Audiology Lecture 4

problems with the "code"

The efficiency and effectiveness of the central nervous system in utilizing auditory information

Difficulties in the perceptual processing of auditory information in the central nervous system

How information is processed after it leaves the peripheral auditory structures

Attention-deficit/hyperactivity disorder (ADHD), language impairment, and learning disability

It provides the basis for learning language and language-based academic skills, including reading, spelling, and writing.

The child is at risk for learning disabilities and may experience severe speech and language delays.

At least 45% of their school day.

All day, not just at school.

At least a +15dB S/N ratio for acoustic accessibility.

Listening begins before birth.

Children with normal intelligence and normal peripheral hearing.

Yes, they can co-exist with peripheral hearing loss or other neurological impairments.

An auditory processing disorder (APD) is considered an eligible criterion for special education services under IDEA; 2004. It may be classified under speech or language impairment, specific learning disability, or other health impairment.

An audiologist.

The nervous system processes information from the auditory system through the brainstem to the auditory cortex.

No, the input from the auditory system radiates out to other neural cortical regions for interpretation, combining, and storage.

Delays in responding, slow and deliberate speech, word-finding difficulties.

Coping with implied or expressed time pressures, appearing "a step behind," difficulty maintaining attention to tasks, exceeding time limits during tests, trouble with social pressures to perform "faster."

Age 7

There is an increase in inconsistency and variability in younger children, weaker reliability for test tasks, and developmental and maturational influences. Normative data availability for certain tests is limited for children under age 7.

Staggered Spondaic Word Test (SSW) by Katz (1962) and SCAN-3:C Tests for Auditory Processing Disorders in Children by Keith (2009).

Multidisciplinary testing involves assessments conducted by different professionals from various disciplines. It provides a more comprehensive understanding of the child's abilities and challenges, helping to identify evidence or indicators of CAPD.

It is essential to assess whether the child can actively participate in the evaluation tasks and tolerate the testing procedures. This ensures accurate and reliable results.

CAPD testing can provide additional information about the child's auditory processing abilities, which may guide interventions and treatment planning. If the results reveal specific deficits or challenges, interventions may be adjusted or added to address these areas.

CAPD testing may or may not be the starting point, depending on the child's individual situation and the information gathered from previous evaluations. It is important to consider the overall assessment results and the specific needs of the child when determining the appropriate starting point for assessment and intervention.

What evaluations have been completed so far to indicate evidence or indicators of CAPD?  Multidisciplinary testing prior to referral – why?

Can the child participate in the evaluation? Complete the tasks and/or tolerate the testing?

Would the results of the CAPD testing add information to the child’s profile and change the program being provided?

Interventions different? Added? Are the areas already being addressed?

CAPD testing: starting point or not? 

•have cognitive abilities to enable testing,

•have English as their primary language (or use assessments in the child’s primary language if other than English)

•have peripheral hearing within the normal range, and

•have intelligible speech.

Children need to have cognitive abilities that enable them to participate in the testing process effectively.

Children should have English as their primary language, or if they speak a language other than English, assessments should be conducted in their primary language.

Children should have peripheral hearing within the normal range.

Children should have intelligible speech.

- Are there significant cognitive deficits?

- Test material demands on language, memory, and attention

- Other global cognitive issues – Difficult to separate APD

- ASD – Known that children with ASD can have difficulty receiving, filtering, organizing, and making use of sensory information.  Etiology already established – testing to provide specific data on which auditory skills are most difficult with possible strategies

- the ability to process language sounds rapidly (speed of processing)

- the ability to recognize incomplete or unusual forms of a word (closure)

- the ability to attend to one part of a sound pattern (auditory attention)

- the ability to understand speech in background noise (figure/ground)

- Damage to the auditory cortex as a result of infection, inflammation, immune disorders, or trauma

- Neurological indications

- Hearing loss

- Lack of language experiences in infancy/ Distorted hearing during the critical period of language development

- Genetics

CAPD primarily affects auditory processing abilities.

Acoustic, phonemic, and linguistic roles must be acknowledged from both a neurologically and behavioral standpoint when differentiating auditory processing from language processing.

Audiologists primarily view auditory processing from a neuropsychological perspective when differentiating it from language processing.

Speech pathologists primarily view auditory processing from a behavioral perspective when differentiating it from language processing.

The first 100-250 msec of an auditory stimulus presentation is considered the most critical for stimulus recognition in auditory processing.

Language processing starts at a very functional, concrete level during the acquisition of basic labels for aspects of our language.

Language processing requires the individual to pay attention to inflection, prosody, and tone in order to determine speaker intent.

Language is oral or spoken.

Literacy primarily pertains to reading and writing.

Phonological awareness serves as a bridge between language and literacy, with a focus on teaching graphic symbols to represent sounds.

code related skills that are prerequisite to developing reading and writing, or literacy.

Auditory processing skills, including phonological awareness, are prerequisite to language processing.

