resources on foleyaudiology...1 resources on foleyaudiology.com auditory processing auditory memory...
TRANSCRIPT
1
R E S O U R C E S O N F O L E Y A U D I O L O G Y. C O M
A U D I T O R Y P R O C E S S I N GA U D I T O R Y M E M O R Y
L A N G U A G E P R O C E S S I N GA T T E N T I O N D E F I C I T
S U Z A N N E M . F O L E Y, M . S . , A U . D . C C C - A
D O C T O R O F A U D I O L O G Y
F O L E YA U D I O L O G Y @ G M A I L . C O M
W W W. F O L E YA U D I O L O G Y. C O M
1
2
2
DR. SUZANNE FOLEYDOCTOR OF AUDIOLOGY
WWW.FOLEYAUDIOLOGY.COM• APD and Balance
• First Steps hearing tests
• Early Hearing Detection and Intervention Director
• Adjunct Faculty
• 18 years at VA
• Extern Supervisor- 20 years
• RESOURCES:
WWW.FOLEYAUDIOLOGY.COM
Purchases benefit Hands and Voices
Hearing is considered a foundation
for the general education
of all children
• Classrooms are auditory verbal -60-70% of instruction is
auditory
• Academic and instruction is presented with the assumption
that the child can hear, attend and understand voice
• High correlation between auditory, language and reading
disorders
• Flexer, 1994 “On any given day, due to ear infections or
middle ear fluid, 30% of kindergarten and first graders were
not hearing enough to perceive the word-sound
distinctions that underline the development of academic
competence”
3
4
3
SIMILAR BEHAVIORS
• Johnny isn’t listening?
– Distracted (ADD)-visual/auditory?
– Decreased hearing in background noise
• He is a poor auditory learner
– Poor memory/focus
• He can’t follow multi-step directions
– Memory, distracted, understand instructions?
– Mom rant
– WATCH BEHAVIORS:
HOW DO WE IMPROVE TREATMENT? DIFFERENTIALLY DIAGNOSE
• Evaluate/identify deficit areas
– Rule out APD/Rule in related areas
• Review test results (psychoeducational/slp)
• Ask the student!
• Watch the students and their behavior
– what is the student doing when not listening?
• Do not say “Did you hear me?”
– Ask: “What did I just say?”
– Oliver-Disney
5
6
4
Do not say “did you hear/understand what I said?” Ask:
“What did I just say?”
WATCH WHAT THE CHILD DOES!!!! ASK THEM!
FOLEY FAMILY TABLE
APD DEFINITION B Y S U Z A N N E F O L E Y
APD=Ear to the Brain
Does the Child hear ?
CAT= CAT
Or
CATCH = CAT
APD Testing DOES NOT test meaning, interpretation or analysis
that is evident in reading, writing or oral expression.
APD=Clarity
Normal peripheral hearing (“I hear the beeps”) and average cognitive skills
7
8
5
A U D I T O R Y V S . L A N G U A G E
B O T TO M U P = A P D
A C O U S T I C I N F O R M AT I O N
B E F O R E L I N G U I S T I C I N T E R P R E TAT I O N .
D E T E C T I O N / C L A R I T Y
A U D I TO RY S I G N A L
F R O M E A R TO B R A I N
Phonological awarenessAuditory discrimination
TOP DOWN=LANGUAGE
CELF/TOLD
Knowledge of language/
interpretation
Meaning of sounds
Affects reading, communication
and learning.
PrelinguisticMeaning
PHONOLOGICAL AWARENESS
• Why is PA in SLP world?????
Most important skill to develop
language, memory and reading!
• Evaluate it! Critical for preschoolers
• Train others and share resources Home programming
• Add to therapy
9
10
6
IMPACT ON ACADEMICS
• Where is child struggling academically? What subjects?
Tests/homework? APD: language/reading
• Communication abilities? Verbal interactions, use of
descriptive words? Pragmatic skills?
• Reading problems? Phonological Awareness (closest to
APD), sight words (symbol imagery), reading
comprehension (LP or ADD)??
SLP RECOMMENDATIONS
Student “struggling academically”
• Standard language assessments are normal….what next?
• Don’t miss these skill areas!!!!!!
