Auditory Processing

Presented by Kimberly Klein

Early interest in CAP in children

Concept was described by Myklebust, 1954

Interest expanded in 1970s

ASHA Consensus Conference on CAPD: Central auditory processes are

mechanisms and processes responsible for the following phenomena:

Sound localization and lateralization

Auditory discrimination

Auditory pattern recognition

Auditory performance decrements with degraded acoustic signals

Temporal aspects of audition, including temporal resolution, masking, integration, and ordering

Auditory performance decrements with competing acoustic signals (ASHA, 1996)

CAP Disorders can be defined as:

Observed deficiency in one or more behaviors described in ASHA Consensus Statement

Auditory specific (disorder of coding and transformation of auditory input or perception) or part of a larger general information processing deficit

Children with CAP

Lack skills to process/carry out multi-step directions

Pass pure-tone hearing tests

Great visual learners

Inability to learn to read with the phonetic approach

Difficulty learning where noise level is high

Children with CAP

Become followers socially & behaviorally

Can be withdrawn, confused, distracted, frustrated

Develop compensatory strategies

Develop listening skills

Reading Blocks

Primarily visual

Phonics

Rhyming words

Sequencing sounds into words

Dividing words into syllables

Retaining sounds

                          

Auditory Skills

Sequential memory

Auditory discrimination

Sound blending

Auditory association

Sound blending

                                                                       

Obstacles

The brain’s inability to process all information correctly at a given time

Common Behaviors of CAP Children

Poor listener

Poor attention (short span)

Easily distracted

Misunderstands

Trouble following verbal instructions

Frustration

Poor speech discrimination

Poor ability to organize information

Seemingly poor memory

Common Behaviors of CAP Children

Doesn’t complete tasks

Daydreams

Hyperactive or hypoactive

Hostility

A “loner” often plays by self

Prefers company of younger friends or adults

“Soft” if any neurological signs

Common Behaviors of CAP children

DisruptiveWithdrawal“Clings” to parents (young children in an active environmentSeeks quiet or structured environment

Researchers say

Willeford & Burleigh noted that “such behaviors are not surprising if the child has failed to understand the teacher’s instructions.”

Toman reports that “70% of the talking in the classroom is done by teachers.”

Children with CAP

Trying hard to process what is being said and often are undiagnosed

Lack the skills necessary to process and carry out multi-step directions

Useful Resources

Fisher’s Auditory Problems Checklist

Willeford and Burleigh’s Behavior Rating Scale for Central Auditory Processing

Corpus Callosum

“The corpus callosum is primarily responsible for communication and integration of information from two cerebral hemispheres

Auditory Function Language

Rapid sequences of auditory stimuli and analysis dominate left hemisphere

While music perception, acoustic contour recognition and perception of gestalt dominates right hemisphere

Time will tell

If a child will outgrow CAP with the neuromaturation of his/her temporal processing abilities.

Skills continue to improve until age 12

Tests Used for selective attention, memory and

performance in sound blending include:Peabody Picture Vocabulary Test-Revised

Clinical Evaluation of Language Fundamentals-Revised

Test of Language Competency

Test of Adolescent Language

Test of Language Development Primary

Other subtests can be used

Interventions

Assistive listening devices--FM systems

Mnemonics

Chunking

Maximization of auditory & visual information

Speaking slower with more pauses

Brain Plasticity

Can take over and help a person compensate for this auditory deficit or disorder

Occurs quicker in younger children

Helps stroke victims who are musically inclined, as the music compensates for the CAP

Competing Sentence Test

Uses dichotically presented sentences that are the same length.Primary message, “My brother is a tall boy,” in right ear at 35 dBCompeting message, “Your mother is a good cook,” in left ear at 50 dBChild is asked to listen/repeat primary message and ignore louder message

Filtered Speech Test

Contains two fifty-word lists presented to each ear.

Words such as “tone, phone, root, tire” are given but are filtered

Child must say word given to testing ear

Each ear is tested with different set of words

Binaural Fusion Test

Gives the same word such as “bagpipe” to both ears simultaneouslyOne ear receives word in a low-pass signal/other receives in a high pass filtered stimuliWhen 2 frequencies played separately: unintelligible. Together the child understands “bagpipe”Testing ear receives low frequency

Alternating Speech Test

Phonemes of sentences are shifted such as “put a dozen apples in the sack”

Give to each ear in short bursts

20 alternating sentences

Test shows which ear is dominant and which is weak

Recommendations

Made on individual basis

If child has dominant right ear…then child’s right ear should be in center of room

Child has better opportunity of distinguishing sounds and processing information

Recommendations

Preferential seating

Implement buddy system: clarify auditory information

Position child away form “busy” areas

Earplugs or earmuffs worn during desk activities

Testing sessions in a quiet room

Rephrase or crosscheck instructions/concept

Teaching Approach

Pre-teach, teach and post-teach format of learning.

Coordinate this approach with parent and resource room teacher

Pre-teach—resource room—presenting new concepts prior to full class instruction

Teaching Approach

Classes relying heavily on auditory transmission of information should be scheduled in initial part of the morning or afternoon.

Re-Teach---parent or tutor revisits the concept for a third time

Creating Learning Environment

Lightly touch child’s shoulder or call child’s name prior to auditory information given

Visual supplements and “hands-on” approach

Use computer for classroom work

Phonics approach should be emphasized

Other students speak in softer voice; reduces strain of listening

Leads to?

Learning becomes fun and exciting rather than an arduous task that is compounded by confusion and frustration.

Activating poor memory

Use chunking, verbal chaining, rehearsal, paraphrasing, and summarizing

Activate right hemisphere through drawing and imagery

Use external aids—calendars, notebooks

Strategy for poor listening comprehension

Induce formal scheme to aid organization, integration and prediction through recognition and explanation of connective (furthermore) patterns of parallelism and co-relative pairs (not only/but also neither/nor

Maximize visual and auditory summation by substituting note taking

Sequencing: first, second, then, next, finally

Which direction does my brain follow?

Teacher trained

To provide classroom that child can thrive and succeed

To practice listening skills then child learns in effective manner

To become aware and talk slowly, emphasizing key words or phrasesTo wear lipstick as the focus becomes on the spoken word of the teacher and not her physical features

If teacher educated in CAP

Does the child need an assistive listening device (FM system)?

Does the teacher’s classroom provide good acoustics?

Does the teacher speak slowly when emphasizing key words or introducing new concepts?

Due to limited resources

Teachers must often compensate

Child is entitled to education regardless of needs

School district is to provide an education that teaches, challenges and meets the needs of its students

Parent should advocate for his/her child providing necessary research and information

Dedication

To the audiologists, research scientists, speech therapists, case managers, psychologists, resource teachers, staff and teachers who have provided knowledge, techniques, and explanations of working, teaching, raising a successful child with CAP