Speech & Language Services for Students with Auditory Processing Disorders
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Transcript of Speech & Language Services for Students with Auditory Processing Disorders
Speech & Language Services for Students with Auditory Processing Disorders
Sarah C. Hanson, M.A., CCC-SLP
MSHA 2011Roundtable
Assessment:What Am I Looking For?
• Occasionally, patients will come in for articulation evaluation • However, more often than not, the evaluation will be
assessing one or more of the following:– Receptive language skills– Auditory memory– Organization of language skills– Language processing– Comprehension of written language– Verbal and/or written language expression– Comprehension/use of higher level language skills– Phonological awareness
Characteristics
• Children struggling with language issues tend to be very different, but as you listen to each case history you will notice two main groups emerge
• The first group is very easy to pick out!• Typical comments you may hear from parents
Case History: Things to Consider• Do the parents report that they feel like they’re re-teaching everything at
home?• Does the child have a history of difficulty learning rote information such as
ABCs, address, numbers?• Any significant medical history?• Have teachers complained about attention in school, but parents don’t
feel it is an attention issue?• Are there friendship issues?• Do they find themselves having to repeat directions at home frequently?• Does their child tend to interpret things literally? Are they black and
white?• Are they inconsistent? “Gets it” one day and not the next?• Parents may be frustrated because they can’t explain what’s wrong
Assessment Tools• Possible Evaluation Tools to Use When Assessing patients
with possible Language Processing Issues– Clinical Evaluation of Language Fundamentals-4 (CELF-4)– Test of Auditory Processing Skills-3 (TAPS-3)– Test for Auditory Processing Disorders in Adolescents and
Adults (SCAN-3:A) or in Children (SCAN-3C)– Lindamood Auditory Conceptualization Test-3 (LAC-3)– Gray Oral Reading Tests-4 (GORT-4)– The Word Test-2 (WORD-A)– Test for Auditory Comprehension of Language -3 (TACL-3)– Test of Language Competence-Expanded (TLC-E)
What do each of these assessment tools evaluate?
Name of Test Areas of Assessment
CELF-4 core language, receptive & expressive language
TAPS-3 word discrimination, phonological segmentation, phonological blending, numbers forward/reversed, word/sentence memory, auditory comprehension, auditory reasoning
SCAN-A ability to process auditory stimuli through use of distorted or compromised speech and dichotic speech tasks
LAC-3 perception and conceptualization of speech sounds using a visual medium
GORT-4 accuracy, rate, fluency of decoding and reading passage comprehension
WORD-A vocabulary in contextual form
TACL-3 vocabulary, grammatical morphemes, phrases/sentence
TLC-E ambiguous sentences, listening comprehension: making inferences, oral expression: recreating speech acts, figurative language
Evaluation
• When you evaluate, it will be more important to watch how students respond and what types of errors they make rather than just the score alone
• The TLC-E does a nice job of outlining behavioral observations to look out for with a checklist for each subtest
Adolescent Reading Theoretical Model
Reading Comprehension
Word Recogn
ition
Language
Comprehension
Executive
Processes
Hock & Deshler, 2006• Integration of word
recognition, language comprehension, and executive processes cumulates in reading comprehension
The Process of Reading
Automatization
Active Working Memory
Accurate Comprehension
Morphological Semantic
Knowledge
Accurate Decoding
Another Model Scarborough, 2001
(from Bashir presentation, ASHA convention, 2007)
Important Related Terms
Executive Function (Phillips Keeley, 2003)
Working Memory (Banotai, 2007)
Metacognitive Strategies (Deshler, Hock & Catts, 2006)
Therapy: A Three Pronged Approach
Direct Skill Instruction
Self-Advocacy
Compensatory Strategies
Direct Skill Instruction
• Where Do I Start?
Direct Skill
Instruction
Self-Advoc
acy
Compensatory
Strategies
Direct Skill Instruction• Therapy model with adolescents
is like therapy with children or adults.
• Content is driven by the results of evaluation – need to see how/why this is
something they should do– how will this help me?
• Bring in schoolwork as soon as you can. – You are not a homework helper,
but you can’t assume they will generalize the skills you are teaching.
