DIAGNOSIS AND MANAGEMENT
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
- following of sequenced
- reading of poetry aloud,
- 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
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
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
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.
Academy of Audiology
8300 Greensboro Dr., Suite 750
McLean, Virginia 22102
10801 Rockville Pike
Rockville, Maryland 20852
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.