Auditory Processing

1. Auditory Processing Teaching “When the Brain Can’t Hear” (Bellis, 2002) Michelle Redman

2. Auditory Processing Is a foundational skill COMPREHENSION DECODING & SPELLING PHONICS PHONOLOGICAL AWARENESS ORAL LANGUAGE AUDITORY PROCESSING WOW!! How do these kids learn?

3. Descriptors • Central Auditory Processing Disorder (CAP) or Auditory Processing Disorder (APD) is a communication disorder • There are deficits in the information processing of audible signals NOT attributed to hearing impairment or to intellectual impairment • CAP involves the Perceptual, Cognitive, and Linguistic functions

4. What does this look like? • Difficulty attending • Difficulty discriminating and identifying acoustic signals (vocal, snaps, claps, accents, telephone, recordings) • Disruption in their ability to transmit information through both peripheral and central nervous system… what does that mean? That means that the information being received by the auditory nerves (Peripheral nervous system) is disrupted, incomplete or inaccurately transmitted to the brain (Central nervous system) so the brain is unsure how to process or react to the provided stimuli without added information

5. What else does it mean? • Conceptual knowledge can have gaps as the Perceptual information from the senses has not been complete, meaning often a student with APD has trouble drawing on background knowledge and experiences • Learners with APD have difficulty with working memory: storing and retrieving information efficiently or completely

6. There’s more!! • Learners may have trouble understanding speech in noisy environments… like a classroom • They may have difficulty following directions • Similar sounding speech patterns may present difficulty when trying to discriminate between the two • The learner may often ask for repetition or clarification • They may have trouble spelling and reading

7. And even more! • Students with APD may act as if they have hearing loss • They may have trouble understanding lectures and information presented verbally • Learner’s with APD have difficulty with auditory sequencing (Have you listed verbal directions with more than one step in your class?) • A student with APD may have language delays due to insufficient information reaching and being interpreted by the Central nervous system • A learner with APD will usually do better when they are clear on what is expected of them

8. How is APD assessed? • Assessment CAN NOT be completed by a screening survey • Evaluation is completed by an audiologist to evaluate the learner’s hearing and identify possible auditory perception problems • Evaluation by a speech-language pathologist to evaluate a learner’s perception of speech and his/her receptive and expressive language use follows the audiologist’s examination

9. What does the audiologist do? • The audiologist administers a series of tests in a sound-treated room. These tests require listeners to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. • There may be other tests to check an individual’s auditory system's physiologic responses to sound may also be administered. • Children are typically not assessed for APD before age 7/8 (Bellis, 2015)

10. How does that affect a Learner’s Reading and Writing? Difficulty discriminating and categorizing speech sounds • Weak spelling • Inability to discriminate between letter sounds • Increased anxiety • Difficulty performing invented spelling • Non phonetic Delayed reading development Difficulty decoding Weak listening skills Failure to recognize which sounds are important to meaning Weak auditory attention Poor auditory memory Delayed phonemic awareness General academic difficulties Delay in oral language Rhyming, songs, nursery rhymes Weak comprehension

11. What about socially? • Learner’s with APD experience mixed success socially • Their inability to follow an interaction with background noise, or with distractions surrounding them, creates difficulty building relationships with classmates • Often on a playground, miscommunications may occur as the student either misinterprets or does not respond the way others think they should in the situation… all because the student with APD really isn’t aware of the situation! (Bellis, 2015)

12. More social effects! • Inability or difficulty initiating and maintaining conversation • Difficulty or miscommunication with turn taking • Difficulty interpreting inflection, emotion, and vocal cues • Anxiety, frustration, withdrawal or conversely, acting out physically

13. How to support learners with APDthrough a three prong approach(Campbell, 2011)

14. Enhancing the Acoustic Signal and the Listening Environment • Teacher/speaker adaptations • Use clear speech • Give simple, brief instructions • Embed sequencing words (such as: first, then, next, finally) • Incorporate gestures • Alter pacing • Emphasis on segmentation of their speech without over exaggeration • Frequent checks for understanding • A pictorial cue system or signal to reduce attention and focus on the student and build trust • Sound Amp • Transforms an ipod, ipad, or itouch into an interactive listening device • Also allows replay for the last 30 seconds • Assisted FM listening systems • As children with APD typically have normal hearing, it is important to use systems designed for normal hearing • Reduce unnecessary noise • Seating location • Provide a study carol • Preferential seating • (least affected ear to centre of class) • Sound absorbing materials in a classroom aid in reducing background noise levels • Carpets • Tennis balls on chair legs • Double glazed windows • Partitions • Draperies • Closed doors • Seals on doors (Campbell, 2011) (Bellis, 2008) (Paul-Brown, 2003)

