Auditory Processing (Psychoeductional, Part V)

This next post in the series on Psychoeducational Assessments (Background History, Testing Observations, Intelligence/Cognition, and Visual-Motor Integration,) has been extraordinarily daunting for a number of reasons:

1) I have a hojillion actual psychoeducational assessments to complete before my darlings all leave school for the summer.*

2) Every single area of “processing” is so much more complex and multidimensional than it seems at first glance.

3) Low scores on measures of “Auditory Processing” can sometimes not be due to “Auditory Processing Deficits” but rather attention, social-emotional distraction, second-language acquisition, phonemic instructional casualties, motivation, hearing loss, etc etc etc.

4) An “Auditory Processing Disorder” is an umbrella term used by a hojillion* different professions in a hojillion* different ways. Sometimes, the diagnosis falls in the realm of a Speech Language Pathologist (especially when called “Central Auditory Processing Disorder”, or CAPD), though a multidisciplinary approach is the best for these reasons.

With those caveats, here’s my best attempt. I’ll start with the “classic” cases I see as a school psychologist working under the guidelines for Special Education law. I’ll explain them like I do in my everyday job, to students and parents. It’s just what I’m used to.

Phonological Processing: This is the way the brain hears the sounds in words and is able to take them apart and put them back together again. For example, you use phonological processing to hear that the word “Cat” is three different sounds, or when I say three sounds (/c/ /a/ /t/), you can tell me that the word is “Cat.” When you have a “phonological processing deficit,” it can look like a number of other things, such as not hearing the difference between “card” and “cart.” So when a teacher is helping the student look at an unfamiliar word and says, “Sound it out!” it is very difficult because the student doesn’t hear the sounds the same ways as others. It can also be hard to remember which letters make which sounds. This is why it takes students with this problem longer to read.

Short-Term Auditory Processing (aka Auditory Working Memory):**This is the ability to hear and remember what is said long enough to do something with it. It’s the same process we all use when someone gives us a phone number and have to remember it long enough to dial it (without the benefit of pencil/paper or punching it in your cell phone), or doing mental arithmetic at the store. You also need your auditory working memory to listen to directions, especially multi-step directions, such as “Get out your book, turn to page 247 and start on section B.” Kids with auditory memory problems may get out their books and have forgotten what to do next.

Language Processing: Language processing can be subsumed under “Auditory Processing” for the purpose of IDEA definitions, but certainly is more in the realm of Speech and Language. Please refer to “Notes from the Speech Pathologist,” if it exists. What? It doesn’t? Okay, here goes, from a School Psychologist’s perspective: Difficulties with overall language processing can be as varied as taking a long time to come up with the word you need (“Lexical Access”) to not being able to make links between verbal concepts (“Abstract Verbal Reasoning”).

For example, a student with language processing problems might have a hard time coming up with answers to inferential questions, where the answer is not stated, but implied. This type of learning happens all the time in reading comprehension or listening comprehension tasks (e.g. Why do you think the character did that? What do you think will happen next? Who do you think is the bravest in the story?). If it wasn’t exactly stated that the bravest character was Judy, the student may not make the connections between all the other bits of information needed to make that assumption, like “Judy raced out of her house as soon as she heard about the crisis” and “Judy had a card up her sleeve.” Sometimes the student has difficulties interpreting the non-literal language, as in the “card up her sleeve” idiom. It does not explicitly say that Judy is brave, but one can infer it. This type of verbal reasoning can be impaired in students with language processing problems.

Overall, “Auditory Processing Deficits” are the hallmark of traditional “Learning Disabilities” sometimes referred to as “Dyslexia.” Contrary to popular belief, reading disabilities are not typically visual in nature (e.g. seeing “b” for “d”) but are typically a problem with the auditory processing channels. And as the length of this post suggests, the variations in what constitutes an “Auditory Processing Deficit” is not exactly cut and dry.

