Spoken Language Processing Disorders: Communication for life

Communication for life
AUDIOLOGY
Voted Rochester’s
Best Hearing
Aid Center
Spoken Language
Processing Disorders:
Could this be one reason
why my child is having
difficulty at school?
Rochester
1000 Elmwood Avenue, Door 1
Rochester, New York 14620-3092
585.271.0680
585.442.2985 TTY
Greece
3199 Ridge Road West
Rochester, New York 14626
585.723.2140
585.723.3856 TTY
Webster
1170 Ridge Road
Webster, New York 14580
585.872.8073
585.442.2985 TTY
www.rhsc.org
A United Way Agency
April2010
Introduction
Comprehending spoken language is a complex task
that involves auditory processing, language, and
various cognitive skills (such as attention, memory, and
sequencing). To process and understand what is heard,
the brain not only has to hear the words but recognize,
retain, and, interpret them. Central auditory processing
is the term that is commonly used but because more
than auditory processing is involved, Rochester Hearing
and Speech Center refers to the intertwining of these
processes as spoken-language processing (S-LP).
Spoken-language processing disorders (S-LPD) occur
when a breakdown in any of the mechanisms involved
in spoken language processing impacts on an individual's
ability to successfully use the information that is heard.
That is, the individual can hear what is presented, but
may not process it rapidly enough or completely enough
to utilize it effectively in learning. The cognitive demands
imposed by this “functional hearing loss” can drain the
child’s mental resources, often leading to fatigue, frustration,
and, inattention, as well as academic difficulties. This
type of functional hearing loss is sometimes first identified
as a behavior problem or misdiagnosed as ADHD. It
is estimated that approximately 10% of the population
has some form of S-LPD.
Some Common
Processing Difficulties
n Difficulty if someone talks quickly
n Difficulty comprehending information and/or
struggling to answer questions
n Problems following a sequence of directions,
carrying out tasks, and/or with organization
n Forgetting what has been said
n Mixing up sounds
n Difficulty paying attention, daydreaming,
or, sustaining attention
n Difficulties in spelling, reading or writing
n Difficulty telling complex stories, relating ideas,
or, putting ideas down on paper
Underlying Mechanisms
Involved in Spoken
Language Processing
For an individual to process language in everyday life,
a number of steps have to occur:
n Each speech sound has critical acoustic features that
need to be compared to patterns stored in the brain,
referred to as decoding; this matching process has
to occur very quickly (i.e., within a third of a second).
n When a match occurs, the corresponding speech
sound or word is activated into short-term memory
(the part of the brain that momentarily stores the
information that people use for talking and thinking).
n In order for the words to be maintained in short-term
memory, a person must actively attend to the
information, otherwise it will quickly fade away.
n The activated words must also be maintained
in the same order as presented.
n The brain must also process the different inflections
and rhythms of speech and integrate this information
with the words that have been processed.
n If the listener is in a very noisy setting, the individual
must direct attention to what he or she wants to hear
while blocking out all competing stimuli.
n One other critical process involved in spoken-language
processing is the ability to segment and manipulate the
speech sounds of language (i.e., phonemic awareness).
In turn, this serves as the foundation for learning to spell
and read.
As a mother of a young child in first grade, finding
out she could not read was devastating. Finding
Dr. Medwetsky at Rochester Speech and Hearing
was a miracle!! We now know why she could not
read, she could not hear the way she needed to!! With
Dr. Medwetsky's help she is now successful in school
and continues to become more confident everyday.
Without him we do not know where our child would
be in her education. Now she is up to grade level.
—Irene Steele, Parent
Spoken-Language
Processing Testing
Rochester Hearing and Speech Center (RHSC) has
developed one of the most comprehensive S-LP test
batteries in the United States, based on the Spoken
Language Processing Model developed by Larry Medwetsky,
Ph.D, VP Clinical Services at RHSC. Our approach allows
us to accurately interpret test findings and to recommend
effective management approaches to best meet individuals’
listening/processing needs, including referrals to other
specialists (such as speech-language pathologists,
psychologists, and occupational therapists).
Management recommendations focus on three components:
1. Compensatory strategies (such as extended time
for test-taking, speaking at a somewhat slower pace);
2. Environmental modifications (such as preferential
seating and acoustic modifications);
3. Specific therapeutic approaches (e.g., phonemic
awareness training, improving word decoding
speed, etc.).
RHSC also provides a spoken-language processing
clinic in which speech-language pathologists conduct
higher order language evaluations- as needed, as
well as individualized interventions to address the
processing issues identified in the spoken language
processing evaluation.
