1. Auditory Processing Presented by Kimberly Klein

2. Early interest in CAP in children Concept was described by Myklebust, 1954 Interest expanded in 1970s

3. ASHA Consensus Conference on CAPD: Central auditory processes are mechanisms and processes responsible for the following phenomena: Sound localization and lateralization Auditory discrimination Auditory pattern recognition Auditory performance decrements with degraded acoustic signals Temporal aspects of audition, including temporal resolution, masking, integration, and ordering Auditory performance decrements with competing acoustic signals (ASHA, 1996)

4. CAP Disorders can be defined as: Observed deficiency in one or more behaviors described in ASHA Consensus Statement Auditory specific (disorder of coding and transformation of auditory input or perception) or part of a larger general information processing deficit

5. Children with CAP Lack skills to process/carry out multi-step directions Pass pure-tone hearing tests Great visual learners Inability to learn to read with the phonetic approach Difficulty learning where noise level is high

6. Children with CAP Become followers socially & behaviorally Can be withdrawn, confused, distracted, frustrated Develop compensatory strategies Develop listening skills

7. Reading Blocks Primarily visual Phonics Rhyming words Sequencing sounds into words Dividing words into syllables Retaining sounds

8. Auditory Skills Sequential memory Auditory discrimination Sound blending Auditory association Sound blending

9. Obstacles The brain’s inability to process all information correctly at a given time

10. Common Behaviors of CAP Children Poor listener Poor attention (short span) Easily distracted Misunderstands Trouble following verbal instructions Frustration Poor speech discrimination Poor ability to organize information Seemingly poor memory

11. Common Behaviors of CAP Children Doesn’t complete tasks Daydreams Hyperactive or hypoactive Hostility A “loner” often plays by self Prefers company of younger friends or adults “Soft” if any neurological signs

12. Common Behaviors of CAP children Disruptive Withdrawal “Clings” to parents (young children in an active environment Seeks quiet or structured environment

13. Researchers say Willeford & Burleigh noted that “such behaviors are not surprising if the child has failed to understand the teacher’s instructions.” Toman reports that “70% of the talking in the classroom is done by teachers.”

14. Children with CAP Trying hard to process what is being said and often are undiagnosed Lack the skills necessary to process and carry out multi-step directions

15. Useful Resources Fisher’s Auditory Problems Checklist Willeford and Burleigh’s Behavior Rating Scale for Central Auditory Processing

16. Corpus Callosum “The corpus callosum is primarily responsible for communication and integration of information from two cerebral hemispheres

17. Auditory Function Language Rapid sequences of auditory stimuli and analysis dominate left hemisphere While music perception, acoustic contour recognition and perception of gestalt dominates right hemisphere

18. Time will tell If a child will outgrow CAP with the neuromaturation of his/her temporal processing abilities. Skills continue to improve until age 12

19. Tests Used for selective attention, memory and performance in sound blending include : Peabody Picture Vocabulary Test- Revised Clinical Evaluation of Language Fundamentals- Revised Test of Language Competency Test of Adolescent Language Test of Language Development Primary Other subtests can be used

20. Interventions Assistive listening devices--FM systems Mnemonics Chunking Maximization of auditory & visual information Speaking slower with more pauses

21. Brain Plasticity Can take over and help a person compensate for this auditory deficit or disorder Occurs quicker in younger children Helps stroke victims who are musically inclined, as the music compensates for the CAP

22. Competing Sentence Test Uses dichotically presented sentences that are the same length. Primary message, “My brother is a tall boy,” in right ear at 35 dB Competing message, “Your mother is a good cook,” in left ear at 50 dB Child is asked to listen/repeat primary message and ignore louder message

23. Filtered Speech Test Contains two fifty-word lists presented to each ear. Words such as “tone, phone, root, tire” are given but are filtered Child must say word given to testing ear Each ear is tested with different set of words

24. Binaural Fusion Test Gives the same word such as “bagpipe” to both ears simultaneously One ear receives word in a low-pass signal/other receives in a high pass filtered stimuli When 2 frequencies played separately: unintelligible. Together the child understands “bagpipe” Testing ear receives low frequency

25. Alternating Speech Test Phonemes of sentences are shifted such as “put a dozen apples in the sack” Give to each ear in short bursts 20 alternating sentences Test shows which ear is dominant and which is weak

26. Recommendations Made on individual basis If child has dominant right ear…then child’s right ear should be in center of room Child has better opportunity of distinguishing sounds and processing information

27. Recommendations Preferential seating Implement buddy system: clarify auditory information Position child away form “busy” areas Earplugs or earmuffs worn during desk activities Testing sessions in a quiet room Rephrase or crosscheck instructions/concept

28. Teaching Approach Pre-teach, teach and post-teach format of learning. Coordinate this approach with parent and resource room teacher Pre-teach—resource room—presenting new concepts prior to full class instruction

29. Teaching Approach Classes relying heavily on auditory transmission of information should be scheduled in initial part of the morning or afternoon. Re-Teach---parent or tutor revisits the concept for a third time

30. Creating Learning Environment Lightly touch child’s shoulder or call child’s name prior to auditory information given Visual supplements and “hands-on” approach Use computer for classroom work Phonics approach should be emphasized Other students speak in softer voice; reduces strain of listening

31. Leads to? Learning becomes fun and exciting rather than an arduous task that is compounded by confusion and frustration.

32. Activating poor memory Use chunking, verbal chaining, rehearsal, paraphrasing, and summarizing Activate right hemisphere through drawing and imagery Use external aids— calendars, notebooks

33. Strategy for poor listening comprehension Induce formal scheme to aid organization, integration and prediction through recognition and explanation of connective (furthermore) patterns of parallelism and co- relative pairs (not only/but also neither/nor Maximize visual and auditory summation by substituting note taking Sequencing: first, second, then, next, finally

34. Which direction does my brain follow?

35. Teacher trained To provide classroom that child can thrive and succeed To practice listening skills then child learns in effective manner To become aware and talk slowly, emphasizing key words or phrases To wear lipstick as the focus becomes on the spoken word of the teacher and not her physical features

36. If teacher educated in CAP Does the child need an assistive listening device (FM system)? Does the teacher’s classroom provide good acoustics? Does the teacher speak slowly when emphasizing key words or introducing new concepts?

37. Due to limited resources Teachers must often compensate Child is entitled to education regardless of needs School district is to provide an education that teaches, challenges and meets the needs of its students Parent should advocate for his/her child providing necessary research and information

38. Dedication To the audiologists, research scientists, speech therapists, case managers, psychologists, resource teachers, staff and teachers who have provided knowledge, techniques, and explanations of working, teaching, raising a successful child with CAP