Transcript Auditory Processing Disorder

AUDITORY PROCESSING DISORDER;
(CENTRAL) AUDITORY PROCESSING
DISORDER
BY: Madonna Kellen, Tammy Oleson, Jacob Udvig, Amanda Wenner,
Julie Wenner
AUDITORY PROCESSING AS IT EVOLVES…
In 1993 the American Speech-LanguageHearing Association (ASHA) set out to
develop a “statement of consensus” in which
professionals could identify auditory
processing problems.
A task force made up of experts in the field of
audiology was developed to define and
answer the four basic questions associated
with auditory processing issues.
They were asked to answer the following
questions within their research…
“Issue #1—What does basic science tell us about the nature of
central auditory processing and its role in audition?
 Issue #2—What constitutes an assessment of central auditory
processing and its disorders?
 Issue #3—What are the developmental and acquired
communication problems associated with central auditory
processing disorders?
 Issue #4—What is the clinical utility of a diagnosis of central
auditory processing disorders?”

THEY ARRIVED AT THE
FOLLOWING CONSENSUS…
“Central Auditory Processes are the auditory
system mechanisms and processes responsible
for the following behavioral phenomena:
•
•
•
•
•
•
Sound localization and lateralization
Auditory discrimination
Auditory pattern recognition
Temporal aspects of audition to include:
– temporal resolution
– temporal masking
– temporal integration
– temporal ordering
Auditory performance decrements with competing acoustic signals.
Auditory performance decrements with degraded acoustic signals.”
THEIR DEFINITION…
“A Central Auditory Processing Disorder (CAPD) is an
observed deficiency in one or more of the abovelisted behaviors. For some persons, CAPD is
presumed to result from the dysfunction of
processes and mechanisms dedicated to audition; for
others, CAPD may stem from some more general
dysfunction, such as an attention deficit or neural
timing deficit, that affects performance across
modalities. It is also possible for CAPD to reflect coexisting dysfunctions of both sorts.”
FROM THIS CONSENSUS GREW DEBATE OVER…
•
Definition
–
•
Diagnosis
–
•
May perform poorly on an APD assessment battery yet have no
evidence of speech or language problems or visa versa.
Treatment
–
•
Is not always recommendation driven.
Assessment
–
•
Information processing theory
Does not correlate and are not driven by assessment.
Coexistence /confusion with other disabilities
–
Sorting out auditory processing disorders and receptive language
disorders.
IN 2005 THE DEFINITION CHANGES…
“Broadly stated, (Central) Auditory Processing [(C)AP]
refers to the efficiency and effectiveness by which the
central nervous system (CNS) utilizes auditory
information.”
“Narrowly defined, (C)AP refers to the perceptual
processing of auditory information in the CNS and the
neurobiologic activity that underlies that processing and
gives rise to electrophysiologic auditory potentials.”
LIMITATIONS TO DEFINITION…
“Although abilities such as phonological awareness,
attention to and memory for auditory information,
auditory synthesis, comprehension and
interpretation of auditory presented information,
and similar skills may be reliant on or associated with
intact central auditory function, they are considered
higher order cognitive-communicative and/or
language-related functions and, thus, are not
included in the definition of (C)AP.”
INCIDENCE…
May effect as many as 10% of children.
 Effects more boys than girls .
 More common than hearing loss.

GRAVEL, WALLACE, AND RUBEN RESEARCH STUDY
(1996)…
Children with mild, fluctuating hearing loss associated
with otitis media had long term problems with higher
an auditory-processing skills and learning.
 Many more children have auditory learning impairment
from CAPD than from hearing loss.
 CAPD is more “hidden” deficit because hearing
impairment is usually recognized more easily and
associated more directly with marked effect on speech
and language.

HIGH OCCURRENCE WITH OTHER DISORDERS…
ADHD
 Dyslexia
 Maturation delays
 Problems in central nervous system
 Autism

CAUSE OF DISORDER…
There is no known cause for this disorder.
 The amount of variables that need to be considered is
especially large, when taking in all that goes into taking
in information as well as processing it.
 Inherited genetics
 Severe ear infections, Otitis Media, with effusion
 Head trauma
 Part of the aging process
 Damage to the Auditory nerve, which results in auditory
neuropathy .
 And many unknown reasons .

