Our chat tonight on Wednesday, May 1, 2002 at 9pm EDT is being hosted by Gail Whitelaw, Ph.D., CCC-AUD. Dr. Whitelaw will lead us in a chat about Central Auditory Processing Disorders. She is currently the Director of Clinical Instruction and Research in the Department of Speech and Hearing Science at The Ohio State University. Dr. Whitelaw is an audiologist with primary interest in pediatrics, including educational issues in children with hearing and listening impairments, classroom acoustics, and amplification issues. She consults and provides educational audiology services to a number of school districts in Central Ohio. In addition, she is a frequent presenter on the topic of Auditory Processing Disorders at State and National meetings. Dr. Whitelaw is currently the audiology faculty member on a 5 year Maternal-Child Health (MCH) Grant with the focus of leadership training in neurodevelopmental disorders at the Nisonger Center at Ohio State. Dr. Whitelaw serves on the Board of Directors of the American Academy of Audiology. <Robin> Welcome! Tonight we are chatting with Gail Whitelaw, Ph.D., CCC-AUD about Central Auditory Processing Disorders (CAPD). <Birmingham> Hello! Is this the Central Auditory Processing Chat? I haven't logged in before. <Robin> Yes, you are in the right place! <Robin> Birmingham, do you have any experience with CAPD? <Birmingham> Basically I just want to know how to treat it differently than just working on listening skills and making accommodations. <Robin> Gail, why don't you give us an overview of CAPD. <Gail Whitelaw> Actually, I want to start with what Birmingham asked. <Gail Whitelaw> Two of the major ways to treat APD are accommodations and environmental modifications. <Birmingham> Are there "therapies" that Audiologists can do? <Gail Whitelaw> Environmental modifications probably have the greatest impact with all kiddos and address listening in the classroom to enchance information to the child. <Birmingham> In my school system, I can ask for a CAPD eval, but it ends up being a dead end. I get back a list of accommodations that I already know how to do for any child with hearing or listening issues. <Birmingham> So, how does the diagnosis help? <Gail Whitelaw> Actually--that's a problem. Different types of CAPD respond in different ways and the recommendations should be tailored to the diagnosis. All kids do well with classroom modifications--normal hearing, APD, etc.--but kids with temporal types of APD don't really get maximal benefit from that and do better with AR (Aural Rehab). <Gail Whitelaw> That focuses on teaching timing issues. <Gail Whitelaw> One of the mistakes that audiologists make is giving a preprinted list of rx that don't target specific skills development. <Birmingham> Can you elaborate on temporal problems? <Gail Whitelaw> Temporal problems are kids that have difficulty with determining timing issues of the audiotory system--SLPs might think of sequencing in the big picutre but audiologists look at a more foundational skills with Pitch or Duration pattern testing and gap detection. <Gail Whitelaw> One of the big questions in our place is to determine which kids might be most appropriate for Fast ForWord. <Birmingham> Do you work with Fast Forword? <Gail Whitelaw> Yes, we use fast forword in our clinic...it's administered by one of our SLP's however I have a role in candidacy decisions. <Gail Whitelaw> Fast ForWord is designed as a program that addresses some temporal issues <Birmingham> What other methods do you use other than Fast ForWord? <Gail Whitelaw> We use a number of methods including Earobics and a program that teaches learning skills which we have developed called CLASS. In addition, we do work on specific skills such as noise desensitization (for kids with issues) of listening in noisy environments or those with difficulty with hyperacusis. <Birmingham> What would you recommend for a child with an ear advantage? <Gail Whitelaw> Depends--ear advantages are normal developmentally, <Gail Whitelaw> however, if a child has difficulty with dichotic listening and they have signficant discrepancy between the two ears, we may look at the poorer ear and address some speech-in-noise issues. <Gail Whitelaw> Also, there are alot of folks who address ear advantages with some different types of things (e.g. switching the phase of headphones on an FM, etc.) but those haven't been proven to work. Building dichotic listening skills certainly helps with reducdancy predictability. <Birmingham> So in a school setting, I am interested in specific therapy techniques I can use to improve these kids ABILITIES. Any suggestions? <Gail Whitelaw> Well....first it depends on what skills you want to work on. Musiek and Shochat have a number of programs that address temporal aspects and work very effectively to build that skill. In addition, FFW works well for that. <Birmingham> From Musiek and Shochat- are they computer programs? <Gail Whitelaw> No--they have published research on their program, but I don't have the reference here by my computer tonight...however, if you e-mail me, I can provide it to you. <Birmingham> yes, I would be interested. <Gail Whitelaw> If you are trying to build issues in competing noise, desensitization techniques developed by Katz and others are a great place to start. <Birmingham> What are some of Katz's techniques? <Gail Whitelaw> Katz uses a noise desensitization program which helps those who are unable to hear well in noise or adjust to the situation develop those skills. This approach supplements classroom amplification. <Gail Whitelaw> Again, that reference isn't sitting here, but I can get it for you...actually, the Katz and Stecker book on CAPD mostly management is a great resource. <Gail Whitelaw> Sloan has a book for addressing some specific auditory processing skills. <Gail Whitelaw> Birmingham--do you work in an elementary school setting? <Birmingham> Yes <Gail Whitelaw> Does your school audiologist do the CAPD testing or do you use someone in the community? <Birmingham> I have 1-2 kids with significant listening comprehension issues. I have had 3 kids tested by the audiology practice my school contracts with and <Birmingham> I have received a blanket sheet of accommodations...like you said. So I am on my own. I do not ask for testing any longer, because in the end, it serves no purpose. So... <Gail Whitelaw> That's too bad...I am in a clinic setting and our school "customers" are pretty demanding about what our reports need