This document discusses auditory processing disorders (APD), including a historical overview of the study and diagnosis of APD. It notes that interest in APD dates back over 50 years, and that understanding of APD has advanced due to developments in neuroscience and functional neuroimaging. APD is often co-morbid with other disorders like language impairment, ADHD, and dyslexia. Both behavioral tests and electrophysiological measures can be used to assess APD. Effective management of APD may involve auditory training and addressing any co-existing disorders.

1. I’m lost in this class! What’s wrong with me? I just can’t hear right. AUDITORY PROCESSING DISORDERS (APD): A Common and Serious Problem

4. 8 th cranial (auditory) nerve) Internal auditory canal Shares space with vestibular nerves, facial nerves, efferent auditory nerves & internal auditory artery Central auditory nervous system Cochlear nuclei Superior olivary complex Lateral lemiscus Crossing pathways Infererior colliculus Reticular (activating) formation Thalamus Primary and secondary auditory cortex Corpus collosum

5. Behavioral Audiometry: True Measures of Hearing

6. Behavioral Audiometry: Sound Field versus Earphone Stimulation

7. The Audiogram: Hearing Sensitivity as a Function of Pure Tone Frequency

8. AUDITORY PROCESSING DISORDERS (APD): Academic Underachievement & Failure F I must be stupid!

9. Age and Gender Distribution in an Unselected APD Population in a Medical Center Audiology Clinic (N = 239) Age in Years 5 Number of Patients 7 8 9 10 11 12 13 14 15 - 18 10 20 25 Male (N = 160) Female (N = 79) 15 Average age = 9 Years

10. AUDITORY PROCESSING: Cornerstone of Language and Literacy (Reading) AUDITORY PROCESSING PHONOLOGIC AWARENESS ORAL LANGUAGE WRITTEN LANGUAGE Reading and Spelling COMPREHENSION

12. Carlo Calearo, M.D. Otorhinolaryngologist “Italian Pioneer in APD Assessment” Bocca E, Calearo C, Cassinari V. A new method for testing hearing in temporal lobe tumors. Acta Otolaryngologica 44: 1954 .

13. Helmer Myklebust, Ph.D. (in psychology) Northwestern University “Pioneer in APD Assessment” Myklebust HR. Auditory disorders in children: A manual for differential diagnosis. New York: Grune & Stratton, 1954 . “ hearing is a receptive sense … and essential for normal language behavior” (p. 11) “ the diagnostician of auditory problems in children has traditionally emphasized peripheral damage. It is desirable that he (sic) also include central damage.” (p. 54)

14. Dichotic Listening Paradigm … A long-standing test strategy for assessment of auditory processing 1956: British Psychologist Donald E. Broadbent, Ph.D. 1961: Canadian Psychologist Doreen Kimura, Ph.D.

15. Dichotic Listening Paradigm RIGHT TEMPORAL CORTEX Association Cortex Primary Auditory Cortex Right Ear air plane 1, 3 Corpus Callosum LEFT TEMPORAL CORTEX Association Cortex Primary Auditory Cortex Left Ear base ball 5, 9

16. Development of APD Assessment & Management: Principles & Procedures Bocca & Calearo Myklebust 1954 1960 Katz Kimura 1975 Willeford Jerger 1986 Keith AMLR studies Musiek 1982 1996 1990s procedures MRI studies ASHA Task Force Tallal Kraus 2000 APD Conference fMRI Earobics

29. Auditory Late Response and P300 Response 500 ms Frequent Unattended e.g., 1000 Hz P2 Amplitude (  V) P2 P3 (300) Infrequent (rare) Attended e.g., 2000 Hz N1

30. Mismatch Negativity (MMN) Response: “Unconcious Brain Response Elicited by Different Properties of Sound (Courtesy of Catharine Pettigrew, Ph.D.)

