Auditory Comprehension

  • By Patti Hamaguchi, MA, CCC-SLP

    An Action Plan for Parents

    Understanding the Test Results & Diagnosis

     

    You have had the IEP or perhaps received a private report from a speech-language pathologist or psychologist. In it, you see that your child’s “auditory comprehension of language” is below average, or even significantly so. Your first job as a parent is to understand what the tests, numbers and terms really mean. There are many questions you will ask yourself: How far behind is your child? Is auditory processing the same as auditory comprehension? What exactly does my child have? When a child has an autism spectrum disorder, comprehending language, particularly at the sentence or conversational level, is usually a challenge.

     

    Numbers – Reports can list scores as “age equivalents” which refer to the fact that your child’s performance was more typical for the average child of a certain age. The first number is the year and the second number refers to the month. So a number listed as “4-5” would indicate that your child performed on the test similar to what a 4 year 5 month old child would be expected to perform.

     

    Another number you may see is called a percentile. With this scale, scores range from the 1st percentile (sometimes it is even listed in decimals, such as .5 percentile) to the 99th percentile. A score of 50 would then be the average score for a child, no matter his/her age. Scores lower than the 7th percentile fall into what is called the “disordered” range in United States public education. This system often determines the dividing line in terms of whether or not a child qualifies for services.

     

    Standard Scores are typically reported in numbers that use 100 as the average, with 85-115 being considered within the average range. That said, some test publishers issue their own “standard scores” and so you may see single digits (such as a nine or 11) indicated instead. In these cases, you will need to know that particular publisher’s scale in order to decipher what those numbers mean.

     

    Lingo – To make matters more complicated, different professionals sometimes use words with “auditory” in them, but not necessarily all labels have universally agreed-upon meaning. The word “auditory” refers to how we hear. If your child is having “auditory comprehension” difficulties, it indicates that your child does not understand the message in a normal way. “Auditory processing” is one of those diagnostic labels that for most people, means the same thing. The words are going in, but the brain cannot translate them.

     

    However, for speech pathologists and audiologists, there is a more specific disorder (Auditory Processing Disorder or Central Auditory Processing Disorder) that refers to pathology in the neural pathways before the information reaches the cerebral cortex for linguistic processing. Audiologists perform very specific tests to diagnose APD. These are generally considered to be most reliable after the age of seven. Children with cognitive delays, hearing loss and developmental disabilities such as autism spectrum disorder, are very challenging to reliably test in this regard, and so often professionals will assume that there is some degree of slow processing or inefficient performance of the auditory neural pathways present due to a more pervasive processing/cognitive impairment that is part of these other syndromes or disorders.

     

    There are three terms that are generally interchangeable and refer to how much the child is able to make sense out of what they hear: “auditory comprehension of language,” “receptive language” and “language processing”.

    Once you understand the numbers in the report, pay attention to the little sub skills within the receptive language/auditory comprehension umbrella. Are there increased difficulties when the information to be processed is too long? Are there certain types of language structures (Negation? Pronouns? Passive voice? Wh-questions?) that are especially problematic for your child? Is your child’s working memory (“short term auditory memory”) poor? This component can really make holding on to language long enough to be processed, an issue. How about attention span? Is your child having trouble comprehending language because he/she is off-task and paying attention to other things in the environment? Lastly, we often find that this group of children often struggles with other auditory elements, such as reading, writing and spelling. If your child is school age, are there associated issues with these skills?

     

    In putting together your “Action Plan” for this week, focus on becoming informed about your child’s current status, and what sub skills are delayed.

     

    Issues at Home – How can I get my child to listen to me?

     

    Children with auditory comprehension weaknesses often “tune out”, get confused, or forget what is said. This can be challenging, frustrating, and on some days downright maddening! So what can you do? Here are some simple tips:

     

    • Work on transitions. Many times, we start talking to a child while they are actively involved in another activity, such as watching TV, doing a puzzle, etc. Children with slow auditory processing often have slow “rise times” (ability to alert and shift focus, process). Say your child’s name, wait, then say, “It’s time to listen” and give your child a 5-finger count, rising each finger, one at a time, while you count slowly: 1-2-3-4-5. Practice this, and reward your child—sticker/star charts work great for this, for stopping and looking at you (even if it’s a quick glance) within this timeframe. After they can make this transition, it’s a good time to start talking.

