So why the increase? No one knowns for sure. Is it the foods we eat (or lack of nutrition in those foods) or could it be the toxins in the environment that are causing the marked increase? Is it that men and women are waiting until much older ages to have children? There is a known genetic predisposition in some families. Whatever the cause, as a SLP, you should be savvy in recognizing the early signs of autism spectrum disorders.

Research has proven early intensive therapy can lessen the impact of the disorder in a child’s life. The earlier the intervention begins, the better. So what should you be looking for?

By the age of FOUR months a child should be actively doing the following:

• Making solid eye contact with adults
• Exhibiting interest in adults and other children in his/her immediate environment
• Reacting to sounds in his /her environment by looking at the source of the sound (i.e., if someone is shouting, the child will turn his head toward that person)
• Exhibiting a preference for people over inanimate objects
• Smiling at a person who smiles at him / her
• Enjoying looking at people

By TWELVE to FOURTEEN months of age, the child should be doing the following.

• Engaging other people into his/her game or activity
• “Giving” items upon request, reaching for desired items, and using gestures to to regulate his/her environment
• Responds consistently to his/her name
• Uses gestures such as waving when saying “hi” and “bye”
• Shows empathy toward a parent or other person who is upset, reacts to “angry” voices with crying

By TWO years of age, the child should be able to:

• Look at items that are pointed to by an adult
• Imitate household routines (i.e, if mom is cooking, child will imitate stirring, pouring etc.)
• Play interactively with other children
• Have a functional vocabulary of at least 50 words and be using two word phrases
• Follow directions without assistance (i.e, “go get your coat and put it on”)

Other red flags include:

• A sudden loss of language or social skills
• Limited or no use of facial expressions
• Parallel or solitary play vs. playing socially with other adults, children
• Fixation or strong preference for a single object
• Delayed motor skills (late walking, delayed ability to ride a bike, climb stairs etc.)
• Repetitive body movements (hand flapping, arm swinging, spinning)
• Preference for lining up items in play (i.e., makes cars into a “train” vs. pretending to drive them in play)
• Sensory differences (reacts strongly / exhibits aversion to certain foods ( i.e., picky eater), lights (i.e., fixates on ceiling lights), smells (i.e., gags when foods are presented), sounds (i.e., puts hands over ears and screams when he hears a fire truck)
• Aversion to being held or hugged (not always present, some kids may actually exhibit an increased demand for hugging or deep pressure due to sensory needs)
• Echoing or repeating conversation or words overheard, can be immediate or delayed

Not all children with autism exhibit or lack the behaviors listed above; however, all of them should be cause for referral to a developmental pediatrician / neurologist and an occupational therapist trained in sensory integration. Remember, just because it looks like a duck and quacks like a duck, doesn’t mean it is a duck….Research has shown, mothers who were placed on bed rest during pregnancy may have a child that has sensory regulation issues that mimic autistic behaviors. I worked with a child who had thyroid problems and exhibited autistic like behaviors.It takes a multidisciplinary team to make the accurate diagnosis of an autism spectrum disorder.

As part of the diagnostic team you should provide the pediatrician with the following information:

The developmental pediatrician should be given a complete profile of the child’s speech, receptive and expressive language, oral motor, and play functioning. If you are trained in feeding therapy, it is often useful to provide information related to feeding skills as well.

For receptive and expressive language and play skill assessment The Rosetti Infant Toddler Scale is useful. It’s a nice tool to guide you through parent interview regarding a child’s skills as well.

A very thorough birth and developmental history is crucial. Even though the doctor will most likely perform a medical history, it never hurts for more than one professional to perform a B&D. A parent may divulge different information to different people. A comprehensive birth and developmental history form asks for information related to family history of disorders, the mother’s pregnancy challenges if there were any, delivery information (birth weight, APGARS, hospitalization history, and early feeding history), developmental milestones, and parental concerns.

There are different levels of membership available ranging from the Free level to private intensive diagnostic and dynamic therapy coaching at the Speechified level.

Discover which membership level is right for you!

