““He just doesn’t He just doesn’t listen!listen!””

Defining Auditory Defining Auditory Processing DisorderProcessing Disorder

Nancy Murray, AuD, CCC-A/SLPNancy Murray, AuD, CCC-A/SLPAndAnd

Allison Tanner, MS, CCC-SLPAllison Tanner, MS, CCC-SLP

Review of the EarReview of the Ear

Outer EarOuter Ear

Middle EarMiddle Ear

Inner EarInner Ear

There are numerous There are numerous functional capabilitiesfunctional capabilities of the ear, all of of the ear, all of which can be related to commonly identified specific which can be related to commonly identified specific

auditory processing abilities or to vestibular function.auditory processing abilities or to vestibular function.

Perceive sound Perceive sound  Process sound without distortion Process sound without distortion  Discriminate between higher and lower Discriminate between higher and lower

frequencies of sound frequencies of sound  Perceive spatial origin of sounds Perceive spatial origin of sounds  Attend to sounds we want to hear and tune Attend to sounds we want to hear and tune

out ones we donout ones we don’’t want t want  Stimulate the brain with sensory input Stimulate the brain with sensory input  Integrate sensory information from muscle Integrate sensory information from muscle

movement movement  Establish good balance/equilibrium Establish good balance/equilibrium  Control phonation (speech) Control phonation (speech)  Control musical abilityControl musical ability

Ear Brain ConnectionEar Brain Connection Auditory system is the only sensory system to be fully Auditory system is the only sensory system to be fully

functioning in utero functioning in utero

By its order in our development the auditory system By its order in our development the auditory system demonstrates its importance to the growth and maintenance of demonstrates its importance to the growth and maintenance of the brain and bodythe brain and body

The ear is physiologically and neurophysiologically connected The ear is physiologically and neurophysiologically connected to nearly every organ in the human body as well as the auditory to nearly every organ in the human body as well as the auditory and language centers in the brainand language centers in the brain

A well developed and fully functioning auditory system serves A well developed and fully functioning auditory system serves as a critical foundation for as a critical foundation for balance, coordination balance, coordination andand movement, communication, relationships, language, self movement, communication, relationships, language, self regulation, attention regulation, attention andand thinking thinking

To the developing child, the auditory system is the first that To the developing child, the auditory system is the first that should be addressed when issues are presentshould be addressed when issues are present

Ear Brain ConnectionEar Brain Connection Auditory system has two parts:Auditory system has two parts:

Cochlear Cochlear ((hearing systemhearing system)) gives us information gives us information about soundabout sound

We rely on this system to inform us about the We rely on this system to inform us about the auditory world- auditory world- languagelanguage, , musicmusic, and the , and the auditory auditory scenescene of our of our environmentenvironment

VestibularVestibular ( (balance systembalance system)) gives us information gives us information about movement and orientation in space about movement and orientation in space

We rely on this system to maintain We rely on this system to maintain balance balance and and

postureposture, for coordinated , for coordinated movementmovement in time and space, in time and space, and for clear and for clear visionvision

Hearing-Listening-Auditory Hearing-Listening-Auditory ProcessingProcessing

Auditory Processing - Is what Auditory Processing - Is what happens when the brain recognizes, happens when the brain recognizes, interprets and can respond to the interprets and can respond to the varied sounds around us such as varied sounds around us such as music, language and the music, language and the environment in which we live. It environment in which we live. It involves both hearing and listening involves both hearing and listening and is simply defined as what the and is simply defined as what the brain does with what it hears.brain does with what it hears.

Auditory Processing SkillsAuditory Processing Skills

Perception Perception -- To perceive the loudness or To perceive the loudness or intensity of sounds. This is measured in intensity of sounds. This is measured in decibels decibels

(abbreviated (abbreviated ““dBdB””).). Attention Attention -- To attend, focus, or listen to To attend, focus, or listen to

sound. sound. Localization Localization -- To identify the source of a To identify the source of a

sound in your environmentsound in your environment Discrimination - Discrimination - To distinguish between To distinguish between

sounds or words that are similar or sounds or words that are similar or different in the way they sound.different in the way they sound.

Simple: in quiet environments.Simple: in quiet environments. Complex: Complex: ““figure groundfigure ground”” listening listening

with background noise.with background noise.

Auditory Processing Skills Auditory Processing Skills

Processing Skills Cont.

Closures - To fill in the missing pieces of sounds or words.

Anticipation - To expect what sound is coming next.