SYMPTOMS OF CAPD…
Trouble paying attention
 Trouble with multi-step directions
 Poor listening skills
 Extra time needed to process information
 Low academic performance
 Behavior problems
 Difficulty with reading, comprehension, spelling and
vocabulary

PHONOLOGICAL AWARENESS
Defined:
“An awareness of how speech
sounds are used in words.”
AFFECTED AREAS OF
PHONOLOGICAL AWARENESS…
Manipulation –Ability to delete or alter the letters in a
word and determine what the new word would be (cat =
bat = tab).
 Segmentation – Separate out speech sounds in a word
(C-a-t).
 Sound Blending – Ability to take separate speech
sounds and put them together into a meaningful
utterance (b-l-a-ck).

MANY CHILDREN AND ADULTS WITH CAPD HAVE
PROBLEMS WITH PHONOLOGICAL AWARENESS HOWEVER
PHONOLOGICAL AWARENESS ALSO REQUIRES…
•
•
•
•
•
•
Memory skills
Ability to follow complex directions.
Good representation of speech sounds.
Segmentation of speech .
Modularity (clapping and singing)
Sound blending (knowing which sound correlates with which
letter of the alphabet).
These tasks cross a wide range of skills and therefore it is
important to consider the suspicion of a more global, higher
level cognitive disorder.
SYNTAX…

With difficulty in syntax, the way in which words in a
sentence are put together, they may struggle with
connecting words to their meanings.
PRAGMATICS…

1.
2.
3.
4.
5.
The social issues that people with CAPD face are
numerous. Due to the fact that their hearing is ok and
their IQ is ok, they are often perceived as people who…
Are not following directions… but in reality are not
understanding what is said.
Do not listen good enough… but in reality are
listening, and can’t process what is said.
Are shy… but are afraid to step out, in case they
understood wrong.
Are poor students… but truly want to do their best.
Are rude… but truly did not know they needed to
respond.
PRAGMATICS CONT…
6.
7.
8.
9.
10.
Are unorganized… but truly did not understand where
to put things.
Are slow… but truly need more time to think through
what people are saying.
Are poor note takers…. But truly did not process the
information needed.
Do not meet deadlines….. but truly did not process
the correct time frame.
Have behavior problems… but have learned this in
result of not being understood, or understanding.
MORPHOLOGY…
Since a morpheme is the smallest unit of sound that
holds meaning, a person with CAPD struggles with
processing the sounds that he or she hears correctly.
 Often words or sounds that are close are mistaken for
each other.
 One example is coat for boat,
 Another example: ch for sh.

SEMANTICS…

People who have CAPD also have difficulty attaining
the correct meaning for what is being said to them.
Due to this difficulty they often have troubles with
reading, writing and doing math computations.
ASSESSMENT…





The first test that needs to be done is a routine hearing test to
make sure that you can hear and are not just deaf.
Then there are many different tests that will be used in the
assessment of CAPD to determine the various auditory functions
of each persons brain.
There are two main categories of test: electrophysiologic test and
behavioral test which are then broken into four subcategories:
monaural low-redundancy speech test, dichotic speech test,
temporal patterning test, and binaural interaction test.
Not all children will be administered all these tests.
Which test the child will take depends on a number of factors
including, the age of the child, the specific auditory difficulties the
child is displaying, the child's native language and cognitive status.
ELECTROPHYSIOLOGIC TESTS…
These test measure how the brain response to sound.
 How these tests are preformed is by placing electrodes
on the earlobes and head of the child being tested.
These will measure the electrical potentials that will
arise from the central nervous system as a response to
the auditory stimulus.
 Then an auditory stimulus, such as a clicking sound is
distributed to the ear of the child and the electrical
responses are then recorded.
 These test can be used to evaluate the processing of the
lower brain, which involves the auditory brainstem
response audiometry.

BEHAVIORAL TEST…
Monaural Low-Redundancy Speech Test




This test is designed to test how well a person can achieve auditory
closure when there is pieces of information missing.
The speech stimuli that is used in the test will be modified by
changing either the characteristics of the speech signal, frequency,
temporal, or intensity characteristics.
Compressed Speech test (Beasley Schwimmer, and Rintelmann,
1972) is an example of this kind of test.
In this test parts of the speech signals have been altered
electronically by removing portions of the original speech. Then
these items are presented to each ear separately and the individual
has to repeat the words that have been presented.
BEHAVIORAL TEST…
5,9
Dichotic Speech Test
These tests present the individual with different speech
items either simultaneously or in an overlapping manner.
Then the individual is asked to repeat either everything
they heard, which is an example of divided attention, or
they are asked to only repeat what they have heard in one
ear, which show directed attention.
 Dichotic Digits test (Musiek, 1983) is a commonly used test
in this category.
 In this test four numbers are conveyed to the individual’s
two ears, two numbers in one ear at the same time and
two in the other ear also at the same time. Then the
individual is asked to repeat all the numbers they heard.