Direct Skill
Instruction
Self-Advoc
acy
Compensatory
Strategies
Direct Instruction TasksGoal Area Activities
Phonological Awareness Sound blending task, use of nonsense words if intact vocabulary, Fast ForWord, LiPS
Auditory Discrimination Use of minimal pairs - typically emphasis on vowels, Earobics, Fast ForWord, LiPS
Localization Walk to different rooms, walk in and identify – is this a good listening environment for me – why or why not? Identify all noises and sources of those noises
Temporal Processing Bop It, Simon Says, Fast ForWord
Interhemispheric Coordination
Simon Says, Brain Gym, karate, tossing ball one hand to another
Auditory Memory Mnemonics, Visualizing/Verbalizing, word list retention/manipulation of word list
Written Language Comprehension
Visualizing/Verbalizing, graphic organizers, Venn diagrams
Direct Instruction TasksGoal Area Activities
Following verbal directions Gross motor, fine motor, paper/pencil, vary the speed & quantity of directions
Following written directions
Many, many worksheets or pages in which the student reads the direction and you may or may not make them complete the page, but they have to describe how they would do it
Narrative oral and written language
Written - teach identification of main Idea and details. Incorporate, sequence and outline skills. Directly teach brainstorm and other process strategies
Identify main idea from text/lecture
Many workbooks available. Key: teach them a system so they are always able to differentiate main idea vs. details
Identify details from text/lecture
Relevant vs. non relevant. Recall of facts. 5 WH?’s
Summarizing/paraphrasing May need to go back to synonyms. Taking telephone messages and note taking
Comprehension of test questions
Cognitive map example/negatives/similar vs. different/ circle action words
Direct Instruction TasksGoal Area ActivitiesImplied meanings Use of sarcasm/humor – good place to start – bring in
nonverbalsFigurative/ambiguous language
Must have context within a story or text – may have to go back and teach how to use context clues
Pragmatic language An issue if the student can’t follow more than 1 conversation at a time or multiple topic changes. Role play & social stories
Expressive language (use of empty words/mazes)
Increase awareness; identify what empty words are – how can you say same thing with REAL words. Be as vague as they are, negative modeling; they identify your use of empty words. Long version vs. short version; mapping sentences
Vocabulary Make it visual. Google image cut and paste for anything these days but especially people; Visualizing/Verbalizing; contextual clues
Multiple meanings Use visuals to teach first. The HELP series and WALC books are age-appropriate
Problem Solving Is there a problem? Yes/no. What is problem? Can I solve problem? If yes, how? If no, do I need help? If I need help who and how should I ask?
Direct Skill Instruction – Therapy Ideas
• Hands-on experience• Objects • Visual aids• Personal experiences• Strategies for study
skills
Direct Skill
Instruction
Self-Advoc
acy
Compensatory
Strategies
Compensatory Strategies• I uses these exact terms
with them and I write it in a triangle – anytime we implement compensatory strategies, I label that is what we are doing.
• Know what you don’t know or can’t do
• Figure out a way to help yourself
Direct Skill
Instruction
Self-Advoc
acy
Compensatory
Strategies
Self-Advocacy
How to get the help you need
Direct Skill
Instruction
Self-Advoc
acy
Compensatory
Strategies
Self-Advocacy• I teach a lot with color coding, visuals
and formulas – anything to make language concrete
• FORMULA: first say what part you DID hear, then say what part you’re missing or DIDN’T hear
• This does 3 things:– 1. Lets the teacher know you were
listening to at least some of what they were saying
– 2. Breaks the cycle of and perception of “He’s just lazy” or “If he would try harder he could do it”
– 3. Gives students a pattern to fill in so they don’t have to think so much
Direct Skill
Instruction
Self-Advoc
acy
Compensatory
Strategies
“The Formula”
I KNOW ___________________
BUT
I DON’T KNOW _____________
ReferencesAmerican Speech-Language-Hearing Association. (2002). Knowledge and Skills Needed by Speech-Language Pathologists With
Respect to Reading and Writing inn Children and Adolescents Knowledge and Skills. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect
to reading and writing in children and adolescents (position statement, executive summary of guidelines, technical report]. ASHA Supplement 21, 17-27. Rockville, MD: Author.
Banotai, A. (2007, July 9). Working memory plays role in language assessment. Advance for Speech-Language Pathologists & Audiologists, 7-8.
Deshler, D., Hock, M. & Catts, H. (2006). Enhancing outcomes for struggling adolescent readers. Perspectives, 32, 21-25.Eggleston, L. & Larson, L. (2007, June 18). Curriculum modifications for language impairments. Advance for Speech-Language
Pathologists and Audiologists, 11.Ferre, J. (2007, Aug. 14). Understanding intervention for (C)APD: As easy as a-b-c. The ASHA Leader, 12, 20-22,34.Larson, V., McKinley, N., & Boley, D. (1993). Clinical forum: adolescent language service delivery models for adolescents with
language disorders. Language, Speech, and Hearing Services in Schools, 51, 36-42.McKinley, N. & Larson, V. (1985). Neglected language-disordered adolescent: a delivery model. Language, Speech, and Hearing
Services in Schools, 16, 2-15. Phillips Keeley, S. (2003). The source for executive function disorders, the. East Moline, IL: LinguiSystems.Pokorni, J., Worthington, C., & Jamison, P. (2004). Phonological awareness intervention comparison of Fast ForWord, Earobics,
and LiPS. Journal of Educational Research, 97, 147-157.Shaywitz, S. (2005). Overcoming Dyslexia: A new and complete science-based program for reading problems at any level.
Vintage.Zimmerman, S. (2007, May 7). Therapy tips: object description plan. Advance for Speech-Language Pathologists and Audiologists,
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