– Screen for auditory processing APD
– Phonological awareness
– Auditory Memory
– Attention Deficit-Inattentive/Hyperactive
– Language Processing (use of language in context)
• Affects listening and reading comprehension
• Word finding
• After elementary school
11
12
7
APD CAUSES/CASE HISTORY
• Articulation-errors longer than normal
• Delayed language development
• History of chronic otitis media
• Jaundice
• 1% have a problem identified on
CT/MRI
**60% of APD is delay in auditory
development- Right ear Advantage****
RIGHT EAR ADVANTAGE
Left hemisphere
Right hemisphereVisual/motor
Corpus callosum
60% with developmental delay in dichotic skills
Left ear Right ear
FUN FACT: 28/42
13
14
8
UMBRELLA ISSUES
–Executive Function
–Memory
–Attention
–Cognition
–Working Memory
–Sensory integration
CHANGES TO EVALUATION AND TREATMENT OF APD
• APD SIMULATION
• https://www.soundskills.co.nz/_literature_104671/Click_to_listen_to_
an_Audio_Simulation_of_APD.mp3
• Evaluation should identify specific skill deficits, not “apd”
• Treatment should be “deficit specific” • Direct intervention due to neuroplasticity instead of
just accommodations • CAPD vs APD
15
16
9
QUESTIONNAIRES-SCREENING
• Fishers Auditory Problems Checklist
• Sifter-Preschool and Secondary
• CHAPS
• Screening checklist:
• http://omnie.ocali.org/dash.php?cat=dash_tab_mn
(Under APD-referral checklist)
SCREENING TESTS-APD• Differential Screening Test of Processing-Linguisystems- good for school
based clinicians-refer to APD or to SLP. $95.00 ages 6-12
-3 APD subtests: dichotic digits/temporal/auditory
discrimination: 2 phonological awareness/3 linguistic subtests
http://linguisystems.com/products/product/display?itemid=10387
• SCAN-3 -Screening Test of Auditory Processing-subtests for
screen/diagnosis (Pearson $309)
Language Assessment:
– any subtest without visual: Recalling sentences
– Lower receptive than expressive language
Psychological Assessment: Lower verbal than performance IQ
17
18
10
DIAGNOSIS OF APD• Must be made by audiologist
• Can co-exist with other conditions
• Remove visual and language aspect of testing
• Rule out hearing loss and other conditions
• Age of diagnosis 7 and over. Screenings from 3-5 yrs old.
• No gold standard of testing
• 60% of all APD can improve auditory function with interventions
• Purpose of diagnosis should be for remediation options
• Incidence is 3-5% of school age population-severe
• 10-15% with weaknesses that are a contributing factor
• Higher ratio of males to females
APD SKILLS
• BINAURAL INTERACTION
• TEMPORAL PROCESSING
• AUDITORY CLOSURE/DISCRIMINATION
• DICHOTIC SKILLS (60% due to delay in auditory
maturation)
– BINAURAL INTEGRATION
– BINAURAL SEPARATION
19
20
11
BINAURAL INTERACTION• Cannot tell where sound is coming from
• Localization/lateralization
• Watch for unilateral hearing loss
• Not common
• Occurs at the brainstem level
• Tests: Spondee fusion/Masking Level Difference
AUDITORY CLOSURE OR DISCRIM=RECEPTIVE LANGUAGE
• Cannot fill in the blanks of what is not heard clearly
• Ability to hear differences in similar sounds
• Affected by poor acoustics, rapid speakers
• Related academic issues: receptive language, decreased decoding
(sounding out words), phonological awareness, difficulty hearing
in noise.