Free Membership

Receive newsletters delivered to your internet mailbox. Get the latest news, innovations, and advice in the SLP Lingo & Speechified Advice section for FREE!

Your email will be used for newsletter purposes only! We do not share personal information.  Sign up now!

The Speechified Therapy Level was created for all levels of therapists’. This level is intended to give therapists access to important information to improve their therapeutic skills to facilitate communication in their clients. Therapy level members receive access to traditional and cutting edge proven ” in the trenches” therapy techniques for frequently occurring communication disorders in both pediatric and adult populations.  A monthly unlimited access pass may be purchased for the current price of $45.00.

Master the Evaluation level members receive step by step suggestions for performing comprehensive evaluations on children and adults exhibiting communication and feeding disorders. In addition to diagnostic guidance you will receive therapy plan suggestions, an IEP goal bank and examples of  functional measurable goals to assist with insurance / medicare reimbursement. A monthly unlimited access pass may be purchased for the current price of $45.00.

Unlimited access to both the Therapy and Mastery Levels can be yours for the current monthly price of  $80.00

Diamond Level members receive unlimited access to both Therapy and Mastering the Evaluation Levels. As a Diamond member you will  also receive exclusive access to Tracy and her team of therapists for consultation about clients via internet, video conferencing and / or over the phone for two (2) hours per month and invitations to exclusive diamond members only trainings held in Beverly Hills, CA  two times annually. Diamond membership can be yours for our current price of only $500.00 per month!

Speechified Membership Level

For top therapists who are ready for financial and career freedom, we offer the Speechified Level of the Exceptional Therapists Club. The Speechified level is for those who have decided to become an exceptional diagnostician and a sought after therapist. The ability to accurately diagnose clients, especially when standardized measures are not usable, and determine appropriate treatment plans will separate you from other therapists.

Get the reputation you deserve, be confident when collaborating with physicians, schools, and parents. Give your clients the correct treatment from the get go. This training will give you the freedom to be your own boss, leap into private practice with accelerated speed, or continue in your current position with increased confidence in your diagnostic and treatment skills. This  ultra-exclusive group receives the ultimate in personalized attention, one-on-one coaching, and proven business and therapy strategies from self-made business woman and acclaimed Speech Pathologist, Tracy Andrew, M.S., CCC. Coaching is delivered via phone, Internet, and exclusive live in-person visits at my clinic in Beverly Hills. Two options are available at the Speechified level. One on one coaching is available at my clinic for $2500.00 daily or I will give you intensive diagnostic and treatment coaching at your site, with your own clients for $3500.00 daily plus all travel / lodging expenses. Download your application here for consideration.

Members receive private benefits, exceptional information and services, and practical proven therapeutic advice that is designed to grow your personal happiness and wealth along with therapy skills. This one of a kind coaching club is designed to support new therapists as well as forward thinking therapists with greater experience levels. You have your masters degree, you’ve completed your CFY, you may be looking to open your own practice and be your own boss. With the knowledge base of Speechified at your fingertips and the support of Tracy and her team of amazing therapists, just think of what you can and will accomplish.

There are different levels of membership available ranging from the silver level to private, one on one coaching at the diamond level. Please see our membership levels page to learn which membership level is right for you.

Information related to structure and function of the oral mechanism is crucial in treatment decisions. So why is it that this valuable info, including Ankyloglossia, is often overlooked in speech evaluations? There is of course the time issue and some of our kids may be noncompliant, but I think its more often related to the fact that alot of SLP’s simply don’t know what they are looking for.

The frenulum is a band of connective tissue covered by a thin layer of mucous membrane located under the tongue. A normal frenulum stretches from the undersurface of the tongue in the midline, to the floor of the mouth.

So what are the red flags for a tight frenulum?

