Along the lines of APD

[MicheleB]

My 7yo ds was initially dx with an auditory processing "difficulty" during his speech and language eval about six months ago. Since then the therapist thinks he has improved and isn't really considering this an issue anymore.

 

However, her assessment is based on 30 mins. of very one-on-one therapy with my son, using visuals the entire time. Visuals being flashcards, games, puzzles for the speech part and worksheets for the APD part.

 

I have noticed at home that ds concentrates much better with a visual.... He likes books that have LOTS of pictures (one on every page), workbooks with pictures and colors, etc. BUT he is very poor at following or understanding purely verbal instruction. We just worked on his worksheets yesterday at home.... the kind where he's given two or three statements and is supposed to follow the direction, such as: All of these animals are big, but only two can fly. Color the ones with wings blue...... Ds gets so "lost" in picking out his crayon and deciding which crayon is "blue" enough that when he gets back to his page he's forgotten he 's supposed to "circle" and underlines instead. So I'm not sure if this is typical APD or not.

 

Does this still sound like APD or more like ADHD? Is it wise for the therapist to pronounce ds is "okay" now APD-wise when she only sees him 30 mins/week? Do APD and ADHD inter-relate?

 

She mentioned referring us to an audiologist at first, but the last few times I've spoken with her she seems reluctant because she thinks he's improved. So while she's going purely on what she sees during ST, I'm going by what I see 24/7. ???

[Mom0012]

Michele -

 

If you still think there is a problem, you should follow your instinct and check it out. There are at least 2 distinct types of processing problems. One is auditory processing disorder and the other is language processing. I think it can be difficult to weed out the difference. If it is auditory processing disorder, then from what I understand, only an audiologist can diagnose this. If it is a language processing issue, the SLP should be qualified to make a diagnosis. If it isn't clear to the SLP what the problem is, then in my experience an APD eval may be recommended to rule it out.

 

My son has always had a great deal of trouble in following oral directions. We had him tested for APD last year and while he has some auditory weaknesses, he does not have APD. For him, it is a language problem and possibly also related to the fact that he has weaknesses in the area of working memory.

 

Lindamood Bell's Visualizing and Verbalizing program is supposed to help with this. My son did this program and made dramatic improvements in comprehension and yet, he still has great difficulty with following oral directions, particularly if they are abstract. This is the one area of their program that he made very little progress in.

 

The main time that I see problems with this is when we are doing our schoolwork and I ask him a question or give him some directions to follow. Many times, I know he knows the answer to the question, but he just doesn't understand what I am asking. If he does not understand the question/directions, what helps is having him repeat it back, sometimes a few times and giving him a few minutes to think about it. It has also been recommended that I repeat myself 3 times. One time so that he can hear the words, a second for (I don't remember) and a third time for meaning. I have to do this maybe once every day or two, so it's not all the time.

 

If you want to practice the skill, Gander publishing sells a couple of Following Directions workbooks.

 

Lisa

[Claire]

I have noticed at home that ds concentrates much better with a visual.... He likes books that have LOTS of pictures (one on every page), workbooks with pictures and colors, etc. BUT he is very poor at following or understanding purely verbal instruction.

 

The therapist is seeing only a portion of your son's problem. To me, it still sounds like APD. I would push her for the audiologist referral. What she is helping him do is use visuals to compensate for his auditory processing problems. Compensation is different from remediation.

 

Actually, he sounds like a good candidate for FastForWord. 7yo is considered the ideal age for this program because the auditory system is finally fully developed but still very plastic. If you have to pay out-of-pocket for an APD evaluation, then you may want to opt instead to use the money for FFW.

 

If you do go to an audiologist, make sure the audiologist has specialized training in APD. Regular audiologists do not have this training. Speech pathologists only have *screening* instruments available to them to assess APD. These screening instruments are helpful, but they do have a high rate of false negatives (indicating no APD when APD is there). Specialized audiologists have the expensive equipment and testing expertise to not only identify APD, but identify the subtypes and severity of APD.

[Laurie4b]

"Compensation is not remediation." Great point! Michelle, I wonder what would happen if you were to ask your speech-language therapist to work with your son without the compensating strategies--to just have him rely on his auditory processing, and then see what she thinks. You could couch it in the language of "Now that he's met his goals with the visual aids to help him compensate, I'd like you to take him to the next step of functioning without the visual aids."

[MicheleB]

If it is a language processing issue, the SLP should be qualified to make a diagnosis.

If this were the problem, instead of APD, would the therapist have picked it up in her inital evaluation? She had him do things like name colors and shapes that varied, as quickly as he could; of course the usual articulation things; etc.

 

Actually, he sounds like a good candidate for FastForWord.

Is this a program that is usable solely by the parent or does it require a professional's oversight?

 

I wonder what would happen if you were to ask your speech-language therapist to work with your son without the compensating strategies

That's a good idea. What specifically could I ask her to do? I have a feeling she'll ask *me* for examples of what I'd like to see her do or what I'm seeing at home. Or should she, if she's a good ST, know how to address this without my suggestions?

[Claire]

FastForWord can be done on a computer at home, but it has to be supervised by a provider. The software costs somewhere in the neighborhood of $850, and then you have the provider's costs to pay above that. Some providers offer packages. Others simply charge by the hour. Assuming you don't have major problems, an hour's worth of oversight a week should be enough. (The provider has access to the program's data via the internet.) You do need a computer with a good quality sound board that has a headphone jack and a set of headphones that meets the program's requirements.

 

FFW is a very intensive program for the child, especially for a child who has auditory processing problems. The original program required 100 minutes of interaction with the computer programs per day, 5 days a week, for 12 weeks. A few years back they offered a modified program for the middle school version that had more on the order of 50 minutes of interaction per day, but spending twice as long to complete the program. Their research found that this less intensive use of the program was just as effective as the original version. I'm not sure what they offer now for 7yo users, but I would ask about this and opt for the fewer-minutes-per-day if you have that choice.

 

Here is the website for FastForWord. Last time I looked, they offered very little specific information on the website, but you could look up local providers. In my admittedly limited experience, I still think that the original FastForWord program (which they have since renamed, and I'm not sure which one it is) is the best. That's the one I would start with.

[Claire]

Glancing at the website, I'm pretty sure it is "FastForWord Language" that is the original program -- not the Basics, and I'm fairly certain not any of the Reading ones. The original program worked on training the brain to process the sounds of speech with speed and accuracy.