• Tests: Monaural low redundancy tests: Filtered words, Auditory figure
Ground, SSI-ICM, Time Compressed Speech Tests
21
22
12
DICHOTIC SKILLS• 60% of APD have this type of deficit
• Due to developmental delay in auditory skills
• Will improve through age 12
• Right ear advantage/left ear weakness
• Related issues; short term auditory memory, clumsy/uncoordinated, poor verbal to motor tasks
• Can’t walk and talk
• Overwhelmed in noise
• Binaural Integration-both ears work together Binaural Separation-directed listening
• Phone examples
TEMPORAL PROCESSING• Cannot hear timing changes in speech
• Misunderstand voice changes with sarcasm, humor and
questions
• Timing of pauses and stress in speech changes meaning
• Related issues: Poor rhyming, pragmatic issues, slow
processors, weak nonverbal skills (IQ)
• Tests: Duration Pattern Test, Pitch Pattern Test
23
24
13
APD IN SCHOOLS• Treatment for significant APD will not come
from school-needs more intensive
intervention-private therapy, CBAT, etc
• APD does not qualify as OHI for 504 except
AK, AZ, CA, HI, ID, MT, NV OR, WA
• Add suggestions to Communication disorder
IEP with SLP
• Commonly misdiagnosed with Language
Processing and Attention issues
TREATMENT FOR APD
25
26
14
BRAIN WIRING VS ENVIRONMENT
• Heredity provides 30-60%
• Environmental impact provides 40-70%-Nurture-majority
• Lack of sensory stimulation “EXPERIENTIAL LEARNING!-Blake engine
• Less movement/recess-need motor movement to develop cognition (car seats-pack and play)
• Fewer resources-experiences (slide, grocery)
• More sedentary, visual only (bike)
• Less motor due to safety and liability concerns
• More exposure to additives, and medications (OTC)
WHAT DO YOU SEE?
27
28
15
EXPERIENTIAL LEARNINGPIZZA PARLOR IN SLP ROOM
• Kids decorated-researched recipes, history of pizza
• Application for a job-vocabulary-how much per hour,
taxes: Took orders from school personnel
• Developed kitchen and supplies needed and cost and
regulations
• Recipes written out and organized food to make pizzas
• Delivered pizzas and took money
• Made sales reports
• Had a pizza party for those who participated
• (vet practice, cookies, gardening, holidays, farmer’s market,
post office)
TREATING APD
• No “cure-all” treatment, management approach,
or intervention for all cases of APD
• Treatment must be diagnosis/skill driven
• “Bottom Up” auditory training
• Includes advocacy, therapy and academic
application to demonstrate skills
• Importance of managing listening environment /
compensatory strategies
29
30
16
AUDITORY TRAINING BASICS
• Auditory training changes central auditory performance
• Frequent, intense, and challenging auditory training = most significant improvement in auditory skills
• Evidence suggests that maximum benefit requires 45-90 minutes/day for several weeks (Bellis)-can mean home programming
• Wide variety of approaches and techniques (CBAT, home programming, private tx)
• Goal: 30 min 5 x week on deficit specific activities for 6 to 8 weeks
MULTI SENSORY
INTERVENTIONS
IMPROVE
CONNECTIONS
IN THE BRAIN
31
32
17
DIRECT THERAPY AUDITORY CLOSURE/DISCRIMINATION ACTIVITIESRECEPTIVE L ANGUAGE DEFICITS
START WITH VISUAL/AUDITORY/TACTILE FIRST
• “The itsy bitsy ____”
• “The dog buried his ____ in the yard.”
• “ba__ball”
• Wheel of Fortune®/Ultimate Hangman/Telephone
Goldman Fristoe Test of Auditory Discrimination
Minimal Pairs Academy app
Sound Match
https://www.pinterest.com/lasenders/apps-for-auditory-processing-sound -discrimination (Lauren Enders)
• Progress to adding noise of varying levels: least impactful noise is constant fan, hardest is “cocktail party” noise
DICHOTIC THERAPY-60%• No direct SLP treatment
• Therapy: Add right/left movement
• Verbal to motor tasks-see list of activities
– Brain gym/Gym teacher https://www.youtube.com/watch?v=O5ChXC-rHLE
– “Me Moves: https://prio-health.com/memoves/
– https://www.youtube.com/watch?v=ukuVdn-opc8&feature=youtu.be
• Twister, Simon Says, Red Light/Green
• Sports with left to ride/midline activity
• Wii, Xbox- Olympic Games, WarioWare Smooth Moves
• Practice listening and/or writing
33
34
18
TEMPORAL PATTERNING
Improves the ability to discriminate differences in rhythmic
patterns of auditory stimuli.
