My client R. is six years old and currently diagnosed as having DSL. R. has been in therapy since he was first referred from preschool screening. In past therapy R. has been working on articulation and some language issues, such as answering “wh” questions appropriately. Current behavior and issues at school however, have led us into considering the possibility of him having CAPD (Central Auditory Processing Disorder) or also known as APD(Auditory Processing Disorder). CAPD refers to how the central nervous system (CNS) uses auditory information. Children with CAPD exhibit a variety of listening and related complaints. For example, they may have difficulty understanding speech in noisy environments, following direction, and discriminating similar sounding speech sounds. Sometimes they may behave as though they have a hearing loss, often asking for those around them to repeat themselves. R. does this on a frequent basis. This disorder is often confused with ADHD because of similar characteristics, which causes misdiagnosis in many cases.
One way a diagnostic team has tested R. is by giving him the TAPS (Test of Auditory-Perceptual Skills). To diagnose CAPD, the audiologist will administer a series of tests in a sound treated room, which will be the next way R. is tested. These tests require the individual to listen and attend to a variety of signals and to respond to them by repetition, pushing a button, or ect. However, even though the diagnostic team has been testing R. for CAPD an official diagnosis can not be administered until he is seven, which will be in seven months. The tests require the age of seven because of the variability in brain function of younger children. But starting the testing early will give us a better idea of what direction we should be going in treating him.
Even though the results of the tests have not yet been given, we have started to work on compensatory strategies. These strategies consist of assisting listeners in strengthening central resources such as following directions, memory, and attention skills. An example of the memory skills we have worked on is having R. repeat a series of numbers or words given verbally by the clinician. The following directions part of therapy is also given verbally. However, it is important to understand that there is no “sure-fire” cure for CAPD and different strategies may work well for one client and not for another.
Teri James Bellis, Ph.D., CCC-A (2007). Understanding Auditory Processing Disorders in Children. Retrieved October 16,2007, from http://www.asha.org/public/hearing/disorders/understand-apd-child.htm
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3 comments:
Hi, April,
I know R is a very challenging client for you! We always get the tough ones for our first clients...I guess it's trial by fire!
Anyway, I just wanted to say that I think it's very good practice that even without a certain diagnosis of APD (or anything else, at this time or possibly ever!), that you are still addressing the client's weaknesses and treating them, as well as providing some compensatory strategies.
I think this is important for us to realize in practice as SLPs how we can help each client on an individual basis, regardless of the "pigeonhole" of disorder they may be put into, or trying to find a hole in which to place each peg. (Ok, now I'm just rambling!)
Anyway, keep up the good work!
Paula
My client has CAPD. I almost seem to forget she does sometimes because we work on so many different things and don’t always focus on her CAPD. I find it is true that some strategies don’t work as well for some clients as they do for others. My client has difficulty repeating words back. She does fine with 3 words but can’t do anymore than that. Sometimes it helps when they are in categories. We’ve gone back to using pictures and games. We did try a game the other day where we made a grocery list out loud and we added on an item each time. She did really well at repeating the items back especially if I categorized them. My client has really improved in following verbal directions so now I write out directions and she has to read and remember them. The ASHA Task Force on Central Auditory Processing Consensus Development actually recommends in the article Central auditory processing: Current status of research and implications for clinical practice using visual cues and writing instructions for children with CAPD. This has really helped with my client. She is a more visual learner. I don’t know if you use any visual cues and your client may do fine without them. But it really does help if you ever need to use them.
American Speech-Language Hearing Association Task Force on Central Auditory Processing Consensus Development. (1996). Central auditory processing: Current status of research and implications for clinical practice. American Journal of Audiology, 5, 41-54.
April,
I think that it's beneficial that your client was diagnosed early and that therapy has been implemented because he will likely have better outcomes than if they had not caught onto his delay until later. It's also good that testing for CAPD will be carried out right when the client turns seven. When reading the Understanding Intervention for CAPD article I found some helpful ways that may help your client. The article mentions bottom up training which involves improving auditory skills in auditory discimination, dichotic listening and temporal processing. The article also mentions top-down training which helps with metalinguistic and metacognitive skills that minimizes the impact of CAPD. It seems as though you are already incorporating things to help him since he might have CAPD.
Understanding Intervention for (C)APD: As Easy as A-B-C. ASHA Leader.(2007)Vol.12 Issue 10, pg 20-34, 4p
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