[private_free]

In infants: (Red Flags Include)

-breast and bottle feeding challenges

-poor weight gain

-frequent upper respiratory infections, reflux

-drooling, chronic anterior saliva loss

-challenges with using novel spoons, other eating utensils

-excessive residue in the oral area following meals

-inability to transfer from liquids to solids by 12 months of age

In older children: (Red Flags Include)

-A developmental history with one or more of the issues listed above

-Children who are classified as “Picky eaters” or exhibiting food jags

-Children who exhibit marked behavioral changes associated with mealtimes

-Persistent rash in the oral area

-Dentition differences, including an anterior open bite, malocclusion and irregular eruptions of teeth, and / or excessive cavities.

-Tongue thrusting

-Swallowing challenges

-Articulation errors

-Stuttering or dysfluency

-Voicing errors, abrupt changes in pitch, or a monotone vocal quality [/private_free]

Given the fact that the preceding red flags can often occur in the absence of a tight frenulum you must do an oral mechanism exam to either substantiate or rule out its presence.

So in addition to red flags what should you look for in an examination. An arbitrary “stick out your tongue” is not diagnostic. Alot of kids that are “tongue tied” can “stick out their tongue.” When evaluating the frenulum here’s what to look for.

[private_free]

When visually inspecting the tongue look at the range of motion, not the actual appearance. All frenulums are different. If the range of motion of the tongue is not impaired, cosmetic appearance has little relevance.

1.Look at whether the child can extend the tongue beyond the margins of the teeth.

Protrusion with a downward point can be acheived by many kids with tight frenulums. The classic “say ahh” movement in which a child protrudes his / her tongue outward and downward can be acheived by some kids with limited range of motion.

2. Engage the child in tongue tip pointing.

Having a child protrude their tongue “straight out” will be challenging if not impossible for a child with a tight frenulum.

3.Look at the tongue tip with movement attempts.

If there is any bowing or a “heart shape” in the tip, the frenulum is restrictive. In some cases the tongue may not move or it can curl under itself during movement attempts.

4. Look at the ability to elevate the tongue tip toward his nose or upper lip with the mouth open.

Tongue tip elevation with a closed mouth is not acceptable. The child must be able to elevate the tongue tip to the upper lip, toward the nose, with teeth apart. If you see eye rolling, lip pursing, or extraneous head movements be suspicious.

5. Look at lateral movements, circumlocution ability with the tip of the tongue, and retraction skills.

Often kids with restrictive frenulums have poor oral awareness in conjunction with limited range of motion.

[/private_free]

In addition to the diagnostic exercises listed above, observe aspects of conversational speech. Older children who have an undiagnosed restrictive frenulum may learn compensatory strategies to compensate for poor articulation. Slow speaking, a quiet vocal volume or a monotone vocal quality are common. Articulation may be precise in isolation and in single words but deteriorate and the conversational level. Lingual sounds may or may not be errant.

So what qualifies as surgery worthy? When should you refer for a frenectomy?

[private_free] If an infant cannot suckle or swallow due to a restrictive frenulum, it should be clipped as soon as possible. Nowadays, most hospitals are savvy at picking up on this issue, but it can be missed. If you have an infant with “latching issues” look at the frenulum and lingual range of motion. In children over the age of six months, surgery may be considered, but always in conjunction with post operative speech therapy. Three to six months of weekly therapy is generally recommended. In some cases, skills improve within weeks. Drooling often resolves quickly. The older the child, the more ingrained the compensatory habits in eating and speech will be, and the longer it will take you to help reestablish appropriate speech and feeding skills.

Even though the procedure is generally quick and performed on an outpatient basis, remember that it still is surgery. Some kids will respond to stretching exercises which may be tried depending on the severity of the tightness. In situations where the “tongue tie” occurs in conjunction with a syndrome or other neurologic disorder, a frenectomy may be a secondary consideration. Always refer to a physician that assesses frenulums and performs the procedure regularly.

It is also relevant to note that the tissue under the tongue can regrow. So even if your client has had a frenectomy, always look at lingual frenulum functioning in your assessment. [/private_free]

Findings included improved the speed of language processing in regions of the brain associated with language and through activating brain regions more commonly associated with attention. The full study was published in Cerebral Cortex.

This new research has exciting implications for both adults and children! Let’s keep our fingers crossed!