An acoustic stimulus must first be perceived as having a linguistic component before meaning can be extracted.

Sound discrimination and segmentation skills, involving the auditory analysis of acoustic stimuli, are considered critical foundation skills for both language and literacy.

Acoustic processing refers to the reception and transmission of the acoustic signal.

The primary focus of discrimination in auditory processing is distinguishing between linguistically encoded input and environmental input.

An audiologist examines the peripheral system, Central Auditory Nervous System (CANS), and the temporal lobe, from the 8th nerve to Heschl's gyrus, to assess the integrity of the auditory system.

Phonemic processing involves recognizing and knowing the code of spoken language, discriminating and analyzing the component parts of the signals, and applying and understanding the recognized code.

The initial requirement for phonemic processing is recognizing and knowing the code of spoken language.

Once the code of spoken language is recognized, it can be applied or understood.

The diagnosis in language processing and auditory processing depends on the tasks administered, the clinician performing the tests, and the stimulus used in the tests.

No, there is no distinct separation between auditory processing and language processing of the same stimulus.

Multiple anatomical and neurological structures overlap and work in cooperation in both language processing and auditory processing.

Pitch discrimination is typically evaluated by an audiologist as part of a Central Auditory Processing (CAP) battery.

Speech-Language Pathologist (SLP) typically evaluates the ability to understand spoken words, including nuances such as sarcasm.

Richards and Goswami (2015) investigated the auditory processing abilities for discrimination of psychoacoustic tasks, such as amplitude rise time, frequency, duration, and intensity.

The participants in the study conducted by Richards and Goswami (2015) were between the ages of 8 and 12 years.

The SLI group scored significantly lower on sensitivity to rise time and sound frequency discrimination, along with linguistic stress tasks, when compared to the typically developing controls.

Richards and Goswami (2015) hypothesized that poor auditory skills in rise time and frequency may relate to difficulty in processing stress patterns of speech, having a negative impact on the development of language.

The stages or transitions in the Processing Continuum from auditory acoustic processing to spoken language processing are: Auditory Acoustic - Auditory-Language - Spoken Language.

Test results should be interpreted in the context of age appropriate normative data by comparing them to the average performance of individuals of the same age.

Management plans for individuals with neuro-audiological development should be based on the stage of neuro-audiological development.

Behaviors associated with CAPD in the pre-school age group include difficulty localizing sounds, difficulty with rhyming sounds, and possible language delays.

Difficulty hearing in background noise, difficulty following directions, and poor "listening" skills are general behaviors associated with CAPD.

Academic difficulties commonly observed in individuals with CAPD include low academic performance, poor phonemic awareness/phonological skills, and difficulty with note-taking.

Yes, all students demonstrate academic indicators associated with CAPD at one time or another.

When assessing for CAPD, it is important to look for patterns and consistent indicators in terms of academic difficulties.

Observable difficulties associated with CAPD in terms of academic development include difficulties with language, listening, and reading.

Reading Disorders are characterized by impairments in the development of word recognition and reading comprehension.

Individuals with Reading Disorders often make errors such as omissions, distortions, and substitutions of words during oral reading.

Writing Disorders are characterized by impairment in the ability to compose written text, including spelling errors, difficulties within sentences, and/or poor paragraph organization.

Phonological Awareness is associated with dyslexia, which involves difficulties in processing speech and non-speech sounds, such as frequency and dichotic digits.

Phonics

Reading

Comprehension

Language Arts

Transcription

Written Language

Spelling

Handwriting

Word Problems 

Sequencing and Organization

Spectrum Disorders

Learning Disabilities

Neurological Impairments

Seizure Disorders

Attention Deficit Hyperactivity Disorder

Language Disorders/Delay/Deficit

Cognitive levels, Academic functioning levels, Neurological indicators, Language skills, Sensory skills, Consideration of age & maturity level

Directly to the Audiologist

SLP to Audiologist

CST to SLP to Audiologist

CST to Audiologist

“Other” professional to Audiologist

Parent to Audiologist

Educational Assessments

Intellectual Status Assessments

Multisensory Status: Visual, Motor, Neurological

Language Assessments 

Familial Information

Audiologist

Speech/Language Pathologist

Child Study Team Members:

  Psychologist

  Learning/Educational Consultant – LDT-C

  Social Worker

Neurodevelopmental Pediatrician

Neurologist

Pediatrician

Other?

Audiologist

Speech-language pathologist

Psychologist/Mental health professional

Social Worker

Learning Consultant

Educator/Teacher

Parents

Neurodevelopmental Pediatrician; Neurologist; Neuropsychologist or other

Single test method

Minimal Screening Battery

Questionnaires

8 years of age

8

A 12-item questionnaire completed by parents or teachers

Auditory processing skills

•Identifies where to refer and/or spend more time in assessment

8

•3 auditory processing

•2 phonemic/phonic

•3 language

A third version of a comprehensive auditory processing test