Identifying and Remediating Auditory Processing Difficulties:
An Interview with Terri Cinotti of SUNY Buffalo
Alice E. Gerard
A boy who remembers only the third step of a three-step direction, a girl who becomes ill in a noisy school bus, and a woman who hears the words "screechy steak" instead of "three-cheese steak" may all be experiencing a condition called "auditory processing disorder."
According to Terri Cinotti,CCC, licensed speech-language pathologist and clinical assistant professor/speech language coordinator at SUNY Buffalo's Speech-Language and Hearing Clinic, a number of models, including one that was designed at UB, have been designed to describe characteristics of auditory processing disorder (APD). The UB model, referred to as the "Buffalo Model," was created by audiologist Jack Katz, audiologist Nancy Stecker, and speech-language pathologist M. Gay Masters.
According to the Buffalo model, there are four categories of APD. They are decoding, tolerance-fading memory, organization, and integration. The diagnosis of APD for anyone age six or above is typically made by an audiologist, who may refer the client to a speech-language pathologist for a language assessment, if it is warranted. Small children are evaluated by speech-language pathologists. Everyone referred for evaluation receives a hearing screening.
Ms. Cinotti recommended that, if parents who suspect that their child has a language problem should watch the child for consistency or inconsistency in following directions; labeling things that are in his knowledge base, such as colors, correctly or incorrectly; saying "what" or "huh" frequently; or communicating with gestures, instead of words. She also suggests that parents of young children "go into the pre-school classrooms and see what all of the other three- and four-year-olds are doing at that age."
Causes for APD could include a familiar history. "I have seen it where parents will come in, and I've seen almost carbon copies." Another cause is early ear infections. "Having ear infections is a huge indicator of whether a person may be at risk for a processing disorder. The person wasn't able to hear clearly and consistently for many months, years of their very critical learning period. So they were getting distorted signals and, therefore, will get a distorted perception of what sounds really sounds like." A high fever can also be a contributing factor, Ms. Cinotti said.
A decoding disorder, which can be the result of early ear infections, is the most common category of APD. This is, Ms. Cinotti said, "difficulty with discrimination, mainly at a sound level. But it affects understanding and expression at a word level, a phrase level, and a sentence level. So, a person with a decoding problem usually has difficulty with discriminating and making smaller units into larger units or sounds into words and taking larger units and breaking them down into smaller units." People with decoding problems might have trouble interpreting words so they might misinterpret them. They also tend to be slow responders. This writer who, when given the word "eclipse" broken into individual sounds, heard "Eek! Lips!" displayed a decoding problem, Ms. Cinotti said. Reading and spelling problems are quite common for people experiencing decoding difficulties.
Tolerance-fading memory, Ms. Cinotti, could result in difficulty with short-term auditory recall. "Part of the message fades away. So if you give a three-step direction to somebody, the first and second part might fade away, and he'll only follow the third. Or maybe, they've learned strategies, and they're rehearsing the first part so much that they hang onto it, but the middle, they can't pay attention to. Also, a part of tolerance-fading memory is the tolerance part and that's a reduced tolerance to noise.
"So the reduced tolerance to noise might be something that they notice, like you notice that the noise bothers you," Ms. Cinotti told this writer. "Other people might not notice it, but their performance might decrease. So they might not notice that they're missing the teacher's lecture when the door's open, but they do fine when it's closed. But the teacher might notice. Sometimes, they might be drifting or distractible, not paying attention, but, in reality, they're distracted by that noise."
These individuals might jump in to answer before they forget. "They might have a tendency to look impulsive. Reading comprehension is often an issue because part of what they're reading is fading away. Many times, they have trouble understanding or formulating long sentences. Also they might have trouble following directions," Ms. Cinotti said.
The third area, organization, involves trouble with organizing auditory information. "If auditory information never came in organized, it's not coming out organized. It could be organizing words into sentences. It could be organizing sentences into a nice paragraph or into a coherent conversation, telling a story with a beginning, a middle, and an end, organizing so that you tell a person what they need to know but you don't tell them what they already know. So, if you already said, 'Bob, Jim, and I went to the store,' you wouldn't say, 'Bob, Jim, and I walked, Bob, Jim, and I...' So it's taking another person's perspective and figuring out what they know already. If you just said, 'We went to the store and bought a lot of things but he didn't like what he bought' first, that's not very organized. You didn't tell who the characters are, who 'we' is, what they bought. This will also show up in a person's writing. We work on that by doing outlines and helping to organize thoughts and ideas." Clinicians also help children organize desks and adults organize schedules as a way of dealing with that area of difficulty.
Auditory integration concerns "how the right brain and left brain communicate, how auditory information is integrated with the rest of the environment. Auditory integration is difficulty interpreting auditory information within your environment. So it's saying, 'I shouldn't attend to the information in the hallway; I should focus on the salient voice, which is Terri's voice.' Also, say you hear a 'beep, beep, beep, beep,' can you integrate that enough to say, 'Well, that's a truck backing up or a fire alarm or what is it?' I remember a story that you told me, and I've used it in presentations. Do you remember the dryer incident? That's an excellent example of how you did not integrate... you thought that the smoke detector was your dryer... you weren't able to localize..." Significant difficulties with reading and writing are common for people with auditory integration problems. People with auditory integration difficulties tend to be very slow responders.
Ways to help a child with APD experience success in school include "teaching the child strategies, such as asking for repetition, self-advocacy, and looking for preferential seating. Also there are some accommodations, such as being given extra test-taking time, having a reader or a scribe during tests."
Strategies and accommodations also help adults in the workplace. "We had one person who was a commodities trader. He couldn't do his job when his processing got worse because he couldn't perceive in that noise what the bids were. So he came in and got a crash course in lip reading. He's reported back that he's doing well. In every job situation, you need to comprehend and express," Ms. Cinotti said. Using a planner is another strategy that helps adults.
Other conditions that frequently co-exist with APD include ADHD, auditory or visual dyslexia, nonverbal learning disability, sensory integration dysfunction, autism, Asperger's Syndrome, hyperacusis, and tinnitus.
Ms. Cinotti said, "It's never too late to get help for an APD. She said that it was the adult clients, who let her know that. "I've learned so much from you guys who, for the most part, were not diagnosed until your late thirties, early forties. You've taught us that it doesn't matter how old you are; you can improve how you're living your life and make positive changes still. Auditory processing disorders are not something that you only need to treat when the child is in first or second grade. It's ongoing treatment until the person feels comfortable with their skills. I do urge that, given your lesson, parents identify or suspect any auditory processing issues early on, so that they can help prevent the years of struggle and misperceptions and wondering that you all have had. I do suggest that they come in, get tested, and make sure that there's nothing going on. And, if there is, then start the path of remediation."
For more information or to schedule an evaluation, contact UB's Speech-Language and Hearing Clinic at 829-3980.