For the last several years, I’ve been working with a student suspected of having Auditory Processing Disorder and Dyslexia. Information from formal testing, language testing, and classroom performance have all been rather inconclusive and inconsistent – as seems to be the case with many of our students who need help the most.
In my work with her this year, I’ve begun to notice a marked difference between her engagement and progress in different types of processing tasks, leading me to do some research on where we currently stand with regards to treatment of APD. Like many in the school-setting, the last few years have tried to convince me that training different forms of sound discrimination and identification would be of benefit. Programs like Fast ForWord and Earobics have been used, sometimes exclusively, in an attempt to improve our struggling students academic skills. Even knowing that my student has participated vigorously in Fast ForWord with little noticeable improvement, I felt tempted to look for auditory training programs – developed specifically for SLPs, if possible – to send home for extra practice. While I feel fairly confident that my work on phonemic and phonological awareness skills has been beneficial, deep down, I was unsure about further auditory-based interventions. I went to ASHA for some insight, utilizing the evidence maps to see what I could find.
One article of particular interest was Auditory Processing Disorders and Auditory/Language Interventions: An Evidence-Based Systematic Review by Fey, M.E., Richard, G.J., et al. (2011). Although several years old, it seems to be in line with additional research that has been conducted. On Tatyana Elleseff’s website, Smart Speech Therapy, I found numerous articles addressing this topic, citing research and presentations from the last several years. The findings seem consistent: namely, that as SLPs, we should be focusing on doing what we do best, which is writing goals and providing treatment based on oral language and literacy in order to improve overall language and academic skills.
That was what I needed to know as far as sending her home with an app and hoping for improvement (not really – but you know what I mean). But, practically, where did I go from here? I’ve been working on her linguistic skills already and we’re a bit stuck. What comes next?
First, I had to look at where I had been and what I was doing.
I’ve been using my Informal Language Assessment for the last few years to get baseline information and write new IEP goals. It’s evolved a bit, but it is nice in that for some students – those that I’ve had for 2 or 3 years in a row – I’m able to easily look at progress in, what I consider, core, underlying linguistic skills. Many SLPs that I know depend heavily on the Common Core State Standards-aligned Communication Assessment by Floyd & Floyd. While I’ve nothing against the assessment itself – it’s very thorough and matches up with the standards beautifully – I’ve found goals written based on it to be difficult to implement and failing to address underlying skills that are deficient, focusing rather on the academic outcome. For example, a CCSSA aligned goal may be written to address 10th grade vocabulary, such as euphemisms and denotations, while my students still don’t have a clear enough understanding of word relationships to identify basic synonyms and antonyms or define words using multiple meanings.
Because I’ve included skills from a variety of areas, I’m able to look at progress and deficits in different areas of processing, including linguistic/semantic, phonological, and auditory/listening. In this particular case, it’s been key. I’ve watched her knowledge of and comfort with identifying and defining word relationships – a key factor in the Language Processing Hierarchy – improve, while watching her skills with listening comprehension plateau.
So, what have I been doing? We’ve been working on main idea and details. I’ve explained main idea at least a dozen ways, provided examples, given multiple choice answers, and combined visual/auditory stimuli. We’ve went alll the way back to “single word level” (essentially, categorizing) and tried working our way up through words, single sentences, 2 sentences, etc… No dice. She’s tired. I’m stuck.
Essentially, I’ve been doing a lot of the talking and I’ve been drilling. What I haven’t explored, are strategies. Digging a little more into ASHA’s recommendations, I’ve looked at several compensatory strategies that could be beneficial for my student, identifying the following as best suited for our specific deficit of listening comprehension.
1. Active Listening
Active Listening is defined as process of engaging multiple senses – not just hearing – while listening to better comprehend and retain information. For example, making eye contact, providing verbal feedback, and taking notes.
2. Graphic Organizers
Graphic organizers could take many forms in this instance, visually defining what it is that the student is listening for. For my student, picking out important information is difficult, as is organizing it in such a way that it can be used appropriately.