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 [email protected] 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