- (C)APD
- ELL
- LLD
- (central) auditory processing disorder
- English Language Learners
- Language Learning Disability
(C) APD
- What you do with what you hear
- around for more than 30 years
- Still controversial
(C)APD definition
- difficulties in the processing of auditory information in the central nervous system” [which are not due to] “higher order language, cognitive or related factors
- But, referrals usually are a complaint about language or learning ability—more later
ELL
- Formerly English as a second language (ESL), or bilingual
- Individual’s first language is something other than English
— English could be a second, third, fourth language
- May/may not include cultural differences
— Some kids come with their families
— Some kids are adopted into American families
Routes to second language acquisition
- Simultaneous
- Successive
- Learn both languages at same time, often with different caregivers
- Learn one language (L1), then learn another language (L2); proficiency of L1 both before and during L2 acquisition can vary a lot
- Must determine most proficient language in order to assess language ability
Routes to second language acquisition
- Subtractive bilingualism
- Subtractive bilingualism occurs when L2 becomes the proficient language at the expense of L1
- Can happen in younger generation of family groups
- Very common in internationally adopted children
2005 Position paper on APD
- 5 skills affected
- CNS difficulties with auditory processing reflected by poor performance in one or more of the following skills:
— Sound localization and lateralization
— Auditory discrimination
— Auditory pattern recognition
- Auditory performance in competing signals, including dichotic listening (used to include noise as a competing signal, probably now in next descriptor)
- Auditory performance in degraded signal (such as noise?)
Temporal aspects on (C)APD
4
- Temporal aspects
— Temporal integration
— Temporal discrimination (gap detection)
— Temporal ordering
— Temporal masking
- Memory is not part of (C)APD
— Higher level process, not central auditory processing disorder
- Previously, memory was part of the disorder
Why is SLP involved in (C)APD
- ASHA advocates phonological awareness testing & training as SLP role
— Children with the (C)APD diagnosis often co-morbid with dyslexia, which in turn is associated with poor phonemic and phonological awareness
- ASHA places reading & writing within the SLP’s scope of practice
Typical Audiological Description Individuals with (C)APD
- Often has history of otitis media
- May have known/unknown ear infection on day of testing
- Says “huh” or “what” a lot
- Misses parts of directions
Otitis Media Myths and Facts
- Average loss is 20 dB (and M. Downs says 15 dB is significant, while C. Berlin says 10 dB)
- Average bout of OM is 1-3 months (or more)
- OM may often affect only one ear, but monaural listening negatively impacts ability to understand in noise and locate sounds
- “one ear is almost as good as two if you live in a sound proof chamber”
Typical S/L Needs of Individuals with (C)APD
- expressive language & speech difficulties
- oral and written production tasks affected
- social discourse difficulties; look off-topic in class discussions
- comprehension difficulties
- significant adverse academic impact: reading, spelling, writing tasks, following directions
(C)APD & “Academic” Difficulties
- Spelling
- Reading
— Both spelling & reading are “language-based”
- Attention
EDUCATIONAL QUESTIONS: IDENTIFYING INDIVIDUALS WITH (C)APD
- Phonics & speech sound discrimination poor
- Often misunderstand; requires speaker to repeat
- Says “huh”, “what” often (and then, often, “never mind”)
- Easily distracted by noises and/or behavior changes in noisy situation
- Forgets auditory information quickly
- Short attention span, especially auditory
Models of (C)APD categories
- Models attempt to differentiate different types of (C)APD
—- No one model is accepted
- All models include a “decoding” type vs. problems with competing signals (dichotic listening) and some include “integration” of auditory information
Decoding
- Slow responders, very possibly the “temporal processing” kids described by Tallal
- Say “huh” and “what” a lot
- Look a lot like kids with hearing impairment
- Very likely to have history of otitis media and phonological processing disorder as preschoolers
- Reading & spelling problems; poor phonetic ability
- Often misunderstand directions
Auditory Decoding Deficit (Bellis)
- “purest” APD, classic example
- “looks” like hearing loss
- Primary auditory cortex of dominant hemisphere
- Auditory discrimination errors
— Voiced cognate
— Other sound categories (the infamous “da-ga”)
- Missing information (auditory closure)
- Problems in noise
- Noise makes first two harder to achieve in any listener
(C)APD: DECODING & ASSOCIATED S/L DIFFICULTIES 1
- word-finding difficulties (poor phonological storage)
- articulation difficulties
— very likely severe phonological processing as preschooler
— /r/, /l/ substitutions and perceptual confusions as older school age child
(C)APD: DECODING & ASSOCIATED S/L DIFFICULTIES 2
- prosodic difficulties
— flat intonation (not frequent)
- misses morphological endings in discourse (e.g., The deer eats apples).