1,6
BEHAVIORAL TESTS…
Temporal Patterning Test





These tests are created to test an individual’s capability on processing
nonverbal auditory signals, as well as being able to recognize the order
or pattern that the presented stimuli represent.
The individual will either be asked to “hum” the patterns they hear or to
explain the patterns in words.
If the individual hums the pattern then the processing of the
information mostly happens will in the right half of the brain. When the
individual describes the pattern in words then the left half of the brain
will be used.
Frequency Pattern Sequences test (Musiek and Pinherio, 1987) is a very
commonly used test in this category.
This test consists of three short tone bursts in one or both ears. In this
pattern two of the bursts are of the same frequency and the third is a
different frequency. The only tones used are high and low frequency
sounds which the child is then asked to describe.
BEHAVIORAL TEST…
Binaural Interaction Test
This test will test children’s ability of the structures low in
the brain, such as the brainstem, and how good this part of
the brain is at taking incomplete information that is
presented to both ears and combining the information
together in some form.
 The Rapidly Alternating Speech Perception test (Willeford,
1976) is another common test used in this category.
 In this test a sentence is divided into brief segments which
are then alternated between both ears. For example in the
word “put” the “pu” would be presented in one ear and the
rest of word in the other ear, and the child would have to
put the word together.

TREATMENT…




1.
2.
3.
There is still much research needed in order to find the best
intervention possible for an individual with CAPD, but there are
some strategies that are available.
Any strategy that is used should be used under the guidance of
professionals with the effectiveness of the strategy on the
individual monitored and evaluated.
Once again which the strategy that will work the best all depends
on many different factors like, the exact nature of the CADP, the
age of the individual, any co-existence of other disabilities, and the
availability of resources.
The strategies fall under three main categories which are;
Enhancing the individual’s auditory perceptual skill.
Enhancing the individual’s language and cognitive resources.
Improving the quality of the auditory signal (cite).
STRATEGIES…

1.
2.
3.
There are five main strategies for improving CADP;
Auditory Trainers, which are electronic devices that
allow a person an easier time to focus on the speaker
and block out any background noise. These are used a
lot in a classroom setting when the teacher wears a
microphone and transmits the sound the a child wearing
a headset of hearing aids.
Environmental Modifications, which is as simple as
classroom acoustics, and or placement of the child in the
classroom. An audiologist may be able to offer some
advise on ways to improve environment listening.
Language-Building Skills, which are different exercises
that can increase an individual’s ability to learn new
words and also increase their language base.
STRATEGIES CONT…
4.
5.
6.
Auditory Memory Enhancement, which is a strategy
that can be used by teacher and or therapists by
making detailed information more simpler and basic
to comprehend.
Auditory Integration Training, is a way to retrain the
auditory system in individuals also decrease hearing
distortion. Although there has been no proven
benefits of this form of treatment yet.
The most important thing and the most stressed
strategy that will make the most improvements is to
make each program based on the individual's needs.
TIPS FOR PARENTS…









Try to reduce any background noise when trying to
communicate with your child.
Make sure your child is looking at you when you speak.
When talking to your child use very simple and expressive
sentences.
Speak at a little slower rate and raise your volume a little to
make sure they are getting everything.
Have your child repeat back to you instructions out loud.
Write your child reminder notes, and also having your child
wear a watch will help.
Keep a general organization of the house and the same basic
routine and chores.
Create a quite place for your child to study.
Help your child build their self-esteem.
TIPS FOR TEACHERS…
 Make sure you speak very clear when giving
directions to the class.
 Rephrasing the information again in a different
way can help reinforce it and it helps to hear the
information again.
 Create a seating chart with the child in a quite
place and where they can most easily hear you
teach.
 Reinforce your information with visual aids to
help out when the auditory information is lost.
THINGS PARENTS AND TEACHERS CAN DO TO HELP
STUDENTS WITH CAPD…
Reduce or eliminate background noise in classrooms, or
at home.
 Insure that the classrooms the student is in are
acoustically sound.
 Provide opportunities for the student to pre-learn new
vocabulary being taught.
 Give child visual and audio instruction.
 Teach the child strategies that will foster focusing on
the speaker.
 Use simple, straight forward sentences in your
speaking.

THINGS PARENTS AND TEACHERS CAN DO TO HELP
STUDENTS WITH CAPD CONT…
Use a little bit slower rate when speaking.
 Use a little lower volume when speaking.
 Use rephrasing instead of repeating when a child
misunderstands.
 Have the child repeat directions to insure their
understanding.
 When directions are to be taken at a later time, insure
the child has taken correct notes, so that the instruction
can be followed through.
 Teach strategies for self advocacy that include the child
positions self in the quietest spot for learning.

