Nowell managing supramodal influences handout
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Audiology Now 2012 conference in Boston 3/30/12: "Managing Supramodal Influences: Distinguishing (C)APD from ADHD."
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Nowell managing supramodal influences handout
- 1. Managing Supramodal Influences: Distinguishing (C)APD from ADHD
- 2. Overview • What – and where – is CAPD? • Assessment of ADHD and CAPD • Managing supramodal influences • Integrating top-down and bottom-up
- 3. Objective • Let’s integrate top-down and bottom-up into assessment and treatment
- 5. Diagnostics as “making distinctions”
- 8. Hard signs and soft signs
- 10. “Top–down” dysfunction • ADHD • Executive dysfunction 3/30/2012 © 2011 David D. Nowell, Ph.D. All rights reserved. 10
- 11. “Bottom-up” dysfunction • Central auditory processing problems • Sensory processing problems 3/30/2012 © 2011 David D. Nowell, Ph.D. All rights reserved. 11
- 12. WHAT – AND WHERE - IS APD?
- 13. Deficits • sound localization • auditory discrimination • auditory pattern recognition • temporal aspects of audition • auditory performance in competing acoustic signals and with degraded acoustic signals
- 14. 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
- 15. 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
- 16. The Construct of APD • may not be exclusively bottom-up • may be impacted by attentional factors
- 17. • Acquired • Secondary • Developmental
- 24. k /a / t
- 25. “cat”
- 26. “Hier gibt es kein platz mehr.”
- 27. NO LOITERING NO SE PERMITTE VAGABUNDOS
- 30. “tomar”
- 34. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 34 reserved.
- 35. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 35 reserved.
- 36. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 36 reserved.
- 37. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 37 reserved.
- 38. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 38 reserved.
- 39. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 39 reserved.
- 40. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 40 reserved.
- 41. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 41 reserved.
- 42. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 42 reserved.
- 43. © 2011 David D. Nowell, Ph.D. All rights 3/30/2012 43 reserved.
- 45. Asssessment of ADHD • History • Review of records • Collateral report • Checklists • Behavioral observations • Assessment of IQ, academics, language, memory, attention/vigilance, and exeuctive functioning
- 46. ADHD is not: • Dementia • Global developmental (intellectual) delay • Psychiatric disorder • Acquired (stroke, brain injury) language disorder • Sleep disorder • Auditory or sensory processing disorder
- 47. Assessment of CAPD • History • Review of records • Collateral report • Checklists • Behavioral observations • APD screening • Diagnostic audiological assessment • Electrophysiologic assessment
- 48. 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”)
- 49. Approaches to Test Scores • norm-based interpretation (absolute), and • patient-based interpretation (relative)
- 53. Buffalo Model • Decoding • Tolerance-fading memory • Integration • Organization “what we do with what we hear”
- 54. Bellis / Ferre Model • Primary – decoding, prosodic, and integration deficits • Secondary – associative and output organization deficits
- 55. Identify (and treat) specific deficits
- 56. Common Recommendations for APD Evaluation • Rule out peripheral auditory involvement • Rule out attention, memory, and intellectual impairment • Rule out a language impairment
- 57. Common Recommendations for APD Evaluation • Rule out peripheral auditory involvement • Rule out attention, memory, and intellectual impairment • Rule out a language impairment
- 59. CAPD or ADHD? • Asks for things to be repeated • Inattention • Poor Listening skills • Academic Difficulties • Difficulty following oral • Daydreams instructions • Difficulty discriminating speech • Distracted • Difficulty hearing with • Poor Listening Skills background noise • Difficulty maintaining auditory • Disorganized attention in quiet • Academic difficulties • Asks for things to be repeated • Slow to process information • Auditory divided attention deficit
- 60. CAPD or ADHD? • Asks for things to be repeated • Inattention • Poor Listening skills • Academic Difficulties • Difficulty following oral • Daydreams instructions • Difficulty discriminating speech • Distracted • Difficulty hearing with • Poor Listening Skills background noise • Difficulty maintaining auditory • Disorganized attention • Academic difficulties • Asks for things to be repeated • Slow to process information • Auditory divided attention deficit
- 61. CAPD or ADHD? • Asks for things to be repeated • Inattention • Poor Listening skills • Academic Difficulties • Difficulty following oral • Daydreams instructions • Difficulty discriminating speech • Distracted • Difficulty hearing with • Poor Listening Skills background noise • Difficulty maintaining auditory • Disorganized attention • Academic difficulties • Asks for things to be repeated • Slow to process information • Auditory divided attention deficit
- 62. CAPD or ADHD? • Asks for things to be repeated • Inattention • Poor Listening skills • Academic Difficulties • Difficulty following oral • Daydreams instructions • Difficulty discriminating speech • Distracted • Difficulty hearing with • Poor Listening Skills background noise • Difficulty maintaining auditory • Disorganized attention • Academic difficulties • Asks for things to be repeated • Slow to process information • Auditory divided attention deficit
- 64. Managing supramodal influences in the assessment • Altering the redundancy of the signal • “Teasing out” aspects of the processing pathway
- 65. 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?