But what should we expect when dealing with dual language learners and culturally diverse students? Is it appropriate to expect those kids to have the same nonverbal / social skills as a child enculturated in the United States and speaking its dominant language? The short answer is no. Obviously all children are different and their circumstances are different, but with sensitivity to other cultures and appropriate knowledge SLP’s can accurately diagnose differences versus disorders.

Let’s look at a scenario as an example:

A second grader is referred by her teacher due to poor eye contact and extreme difficulty even in answering personal questions. The student is described as quiet, dependent upon other classmates for academic performance, and has difficulty retelling or producing novel stories. According to the teacher English is her only language. Her parents are reported as being uninterested in her academics. The teacher is concerned that there may be a potential learning or processing problem.

The SLP sends home a permission to evaluate form and it is returned signed. Since there is no ELL /ESL classification she performs language testing in English only. During the assessment she notes the same behaviors the teacher reported. There is a lack of eye contact. With questions and urging the child’s head bows even further. She is extremely hesitant in answering personal questions, but complies upon persistent urging. She exhibits significant pauses while speaking. Her facial expressions are subtle, if not absent.

During the standardized testing she performs poorly on timed tasks, exhibits verb tense challenges, and sequencing difficulty in narratives. In some sub tests she simply doesn’t give answers. The results of the timed testing indicate receptive and expressive language disorders that are further impacted by her poor social skills. When the IEP team meets the SLP intends to recommend therapy services.

Do you think she was correct in her recommendation?

Unfortunately, this situation is more common than it should be. Some districts do not require multidisciplinary evaluations prior to implementation of IEP services. In the case of articulation, this benefits professionals and families. In the case of language questions, it is essential to complete a full profile.

Several factors would be consisdered “red flags” in her case. The fact that she just moved would lead me to question her stress and family stress levels. I might ask the school counselor and psychologist to evaluate her with parental permission. A health examination and hearing / vision screen would be in order…is she “relying on others because she cant see the board?” It may be prudent to call her previous school with parental permission to discuss her performance there. An important missing piece is the family / parent interview. Had the SLP called the family she would have learned that in fact, this student, is bilingual and bicultural.

With the information provided by the mother the SLP learns invaluable diagnostic information. The child in question comes from a Native American background and is in fact bilingual, with English being her second language learned in a sequential fashion. Her verb tense errors are reflective of her primary language (L1) influencing her English (L2 or second language) productions. Her delayed response time is appropriate in her L1, as is her nonlinear sequencing in stories. From a pragmatic perspective, lack of eye contact is considered a sign of respect in her culture. Among her people, personal information is highly guarded and is not readily given and the person asking questions is viewed as prying. Her reliance on classmates is cultural as well. Her community places an emphasis on cooperative learning versus individual work and competition.

In this case, service recommendation would be errant. Pulling her out of the classroom could utimately lead to a greater academic gap. Giving the teacher strategies to help the child and perhaps pulling in the ESL team (if available) could aide that student. But she was not language disordered, she was exhibiting a difference based on length of language exposure. understanding that her language and classroom challenges were stemming from a language / pragmatic difference due a primary language and cultural influence.

What should this teach SLP’s??? Always seek out the input from a child’s parents. It is invaluable. They may not divulge alot, they may not be cooperative. But that is the exception rather than the rule. I’ve learned that “the apple never falls far from the tree” and you can learn plenty about language models, cultural differences, and expectations in a five minute phone call.

There will be kids from diverse backgrounds that have language and learning disorders. With appropriate knowledge and an appropriate assessment that is comprehensive and linguistically and culturally sensitive, your ability to separate a difference from disorder will be there!

So when you are looking at the general social skills of your culturally diverse kids here’s a couple of examples you can expect as a difference:

Criteria: Student maintains appropriate proximity to conversation partner (e.g., does not stand too close or touch other person).

In America, we expect a personal space of about two feet from another speaker.

In Asian cultures, men and women touch each other on a regular basis, holding hands between same sexes is common. Public displays of affection between members of the opposite sex are not common.

In Latin American cultures touching is common with a conversational partner and proximity is much closer.

