Jeanane M. Ferre, PhD, CCC-A
Auditory processing is a true process that begins at the ear and ends when we execute a response. This peripheral-to-central continuum consists of acoustic and related phonologic, linguistic, and cognitive-communicative skills that enable us to communicate successfully, achieve academically, and maintain our sense of self. Breakdowns along this continuum can affect a listener at school, in the home, and in social communication situations. Audiologists and speech-language pathologists work together to assess deficit areas, describe impact, and provide intervention.
The Common Core State Standards, now adopted by 44 states, represent learning goals for students in grades K–12 designed to ensure that students graduating from high school are prepared to begin post-secondary education and/or to enter the workforce. The Core, as it has come to be known, currently includes standards for math and English language arts, with the latter including reading, writing, speaking, listening, and language usage (National Governors Association Center for Best Practices, Council of Chief State School Officers, 2010). Because breakdowns along the processing continuum adversely affect academics and/or communication, audiologists and speech-language pathologists play important roles in the implementation of the Core, assisting both students and teachers in meeting these goals.
Speech-language pathologists use formal and informal tools to examine phonologic, linguistic, and executive aspects along the continuum. Psychologists, educational specialists, and other professionals obtain information regarding a client's academic achievement and everyday listening skills. Audiologists diagnose central auditory processing deficits by using assessment tools designed to maximize the load on the auditory system while minimizing the influence of other neurocognitive skills (e.g., attention, receptive language). This interprofessional team is able to clarify the nature of the listener's functional impairment and develop deficit-specific intervention plans to reduce or resolve the auditory impairment, improve affected communicative and academic skill sets, and minimize the impact of the processing disorder on the student's life.
Central auditory processing disorders (CAPDs) are breakdowns in the acoustic components of the processing continuum, specifically deficiencies in the brain's ability to use auditory information sent to it from the peripheral auditory system (i.e., outer, inner, middle ears and the auditory nerve). The central auditory processes identified to date broadly fall into one of three types: auditory discrimination, binaural processing, and temporal processing. Substantial research has indicated that a deficit in any of the central auditory processes can co-exist with or be a significant contributing factor to other functional deficits, including learning disabilities, speech-language impairment, attention deficit, or developmental disabilities (Bellis, 2003; Burns, 2013; Ferre & Wilber, 1986; Geffner, 2007; Jerger, Martin, & Jerger, 1987; Tillery, Katz, & Keller, 2000).
Deficits in auditory discrimination are the result of inefficient extraction of the fine acoustic cues in the speech signal. A student who does not "hear" the sounds of speech efficiently will struggle to attach meaning to those sounds. Thus, secondary deficits in phonologic processing, reading decoding and comprehension, and spelling are common. Inefficient central hearing can adversely affect all aspects of language development, including acquisition of age-appropriate vocabulary, morphology, syntax, semantics, and/or a second verbal language. Even under optimal listening conditions, this student's auditory system is working harder than normal to analyze incoming acoustic information. As listening conditions become more difficult, the student risks excessive auditory fatigue and reduced listening comprehension (Bellis, 2003; Bellis & Ferre, 1999; Burns, 2013; Ferre, 1997; Geffner, 2007; Tazeau & Hamaguchi, 2013).
Deficient binaural processing is characterized by difficulty synthesizing, manipulating, and/or attaching meaning to multiple incoming auditory targets. The listener may be overwhelmed by the amount of verbal information flooding the system, thereby adversely affecting comprehension skills. By extension, writing, note-taking, and direction following can be adversely affected. An inability to synthesize and attach meaning quickly and efficiently to incoming verbal information places the listener at risk for secondary issues in receptive and expressive language, including syntax, semantics, symbolic, and social/pragmatic skills, and/or word recall/retrieval (Bellis, 2003; Bellis & Ferre, 1999).
