) estimated that APD occurs in 2 to 3% of children, with a 2-to-1 ratio between boys and girls.67% of ASHA certified SLPs who work in a school setting report regularly serving children with APD (ASHA 2005))

Areas of Deficiency

Auditory

Processing Disorder is

defined as

having a

deficiency

in one or more of the following

behaviors

:

Sound

Localization and Lateralization

refers

to

the ability

to know where a sound has occurred

in space

Auditory

Discrimination

refers

to the ability

to distinguish

one sound from

another

most

often used for distinguishing speech

sounds, such

as phoneme /p/ from phoneme /t/ as

in “hop” and

“hot

”

Sound/Symbol

Association

the

ability

to associate

a symbol

(a

letter) with a sound

(S with “

ssss

”).

Temporal Auditory Processing

the

ability

to integrate

a sequence of sounds into words

t

he ability to perceive

sounds

as separate

when they quickly follow one

another

Auditory

Figure Ground

refers

to the ability

to perceive

the main message when other sounds

are present (understanding

a conversation

in a movie theater)

(ASHA 2005)

Areas of Deficiency Cont.

Tolerance-Fading

Memory

refers

to weak short –term memory

when information is presented

audibly in the presence of distractible sounds

Sound

Blending

ability

to blend

individual speech

sounds together into a meaningful word

(c-a-t



ca

t)

Auditory

Closure

ability

to

perceive information

in which some of the information

is missing (“it is raining and I ____ my umbrella”)

Decoding

problems

are related to difficulties

with phonics

may spell

words phonetically, spell inconsistently,

have reading

problems, confuse similar sounding

words

(ASHA 2005)

Diagnosis of APD

Diagnosis is

also

very difficult due to the fact that

no two individuals will exhibit the same symptoms or behaviors

.

APD can be formally diagnosed

only by an Audiologist

.

(ASHA 2005)

Initially, an Audiologist should rule out hearing loss as a primary cause of the symptoms exhibited.

Factors that may help to determine if an APD assessment is necessary:

A child must be at least seven years old before a behavioral central

a

uditory evaluation can be completed.

Hearing loss

Significant cognitive or language delays related to mental retardation, AD/HD, and/or Autism

(Bellis 2002)

Diagnosis

The following factors

influence behavioral testing performance

and should be considered when choosing the assessment battery:

C

hronological

and developmental

age

C

ognitive abilities (attention, memory, education)

Linguistic

, cultural, and social

background

Medications

Motivation

D

ecision processes

M

otor skills

(

DeBonis

2008)

The Audiologist will take a complete history

and a

variety of auditory processes will be assessed such as:

dichotic listening (listening to a different signal in each ear simultaneously)

perception of distorted speech (which may consist of filtered speech or very rapid time-compressed speech)

p

erception of nonverbal auditory stimuli (tone patterns)

temporal auditory processing (sequencing

and patterns, gap

detection)

(ASHA 2005)

APD

screening can be conducted

by audiologists

, SLPs,

and psychologists

,

using

a variety of measures

that evaluate

auditory-related skills

.

Other tests that are not administered in a sound booth should not be considered diagnostic tests for APD, however, they may be used to provide valuable information about the individuals overall listening and comprehension abilities.

(Bellis 2002)

Assessment Tools

A complete battery of testing may include the following:IQ tests – WPPSI (preschool), WISC (6-16), WAIS (16+)Academic tests – Woodcock JohnsonAuditory Processing tests – SCAN-C & SCAN-AAuditory Skills Assessment (ASA) Test of Auditory Processing Skills (TAPS)Parent & teacher questionnaires – BehavioralAssessment Scale for Children (BASC) Conner’s Comprehensive Behavior Rating Scales

Assessment Tools

Auditory Skills Assessement (ASA)Screen children as young as 3.6 years oldMeasures auditory and phonological processing skillsSpeech discrimination in noiseSound blendingRhymingSound discriminationSound patterningUsed as a preliminary assessment of skills as well as for a re-evaluation tool to measure the success of interventionsTest of Auditory Processing Skills (TAPS)Measures of various aspects of auditory processing as well as language processingPhonological processing (decoding and encoding)Auditory closureShort-term auditory memory for contextual and noncontextual informationLanguage comprehension and making inferences

Types of APD

There is no one universally accepted theoretical model of APD!

The Buffalo Model – Dr. Jack Katz

Looks at the relationship between patterns of performance on specific tests of auditory processing and learning difficulties in children.

Decoding

Tolerance-Fading Memory

Integration

Organization

(

Masters,

Stecker

& Katz, 1998)

Dartmouth Medical School – Dr.

Frankl

Musiek

Divided auditory processing deficits into subgroups on the basis of underlying brain-based etiologies

.