* Clapping hands, musical instruments, non linguistic first
* High/Low, Long/Short
* Linguistic stimuli next
* Ask Music teacher
* Focus on timing of speech in words and sentences.* Increase speed, loudness and rhythm-metronome
* Games:
Simon(http://www.thepcmanwebsite/com/media/simon/)
Bop it- new one with more typical movements
https://www.youtube.com/watch?v=fKi6RK6CO2s&feature=youtu.be
(3:37)
PROSODY TRAINING
• Improve recognition of rhythm, stress and intonation of speech
(adds meaning to speech
* Recognize which syllable is stressed (e.g., convict/convict;
“You are welcome back vs “If you are well, come back.”)
* Say “I got an A on the test” with the wrong emotion to identify.
Have student practice to hear their own voice.
* Non verbal training to “see” emotion
* Sing-along videos with words and bouncing ball
https://midnightmusic.com.au/2014/08/make-your-own-follow-
the-bouncing-ball-lyrics-videos-with-explain-everything/
* Musical chairs, cake walks, Mad Gab®, drama and music
activities, therapy for pragmatic and social language
35
36
19
PHONOLOGICAL AWARENESS
• Isolation/Blending-(“mail__man”-what is it?)
• Rhyming
• Elision-omit syllable or sound. (Baseball, say it again without “ball”)
• Sound manipulation (each colored block is a sound; manipulate sound patterns) –how many sounds and in what order? Felt squares
• MAKE CENTERS FOR K/1/2ND GRADE CLASSES
• Literaryresourcesinc.com: PA assessment by grade-free-Michael Haggerty
• Phonological Awareness Kit-Linguisystems: elementary/secondary
• www.fcrr.org Phonemic Awareness (Lesson plan by grade level)
• Two Peas in a Pod assessment – Free assessment for monitoring
• Sounds Abound
• Spondee Bingo-Lexicon press
• Chipper Chat Super Duper
• Smarty Ears: Profile of PA and PA labs
AUDITORY PROCESSING VS
ATTENTION DEFICIT
DIFFERENT BRAIN FUNCTIONDIFFERENT BRAIN FUNCTIONDIFFERENT BRAIN FUNCTIONDIFFERENT BRAIN FUNCTION
TYPES OF ADD/ADHD
• ADHD-HI
Hyperactive/Impulsive
• ADHD-I : Inattentive (higher
incidence in girls)
• ADHD-Combined
APD SKILLS
Auditory closure
Temporal-timing
Dichotic
Binaural integration
Binaural separation
37
38
20
SCREEN FOR ADD/ADHD
• Student Behaviors
– They report information back accurately
• Poor working and auditory memory: (pschoed)
• Unusual errors and patterns-impulsive behaviors
• Connor’s and Vanderbilt Checklists
DIFFERENT BEHAVIORS
ADD
• Physical anomalies: Sleep/wake
cycles, bladder/bowel control,
alcohol/drugs
• Academic performance is
inconsistent –spelling test Fri vs
Thurs
• Distracted by different stimuli:
visual, tactile, smell , auditory
• Impulsive and interrupts-baseball
game
• Social situations affected by what
they say
APD
• No sleep problems -
Exhausted from listening
• Slow academic progress
• Distracted by auditory
information.
• Misunderstands meaning- mis-
hears
• Social situations affected by
not understanding the
meaning behind the
conversation
39
40
21
EXECUTIVE FUNCTION
“The ability to regulate adapt and control our behaviors, responses and
actions for both present demands and for future oriented goals. Include:
Attention, inhibition, working memory, fluency, strategic planning,
initiation, flexibility and self monitoring”. Gail Richard
Coordinate and integration skills
Each section of the orchestra can be good, but the conductor brings all
sections together for the overall effect of the song.
So, there can be deficit areas in addition to EF deficits
Different types of EF deficits depending on the type of ADD/ADHD
BASICS FOR ADD/ADHD• Medication is prescribed in 88% of ADD students.
– Considerations: age, other meds, dosage, flexibility
• Parent Education- Don’t ignore the diagnosis
• Diet/supplements/Exercise
– Protein is critical for neurotransmitters!
• It will not go away-gas pedal equals brake!
