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Lecka (or anyone): ABA + CAPD, teaching kids with CAPD, etc.


PeterPan
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I read something (don't remember where, sorry) saying that ABA wasn't recommended or as effective if there are auditory processing issues plus the spectrum.  That got me to thinking about whether boatloads of what I try to do with ds is so verbal that it's not processing adequately or connecting adequately.  

 

What else do they do in that case if it's spectrum AND the auditory processing disorder???

 

And just in general to anyone, what are your best interaction (instruction, discipline, life coaching, discussion, etc.) techniques with someone with an APD?  Even basic things like getting his attention when he's walking down the hall and you call to him...  

 

I don't know, I'm just so embarrassed mentally, sitting here looking at what I thought I could do with him, and realizing just HOW MUCH of it is verbal.  And I thought it would be fine if we just added on the kinesthetic while we did the verbal.  However if there's an actual APD going on with him, then that totally skews how EVERYTHING is being interpreted, right?

 

I don't know.  

 

I think I'm just in the I don't know stage.  Need a better glass ball.  Two and half weeks till evals, sigh.  Actually though, maybe we'll get some answers with the audiologist thing next week?  Just a thorough hearing eval, but I guess something could turn up.

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Many kids with ASD have auditory processing difficulties so ABA therapists often use picture or other non-verbal prompts, schedules, etc.

 

One of the programs that DD's ABA team is running is following directions, and they always start with non-verbal directions. For example, to teach following 2-step directions, the therapist might model clapping her hands, then touching her nose. Once that type of non-verbal prompt was mastered, they started on following verbal prompts. That has been more difficult for her, and that's a clue that she probably has APD issues.

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I don't agree with ABA not being effective with auditory processing problems.  

 

I agree with Crimson Wife.  

 

1) lots of visuals can be used

 

2) we have done a lot where we start with doing something in a quiet environment, then it gets a little louder and a little louder.  And, starting with following a direction from a near distance, then slowly increasing the distance farther and farther.  We have done both of these things, built-in with a lot of programs.  Ultimately there are times when goals need to be mastered in a classroom environment -- which means mastered with that level of distraction/background noise.  But you don't start there -- you slowly work up to it.  For following a direction going down a hall, we started with the same task (and in a variety of ways) when he is very near and work up.  Also we have used visual cues when he has been farther away, then fade the visual cues.  

 

I think ABA could definitely be done in a way that is not a good fit for auditory processing issues.  But -- I think it also can be done in a way that is a good fit.  Maybe it is not the best -- I don't know.  I do think it can be done in a way where it is not trying to work against the child instead of with the child, for sure.  

 

My son spent a lot of time with picture card support for "clap hand then touch nose."  It was easier for him to copy a picture card (when he knows what they mean) than to copy a person.  I think it is remembering for him -- remembering the first action and the second action.  With a picture card support he doesn't have to remember them.  But it is always like -- start with needed prompts/supports, then fade them.  If a goal is not working out -- the therapist should take what he/she knows about the child to increase supports or increase motivation.  Then fade the supports and increase the intrinsic motivation (by linking it to something motivation, or just it is easier and the child feels like "ooh, I can do this").  Until then -- there are supports and there is non-intrinsic motivation -- some combination of those two are a real theme for my son.  

 

Edit:  I was thinking about it more, and I can see saying that ABA is not a direct treatment for apd.  But -- I don't think that means it is bad for it, or that there couldn't be supports so the child could learn or communicate in other ways.  I don't think ABA is super auditory *at all* and there is a lot that can be done and is done for kids who are better with visual methods or visual supports.  It is not something that has to be primarily auditory.  But -- if people are saying -- you need to treat apd with a specific apd treatment, and ABA is not doing it -- I can see that.  

 

I think my son appears to have better auditory processing since he has done ABA -- but I do think he just had not learned to pay attention or pay attention with background noise -- I think whatever was going on with him is not the same that is going on with other kids -- where the things that have helped him, might not help them, b/c it is not the same thing going on.  But -- I don't think it is something to blow off or rule out, either.  