    • Get closer! Speech is easier to understand, and attention is easier to get and maintain, when the acoustic signal is closer to the ear. Make sure you are at eye level, and move so your child can easily see and attend to you. A maximum of about 2-3 feet away is perfect.

    • Write and draw: For important directions, keep blank paper and markers handy at all times. Make a quick sketch, with words underneath to show your child what you want him/her to do. Tape/clip it so it is easily visible. If possible, it’s even better to have your child do a part of it, as it will be more easily remembered. Visual, visual, visual! Children with weak auditory systems are often much stronger with visual skills, so if this is the case, use those strengths! If several steps are involved, number them 1-2-3.

    • Break it down and keep it short: One direction orally at a time is best. Too much information can be overwhelming and result in a shutdown or inattention. Keep your language simpler and shorter.

    • Slow down your rate: We know from research that children process language better when the pace and rate of speech is SLOWED down. Not in a way that sounds like a record on the wrong speed, but a slower, comfortable rate so the words have time to be processed. This is very, very important! Use expression and good volume so your child is easily engaged with the listening process.

    • Use language he/she can understand. One of the biggest challenges parents can face—especially highly educated and verbal adults—is to watch the use of idiomatic expressions that can be confusing (“Mind your beeswax!”) or vocabulary terms that are unknown to the child. (“It doesn’t pertain to you, Joe!”)

    Typically developing children can easily use contextual cues to figure out what the parent is saying, including the tone of voice, facial expressions, and body language. But for children with weak auditory systems, many times there are weaknesses in this area as well and so their ability to figure out what you are trying to say is further compromised because integrating all this information at once can be a challenge.

    • Limit background noise: In many cases, auditory discrimination and figure-ground difficulties add to their listening challenges. Make a point to mute the TV, turn off the fan/faucet, and turn down the radio in the car, and other noise distractions, when you want to talk with our child.

     

    What should the school be doing?

    If your child has been formally assessed, there will be test results and an IEP that should include accommodations. For most good teachers, the accommodations should be intuitive and a part of good teaching. In a self-contained special education class, these are basic principles of teaching as well. The issues that I see tend to be in regular education classes where the teacher is a fast-talker and resists slowing down or repeating/restating important instructions or directions. In general, these are the typical types of instructional modifications that are recommended:

     

    • Speak at a slower rate.

    • Use sufficient volume and animation to keep the child’s attention.

    • Seat in a preferential way—as close to the teacher as possible.

    • In a regular-education class, consider a willing buddy that the child is able to ask for clarification of directions or instructions so he/she doesn’t have to wait until the teacher walks around and notices the worksheet or activity is not started or done correctly.

    • Don’t penalize or chastise the child for asking for help. In fact, this should be praised and encouraged!

    • Keep important directions posted on the board so the child can write them, and not rely on auditory memory

    • Get the child’s attention by name, before beginning to ask a question so there is time to transition attention/focus.

    • Make sure the curriculum content is a good match. For some children, learning in a large class with a fast-paced curriculum, can be overwhelming, despite the teacher’s best intentions. Small schools, small classrooms, homeschooling, and self-paced online learning can be good alternatives.

    • Subject-area tutors who can come to your home and reteach/preview the concepts can be invaluable. To reduce costs, consider hiring a superstar high school honors student or a local community college student. If you have more resources, an educational therapist is often a great support for academic and learning strategies.

    • A speech-language pathologist or resource teacher can also work with your child at school and work as a liaison to ensure that your child’s auditory deficits are properly accommodated in the classroom.

    • Individual therapy by a speech-language pathologist for treating the underlying auditory condition should usually be a part of the program or plan. In some cases, the self-contained special education classroom teacher incorporates this into the child’s program and less direct work is necessary.

     

    In putting together your “Action Plan”, focus on how the people and environment at home and school can help your child at his/her current level, so as to minimize frustration and confusion.

