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Download Auditory Processing: Answers, Assessments and Treatment options
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“He just doesn’t listen!” Defining Auditory Processing Disorder Nancy Murray, AuD, CCC-A/SLP And Allison Tanner, MS, CCC-SLP Review of the Ear Outer Ear Middle Ear Inner Ear There are numerous functional capabilities of the ear, all of which can be related to commonly identified specific auditory processing abilities or to vestibular function. Perceive sound Process sound without distortion Discriminate between higher and lower frequencies of sound Perceive spatial origin of sounds Attend to sounds we want to hear and tune out ones we don’t want Stimulate the brain with sensory input Integrate sensory information from muscle movement Establish good balance/equilibrium Control phonation (speech) Control musical ability Ear Brain Connection Auditory system is the only sensory system to be fully functioning in utero By its order in our development the auditory system demonstrates its importance to the growth and maintenance of the brain and body The ear is physiologically and neurophysiologically connected to nearly every organ in the human body as well as the auditory and language centers in the brain A well developed and fully functioning auditory system serves as a critical foundation for balance, coordination and movement, communication, relationships, language, self regulation, attention and thinking To the developing child, the auditory system is the first that should be addressed when issues are present Ear Brain Connection Auditory system has two parts: Cochlear (hearing system) gives us information about sound We rely on this system to inform us about the auditory world- language, music, and the auditory scene of our environment Vestibular (balance system) gives us information about movement and orientation in space We rely on this system to maintain balance and posture, for coordinated movement in time and space, and for clear vision Hearing-Listening-Auditory Processing Auditory Processing - Is what happens when the brain recognizes, interprets and can respond to the varied sounds around us such as music, language and the environment in which we live. It involves both hearing and listening and is simply defined as what the brain does with what it hears. Auditory Processing Skills Perception - To perceive the loudness or intensity of sounds. This is measured in decibels (abbreviated “dB”). Attention - To attend, focus, or listen to sound. Localization - To identify the source of a sound in your environment Discrimination - To distinguish between sounds or words that are similar or different in the way they sound. Simple: in quiet environments. Complex: “figure ground” listening with background noise. Auditory Processing Skills Processing Skills Cont. Closures - To fill in the missing pieces of sounds or words. Anticipation - To expect what sound is coming next. Temporal Processing - To analyze the timing and pattern of sounds. -Intonation Memory - To sequence sounds, words, or other meaningful combinations. To receive, store, process and recall auditory information. What is listening? -An active process; a dynamic process in which one takes in information as well as filters out information. -An ability and desire to use our ears. The “auditory ear” as well as the “ear of the body” - Our auditory system and our sensory systems. Jane Ayres If there’s a deficit here then it could be an Auditory Processing Disorder. Auditory Processing Disorders Cause is unknown. “Processing” continues to develop from time of birth to early adulthood (20’s). Ear infections, noise, hearing loss, harm to the auditory pathways through stroke or head injury can cause auditory processing difficulties. By itself or in individuals with dyslexia, ADHD, ASD, language disorders, and anxiety. Types of Auditory Processing Disorders Decoding Tolerance Fading Memory/Auditory Associative Integration Output Organization Prosodic Areas affected by APD Listening Writing Speaking Behavior Spelling Attention Math Social Reading Affect Characteristics of Auditory Processing Disorders Characteristics Difficulty with reading fluency Difficulty with reading comprehension Difficulty with math, especially applications Difficulty understanding multiple meanings words Poor written language Poor social skills and ability to judge pragmatics Poor musical abilities Poor memory Poor self-starter More Characteristics Highly verbal but communication lacks meaningful information Appears bright but unmotivated Problems with understanding “how to” tasks Difficulty following verbal directions A visual and/or hands on learner Poor ability to link prosodic features with linguistic content Difficulty with transitions Distractible Executive function problems Often a late identification of a learning disability “I heard it, I understood it, but I cannot remember it or I cannot do it.” Evaluation Process and Assessments Accurate diagnosis is key!!! There is NO one standardized evaluation protocol Age: 3 years, 6 months and above Evaluation Process and Assessment Evaluation of APD falls under the Audiologists scope of practice, but the team approach is vital Evaluation Process and Assessment Teachers are a vital member of the team. Evaluation Process and Assessment Parent and teacher observations and reports General Principles of Treatment There is no one proven treatment method There are general principles Direct Treatment Accommodations Environmental modifications The Brain Can Change Brain Plasticity The brain is a dynamic structure that has a natural ability to change itself. Learning is the process of the brain changing. We can use this ability to normalize and improve sensory processing by teaching the brain through the appropriate stimulation provided with the right frequency, intensity and duration. Learning Theory • Short frequent sessions result in increased amount learned as well as amount recalled and generalization when compared to long infrequent sessions APD In The Classroom Does APD exist? Accommodations or Modifications. 504 plan or IEP. Accommodations Allow un-timed tests Test in quiet environments Aim for quiet environments Use multiple choice or closed set testing Waive foreign language requirements Use external organization aids (outlines, lists, checklists, calendars, planners) Note taking assistance Use of a computer Use written information vs. oral directions Multisensory learning Animated teachers Tips for Teachers • • • • • • Pay attention to self-esteem; it’s hugely important. Strong peer partner Music (Classical around 60 bpm) Flexible seating Brain breaks Provide a desktop class schedule More Teacher Tips FM Amplification Audiobooks (read while listening) Allow extra time especially for test taking Assignment reduction Insist that the audiologist and the speechpathologist be involved. If they don’t know about (C)APD then ask them to learn Top “Things” to Know about Children with APD My hearing is inconsistent. My self-esteem is most important Transitions are tough for me so try to give me a heads up about transitions Work with me to find a cueing system Emphasize important/key points for me More Tips Use visual input to support what you are teaching Use short simple directions with my age and grade level vocabulary Check-in with me or pair me up with a strong peer to make sure I am on target I’m working really hard and my brain gets tired faster than my peers I need to go to recess. Lunch is not a break for me, I need to get up and move; it’s good for me. Top 3 Teacher Tips Music Brain Breaks Self Esteem When nothing else “fits”, could it be an auditory processing disorder? Resources Same Journey Different Paths: Stories of Auditory Processing Disorder. (2013) Various Authors Blah, Blah, Blah; What to Do When Words Don’t Work. (2011). Roam, Dan The Source Book for Processing Disorders. (2001) Richard, Gail. Soft-Wired. How the New Science of Brain Plasticity Can Change Your Life. (2013). Merzenich, Michael Websites/Overview of APD American Speech-Language-Hearing Association http://www.asha.org/public/hearing/Understanding-AuditoryProcessing-Disorder-in-Children/ National Center for Learning Disabilities http://www.ncld.org/types-learing-disabilities/adhd-relatedissues/auditory-processing-disorder/auditory-processing-disorderby-age-group APDUK: Auditory Processing Disorders UK http://apduk.org.uk Websites National Coalition of Auditory Processing Disorders http://ncapd.org Support Group(s) http://www.capdsupport.org/Diagnosis/what-is-capd.html APD Foundation http://www.theapdfoundation.org Questions/Contact Info Nancy Murray, AuD, CCC-A/SLP 801-750-6932 [email protected] Allison Tanner, MS, CCC-SLP 801-501-4125 [email protected]