And, I do think that if there is an absence of progress, then it is good to look at supports -- and if that means visual supports, then that is what it means.  Or, motivation.  Those are the two things for my son -- there could be more, but I do not know about them, those are main things for my son.  

 

He is also able to attend better when he is very motivated.  

 

But I don't know, with him, if it was all attending.  I don't think so -- I think he has truly improved, b/c there were times before when he was motivated but still didn't seem like he could do it, now it seems like he has just improved in skills.  But I do think it is very possibly that he was weak or undeveloped in this area, for a reason, and the reason, maybe was more of an autism "lack of attending" thing.  But it is hard to know what came first or if one came first, and I think they are related for him.  

 

But, that it may be something very different going on, too, than with someone who has apd and who needs a specific apd treatment.  I think my son did improve with things he did like I have mentioned.  I know he has, really.  But I don't think it is something that is going to be applicable to everybody.  But I do think this has worked with my son.  

 

I can see that another person might have a treatment targeting apd and then with auditory processing easier -- then have that make attending easier.  I can see that.  Or -- just needing apd treatment specifically.  I think that is a real thing.  I think at a certain point -- my son would have been somebody where he would not even attend to the treatment -- b/c he had pretty low attending.  But that would not be the case for everyone -- just what I think with him.  

 

Pretty much anything that is a goal -- you reduce it down to a more basic or simple level, until the child can do it.  Then slowly, slowly you work your way up.  So that becomes -- doing things near and working up to doing them far.  Doing them in a small group and then a large group.  Doing things in a structured environment and then in a less structured environment.  Doing things with visual supports and other supports and then not using them as they can be faded.  And -- this kind of thing works with my son.  And this is also why I am sure he has autism -- the autism treatment of ABA works -- so it is like a confirmation to me, that it is a sign he has autism.  If I didn't see that it worked -- I would probably be thinking -- he needs something else, either b/c ABA is not working for him, or maybe he doesn't even really have autism.  B/c it does not seem like it works as well for everyone.  But it is a good fit for my son, I think.  

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Also -- for my son, in a way it is not a clue that he has apd issues.  In a way of course he has apd issues, but I think this is part of autism for him or covered by him having autism.  Just my feeling, maybe.  

 

He has been making slow by steady progress in improving how well he can attend to auditory information, notice auditory information, follow directions, etc.  

 

But for him to follow a direction, first he has to notice it, and hear it and understand it, and act on it.  He could have a break-down at any level for many reasons.  

 

I think the "total demand" type of model fits him.  That mean -- there are a ton of demands that can be present or that are competing or making things more difficult.  This can be -- noise, wind (wind can be very distracting to him), sun light, other kids, something fun he sees and really wants to do, ducks (he likes ducks), so many things.  

 

When demands are lower, he has an easier time with attending, noticing, following through.  

 

So then, if he is not doing well, I don't necessarily think of that as an apd issue.  On one hand, of course it is an apd issue.  But, a lot of it is that he has not developed the skill of paying attention etc. when there are higher demands or a lot of things competing for his attention.  It is *not* only other auditory information for him, I don't think it is primarily auditory.  Seriously -- wind is a thing, he does not seem like he can do as well with anything auditory, when there is wind.  And, it is the feel of wind, not the sound of it.  

 

So it makes sense to me -- he needs to get used to paying attention even when there is wind.  He can start with me having higher expectations and more prompts to help him, when there is a light wind.  Then when he can do that -- when it is a little windier.  When it is extremely windy -- whatever, he can just stand and feel the wind.  I will adjust accordingly.  (We live in Kansas, so it is often windy here.)  

 

But it doesn't seem like it is something where I need to look for apd treatment -- b/c I don't think it is so much that it is primarily apd.  With what I am seeing with him.  

 

I think part of it, too, he has been having therapy for a little less than 2 years.  It is something where it is going to take him time to work up.  He has come a long way, but he has a way to go.