- 66. Comorbidity “tell me two stories”
- 67. 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?
- 68. What’s the kid’s deal?
- 69. Modularity
- 77. • Phonemic awareness or auditory aphasia? • Working memory or divided attention?
- 79. Bottom up interventions • Auditory training • FM transmission • Environmental modification • Training the speaker to face the listener, check for understanding
- 80. Bottom up interventions • Preferential seating • Increased use of visual cues • Auditory training • Untimed testing • Prosody, intonation
- 81. 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
- 82. Future directions • Research • Clinical collaboration – Assessment – Treatment • School-based collaboration • Mutual education • Humility
- 83. Let’s stay in touch! Join my e-newsletter list: Fill out a card today and drop it in the box. Text to join: text DNSEMINARS to 22828 Sign up on my web site or Facebook page Visit us on the web: www.DrNowell.com davidnowell David Nowell Seminars
- 84. 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
- 85. 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
- 86. 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.
- 87. 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.
- 88. 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.
- 89. 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.
- 90. 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.
- 91. 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.
Editor's Notes
- 5 MINUTE OVERVIEW
- Who does capd in worc?Happy to receive your feedback to help me answer Qs at my workshops
- Who does capd in worc?Happy to receive your feedback to help me answer Qs at my workshops
- 2038
- Scott peck: diagnostician. DI vs. intake, etc.NLP: distinctions.
- Neurological hard signs, soft signs, and developmental soft signs
- The softest of them all!
- No “gold standard” but…
- You like thick puddings.You like thickpuddings?You LIKE thick puddings!You like THICK puddings!You like thick puddings.(Brit. Accent) You like fick (thick) puddings?
- Converts movement into elec. signals
- VIII
- Intensity, basic phonemic info, timing infoorganized tonotopically
- Sharpening / Suppresses sensitivity / localizationPons1st major site of convergence
- Passes through laterallemniscus on way to ICSound info integrated / ?pitchVestibulo-ocular reflex (just beneath the superior colliculus)
- Relay?auditory fear conditioning?
- Prior to evaluation with the Buffalo Battery pure-tone thresholds, tympanometry and acoustic reflexes should be carried out to determine the status of the person's peripheral hearing and middle ear functions."But the four categories within the Buffalo Model can help us understand the child's deficits," Dr. Richburg said. Decoding deficits refer to the difficulty children have in processing what they hear accurately and quickly. They have problems keeping up with the flow of communication and running discourse."These children have problems processing at a phonemic level," she explained. "They can't put 'sh,' 'u' and 't' together to make the word 'shut.' They have poor phonic abilities and trouble reading and spelling."These children also may have receptive language problems and impairments in discrimination, closure abilities and temporal resolution. "That's my problem with these categories," she said. "A lot falls under this one decoding deficit classification."Children with tolerance-fading memory deficits have difficulty blocking out background noise. Their performance suffers in a noisy classroom environment, leading teachers to label them as distractible. They have poor reading comprehension, oral and written expression, and short-term memory, which prevents them from filling in the information they might have missed.Integration deficits make it difficult for children to bring in information from different modalities, such as receiving auditory and visual information at the same time. These children often are labeled as learning disabled or even dyslexic. They may be poor readers, have trouble with spelling, and exhibit difficulty with multimodal tasks. "If they see and hear something, it's as if one is cancelling out the other," Dr. Richburg said. "It creates confusion." They may have word-finding problems and trouble with oral and written language expression as well.Children with organization deficits often have a disheveled appearance, disorganized thoughts and messy handwriting. They turn in sloppy work and fatigue easily because of the constant energy they must exert in trying to organize their thoughts."The literature says they frustrate easily and try to take shortcuts because that seems easier for them," said Dr. Richburg. "They are trying to reduce all the strain and fatigue they have when trying to listen to their environment."
