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Yes, you CANS! Treatment/management of children’s central auditory processing disorders

Yes, you CANS! Treatment/management of children’s central auditory processing disorders. Jeanane M. Ferre, PhD, CCC-A Oak Park, IL 60301 708.848.4363 Fax: 708.848.7233 jmfphd@comcast.net www.dr-ferre.com. disclosures. Financial Invited speaker – honorarium Pro-Ed author

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Yes, you CANS! Treatment/management of children’s central auditory processing disorders

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  1. Yes, you CANS! Treatment/management of children’s central auditory processing disorders Jeanane M. Ferre, PhD, CCC-A Oak Park, IL 60301 708.848.4363 Fax: 708.848.7233 jmfphd@comcast.net www.dr-ferre.com

  2. disclosures • Financial • Invited speaker – honorarium • Pro-Ed author • Consultant – school districts in IL, GA, WI, HI • Adjunct Faculty- Northwestern University Rush University • Nonfinancial • ASHA member • ISHA member

  3. CAP processes • Auditory discrimination - ability to analyze fine differences in acoustic spectra • Binaural processing - ability to recognize and manipulate multiple acoustic targets • Temporal processing - ability to use timing aspects of auditory signals

  4. Underlie ability to recognize/use speech • Necessary for active listening/learning/language • Educationally relevant to ALL Common Core standards, including standard for Speaking and Listening • Reading, Spelling, Written language, Math • All aspects of language acquisition/usage • Classroom listening, Note-taking, Test-taking

  5. Summary of CAPD types • Primary CAPDs • Decoding deficit - LH • Integration deficit - CC • Prosodic deficit – RH • Represent truly CENTRAL AUDITORY processing issues • Secondary profiles • Associative • Output-organization • The “auditory manifestations” of language processing or executive function issues NOT true CAPD

  6. Intervention for CAPDs the m3 model

  7. Management • Modification of the communicative environment • Use of compensatory strategies • Minimizes adverse effect of disorder of client’s life Remediation • Formal and informal therapy to develop deficient skills AND • Teach compensatory strategies • Designed to reduce or resolve deficit

  8. Direct Remediation for PDs • Remediation based on research in neural plasticity. • Plasticity is brain’s ability to organize/reorganize in response to internal/external changes. • When choosing treatment program, consider • Reported efficacy of program for specific populations – Does it work? • Program’s neuroscientific foundations – Should it work? • Appropriateness for type of deficit identified – Does it fit?

  9. Remediation for CAPDs • Auditory training • bottom-up therapy, plasticity-based • auditory, although not exclusively, stimuli • stimuli are repetitive • max number of responses elicited • feedback on accuracy provide • activities adaptive, systematic, and varied • nearly any CAP skill can be trained this way

  10. Remediation for CAPDs • Linguistic-Cognitive therapy • top-down therapy • based on neurocognitive theory • concept-driven • teaches compensatory strategies • central resources training • use of visual cues • counseling

  11. Auditory decoding deficit • Characterized by poor analysis of fine acoustic differences in speech spectra – primarily a discrimination issue • Management focuses on acoustic signal clarity, access and use • Treatment focuses on auditory training and teaching compensatory strategies

  12. Auditory discrimination inefficient analysis of acoustic cues • Impacts • Phonological awareness • Spelling • Listening stamina • Direction following • Comprehension • Language skills • Foreign language acquisition • Treatment needs • Sound discrimination • Auditory closure • Phonemic awareness • Recognition in noise • Use of visual cues • Listening comprehension

  13. Sample goals for student with impaired auditory discrimination • Student will discriminate speech presented under a variety of listening conditions • Student will recognize speech under adverse listening conditions • Student will use visual cues to improve speech recognition • Student will recognize and use key elements in spoken targets

  14. Sample benchmarks - discrimination Discriminate minimally contrasted phoneme pairs presented auditorily only (i.e. no lipreading cues) in quiet with 90% accuracy. Discriminate minimally contrasted phoneme pairs presented auditorily only (i.e. no lipreading cues) in background of multi-speaker babble that is of equal loudness (i.e., at a 0 signal-to-noise ratio) and emanates from the same location as the target signal  with 90% accuracy. .

  15. Recognition in noise (noise tolerance) • Student will recognize everyday sentences presented without visual cues in a background of equal loudness noise with 85% accuracy. • Student will recognize everyday sentences presented with visual cues in a background of noise that is much louder than the target with 75% accuracy.

  16. Using visual cues Student will discriminate same-difference  for target presented visually only with 90% accuracy. Student will identify target compound word presented visually-only (i.e., no auditory input) from among a closed set of no more than 30 printed word or picture choices with 90% accuracy.