Temporal Processing - To analyze the timing and pattern of sounds.-Intonation

Memory - To sequence sounds, words, or other meaningful combinations. To receive, store, process and recall auditory information.

What is listening?What is listening?

-An active process; a dynamic process in which one -An active process; a dynamic process in which one

takes in information as well as filters out takes in information as well as filters out information.information.

-An ability and desire to use our ears. -An ability and desire to use our ears. - The The ““auditory earauditory ear”” as well as the as well as the ““ear of the ear of the

bodybody””- Our auditory system and our sensory systems.Our auditory system and our sensory systems.- Jane AyresJane Ayres

If thereIf there’’s a deficit here then it could s a deficit here then it could be an Auditory Processing be an Auditory Processing Disorder.Disorder.

Auditory Processing Auditory Processing DisordersDisorders

Cause is unknown.Cause is unknown. ““ProcessingProcessing”” continues to develop from continues to develop from

time of birth to early adulthood (20time of birth to early adulthood (20’’s).s). Ear infections, noise, hearing loss, harm to Ear infections, noise, hearing loss, harm to

the auditory pathways through stroke or the auditory pathways through stroke or head injury can cause auditory processing head injury can cause auditory processing difficulties.difficulties.

By itself or in individuals with dyslexia, By itself or in individuals with dyslexia, ADHD, ASD, language disorders, and ADHD, ASD, language disorders, and anxiety.anxiety.

Types of Auditory Processing Types of Auditory Processing DisordersDisorders

DecodingDecoding

Tolerance Fading Memory/Auditory Tolerance Fading Memory/Auditory AssociativeAssociative

IntegrationIntegration

Output OrganizationOutput Organization

Prosodic Prosodic

Areas affected by APDAreas affected by APD

ListeningListening WritingWriting SpeakingSpeaking BehaviorBehavior SpellingSpelling

AttentionAttention MathMath SocialSocial ReadingReading AffectAffect

Characteristics of Characteristics of Auditory Processing Auditory Processing

DisordersDisorders

CharacteristicsCharacteristics Difficulty with reading fluencyDifficulty with reading fluency Difficulty with reading comprehensionDifficulty with reading comprehension Difficulty with math, especially Difficulty with math, especially

applicationsapplications Difficulty understanding multiple Difficulty understanding multiple

meanings wordsmeanings words Poor written languagePoor written language Poor social skills and ability to judge Poor social skills and ability to judge

pragmaticspragmatics Poor musical abilitiesPoor musical abilities Poor memoryPoor memory Poor self-starterPoor self-starter

More CharacteristicsMore Characteristics Highly verbal but communication lacks meaningful

information Appears bright but unmotivated Problems with understanding “how to” tasks Difficulty following verbal directions A visual and/or hands on learner Poor ability to link prosodic features with linguistic content Difficulty with transitions Distractible Executive function problems Often a late identification of a learning disability

““I heard it, I I heard it, I understood it, but I understood it, but I cannot remember it cannot remember it or I cannot do it.”or I cannot do it.”

Evaluation Process and Evaluation Process and AssessmentsAssessments

Accurate diagnosis is key!!!

There is NO one standardized evaluation protocol

Age: 3 years, 6 months and aboveAge: 3 years, 6 months and above

Evaluation Process and Evaluation Process and AssessmentAssessment

Evaluation of APD falls under the Audiologists scope of practice, but the team approach is vital

Evaluation Process and Evaluation Process and AssessmentAssessment

Teachers are a vital member of the

team.

Evaluation Process and Evaluation Process and AssessmentAssessment

Parent and teacher Parent and teacher observations and observations and

reportsreports

General Principles of General Principles of TreatmentTreatment

There is no one proven treatment method

There are general principlesDirect TreatmentAccommodations Environmental modifications

The Brain Can ChangeThe Brain Can Change

Brain PlasticityThe brain is a dynamicstructure thathas a natural abilityto change itself.

Learning is the process ofthe brain changing.

We can use this ability to normalize and improvesensory processingby teaching the brain through the appropriate stimulation provided with the right frequency, intensity and duration.

Learning TheoryLearning Theory

• Short frequent sessions result in increased amount learned as well as amount recalled and generalization when compared to long infrequent sessions

APD In The ClassroomAPD In The Classroom

Does APD exist?Does APD exist?

Accommodations or Modifications.Accommodations or Modifications.

504 plan or IEP.504 plan or IEP.

