AUDITORY PROCESSING DYSFUNCTION: Concepts and Guidelines

Transcription

1 AUDITORY PROCESSING DYSFUNCTION: Concepts and Guidelines Barbara A. Gutkin Dixie D. Sanger T. Newell Decker Auditory processing deficiencies require a coordinated, interdisciplinary approach if the child is to be well served. Caught in the middle of a professional controversy are children who are experiencing language, learning, social, and possibly emotional problems. Parents turn to educators, psychologists, pediatricians, speech-language pathologists, audiologists, and other professionals for answers to common concerns. What is the matter with my child? What is the cause for his language and learning problems? What are the behavioral symptoms indicating that an auditory processing problem exists? What can be done to help him overcome his disabilities and function normally? The answers they receive may be quite divergent and contradictory depending on the orientation and training of the expert. One alternative to best serve the child is to provide a coordinated, interdisciplinary approach to diagnose and remediate language and learning problems that appear to be related to auditory processing deficiencies. Remediation When making decisions concerning remediation techniques for children who exhibit characteristics of dysfunction in auditory processing, the utility of formal test results may be SEPT

2 limited. The most valuable strategy to help these children may be to form a comprehensive profile of strengths and weaknesses through a coordinated interdisciplinary approach. Deficiencies that are impeding progress in language development or academic training will need remedial attention and training. Patricia Newcomer, Stephen Larsen and Donald Hammill (1975) recommend the application of remedial guidelines which relate directly to the child's specific language, academic or social problem. If a child has an expressive language problem, his program should be directed at his use and understanding of words in sentences as well as other linguistic contexts. Along with this approach, if he is having difficulty learning to read, he should be taught reading through techniques that rely heavily on his strongest modalities. Jack Williford (1980) advocates maximizing the acoustic environment of children who exhibit auditory perceptual problems. Rather than training selected skills out of context, he suggests counseling with a child or his parents and teachers on ways to modify the child's auditory world. This position suggests the child should be aware of his handicap and select optimal seating when involved in a group. When talking to others, he should move away from distracting noises that could interfere with listening. Williford suggests the use of muffs or ear plugs to attenuate some of the background noise as well as the possible use of frequency modulated hearing aids. The following lists represent a guideline of suggestions for professionals working with children suspected of, or identified as having auditory processing problems. These suggestions might be helpful in the coordination of an interdisciplinary approach for auditory processing dysfunction in children. In addition to these guidelines, Eilleen Goodman (1978) offers a number of suggestions for "training attention focus" that might be considered as a viable remedial inclusion to help children learn to focus their attention during the course of day-to-day functioning. Suggestions for Audiologists The following guidelines for audiologists were developed in accordance with suggestions made by R. Keith 1981, Bernice Heasley 1980, and Jack Williford ACADEMIC THERAPY/20:1

3 1. Since the study of central auditory functioning is in its infancy, the audiologist can play an important role in gathering normative data. 2. The audiologist should be aware of factors that put children at risk for central auditory dysfunctioning. 3. Audiologists should administer tests that are appropriate for the developmental level of the child. 4. It is crucial in the interpretation of the data that the information be made relevant to the behavioral problems exhibited by the child. This information should lead to appropriate comprehensive management. 5. The audiologist should be able to suggest appropriate procedures for maximizing the acoustic environment of children who exhibit central auditory dysfunction. 6. The audiologist should present test results to other professionals simply and clearly. Suggestions for Speech-Language Clinicians The following guidelines are derived from recommendations made by R. Keith 1981 and B. Heasley Be aware of the range of abilities in the auditory area both for maturation and neurological reasons. 2. Be critical of commercial test instruments and use valid and reliable tools. 3. Devise individualized educational plans based on a profile of strengths and weaknesses. 4. Integrate auditory processing activities with expressive and receptive language activities. 5. Do not expect simplistic explanations about complex and poorly understood behaviors. 6. Act as a consultant to teachers and parents through the communication of specific, realistic instructional activities and recommendations SEPT. 1984/AUDITORY PROCESSING 103

4 (Dixie Sanger and Kathy Coufal 1976; D. Sanger and K. Coufal 1977). Suggestions for Teachers The following guidelines are derived from recommendations made by Janette Smith and Dixie Sanger Maximize the teaching environment of the child through such measures as: a) preferential seating; b) avoidance of distracting noise; c) utilization of a multisensory approach (verbal as well as written directions in assignments); d) encouraging the child to ask for repetition of instructions when necessary; e) presenting information in a brief, concise and clear fashion; f) encouragement of compensatory strategies to aid memory such as teaching aids to note taking. 2. Devise individualized educational plans based on a profile of strengths and weaknesses. Make the child aware of his strengths and show him ways to use his strengths to compensate for his weaknesses. 3. Objectively evaluate progress and be flexible in changing goals or objectives if revision is required. 4. Consult with other professionals and parents regularly for information sharing and program evaluation (D. Sanger and K. Coufal 1976; D. Sanger and K. Coufal 1977). Suggestions for Pediatricians The following guidelines are in accord with suggestions made by Sylvia Richardson The pediatrician should become acquainted with speech, language and hearing professionals in the community and utilize the expertise of these professionals in the assessment of auditory perceptual abilities. 2. The pediatrician should be aware of any specific medical therapies that could be used to aid the child. 104 ACADEMIC THERAPY/20:1