- family/genetic historypre-, peri-, and post-natal coursehealth statuscommunication listening and auditory behaviorpsychological factorseducational achievementsocial development cultural and linguistic backgroundprior related therapycurrent therapy (ASHA, 2005)uditory and/or communication difficulties experienced by the individual..family history of hearing loss and/or central auditory processing deficits..medical history, including birth, otologic and neurologic history, general health history, and medications..speech and language development and behaviors..educational history and/or work history..existence of any known comorbid conditions, including cognitive, intellectual, and/or medical disorders..social development..linguistic and cultural background..prior and/or current therapy for any cognitive, linguistic, or sensory disorder or disability. Childhood history of repeated ear infections• Difference in auditory attentiveness and processing in large groups vs. one-on-one(Unlike the A.D.D. child who is intrinsically distracted, even in a one-on-oneenvironment)• Difference in attentiveness depending on the task. (Unlike A.D.D. child who hasdifficulty completing written tasks or independent projects. The child with CAP hasmarked inattention during whole-class instruction and conversations, but does betterwhen "doing" something)• Often has word retrieval issues or poor ability to learn new words, particularly multisyllabic• Difficulty with reading and spelling• History of speech deficits (may have residual articulatory "imprecision" andinconsistent errors, "mumbly-sounding" speech)• Difficulty following directions• Needs instructions and information repeated many times for it to "sink in"• Seems "tired" with his/her head on the desk after a long direct lesson or by the end ofthe day• Often doesn't attend to his or her name (seems hearing-impaired but isn't)• Misinterprets questions or the point of a class discussion• May score adequately on language and processing tests given by the SLP, yetdemonstrate listening problems in the classroom• May have sensory integration weakness• May have fine and/or gross motor weaknesses• May have neurological impairment or "soft signs"difficulty understanding speech in the presence of competing background noise or in reverberant acoustic environments..problems with the ability to localize the source of a signal..difficulty hearing on the phone..inconsistent or inappropriate responses to requests for information..difficulty following rapid speech..frequent requests for repetition and/or rephrasing of information..difficulty following directions..difficulty or inability to detect the subtle changes in prosody that underlie humor and sarcasm..difficulty learning a foreign language or novel speech materials, especially technical language..difficulty maintaining attention..a tendency to be easily distracted..poor singing, musical ability, and/or appreciation of music..academic difficulties, including reading, spelling and/or learning problemsPrior to evaluation with the Buffalo Battery pure-tone thresholds, tympanometry and acoustic reflexes should be carried out to determine the status of the person's peripheral hearing and middle ear functions."But the four categories within the Buffalo Model can help us understand the child's deficits," Dr. Richburg said. Decoding deficits refer to the difficulty children have in processing what they hear accurately and quickly. They have problems keeping up with the flow of communication and running discourse."These children have problems processing at a phonemic level," she explained. "They can't put 'sh,' 'u' and 't' together to make the word 'shut.' They have poor phonic abilities and trouble reading and spelling."These children also may have receptive language problems and impairments in discrimination, closure abilities and temporal resolution. "That's my problem with these categories," she said. "A lot falls under this one decoding deficit classification."Children with tolerance-fading memory deficits have difficulty blocking out background noise. Their performance suffers in a noisy classroom environment, leading teachers to label them as distractible. They have poor reading comprehension, oral and written expression, and short-term memory, which prevents them from filling in the information they might have missed.Integration deficits make it difficult for children to bring in information from different modalities, such as receiving auditory and visual information at the same time. These children often are labeled as learning disabled or even dyslexic. They may be poor readers, have trouble with spelling, and exhibit difficulty with multimodal tasks. "If they see and hear something, it's as if one is cancelling out the other," Dr. Richburg said. "It creates confusion." They may have word-finding problems and trouble with oral and written language expression as well.Children with organization deficits often have a disheveled appearance, disorganized thoughts and messy handwriting. They turn in sloppy work and fatigue easily because of the constant energy they must exert in trying to organize their thoughts."The literature says they frustrate easily and try to take shortcuts because that seems easier for them," said Dr. Richburg. "They are trying to reduce all the strain and fatigue they have when trying to listen to their environment."