 

Right now he is doing pretty well when he is sitting, he is able to attend in a large group (yay!).  He is not doing as well when he is not sitting.  So -- now we are doing more things for when he is moving around.  For him it is like a higher demand for him to do things when he is not sitting.  So, we are working on it now.  And we were always working on it, but he has always been "ahead" in how he does when sitting, compared to how he does when he is not.  Also -- when he is sitting, it is mostly going to be more structured, and there is going to be less visual stuff.  He does get hyper when there is a lot of stuff going on, I think it is an overload of visual processing.  But, I think that can get better, too, as he is around more and is exposed to more, and that he can start smaller and work his way up, too.  

 

But this is also like -- doesn't it just sound like autism?  It does not sound like apd, even though I think it is definitely auditory processing in its way.  If it starts to seem like it is auditory processing specifically that is holding him back, I would want to really look at it.  But it seems like -- he is making progress.  

 

But there are specific things where he didn't attend or follow a direction, and it seems like it could be that he was having trouble with visual processing, or sensory processing, more than with auditory processing.  That is just how he seems.  I have read things where kids have a hard time processing auditory and visual at the same time, they are looking or they are listening.  I think sometimes when he is not listening, he is looking at things and seems mesmerized, or is feeling wind.  I don't know -- if that makes sense.  Just, maybe more what I am seeing with him.  Other times he listens great, just certain times. 

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Lecka, somehow what you're saying actually makes sense!  Thanks for sharing that.  I may try some of the comprehension with background noise (radio on, etc.).  I appreciate the suggestion there.  I hadn't thought of something so simple.  I kept thinking I needed to take him someplace crazy noisy, lol.  So that's something I can work on this week, seeing what happens with that.  

 

The SLP got back to me with some more results but didn't give me the numbers yet.  She said that he had a huge spread, with clusters 1 SD below the mean *and* clusters 1SD above.   :lol:   But that's no shock, as some of the skills tested we had been explicitly working on.  And he had a score 2 SD below the mean.  Since that score wasn't one of the ones I had seen the percentiles on, that kind of raises my eyebrows.  

 

She's going to do more testing next week with "problem solving"...  I have no clue what in the world problem solving is to a SLP.  His auditory comprehension was 1SD above the mean.  Maybe that's a good sign?  Her email made it sound like she's trying to tease that apart, why you'd have those big spreads.  Maybe it means there's a lesser explanation like dyslexia? (I don't know, the idea of CAPD strikes fear in my soul, sorry.) Or maybe it just means we've been doing useful interventions tackling some of the areas but just have more to hit?  Dunno.

 

Anyways, thanks for explaining all that, Lecka.  You really put shoe leather on the concepts for me.  :)

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I agree with Lecka that it can be difficult to tease apart APD issues from general ASD issues. However, there are certain things my DD does that are clearly APD rather than ASD. For example, mixing up phonemes (/t/ vs. /k/, /b/ vs. /p/ vs. /g/, substituting /b/ for /f/, etc.) is a big red flag for APD.

 

DD is too young for formal CAPD testing but I'm trying to get her into the closest Scottish Rite Center for their Fast ForWord program. She's clearly struggling with phonological awareness/discrimination regardless of the specific underlying issue. I'm not going to sit around twiddling my thumbs for another 2.5 years waiting for her to be old enough for a CAPD eval.

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Yup, that was my realization this weekend, that there may be more interventions to try, sigh.  Just gotta wait and hear what the psych says first.  Actually, I'm really curious even about the basic hearing exam coming up.  Some of these letters (articulation) have been taking a long time to come, even for apraxia.  He can say them just fine in therapy sessions where she is giving the prompt, but he doesn't seem to *hear* them to pick the correct one in speech.

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My older son had trouble with distinguishing phonemes, and I don't think my younger son does.  If he does, it is much, much less severe.  He is having an easier time with letter sounds and with learning to write letters and numbers, compared to my older son. 

 

I would definitely think that about apd, if my younger son was also having the same problems.  

