That Thing That Isn't APD - Ep. 044

When a child has difficulty with listening skills, auditory processing and auditory memory, we could give it a lot of names, including Auditory Processing Disorder, or APD. But whether or not a client has an official APD diagnosis, SO many of them struggle in these areas. When it comes to working on listening, attention, and memory, you can’t start too soon, because improving listening and  processing improves everything else. 

---- Podcast Links ----

Phonological Awareness Tracking Form episode 11,
Narrative Language Intervention with Doug Peterson Part 1 episode 23,
Narrative Language Intervention with Doug Peterson Part 2 episode 24,
Opportunity Cost episode 42,

Phonological Awareness Products
Prime to Rhyme Cards,
Phonological Awareness Tracking Form (actual form)

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Denise: Welcome to The Mindful SLP, the show that explore simple but powerful therapy techniques for optimal outcomes. I'm Denise Stratton, a pediatric speech language pathologist of 30 years. I'm closer to the end of my career than the beginning and along the way, I've worked long and hard to become a better therapist.

Join me and I'll do my best to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. Joining me in the conversation is Dan, my technical wizard and office manager.

Today. I want to talk about auditory processing disorders or disorders where children seem to have trouble understanding the sequence of sounds. And we might not even call that auditory processing disorder. And that's why this episode is called That Thing That Isn't APD, because there is some confusion based around that.

A couple of years ago, I went to my state convention and went to a presentation on this subject. The presentation I went to was put on by audiologists. They were the presenters, right? And their position, which I find really interesting was that auditory processing disorder doesn't need to be a separate diagnostic category.

In other words, all the symptoms that someone with auditory processing disorder has, could fit within the speech language realm, if you want to call it that.

Dan: It's not just an audiology thing is what they're saying.

Denise: And I was a lone SLP in a sea of audiologists, which I find really interesting because it was so pertinent to our field. I looked around and I'm like, am I the only speech therapist in this room? And they had lots of research, which I won't go into here to back up their position. It's kind of what I had been thinking already. I had just created my prime to rhyme cards, just like a month before I went to this conference.

And so I was already thinking, I was really thinking about the kids who couldn't seem to process a sequence of sounds not even a consonant vowel. They couldn't remember two sequences of sounds long enough to say that boo rhymed with who or whatever.

Dan: Uh huh. That makes sense why you'd pick up on that. And it would be interesting.

Denise: Now not everyone agrees, just so we are clear there.

Dan: Does anybody in your profession agree?

Denise: Because, because to be honest, I couldn't find that research from 2020, I wanted to reference it for this podcast. So I just went to the ASHA website and I put in auditory processing disorders. And if you do that, you might come away more confused than enlightened, which is what happened to me. I thought it was really clear when I just remembered that presentation at the convention.

And then I read all this stuff and I was like, oh, this is so confusing, but this is what I do know. Many, many of my clients struggle with processing what they hear, with processing sounds in a sequence and so forth. So I do know that. There's something there, don't know what you want to call it.

And I do know that the whole term of auditory processing disorder or even central auditory processing disorder is a huge overwhelm for parents, or they hear something like your child has a language disorder. Oh. And by the way, they also have, this.

Dan: Double the words and they're huge and they're scary. It sounds scary. It sounds like their brains don't work.

Denise: I know. And I treated a child for dyslexia this summer and his mom was just so intimidated by that. She said she had him tested. I wasn't one who tested him because he was having difficulty reading. So he took him to a specialist and he said, they say he can't process.

I mean, she was just like, she was petrified for his future. I did some Equip for Reading Success, the program by Dr. Kilpatrick. He didn't have any other issues, no other language issues. It was just, he didn't know how to process sounds, how to break syllables apart, put them back together, manipulate sounds within. And he was a real easy fix. Now they didn't tell her he has auditory processing disorder. They said he has dyslexia, but the whole term for her is he has a processing problem. I mean, that's what I'm trying to get at that just scared the pants off of her.

Dan: Yeah, well, it would, that's lots of big words for people who don't know what it is.