- (Bellis, 2003; Musiek & Chermak, 1997, 2007, ASHA 2005)
- 8:20
- 8:20
- 8:20
- Prior to evaluation with the Buffalo Battery pure-tone thresholds, tympanometry and acoustic reflexes should be carried out to determine the status of the person's peripheral hearing and middle ear functions."But the four categories within the Buffalo Model can help us understand the child's deficits," Dr. Richburg said. Decoding deficits refer to the difficulty children have in processing what they hear accurately and quickly. They have problems keeping up with the flow of communication and running discourse."These children have problems processing at a phonemic level," she explained. "They can't put 'sh,' 'u' and 't' together to make the word 'shut.' They have poor phonic abilities and trouble reading and spelling."These children also may have receptive language problems and impairments in discrimination, closure abilities and temporal resolution. "That's my problem with these categories," she said. "A lot falls under this one decoding deficit classification."Children with tolerance-fading memory deficits have difficulty blocking out background noise. Their performance suffers in a noisy classroom environment, leading teachers to label them as distractible. They have poor reading comprehension, oral and written expression, and short-term memory, which prevents them from filling in the information they might have missed.Integration deficits make it difficult for children to bring in information from different modalities, such as receiving auditory and visual information at the same time. These children often are labeled as learning disabled or even dyslexic. They may be poor readers, have trouble with spelling, and exhibit difficulty with multimodal tasks. "If they see and hear something, it's as if one is cancelling out the other," Dr. Richburg said. "It creates confusion." They may have word-finding problems and trouble with oral and written language expression as well.Children with organization deficits often have a disheveled appearance, disorganized thoughts and messy handwriting. They turn in sloppy work and fatigue easily because of the constant energy they must exert in trying to organize their thoughts."The literature says they frustrate easily and try to take shortcuts because that seems easier for them," said Dr. Richburg. "They are trying to reduce all the strain and fatigue they have when trying to listen to their environment."
- 2’ary subtypes recognize relat. b/t audition and higher order language or organizational fx? Assoc ll what I would see as SCT? (ll aphasia)Associative – intra-hemispheric / comm. b/t 1ary and 2ary auditory areasOutput-org lladhd, and may include deficits w/ acoustic reflexes
- “third” model (?musiek) per jasonmosheim article
- 1. They are bored because the work is too easy.2. They are overwhelmed because the work is too hard.3. They are worried about any number of other things (from family issues to whether there is going to be pizza left at lunchtime)4. The teacher is speaking too quietly.5. The acoustics in the room are poor.6. They are tired from lack of sleep.7. They are hungry.8. They are not from an English-speaking family and therefore do not process theinstructions or information well.9. They have a hearing impairment in one or both ears.10. They have fluid in their ears from a recent cold or allergies.11. They are allergic to something they ate at breakfast or lunch and so are distractible.12. They are taking medications for allergies, asthma, or any number of things that cause a child to be "jumpy".13. They don't feel well.14. A child sitting near them is engaging in behaviors that are distracting.15. The teacher has a monotonous voice.16. The content of the lesson is not interesting.17. The child has been sitting for too long and needs to move around.18. The teacher's expectations of the class’s auditory attention are overestimated for theirage and development.19. The teacher is not using a good mix of visual/ auditory/ and "hands-on" methods.20. Young children may have little preschool experience listening in large groups.21. The child has poor balance and trunk control resulting in difficulty staying seated,causing him/her to be distractible.22. The child has a learning disability, A.D.D., or other auditory processing disability.