 

But, I don't think he has those problems, or at least not as severe.  My older son had trouble distinguishing in the best of times -- initial position in a word, word spoken clearly, someone talking fairly slow, talking one on one, and then it would be downhill from there.  

 

It is something different with my younger son, at least to a great extent.  He is doing better with his articulation than my older son was at the same age.  B/c we know about it with my older son, we have also done things where we show him two pictures, that are of similar words, and ask him to point at the one we say.  He does pretty good.  My older son was straight guessing (or getting the same number right or wrong as if he was straight guessing) when he was a year older than my son is now.  My younger son is also kind-of starting to do this "say-it-fast" kind of blending.  He is not quite blending -- but he is better than my son was.  He seems like he understands what he is supposed to do, just isn't quite able to do it.  My older son didn't even understand what he was being asked to do.  

 

Crimson Wife -- my oldest son went to private speech therapy in 1st grade, he had very low articulation scores then, and many pairs or sets of 3 sounds he had trouble telling apart, and he was eliding all -l and -r blends to w, and it seems like he was hearing them all as ????? I don't know, maybe he heard them like a w.  Then a lot of sounds he said as "t," he said "k" as t, any blend (or consonant cluster) ending in t (he wouldn't hear the c in -ct or the n in -nt at the ends of words -- and sometimes maybe not come close to making out final consonants at the ends of words).  

 

But anyway -- he is someone who was able to make major progress in speech therapy.  He has average articulation now.  He is reading on grade level in 4th grade.  He did a lot of speech therapy in 1st grade, and I was doing a lot of reading remediation with him.  He finished 1st grade below grade level in reading, and with more reading remediation and the passage of time over the summer, he started 2nd grade right at grade level in reading (still on the low side, but on grade level instead of below).  So -- he turned 7 at the end of 1st grade, and was a young 7 at the beginning of 2nd grade.  And -- basically caught up then.  He still has some wobbles, but it is so much less, and also, when it is a word here or there I think he is very able to fill in the few blanks here and there with context, in pretty much every situation.  He almost always says words correctly and can usually repeat words correctly.  That is now at age 9 -- he kept improving through 2nd and 3rd grade, until now it is really not something that I notice much and it doesn't come up much.  His spelling has also gotten better -- I am not seeing spelling anymore, where he has written the word like he is hearing different sounds.  

 

So -- I definitely think it is good to pursue speech therapy or Fast Forward or something, while she is still too young for the testing.  And, I think maybe she can even make a lot of progress between now and then.  I think I am very lucky my son could make so much progress, but I know he is not the only one.  He did speech therapy, and I did OG-style reading remediation.  I think he needed the speech therapy to be able to get started, and then the reading was practice and a chance to get better.  

 

It is different than what is going on with my younger son, though.  I know what it was like with my older son, when he would not be able to follow directions at soccer practice with the person speaking from a distance, with background noise, with commotion ----- and I think it had everything to do with him not being able to make out the words.  

 

With my younger son -- it is not the same.  There is more to it, and I would say he has an easier time making out the words, if he can pay attention to hear them.  Sometimes he will be listening to something else, and not listening to someone talking.  My older son never did that.  He could always focus attention, focus on someone talking, block out background noise, but background noise would make things too fuzzy, instead of being the thing he was listening to instead.  

 

I think my younger son still falls under the umbrella of auditory processing, but I think not so much in the "have him do Fast Forward" way.  But -- I think it sounds like a great thing to pursue with your daughter.  

 

I have looked up some things, too, in the past, about kids who have made really good progress with telling apart sounds.  If you are ever looking for some encouragement :)   I also don't know if you have already looked into dyslexia resources, but I found dyslexia resources to be more helpful than the more apd-focused stuff I was able to find.  But -- once I saw that I was getting good stuff for my son under the dyslexia area, I quit looking at apd very much.  Anyway -- for exactly what you are talking about, I think it is worth looking at dyslexia resources if you haven't yet.   It is something I wish I had known about.  

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