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

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

3. Descriptors Central Auditory Processing Disorder (CAP) or Auditory Processing Disorder (APD) is a communication disorder 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 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 CAP involves the Perceptual, Cognitive, and Linguistic functions

4. What does this look like? Difficulty attending Difficulty attending Difficulty discriminating and identifying acoustic signals (vocal, snaps, claps, accents, telephone, recordings) 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 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 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 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 Learners may have trouble understanding speech in noisy environments… like a classroom They may have difficulty following directions They may have difficulty following directions Similar sounding speech patterns may present difficulty when trying to discriminate between the two Similar sounding speech patterns may present difficulty when trying to discriminate between the two The learner may often ask for repetition or clarification The learner may often ask for repetition or clarification They may have trouble spelling and reading They may have trouble spelling and reading

7. And even more! Students with APD may act as if they have hearing loss Students with APD may act as if they have hearing loss They may have trouble understanding lectures and information presented verbally 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?) 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 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 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 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 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 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. 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. 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 Children are typically not assessed for APD before age 7/8 (Bellis, 2015)

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

11. What about socially? Learner’s with APD experience mixed success 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 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! 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 Inability or difficulty initiating and maintaining conversation Difficulty or miscommunication with turn taking Difficulty or miscommunication with turn taking Difficulty interpreting inflection, emotion, and vocal cues Difficulty interpreting inflection, emotion, and vocal cues Anxiety, frustration, withdrawal or conversely, acting out physically Anxiety, frustration, withdrawal or conversely, acting out physically

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

14. Reduce unnecessary noise Reduce unnecessary noise Seating location Seating location –Provide a study carol –Preferential seating (least affected ear to centre of class) (least affected ear to centre of class) Sound absorbing materials in a classroom aid in reducing background noise levels 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) 1.Enhancing the Acoustic Signal and the Listening Environment Teacher/speaker adaptations 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 A pictorial cue system or signal to reduce attention and focus on the student and build trust Sound Amp 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 Assisted FM listening systems –As children with APD typically have normal hearing, it is important to use systems designed for normal hearing

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

16. 3. Metacognitive and Metalinguistic Strategies Explicitly teach self-regulation to develop attention, persist in activities, manage our emotions, regulate our behaviour 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 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 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 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) 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?” 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” “Thank you for your patience” “I appreciate your use of the signal” “I appreciate your use of the signal” (Chapin, 2011)

17. Metacognitive and Metalinguistic continued Reciprocal teaching Reciprocal teaching Metamemory strategies 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 Explicitly teach organizational skills –Use of a daily planner –Following class schedule (posted clearly) –Utilizing a mobile device for calendar and schedule items Shared reading Shared reading –Everyday, every child –Incorporate specific phonological and phonemic skills into authentic reading and textual frameworks Incorporate reauditorization Incorporate reauditorization –Paraphrasing –Repetition –Summarizing –Tape record lectures to provide permanent record for repetitive listening Explicitly teach problem solving skills Explicitly teach problem solving skills Identify the problem Identify the problem Structure the problem Structure the problem Look for possible solutions Look for possible solutions Make a decision Make a decision Implement Implement Monitor/seek feedback Monitor/seek feedback

18. What about the associated behaviour? Define and teach pro-social behaviour Define and teach pro-social behaviour –Role play Teach visual cues or actions Teach visual cues or actions Adapt environments to reduce problem behaviour Adapt environments to reduce problem behaviour Identify helpers for social situations Identify helpers for social situations Build classroom scripts for participation in discussions, turn-taking, listening Build classroom scripts for participation in discussions, turn-taking, listening Relaxation strategies 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 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.htmhttp://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.p df http://www.asha.org/uploadedFiles/aud/LetsTalkAuditoryProcessing.p df 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/ 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/19681060 0?pq-origsite=summon&accountid=14656 http://search.proquest.com.ezproxy.library.ubc.ca/docview/19681060 0?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 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 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)00056-7 http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/ S0030666502000567 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)00056-7 http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/ S0030666502000567Volume 35, Issue 4doi:10.1016/S0030-6665(02)00056-7 http://www.sciencedirect.com.ezproxy.library.ubc.ca/science/article/pii/ S0030666502000567Volume 35, Issue 4doi:10.1016/S0030-6665(02)00056-7 http://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 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 OrleansMartha.coen- cummings@cchmc.orgMartha.coen- cummings@cchmc.org Florez, Ida Rose. (2011) Developing Young Children’s Self-Regulation through Everyday Experiences. Young Children. 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 Skills You Need. (2015). Problem Solving. Retrieved from http://www.skillsyouneed.com/ips/problem-solving.html Skills You Need. (2015). Problem Solving. Retrieved from http://www.skillsyouneed.com/ips/problem-solving.html 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 Slideshare. (2015) Teaching children self regulation. [Weblog message]. Retrieved from http://www.slideshare.net/HLagace/teaching-children-selfregulation Slideshare. (2015) Teaching children self regulation. [Weblog message]. Retrieved from http://www.slideshare.net/HLagace/teaching-children-selfregulation Slideshare. (2015) Teaching children self regulation. [Weblog message]. Retrieved from http://www.slideshare.net/HLagace/teaching-children-selfregulation