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Understanding the Differences Between Auditory Processing, Speech and Disorders, and Disorders October 2014

INTRODUCTION revealed. Although not all students diagnosed This document has been prepared to provide with a disorder will develop an overview of the differences among a reading disorder, some may require auditory processing disorders, accommodations to enable them to benefit communication disorders, and reading from their education. disorders to clarify the need for accommodations for students with RECOMMENDATIONS communication and processing disorders. Based on the results of the GAO study, the The document is organized by definition of impact on student performance for those the disorder, treatment options, and students denied accommodations, and the accommodations, followed by results of a differentiation between the needs of students study that differentiates between reading and with communication disorders and those with language disorders. reading disorders, ASHA recommends that decisions about the need for accommodations A 2011 Government Accountability Office be made by reviewing the student’s history, (GAO) study recommended that the the accommodations that have been provided Department of Justice develop a systematic to the student throughout his or her school approach to ensuring that all eligible students years, and the recommendations of the receive accommodations. GAO further student’s educational team. As noted above, recommended that the decision to allow for no single criterion should be used to accommodations be based on the individual’s determine eligibility for testing history and the recommendations of teachers accommodations, and rules for and service providers and not on a single accommodations should be applied measure of performance. consistently across disability categories.

This document includes study highlights, a DEFINITIONS link to the full study, and specific examples of the impact that lack of accommodations Auditory Processing Disorder has on individual student performance. Auditory processing disorders (ADP) are deficits in the processing of STUDENT ELIGIBILITY FOR SPECIAL audible signals not attributed to impaired EDUCATION peripheral hearing sensitivity or intellectual Students are sometimes determined to be impairment. This information processing eligible for services based solely on their involves perceptual, cognitive, and linguistic communication disorders. Once identified as functions that, with appropriate interaction, eligible, these students have access to all result in effective receptive communication necessary services and supports. Because of auditorily presented stimuli. Specifically, they receive such supports and services, APD refers to limitations in the ongoing additional testing may not be performed and transmission, analysis, organization, a subsequent reading disorder may not be transformation, elaboration, storage, retrieval, and use of information contained in audible

2200 RESEARCH BOULEVARD • ROCKVILLE, MARYLAND 20850-3289 • 301-296-5700 OR TTY • www.asha.org signals. APD may involve the listener's active pushing a button, or in some other way. and passive (e.g., conscious and unconscious, Other tests that measure the auditory system's mediated and unmediated, controlled and physiologic responses to may also be automatic) ability to do the following: attend, administered. Most of the tests for APD discriminate, and identify acoustic signals; require that a child be at least 7 or 8 years of transform and continuously transmit age, because the variability in function information through both the peripheral and is so marked in younger children that test central nervous systems; filter, sort, and interpretation may not be possible. combine information at appropriate perceptual and conceptual levels; store and retrieve information efficiently; restore, Key Points: organize, and use retrieved information;  APD is an auditory disorder that is not segment and decode acoustic stimuli using the result of higher-order, more global phonological, semantic, syntactic, and deficit, such as , mental pragmatic knowledge; and attach to retardation, attention deficits, or similar a stream of acoustic signals through use of impairments. linguistic and nonlinguistic contexts.  Not all learning, language, and communication deficits are due to Children with APD may exhibit a variety of APD. listening and related complaints. They may  No matter how many symptoms of have difficulty understanding speech in noisy APD a child has, only careful and environments, following directions, and accurate diagnosis can determine if discriminating (or telling the difference APD is, indeed, present. between) similar-sounding speech .  Although a multidisciplinary team Sometimes they may behave as if a hearing approach is important in fully loss is present, often asking for repetition or understanding the cluster of problems clarification. In school, children with APD associated with APD, the diagnosis of may have difficulty with , reading, APD can only be made by an and understanding information presented audiologist. verbally in the classroom. Often their  Treatment of APD is highly performance in classes that don't rely heavily individualized. There is no one on listening is much better, and they typically treatment approach that is appropriate are able to complete a task independently for all children with APD. once they know what is expected of them. APD may co-exist with attention deficit hyperactivity disorder (ADHD) or other disorders. Treatment Treatment of APD generally focuses on three A multidisciplinary team approach is critical primary areas: changing the learning or to fully assess and understand the cluster of communication environment, recruiting problems exhibited by children with APD, higher-order skills to help compensate for the but the actual diagnosis of APD is made by disorder, and remediation of the auditory an audiologist, who administers a series of deficit itself. The primary purpose of tests in a sound-treated room. These tests environmental modifications is to improve require listeners to attend to a variety of access to auditorily presented information. signals and to respond to them via repetition, Suggestions may include use of electronic

