Speech & Language Services for Students with Auditory Processing Disorders

Sarah C. Hanson, M.A., CCC-SLP

MSHA 2011Roundtable

Assessment:What Am I Looking For?

• Occasionally, patients will come in for articulation evaluation • However, more often than not, the evaluation will be

assessing one or more of the following:– Receptive language skills– Auditory memory– Organization of language skills– Language processing– Comprehension of written language– Verbal and/or written language expression– Comprehension/use of higher level language skills– Phonological awareness

Characteristics

• Children struggling with language issues tend to be very different, but as you listen to each case history you will notice two main groups emerge

• The first group is very easy to pick out!• Typical comments you may hear from parents

Case History: Things to Consider• Do the parents report that they feel like they’re re-teaching everything at

home?• Does the child have a history of difficulty learning rote information such as

ABCs, address, numbers?• Any significant medical history?• Have teachers complained about attention in school, but parents don’t

feel it is an attention issue?• Are there friendship issues?• Do they find themselves having to repeat directions at home frequently?• Does their child tend to interpret things literally? Are they black and

white?• Are they inconsistent? “Gets it” one day and not the next?• Parents may be frustrated because they can’t explain what’s wrong

Assessment Tools• Possible Evaluation Tools to Use When Assessing patients

with possible Language Processing Issues– Clinical Evaluation of Language Fundamentals-4 (CELF-4)– Test of Auditory Processing Skills-3 (TAPS-3)– Test for Auditory Processing Disorders in Adolescents and

Adults (SCAN-3:A) or in Children (SCAN-3C)– Lindamood Auditory Conceptualization Test-3 (LAC-3)– Gray Oral Reading Tests-4 (GORT-4)– The Word Test-2 (WORD-A)– Test for Auditory Comprehension of Language -3 (TACL-3)– Test of Language Competence-Expanded (TLC-E)

What do each of these assessment tools evaluate?

Name of Test Areas of Assessment

CELF-4 core language, receptive & expressive language

TAPS-3 word discrimination, phonological segmentation, phonological blending, numbers forward/reversed, word/sentence memory, auditory comprehension, auditory reasoning

SCAN-A ability to process auditory stimuli through use of distorted or compromised speech and dichotic speech tasks

LAC-3 perception and conceptualization of speech sounds using a visual medium

GORT-4 accuracy, rate, fluency of decoding and reading passage comprehension

WORD-A vocabulary in contextual form

TACL-3 vocabulary, grammatical morphemes, phrases/sentence

TLC-E ambiguous sentences, listening comprehension: making inferences, oral expression: recreating speech acts, figurative language

Evaluation

• When you evaluate, it will be more important to watch how students respond and what types of errors they make rather than just the score alone

• The TLC-E does a nice job of outlining behavioral observations to look out for with a checklist for each subtest

Adolescent Reading Theoretical Model

Reading Comprehension

Word Recogn

ition

Language

Comprehension

Executive

Processes

Hock & Deshler, 2006• Integration of word

recognition, language comprehension, and executive processes cumulates in reading comprehension

The Process of Reading

Automatization

Active Working Memory

Accurate Comprehension

Morphological Semantic

Knowledge

Accurate Decoding

Another Model Scarborough, 2001

(from Bashir presentation, ASHA convention, 2007)

Important Related Terms

Executive Function (Phillips Keeley, 2003)

Working Memory (Banotai, 2007)

Metacognitive Strategies (Deshler, Hock & Catts, 2006)

Therapy: A Three Pronged Approach

Direct Skill Instruction

Self-Advocacy

Compensatory Strategies

Direct Skill Instruction

• Where Do I Start?

Direct Skill

Instruction

Self-Advoc

acy

Compensatory

Strategies

Direct Skill Instruction• Therapy model with adolescents

is like therapy with children or adults.

• Content is driven by the results of evaluation – need to see how/why this is

something they should do– how will this help me?

• Bring in schoolwork as soon as you can. – You are not a homework helper,

but you can’t assume they will generalize the skills you are teaching.

Direct Skill

Instruction

Self-Advoc

acy

Compensatory

Strategies

Direct Instruction TasksGoal Area Activities

Phonological Awareness Sound blending task, use of nonsense words if intact vocabulary, Fast ForWord, LiPS

Auditory Discrimination Use of minimal pairs - typically emphasis on vowels, Earobics, Fast ForWord, LiPS

Localization Walk to different rooms, walk in and identify – is this a good listening environment for me – why or why not? Identify all noises and sources of those noises

Temporal Processing Bop It, Simon Says, Fast ForWord

Interhemispheric Coordination

Simon Says, Brain Gym, karate, tossing ball one hand to another

Auditory Memory Mnemonics, Visualizing/Verbalizing, word list retention/manipulation of word list

Written Language Comprehension

Visualizing/Verbalizing, graphic organizers, Venn diagrams

Direct Instruction TasksGoal Area Activities

Following verbal directions Gross motor, fine motor, paper/pencil, vary the speed & quantity of directions