• Behavioral Management is KEY KEY KEY
• Student advocacy to minimize negative “zingers”
• Active listening is not “sitting still”. ADHD-movement – hold ball,
chew gum, fidget spinners, Velcro, paper clips, therabands, tennis ball
on chairs, exercise ball,
41
42
22
ADD CLASSROOM MANAGEMENT-ADD
• Positive behavior modifications-do not reinforce lack of
negative behaviors-
• Reinforcement must be timely/now-no concept of “next
week”
• Teaching Style: Organized, clear expectations
• Visual reminders for all routine tasks (they make the
visuals) –baseball game interruption
• 504 for attention deficit –need supports in place
• MOVEMENT: Movement/exercise elevates dopamine and
norepinephrine levels (low in ADD/ADHD students) that
improves focus, self control and mood.
ADD RESOURCESBEHAVIOR MANAGEMENT
• Teaching Teens with ADD and ADHD –Chris Dendy, M.S.
• Understanding Girls with ADHD-Patricia Quinn/Kathleen Nadeau
• Parenting Children with ADHD- Vincent Monstra
• Strong Willed Child- James Dobson
• Parenting the Strong Willed Child -Rex Forehand
• Raising Your Spirited Child- Mary Kurcinka
• Disconnected Kids, Robert Mellilo
• Explosive Child-Ross Greene, Ph.D.
• 1-2-3 Magic: Thomas Phelan-younger children
• Additudemag.com –free newsletters via email/trainings
• Chadd.org
43
44
23
RESOURCES EXECUTIVE FUNCTIONThe Source: Development of Executive Functions: Jill Fahy/Gail Richard
Executive Skills in Children and Adolescents: A practical guide to assessment
and intervention and Smart But Scattered, both by Peg Dawson and
Richard Guare
Promoting Executive Function in the Classroom (What Works Best for Special
Needs Learners) by Lynne Meltzer.
Sarah Ward: www.efpractice.com
Russell Barkley: Executive Functions: 2012 book
Delis Kaplan Executive Function System-Pearson
https://jillkuzma.wordpress.com – Social/Emotional management
Smarts Executive Function Program
https://www.researchild.org/smarts/ or https://smarts-ef.org/
https://developingchild.harvard.edu/resources/activities-guide-enhancing-
and-practicing-executive-function-skills-with-children-from-infancy-to-
adolescence/
L A N G U A G E V S A U D I T O R Y P R O C E S S I N G
H I N T : I T I S L I K E L Y L A N G U A G E P R O C E S S I N G
C A P D = A P D
45
46
24
A U D I T O R Y V S . L A N G U A G E
B O T TO M U P = A P D
A C O U S T I C I N F O R M AT I O N
B E F O R E L I N G U I S T I C I N T E R P R E TAT I O N .
D E T E C T I O N / C L A R I T Y
A U D I TO RY S I G N A L
F R O M E A R TO B R A I N
Phonological awarenessAuditory discrimination
TOP DOWN=LANGUAGE
Celf/Told
Knowledge of language/
interpretation
Meaning of sounds
Affects reading, communication
and learning.
PrelinguisticMeaning
LANGUAGE PROCESSING
DEFINITION-GAIL RICHARD
“A Language Processing problem is difficulty with
accessing acquired language abilities (ie: vocabulary)
and efficiently integrating those skills to formulate
more complex thoughts and formulate a response
(verbal, behavior, gesture or written)”.
EVALUATE FOR LP WHEN STANDARD LANGUAGE TESTS ARE
NORMAL
47
48
25
LANGUAGE PROCESSING HIERARCHY
Similarities
Associations
Functions
Multiple Meaning
s
Labeling
Categorization
Differences
SynonymsAntonyms
Word findingMemory
Inferences Idioms
BEHAVIORAL ASPECTS OF LPD
� Problems with following directions (can repeat back
information accurately)
� Problems understanding stories or concepts (main idea)
� Trouble “getting to the point” or answering questions with
the appropriate information
� Difficulty naming objects or people (without visual)
� Difficulty knowing what to expect based on information they
are given (thinking and reasoning)
� Inferences-cannot discuss what is “beyond the picture”.
“What happens next-why did that happen?”