Denise: And this also reminds me of our friend who called us. In fact, this was right after I went to that convention just a couple of months after.

Dan: A friend of ours whose wife, she was going back to college to become a lawyer, and she was, she was having a little bit of a tough go of it being a law student and having what had been diagnosed as an auditory processing disorder.

Denise: And he's like, okay, so what do we do? And I said, well, what are you doing now? What are you looking for? And he names off all these things that they're already doing, accommodations, and also mentions that she has ADHD and we got talking more and he's kind of like, yeah, that stuff, I mean, those could just be symptoms of ADHD too, couldn't it?

So it gets really, really confusing. And I know that on ASHA some of the articles, they talk about this, you know, how you separate these things out and you've got to be careful that you don't say ADHD is Auditory Processing Disorder, but my point and I think the point of the presenters at my state convention was, well, what good did the Auditory Processing Disorder diagnosis even do for her?

Dan: There's so many other things going on and it's all kind of wrapped up into a whole package and she just was struggling.

Denise: She was struggling and they were already giving her accommodations. And one of the problems was one of the professors didn't want to give her certain accommodations. I think COVID probably took care of that.

She probably got everything she needed in the end with all that stuff going on, and online classes and all that. But in my mind, I'm just going. I don't think that diagnosis really gave them any clarity on what was going on.

Dan: So what good is the diagnosis if it doesn't point to a solution, is that kind of, that's what you're trying to say. Okay. So you're seeing a lot of your clients who are having difficulty processing sounds so that what you're saying is that doesn't necessarily lead to an APD diagnosis?

Denise: No, not necessarily, but I, what I'm seeing of, what I've seen so much of it, now that my attention is drawn to it. I see it everywhere. It's certainly involves processing sounds and the order of sounds and remembering them. And most of my clients have some level of it. Just saying that probably removes them from the APD diagnostic category. Just because if a whole bunch of people have this, it's probably not Auditory Processing Disorder as the people who believe it exists would diagnose it. So what if it's a spectrum like autism? So we used to have autism and Asperger's, and we kind of took this, what we used to call high functioning autism and split off and called it Asperger's and said, but it is still within the realm of autism, but it's so different we're giving it its own category.

And then they took that away and said, no, no, no, no, it's just autism. And we have all these levels of it and they're more alike than they're different. So what if clients who have difficulty processing sounds are just on a spectrum and some have mild difficulty, some have moderate, some have pretty hard, and some of them are super severe.

Dan: Yeah. Well that sounds like a spectrum to me. And if that's the case, then that would explain why you're seeing clients at all different levels. Give me some examples of some of these clients at the opposite ends of the spectrum.

Denise: Okay. So I have two children, they're both three. They're just started with me just about the same age. One little boy is almost what I call purely motor. I mean, his issues are almost purely motor. And how can I tell that? Well, besides looking at how his jaw is not working and how his lips are not rounding, he's very conversational and he wants to engage in songs and nursery rhymes and things like that even though they can't understand him. He walks into the waiting room, he sees my ABC toy and he starts singing the ABC song although it sounds like A E E E 'cause he can't say most of his consonants. We know he is engaged with the sequence of sounds. And then I have the other three-year-old who can Jabber away. I would say there's very little to maybe no motor involvement.

She's just so new. I've just barely started to work with her. But she can babble all these different sounds and her mouth seems to move pretty easily, her jaw moves pretty easily, you can't understand much of what she's saying. She's imitating some words. What her dad said at her evaluation was so telling, he said she won't play ball. Her mom jumped in and said, well, what dad means by that is she won't engage with like the ABC song. We want to sing songs with her. We want to do nursery runs with her and she pushes us away. Huh, just like get away from me, get out of my face. And by the way, she's not on the autism spectrum and she engages in lots of other ways.

And so I'm thinking, oh, this is really interesting. These sounds aren't making sense to her. Why would the ABC song even make sense to her? And she's not processing things like that. So it's, it's just very interesting to me. And I think that her problems are mostly on the sound processing, not going to say she has Auditory Processing Disorder, cause I don't think she'd actually fit in that sort of select category, but she's definitely having difficulty processing sounds and I would see in the future that she might be one who maybe would have problems with reading if we don't intervene right now, which we're going to do.