  17. Listening comprehension Given a sentence, student will state information conveyed by key (i.e., stressed) word with 90% accuracy (e.g., My sister baked two dozen chocolate chip cookies on TUESDAY. Key word: Tuesday. Information conveyed: when). Given a sentence, student will state information conveyed by two (or more) key (i.e., stressed) words with 90% accuracy (e.g., MY sister baked TWO DOZEN chocolate chip cookies on Tuesday. Key words: My, two dozen. Information conveyed: who, how many).

  18. Integration deficit • Integration deficit is characterized by poor synthesis and manipulation of multiple incoming signals (interhemispheric) • Management focuses on improving the quantity and structure of incoming signals • Treatment focus is on increasing “highways” and compensatory strategies

  19. Associative deficit • Associative deficit characterized by difficulty applying linguistic rules to information (intrahemispheric) • Management focuses on improving the linguistic quality of the target and use of linguistic rules • Treatment focuses on “learning the rules”

  20. Binaural processing • Impacts • Reading comprehension • Spelling • Listening comprehension • Direction following • Task completion • Note-taking • Treatment needs • Dichotic listening • Interhemispheric communication • Synthesis of multiple auditory targets • Manipulation of auditory & non-auditory signals

  21. Sample goals for student with binaural processing • Student will recognize dichotically presented targets • Student will increase communication between the two hemispheres. • Student will synthesize and manipulate multiple auditory targets. • Student will recognize & manipulate auditory, auditory-visual, and acoustic-linguistic targets.

  22. Dichotic  listening • Repeat 2 digits presented simultaneously, 1 to each ear, with 90% accuracy (binaural integration ) • Repeat four words presented simultaneously, two to each ear, with 80% accuracy for each ear (binaural integration ) e.g., RE - house, car; LE – goat, dig; house & goat overlap and car & dig overlap • Given two sentences, presented simultaneously, one to each ear, student will repeat sentence directed to right ear only (or to left ear only) with 90% accuracy (binaural separation).

  23. Interhemispheric integration • Given array of common objects, student will name object without looking with 90% accuracy. • Given array of common objects, student will find named object without looking with 90% accuracy. • Student will follow 2-part, 3-element verbal directions (e.g., point to large white square & small blue triangle), w/out visual cues in equal loudness noise with 90% accuracy.

  24. Sound blending/synthesis Given a word and using a “phoneme list”, student will create as many rhymes as possible within two minutes. Student will smoothly blend three nonsense syllables (e.g., puh-tuh-kuh, spruh-struh-skruh) using equal stress on each phoneme (or varying stress across phonemes, e.g., SPRUH-struh-skruh).

  25. Diadochokinetics • Puh • Puh-tuh • Puh-tuh-kuh • Pruh-fuh-guh • Plu-fru-luh • Plu-glu-gru • Spuh-stuh-shuh • Spruh-struh-skruh

  26. Recognize /manipulate multisensory targets Given a “deck” of 50 word cards, student will generate single rhyming word for printed target within two minutes with 90% accuracy. Given a list of 50 words, student will generate two rhymes for each word within 3 minutes with 90% accuracy.

  27. Prosodic deficit • Prosodic deficit characterized by difficulty analyzing, synthesizing, & attaching meaning to rapidly changing acoustic patterns (RH) • Management focuses on improving quality and structure of incoming signal • Treatment focuses improved analysis/ synthesis and compensatory strategies

  28. Temporal processing • Impacts • Listening comprehension • Memory • Reading comprehension • Social & pragmatic language • Direction-following • Treatment needs • Pattern recognition • Use of prosody • Listening comprehension • Use of visual cues • Working memory • Sequencing

  29. Sample goals for student with temporal processing • Student will recognize auditory patterns. • Student will discriminate, recognize, and interpret stress in speech. • Student will recognize/use key elements within a spoken target. • Student will use visual cues to assist message comprehension. • Student will recognize/use patterns within linguistic signals.

  30. Temporal pattern discrimination/recognition Determine same-difference for 2-, 3, or 4-tone sequences composed of soft/loud (e.g., loud-soft), high/low (e.g., high-low-high), short/long (e.g., short-short-long-short) tones with 90% accuracy Imitate two-, three-, or four-tone patterns, presented with equal stress with 95% accuracy. Attach verbal label to 2-, 3-, or 4-tone sequences varying in pitch, loudness, or duration with 90% accuracy.

  31. Use of prosody Identify three-phoneme sequence from among a closed set of three choices, with 90% accuracy. Imitate three-phoneme sequences with 85% accuracy. Judge intent of statements with 85% accuracy, including sincerity/insincerity and emotion (e.g., anger, happiness, fear, sadness).