And if I ever want to finish my actual psychoeducational reports I need to write, I might want to look into abandoning the blog for Twitter, where there each post is required to be 140 characters or less. Somehow, ”Auditory processing is complex. It involves sounds, memory, and language” doesn’t really satisfy me.

*Hojillion (hoh.jill.eee.on). (Adj.) A large and exaggerated number somewhere between a hundred and a million, typically used at the end of the school year to purport an overwhelming sense of a ticking time table for work completion.

**Ug. Such a huge topic. So much overlap with other disabilities, such as Attention Deficit Hyperactivity Disorder. Distilling it to a paragraph makes me queasy, but here goes.

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Comments on Auditory Processing (Psychoeductional, Part V)

  1. Hi, Rebecca. Do you know of a standardized instrument that explicitly assesses “Short-Term Auditory Processing (aka Auditory Working Memory)” (what I would call statement repetition)? I’m interested in the distribution of scores on such an instrument…or some good data on average (and variation around the average) facility with statement repetition.

  2. Hi John,

    There are a number of instruments that have components of Auditory Working Memory in them, such as the Wide Range Assessment of Memory and Learning (WRAML), and the Test of Memory and Learning (TOMAL). The new NEPSY-II has a Language and Memory Scale, though you can only get subtest scores, not overall standard scores for the construct “Auditory Processing” because they didn’t cluster together in the standardization sample. So if you want a broad measure of AP, check out the WRAML or TOMAL and if you are measuring discrete skills, I’d go NESPY-II.

    Lastly, the Test of Auditory Processing Skills–3rd Edition (TAPS-3) has a memory scale that consists of sentence memory, word memory, numbers forward, and numbers backward. It can give you scaled scores for each task and a standard score for Auditory Memory. I’m not sure about the quality of the psychometric properties on the subtests, but if you can get your hands on the technical manuals you’d get the data you need. I do know that the NESPY-II was just re-normed.

    Good luck! Is this for a study or for clinical practice?

    RB

  3. Dee says:

    I am a school psychologist working in the Los Angeles area and have been using the Test of Auditory Processing Skills-3(TAPS-3) for about two years now. The problem: kids seem to fail the last subtest called “auditory reasoning.” It is so consistent that I wonder if it is a fault of the test. Does any one else out there use this test and observe the same problem?

  4. Hi Dee,

    I have had that experience if I give the whole TAPS in one sitting…the kids are usually so bored by the end, they don’t care about the Auditory Reasoning subtest and if Sam needs his sweater anymore. So if you aren’t already, give the Aud. Reasoning first thing on a second testing day.

    If you are pretty sure attention isn’t the issue, then my other note is that I find my students (who are generally low-income and do not make their own compost so have a hard time remembering the steps, and generally do not partake in food drives) need an extra prompt when they are close to the right answer. I usually say “Tell me more about what you mean by that” and they get it. If I don’t prompt, then it seems like they don’t understand the inference they are supposed to make.

    One final note: My kids always get the one about the birthday party wrong. They say, “There’s probably not enough money.” So I take the “Auditory Cohesion” scale with a grain of salt and use other data as well, such as the DAS-II Similarities subtest. If they bomb the TAPS and do fine on the DAS, then I usually don’t call it a language problem.

    Hope that’s helpful. Other school psychs, please weigh in! 😉

    RB

  5. JKimbrell says:

    My son is in 3rd grade and his reevaluation currently underway to see if he will qualify to maintain his IEP. I just received results from the school psych. It was so interesting to see your comments about the TAPS-3 because he scored in the 1st percentile on the Auditory Reasoning portion and in the 25th percentile for Auditory Comprehension his Cohesion score is 7th percentile. Phonologic Index is 47th percentile. What do you think about this? What would you do? Thanks for any suggestions.