The listener with a temporal processing deficit has difficulty recognizing the perceptual boundaries between/among targets and the acoustic contours (i.e., patterns) in the rapidly occurring speech stream. Students with this deficit may have difficulty in reading, phonological, and spelling skills, direction following, note-taking, sequencing, auditory attention, working memory, and problem-solving. Communication problems can include difficulty understanding sarcasm, recognizing word meaning that may vary depending upon stress (e.g., CONvict vs. conVICT), and recognizing and using nonverbal pragmatic language cues, such as facial expressions, body language, and gestures (Bellis, 2003; Bellis & Ferre, 1999; Ferre, 1997; Rawool, 2007).
Given these significant adverse effects on communication and academics, a CAPD places the student at risk for failure to meet the Common Core Standards in English language arts, including spelling, written language, and speaking/listening.
Effective intervention for CAPDs involves the balanced implementation of deficit-specific management and treatment goals/objectives. In management, compensatory strategies and environmental accommodations are selected to minimize the impact of the disorder on the listener's day-to-day functioning. In treatment, formal and informal therapy techniques are used to reduce or resolve the auditory deficiency and to teach functional compensatory strategies.
A growing body of research indicates that inclusion of direct skills remediation, or bottom-up therapy, can change auditory behavior (Alonso & Schochat, 2009; ASHA, 2005; Chermak, Musiek, & Bellis, 2007; Ferre, 2010; Foxton, Brown, Chambers, & Griffiths, 2004; Loo, Bamiou, Campbell, & Luxon, 2010; Moore, Rosenberg, & Coleman, 2005; Tremblay, 2007). Because impaired auditory discrimination, binaural processing, and temporal processing can adversely affect academic success, the inclusion of therapy goals and activities to improve these skills is a necessary and educationally relevant component of a student's individualized education program (IEP).
The speech-language pathologist and audiologist establish and/or implement goals designed to improve these core auditory perceptual skills. Improving the student's sensory processing foundation reduces functional performance gaps in related language and learning skills. Goals and benchmark examples for these skill sets are given below.
Appropriate goals for the student with impaired discrimination include discrimination and/or recognition of speech under adverse listening conditions, recognition and use of key elements in spoken targets, and use of visual cues to assist speech recognition (e.g., speechreading).
Appropriate goals for the student with binaural processing deficit may include recognition of dichotically presented targets, improved communication between the two hemispheres, and synthesis/manipulation of multiple auditory, auditory-visual, and acoustic-linguistic targets.
For the student exhibiting deficient temporal processing, the therapy protocol includes exercises to improve recognition of auditory patterns, recognition and use of stress in speech, and recognition and use of visual cues and patterns to assist comprehension.
For all students, the IEP should include goals for active listening and vigilance. Active listening means taking responsibility for one's listening success or failure by understanding the impact of auditory impairment in one's life, recognizing the aspects of communication that are under the listener's control, displaying effortful listening behaviors, and taking overt steps to avoid or correct potential communication mishaps. In vigilance, listening and discrimination skills are used to maintain focus and identify key information in running speech.
By intervening in a timely manner after differential diagnosis and by including deficit-specific auditory processing training in therapy, we maximize the intervention process, enabling our students to meet the Common Core State Standards in Academics, including Speaking and Listening. In so doing, we minimize the long-term effects of processing-based learning and psychosocial disability on the individual as well as on society.
Jeanane M. Ferre, PhD, CCC-A, has been in private practice for over 25 years in the Chicago metropolitan area, providing assessment and intervention of central auditory processing disorders among children and adults. She has published numerous journal articles and presented at the local, state, national, and international levels on CAPD. Her works include Processing Power: A Guide to CAPD Assessment and Management, The M3 Model for Treating Auditory Disorders, and The Differential Screening Test for Processing, as well as chapters in three recent texts on central auditory processing. Dr. Ferre has received Fellowship, the Clinical Achievement Award, and Honors of the Illinois Speech-Language-Hearing Association. She is a Fellow of the American Speech-Language-Hearing Association and co-chair for the 2015 ASHA Annual Convention. Contact her at firstname.lastname@example.org.