THINGS PARENTS AND TEACHERS CAN DO TO HELP
STUDENTS WITH CAPD CONT…
Provide a quiet study area for child at home and school.
 Ask to sit in front of classroom, or within 10 feet of the
speaker.
 Keep classroom and home as chaotic free as possible.
 Encourage healthy eating habits.
 Provide structure.
 Teach organization strategies.
 Foster positive self-esteem.
 Remember that CAPD is REAL!

PERSONAL ONLINE INTERVIEW OF:
TERI JAMES BELLIS, PH.D., CCC-A, FAAA, F-ASHA
PROFESSOR AND CHAIR, DEPARTMENT OF COMMUNICATION DISORDERS
DIRECTOR, SPEECH-LANGUAGE-HEARING CLINICS
What historical changes have you seen to the definition of auditory
processing disorder?
“Mostly it has been honed to make it clear that this is a
Neurobiological disorder involving the central auditory
pathways,
Not just "listening." It's a diagnosis, not a descriptor.”
What is your general definition of auditory processing disorder?
“I use the ASHA (2005) definition.”
INTERVIEW QUESTIONS CONTINUED…
What problems in phonology would a child with an auditory
processing disorder present with?
“I would say that children with CAPD often present with
phonological difficulties that involve substitutions of similar
sounding phonemes (e.g., stop consonants and others that
include rapid spectrotemporal acoustic changes) and/or
deletions of weak phonemes.”
What motivated you to begin working in the area of CAPD?
“Had an interest in neuroscience from way back, and coupled
with my interest in pediatrics...well, that's where the two
met somehow. Really just fell into it!”
FOR MORE INFORMATION ON CAPD AND INTERVENTIONS
TO USE SEE THE FOLLOWING WEBSITES:

http://www.themlrc.org/index.htm

www.tomatis.com

www.earobics.com

http://www.asha.org

http://www.audiology.org

http://www.edaud.org

http://www.theshop.net/campbell/central.htm

http://www.audiologyinfo.com

http://www.searchwave.com

http://www.kidspeech.com/tips.html

http://www.engr.colostate.edu/depts/eeresearch/cad

http://www.kidshealth.org/parent/healthy.centralauditory.html

http://www.listen-up.orghttp:pages.cthome.net/bristol/capd.html

http://www.hearingbalance.com/hbscapd.htm

http://www.families.com/experts/advice/0.1183.1-3347.00.html

http://www.thehearinjournal.com
REFERENCES

American Speech-Language-Hearing Association. (1996). Central Auditory Processing: Current
Status of Research and Implications for Clinical Practice [Technical Report]. Available
from www.asha.org/policy.

Auditory Processing Disorder (APD). MRC Institute of Hearing Research. April2004. British Society of
Audiology APD Special Interest Group. Aug 9 2008.

Baran, Jane. An Overview of Assessment and Management Practices. “Central Auditory Processing
Disorders.” April 27 2004. Department of Communication Disorders. Aug 6 2008.

Bellis, T. J. (2004, March 30). Redefining auditory processing disorder: An audiologist‘s perspective. The
ASHA Leader, pp. 6, 22-23.

Bellis, Teri. Why the brain can't hear: Unraveling the mystery of Auditory processing disorder.
New York: PB Press, 2002

“Management of Auditory Processing Disorders.” Kidspeech. 2008. 08/08/2008.

Morlet Thierry PhD. “Auditory Processing Disorders.” KidsHealth. 2007. 08/08/2008.

NIDCD. Auditory Processing Disorder in Children. “National Institute on Deafness and Other
Communication Disorders.” Feb 2004. NIDCD. Aug 6 2008.
http://www.nidcd.nih.gov/health/voice/auditory.htm#5.

Paton, Judith. “Living and Working With a Central Auditory Processing Disorder (CAPD).” LDOnline.
2008. 8/08/2008.

Pillow L. Gary. “Auditory Processing Disorders A Guide for Parents and
Professionals.”08/08/2008.

Richard, G. (2004, March 30). Redefining auditory processing disorder: A speech-language pathologist‘s
perspective. The ASHA Leader, pp. 7, 21.

Young L. Maxine M.S., CCC-A/SLP, FAAA. “Recognizing and Treating Children with Central Auditory
Processing Disorders.”
http://www.scilearn.com/results/foundationalresearch/whitepapers/index.php#capd.
08/08/2008.