49
50
26
TESTING FOR LPDRule out APD-confirm the clarify of the signal – can the student repeat the information accurately but not follow direction-
Reduce visual stimuli in language tests
• TAPS-3/4-Test of Auditory Perceptual Skills –Auditory Comprehension/Reasoning (TAPS-4)
• Comprehensive Assessment of Spoken Language (CASL)
• Listening Comprehension Test -2 –Elementary and Adolescent
• TOPS-Test of Problem Solving-Elementary and Secondary
• TOWL-Test of Written Language
• Language Processing Test-3
• Word Test-3-Elementary and Word Test -2 Adolescent
• Test of Word Finding 2
• Test of Narrative Language
• CELF-5 Metalinguistics
• Auditory Processing Abilities Test
• TILLS-Test of Language and Literacy Skills-Brooks Publishing
• OPUS (Oral Passage Understanding Scale)- Pearson
• Test of Adolescent and Adult Language
• RESCA-E-Receptive, Expressive and Social Communication Assessment-Elementary
LP SKILLS REQUIRES WORKING MEMORY – “TV SCREEN”
• Affected by working memory-target memory
• Ability to visualize verbal and written information
• Use symbol imagery
• Visualizing and Verbalizing-Socratic questioning
• Expanded Expression Tool
• Help them see the picture
• Watch movie before picture
• Difference between LP and poor working
memory (ADD)
51
52
27
HIGHER LEVEL VOCABULARY• Emotions-envy, despair, proud, disappointed,
uninterested, nervous, confident (Drew)• Clever Endeavour, Plexers, Taboo, Apples to
Apples • You tube : Simon’s Cat-non-verbal awareness and
Spanish soap operas, Pixar Shorts, Suite life of Zach and Cody
• Descriptive words-without visual representation
Give relevant examples-movies, etc.
• Inferences –” we just got a puppy-that ball of
energy is taking over our lives”
• Vocabularycartoons.com
WORD FINDING• The most educationally significant communication
disorder. ---OUTPUT-Margo Courter
• Under-diagnosed and under-treated
• Poor expressive language vs receptive
• Word Finding Checklist –www.foleyaudiology.com
• Diane Germane-Word Finding Program
• Stuck for Words www.foleyaudiology.com
• “Word retrieval for adolescents and adults”-
Acadcom.com
• Help series for Word Finding/Rocky’s Mountain -
Linguisystems
• Word Burst/Language Burst/Word Finding app
53
54
28
WORD FINDING FOR SURE
TREATMENT OPTIONSWordless books
Linguisystems
• Help series
• Spotlight book series-Listening Comprehension and Reasoning and Problem Solving
• Language Processing Treatment Activities-Gail Richard (Pro-Ed)
Visualizing and Verbalizing –Lbell
Buttons with face, house, clock as bookmarks
Expanded Expression Tool (EET) www.expandingexpression.com
http://www.northernspeech.com/early-intervention-language-and-speech/eet-expanding-expression-tool-kitmdash2nd-edition/
• https://youtu.be/Wr8EXEzN5CU
Story, Grammar, Marker www.mindwingconcepts.com
Narrative Language Measure “Story Champs” https://www.languagedynamicsgroup.com/products/story-champs/story-champs-about/
55
56
29
FOLEY FAMILY TABLELANGUAGE PROCESSING
DO NOT DISCHARGE ELEMENTARY WITHOUT
EVALUATING LP
MONITOR, EVALUATE and TREAT WORD
FINDING
EARLY INTERVENTION: PHONOLOGIAL
AWARENESS AND PHONOLOGICAL
MEMORY
DIRECT VOCABULARY INTERVENTION
“ACADEMIC VOCABULARY”
M E M O R Y
F O L E YA U D I O L O G Y. P B WO R K S . C O M
57
58
30
AUDITORY MEMORYCONCERNS
• Students not developing it spontaneously (ie: my phone #)
• Early activities not present to develop it-nursery rhymes
• Technology provides solutions-no problem solving, sequencing
• Expectations from parents and teachers unrealistic
• No IEP goals for memory – ADD THEM
• Age range of when it develops-and then STOP
• Have to work on strategies for poor memory
– What are your strategies for names?
– Practice trial/error
– Share with student/teacher and parents
ASSESSMENT TOOLS ON FOLEYAUDIOLOGY.COM
AUDITORY MEMORY EXPECTATION PER AGE(ROWE ET AL. 2004) –HANDOUT PG 112
Age Numbers Sentence Length (words)
FAMILIAR WORDS
4-5 4 digits 7-8 words
5-6 4 digits 9 words
6-7 4 digits 10 words
7-8 4 digits 11 words
8-9 4 digits 13 words
9-10 4 digits 13 words
10-11 5 digits 14 words
11-12 5 digits 14 words
59
60
31
TYPES OF MEMORY
• HIERARCHY OF SKILLS
• Short Term Memory-earliest skill
• Working Memory
–based on short term memory development
–Role in early language development and executive function
• Visual Memory
• Long Term Memory
SHORT TERM AUDITORY MEMORY
• Brief retention, new information (released, forgotten).