Criteria: Maintain appropriate eye contact.

In multiple cultures, asian, native american, and latino cultures direct eye contact is disrespectful or a sign of defiance of authority.

With African Americans, direct eye contact is considered respectful while speaking, but rarely is eye contact insisted upon while listening.
Criteria: Use an appropriate voice volume.

In African American culture and others loud volume and emotionally intense behavior is viewed as within normal limits and non aggresive.

In Asian cultures, children and adults do not challenge and are taught not to be aggressive in conversation. Tone is therfore considered low and monotone to the American listener.

Criteria: Answer subjective questions such as “what do you like to eat/drink?” or “what is your favorite color/video?”).

In African American, Native American, and Latino cultures direct questions are frowned upon as being too intrusive and improper.

The list goes on and on as do cultural differences. The idea is to become sensitive to the person you are screening and pitentially evaluating and “think outside of the box.” Monolingual / Amercian social norms do not apply to culturally different students. Look at those kids with a therapuetic eye, not a political eye if inclined.

Get involved!

What is your experience with culturally diverse students?

What additional information would be helpful?

 A large number of children can use a pacifier and sippy cup without it negatively impacting speech and oral motor development. You probably used one and have given them to your kids. But for our clients exhibiting tonal differences, sippy cups and passy’s can be bad news. Daily  use of them can lead to an inappropriate lingual resting posture, swallowing and chewing differences,  speech disorders, and dental problems.

The problem with both beloved items is that they reinforce an immature back and forth suckle pattern in the lingual musculature. Around the age of two we expect a mature swallow to have developed. I see plenty of three and four year old cruise through my door with a nuk in their mouth. Is their swallow pattern matured? No. Do they have the beginnings of a lisp? Yes.  Are most of them drooling? Yes. Did the parents deliberately give the nuk to their child knowing it would cause such problems? Of course not. They followed the advice of their mom, their friends, and the magazines touting passy use for psychological reasons.Â

From a cleaning perspective I can fully appreciate a no spill sippy cup. But as a therapist, I would love to start a “no sippy cup” campaign. Getting your parents to throw out those cleaning friendly cups can be tough. I tell parents to opt for straw cups. The trouble is that straws can be pulled out of the cups and liquid dumped..fun game! Big headache for mom! Be patient and supportive. I will often recommend straw use only at the home and will “o.k.” no spill cups for travel / outings.  There are also several brands available that have “built in” straws. Some are good but beware of the straws that a child has to bite on prior to sucking. They may be less messy but the oral motor implications are negative.

Discontinuing pacifier use can be challenging for both the child and the parent. I recommend giving the child a passy and a new item the child really likes together for two weeks. Following the two week period, I tell my parents to pick a night when no one has to work the next day, have a “bye bye passy” party, throw out every nuk in the house (and have the courage to throw the bag in the trash), and present the second item only to the child that night. There will be tears from both the kid and the parent. The parent will probably curse you under her breath. And then one of two things will happen. The child will self soothe with the other item the parent presented and fall asleep, or no one will sleep that night.

If the child cannot get to sleep without a nuk after several trial nights without it, there may be an underlying need for oral motor stimulation. There are a multitude of items that can be used in place of a passy without concern to lingual and dental impact.Â

Some of your chronic passy users may also be thumbsuckers. Thumbsucking is another “ball of wax.”  Before you can expect your client to have improved articulation skills you have to get the parents on board with limited or ideally no use of pacifiers, sippy cups, or thumbsucking.

When a parent raises a concern about their child’s ability to understand or speak, often they are told not to worry , to give “it” time. There may be a family history of “late talkers,” who turned out “just fine.” The family doctor says the child’s height and weight are fine so “not to worry”. Parents are often told that if the child is still having problems when they get to be school aged, then a communication evaluation is warranted.