    Julie

  6. JKimbrell says:

    My son is in 3rd grade and his reevaluation currently underway to see if he will qualify to maintain his IEP. I just received results from the school psych. It was so interesting to see your comments about the TAPS-3 because he scored in the 1st percentile on the Auditory Reasoning portion and in the 25th percentile for Auditory Comprehension his Cohesion score is 7th percentile. Phonologic Index is 47th percentile. What do you think about this? What would you do? Thanks for any suggestions.

    Julie

  7. Hi Julie,

    Seems like your son is able to hear the difference between sounds, blend and segment them at an average level (remember 47th %ile is not 47 %, it means that he scored better than 47/100 kids). His Cohesion score could be low for a number of reasons, one of which is a language-based learning disability. He could have also scored low because of inattention. Did the school psych test short-term auditory memory (or working memory)?

    I would have to see the full profile to say what’s going on, esp. his other language scores to say if the Cohesion score is a fluke or something meaningful. As people have commented above, it may not be the most reliable indicator of actual “auditory processing”.

    I’ll be curious to hear more! R

  8. Kelly says:

    My son was recently diagnosed with an LD (he’s already ADHD/AS). He has the issue with Working Memory and Processing Speed.

    Could you make suggestions as I’m waiting on the full report at the moment?

    I run into problem with his homework especially with science (projects) and english (book reports), I get lots of “I forget…” Suggestions would be great.

  9. Hi Kelly,

    Ah yes, the working memory and processing speed sometimes go hand in hand. The interventions that target those areas depend on how old your son is, and the specific deficits he has. It sounds sort of like he may be having some executive functioning deficits, which is problems in long-term planning, memory, and organization. Check out (if you haven’t already!) my post on this area: http://studentsgrow.blogspot.com/search/label/Executive%20Functioning

    Hopefully, the report you will get will have targeted interventions and accommodations for him.

    Thanks for reading and stay tuned for more posts on interventions. 🙂

  10. This is an excellent overview of what to expect when the school psychologist does an assessment. I wonder if there are indications of an auditory processing disorder, is it the school psychologist's job to refer for an assessment? We spent six months begging for an assessment and finally paid privately. The school psychologist said she didn't think he had it so wouldn't refer us to the audiologist. Turns out he has it severely. He's functionally deaf in the presence of ambient noise, hearing only 10% of what is said. And his classroom was right next to the school's main playground, so it was almost continuously noisy. Perhaps we were asking the wrong person? Nobody guided us, so maybe we should have done it differently. Thanks for your info!

  11. Christine says:

    Sorry to comment so late, but I just found your site.

    My daughter (age 6) just got dx'ed with language processing disorder based on TAPS-3. Her biggest problems were: word memory 25%, sentence memory 16%, aud. comprehension 16%, aud. reasoning 9%.

    Last year, her PLS-4 scored 61% in aud. comprehension. Is the drop on TAPS-3 related to other's comments about a poor reasoning subtest, or should I be concerned? Do I need a second opinion or different evaluation?

    She is smart but seems to need a lot of broken down instructions and repeated directions. I'm at a loss. Sorry to bother you, but thanks for your time. 🙂

  12. Rebecca says:

    Hi Christine,

    Glad you found the blog! It is confusing when similar sounding tests have such different results. Usually, it is because they measure slightly different skills. It can also be the case that kids with auditory processing challenges allot their attention differently on different tasks and at different times, so auditory attention could be the difference. What I know about the PLS-4 (I'm not a speech language pathologist, and that is a speech test) is that auditory comprehension involves ability to follow one step and two step directions, point to features based on a direction, etc.

    The TAPS AR subtest is very different in that it asks the student to listen to a short passage and make an inference about it. So it's not straight up memory of a discrete direction but an ability to "read between the lines". I don't know if you need another eval, just know that her reading comprehension will require the same skill and intervention in helping her make language inferences will be a good reading comp intervention. Your friendly school psychologist and/or speech pathologist will have good recs for that.

    Good luck! R

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