• Affects acquisition of new vocabulary
• 20 seconds of memory
• Cannot register information quickly
• Cannot make attention and memory work together
• Test # forward or digit memory, word memory or
phonological memory
• Age range of development and then STRATEGIES
• Span of STM related to familiarity of stimuli
61
62
32
THE “BASICS” OF AUDITORY MEMORY TREATMENT
• Improve acoustics (FM)
• Visual adds 20%
• Language and vocabulary familiarity
• Speech therapy to teach rehearsal, mnemonics
• Use music/tempo
• Hear Builders: Auditory Memory and other apps
• Participation in an event (vs observation)
• Normal development: hear word 35 times to understand/remember
• Movement-improves blood flow and oxygen in brain
• Laughter increases endorphins, well being and positive emotions
enhance learning retention
• Hydration! Keeps lungs moist to get oxygen to brain!
• ANY AGE: PHONOLOGICAL AWARENESS
WORKING MEMORY- “TV SCREEN”
• Varied definitions
• DEPENDENT ON SHORT TERM AUDITORY MEMORY
• Ability to store and manipulate information (visual or auditory)
• Capacity is not “amount of storage” but is affected by ability for
control and attention while protection from interference
• Controls attention
• Affects reading and listening comprehension and written expression
• Impacts complex math
• Teenagers: 10-20 minutes
63
64
33
WORKING MEMORY-TREATMENT• Use visual and auditory first and reduce visual
• Provide delay in their response: “Do not respond until I raise my hand “
• Practice memory in reverse
• Air writing
• Socratic questioning-Visualizing and Verbalizing-Lindamood Bell
• Use symbol imagery to improve visualization
• Improve vocabulary knowledge
• Therapy: Telephone, I am going to Grandma’s house and need to pack…, rapid naming tasks-use known stimuli (objects, numbers, colors, shapes)
STRATEGIES
• Use music or songs
• Chunking
• Concept Imagery “mental picture”
• Use color to highlight key facts or code materials
• Acronym/Acrostic: “King Henry Died Monday” (kilo, hector, deka, meter)
• Sub localization rehearsal (strategy)
• Give visual reminders
• Abbreviations
• Association: “confiscate” when your mom took your phone
65
66
34
MEMORY RESOURCES• Boudreau, D. & Costanza-Smith, A.(2011)Assessment and
Treatment of Working Memory Deficits in School-Age Children:
The Role of the Speech-Language Pathologist. Language,
Speech and Hearing Services in Schools, Vol 42, 152-166.
APPS:
• http://langwitches.org/blog/2011/08/21/blooms-taxonomy-
and-ipad-apps/ (LIST OF APPS FOR MEMORY)
• Mimic App
• “Mainstream Memory” app by Virtual Speech Center
• “Auditory Memory Ride” app by Virtual Speech Center
• “Memory Exercises” app by Virtual speech center (adults
FOLEY FAMILY TABLE
Evaluate short term and auditory memory
and target skills
Add memory accommodations to
504 or IEP
Teach students strategies and share what works for that
student with teachers and parents
Observed classroom instructions for
appropriate length and vocabulary
67
68
35
C L A S S R O O M S T R A T E G I E SS U Z A N N E M . F O L E Y, M . S . , A U . D . C C C - A
D O C T O R O F A U D I O L O G Y
F O L E YA U D I O L O G Y @ G M A I L . C O M
W W W. F O L E YA U D I O L O G Y. C O M
SCHOOL SUGGESTIONS
Goal: Improve access and retention of auditory
information
• Classroom/Environment changes
• Academic Plan Changes
• Teaching style-accents/organization
• Specific to skill deficit
• Technology
`
69
70
36
ALL STUDENTS BENEFIT…– Multi sensory teaching: weak auditory learners for life
– Improve access to auditory information
– Decrease sound distraction and background noise
– Self advocacy – how does my disability impact my day to
day life and school?
http://www.boystowntraining.org/lesson-plans.html
– Preferential seating-Do they know why?