Are grandmothers, mothers, and doctors wrong? In a nutshell, yes. Can I blame them, no. From a historical perspective, the incidence of speech, language, and global communicative delays, including autism, cerebral palsy, and apraxia was much lower than it is today. Whether the increase in numbers is due to more accurate diagnosis or an increase in developmental disabilities is the topic of another article. Family members speak from the heart and doctors have more than enough to evaluate when it comes to the general health of a child. The bottom line is a doctor’s responsibility is for the health of the child. It is the role of an SLP to determine whether a child is on track developmentally from a communication standpoint.

From birth there are milestones that are acheived by typically developing children within an age range. As SLP’s we know that by 3 months a baby will seek out the eye contact of an adult and will cry to get attention. By 6 months we expect differing cries for different situations, imitation of facial expressions, reaching for objects, and the banging of toys.

We know what a child should be doing from birth until …well, death. We have norms that apply from day one. When a child is not meeting said milestones, it is a red flag. The sooner we can begin treatment to move the child as far as they can go along the developmental path, the better.

Early Intervention is essential in young children exhibiting delays. We know the norms from birth. The earlier we can begin treatment, the more likely the child is to move along a typical developmental sequence. With certain populations, particularly children with Downs Syndrome, early intervention is crucial.

Research has proven the plasticity of the young brain. Therapy has proven to increase communicative skills.

My education on language development in monolingual children was essential; however, I had to learn to throw those developmental norms out the door when it came to children from bilingual environments or those coming from other countries. I had to learn about “portfolio assessment,” “language exposure,” “language dominance,” “silent periods,” so on and so forth. My level of knowledge exploded under her guidance.

In retrospect everything I learned makes perfect sense, at the time the information seemed revoulutionary. The fact that 10 years later children are still being misdaignosed by competent SLP’s is unfortunate and must be stopped. The information is available. It’s more than high time to ensure you are evaluating and making recommendations based on valid norms and not monolingual English speaker norms.

When assessing children, it is essential to look at daily language exposure, play skills, and the communicative styles of the family and their respective culture. If a child has only been exposed to Spanish since birth and is enrolled in an English only classrrom at the age of three, should we expect them to follow verbal directions and communicate in two to three word phrases in English? Does it mean he or she is language disordered because their English is poor or they seemingly have trouble paying attention to circle time? Please say no. Now it could be the case that the child does have a delay but unless the child is assessed BOTH in their native language and the language of the dominant culture (in the US = English) in areas such as receptive language, expressive language, play skills, cognition, and their performance is evaluated over time in an academic setting it is irresponsible to give that child a label.

Children learning dual languages may appear to have attentional differences. Their performance academically may be poor. A lack of eye contact may be considered a sign of respect in their culture not a pragmatic deficit!

In a perfect world both children of immigrants and citizens would be given a dual language program at school. Research proves a full English language immersion program is detrimental to the academic growth of multilingual students and yet that is the model that persists in most states. Thousands of children are misdiagnosed as language disordered and learning impaired annually. Is it their fault or a glitch in the educational system? I could write thousands of words in response but will leave you with the following. I am a proud American but I also recognize that if I moved to Tanzania with no prior knowledge of Swahili and was expected to earn an education in a Swahili only environment…well lets just say there would be gaps, if not canyons, in my knowledge base.

Years of research has proven Basic Interpersonal Skills (BICS), meaning an ability to carry on a social conversation, develops in two to five years and CALP or Cognitive Academic Language Profoceincy Skills average seven to ten years to develop. That means in theory, if a child from a Mandarin Chinese language dominant background is exposed to English at the age of 5, he or she will be a decent conversationalist by the age of seven or eight. In comparison to monolingual peers, he or she will appear language disordered when they are not. On the contrary, JUST because a student from a bilingual background speaks in a conversational background DOES NOT mean he / she has the vocabulary or meta-skills to achieve academically.

Basic standardized assessments will not help this population. A standardized test normed on English only speakers and given to a bilingual student IS NOT VALID.

For more information read my articles on Bilingual Language Acquisition Norms, Characteristics, and ethical evaluation practices.

I want to hear from you.

• Are you taking language exposure and cultural differences into consideration when evaluating your ESL kids?
• What performance based assessments (i.e. portfolio based assessments) have been the most valid in identifying or negating a diagnosis in language disorder versus language difference?
• What cultural/language populations would you like more developmental norms for?

