Right, you don't know. Please I'm not being facicious
lynne (ID=41) (Dec 5, 2000 8:58:20 AM)
that is why
lynne (ID=41) (Dec 5, 2000 8:59:43 AM)
i think so
dr.j (ID=42) (Dec 5, 2000 9:01:04 AM)
Lynne, you think so, does that mean, you think the ONLY evaluation of auditory processing was the Screening Test for Auditory Processing or the SCAN? ? ? And from a screening test and ONLY that one test, a dx was made that your daughter had an APD (or CAPD)?
lynne (ID=41) (Dec 5, 2000 9:01:33 AM)
thats right
lynne (ID=41) (Dec 5, 2000 9:02:00 AM)
what else need to be done
dr.j (ID=42) (Dec 5, 2000 9:03:22 AM)
Lynne, please what I say now is NOT to put down ANYTHING, but to educate you etc. You ask what else needs to be done. Answer is a comprehensive battery of behavioral tests looking at all of the areas involved in auditory processing. From the SCAN alone, this is what I as a professional notice and these are the questions I have diagnostically before I would make ANY diagnosis........please follow....
dr.j (ID=42) (Dec 5, 2000 9:04:00 AM)
First, the norms for the SCAN are standard scores between 7-13. Thus, scores below 7 are not normal. So, let's look at the three subtests of the SCAN.
dr.j (ID=42) (Dec 5, 2000 9:05:15 AM)
First, Filtered Words. These are monosyllabic words like "car," "ship," "chair" etc. that have been electronically distorted. They are like hearing these words with a person speaking having his/her hand placed over his/her mouth. This is the type of distorted sound for these words.
lynne (ID=41) (Dec 5, 2000 9:06:34 AM)
she scored 5
dr.j (ID=42) (Dec 5, 2000 9:07:16 AM)
Filtered Words requires the listener to hear the words (be aware that they are present as a stimulus) and decode what was heard. But, since there is distortion, the listener has to extract whatever auditory information is available and fill-in the missing pieces (auditory closure). However, there is also a level of decision making in which the listener can figure out the probability of what is the real word based on vocabulary knowledge. Thus, the processes involved are many as......
dr.j (ID=42) (Dec 5, 2000 9:08:32 AM)
Auditory awareness, auditory decoding, auditory closure, phonemic awareness, decision making (choices from vocabulary memory), and vocabulary. Any one or combination of these factors could account for problems on the Filtered Word test.
dr.j (ID=42) (Dec 5, 2000 9:11:03 AM)
Now, Auditory Figure-Ground for which your daughter scored normal (I believe the score was a 10 - right smack on the mid-norm). The words, again, are monosyllabic and are supposed to be equal in auditory and language level of difficulty to the Filtered Words test items. Essentially they are. Some are even the same or similar words. However, the words are not distorted. Actually, the words are quite clear, but there is an ongoing multitalker babble in the background......like the background of noise in a restaurant called cafeteria noise. The listener COULD be distracted by the noise, and loose awareness or attention of the presence of the clearly spoken test items. Now.......
dr.j (ID=42) (Dec 5, 2000 9:11:47 AM)
The processing needed for Auditory FIgure-Ground on the SCAN test (not necessarily the same on other auditory figure-ground tests) is....AUditory Attention, AUditory awareness, decoding and vocabulary.
dr.j (ID=42) (Dec 5, 2000 9:13:35 AM)
BRB......
debbie (ID=40) (Dec 5, 2000 9:13:48 AM)
Lynn...are you following with what Dr J is saying so far?
lynne (ID=41) (Dec 5, 2000 9:14:34 AM)
i think so
dr.j (ID=42) (Dec 5, 2000 9:14:40 AM)
Back....yes, thank you debbie. Lynne I hope you are following because there will be a quiz on this tomorrow.... ;-)
lynne (ID=41) (Dec 5, 2000 9:14:58 AM)
need more that 24 hours to study
dr.j (ID=42) (Dec 5, 2000 9:15:00 AM)
Lynne, what I want to get at is what we KNOW and what we DON'T KNOW from the SCAN test results.