Dan: So you've basically just got one kid who has all sorts of motor problems, but loves sounds, and loves to just go after them.

Denise: He wants to play with language.

Dan: And you got another client who she's got the motor stuff down, but she just doesn't wanna engage with sounds. And so, yeah, I can see that's definitely the opposite ends of that.

Denise: And then you've got everyone in between. And your most severe case, someone who has apraxia and all these motor issues, 100% of my clients have also had really severe processing issues with sound. And so apraxia takes a long time to overcome. You get the motor stuff overcome, and then you've got just as long or even longer on the processing.

Dan: Well what should be the approach with ADP then, or this auditory processing problem?

Denise: Yeah, we don't want to call it ADD, give it its own name. Okay. Anyway, harking back to our last podcast, where we talked about, we want to build new neural pathways and not just do accommodations. This is something to meet with, not just accommodations. And I do see a lot of suggestions for kids who have what we call it, Auditory Processing Disorder.

I see a lot of accommodations, accommodations, accommodations, and here's a few suggestions for actually treating the problem, and unlike all about let's build new neural pathways. Let's treat the problem. Here's an analogy you might understand. I was in the kitchen the other day, and I was trying to find myself a healthy snack when really all I wanted to do was take a big spoon and dive it into the Nutella bottle and just eat Nutella right off this thing.

That's what I really wanted to do. But I'm trying to be healthy. So looking around for my healthy snack and I thought your body can be bathed in a healthy nutritional environment if you feed it right, right. If you feed it right, it's going to be able to fight diseases so much better. It's going to have this underlying substrate of health.

And no doctor that you went to, if you had a specific problem that needed intervention, no doctor would say forget about your diet. If you knew you were eating poorly, right? He wouldn't say, oh, forget about the diet and just do this. He would have to ask about your diets.

But for your optimal health, you always want to have the optimum environment, nutritional environment. And then people can come in with certain interventions and they're gonna have a much better chance of working. So what if we've got these clients with these listening problems, who just have a really poor listening environment. They don't have the ability to process sounds, to take in sounds. So we know, like, even with vitamins, some vitamins are fat soluble. If you don't have the fat, you can't process the vitamin, right? You can't take it in your body, can't use it. Right. So, so what if, what if they can't take sound in, what if they can't even use the sound they're hearing?

Because they have this poor environment as far as sound goes, the brains don't know what to do with it.

Dan: Okay. So what the audiologists usually do is they're looking for hearing aids. Can they physically not hear. But this is beyond that, we know they can hear, they don't have a problem failing a hearing test, but the brain's just overwhelmed and just not processing it. And therefore the connections are just not being made.

Denise: Yeah, that's exactly it. Now of course, the audiologist should always, always, always check the hearing and they also do have other special tests they do, about can you block noise out of one ear and hear something being said in the other ear, stuff like that.

And they use that actually to test for Auditory Processing Disorder. When you work in a school district, there's an audiologist that you can refer children to, to be checked for Auditory Processing Disorder. And I referred some, and I think in my whole career in the schools, I had maybe one, maybe one client who failed one of those tests that they give to select out or to diagnose Auditory Processing Disorder.

And as a speech therapist, you're going wait a minute. I know they're having trouble processing auditory signals, I just can't call it Auditory Processing Disorder. Another nail in the coffin, maybe for the selector diagnosis.

Dan: So obviously there's just more going on here, where you have a large spectrum of clients that have some level of this problem. What do you do about it? Where do you go from here? I mean, I'm still not quite sure how the nutrition analogy is a connection here.

Denise: Well, let me see if I can explain, it's so much sense to me. It's like, if you want to intervene with someone who has a health problem, you would want them to have optimum nutrition too. So that they could take advantage of whatever the intervention is.

