Understanding Auditory Processing Disorder (APD)

1. Understanding Auditory Processing Disorder (APD) Maureen E. Jones, M.A., CCC-SLP

2. 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.

3. 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

4. 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.

5. 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’.

6. 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?

7. 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/?

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.

10. 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.

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

13. 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

14. 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

15. 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

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

17. 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.

18. 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

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

20. 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

21. 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

22. 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

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

24. 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

25. Questions????

26. References • 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.