32. Neuroscience Evidence for APD: Functional Neuro-Imaging (fMRI) Left Handed 18 Year Old with Right Ear Deficit on Dichotic Tests Right TL

36. Shared Anatomy Reading Language Auditory processing

38. AUDITORY PROCESSING DISORDERS (APDs): Co-existing Disorders (Co-morbidity) SLI ADHD dyslexia APD

42. APD: Screening and Assessment in Pre-School Children I can’t figure out what they are saying!

46. Auditory Processing Disorders: Indicators in Early School Age Population and Screening for At Risk Children (SIFTER)

47. Auditory Processing Disorders: Indicators in Early School Age Population and Screening for At Risk Children (CHAPS)

52. Assessment of APD: Central Auditory Test Battery (~ 80 minutes)

54. Dichotic Digits Procedure LEFT TEMPORAL CORTEX Association Cortex Primary Auditory Cortex Right Ear 2, 9 Left Ear 1, 4 Corpus Callosum RIGHT TEMPORAL CORTEX Association Cortex Primary Auditory Cortex

64. APD MANAGEMENT: Computer-based Auditory Therapy (www.cogcon.com) Earobics comes in two versions: Earobics Foundations for pre-kindergarten, kindergarten, and first grade students • Earobics Connections for second and third grade students, and other struggling readers Instructions available in 10 languages

66. Earobics: Comments from Website (www.cogcon.com) Earobics is widely considered to be one of the most validated and quantifiable reading intervention programs. States across the country have reviewed the program and approved its use in their schools to quickly and effectively build student reading achievement. Independent industry reviewers, including the Florida Center for Reading Research (FCRR), confirm these findings. As a vital source for districts and schools, FCRR regularly reviews reading programs to help teachers, principals, and district administrators make informed choices on effective instruction. Earobics was among the select few programs in the supplemental, intervention, and technology-based program categories to achieve the FCRR’s highest ranking in all five reading areas. NOTE: FCRR = Florida Center for Reading Research (www.fcrr.org)

70. Classroom Assistive Listening Devices Personal FM Headset Style Desktop Toteable FM Infrared Sound Field FM

71. Phonak EduLink A viable option for all children, particularly adolescents Campus S Transmitter EduLink Receivers Mini-Boom Microphone

72. SNR improvement on the HINT in normal hearing adults and children without and with APD: Three different FM system types Listening Condition 2 SNR Improvement (in dB SPL) Adults (N = 10) Non-APD (N = 8) APD (N = 12) 4 6 8 Head set Desk top 7.5 4.0 7.4 3.8 9.5 6.5 10 Sound field 4.7 4.3 7.2

74. Educational Performance: Fisher’s Auditory Checklist Findings Completed by Parents (Difference in scores between groups significant at p < .000)

76. Educational Performance: SIFTER (Difference in scores between groups for all categories except School Behavior [p < 0.57)]significant at p < .05)

84. Dichotic Intensity Increment Difference (DIID) LEFT TEMPORAL CORTEX Association Cortex Primary Auditory Cortex Strong Ear increasing intensity Weak Ear fixed intensity Corpus Callosum RIGHT TEMPORAL CORTEX Association Cortex Primary Auditory Cortex

92. Multiple Tiers of Reading Instruction Models: Conventional (e.g., Torgesen, 2005) vs. Early Intervention (EARS) Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12 Grade Reading Skills Core Reading Program Powerful Intensive Intervention (Struggling Readers) EARS Program

93. EARS Program (2005-2006): Early (Kindergarten) Intervention Program for At Risk Struggling Children Core Reading Program (Tier 1) All kindergarten children in Title I schools undergo auditory and language screening Intensive Intervention (Tier 3) Small group inclusive instruction Pre-reading skills Phonologic awareness instruction At risk? Monitor Outcome (DIBELS) National 70%ile? Not at risk? Phonologic Awareness Enhancement (Tier 2) Classroom FM system Classroom instruction Earobics program

94. Early Auditory Reading Success (EARS): Final Outcome 2005 by DIBELS scores (Williams Elementary School) National %ile Letter Sound Fluency 20 40 60 80 100 96 92 94 Phonemic Sequence Fluency Nonsense Word Fluency HR MR LR AA Est HR MR LR AA Est HR MR LR AA Est Established 04

95. EARS: DIBELS Final Grade Assessment 2005/2006 First Grade PSF NWF ORF

96. EARS: DIBELS National %ile rank in final test interval of First Grade for EARS participants (2005/2006) OLV Oral Language Vocabulary Reading Comp Reading Comprehension

98. MANAGEMENT OF APD: Facilitating academic achievement & success I must be smart!