     

    Games and Activities to Strengthen Auditory Skills

     

    Parents often ask, “What can I do at home to help my child? Are there games and activities that will help him listen better?” While playing games won’t cure a weak auditory system, continued practice and exercising of listening skills should help improve it. In general, it is best to get input from a professional in terms of the specific needs and level of your child, but here are a few fun things you can do:

     

    1. Simon Says! Listening to what you say and tuning out what you do is a great way to work on focusing and listening. In case you forget how to play:

     

    Rules for Simon Says

    One person is Simon and he calls out instructions to  the rest of the players standing in a line facing him. If you don’t follow a Simon says instruction you are out. If you do follow an instruction that doesn’t have “Simon says” first, you are also out. The person who wins can then be Simon next time.

     

    2. Songs, Singing and Music: Listening and matching your pitch to music, remembering lyrics, and listening for directions embedded in a song are a great way to work on early auditory skills. It may take many repetitions of a song to remember the words or tune, but it’s a fun, easy way to tune up the brain. Adding physical movements (I’m a Little Teapot, Where is Thumbkin, Hokey Pokey, Itsy Bitsy Spider) helps the left-right brain connections, but feel free to modify as you need to! For older children, learning a musical instrument and playing in a band is a terrific way to develop pitch/pattern.

     

    3. Listening to Stories on CD: Reading to your child is certainly a super way to enrich their vocabulary and language. But to really work the auditory system, it’s especially helpful to make a bedtime routine of having your child lie down and listen to a favorite, familiar story on a CD. Turn out the lights and have your child close his eyes and listen. Why? Because it is familiar, your child can picture or visualize the story elements and make connections with what he is hearing. These stories can be as simple as a Curious George story or as complex as Harry Potter. The added benefit of doing this at night is that your child is generally a little bit sleepy, or perhaps reluctant to go to sleep yet. By closing his or her eyes, it helps them focus on the action and words of the story in a way that is often too challenging to do when the eyes are open and your child wants to move around.

     

    4. Go Get It! There are lots of variations of this game, but the idea is that you start with a basket or box of objects and put it fairly close by. One player tells the other which 2 to retrieve from the basket. The player finds them. (*If your child gets stuck or YOU do—the other player can give them the first sound of the name of the object they should be looking for. For example, “It starts with the ‘b’ sound”) Each time, the basket or box gets moved further away—to another room, upstairs, in a closet, in the bathroom, etc. You can have a list of acceptable places, and the other person has to choose one. Once 2 objects are done fairly easily, move on to 3 objects, then 3, then 5, etc. The player who is searching for the basket should be careful to use a strategy to remember them, typically repeating them over and over out loud works well, especially in a melodic way if possible or to a rhythm. Share with each other strategies you use to help keep it in your head. Each time you collect the correct number of objects, you get that number of points. Whoever gets the most points wins. (Make sure you “forget” a few times so it is a close competition and your child can feel some success.)

    5. Toss Across: Use a beanbag or ball. Have family members in a circle or just go back and forth with your child. You name a category and a sound. The other player has to tell an object that begins with that sound that belongs in that category. For example, “Animals—p” could be panda, pig, penguin, or polar bear. If the other player can’t think of one, it goes back to you. If you don’t have one either, they get the point because you are supposed to have a ready answer for anything you propose. If you do have a ready answer (that has not already been said previously) they get the point. Whoever has the most points, wins. The idea for this game is to work on remembering 2 things at once (category/sound) and for sound discrimination and word retrieval, which is often a challenge for children with weak auditory skills.

     

    6. Rhyming! Books that have rhymes such as Mother Goose Nursery Rhymes, Dr. Seuss, Shel Silverstein, and A.A. Milne (Now We Are Six) all have great poems in them. Read them to your children and practice rhyming with other words, such as your names. Make it silly and make it fun! Hearing auditory patterns is a great way to strengthen auditory discrimination and prepare for reading and spelling patterns.

     

    7. What Am I? Have your child listen to a series of 5 clues about an object. He will need to listen and remember them, and figure out what object you are describing. Try to keep the obvious clues for the last one. Start with more general clues—keep them guessing! This forces them to keep remembering what is being said. For example, for “train” you could say: 1. I have wheels.  2. I can go fast.   3. I have seats.  4. You buy tickets to go on me.  5. I go on tracks.   What am I?   Make it harder/easier, depending on your child’s age. Take turns but don’t be critical of the way he/she gives clues. It is tricky and so he might give it away or tell you outright what it is. Use a marker and paper to help draw out the clues if needed, then turn it over and see if your child can “put it together”.

