1 UNDERSTANDING AUDITORY PROCESSING DISORDER APD Maureen E

1 UNDERSTANDING AUDITORY PROCESSING DISORDER (APD) Maureen E. Jones, M. A. , CCC-SLP

What is Auditory Processing? 2 Term used to describe what happens when your brain recognizes and interprets the sounds around you. The disorder part of APD – something is interfering or affecting the processing and interpretation of the information.

ASHA definition of APD (ASHA, 2005) 3 Difficulties in the processing of auditory information in the central nervous system (CNS) as demonstrated by poor performance in one or more of the following skills: • sound localization and lateralization • auditory discrimination • auditory pattern recognition • temporal aspects of audition • auditory performance in competing acoustic signals • auditory performance with degraded acoustic

Sound localization 4 Sound localization and lateralization: the listener’s ability to identify the origin of a sound in distance and direction. Basically it is knowing where the sound occurred. One must be able to aware of the sound source in order to identify and interpret.

Auditory discrimination 5 Auditory discrimination: the ability to discriminate speech sounds. Knowing the difference between an /m/ and /n/. Knowing the difference between ‘cake’ and ‘lake’.

Auditory pattern recognition 6 Auditory pattern recognition: the ability to identify similarities and differences in patterns of sounds. Which sounds are the same in ‘lake’ and ‘cake? Which sounds are different?

Temporal aspects of audition 7 1. the ability to sequence sounds: what sounds do you hear in ‘cup’? 2. combine sounds into words and make meaningful combinations: combine these sounds: /a/, /p/, /l/. What word do you make? 3. perceive sounds individually when they quickly follow one another: /k/ /uh/ /p/?

8 Auditory performance in acoustic signals The ability to perceive speech or other sounds when another signal is present. This can be noise or another similar speech signal Competing signal can be loud or soft.

9 Auditory performance with degraded acoustic signals The inability to “fill in” the missing parts of a word. We all miss words in conversation. However our knowledge of words and sounds allows to fill-in parts when we miss a sound or word.

Hierarchy of Auditory Processing Skills 10 • • • Step 1: Auditory awareness: includes being aware localizing, and attention Step 2: Auditory discrimination: discriminating environmental sounds, suprasegmentals (non-speech sounds rate, prosody, pitch) and segmentals (speech sounds). Step 3: Auditory Identification: auditory association, auditory feedback, phonological awarenes.

11 Hierarchy of Auditory processing Skills Step 4: Auditory Comprehension: understanding longer conversations, stories, following directions, auditory closure (filling in the missing pieces), auditory memory, linguistic auditory processing (interpret, retain, organize, and manipulate spoken language for the purpose learning and communication)

12 Characteristics seen in children with APD • • Says “huh” or “what” frequently Gives inconsistent responses to auditory information Often misunderstands what is said Poor auditory attention Easily distracted Difficulty following oral directions Difficulty listening when background noise is present

Characteristics seen in children with APD 13 • • Poor receptive and expressive language skills Often repeats questions or last word in a sentence Slow to respond to questions May have reading, spelling, writing or academic difficulties May have behavioral problems Needs extra time Poor perception of prosody Difficulty understanding humor

Diagnosing APD 14 Must be diagnosed made by an Audiologist Should also include a multidisciplinary approach SLP, teacher and psychologist Child must be at least 7 years. Some Audiologist prefer to wait until 8 due to brain maturation. Cannot use a symptom checklist Comprehensive battery of tests needed

APD Assessment 15 Audiologist administer a number of tests is sound-treated room Child required to attend to a number of signals Must respond via repetition, pushing a button or respond in some other way

APD Assessment: Areas Tested 16 • • • Figure ground Auditory Closure Binaural Integration Binaural Separation Binaural Interaction Phonemic Synthesis Pitch Patterning Gap Detection Sustained Auditory Attention

APD Assessment 17 Once diagnosed, area of auditory deficit must be determined. Ex: decoding, auditory memory, auditory comprehension, auditory discrimination, etc. This allows to individualize the patient and type of treatment. No two cases are the same.

SLP Evaluation 18 Tests receptive and expressive language skills Auditory processing, comprehension, decoding, listening Following directions Sound blending, discrimination, rhyming CELF-5 TAPS TOPS CASL

19 APD Classroom Manifestations Difficulty with spelling, reading, writing and math Taking a long time to complete assignments Poor perception and use of prosody Difficulty with multimodal tasks Difficulty following instructions Poor Attention and easily distracted

Treatment 20 SLP provides therapy Incorporates a variety of techniques and strategies No one cure-all method Usually focuses on 3 areas: Changing the learning or communication environment Compensatory strategies to address higher-level language skills Remediating APD skills directly

Treatment 21 Changing the learning or communication environment: Improve access to auditory information presented (ex: changing seats) Using devices to assist listening Teacher/classroom modifications to allow student focus attention on the message

Treatment 22 Compensatory strategies: Increase language, problem-solving, memory, attention, or other cognitive skills Teach children to take responsibility for their own listening Active participant in daily active listening activities

Treatment 23 Direct-treatment of APD Computer-assisted programs One-to-one training with a speech therapist Home-based programs

Things to Remember 24 No one treatment is appropriate for all children May need a combination of strategies Treatment should be individualized Therapy may need to be adjusted and modified as children grow and mature

Questions? ? 25

References 26 American Speech-Language Hearing Association (2005). Auditory Processing Disorders: Technical report and Guidelines. Rockville, MD. Nevins, M. E. , & Garber, A. (2006, May). Auditory skill development. Cochlear America Habilitation Outreach for professionals in education. Retrieved from http: //professionals. cochlearamericas. com/sites/default/files/resources/HOPEFUN 66 6. pdf Roeser, R. . , & Downs, M. P. (2004). Auditory disorders in school children: The law, identification, remediation 4 th ed. New York: Thieme Medical Publishers, Inc. Stredler-Brown, A. & Johnson, C. D. (2004). Functional auditory performance indicators: An integrated approach to auditory skill development (3 rd ed). Retrieved from http: //www. cde. state. co. us/cdesped/download/pdf/FAPI _33 -1 -04. pdf Vinson, B. P. , 1999). Language disorders across the lifespan: An introduction. New York. Singular Publishing Group.