  32. Diadochokinetics • Puh • Puh-tuh • Puh-tuh-kuh • Pruh-fuh-guh • Plu-fru-luh • Plu-glu-gru • Spuh-stuh-shuh • Spruh-struh-skruh

  33. Listening comprehension When given a sentence, student will identify stressed word in sentence with 90% accuracy. When given a sentence, student will identify two stressed words with 90% accuracy.

  34. Use of visual cues Given picture choices, student will match emotion word/phrase, e.g., They are frightened, with corresponding picture with 90% accuracy. Given printed sentences, student will identify and imitate the “prosodic” marker in the sentence with 90% accuracy (e.g., identify the ? in a sentence to denote questioning/rising intonation and imitate same)

  35. Using linguistic patterns (working memory) Given no more than three clues, student will recognize word with 90% accuracy(e.g., given white, fluffy, falls student would respond snow) When given a sentence, student will state what information is conveyed by two (or more) key (i.e., stressed) words with 90% accuracy (e.g., MY sister baked TWO DOZEN chocolate chip cookies on Tuesday. Key words: My, two dozen. Information conveyed: who, how many).

  36. Sequencing – using verbally mediated strategies to sequence/organize auditory information Given a single word target, student will create as many rhyming words as possible in 2 minutes and in alphabetical order with 90% accuracy. Student will execute 3-step sequential directions, in which each direction has 1- or 2-critcal elements, with 90% accuracy when presented in a quiet environment (e.g., 1st, draw a straight line, then draw a circle below the line, & then draw a red star above line.

  37. For all students • Student will demonstrate ability to use active listening strategies • Active listening - taking responsibility for one’s listening success or failure by understanding impact of auditory impairment in one’s life, recognizing aspects of communication under listener’s control, displaying effortful listening behaviors, taking overt steps to avoid or correct potential communication mishaps. • Student will maintain auditory vigilance for “X” amount of time

  38. Active listening • Student will state two difficult listening situations that he/she has encountered • For a self-reported difficult listening situation, student will state (and practice) one strategy to minimize the listening difficulty.

  39. Auditory vigilance • Given a string of random words (or phonemes), student will indicate through hand signal each occurrence of pre-determined “target” word • Student will indicate through hand signal “rare” or different target from within a string of common targets (e.g., buh-buh-dee-buh-buh-buh-buh-dee)

  40. Thirty great games/books to enhance auditory processing and related skills Game Processing skill taxed • A Rhyme in Time sound discrimination, auditory closure • Battleship listening, visual patterning, integration • Blind Man’s Bluff localization, binaural interaction • Boggle pattern recognition, integration • Bopit, integration, vigilance • Brain Warp vigilance, integration, problem-solving • Card games pattern recognition, sequencing • Catch Phrase integration, vocabulary, output • Clever Endeavour metalinguistic strategies, critical listening • Feely Bag interhemispheric communication

  41. Game processing skills taxed • Ending sound game auditory discrimination • Mad Gab temporal patterning, language • Marco Polo localization, binaural interaction • Musical Chairs vigilance • Name that tune interhemispheric integration • Password vocabulary, linguistic skills • Plexers metalinguistic strategies • Rags to Riches metalinguistic skills (idioms) • Read My Lips lipreading/speechreading • Red Light-Green light vigilance, active listening

  42. Game Processing skills taxed • Rummikub patterning, problem solving, integration • Scattergories vocabulary building, linguistic strategies • Scrabble integration, language, visual patterning • Simon auditory-visual patterning • Simon Says vigilance, active listening • Taboo vocabulary, metalinguistic strategies • Telephone game attention, active listening, discrimination • Twister integration, critical listening • UpWords integration, visual patterning • Wheel of Fortune auditory closure

  43. Resources for therapy • www.linguisystems.com - Differential Processing Training Program – auditory, phonologic and linguistic goals • www.acousticpioneer.com – dichotic listening and temporal patterning training • www.pluralpublishing.com – Sound Auditory Training - temporal resolution, discrimination, and patterning – release date TBD • www.SeeingSpeech.com – lip/speechreading • www.neurotone.com – LACE: Listening & Communication enhancement – for adults

  44. Resources for therapy • Earobics – www.earobics.com – discrimination, closure, phonologic skills • Fast ForWord – www.scilearn.com – discrimination, temporal processing, phonologic processing • CAPDOTS – www.capdots.com – dichotic listening • HearBuilder - www.superduperinc.com – phonologic awareness (taps discrim), memory for auditory info, usage

  45. Resources for therapy • Auditec of St. Louis – Constraint Induced Auditory Training (CAIT) – dichotic listening • BrainHQ programs from Posit Science – exercises for attention, memory, discrimination, patterning • LISN and Learn Auditory Training software – trains listening in noise and spatial processing (Cameron and Dillon)

  46. Resources for therapy • Apps from • www.superduperinc.com • www.smartyearsapps.com • www.virtualspeech.com • www.hamiguchiapps.com

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