Nowell managing supramodal influences handout

Managing Supramodal Influences:Distinguishing (C)APD from ADHD

Overview

• What – and where – is CAPD?• Assessment of ADHD and CAPD• Managing supramodal influences• Integrating top-down and bottom-up

Objective

• Let’s integrate top-down and bottom-up into assessment and treatment

Diagnostics as “making distinctions”

301.13, rule out 296.89

Hard signs and soft signs

Developmental soft signs

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“Top–down”dysfunction

• ADHD

• Executive dysfunction

© 2011 David D. Nowell, Ph.D. All rights reserved.

04/10/2023 11© 2011 David D. Nowell, Ph.D. All rights reserved.

“Bottom-up” dysfunction

• Central auditory processing problems

• Sensory processing problems

WHAT – AND WHERE - IS APD?

Deficits

• sound localization• auditory discrimination• auditory pattern recognition• temporal aspects of audition• auditory performance in competing acoustic

signals and with degraded acoustic signals

Home/classroom observations

• Poor “communicator”(terse, telegraphic)

• Memorizes poorly

• Hears better when watching the speaker

• Problems with rapid speech

• Interprets words too literally

• Often needs remarks repeated

• Confuses similar-sounding words

The Construct of APD

• associated with poor perception of both speech and non-speech sounds

• has its origins in impaired neural function• impacts everyday life• should be assessed through standardized tests

of auditory perception• may co-occur with other neurodevelopmental

disorders

The Construct of APD

• may not be exclusively bottom-up• may be impacted by attentional factors

• Acquired• Secondary• Developmental

k /a / t

“cat”

“Hier gibt es kein platz mehr.”

NO LOITERING

NO SE PERMITTE VAGABUNDOS

Unmittelbar

Immediately

“Where’s the bubblah?”

“tomar”

04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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04/10/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.

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ASSESSMENTADHD and CAPD

Asssessment of ADHD

• History• Review of records• Collateral report• Checklists• Behavioral observations• Assessment of IQ, academics, language,

memory, attention/vigilance, and exeuctive functioning

ADHD is not:

• Dementia• Global developmental (intellectual) delay• Psychiatric disorder• Acquired (stroke, brain injury) language

disorder• Sleep disorder• Auditory or sensory processing disorder

Assessment of CAPD

• History• Review of records• Collateral report• Checklists• Behavioral observations• APD screening• Diagnostic audiological assessment• Electrophysiologic assessment

APD is not:

• Dementia• Global developmental (intellectual) delay• Psychiatric disorder• Acquired (stroke, brain injury) language

disorder• Attention Deficit Hyperactivity Disorder• Behavioral Disorder (extreme “selective

listening”)

Approaches to Test Scores

• norm-based interpretation (absolute), and • patient-based interpretation (relative)

Buffalo Model

• Decoding• Tolerance-fading memory• Integration• Organization

“what we do with what we hear”

Bellis / Ferre Model

• Primary– decoding, prosodic, and integration deficits

• Secondary– associative and output organization deficits

Identify (and treat) specific deficits

Common Recommendations for APD Evaluation

• Rule out peripheral auditory involvement• Rule out attention, memory, and intellectual

impairment• Rule out a language impairment

Common Recommendations for APD Evaluation

• Rule out peripheral auditory involvement

• Rule out attention, memory, and intellectual impairment

• Rule out a language impairment

MANAGING SUPRAMODAL INFLUENCES

CAPD or ADHD?

• Asks for things to be repeated• Poor Listening skills• Difficulty following oral

instructions• Difficulty discriminating speech• Difficulty hearing with

background noise• Difficulty maintaining auditory

attention in quiet• Academic difficulties• Slow to process information

• Inattention• Academic Difficulties• Daydreams

• Distracted• Poor Listening Skills

• Disorganized

• Asks for things to be repeated• Auditory divided attention

deficit

CAPD or ADHD?

• Asks for things to be repeated• Poor Listening skills• Difficulty following oral

instructions• Difficulty discriminating speech• Difficulty hearing with

background noise• Difficulty maintaining auditory

attention• Academic difficulties• Slow to process information

• Inattention• Academic Difficulties• Daydreams

• Distracted• Poor Listening Skills

• Disorganized

• Asks for things to be repeated• Auditory divided attention

deficit

CAPD or ADHD?

• Asks for things to be repeated• Poor Listening skills• Difficulty following oral

instructions• Difficulty discriminating speech• Difficulty hearing with

background noise• Difficulty maintaining auditory

attention• Academic difficulties• Slow to process information

• Inattention• Academic Difficulties• Daydreams

• Distracted• Poor Listening Skills

• Disorganized

• Asks for things to be repeated• Auditory divided attention

deficit

CAPD or ADHD?

• Asks for things to be repeated• Poor Listening skills• Difficulty following oral

instructions• Difficulty discriminating speech• Difficulty hearing with

background noise• Difficulty maintaining auditory

attention• Academic difficulties• Slow to process information

• Inattention• Academic Difficulties• Daydreams

• Distracted• Poor Listening Skills

• Disorganized

• Asks for things to be repeated• Auditory divided attention

deficit

Other “rule outs”

Managing supramodal influences in the assessment

• Altering the redundancy of the signal• “Teasing out” aspects of the processing

pathway

Managing supramodal influences in the history and interview

• Where do you see it the most?• Where do you see it the least?• Pediatric genie question• What would make the greatest difference?