Alonso, R., & Schochat, E. (2009). The efficacy of formal auditory training in children with (central) auditory processing disorder: Behavioral and electrophysiological evaluation. Brazilian Journal of Otorhinolaryngology, 75, 726–732.
American Speech-Language-Hearing Association. (2005). (Central) auditory processing disorders [Technical report]. Rockville, MD: Author.
Bellis, T. (2003). Assessment and management of central auditory processing disorders in the educational setting (2nd ed.). Clifton Park, NJ: Thomson Delmar Learning.
Bellis, T., & Ferre., J. (1999). Multidimensional approach to the differential diagnosis of central auditory processing disorders in children. Journal of the American Academy of Audiology, 10, 319–328.
Burns, M. (2013). Auditory processing disorders and literacy. In D. Geffner D., & D. Ross-Swain, (Eds.), Auditory processing disorders (2nd ed., pp. 301–318). San Diego, CA: Plural Publishing.
Chermak, G., Musiek, F., & Bellis, T. (2007). Neurobiology, cognitive science, and intervention. In G. Chermak & F. Musiek (Eds.), Handbook of (central) auditory processing disorder: Comprehensive intervention (Vol. 2, pp. 3–28). San Diego, CA: Plural Publishing.
Ferre, J. (1997). Processing power: A guide to CAPD assessment and management. San Antonio, TX: The Psychological Corporation.
Ferre, J. (2010). Aural rehabilitation & central auditory processing disorders (CAPD): Outcome evidence among school-age children. Educational Audiology Review, 27, 8–17.
Ferre, J. M., & Wilber, L. A. (1986). Normal and learning disabled children's central auditory processing skill: An experimental test battery. Ear and Hearing, 7, 336–343.
Foxton, J., Brown, A., Chambers, S., & Griffiths, T. (2004). Training improves acoustic pattern perception. Current Biology, 14, 322–325.
Geffner, D. (2007). Central auditory processing disorders: Definitions, description, behaviors. In D. Geffner, & D. Ross-Swain (Eds.), Auditory processing disorders (pp. 25–48). San Diego, CA: Plural Publishing.
Jerger, S., Martin, R. C., & Jerger, J. (1987). Specific auditory perceptual dysfunction in a learning disabled child. Ear and Hearing, 8(2), 78–86.
Loo, J., Bamiou, D., Campbell, N., & Luxon, L. (2010). Computer-based auditory training (CBAT): Benefits for children with language- and reading-related learning difficulties. Developmental Medicine & Child Neurology, 52, 708–717.
Moore, D., Rosenberg, J., & Coleman, J. (2005). Discrimination training of phonemic contrasts enhances phonological processing in mainstream school children. Brain and Language, 94, 72–85.
NGACBP/CCSSO–National Governors Association Center for Best Practices, Council of Chief State School Officers. (2010). Common Core State Standards. Washington, DC: Author.
Rawool, V. W. (2007). Temporal integration and processing in the auditory system. In D. Geffner & D. Ross-Swain (Eds.), Auditory processing disorders (pp.117–138). San Diego, CA: Plural Publishing.
Tazeau, Y. & Hamaguchi, P. (2013). Disorders and deficits that co-occur or look like APD. In D. Geffner & D. Ross-Swain (Eds.), Auditory Processing Disorders (2nd ed., pp. 91–116). San Diego, CA: Plural Publishing.
Tillery, K. L., Katz, J. & Keller, W. D. (2000). Effects of methylphenidate (Ritalin) on auditory performance in children with attention and auditory processing disorders. Journal of Speech,Language, and Hearing Research, 43(4), 893–901.
Tremblay, K. (2007). Training-related changes in the brain: Evidence from human auditory evoked potentials. Seminars in Hearing, 28, 120–132.
Differential Processing Training Program (Linguisystems)
Processing Power (Pearson Assessments)