2 devices that assist listening, teacher-oriented SPEECH AND LANGUAGE/ suggestions to improve delivery of COMMUNICATION DISORDERS information, and other methods of altering the learning environment so that the child Definitions with APD can focus his or her attention on Receptive/Expressive the message. A is an impairment Accommodations in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal, Environmental modifications include both and graphic systems. A bottom-up (e.g., enhancement of the signal communication disorder may be evident in and listening environment) and top-down the processes of hearing, language, and/or (e.g., classroom, instructional, workplace, speech. A communication disorder may recreational, and home accommodations) range in severity from mild to profound. It management approaches designed to improve may be developmental or acquired. access to information presented in the Individuals may demonstrate one or any classroom, at work, or in other combination of communication disorders. A communicative settings. Environmental communication disorder may result in a accommodations to enhance the listening primary disability, or it may be secondary to environment may include but are not limited other disabilities. to preferential seating for the individual with APD to improve access to the acoustic (and  A is an impairment the visual) signal; use of visual aids; of the articulation of speech sounds, reduction of competing signals and , and/or voice. reverberation time; use of assistive listening  An articulation disorder is the systems; and advising speakers to speak more atypical production of speech sounds, slowly, pause more often, and emphasize key characterized by substitutions, . Specific suggestions may include omissions, additions, or distortions support for focused listening (e.g., use of that may interfere with intelligibility. note takers, preview questions, organizers),  A fluency disorder is an interruption (e.g., multisensory instruction, in the flow of speaking characterized computer mediation), and use of written by atypical rate, rhythm, and output (e.g., e-mail, mind maps) repetitions in sounds, syllables, There is no one treatment approach that is words, and phrases. This may be appropriate for all children with APD. The accompanied by excessive tension, type, frequency, and intensity of therapy, like struggle behavior, and secondary all aspects of APD intervention, should be mannerisms. highly individualized and programmed for  A voice disorder is characterized by the specific type of auditory disorder that is the abnormal production and/or present. absences of vocal quality, pitch, loudness, resonance, and/or duration, For more information see: which is inappropriate for an www.asha.org/public/hearing/Understanding- individual's age and/or sex. Auditory-Processing-Disorders-in-Children/;  A language disorder is impaired and www.asha.org/policy/TR2005- comprehension and/or use of spoken, 00043.htm#sec1.6. written, and/or other symbol systems. The disorder may involve (1) the

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form of language (, phonological/language-based intervention. , ), (2) the content Most treatment approaches focus on three of language (), and/or (3) phases: establishing target behaviors, the function of language in generalization or carryover of sound communication () in any production, and maintenance that involves combination. stabilization of target behaviors and self- correction of errors. Further information on Form of Language treatment for sound production disorders can  Phonology is the sound system of a be found on ASHA’s Practice Portal at language and the rules that govern the www.asha.org/PRPSpecificTopic.aspx?folder sound combinations. id=8589935321§ion=Treatment.  Morphology is the system that governs the structure of words and the Language Disorders construction of forms. The objective of language treatment is to  Syntax is the system governing the increase the frequency and quality of order and combination of words to language to age-appropriate levels. Speech- form sentences and the relationships language pathologists play a critical and among the elements within a direct role in helping children with language sentence. disorders learn to speak, listen, read and write. Content of Language  Semantics is the system that governs Treatment for young children may involve the meanings of words and sentences. improving intelligibility, increasing phonological awareness, increasing Function of Language and social communication skills,  Pragmatics is the system that and building emergent skills. combines the above language components in functional and socially The focus of language intervention for appropriate communication. elementary school children with language difficulties is to help the child acquire the Communication Variations language skills needed to learn and succeed  Communication difference/dialect is a in a classroom environment. Interventions are variation of a symbol system used by curriculum based, so that goals address a group of individuals that reflects language needs within the context of the and is determined by shared regional, curriculum. social, or cultural/ethnic factors. A regional, social, or cultural/ethnic Interventions may also address literacy skills variation of a symbol system should (e.g., improving decoding, reading not be considered a disorder of speech comprehension, and narrative and expository or language. ), as well as metacognitive and metalinguistic skills (e.g., increasing Treatment awareness of rules and principles for use of Speech Sound Disorders various language forms, improving the ability Treatment for speech sound disorders may to self-monitor and self-regulate) that are focus on articulation production or critical for the development of higher-level language skills.