- delay in following directions; self-corrects
- oral & written discourse (see w-f above)
- interaction spelling problems & w-f
(C)APD: DECODING & ASSOCIATED S/L DIFFICULTIES 3
- inconsistent articulation errors with coalescence and metathesis
- omits steps in following directions or is impulsive
- may demonstrate cluttering of speech
- prosodic differences
— choppy rate (fast-slow-fast mixtures)
— pauses within words and phrases
(C)APD: DECODING & ASSOCIATED S/L DIFFICULTIES 4
- Longer & more elaborate utterances (e.g., “The baby the woman held clapped her hands”) more difficult than short, simple utterances
- Inconsistency of performance may be related to presence/absence of noise
Less common but more issues with APD
- Very long delay in responding
- Very poor spelling
- Very poor reading
- Very poor handwriting
- responses to speech in noise reveal ear discrepancy; usually both ears work like poorest ear
- Problems fusing, or integrating auditory info
- Problems integrating auditory and visual
S/L Needs of LLD
- Expressive language & speech difficulties
— oral and written production tasks affected
- Social discourse difficulties
— look off-topic in class discussions
- Comprehension difficulties
— Following directions
— Reading comprehension
English Language Learners
- Proficiency in two languages
— Minimal to complete fluency in both; balance is rare
— Code switching
— Linked to caregiver or setting
— Vocabulary may differ (e.g. shapes, numbers in “academic” language)
- Simultaneous
- Successive
- Subtractive vs. additive
- BICS
2. CALP
- Basic Interpersonal Communication Skills (BICS)
- – Conversational fluency - Cognitive Academic Language Proficiency (CALP)
- – Vocabulary
— Expressive, written and reading
ELL: Traditional Knowledge
- BICS: 2-3 years to develop
- CALP: 5-7 (7-9) years to develop
- Interference: rule from 1 language used in another
- Fossilization: errors become “stuck”
- Silent period: some kids silent, thought to be comprehension period, for up to 3-6 months
- Transfer: reading transfers most readily from L1 to L2
- Language loss of L1 is typical; amount not specified
S/L needs of ELL
- Spelling
- Reading
— Both spelling & reading are “language-based”
- Attention
Code Switching
- Common in bilingual children
- – Use of both languages in a single utterance
- — “I ni hochu school”.
—- “Ya has to go pee-zits”.
Effects of institutional care on development
- 1 month delay for every 3-5 months institutionalization
— Age at placement
— Age at adoption
— Amount of time in institutional setting
- Caregiver ratios
- Cultural factors
— Swaddling
— Perspective on disabilities
— Poverty
Notes on Institutional Care
- Always look at native language, look at phonological engram of 1st language
- If children are adopted before 18 months by the time they are 3, they are caught up
—WNL on standardized test, so at 3 we can use English standardized tests
- Kids that have problem after this point are disordered
- Kids adopted before 3- minor delays, catch up quickly
- Over 3, kids pick up BICS by 6 months but they struggle with CALP- will have articulation issues
- Loss of 1st language is very quick
- We don’t mark gender, we mark tense, and number
Additional Risk Factors for kids institutionalized
- Many kids have poor oral motor development
— Hold food in mouth
— Stuff mouth
- Feeding practices
— propped to feed
— Nipples with large holes
— Kefir and overcooked broths
— tablespoons
S/L Needs of ELL
- expressive language & speech difficulties
— oral and written production tasks affected
- social discourse difficulties
— look off-topic in class discussions
- comprehension difficulties
— Following directions
— Reading comprehension
- Look different in school
- Look off topic because they don’t know the language (slower processing time)
- Often hypervigilant- look ADD, but not
ELL vs. (C)APD
- (C)APD & LLD often have difficulty with classroom language
- ELL typically would be expected to have difficulties with classroom language under following conditions
— Older at time of adoption, submersed in classroom while acquiring BICS, have expectations from previous school experience