– “Sophie factor”- note taking buddy
– Teach “scripts” for certain situations –attention deficit vs
asking teacher
ALL STUDENTS BENEFIT…– Academic Vocabulary Training
– Pragmatic language/conversation training/social skills groups
– Active listening skills CAUTION: AUTISM AND ADHD
STRATEGIES
– Online textbooks: won’t check at locker, memory, preteach
vocabulary (Incan/Aztec Indians)
– Extra time for tests: Resource assistance: to help stay on task or
understand the instructions, have them recheck their work
– Written instructions in addition to verbal assignments-student
writes the information and teacher signs it for completion
– Foreign Language waiver/alternate
– Study skills training-note taking, highlighting, tricks
– For poor memory: allow index card with formulas, acronyms, etc on
tests
71
72
37
ENVIRONMENTAL ISSUES• Classroom acoustics
• OBSERVE IN THE CLASSROOM-Train example/Tractor
• Monitor and reduce Noise levels: free apps foleyaudiology.com
• Reverberation
• https://www.ted.com/talks/julian_treasure_why_architects_need_to_use_their_ears-243
• Preferential Seating: Where is the teacher and student?
• Minimize visual issues-glare, lighting on speaker, distraction while teaching
• Minimize distractions that break concentration
PURPOSE OF FM SYSTEMS
Improve the signal to noise ratio in the classroom. Ideal Signal to Noise: +6dB –ASHA recd +15dbAuditory disorders: +20dBDepartment of Education Study: Average
classroom:+3 SNFM systems provide 10dB Not all APD students benefit from individual FMAUDITORY CLOSURE/DICHOTIC DEFICITSRoger FocusQ ball www.buyqball.comSound field systems/personal/ tower
73
74
38
ACADEMIC VOCABULARY
• Have to use stimuli that will generalize to
communication and academics
• Average IQ: Students have to hear a word 35 times to
remember and understand vocabulary words
• “Academic vocabulary” ie: operation, specific, investigate,
compare/contrast, etc.
• Smarter Balance –academic vocabulary by grade level
• MAVA – super duper- analyzer for tier level words
• Linguisystems: Word Feast –elementary/middle/high
SPECIFIC APD SUGGESTIONS
• Auditory Closure- REPETITION, NOT REPHRASE
• Temporal Processing- Slow rate of speech, Repeat once,
then rephrase
– Use dramatic speech inflection
• Dichotic (R/L hemisphere)- EITHER Listen OR Write-not
both
– Note taking friend. Use of smart pen. Record lecture
75
76
39
COMPUTER BASED PROGRAMS
• Under headphones: 30 minutes a day/5 days a week/10 weeks max
• Hear Builders– 4 programs-auditory memory, sequencing, following
directions and phonological awareness– Superduperinc.com– School licenses $199 for 20 licenses; $100 for all four for
one year (private)
• Fast ForWord www.scilearn.com– Receptive language – Auditory closure and temporal processing APD– Needs a provider for the basic programs– Several programs from auditory to reading comprehension
ADDITIONAL CBAT OPTIONS
• Acoustic Pioneer-eval: Feather Squandron
• https://acousticpioneer.com/auditorytraininggame
s.html
• Brain HQ-adults and adolescents
www.brainhq.com
• Capdots –dichotic deficits
77
78
40
OTHER TECHNOLOGY
• APPS – ASHA leader, Speech bubble.com, apps
wheels
• www.virtualspeechcenter.com
• BITS BOARD
• Mind Meister-mapping
• Listening Therapies:
– The Listening Program
– Therapeutic Listening
TECHNOLOGY IN CLASSROOMALL STUDENTS WITH
• Smart Pens and Apple Pencils
https://store.livescribe.com/catalog/product/view/id/699/category/7
8/
• C pen reader pen/Dictionary Pen/Exam Reader
• Smart Boards- can record
• Speech to Text (Microsoft translator- free
https://translator.microsoft.com/help/education/
• Learning Ally, Epic and Book Share -narrated textbooks
• Googledocs-add ons-tools-
• Snap and Go Read-Text to speech on websites, documents and
their own work
• Co-writer
• Cpens
• Low gain hearing aids
79
80