dr.j (ID=42) (Dec 5, 2000 9:15:23 AM)
Lynne, you're better than my students, they usually cram the night before the tests ;-)
lynne (ID=41) (Dec 5, 2000 9:15:30 AM)
how fdo we find out what we do not know
debbie (ID=40) (Dec 5, 2000 9:15:30 AM)
isn't that the truth lynne!
lynne (ID=41) (Dec 5, 2000 9:15:57 AM)
i used to do that when i was a college learned the error of my ways
dr.j (ID=42) (Dec 5, 2000 9:16:33 AM)
ANyway, since Your daughter did well on the Aud Fig-Ground (Let's abbreviate AFG for typing ease), vocabulary is probably NOT a factor in AFG or in Filtered Words (FW). ALso, awareness is NOT a factor and attention/distractibility only is not a factor. SO,
lynne (ID=41) (Dec 5, 2000 9:17:15 AM)
she has always been discribes as quietly distracted
lynne (ID=41) (Dec 5, 2000 9:17:31 AM)
not the best typer
lynne (ID=41) (Dec 5, 2000 9:17:35 AM)
typer
dr.j (ID=42) (Dec 5, 2000 9:17:38 AM)
What we STILL HAVE are possible decoding problems, phonemic awareness problems, auditory closure (an integrative process) problems. Now, on to Competing Words (CW).
dr.j (ID=42) (Dec 5, 2000 9:18:37 AM)
Lynne, well if your daughter seems "quietly distracted," it's not based on auditory (extraneous auditory stimuli) distractibility. Many children who are "distracted" have decoding problems or internal distractibility issues or boredom.......but, let's continue.
dr.j (ID=42) (Dec 5, 2000 9:19:58 AM)
CW requires hearing two words (again, monosyllabic words similar in vocabulary and auditory level as the FW and AFG words) ...but with CW the words are presented simultaneous one (different) word to each ear and the listener has to repeat BOTH words......
dr.j (ID=42) (Dec 5, 2000 9:21:09 AM)
Factors in processing.....rapid decoding, switching of attention, rapid storing of information in memory (but not much of a memory load - only two words and really only one needs to be in memory as you can immediately repeat the other). And, your daughter performed poorly on this test as well.
dr.j (ID=42) (Dec 5, 2000 9:22:17 AM)
So, what we have left is a continuous question of auditory decoding as a possible underlying issue, rapid speed of processing as an issue, decision making about what was heard, what to hold in memory, and what to recall from memory (decision making) as an issue, and switching attention or dividing attention as an issue.
dr.j (ID=42) (Dec 5, 2000 9:22:29 AM)
Do you follow now, Lynne, and Debbie! ! !????
debbie (ID=40) (Dec 5, 2000 9:22:52 AM)
I'm following..
lynne (ID=41) (Dec 5, 2000 9:22:59 AM)
yes
dr.j (ID=42) (Dec 5, 2000 9:23:01 AM)
P.S. Lynne, if it would help you, these chats are archived and you can read them again later.
lynne (ID=41) (Dec 5, 2000 9:23:09 AM)
ok
lynne (ID=41) (Dec 5, 2000 9:23:34 AM)
he also did a competing sentence subtest
dr.j (ID=42) (Dec 5, 2000 9:25:02 AM)
So, what's the underlying factor accounting for your Daughter's problems in school, Lynne? A problem in decoding? A problem in decision making/ A problem in rapid processing (time/temporal processing we call this)? A problem in switching attention/dividing attention? And, I forgot this before, auditory closure/filling in and repeating the two words correctly in the order requested (on the CW test) involve what we call INTEGRATION......putting pieces together to form the whole.....so, is the problem integration? ? ?
lynne (ID=41) (Dec 5, 2000 9:25:25 AM)
you tell me
dr.j (ID=42) (Dec 5, 2000 9:25:49 AM)
Lynne, Oh, so the audiologist used the Newer SCAN-C with the competing sentences test. Do you have the results of the CS or competing Sentences Test. That will provide additional cues.?????
lynne (ID=41) (Dec 5, 2000 9:26:53 AM)
50% right ear 70% lt ear she seemed to error mostly on the last word of each sentence
lynne (ID=41) (Dec 5, 2000 9:27:45 AM)
he did not know if this reflected difficulty processing or auditoy memory
dr.j (ID=42) (Dec 5, 2000 9:27:50 AM)
WHile we wait, the CS test involves listening to two sentences, but only responding to one. The two sentences are presented one to each ear.........Lynne, was there no standard score given for the CS test? BUt, FYI 50% is 5 out of 10 and 70% is 7 out of 10......
