Auditory Comprehension Weaknesses: An Action Plan for Parents
By Patti Hamaguchi, M.A., CCC-SLP
Throughout May, in recognition of “Better Speech and Hearing Month,” I’ll be writing each week about one facet of an “action plan” for parents of newly-diagnosed children with auditory comprehensions weakenesses, exclusively for TechnologyinSpecialEd.com! Week 1: Understanding the Test Results & Diagnosis
For the sake of this series, we will be talking about the “auditory comprehension of language”, also known as “receptive language” or “language processing”. These three terms are generally interchangeable and refer to how much the child is able to make sense out of what they hear—what do they understand?
Your Child Has Just Been Diagnosed-Now What?
You’ve had the IEP or perhaps received a private report from a speech-language pathologist or psychologist. In it, you see that your child’s “auditory comprehension of language” is below average, or even significantly so. Your first job as a parent is to understand what the tests, numbers and terms really mean. How far behind is your child? Is auditory processing the same as auditory comprehension? What exactly does my child have?
First, let’s talk about how to decipher the numbers. Reports can list scores as “age equivalents” which refer to the fact that your child’s performance was more typical for a child of a certain age. The first number is the year and the second number refers to the month. So a number listed as “4-5” would indicate that your child performed on the test similar to a child who is 4 years 5 months would be expected to perform.
Another number you may see is called a percentile. With this scale, scores range from the 1st percentile (sometimes it is even listed in decimals, such as .5 percentile) to the 99th percentile. A score of 50 would then be the average score for a child, no matter his/her age. Scores lower than the 7th percentile fall into what is called the “disordered” range and in the world of public school education in the US, are often the dividing line in terms of whether or not a child qualifies for services.
Standard Scores are typically reported in numbers that use 100 as the average, with 85-115 being considered with the average range. That said, some test publishers issue their own “standard scores” and so you may see single digits (such as a 9 or 11) indicated instead. In these cases, you will need to know that particular publisher’s scale in order to decipher what those numbers mean.
To make matters more complicated, different professionals sometimes use words with “auditory” in them, but not necessarily all labels have universally agreed-upon meaning. To start, the word “auditory” refers to how we hear. If your child is having “auditory comprehension” difficulties, it indicates that your child does not understand what is being said—the message– in a normal way. “Auditory processing” is one of those diagnostic labels that for most people, means the same thing. The words are going in, but the brain cannot translate them. However, for speech pathologists and audiologists, there is a more specific disorder (Auditory Processing Disorder or Central Auditory Processing Disorder) that refers to a pathology in the neural pathways before the information reaches the cerebral cortex for linguistic processing. Very specific tests are done to rule in/out APD by an audiologist. These are generally considered to be most reliable after the age of seven. Children with cognitive delays, hearing loss and developmental disabilities such as autism spectrum disorder, are very challenging to reliably test in this regard, and so often professionals will assume that there is some degree of slow processing or inefficient performance of the auditory neural pathways present due to a more pervasive processing/cognitive impairment that is part of these other syndromes or disorders.
Once you understand the numbers in the report, pay attention to the little subskills within the receptive language/auditory comprehension umbrella. Are there increased difficulties when the information to be processed is too long? Are there certain types of language structures (Negation? Pronouns? Passive voice? Wh questions?) that are especially problematic for your child? Is your child’s working memory (“short term auditory memory”) poor? This component can really make holding on to language long enough to be processed, an issue. How about attention span? Is your child having trouble comprehending language because he/she is off-task and paying attention to other things in the environment? Lastly, we often find that this group of children often struggles with other auditory elements, such as reading, writing and spelling. If your child is school age, are there associated issues with these skills?
In putting together your “Action Plan” for this week, focus on becoming informed about your child’s current status, and what subskills are behind, and which ones are doing already. Next week, we’ll talk about Issues at Home and School.
Leave your questions/comments in the comments below. Patti will try to address them as best as she can.
Patti Hamaguchi has been a speech-language pathologist for over 30 years. She is Director at Hamaguchi & Associates, a pediatric speech therapy practice in Cupertino, CA, and the author of Childhood Speech, Language & Listening Problems: What Every Parent Should Know, as well as several books on auditory processing disorders. She is a columnist with Autism Bay Area, and an expert speech pathologist panelist on BabyCenter.com. Patti is also the founder and creator of Hamaguchi Apps for Speech, Language & Auditory Development.
Week 2: Issues at Home and School
Week 3: Games and Activities to Strengthen Auditory Skills
Week 4: Resources and Programs for Children with Auditory Comprehension Weaknesses
Wrap-Up: What to Expect & What to Do