- Hypervigilant IA kids
S/L Needs of LLD
- Spelling
- Reading
— Both spelling & reading are “language-based”
- Attention
APD or ELL or Both: Differential Diagnosis
- Hard to determine what the problem area is
- Length of time with English is a confounding factor
- World knowledge gaps except for those adopted as infants & toddlers
- Auditory perception—re-learn sounds to listen for—doesn’t seem to be much of a factor
- Kids at birth pay attention to all languages but at 6 months they only pay attention to their language
- Smell can be an issue (people smell different)
Aids in Differential Diagnosis
- Delay in first language
— can occur if a child is institutionalized
- Difficulty acquiring English post adoption
— Usually happens quickly, if it doesn’t it’s a problem
- Phonological awareness ability
- Auditory confusions and mistakes:
— “Bueno” is not “guano”
— Could be APD
- Analysis of Invented Spelling
— There are typical patterns for invented spelling
ELL : BICS vs. CALP
- May have Basic Interpersonal Communication Skills (BICS) but lack Cognitive Academic Language Proficiency (CALP)
- Bilingual literature suggests it takes up 2-3 years to achieve BICS, and 5-7 (some sources say 7-9) years to achieve CALP
Expressive Language
- Problems shown by (C)APD and LLD kids but not ELL kids post BICS
- Abandoned utterances and words
- Word-finding substitutions
- “empty” utterances (cocktail party talkers)
- excessive or incessant questions
- tangential utterances
- Tangled speech: repeated words & phrases, filled pauses (e.g., “uhm”), silent pauses, excessive interjections (e.g., “well”)
Speech Milestones 1
- Speech
— By 8 years of age, no articulation errors
— Able to produce phonologically complex words (e.g., aluminum, statistics, Leonardo Di Caprio)
— Socially accepted rate of speech
- Kids with (C)APD tend to have persistent articulation errors (mostly /r/, /l/), inconsistent articulation (see PCW), excessive rate (some)
- LLD kids: problems with phonologically complex words
- PCW- phonologically complex words
Speech Milestones 2
- Kids who are ELL
— May have developmentally appropriate articulation errors
—– “r”, “l”, “s”, “sh”. “ch” “j” are later sounds
— May have “interference” type articulation errors
—– w/v- common substitution
Language
- Into preschool years, children are learning language
- School-age begins transition to using language to learn
- Early reading is learning to read
- By grade 3, reading to learn
- School-age ELLs must use language to learn, and read to learn
Language Milestones 1
- By 8 years of age, should be able to tell personal narrative or retell movie in logical order, with specific terms & names, in story format, with minimal linguistic disruptors- no more than 8 linguistic disfluencies in 100 words
- Kids with (C)APD & LLD tend to start stories in the middle, jump around, use vague terms (pronouns, “thing”, “stuff”), have more than 8 disruptors in 100 words
Language Milestones 2
Kids who are ELL and have achieved BICS should be able to tell personal narratives/retell a movie or story
Language Milestones 3
- Figurative language develops throughout school years: metaphors, analogies, slang, humor
- Inferencing ability improves
- Kids with (C)APD & LLD
– tend to be literal
– miss slang
– not get humor
– have simple cause-effect and “what you see is what you get” thinking
Language Milestones 4
- Figurative language and inferencing require ELL to be proficient in CALP (problems with multiple meaning words)
— “dugout” example: how did Indians get concrete baseball structures to float down rivers?
- Learn new vocabulary from teacher’s lectures & reading assignments
— Both assume background knowledge that may be different, deficient or absent due to the ELL’s early years
— Gaps for ELLs because they don’t have background knowledge
Classroom Language Milestones
- By third grade, children demonstrate knowledge of
- hidden curriculum
— Recognizing teacher’s cues
— Socially acceptable responses
- Scripts in classroom
— Transitions between activities
— Announcements regarding exceptions to routine
— Lesson format- IRE- initiation, response, evaluation