Okay. So if we have specific interventions for clients with speech language disorders, or whatever, if they have this poor, poor listening environment, they cannot benefit as much from our targeted interventions. We've got to fix the listening environment when that is appropriate, when we recognize that in clients, and it's way more broad than just the term Auditory Processing Disorder. So many clients have it, and I have seen so much success when I'm addressing this underlying issue. So the nutrition analogy works because it makes the other things I do work so much better. So fix the nutrition first or fix the listening environment in the brain or whatever you want to call that, the ability of the brain to process.

Dan: Okay, so how do you go about... I'm not quite sure what you mean by listening environment, but to me that's a room, but there's more to it obviously than that.

Denise: And listening, okay, that's not the greatest term listening environment. I'm struggling to explain this, but the body has environment of health, right? What if you can build new neural pathways in the brain so they can process sounds better?

Dan: Okay. So that's what you're saying is an environment, it's what's going on necessarily inside the head. Not necessarily what's going on outside the head.

Denise: Yeah, that's right.

Dan: But most people are going to think of the environment as the stuff that's outside ourselves. You need a word for something that's inside the head.

Denise: Yes. So thanks for helping me out there. And I'm trying to stay away from the term Auditory Processing Disorder because we don't, we're not really sure what to do with that term, right?

Dan: Oh boy. Here we go. We got to make up a new term folks. It must be 17 syllables and four words.

Denise: Okay. So in my phonological awareness tracking form, I have a section called early listening, right? And that is really a lot of what I'm doing. I am intervening so early. I've got three-year-olds that I'm doing some of these really early listening things with, and I am so excited. So in future podcasts, I'm going to tell you about them, but just a little teaser, three clients who I worked with, I think about a year, working mainly on their ability to listen and pay attention. The ability to remember a sequence of sounds. Things like that. And I was able to get them to telling stories just barely. They just barely reached the cusp of it. But within a year, getting to telling really basic stories. And their language was really, really poor at first. So to me, that's just amazing, because we can do so much with the language once they can start putting stories together.

Dan: We've talked about this last week a little bit. As you're helping these clients build these pathways. I mean, it's it's you said it's almost like you can see them making the connections. And, and, and that's when things are changing and that whole listening cognitive thing is starting to fire.

Denise: And their language you can just take off.

Dan: The tracking form is a great place to start. And that tracking form is available on the website at slpproadvisor.com and also over on Teachers Pay Teachers.

Denise: But I've realized that after I created the tracking form, I've created so many activities that I love. I just say, you know, the tracking form has things like follow two-step directions and now I've got so many activities for that kind of thing. So what I'm going to do is I'm going to do a lot more Simple Tool videos. I'm going to do more podcasts about this. I'll have materials for purchase too, because I've created tons of materials to work with my clients, all of this, to work on fixing this listening and this listening processing or whatever you want to call it. Uh, so I've saved those success stories for a future podcast, but I'm really excited to share with you some of the things I've been doing.

Dan: We look forward to discussing this further in our future episodes. Now it's not going to all be one at a time, you know, right in order, it's going to be scattered around, but there's a lot of things. So you're going to want to come back to the website, of the show notes for this episode and other episodes, make sure you see all the different things that are there for you, because if this interests you and you're seeing some progress with some of your clients, this is, this is an interesting topic.

Maybe we're going to have to have a contest to try and name this thing. I don't know.

Denise: And then we would have to submit it to ASHA and they would say no.

Dan: That's okay, we'll start a movement. For this week, take a look at the phonological awareness tracking form and listen to episode 11 of the podcast for more information on that. We'd love to hear from you, so, you know, drop us a line at [email protected]. Let us know what you think on this. It's an interesting topic and we look forward to talking with you more next week. Thanks for listening.

Thanks for listening to The Mindful SLP. We invite you to sign up for our free resource library at slpproadvisor.com slash free. You'll get access to some of Denise's best tracking tools, mindfulness activities, and other great resources to take your therapy to the next level. All this is for free at slpproadvisor.com slash free. If you enjoyed this podcast, subscribe, and please leave us a review on apple podcasts and other podcast directories.