Bellis

/

Ferre

Model

The model is based on both the underlying neurophysiology and the relationship among different types of APD and language, learning and communication difficulties.

(Bellis 2002)

Bellis/Ferre Model

Three primary subtypes:

Auditory decoding deficit

D

ifficulty with speech in noise, speech

discrimination, sound blending, retention of

phonemes, reading, speech to print may be poor.

Integration deficit

D

ifficulty with multimodality tasks that require

inter-hemispheric transfer of information.

Prosodic deficit

Difficulty with humor, multiple meanings and

utilizing information in

suprasegmentals

of speech.

Two secondary subtypes:

Associative deficit

May

demonstrate receptive language difficulties, can not apply rules of language to incoming auditory information

Output-Organization

Difficulty

in sequencing, planning and organizing responses

.

(Bellis 2002)

Management: Environmental Modifications

Management of APD should incorporate three primary principles and all are necessary for interventions to be effective:

Environmental modifications

Remediation techniques (direct therapy)

Compensatory strategies

Environmental Modifications:

Classroom Accommodations

Preferential Seating

Pre-teaching of new material

Frequently check for understanding

Rephrase

vs

Repeat

Provide a note taker

Use visual cues and modeling procedures

Amplification

Personal FM systems

Access

to word processors and other

technology

(Bellis 2002)

Management: Direct Therapy

Phonological Awareness Activities:

Discriminating between speech sounds that are similar (pop/top)

Discriminating between vowels (a in cat vs. e in egg)

Segmenting words (CAT=C…A…T)

Blending sounds into words (C…A…T=CAT)

Before Therapy:

Twhnkke

,

tvinjle

kitsle

rtaq

.

Hov I wnnddr wgat wou zre.

After Therapy: Twinkle, twinkle little star. How I wonder what you are.

Auditory

Closure

Activities

:

Using contextual cues to fill in the missing pieces (Jack and Jill went up the ___)

Noise is added to make activities more

challenging.

Before Therapy: O

ing ol was a ry o

ol

After Therapy: Old

King Cole was a merry old soul

Selective Attention and Localization

Activities

:

Training in

d

ichotic listening

(Bellis 2002)

Management: Direct Therapy

Temporal Patterning Training:Typically nonverbal exercises that address rhythm (clapping, tapping on the table)Prosody Training:Exercises to teach interpretation of nonlinguistic cues (tone of voice)Computer-Based Therapy Programs:Fast ForwardEarobicsAuditory Integration Therapy (Bellis 2002)

Management: Compensatory Strategies

It is important to become an ACTIVE LISTENER!The Whole Body Listening ApproachSit or stand up straight so that the body is alertLean the upper body slightly or the head toward the speakerKeep your eyes on the speakerEliminate unnecessary movementMetacognitive and Metalinguistic StrategiesSelf-instructionSelf-regulationUsing context cluesDrawing inferencesRephrasing information

Areas of Concern

Many clinicians are still skeptical about the existence of APD and point

out

three big areas of concern.

(1) Disorders

such as Autism Spectrum Disorders, Attention Deficit

Hyperactivity Disorder

(ADHD), language impairments and learning disabilities produce similar behaviors

associated

with APD.

Skeptical clinicians have deemed the auditory deficits a function of these broader

disorders

.

(2) It

is often difficult to diagnosis a problem if the problem can’t be

seen.

N

o

two individuals will exhibit the same symptoms or

behaviors

no audiological assessments

or medical physiologic tests

that

adequately differentiate APD from other

disorders

Physiologic

tests such as brain scans,

electrophysiology

and magnetic resonance imaging (MRI) often fail to reveal any obvious structural or

functional

damage

(3) Finally

, an individual’s motivation to participate in APD screening may lead to problems making an accurate diagnosis.

References

American

Speech-Language-Hearing Association (1996). Central auditory processing:

Current status

of

research

and implications for clinical practice.

American Journal of Audiology

, 5 (2),

41-54

.

American

Speech-Language Hearing Association (2005). (Central) Auditory Processing

Disorders [Technical

Report]. Retrieved from www.asha.org/policy.

American

Speech-Language-Hearing Association. (2005).

(Central) Auditory Processing Disorders—The

Role

of the Audiologist

[Position Statement]. Retrieved from www.asha.org/policy.

Bellis, T. (2002).

When The Brain Can’t Hear: Unraveling The Mystery of Auditory

Processing

Disorder

.

New

York, NY: Simon & Schuster.

DeBonis

, David A., et. al (2008). Auditory Processing Disorders: An Update for Speech-Language

Pathologists

.

American Journal of Speech-Language Pathology

, 17, 4–18.

THANK YOU!

Jennifer

Saliba