debbie (ID=40) (Dec 5, 2000 9:27:56 AM)
so what we want to do when looking for the underlying problem is look at the skill required for each test and look at the common threads between the tests that are scored low on?
dr.j (ID=42) (Dec 5, 2000 9:28:04 AM)
Lynne, I need to know this. Is your daughter right or left handed?
dr.j (ID=42) (Dec 5, 2000 9:28:22 AM)
Debbie....100000000000000000000000000000000000000000000% correct! ! !
lynne (ID=41) (Dec 5, 2000 9:28:31 AM)
no standard score
lynne (ID=41) (Dec 5, 2000 9:28:49 AM)
right handed
debbie (ID=40) (Dec 5, 2000 9:29:47 AM)
ok..i'm curious...what difference does it make if a child is left or right handed...does that give us a hint if it's an integration deficit?
lynne (ID=41) (Dec 5, 2000 9:29:53 AM)
so was he
dr.j (ID=42) (Dec 5, 2000 9:29:53 AM)
OK, then the audiologist did NOT use the SCAN-C test since that test has the CS norms. But, the audiologist may have used the CS of the adolescent/adult version of the test. BRB, I'll look up the norms for 10 years old on the CS for the SCAN-C to see if the raw score of 12 is within normal limits .....Thank you for the right hand info....
debbie (ID=40) (Dec 5, 2000 9:30:03 AM)
as far as which side is dominant?
lynne (ID=41) (Dec 5, 2000 9:31:11 AM)
he was curious about the fact that it was usually the last word she missed
dr.j (ID=42) (Dec 5, 2000 9:31:30 AM)
Debbie, yes, Notice that Lynne's daughter is right handed, and should do better with the right ear on the CS test. But, she performed 20% better on the left ear. In my practice, I often see children scoring 100% in the dominant ear and 0% in the non-domiant ear and obtaining 7 or 8 on the Standard Score because the score is for the total and a 7 or 8 is a raw score of 10......
dr.j (ID=42) (Dec 5, 2000 9:32:42 AM)
A raw score of 12 is a standard score of 6 = not normal (below 7)....
lynne (ID=41) (Dec 5, 2000 9:33:52 AM)
is there any connection between apd and reoccuring ear infections
dr.j (ID=42) (Dec 5, 2000 9:34:00 AM)
Missing the last word is a great observation made by the audiologist. Unfortunately the audiologist does not know what that means. It is called a primacy effect and relates to the fact that one problem you daughter MAY have is in auditory memory. SHe has problems getting the information IN TO her memory store.......based on my approach/model of APD, this is related to problems with decoding and rapid decoding.
dr.j (ID=42) (Dec 5, 2000 9:34:21 AM)
So, here's what we have and we can get to the ear infections in a moment.
debbie (ID=40) (Dec 5, 2000 9:37:04 AM)
brb dr on the phone
dr.j (ID=42) (Dec 5, 2000 9:37:48 AM)
Problems on tests of integration (all three tests FW, CW, and CS involve integration).....definitely there is some integration problem. Thus, your daughter is having problems putting pieces together. She may be processing only pieces of information, she may be getting only the surface meaning and not able to proces the implications. Example, "Go to your room and clean up." Well the surface structure or meaning is for me to go to my room (usually a bedroom) and get washed up (clean up). But there is no water in my room, and there is no soap, towel, etc. So, I am confused. What should I do? I know you are the adult, I love you and respect you and you are smart, so, you know what you are saying, so, I don't want to question you???? SO, I guess I'll go up to my room and wait for you there. Do you understand or follow how an integration problem can lead to a great deal of misunderstanding and difficulties learning and communication problems, Lynne?
dr.j (ID=42) (Dec 5, 2000 9:38:59 AM)
But, what we still don't know is whether the integration problems are primary or secondary to primary deficits in decoding, dividing attention, and/or memory. I would think the memory problem is secondary to another primary problem. My gut feeling is that your daughter has .....
