Special Education Resources

DIAGNOSIS AND MANAGEMENT OF
CENTRAL AUDITORY PROCESSING DISORDER

Part III: Management
Gail D. Chermak, Ph.D.
Washington State University

The brief article below is the final installment of a three part series of brief articles by Dr. Chermak on central auditory processing disorder.

Central Auditory Processing Disorder (CAPD) is a sensory processing deficit that commonly impacts listening, spoken language comprehension and learning. Although central auditory processing is dependent on the integrity and function of the central auditory nervous system, non-modality specific factors, including attention, motivation, memory, learning and decision processing can exacerbate or mitigate the impact of CAPD. As noted in Part II of this series, evaluation of language development, speech understanding and learning is necessary to identify associated (co-morbid) conditions, as well as clarify the functional impact of CAPD. Once this multidisciplinary evaluation is completed, comprehensive management can be implemented.

Managing CAPD typically involves signal enhancement and environmental modifications, auditory training, compensatory metalinguistic and metacognitive strategy training, and instructional modifications. The relative emphasis depends upon the findings of the comprehensive assessment. Illustrative examples of each approach are provided.

• Signal Enhancement and Environmental Modifications

  Technology is available to improve the quality of the acoustic signal and the listening environment. Personal and sound field FM (frequency-modulated) systems and other assistive listening systems (e.g., infrared) coupled with physical space alterations benefit the individual listening in noisy or reverberant (i.e., echoing) environments. By placing a microphone near the speaker's mouth and transmitting the signal via FM radio waves to a receiver on or near the listener, the effects of noise, reverberation and distance are largely overcome. While the most effective means of reducing noise levels and limiting reverberation is through proper planning and architectural design, noise levels can be reduced after construction through inexpensive modifications. Such modifications include: installation of carpet, curtains, acoustic paneling, rubber tips on chair legs and desks, and use of corkboard as bulletin boards and bookshelves as room dividers to produce quieter spaces for communication and instruction.

• Auditory Training

  Auditory training (AT) is designed to improve the function of the auditory system in resolving acoustic signals. Fromal AT is conducted by the audiologist or speech-language pathologist in a controlled setting. Formal AT is analytic in focus, targeting specific auditory processes using acoustically controlled stimuli (e.g., nonverbal or simple verbal signals) and rigorous training paradigms.

  Examples of formal AT include:

  • auditory discrimination of frequency, intensity, or duration differences;
  • detection of silence (gaps) in an ongoing signal; and
  • ordering of two or three rapidly presented acoustic elements.

  Informal AT employs verbal stimuli and emphasizes the use of linguistic context to benefit auditory function. It can be conducted as part of a home or school program and offers a complementary and more synthetic approach to AT than does formal AT.

Examples of informal AT include:
• following of sequenced auditory directives,
• reading of poetry aloud, and
• discrimination and recognition of degraded (e.g., filtered or time compressed) speech.

Coupling formal with informal AT should maximize generalization of skills and treatment efficacy.


• Metalinguistic Strategies

  Understanding spoken language requires the listener to construct the meaning of the message. Deducing word meaning from context is one of the most practical and useful approaches to building vocabulary, improving auditory closure, and enhancing message comprehension. In many instances, sentence context clarifies word meaning, as in the sentence "The robber pilfered the jewels." The context surrounding the unknown word pilfered is sufficiently informative to enable a listener with basic vocabulary knowledge to derive its meaning. Effort may also be expended to improve phonemic analysis (i.e., sound differentiation) and phonemic synthesis (i.e., sound blending), which train segmentation skills that are essential to both spoken language comprehension and reading.
  

• Metacognitive Strategies

  Metacognition refers to the appropriate use of knowledge to plan, monitor and regulate performance. Cognitive behavior modification (CBM) approaches promote an active, self-regulatory listening style. CBM includes self-instruction, problem solving, self-regulation and cognitive strategy training. Self-instruction trains individuals to formulate self-directing verbal statements to guide task performance. The five-step process begins with the clinician self-verbalizing aloud while performing a task and concludes with the client self-instructing. Self-regulation procedures target self-control through a three-step process involving self-monitoring, self-evaluation and self-reinforcement.
  

• Instructional Modifications

  Collaboration among speech-language pathologists, audiologists and teachers is key to the successful management of youngsters with CAPD. Pivotal to this collaboration is understanding the superiority of bisensory (auditory-visual) speech recognition. It is imperative for teachers to incorporate visual cues as supplements to auditory information. Likewise, audiologists and speech-language pathologists should support the educational curriculum by using academic concepts and materials as content for therapy.
  

Visit the American Academy of Audiology and the American Speech-Language-Hearing Association web sites for additional information and/or to locate an audiologist or speech-language pathologist in your area.

American Academy of Audiology
8300 Greensboro Dr., Suite 750
McLean, Virginia 22102
Phone: 800-AAA-2336
Fax: 703-790-8631

MEET YOUR PAL

Gail D. Chermak Ph. D., is an Edward R. Meyer Distinguished Professor of Audiology and Chair of the Department of Speech and Hearing Sciences at Washington State University. She earned her doctorate in speech and hearing sciences from the Ohio State University, holds the Certificate of Clinical Competence in Audiology, and is a fellow of the American Academy of Audiology.

Dr. Chermak chaired the ASHA Ad Hoc Committee on Central Auditory Processing which prepared the 1992 report entitled, Issues in Central Auditory Processing Disorders. She served as a member of the ASHA Task Force on Central Auditory Processing Consensus Development responsible for the 1995 report, Central Auditory Processing: Current Status of Research and Implications for Clinical Practice. She was among 14 senior scientists and clinicians who met recently at the University of Texas at Dallas (the Bruton Conference) to reach consensus on best practices in diagnosis of auditory processing problems in school-age children.

Dr. Chermak has published articles and delivered numerous workshops on assessment and management of central auditory processing disorders. Her co-authored articles on central auditory processing disorder and attention deficit hyperactivity disorder have been named by her peers as among the best in diagnostic audiology for the past two consecutive years. Her 1997 book, Central Auditory Processing Disorders: New Perspectives, co-authored with Frank Musiek and published by Singular Publishing Group, has become a landmark volume in the field.