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UNDERSTANDING AUDITORY PROCESSING DISORDER (APD)
Maureen E. Jones, M.A., CCC-SLP
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What is Auditory Processing? 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.
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ASHA definition of APD (ASHA, 2005)
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
signals
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Sound localization
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.
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Auditory discrimination
Auditory discrimination: the ability to discriminate speech sounds.
Knowing the difference between an /m/ and /n/.
Knowing the difference between ‘cake’ and ‘lake’.
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Auditory pattern recognition 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?
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Temporal aspects of audition 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/?
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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.
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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.
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Hierarchy of Auditory Processing Skills
• 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.
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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)
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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
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Characteristics seen in children with APD
• 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
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Diagnosing APD
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
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APD Assessment
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
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APD Assessment: Areas Tested• Figure ground• Auditory Closure• Binaural Integration• Binaural Separation• Binaural Interaction• Phonemic Synthesis• Pitch Patterning• Gap Detection• Sustained Auditory Attention
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APD Assessment
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.
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SLP Evaluation
Tests receptive and expressive language skills
Auditory processing, comprehension, decoding, listening
Following directions Sound blending, discrimination, rhyming CELF-5 TAPS TOPS CASL TOWL
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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
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Treatment
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
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Treatment
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
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Treatment
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
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Treatment
Direct-treatment of APD Computer-assisted programs One-to-one training with a speech therapist Home-based programs
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Things to Remember
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
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Questions????25
References26
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/HOPEFUN666.pdf
Roeser, R.., & Downs, M.P. (2004). Auditory disorders in school children: The law, identification, remediation 4th 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 (3rd 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.
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