- Sounds are redundant, and auditory system is redundant
- The Committee of UK Medical Professionals Steering the UK Auditory Processing Disorder Research Program have developed the following working definition of Auditory Processing Disorder: "APD results from impaired neural function and is characterized by poor recognition, discrimination, separation, grouping, localization, or ordering of speech sounds. It does not solely result from a deficit in general attention, language or other cognitive processes.
- The Committee of UK Medical Professionals Steering the UK Auditory Processing Disorder Research Program have developed the following working definition of Auditory Processing Disorder: "APD results from impaired neural function and is characterized by poor recognition, discrimination, separation, grouping, localization, or ordering of speech sounds. It does not solely result from a deficit in general attention, language or other cognitive processes.
- The Committee of UK Medical Professionals Steering the UK Auditory Processing Disorder Research Program have developed the following working definition of Auditory Processing Disorder: "APD results from impaired neural function and is characterized by poor recognition, discrimination, separation, grouping, localization, or ordering of speech sounds. It does not solely result from a deficit in general attention, language or other cognitive processes.
- Dx approach
- Strive for it, be open to seeing modularity. And also note nonmodularity when it shows up.One particular area of debate has concerned the modality-specific nature of (C)APD and its differential diagnosis. Some definitions of (C)APD imply (or state outright) that the diagnosis of (C)APD can be applied only when a (perceptual) deficit is demonstrated in the auditory system and nowhere else (e.g., Cacace & McFarland, 1998; Jerger & Musiek, 2000; McFarland & Cacace, 1995). At its extreme, this would mean that individuals with auditory temporal processing deficits who also display pansensory temporal deficits (e.g., Tallal, Miller, & Fitch, 1993) would, therefore, not meet diagnostic criteria for (C)APD. An extensive literature in neuroscience influenced the Working Group's conclusion that the requirement of “modality-specificity” as a diagnostic criterion for (C)APD is not consistent with how processing actually occurs in the CNS. Basic cognitive neuroscience has shown that there are few, if any, entirely compartmentalized areas in the brain that are solely responsible for a single sensory modality (Poremba et al., 2003; Salvi et al., 2002). Instead, multimodality influences inform even the most basic neural encoding and manipulation of sensory stimuli (e.g., Calvert et al., 1997; Mottonen, Schurmann, & Sams, 2004; Sams et al., 1991). Evidence of convergent sensory “tracks,” multisensory neurons, and neural interfacing further demonstrates the interdependent and integrated processing of sensory data, supported by cognitive domains (i.e., attention, memory) and language representations (e.g., Bashford, Reinger, & Warren, 1992; Bradlow & Pisoni, 1999; Groenen, 1997; Phillips, 1995; Salasoo & Pisoni, 1985). In fact, a rigorous assessment of multimodality function is not within the scope of practice of any one professional group or discipline. Therefore, based on an extensive review of the literature in auditory and cognitive neuroscience, neuropsychology, and related areas, this Working Group concluded that any definition of (C)APD that specifies complete modality-specificity as a diagnostic criterion is neurophysiologically untenable. Instead, our definition and conceptualization of (C)APD must be consistent with the manner in which auditory and related processing occurs in the CNS. Nevertheless, it is recognized that individuals with (C)APD exhibit sensory processing deficits that are more pronounced in the auditory modality and, in some individuals, auditory-modality-specific effects may be demonstrated (Cacace & McFarland, 1998).
- Training, px, and referral silos
- Phonemic awareness or auditory aphasia?Working memory or divided attention?
- Phonemic awareness or auditory aphasia?Working memory or divided attention?
- MYSTERY BOXHAVE ST / VP PUT NAMES OF ATTENDEES IN HATAPPENDIX A p. a2: TO DO