lynne (ID=41) (Dec 5, 2000 9:39:27 AM)
yes she tells me that a school she listens really hard to what the teacher is telling her(processing) then she does not hear the rest of what she is saying
dr.j (ID=42) (Dec 5, 2000 9:40:37 AM)
either a primary decoding problem, a primary decision making problem, a primary rapid processing problem, and/or a primary dividing attention problem or some combination of these. But, you do NOT have sufficient test information to see what patterns occur on OTHER tests of APD to see which of these factors POPS up as the one or two real underlying factors accounting for deficits your daughter is having.
lynne (ID=41) (Dec 5, 2000 9:41:05 AM)
she is for follow up in 6 months any suggestions
dr.j (ID=42) (Dec 5, 2000 9:41:27 AM)
Lynne, your daughter has a great deal of excellent insights in understanding her problems. And, yes there really are prooblems.
Irene (ID=43) (Dec 5, 2000 9:41:36 AM)
(This user has entered CAPD: From the Heart) (IP = 172.170.164.80 )
dr.j (ID=42) (Dec 5, 2000 9:42:19 AM)
You ask about the 6 months follow-up. I ask you, Are you comfortable with understanding what is the bottom line or underlying factor or factors accounting for your daughter not being able to process verbal information to wait 6 months? ? ?
lynne (ID=41) (Dec 5, 2000 9:42:21 AM)
hello irene
Irene (ID=43) (Dec 5, 2000 9:42:40 AM)
Hello. I'm sorry I am so late. I will probably just "listen."
dr.j (ID=42) (Dec 5, 2000 9:42:41 AM)
Good morning Irene. I hope you can follow this converstation.
lynne (ID=41) (Dec 5, 2000 9:43:14 AM)
no what would you suggest for now
dr.j (ID=42) (Dec 5, 2000 9:44:05 AM)
Lynne, if I were your patient/client, and I said, "I'm not comfortable with the information I have, and I'd like to have a better understanding," what would you suggest I do?
lynne (ID=41) (Dec 5, 2000 9:44:20 AM)
get a second opion
debbie (ID=40) (Dec 5, 2000 9:45:34 AM)
hello Irene....
Irene (ID=43) (Dec 5, 2000 9:45:53 AM)
Good morning, Debbie.
lynne (ID=41) (Dec 5, 2000 9:46:05 AM)
i just do not know if the resourses are available here
dr.j (ID=42) (Dec 5, 2000 9:46:21 AM)
Well, Lynne, that's what I would support. You need to have a more in-depth, a more comprehensive (a) evaluation of your daughter's APD abilities and weaknesses (b) focusing on identifying the underlying factors that may account for the problems your daughter is having in processing auditory-verbal information and (c) with that better understanding a clearer path to identify what appropriate interventions will help my daughter.
dr.j (ID=42) (Dec 5, 2000 9:47:47 AM)
Lynne, there are a number of things you can do. One is to have an audiologist who has the additional tests give those tests and have an outside consultant come in to do the interpretation, assessment of what the test results really tell us, and set up the interventions and goals to help based on the factor analysis.
lynne (ID=41) (Dec 5, 2000 9:49:02 AM)
have you allready mentioned those tests
dr.j (ID=42) (Dec 5, 2000 9:50:54 AM)
Lynne, no, there are a variety of other APD tests that can be administered to help differentially factor out the integration problems, the divided attention factors, the decoding factors, and the time/temporal factors and all of them involve decision making.
lynne (ID=41) (Dec 5, 2000 9:54:15 AM)
are you aware of where this testing might be carries out in Ont. Can
dr.j (ID=42) (Dec 5, 2000 9:54:58 AM)
Where do you live specifically in Ontario. Are you north or near Toronto or near Ottawa? WHere?
lynne (ID=41) (Dec 5, 2000 9:55:19 AM)
In the middle she was tested in Kingston
dr.j (ID=42) (Dec 5, 2000 9:58:15 AM)
Well, one possibility is to see if the audiologist who tested her is able to do further testing other than just the SCAN. Even if the audiologist can't do the analysis and interpretation, you could always get an outside consultant to do the analysis and interpretation, write the report, integrate all of the information, identify the underlying factors and provide concrete intervention with goals, etc.
