ASHA Schools Conference 2013: Tx Decision Dilemmas/Strategies for APD: Part 1-Assessment!

Gail Richard, PhD, CCC-SLP, presented on Treatment Decision Dilemmas and Strategies for Auditory Processing Disorders (APD) in July at this year’s ASHA schools conference.  Below is a recap of what I found interesting and important to share from this presentation.  I broke this up into two blog posts.  This is part one, focusing on assessment of APD!

Important Things to Remember:

1.  APD and CAPD are synonymous.
2.  SLPs need to work together with audiologists to understand audiology in terms of APD AND to effectively treat students.
3.  Many times we are hearing psychologists, teachers, neurologists label student with “processing problems”, however we need determine if the student truly presents with signs or symptoms of APD and make appropriate recommendations.
4.  Dr. Richard described students with APD as those students that are “close but no cigar”, meaning they may be able to perform auditory closure tasks with semantically or phonetically similar words but the words are not quite accurate or functional.  (Eg.  Child says “The fireman came down the ladder pregnant” -child using the word “pregnant” to mean “carrying a child”, not the right word for the context; OR child says “The best part of waking up are soliders in our cup” -instead of “Folders”)
5.  As SLPs we need to be able to discriminate which processing skill(s) are weak and which are strong so we can create an effective treatment program.
6. Problem with determining correct diagnosis and creating effective treatment plans is that APD can be comorbid with deficits in: phonological awareness, auditory attention, and auditory memory.
7. Also the fact that there is little consensus on a standard definition of APD by various professionals affects diagnosis.

Diagnosis of APD:

1.  Deficits under definition of APD are so encompassing there are a number of assessment tools that should be used to make an appropriate definition.
2.  Dx of APD should NEVER be made based on one single test or subtest!
3.  Even within assessment instruments there is not agreement on performance, therefore ASHA recommends that performance of at least 2 SD (standard deviations) below the mean on 2 tests be the minimum to obtain a dx of APD.

Relationship between APD and LD:

1.  Auditory perception skills play a vital role in literacy as if a child cannot perceive a sound, he/she will struggle to read that sound therefore it is VITAL to work on auditory perception skills.
2.  Previous belief that we need to work on auditory perception before language is not effective.  Therefore we SHOULD be SIMULTANEOUSLY working on auditory perception AND language skills.
3.  We also need to determine if audition or amplification must be put in place in order to improve auditory perception skills.
4.  Determining if there is an underlying language deficit rather than auditory perception skills deficit is a must as it will determine the course of treatment. 

Assessment of APD:


1.  Audiologist area of testing:
               peripheral and central nervous system including:
                      -acuity and signal transformation
                      -binaural interaction
                      -auditory discrimination
                      -temporal processing
                      -dichotic listening
2. SLPs should test phonemic and language processing skills as well as executive functioning skills.
SLP Role of Assessment in APD:
Phonemic Processing Assessment:
 1.  Must screen for the following Phonemic Processing Skills:
                     -auditory analysis/segmenting
                     -auditory attention
                     -auditory association
                     -auditory closure
                     -auditory discrimination
                     -auditory figure ground
                     -auditory localization
                     -auditory memory
                     -auditory sequential memory
                     -auditory synthesis/sound blending/closure
2.  As SLPs we do not need a standardized test to probe these areas when determining which areas are in need of treatment.  However, we need to ask ourselves:
                     -Can the student hear it?
                     -Can the student repeat it?
                     -What is the 1st sound?
                     -What is another sound?
                     -What does it mean?
                     -What if I repeat multiple times?
                     -What if I say it slower?
                     -What if I say it louder?
4.  Assessment instruments for functional auditory skills:
                      ITPA: Illinois Test of Psycholinguistic Abilities
                      DSTP: Differential Screening Test for Processing
                      PAT: Phonological Awareness Test
                      CTOPP:  Comprehensive Test of Phonological Processing
                      TAPS: Test of Auditory Processing Skills
Language Processing Assessment:
1.  Assess the following areas:
                 stating object function
                 multiple meanings
                 stating attributes
2.  Assessment instruments for language:
                LPT:  Language Processing Test
                CASL:  Comprehensive Assessment of Spoken Language
                Bracken Basic Concepts Scale
                TOPS: Test of Problem Solving
                Listening Test
                TOLD: Test of Language Development
Executive Functioning Assessment:
1.  Areas of EF to assess:
                   planning and organizing
                   initiation and persistence
                   flexibility and self-regulation
                   goal selection
                   problem solving
                   working memory
                   abstract reasoning
2.  Assessment instruments for EF:
                   BRIEF:  Behavioral Rating Inventory of Executive Functions
                   BADS-C: Behavioral Assessment of Dysexecutive Syndrome in Children
                   FAVRES: Functional Assessment of Verbal Reasoning and Executive Strategies
                   Stroop Color and Word Test-children
                   DANVA 2: Diagnostic Analysis of Nonverbal Accuracy-2


I hope you enjoyed part 1 of this presentation.  Come back next week for part 2 where treatment of APD will be discussed!

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