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Interventions for older students (adolescents) self-advocate in academic and employment tend to focus on teaching ways to compensate settings. for language deficits. Student involvement is important at this age to foster a feeling of Accommodations collaboration and responsibility for Secondary school personnel can assist developing and achieving intervention goals students with language disorders through the and to enable the student to learn self- transition process by providing current advocacy skills for the classroom. documentation needed to access services Instructional strategies focus on teaching (e.g., testing and academic accommodations rules, techniques, and principles to facilitate in a post-secondary setting) and helping acquisition and use of information across a students identify and advocate for supports, broad range of situations and settings. accommodations, and assistive technologies Classroom assignments are often used to as needed. teach strategies for learning academic content. Individualized support for college-level students may include accommodations, such Difficulties experienced by children and as extended time for tests and the use of adolescents with language impairment can assistive technology (e.g., to help with continue to impact functioning in post- reading and writing tasks). Further secondary education and vocational settings. information on treatment for expressive When compared with typically developing (spoken) language disorders can be found on peers, fewer individuals with language ASHA’s Practice Portal at impairment complete high school or receive www.asha.org/Practice-Portal/Clinical- an undergraduate degree (Johnson, Topics/Spoken-Language-Disorders/. Beitchman, & Brownlie, 2010). The data on Additional definitions of communication educational and vocational outcomes for disorders can be accessed at individuals with speech and language www.asha.org/policy/RP1993-00208.htm. disorders highlight the need for continued support to facilitate a successful transition to READING DISORDER young adulthood. A formal transition plan should be developed in high school and Definitions include career goals and educational needs, A reading disorder is a learning disorder that academic counseling (including discussion of involves significant impairment of reading requirements for admission to post-secondary accuracy, speed, or comprehension to the schools), career counseling, opportunities to extent that the impairment interferes with gain work experience, and community academic achievement or activities of daily networking. life. People with reading disorders perform

reading tasks well below the levels one Goals for successful transitioning to post- would expect on the basis of their general secondary school or employment may intelligence, educational opportunities, and include preparing a resume, completing a job physical health. Reading disorders are most or college application, effectively presenting commonly called . Dyslexia usually skills and limitations during an interview, includes deficits in spelling and writing as expressing concerns to authority figures well as reading. about academic or job performance, and stating or restating a position to effectively

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A reading disorder is a learning disorder 90% of children diagnosed with a reading characterized by a significant disparity disorder have other language deficits between an individual's general intelligence (www.minddisorders.com/Py-Z/Reading- and his or her reading skills. Learning disorder.html). disorders, formerly called academic skills disorders, are disorders that account for DIFFERENTIATING READING AND difficulty learning and poor academic LANGUAGE DISORDERS performance when low performance cannot In a study by Hugh Catts, University of be attributed to mental retardation, low Kansas, published in the Journal of Speech intelligence, lack of learning opportunities, or and Hearing Research (1993), kindergarten such specific physical problems as vision or students with speech-language impairments hearing deficits. Common learning were given a battery of speech-language tests disabilities include reading disorder (often and measures of phonological awareness and called dyslexia), mathematics disorder, rapid naming. In second grade they were disorder of written expression, and some given a test to measure written word language processing disorders. recognition and reading comprehension.

Researchers found that children with A reading disorder can cause severe semantic (language) impairments were at a problems in reading, and consequently in higher risk for a than were academic work, even in people with normal those with articulation and phonological intelligence, educational opportunities, disorders. Not all children with speech- motivation to learn to read, and emotional language impairments requiring speech- self-control. Reading disorder is different language pathology services developed a from slowness in learning or mental reading disorder. Standardized testing and retardation. In a reading disorder, there is a other reliable measures of semantic language significant gap between the expected level of and phonological awareness can help predict performance and actual achievement. which students with speech-language Difficulties in reading can occur on many impairments will develop a reading disorder. levels and a reading disorder may have http://jslhr.pubs.asha.org/article.aspx?articlei several causes that manifest in different d=1779577 ways.