Following written directions

Many, many worksheets or pages in which the student reads the direction and you may or may not make them complete the page, but they have to describe how they would do it

Narrative oral and written language

Written - teach identification of main Idea and details. Incorporate, sequence and outline skills. Directly teach brainstorm and other process strategies

Identify main idea from text/lecture

Many workbooks available. Key: teach them a system so they are always able to differentiate main idea vs. details

Identify details from text/lecture

Relevant vs. non relevant. Recall of facts. 5 WH?’s

Summarizing/paraphrasing May need to go back to synonyms. Taking telephone messages and note taking

Comprehension of test questions

Cognitive map example/negatives/similar vs. different/ circle action words

Direct Instruction TasksGoal Area ActivitiesImplied meanings Use of sarcasm/humor – good place to start – bring in

nonverbalsFigurative/ambiguous language

Must have context within a story or text – may have to go back and teach how to use context clues

Pragmatic language An issue if the student can’t follow more than 1 conversation at a time or multiple topic changes. Role play & social stories

Expressive language (use of empty words/mazes)

Increase awareness; identify what empty words are – how can you say same thing with REAL words. Be as vague as they are, negative modeling; they identify your use of empty words. Long version vs. short version; mapping sentences

Vocabulary Make it visual. Google image cut and paste for anything these days but especially people; Visualizing/Verbalizing; contextual clues

Multiple meanings Use visuals to teach first. The HELP series and WALC books are age-appropriate

Problem Solving Is there a problem? Yes/no. What is problem? Can I solve problem? If yes, how? If no, do I need help? If I need help who and how should I ask?

Direct Skill Instruction – Therapy Ideas

• Hands-on experience• Objects • Visual aids• Personal experiences• Strategies for study

skills

Direct Skill

Instruction

Self-Advoc

acy

Compensatory

Strategies

Compensatory Strategies• I uses these exact terms

with them and I write it in a triangle – anytime we implement compensatory strategies, I label that is what we are doing.

• Know what you don’t know or can’t do

• Figure out a way to help yourself

Direct Skill

Instruction

Self-Advoc

acy

Compensatory

Strategies

Self-Advocacy

How to get the help you need

Direct Skill

Instruction

Self-Advoc

acy

Compensatory

Strategies

Self-Advocacy• I teach a lot with color coding, visuals

and formulas – anything to make language concrete

• FORMULA: first say what part you DID hear, then say what part you’re missing or DIDN’T hear

• This does 3 things:– 1. Lets the teacher know you were

listening to at least some of what they were saying

– 2. Breaks the cycle of and perception of “He’s just lazy” or “If he would try harder he could do it”

– 3. Gives students a pattern to fill in so they don’t have to think so much

Direct Skill

Instruction

Self-Advoc

acy

Compensatory

Strategies

“The Formula”

I KNOW ___________________

BUT

I DON’T KNOW _____________

ReferencesAmerican Speech-Language-Hearing Association. (2002). Knowledge and Skills Needed by Speech-Language Pathologists With

Respect to Reading and Writing inn Children and Adolescents Knowledge and Skills. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect

to reading and writing in children and adolescents (position statement, executive summary of guidelines, technical report]. ASHA Supplement 21, 17-27. Rockville, MD: Author.

Banotai, A. (2007, July 9). Working memory plays role in language assessment. Advance for Speech-Language Pathologists & Audiologists, 7-8.

Deshler, D., Hock, M. & Catts, H. (2006). Enhancing outcomes for struggling adolescent readers. Perspectives, 32, 21-25.Eggleston, L. & Larson, L. (2007, June 18). Curriculum modifications for language impairments. Advance for Speech-Language

Pathologists and Audiologists, 11.Ferre, J. (2007, Aug. 14). Understanding intervention for (C)APD: As easy as a-b-c. The ASHA Leader, 12, 20-22,34.Larson, V., McKinley, N., & Boley, D. (1993). Clinical forum: adolescent language service delivery models for adolescents with

language disorders. Language, Speech, and Hearing Services in Schools, 51, 36-42.McKinley, N. & Larson, V. (1985). Neglected language-disordered adolescent: a delivery model. Language, Speech, and Hearing

Services in Schools, 16, 2-15. Phillips Keeley, S. (2003). The source for executive function disorders, the. East Moline, IL: LinguiSystems.Pokorni, J., Worthington, C., & Jamison, P. (2004). Phonological awareness intervention comparison of Fast ForWord, Earobics,

and LiPS. Journal of Educational Research, 97, 147-157.Shaywitz, S. (2005). Overcoming Dyslexia: A new and complete science-based program for reading problems at any level.

Vintage.Zimmerman, S. (2007, May 7). Therapy tips: object description plan. Advance for Speech-Language Pathologists and Audiologists,

13.