lynne (ID=41) (Dec 5, 2000 10:02:13 AM)
actually he closes with should you have any questions regarding this report otr would like any additional info please feel free to contact me
dr.j (ID=42) (Dec 5, 2000 10:02:32 AM)
Lynne, I know it is getting close to the 10 am time I have to leave by 10:15am.
lynne (ID=41) (Dec 5, 2000 10:02:57 AM)
thank you you have been helpful
debbie (ID=40) (Dec 5, 2000 10:03:23 AM)
Lynne, just as a reminder there will be a parent chat tonight at 9 pm EST too
lynne (ID=41) (Dec 5, 2000 10:03:29 AM)
what about ear infections and ???genetic link
dr.j (ID=42) (Dec 5, 2000 10:03:34 AM)
Well, maybe you can ask that audiologist if he is able to do more than just the SCAN testing. What you'd want would be testing of integration (best test is SSW), testing for temporal processing (there are a variety of these tests), testing of decoding, and all of these would involve decision making.
lynne (ID=41) (Dec 5, 2000 10:03:44 AM)
have to work this eve
debbie (ID=40) (Dec 5, 2000 10:04:46 AM)
ok lynne..the morning chat is every other week
debbie (ID=40) (Dec 5, 2000 10:06:53 AM)
lynne do you feel comfortable with calling your audiologist back and asking futher questions?
lynne (ID=41) (Dec 5, 2000 10:07:03 AM)
yes
lynne (ID=41) (Dec 5, 2000 10:07:25 AM)
he seemed like an approachable fellow
dr.j (ID=42) (Dec 5, 2000 10:07:39 AM)
Lynne, there has been a lot of research on ear infections and a possible link to APD and language factors. The real bottom line is NOT the ear infections. The factor is in what way does the ear infections affect the auditory input to the child. Many children have ear infections with NO affect on their hearing and auditory system. Many children undergo changes in hearing and auditory system, but adapt well and have no effects. Many children are thrown so much by the chronic flucctuations in hearing and changes in the auditory system due to the ear infections, that they are affected and wind up with APD and/or language problems or both. So, there really is no support that chronic ear infections lead to APD. But, they may be the stimulator of APD problems in some children.
debbie (ID=40) (Dec 5, 2000 10:07:42 AM)
great! That is very important.
debbie (ID=40) (Dec 5, 2000 10:10:17 AM)
Dr J I know it's getting close to time for you to have to go...I just want to thank you for your time this am
dr.j (ID=42) (Dec 5, 2000 10:11:37 AM)
As for genetic factors. We don't have ANY idea of what is and what is NOT APD, so, we could never study genetic or hereditary factors until we can find a concensus of who we should study? However, many people have noted (and this is anecdotal not pure research, so take it only with a "grain of salt" as the saying goes) that many children who they see with APD have other siblings also with APD and even are reported to have parents who have had histories of learning problems or APD factors. So, there is probably a strong hereditary factor, but, it could also be that the environment is such that proper auditory processing is NOT being developed in many cases. SO, there is probably some hereditary/ possible genetic factors and probably some relationship with a child born with the likelihood of developing APD problems being set off to have those problems due to auditory deficits secondary to chronic middle ear infections and fluid.
lynne (ID=41) (Dec 5, 2000 10:11:37 AM)
yes thanks for the new insight
dr.j (ID=42) (Dec 5, 2000 10:13:10 AM)
Lynne, if you find you have more questions, please if you'd like to sound them out with me, or ask, or just discuss anything further, you can private email me at jay.lucker@gallaudet.edu or come back in two weeks on Tuesday morning for another parent chat. I hope what we've discussed is not TOO overwhelming, and I hope it helped clarify some things for you.
dr.j (ID=42) (Dec 5, 2000 10:13:38 AM)
BTW, yes, Debbie, thank you, I realize it's almost 10:15 and I must leave by then.
lynne (ID=41) (Dec 5, 2000 10:14:19 AM)
i believe my husband had a learning disbility and my daughter suffered from chronic middle ear unfections
lynne (ID=41) (Dec 5, 2000 10:15:48 AM)
ty
dr.j (ID=42) (Dec 5, 2000 10:15:57 AM)
lynne, sounds like your daughter has a number of underlying factors that could account as "causes" for the APD problems she has. Now, our goal is to get the the underlying factors so we know what to specifically address in remediation and intervention and we can understand what to do now to help her maximize here learning.