RESULTS OF 2011 GAO STUDY Common problems in people with a reading disorder include: The GAO study • slow reading speed, (www.gao.gov/products/GAO-12-40 ) • poor comprehension when reading requested by Representatives George Miller material either aloud or silently, (D-CA), Pete Stark (D-CA), and Cathy • omission of words while reading, McMorris Rodgers (R-WA), examined the • reversal of words or letters while process that testing companies use to render reading, decisions regarding testing accommodations • difficulty decoding syllables or for students with disabilities, and how federal single words and associating them agencies (including the Department of with specific sounds (), Justice) enforce compliance with relevant • limited sight word vocabulary. federal disability laws and regulations, including the ADA. In its report, GAO recommended that the Department of Justice

6 develop a systematic approach to ensuring College, a 2-year college of the Mennonite that all eligible students receive appropriate Church in Kansas. He ran cross country for accommodations. The agency further the college and studied youth ministry. He recommended that the decision to allow graduated with his associate degree in May accommodation requests should be based on 2014 with a 2.27 GPA. While in college, he individual disability history rather than received test accommodations of a separate diagnostic testing or other single criterion. location and extended time for testing. AB will be attending Greenville College in In other words, testing companies should rely Illinois this fall in order to obtain his on the unique experiences of the individual bachelor’s degree. and the recommendations of teachers, clinicians, and other providers. In the case of His areas of deficit are in expressive and individuals with speech-language receptive language. His language deficits impairments, accommodation decisions cause him to process written and verbal should be based on the history of information much more slowly than does a accommodations for test taking and other typically functioning student. activities and recommendations of the Receptively, AB has to reread information individual’s IEP team and not on the arbitrary multiple times in order to comprehend what criterion of whether or not the individual also is being expressed or what a question is presents with a reading disorder. asking. He will take longer to understand a story, a question stem, or answer choices. He We urge the Department of Justice to require will then take longer to make a decision and testing companies to be ADA compliant choose the best answer, because he has to when assessing the accommodation needs of reason through the information and the all students who require accommodations, related words in order to make that choice. including students with speech and language AB will take longer to complete the writing disorders absent a reading disorder. portion of the ACT. He will need to process the directions and the writing prompt. He will SCENARIOS then need time to formulate and organize his written response. AB is slow and inaccurate Below are specific scenarios, written by due to his word-finding deficit and will take speech-language pathologists whose clients longer to select the appropriate words to with APD and language disorders needed include in his written responses. continued accommodations. AB requires extended time on each test and

give authorization over multiple days. He Student AB had been denied ACT needs these accommodations due to his accommodations (twice), the first time 3 receptive and expressive language deficits. years prior. Following the denials, I had to submit the attached letters to request Student A had to take the ACT without additional time, because ACT would not accommodations. She did not have a reading recognize the diagnosis of Speech Language disorder but had a language disorder. Her Impairment as grounds for accommodations. disorder caused her to need additional time to For students with a diagnosis of Specific gather meaning from the text, although she Learning Disabilities (SLD), I did not need to was a fluent reader. She had receptive send additional information; the SLD language and language memory deficits but diagnosis alone was sufficient justification. was competent in analyzing word (prefixes, Following graduation, AB attended Hesston

7 suffixes, root words) and context clues, CONTACT INFORMATION including sentence structure and related For more information on practice related words, to improve her comprehension. She issues, contact Deborah Dixon, ASHA's needed to read and reread passages for director of school services, at 301 296-5690 understanding. The reading comprehension or by e-mail at [email protected], or Janet portion of standardized academic Deppe, ASHA's director of state advocacy, at assessments, such as the Woodcock-Johnson, 301-296-5668 or by e-mail at is not timed. A student may take the time to [email protected]. think through the passage, questions, and answer choices. Student A used her skills and For advocacy related issues contact Catherine time to formulate or choose correct answers. D. Clarke, ASHA's director of education and All of this analysis took extra time, which regulatory advocacy, at 202- 624-5953 or by student A was not given on the ACT. She e-mail at [email protected]. graduated in May 2014 from Northern

Illinois University (NIU), where she was admitted through a special program called Chances. She had been denied regular admission due to her ACT scores (14 and 15); she took the test twice with no accommodations. Student A did extremely well at NIU academically and with her involvement on campus activities. She graduated from the university in 4 years with a 3.14 GPA.

Students with communication disorders may be good readers and processors of information, given sufficient time. These are individuals who must work hard to process and comprehend information.

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