The following is a summary of the processes
assessed using the RHSC approach:
n Temporal resolution: the ability to detect rapid
changes in the speech signal
n Lexical decoding speed: the ability to process
the words of speech quickly and accurately
n Short-term/working memory: the degree and
patterns in which information is maintained in
conscious memory
n Short-term/working memory span: the amount
of information (# units) that can be retained in
short-term/working memory
n Sequencing: the ability to maintain speech sounds,
words, or directions in correct order
n Auditory-linguistic integration: the ability to integrate
information across different auditory/language
processing regions
n Prosodic perception: the ability to perceive/replicate
rhythmic patterns
n Selective auditory attention: the ability to focus
and recall target stimuli while blocking out competing
stimuli. This can be evaluated by:
(a) Figure-ground tests (i.e., speech embedded in noise)
(b) Binaural separation tests (whereby competing speech
stimuli are presented separately to each ear)
n Divided auditory attention: the ability to recall both
competing speech stimuli presented
n Sustained auditory attention: the ability to maintain
attention to verbally presented information over a
period of time
Higher order phonological skills are also examined, including:
n Phonemic Synthesis: the ability to blend individually
presented speech sounds and derive the target
whole word
n Sound-symbol associations (i.e., phonics): the ability
to discriminate, sequence and represent speech
sounds/syllables through the use of symbols
What does S-LP Testing Entail?
At RHSC, S-LP testing can be done with children as young
as five. The evaluation generally involves two test sessions
and one review session. If the client is a child, this latter
session is with just the parent(s). As part of the S-LP
evaluation, a hearing assessment is also conducted
to ensure that a hearing loss is not present; a hearing
loss, even a minimal one, can result in significant
processing difficulties.
The following is an overview of the services provided
(the following applies to when a child is evaluated but
similar procedures are conducted with adult clients):
First visit (1½ hours). The audiologist first reviews:
a) The parents’ and involved professionals’ responses
to RHSC customized questionnaires
b) Any test or treatment findings from elsewhere
The audiologist then conducts a number of tests, beginning
with two or three tests in which the audiologist and the
parent(s) are in the same room with the child. This allows
the child to become comfortable with the audiologist and
test situation. Subsequent testing is done using earphones.
Second visit (1 hour). The audiologist completes
the remainder of the test battery.
During testing, parents are encouraged to observe their
child to see how the child is doing on the various tests.
Please note that if the child is taking any medication
for attentional issues, the child should take his or her
medication as he or she would normally.
Third Visit (approximately 1½ hours). The audiologist
reviews with the parent(s) the various tests administered,
the findings and their implications, and specific
management recommendations. Because of the time
involved and the nature of the material covered, it is
preferred that children less than 14-15 years old not
be present during this visit.
Dr. Medwetsky's diagnostic expertise and
understanding of spoken language processing
enable me as a Speech Language Pathologist,
to provide the best possible therapy, based on his
critical input about the underlying nature of my
patient's profile. This allows me to work not just
on the spoken language processing symptoms but
also on the underlying processes with great clarity.
Since I work with many children with processing
difficulties, I find Dr. Medwetsky's work to be an
invaluable part of my evaluation process.
—Karen Glauber
Speech Language Pathologist
Scheduling a S-LP
Appointment at Rochester
Hearing and Speech Center
To schedule an appointment, please call 585.271.0680
and ask for the spoken-language processing scheduling
secretary. The total costs of the evaluation include:
n The cost of the Spoken Language Processing (S-LP)
evaluation.
n The cost of the Hearing Assessment. Note that although
the hearing assessment is covered by most health
insurance companies (except for the co-pay), the
S-LP evaluation generally is not. Payment in full
is due at the first appointment.
The S-LP Testing program is overseen by Larry Medwetsky,
Ph.D., Vice-President of Clinical Services. Dr. Medwetsky
is recognized nationally as a leader in this Field. He has
presented at numerous workshops and conventions,
both locally and nationally, and written many articles
and chapters on this topic. Dr. Medwetsky has also
recently served on committees for both the American
Speech-Language Hearing Association and American
Academy of Audiology to develop central auditory
processing guidelines for audiologists as well as
speech-language pathologists. Dr. Medwetsky can
be contacted by e-mail at lmedwetsky@rhsc.org
or by phone at 585.271.0680 ext.1245.
We look forward to working with you in addressing
your child’s needs. At all times, we encourage
you to ask questions and we will try to address
any issues you may have.
As a support group for parents of children
with disabilities, we regularly schedule
Dr. Medwetsky’s presentations because of his
genuine dedication to educating parents on
issues of processing disorders. He effectively
communicates his extensive knowledge and
depth of experience in a way that advances
parents' understanding of processing disorders,
contributing to them becoming better
advocates for their children.
—Donna Evevsky
Webster Parent To Parent
Presentation Co-ordinator