to look like and what types of recommendations they need. <Gail Whitelaw> What do you mean by listening comprehension--what behaviors are you working on? <Birmingham> I work on focus, auditory memory, verbal rehearsal and gradually building these skills. By listening comprehension I mean kids who can't answer basic questions if done in a listening format, but could do it, if they could read it or if they had the printed text to look up the answer. <Gail Whitelaw> I'm glad for that, since I think we work hard to address specific things for the kiddos. <Gail Whitelaw> For these kids, is the answer "bottom up" (e.g. auditory) or a combination of "bottom up and top down (auditory and language)? <Birmingham> I think our group is just coming from inexperience in the area....they want to help. <Gail Whitelaw> And it's great to have resources, since they can learn what your needs are and better serve them and the kids. <Gail Whitelaw> Often kids with "listening comprehension" are the types that do well with classroom amplification. <Gail Whitelaw> That added "boost" provides additional benefit in the manner that you suggested-- "equals" other modalities. <Birmingham> Yes, the teachers of children with cochlear implants love it because of what it does for all their kids. <Gail Whitelaw> There is a wonderful study by Gail Rosenberg and her colleagues that indicates that all children benefit from soundfield amplification. <Gail Whitelaw> But the children that benefit the most are the normal hearing, normal language kids. <Gail Whitelaw> It was done over 30 school districts in FL over several years. <Gail Whitelaw> Actually, some of the auditory-verbal strategies for CI kids work well for APD kids also. <Birmingham> Ok, thank you for your help. <Gail Whitelaw> There is a program called the WASP (author is Mary Koch) that works on building foundational listening skills in hearing impaired kids that can work well with APD kids. <Gail Whitelaw> Robin...it's interesting to see how APD testing is done in kids...no wonder people in schools are confused when minimal information about the child's skills are provided. <Gail Whitelaw> It would be like me getting a report that indicated a child had a expressive language disorder--doesn't tell much without the details! <Robin> Yes, based on the eval info you told us about in the student chat, there should be a lot of info available from the eval. <Gail Whitelaw> And for some "types" of APD, listening strategies and accommodations are fine... so Birmingham might be doing the right thing for some kids and not for others. <Robin> Obviously, the group doing the evals for Birmingham's students could use a little advice! <Robin> You would think that there would be a standard battery of tests, right? <Gail Whitelaw> Yes, that's a problem with APD....there's no standard of anything. Many audiologists with lots of experience do well with this stuff but for others, it's a stab in the dark...and I believe that we have to be shaped by the need for a functional assessment--that's what drives our test battery. <Robin> exactly <Birmingham> What age do you recommend CAPD testing? <Gail Whitelaw> It's most effective around age 7, however children as young as 4-5 can be tested provided they have intelligible speech and normal hearing acuity has been confirmed. <Birmingham> Who should be referred? <Gail Whitelaw> In our practice, we also want to see normal cognitive abilities, and as we all know, sometimes we're still trying to get the details on kids at that age. <Gail Whitelaw> Well...there's probably a laundry list here--many kids with APD have trouble distinguishing speech sounds--they have often been in treatment forever with no progress. <Gail Whitelaw> They are also often the kid that says "huh or what" and teacher is convinced there is a hearing loss. <Gail Whitelaw> Generally, it's a long standing problem and these are often kids with significant histories of otitis media. <Gail Whitelaw> There are a couple of good checklists that are normed which help to direct referrals. <Gail Whitelaw> One is the Fisher's <Gail Whitelaw> The one we use is the CHAPPS <Gail Whitelaw> and the SIFTER is also good....these are all available from the educational audiology association for a very reasonable price. <Birmingham> How accurate have you found it as a screening tool? <Gail Whitelaw> CHAPPS is MUCH better than the TAPS, which is what a lot of SLP's in our area seem to use. <Gail Whitelaw> Actually, we find that CHAPPS pretty good as a screener, and as I mentioned, I think its' also well normed. <Birmingham> Do you feel CAPD and Phon. Awareness are linked? <Gail Whitelaw> Great question and yes...many kids with specific types of APD have issues with phonological awareness. In our battery, we sometimes include phonemic synthesis and the LAC to augment some of the other PA testing the SLP's do. <Gail Whitelaw> In addition, many of these kids have poor "closure" abilities. <Birmingham> Closure? <Gail Whitelaw> Auditory closure---it's a skill that audiologists measure by filtered word types of testing, which was actually the first type of APD testing used in the 1950's. <Gail Whitelaw> Kids with these types of difficulties are often unable to "fill in" missing information from the bottom up--they have the "higher level" skills but their auditory system isn't providing enough information to them. <Birmingham> Yes! Many of my Asperger/ PDD kids also demonstrate this.. <Gail Whitelaw> However, it's probably from a "different' place in this population--not just Central Auditory Nervous System related. <Gail Whitelaw> We have stopped seeing PDD kids for APD evaluations due to the conclusion that it really doesn't do much to direct treatment (so that's probably a candidacy issue, too). <Birmingham> By that do you mean the treatments weren't effective with this population <Gail Whitelaw> I think that some of the treatments can be beneficial but don't work to alliveate the behaviors (e.g. listening, etc) that present, which is a different perspective than in APD only (exclusive kids). <Birmingham> I see. <Gail Whitelaw> In addition, I think that some of the treatments designed to address APD address CANS issues and for PDD/Aspergers it's more global. <Robin> I see it's getting late....any last questions? <Birmingham> Well, I will look forward to reading the references you cited. <Robin> Thanks so much time for your and wisdom, Gail! <Gail Whitelaw> you're welcome--good night <Robin> goodnight all!!!! |
