Activity

Language and Central Auditory Processing Disorders and Speech/Language Therapy

Michael is a 13 year, 1 month old boy in the eighth grade.  He is classified as learning disabled and receives one period of resource help each day.  Verbal and logic-oriented tasks present problems for him.  Reading comprehension and language skills are weak.  According to Michael’s mother, throughout preschool, kindergarten, and first grade he did well academically.  In second grade, he began to experience problems in reading and language.  After testing, Michael received a diagnosis of learning disability and difficulties with auditory learning. At the end of the fifth grade his parents requested an assessment in central auditory processing due to the fact that he continued to experience academic difficulties. 

Michael’s mother indicates that speech and language milestones were normal.  He had moderate ear infections in early childhood but was not treated with ventilation tubes.  An audiological evaluation and tympanometric screening noted normal functioning.

Michael has difficulty maintaining focus and interest in activities, is artistic, and displays pragmatic weaknesses in conversation with relation to topic choice and remaining on topic.  His mother indicates that she feels that he suffers from low self-esteem and has poor peer relationships.

Questions to ponder: 

1.  During early years how do ear infections impact a child such as Michael’s ability to identify specific acoustic signals?

2.  If a student’s hearing acuity is within normal limits, why does he continue to experience weaknesses in auditory learning?

3.  How might the use of visuals aid in the reduction of inattentiveness and an increase in memory?

4.  What information can the speech therapist and audiologist provide for the classroom teacher?

Central auditory processing disorders (CAPD) are deficits in the ability to process audible sounds or signals, which are not attributed to either intellectual impairment or peripheral hearing sensitivity. Individuals with CAPD do not successfully make use of information read or information that is heard.  The listener’s active and passive ability to do the following are impacted:    

·        discriminate, recognize and identify acoustic signals (sounds);

·        store and retrieve information effectively;

·        segment and decode auditory information using phonological, semantic, syntactic, and pragmatic knowledge and;

·        derive meanings from acoustic signals.

There are five basic skill areas that impact language performance most:

Auditory Memory – The ability to recall information with correct sequential orders in words, numbers, and sentences.  Many children have the ability to recall numbers but not words.  On the other hand there are instances where children may recall words but not numbers in the correct sequence.  Even though a child is able to recall information he may not be able to respond to and act upon it.

Auditory Discrimination – The ability to notice phonemic differences in words. Children must be able to recognize and identify a specific phoneme as well as understand the concept of same or different.  A child’s discrimination skills will be noticed in spelling, reading, and following directions. Children are often able to discriminate some but not all phonemic sounds. For example,   /T/ and /k/ would be more difficult than /S/ and /G/.

 Auditory Figure-Ground – The ability to screen or block out noise distractions and just focus on a primary signal. Background noises in the class create a less than ideal situation for children.  If a child is unable to screen out papers shuffling, aquariums, etc. interpretation of the primary signal is interrupted.

Auditory Cohesion – The ability to interpret and process information on a higher level, where linguistic structures are more complicated, has a strong relationship to the child’s cognition.  Abstract thinking, problem solving, auditory math word problems are some areas that require good cohesion. If discrimination, auditory memory, and auditory figure-ground are delayed, auditory cohesion will also be compromised because of decreased skill level.

Auditory Attention – The ability to maintain focus over an extended time to auditory signals.  Variables such as the child’s interest and presence in a distracting environment will influence auditory attention and ability to focus.  If the topic is not interesting to the child, he may easily “tune out” the auditory signal.

 It is often difficult to determine if a child’s communication skills are deficient because of language impairment or central auditory processing dysfunction, where he does not have the necessary tools for language development, or both. In the case of Michael, language weaknesses, lack of good pragmatic skills, memory and remaining on topic are all reasons for his difficulties in school. Once cognitive ability and peripheral hearing have been ruled out as a delay, the child should receive a language assessment by a speech therapist to determine if skills are developed or if a central auditory processing disorder is present.  Learning objectives and techniques for remediation in the above areas are as follows:     

Objective 1: The student will improve short term memory skills when information is presented orally.

To improve auditory memory deficits, improving nonverbal skills should precede verbal memory remediation.                                                                                                                                                                                                                             
 An example of this would be tapping rhythms with the hand or using musical instruments in an effort to increase awareness and memory of different rhythms and pitches. 

Once this skill area has met success the student can begin to follow one-step directions.  These directions may be verbal or nonverbal.

When increasing memory of sentences it is beneficial to point out specific parts of the sentences such as subject, predicate, adjective, verb.

Aids for increasing auditory memory are tape recorders for review of information, games to expand sentences or stories and activities to increase recall of information.  Schedules, calendars and digital recorders are good reminders for reviewing tasks.
 
Objective 2:  The student will identify similarities and differences in phonemes.

To improve auditory discrimination skills teach how phonemes are the same or different.  It is important to determine if the student understands the concept of same or different first. 

Voicing, visual appearance of a sound, and length may be described.  Using a whole-language approach when improving auditory discrimination is recommended because a variety of tasks may be implemented to teach the skill.  For example, following direction games, spelling, and poetry may be used.
 
Objective 3: The student will respond to oral directions by tolerating minimal background noise.

The teacher may have a tape recording of an air conditioner, aquarium, or clock ticking.

The student is then presented information while these noises are in the background. 

Therapy should move from the controlled therapy room to the cafeteria or gymnasium.  The goal is for the child is to be able to tolerate the background noises while being asked to follow directions, or answer a question.
 
Objective 4: To be able to improve critical thinking skills when a situation is presented orally.

To improve auditory cohesion skills the speech/language pathologist will teach analogies, logical sequences or responses, decoding, absurdities, and categorizations.

This is an area where the student’s cognitive ability is challenged because critical thinking skills are challenged.
 
Objective 5: The student will be able to attend to the therapist for an appropriate amount of time when give an auditory                                                                                                                                                                                                    
To improve auditory attention skills the child may use a timer, a minute sand glass or bell usually with some type of reward or positive praise as the child increases his time to attend to a task.

The therapist should be aware of the child’s interest in a task, activity or subject to be discussed when increasing auditory attention.

References and Sources