Auditory Processing

Presented by Kimberly Klein

Early interest in CAP in children

Concept was described by Myklebust, 1954

Interest expanded in 1970s
ASHA Consensus Conference on CAPD:
Central auditory processes are
mechanisms and processes
responsible for the following
phenomena:
Sound localization and Temporal aspects of
lateralization audition, including
Auditory discrimination temporal resolution,
Auditory pattern masking, integration,
recognition and ordering
Auditory performance
Auditory performance
decrements with
decrements with
competing acoustic
degraded acoustic
signals (ASHA, 1996)
signals
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
 Children with CAP
Lack skills to Inability to learn to
process/carry out read with the
multi-step directions phonetic approach
Pass pure-tone Difficulty learning
hearing tests where noise level is
Great visual high
learners
 Children with CAP
Become followers Develop
socially & compensatory
behaviorally strategies
Can be withdrawn, Develop listening
confused, skills
distracted, frustrated
 Reading Blocks
Primarily visual
Phonics

  Rhyming words
                         
Sequencing sounds
into words
Dividing words into
syllables
Retaining sounds
 Auditory Skills
Sequential memory
Auditory
discrimination
  Sound blending
                                  

Auditory association
Sound blending
 Obstacles
The brain’s inability
to process all
information correctly
at a given time
Common Behaviors of CAP Children

Poor listener Frustration

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

Doesn’t complete A “loner” often plays

tasks by self
Daydreams Prefers company of
Hyperactive or younger friends or
hypoactive adults
Hostility “Soft” if any
neurological signs
Common Behaviors of CAP children

Disruptive
Withdrawal
“Clings” to parents
(young children in
an active
environment
Seeks quiet or
structured
environment
 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.”
 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
 Useful Resources
Fisher’s Auditory Problems Checklist
Willeford and Burleigh’s Behavior
Rating Scale for Central Auditory
Processing
 Corpus Callosum
“The corpus
callosum is primarily
responsible for
communication and
integration of
information from two
cerebral
hemispheres
 Auditory Function Language
Rapid sequences of While music
auditory stimuli and perception, acoustic
analysis dominate contour recognition
left hemisphere and perception of
gestalt dominates
right hemisphere
 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
Tests Used for selective attention, memory

and performance in sound blending include :

Peabody Picture Test of Adolescent
Vocabulary Test- Language
Revised Test of Language
Clinical Evaluation Development
of Language Primary
Fundamentals- Other subtests can
Revised be used
Test of Language
Competency
 Interventions
Assistive listening devices--FM systems
Mnemonics
Chunking
Maximization of auditory & visual
information
Speaking slower with more pauses
 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
 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
 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
 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
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
 Recommendations
Made on individual Child has better
basis opportunity of
If child has dominant distinguishing
right ear…then sounds and
child’s right ear processing
should be in center information
of room
 Recommendations
Preferential seating Earplugs or
Implement buddy earmuffs worn
system: clarify during desk
auditory information activities
Position child away Testing sessions in
form “busy” areas a quiet room
Rephrase or
crosscheck
instructions/concept
 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
 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
 Creating Learning
Environment
Lightly touch child’s Use computer for
shoulder or call classroom work
child’s name prior to Phonics approach
auditory information should be
given emphasized
Visual supplements Other students
and “hands-on” speak in softer
approach voice; reduces strain
of listening
 Leads to?

Learning becomes
fun and exciting
rather than an
arduous task that is
compounded by
confusion and
frustration.
 Activating poor memory

Use chunking, Use external aids—

verbal chaining, calendars,
rehearsal, notebooks
paraphrasing, and
summarizing
Activate right
hemisphere through
drawing and
imagery
 Strategy for poor listening
comprehension
Induce formal scheme Maximize visual and
to aid organization, auditory summation
integration and
by substituting note
prediction through
recognition and taking
explanation of Sequencing: first,
connective (furthermore) second, then, next,
patterns of parallelism
finally
and co-relative pairs
(not only/but also
neither/nor
Which direction does my
brain follow?
 Teacher trained

To provide To become aware

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