dr.j (ID=42) (Dec 5, 2000 10:17:47 AM)
Got to run. Hope you both have a great day, and week. Lynne it was a pleasure chatting with you. Debbie, see you soon.
debbie (ID=40) (Dec 5, 2000 10:18:12 AM)
Lynne, I hope you will let us know what happens when you call the aud back
lynne (ID=41) (Dec 5, 2000 10:18:51 AM)
i will sometimes you just dont know whereto start first when faces with new challenges
debbie (ID=40) (Dec 5, 2000 10:19:36 AM)
Lynne I really do understand...My daughter was dx 2 1/2 years agao and I'm still looking for some answers on what to do
debbie (ID=40) (Dec 5, 2000 10:19:54 AM)
seems as if it's new challenges all the time....
lynne (ID=41) (Dec 5, 2000 10:19:56 AM)
do you know much about fast forward there is actually someone in my area that teaches it
debbie (ID=40) (Dec 5, 2000 10:20:26 AM)
my daughter went through FFW last year....
lynne (ID=41) (Dec 5, 2000 10:20:51 AM)
was it helpfull and how old is your daughter
debbie (ID=40) (Dec 5, 2000 10:21:08 AM)
she did FFW at the same time she started using an FM trainer........she seemed to be doing better.....but right now she is really really struggling in school
debbie (ID=40) (Dec 5, 2000 10:21:17 AM)
my daughter is 9 in 3rd grade
lynne (ID=41) (Dec 5, 2000 10:22:06 AM)
my paed thought the fm trainer might point her out too much in the classroom
debbie (ID=40) (Dec 5, 2000 10:22:17 AM)
in the spring Sarah seemed to really make progress....it seemed as if things were clicking for her..but right now she's having a harder time in school than she's ever had..i dont know if it's just the new material or what
debbie (ID=40) (Dec 5, 2000 10:23:25 AM)
it is true that the FM lets the other kids know she has a problem...but why should it be any different than having bad eyesight and needing glasses.....my daughter has never ever had one child say a bad thing to her about the FM
lynne (ID=41) (Dec 5, 2000 10:23:37 AM)
this is the first time that Taylor's teacher told me that her reading was not an issue and that she would volunter to read in class
debbie (ID=40) (Dec 5, 2000 10:24:10 AM)
although kids can be cruell....they know it helps her and the kids have accepted it..I think it's importatnt how the teacher introduces it in the classroom
lynne (ID=41) (Dec 5, 2000 10:24:15 AM)
they recomendeed ear plugs in class
debbie (ID=40) (Dec 5, 2000 10:24:32 AM)
ear plugs??? then how does she hear the teacher?
lynne (ID=41) (Dec 5, 2000 10:25:34 AM)
Taylor has a great teacher this year she also had her last year i think for testing and quiet reading
debbie (ID=40) (Dec 5, 2000 10:26:09 AM)
sarah has a fantastic teacher last year............
debbie (ID=40) (Dec 5, 2000 10:27:06 AM)
i have sarah's science book in the other room and i need to be able to read through it
debbie (ID=40) (Dec 5, 2000 10:27:17 AM)
so im going to have to get going pretty quick too]
lynne (ID=41) (Dec 5, 2000 10:27:37 AM)
all this started when her resourse teacher suggestedd we try to get her in a special program classroom size 10 - 15 focusing on math and language in aft regular classroom
debbie (ID=40) (Dec 5, 2000 10:28:28 AM)
lynne, my email is capdfromtheheart@aol.com i hope you will stay in touch with me
lynne (ID=41) (Dec 5, 2000 10:28:36 AM)
she got turned down for grades 4,5,6 only
lynne (ID=41) (Dec 5, 2000 10:28:50 AM)
will do should get cracking on stuff myself
lynne (ID=41) (Dec 5, 2000 10:29:01 AM)
bye for now
debbie (ID=40) (Dec 5, 2000 10:29:07 AM)
take care and join back wth us in two weeks..bye for now