Please comment below.

I was to look for children who had difficulty understanding speech in noisy environments, following directions, discriminating (or telling the difference between) similar-sounding speech sounds . Those kids asking for repetition or clarification were suspect.

The school aged child who had trouble with spelling, reading, and understanding information presented verbally in the classroom must have APD. Those kids who performed better in multimodal teaching environments where the “hidden agenda” was verbally outlined for them versus a conventional classroom which was taught primarily orally were flagged.Â

I remember wanting  a clear “cookbook” approach or a checklist to aid in the evaluation  of  those kids because I didnt know enough to confidently add my “two cents” at a multi disciplinary team meeting when it came time to “label” the child.

Thankfully in recent years the definition of what APD is, and is not, has improved. SLP’s have a clear role. Auditory processing of information is very simply put how the central nervous system uses auditory information. It is not related to a hearing deficit nor a language or cognitive impairment. Language processing and auditory processing are not the same thing. It is our responsibility to ensure children with language processing deficits, or those kids whose challenges stem from a higher level or global disorder, are not misdiagnosed.

Many disorders impact a person’s ability to understand auditory information. Children diagnosed  with Attention Deficit/Hyperactivity Disorder (ADHD) may well be poor listeners and have difficulty understanding or remembering verbal information; however, their actual neural processing of auditory input in the CNS is intact. Instead, it is the attention deficit that is impeding their ability to access or use the auditory information that is coming in. Children with autism may have great difficulty with spoken language comprehension. It is the higher-order, global deficit known as autism that is the cause of their difficulties, not auditory processing challenges. Children with sensory integration dysfunction may exhibit symptomes of APD but their challenges with attention to task and comrehension are ultimately rooted in global CNS dysfunctyion not simply APD.Â

Remember these points when assessing your kids:

• Children with APD may exhibit a variety of listening and related complaints
• Not all language and learning problems are due to APD, and all cases of APD do not lead to language and learning problems.
• Â APD cannot be diagnosed from a symptoms checklist
• A multidisciplinary team approach is critical to fully assess and understand the cluster of problems exhibited by children with APD. A comprehensive picture of the child’s strengths and weaknesses as determined by an SLP, OT, Psychologist, and audiologist is essential.
• The actual diagnosis of APD can only be made by an audiologist.

In order to diagnose APD, an audiologist will administer a series of tests in a sound-treated room. The tests require a child (who must be at least 7 to 8 years of age) to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Other tests that measure the auditory system’s physiologic responses to sound may also be administered. Once a diagnosis of APD is made, the nature of the disorder is determined.

There are many types of auditory processing deficits and, because each child is an individual, APD may manifest itself in a variety of ways. In keeping with my evaluation and treatment stance, ASHA has specified the individualized management and treatment of children with APD as best practices.

There is not one “quick fix” method of treating APD. Resist the  “miracle cures” available on the internet.

Remember:

• Treatment of APD must be highly individualized and deficit-specific.
• A particular therapy approach may have been amazing and successful for another child but it does not mean that it will be effective for your child.
• Appropriate treatment begins with an expert diagnosis by an audiologist.
• Treatment focuses on three primary areas: changing the learning or communication environment, recruiting higher-order skills to help compensate for the disorder, and remediation of the auditory deficit itself.

Environmental modifications help to improve access to verbal or auditorially presented information. The modifications may include coaching teacher’s on different verbal delivery methods, use of an FM device, and so on.

Speech therapy which directly teaches Compensatory strategies in conjunction with self monitoring can strengthen central resources (language, problem-solving, memory, attention, other cognitive skills) so that they can be used to help overcome the auditory disorder.

Finally, direct treatment of APD seeks to remediate the disorder at its origin. Approaches include use of  computers or intensive individual sessions with a SLP either in home or in a clinic.

Not all kids with auditory processing deficits will overcome them or be “cured. As SLP’s we can provide children with strategies to make them successful in school and in life.