Mountain BOCES

Definition of APD A deficit in the processing of information that is specific to the auditory modality. The problem may be exacerbated in unfavorable acoustic environments. It may be associated with difficulties in listening, speech understanding, language development, and learning. In its pure form, however, it is conceptualized as a deficit in the processing of auditory input.

APD is not… ADHD Autism Language Processing Disorder

Behaviors of Children w/ APD Behave as if a hearing loss is present Difficulty following speech in noisy environments Asks for repetition or clarification often Difficulty discriminating between similar speech sounds (s/t/sh/f) or similar words (cat/bat/hat)

Behaviors of Children w/ APD Need more time to process auditory information Easily distracted Difficulty following multi-step auditory directions Inability to attend to the correct sound source May answer questions inappropriately Performance is better in subjects that don’t rely heavily on listening ****These behaviors may be present in children who do not have APD****

How Is APD Identified APD cannot be diagnosed from a “symptoms checklist” There is no screener for APD Multidisciplinary team approach: SLPs, parents, educational audiologist, school psychologist, general education teacher, special education teacher Must be diagnosed by an Audiologist

Management of APD Team approach Highly individualized Deficit specific There is NO miracle cure Possible areas of management: Changing the learning or communication environment Recruiting higher-order skills to help compensate

Mountain BOCES Protocol Preface: Protocol was developed due to a substantial increase in referrals where APD testing was inappropriate. APD referrals were being used as a last resort when the team was unable to identify the cause of a deficiency/difficulty. Referrals for screening when there is no “screening” for APD and testing is very invasive, time consuming, and identification may not alter intervention strategies

Mountain BOCES Protocol Generally, APD assessments are performed on: Students who already receive special education services Have a disability under IDEA And are already on an IEP

*An auditory processing disorder alone does not qualify as an IDEA disability but a diagnosis of auditory processing disorder can help to guide intervention strategies for students who already receive special education services for another disability.

Auditory processing disorder testing requires: Substantial participation by the student Is time consuming And necessitates extensive coordination and communication by the multidisciplinary team Referral for testing should be done selectively and only when clear indications are present.

Prior to Referral to Audiologist *Have participated in at least 2 RtI Tier 3 interventions without measurable progress *And/or already has an IEP and is demonstrating limited progress. After the referral is made, the audiologist will meet with the referrer to discuss the appropriateness of initiating the APD protocol

Review of Referral Considerations Peripheral hearing – must be within normal limits Age of child – must be 7+ Language competence – English proficient Speech intelligibility Cognitive ability Co-morbid conditions RtI interventions

Initial Questionnaires/Assessments Parent/Teacher Questionnaires Speech Language Assessment Educational Assessment Psychological Assessment MEET WITH TEAM Discuss the body of evidence Do we proceed w/ APD testing? (Refer to Audiologist) Do we continue w/ RtI and progress monitoring?

Audiologist Testing Classroom Observation Diagnostic Peripheral Hearing Test Dichotic Speech Test Monaural Low Redundancy Testing Temporal Processing Supplementary Testing if needed

Identification of APD Identification of APD requires one of the following: Performance deficits of at least two (2) standard deviations below mean on two (2) or more subtests in the battery, OR Performance deficit on one (1) test of at least three (3) standard deviations below the mean or when the finding is accompanied by significant functional difficulty in auditory behaviors reliant on the process assessed Post-testing team meeting: Is there sufficient evidence to identify APD?

Other Considerations Can this auditory processing disorder be differentiated from related deficits? Does the severity of the disorder impact this student’s special education disability determination? There is no federal category of disability for auditory processing. In Colorado, the disability categories are either speech‐language disability or specific learning disability. Consideration of accommodations under Section 504 maybe made for those students exhibiting a disorder or deficit (s) who do not meet Special Education eligibility requirements.

Intervention and Management Deficit specific Trial and error Data collection to determine effectiveness

Re-evaluation Every 3 years or if team decides to repeat sooner.

Independent Evaluations The multidisciplinary team is only obligated to consider the information contained in an independent report relative to the impact for the student in the classroom.

Recent Colorado Audiology Survey The average educational audiologist in Colorado receives about 6 referrals per school year A referral does not mean the full battery of assessments is performed Since implementation of RtI, testing for APD is not always necessary and the number of referrals have decreased Because most referrals come from IEP teams, the reason for testing is to drive intervention Not to look for eligibility

SUMMARY Be selective in referrals Only when clear indications are present Only when it would change the intervention APD itself is not an IDEA disability In the absence of an IDEA disability, identification of APD may not produce a benefit for the student beyond what RtI could provide Refer to APD protocol or consult audiologist with questions on referral process