AccommodationsAccommodations Allow un-timed tests Test in quiet environments Aim for quiet environments Use multiple choice or closed set testing Waive foreign language requirements Use external organization aids (outlines,

lists, checklists, calendars, planners) Note taking assistance Use of a computer Use written information vs. oral directions Multisensory learning Animated teachers

Tips for TeachersTips for Teachers

• Pay attention to self-esteem; it’s Pay attention to self-esteem; it’s hugely important.hugely important.

• Strong peer partnerStrong peer partner• Music (Classical around 60 bpm)Music (Classical around 60 bpm)• Flexible seatingFlexible seating• Brain breaksBrain breaks• Provide a desktop class scheduleProvide a desktop class schedule

More Teacher TipsMore Teacher Tips

FM Amplification Audiobooks (read while listening) Allow extra time especially for test

taking Assignment reduction Insist that the audiologist and the

speech-pathologist be involved. If they don’t know about (C)APD then ask them to learn

Top “Things” to Know Top “Things” to Know about Children with APDabout Children with APD

My hearing is inconsistent.My hearing is inconsistent. My self-esteem is most importantMy self-esteem is most important Transitions are tough for me so try to Transitions are tough for me so try to

give me a heads up about transitionsgive me a heads up about transitions Work with me to find a cueing systemWork with me to find a cueing system Emphasize important/key points for Emphasize important/key points for

meme

More Tips More Tips Use visual input to support what you are Use visual input to support what you are

teachingteaching Use short simple directions with my age Use short simple directions with my age

and grade level vocabularyand grade level vocabulary Check-in with me or pair me up with a Check-in with me or pair me up with a

strong peer to make sure I am on targetstrong peer to make sure I am on target I’m working really hard and my brain I’m working really hard and my brain

gets tired faster than my peersgets tired faster than my peers I need to go to recess. Lunch is not a I need to go to recess. Lunch is not a

break for me, I need to get up and move; break for me, I need to get up and move; it’s good for me.it’s good for me.

Top 3 Teacher TipsTop 3 Teacher Tips

Music

Brain Brain BreaksBreaks

Self Self EsteemEsteem

When nothing else When nothing else “fits”, could it be an “fits”, could it be an auditory processing auditory processing

disorder?disorder?

ResourcesResources

Same Journey Different Paths: Stories of Same Journey Different Paths: Stories of Auditory Processing Disorder. (2013) Auditory Processing Disorder. (2013) Various AuthorsVarious Authors

Blah, Blah, Blah; What to Do When Words Blah, Blah, Blah; What to Do When Words Don’t Work. (2011). Roam, DanDon’t Work. (2011). Roam, Dan

The Source Book for Processing The Source Book for Processing Disorders. (2001) Richard, Gail.Disorders. (2001) Richard, Gail.

Soft-Wired. How the New Science of Soft-Wired. How the New Science of Brain Plasticity Can Change Your Life. Brain Plasticity Can Change Your Life. (2013). Merzenich, Michael(2013). Merzenich, Michael

Websites/Overview of Websites/Overview of APDAPD American Speech-Language-Hearing American Speech-Language-Hearing

AssociationAssociationhttp://www.asha.org/public/hearing/Understanding-http://www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorder-in-Children/Auditory-Processing-Disorder-in-Children/

National Center for Learning DisabilitiesNational Center for Learning Disabilitieshttp://www.ncld.org/types-learing-disabilities/adhd-http://www.ncld.org/types-learing-disabilities/adhd-related-issues/auditory-processing-disorder/auditory-related-issues/auditory-processing-disorder/auditory-processing-disorder-by-age-groupprocessing-disorder-by-age-group

APDUK: Auditory Processing Disorders APDUK: Auditory Processing Disorders UKUKhttp://apduk.org.uk http://apduk.org.uk

WebsitesWebsites

National Coalition of Auditory Processing National Coalition of Auditory Processing DisordersDisordershttp://ncapd.org http://ncapd.org

Support Group(s)Support Group(s)http://www.capdsupport.org/Diagnosis/what-is-http://www.capdsupport.org/Diagnosis/what-is-capd.htmlcapd.html

APD FoundationAPD Foundationhttp://www.theapdfoundation.orghttp://www.theapdfoundation.org

Questions/Contact InfoQuestions/Contact Info

Nancy Murray, AuD, CCC-A/SLPNancy Murray, AuD, CCC-A/SLP

801-750-6932801-750-6932

nancy@wasatchapd.comnancy@wasatchapd.com

Allison Tanner, MS, CCC-SLPAllison Tanner, MS, CCC-SLP

801-501-4125801-501-4125

allison.tanner@imail.org allison.tanner@imail.org