     

    Resources and Programs for Children with Auditory Comprehension Weaknesses

     

    If your child is struggling with auditory comprehension weaknesses, you will likely want to consider some kind of intervention either as part of their school curriculum or at home. For children in a self-contained special education class, the intervention may be woven into a more comprehensive curriculum rather than a separate therapeutic program. In fact, introducing new curricular concepts within a cohesive class setting is often preferred to a fragmented, isolated introduction of vocabulary (typically nouns) concepts.

     

    But for many children, comprehension generally gets bogged down in those pesky “little words” that connect the noun concepts including actions, prepositions (to, from, for, by, with) plurals, possessives, pronouns and other elements of language. When they are all put together in a sentence—not to mention when spoken rapidly—the meaning can become confusing, or quickly forgotten, if there are memory problems. In these cases, consider these options in addition to formal speech-language/auditory therapy:

     

    Resources:

    Commercial Therapy Programs:

    * Please note: We have had children come to our practice who have been through the programs listed below and have reported positive changes in their child’s auditory skills. We have also had children go through them and not have any reported success. No program can “cure” auditory processing/comprehension difficulties so beware anyone who promises otherwise!

     

    1. Fast ForWord: This is a computer-based, intensive (5 days a week) program that focuses on processing speed, auditory discrimination, memory and attention. They are currently marketing more towards the reading aspects of this program, but its original intent was auditory processing and it still offers a super way to work on these skills intensively.  (I generally prefer to have children do this program over the summer due to the intensity level.) Their website: http://www.scilearn.com/

     

    2. Therapeutic Listening: There are a number of programs that work at the frequency level and report to strengthen auditory processing through the use of carefully selected music, through headphones. The American Speech-Language-Hearing Association does not advocate for these programs and feels the collective research is still lacking to prove their efficacy and thus considers them “experimental”. That said, many people do report some improvements with them, especially children who have attending, memory, processing speed, and sound sensitivity issues.  Some of these programs include:

    • Tomatis www.tomatis.com

    • Integrated Listening System: http://www.integratedlistening.com/ (This also includes some motor activities, which is helpful for left-right brain integration)

    • The Listening Program: http://www.thelisteningprogram.com/

     

    3. Lindamood Bell: These are centers/programs that offer some structured, programmed activities that are designed for auditory discrimination (“LIPS” program) and also visualizing language (Visualizing and Verbalizing).

     

    Apps (iPad)

    1. Picture the Sentence   (Hamaguchi Apps)

    2. Fun with Directions  (Hamaguchi Apps)

    3. More Fun with Directions (Hamaguchi Apps)

    4. Sound Matching SM (Foundations Developmental House)

    5. Syllable Counting (Foundations Developmental House)

    6. Target Sound ID (Foundations Developmental House)

     

    Books:

    1. Childhood Speech, Language & Listening Problems: What Every Parent Should Know (Hamaguchi, 3rd edition 2012, Wiley & Sons Inc)

    2. The Sound of Hope: Recognizing, Coping with, and Treating Your Child’s Auditory Processing Disorder by Lois Cam Heymann  (Ballantine Books 2010)

    3. When the Brain Can’t Hear by Teri James Bellis (Atria Books 2003)

     

    Websites/Blogs/Facebook:

    1. http://www.ncapd.org/

    2. Council for Exceptional Children (CEC)- www.cec.sped.org Search on” auditory processing disorder”. Detailed information about APD including remediation techniques is provided.

    3. Kuster, JM, Do You Hear What I Hear? Listening Activities -

    http://www.mnsu.edu/comdis/kuster4/part88.html

    4. http://www.facebook.com/pages/Auditory-Processing-Disorder/146933822007436

     

                      Patti Hamaguchi has been a speech-language pathologist for over 30 years. She is Director at Hamaguchi & Associates, a pediatric speech therapy practice in Cupertino, CA, and the author of Childhood Speech, Language & Listening Problems: What Every Parent Should Know, as well as several books on auditory processing disorders including “It’s Time to Listen” and “A Metacognitive Program for Treating Auditory Processing Disorders” (Proedinc.com) and an expert speech pathologist panelist on BabyCenter.com. Patti is also the founder and creator of Hamaguchi Apps for Speech, Language & Auditory Development.

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