15. 2. Auditory Training Additional auditory training tools/techniques • Speech-Language Therapist training • Dichotic listening training (different signal to each ear received simultaneously) • Listening centres • Cloze procedures to complete missing word from the tape • Punctuation cloze procedure • Learner listens to a recording, following along on a print copy and fills in missing punctuation • Musical training • There are many studies completed and on-going into the positive effects of musical training for learners with APD • Evidence of improved auditory attention and perception • “Lower level sound processing can be shaped by musical training” (D.L.Strait et al, 2010) There are many computer based auditory training tools and programs recommended by Professionals, researchers and educators. Some examples include: • ‘What’s that Sound’ Itunes app, compatible with ipad, ipod, itouch, iphone • ‘Lumpty.com’ pitch pattern sequencing, available free on Google Play or itunes app • ‘Simon Sings’ melody matching, available on all IOS products • ‘Fastforword’ www.innovative-therapies.com phonemic awareness, auditory memory, sequencing skills (Strait et al, 2009) (Tallal et al, 2006) (Campbell, 2011)

16. 3. Metacognitive and Metalinguistic Strategies • Explicitly teach self-regulation to develop attention, persist in activities, manage our emotions, regulate our behaviour • Model self-regulation, model respect, model balance • Instruct in strategies • Cognitive – recognize personal patterns of behaviour, try alternative strategies, incorporate student strengths and implement alternative tools to best support student in cognitive efforts • Emotional – recognize emotional changes as clues, label emotions, use visuals, take responsibility for emotions, find appropriate ways to express honest emotions • Physical (low level thinking) – recognize physical changes happening in own body as clues, use repetitive movements, breathing, stretching, change of physical position, to effect higher level thinking • Coach Use hints and cues (visual) • Offer correction/re-direction • Debrief what happened (verbally if able, pictorially or with use of symbols) • Ask specific questions “what was missing just now? Patience? Kindness? Use of visual aid? “ “how will you act differently?” • Acknowledge efforts and express belief in student abilities • “Thank you for your patience” • “I appreciate your use of the signal” (Chapin, 2011)

17. Metacognitive and Metalinguistic continued • Shared reading • Everyday, every child • Incorporate specific phonological and phonemic skills into authentic reading and textual frameworks • Incorporate reauditorization • Paraphrasing • Repetition • Summarizing • Tape record lectures to provide permanent record for repetitive listening • Explicitly teach problem solving skills • Identify the problem • Structure the problem • Look for possible solutions • Make a decision • Implement • Monitor/seek feedback • Reciprocal teaching • Metamemory strategies • Implement use of mnemonics (memory devices like acronyms), mind mapping (visual organizer), pictorial presentation, and graphic organizers in classroom • Utilize verbal rehearsal • Explicitly teach organizational skills • Use of a daily planner • Following class schedule (posted clearly) • Utilizing a mobile device for calendar and schedule items

18. What about the associated behaviour? • Define and teach pro-social behaviour • Role play • Teach visual cues or actions • Adapt environments to reduce problem behaviour • Identify helpers for social situations • Build classroom scripts for participation in discussions, turn-taking, listening • Relaxation strategies • Breathing • Stretching • Change of physical position

19. Bibliography • American Speech-Language-Hearing Association. (2002). Appropriate school facilities for students with speech-language-hearing disorders [Technical Report]. Available from http://www.asha.org/policy/TR2002-00236.htm • American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [relevant paper]. Retrieved from http://www.asha.org/policy/RP1993-00208.htm • American Speech-Language-Hearing Association. (2003). Let’s talk… for people with special communication needs. Retrieved from http://www.asha.org/uploadedFiles/aud/LetsTalkAuditoryProcessing.pdf • Bellis, Teri James. PhD. CCC-A. (2015). Understanding auditory processing disorders in children. Retrieved from http://www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children/ • Bibel, B. (2003). When the brain can't hear: Unraveling the mystery of auditory processing disorder. New York: Retrieved from http://search.proquest.com.ezproxy.library.ubc.ca/docview/196810600?pq-origsite=summon&accountid=14656 • Campbell. N. (2011). Supporting children with auditory processing disorder. British Journal of Nursing, 6(6), 273-277. Retrieved from http://search.ebscohost.com.ezproxy.library.ubc.ca/login.aspx?direct=true&db=ccm&AN=2011230133&site=ehost-live&scope=site

20. Bibliography • Chapin, Brad. LCP. LLMP. (2011, July 1). Engaging strategies for social, emotional and behavioural issues. [weblog message]. Retrieved from http://www.slideshare.net/chapin55/selfregulation-strategies-for-schoolage-children?related=1 • Chermak, Gail D. PhD. (2002). Deciphering auditory processing disorders in children. Otolaryngologic Clinics of North America.Volume 35, Issue 4, August 2002, Pages 733–749 doi:10.1016/S0030-6665(02)00056-7http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/S0030666502000567 • Coen-Cummings, Ph.D. CCC-SLP. Intervention Using Metalinguistics to Improve Comprehension and Literacy. Retrieved from Martha.coen-cummings@cchmc.org ASHA 2009 Conference New Orleans • Florez, Ida Rose. (2011) Developing Young Children’s Self-Regulation through Everyday Experiences. Young Children. • Skills You Need. (2015). Problem Solving. Retrieved from http://www.skillsyouneed.com/ips/problem-solving.html • Slideshare. (2015) Teaching children self regulation. [Weblog message]. Retrieved from http://www.slideshare.net/HLagace/teaching-children-selfregulation