5 3. The pediatrician should inform parents that many normal variations occur in humans and not all specific learning deficits should be treated as abnormalities. The child's abilities as well as disabilities should be emphasized. 4. Developmental history should be carefully evaluated to determine etiology of the problem. 5. The pediatrician could determine if the problem is static or progressive and what the prognosis is for future neurological development. A referral to a pediatric neurologist should be made when appropriate. 6. It is important for the pediatrician to realize that a child may demonstrate attention-activity problems which are secondary to language disorders and/or memory deficiencies. 7. The pediatrician should work with other team members when making decisions on what additional diagnostic tests are needed and when formulating treatment programs. Suggestions for Psychologists The following guidelines are in accord with suggestions made by Jan Culbertson The psychologist can contribute valuable information through the psychological evaluation which should include the following goals: a) Determining cognitive ability. b) Examining perceptual modes of learning (auditory, visual, and motor modalities). c) Evaluating academic strengths and weaknesses. d) Examining social/emotional adaptation. 2. The psychologist should use reliable and valid evaluation tools. 3. The psychologist should obtain a case history including information on any significant illnesses, data on family history, and descriptive behavioral information on school performance. SEPT. 1984/AUDITORY PROCESSING 105

6 4. The psychologist should be familiar with the assessment methods of speech pathologists, audiologists and educators in order to appropriately share information and refer clients. 5. The end result of the evaluation should be a profile of strengths and weaknesses which form a basis for future educational planning. The suggestions offered are not intended to be exhaustive but rather reflect the emerging and experimental nature of the art where "lack of agreement and understanding about central auditory problems" is the norm (Keith 1981). As our society becomes more complex, our educational system, reflecting the needs of society, will continue to place greater demands on children for more sophisticated performance in all areas of achievement. Individual weaknesses and learning problems will become more apparent in such a high pressure environment. The challenge for professionals is to diagnose these problems early in the student's school years and implement effective remediation to prevent the establishment of a pattern of failure in school that could demoralize the child, affecting his current and future performance in linguistics, socialization, emotional development, and academic growth. References Cohen, R.L Auditory skills and the communicative process. In R.W. Keith (ed.), Seminars in speech, language and hearing. New York: Thieme-Stratton. Culbertson, J.L Psychological evaluation and educational planning for children with central auditory dysfunction. In R.W. Keith (ed.) Central auditory and learning disorders in children. Houston, Texas: College-Hill Press. Goodman, E Training attention focus-suggestions for parents. Academic Therapy 14: pp Heasley, B.E Auditory processing disorders and remediation. Springfield, Illinois: Charles C. Thomas. Keith, R.W Tests of central auditory function. In R.J. Roeser and M.P. Downs (eds.), Auditory disorders in school children. New York, NY: Thieme-Stratton. Newcomer, P.L.; Larsen, S.; and Hammill, D Research on psycholinguistic training: Critique and guidelines. A response. Exceptional Children 42: pp Richardson, S.O A pediatrician's view of central auditory disorders: Bridging the gap between diagnosis and treatment. In 706 ACADEMIC THERAPY/20:1

7 R.W. Keith (ed.), Central auditory and learning disorders in children. Houston, Texas: College-Hill Press. Sanger, D., and Coufal, K I hear funny. Slide-tape production, Omaha, Nebraska: Meyer Children's Rehabilitation Institute, University of Nebraska Medical Center. Sanger, D., and Coufal, K What's the difference? Slide-tape production, Omaha, Nebraska: Meyer Children's Rehabilitation Institute, University of Nebraska Medical Center. Smith, J., and Sanger, D An identification, assessment and remediation program for school-aged children exhibiting auditory perceptual deficits. Unpublished manuscript, University of Nebraska-Lincoln. Williford, J.A Central auditory behaviors in learning disabled children. In R.W. Keith (ed.), Seminars in speech, language and hearing. New York, NY: Thieme-Stratton. Barbara A. Gutkin, MS, is affiliated with the Lincoln Public Schools, P.O. Box 82889, Lincoln, NE Dixie D. Sanger, PhD, is an assistant professor, and T. Newell Decker, PhD, is an associate professor in the Department of Speech Pathology and Audiology, 202 Barkley Center, University of Nebraska- Lincoln, Lincoln, NE ATP THE RELAXATION/HANDWRITING PROGRAM IMPROVEMENT This is a new handwriting improvement program carefully developed for children and adolescents with an A IN THEIR HEAD AND AN F IN THEIR HAND. The Handwriting Improvement Kit was developed for school or home use. It combines the principles of deep relaxation, visual imagery and interesting practice. The program has been carefully developed over the past seven years in a university center and field tested on over 800 children and adolescents. In addition to the improvement shown in this example, large gains in reading, spelling, attention, and memory were made by over 85% of the children who completed this program. $50.00 plus $5.00 shipping & handling Special prices for volume orders. Order or obtain more information from: BIO-EDUCATIONAL RESEARCH, INC Tremont Galveston, Texas (409) SEPT. 1984/AUDITORY PROCESSING 107