Comorbidity

“tell me two stories”

Managing supramodal influences in your behavioral observations

• What does the client elicit?• What qualitative comments can you make

about errors?• Where do you see “it” the most? The least?

What’s the kid’s deal?

Modularity

INTEGRATING TOP-DOWN AND BOTTOM-UP

Obstacles to integrating

• Phonemic awareness or auditory aphasia?• Working memory or divided attention?

Phonemic awareness

Working memory

Bottom up interventions

• Auditory training• FM transmission• Environmental modification• Training the speaker to face the listener, check

for understanding

Bottom up interventions

• Preferential seating• Increased use of visual cues• Auditory training• Untimed testing• Prosody, intonation

Top down interventions

• Metalinguistic training– schema induction– context-derived vocabulary building, phonological

awareness– semantic network expansion

• Metacognitive training– strengthening higher order central resources

• Assertiveness training

Future directions

• Research• Clinical collaboration – Assessment– Treatment

• School-based collaboration• Mutual education• Humility

Let’s stay in touch!

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References

• American Academy of Audiology Clinical Practice Guidelines: Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. (2010). Available from www.Audiology.org

• American Speech-Language-Hearing Association. (2005). (Central) Auditory Processing Disorders [Technical Report]. Available from www.asha.org/policy.

• Baran JA. (1996). Audiologic evaluation and management of adults with auditory processing disorders. Seminars in Speech and Language, 233-44.

• Bellis, T.J. (2002). When the Brain Can’t Hear

References

• Bellis, T. J. (2003). Assessment and management of central auditory processing disorders in the educational setting

• Cacace, A. T., & McFarland, D. J. (1998). Central auditory processing disorder in school-aged children: A critical review. Journal of Speech, Language, and Hearing Research, 41, 355–373.

• Cacace, A.T. (2006). Personal communication

References

• Cameron, S. & Dillon, H. (2005). Auditory Processing Disorder from Screening to Diagnosis and Management. Audiology Now. 47-55.

• Chermak, G. D. (2002). Deciphering central auditory processing disorders in children. Otolaryngologic Clinics of North America, 35, 733–749.

• Dillon H, Cameron S, Glyde H, Wilson W, Tomlin D. (2012). An opinion on the assessment of people who may have an auditory processing disorder. Journal of the American Academy of Audiology, 97-105.

References

• Farah, R. (2012). Current Views and Controversies in Auditory Processing Disorders. Presentation at convention of Ohio Speech Language Hearing Association

• Farah, R. (2012). Personal communication.• Ferguson MA, Hall RL, Riley A, Moore DR. (2011).

Communication, listening, cognitive and speech perception skills in children with auditory processing disorder (APD) or Specific Language Impairment (SLI). Journal of Speech Language and Hearing Research, 211-27.

• Ferre, JM (2002). Managing children’s CAPD deficits in the real world: What teachers and parents want to know. Seminars in Hearing, 319-326.

References

• Fey, M.E. (2011). Auditory Processing Disorder and Auditory/Language Interventions: An Evidence-Based Systematic Review. Language, Speech, and Hearing-Services in Schools 42, 246-264.

• Geffner, D., & Ross-Swain, D. (2007). Auditory Processing Disorders: Assessment, Management, & Treatment.

• Hamaguchi, P. (2010). Childhood Speech, Language, and Listening Problems

• Jerger, J., & Musiek, F. (2000). Report of the consensus conference on the diagnosis of auditory processing disorders in school-aged children. Journal of the American Academy of Audiology, 11, 467–474.

References

• Katz, J. (1992). Classification of central auditory processing disorders. In J. Katz, N. Stecker, & D. Henderson (Eds.), Central auditory processing: A transdisciplinary view (pp. 81–91). St. Louis, MO: Mosby.

• Kamhi, G. (2011). What Speech-Language Pathologists Need to Know About Auditory Processing Disorder. Language, Speech, and Hearing Services in Schools 42 265-272

• Kreisman, NV, John AB, Kreisman BM, Hall JW, Crandell CC. (2012). Psychosocial status of children with auditory processing disorder. Journal of the American Academy of Audiology, 222-33.

References

• Musiek, F. E., & Oxholm, V. (2000). Anatomy and physiology of the central auditory nervous system. In R. J. Roeser, M. Valente, & H. Hosford-Dunn (Eds.), Audiology Diagnosis (45–72)

• Musiek, F. (2006). Personal communication• Pichora-Fuller MK. (2007). Audition and cognition:

What audiologists need to know about listening, In C. Palmer & R. Seewald (Eds.) Hearing Care for Adults. 71–85.

References

• Richard, G. (2011). The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder. Language, Speech, and Hearing-Services in Schools 42, 297-302.

• Shinn, JB, Baran, JA, Moncrieff, DW, Musiek, FE. (2005). Differential attention effects on dichotic listening. Journal of the American Academy of Audiology. 205-218.