Over the years several questions have been asked by patients, families, and professionals. Some answers have been stated simply, whereas others have been stated in the context of evidence-based practice, peer-reviewed research findings, and the conventions concerning best practice. The following questions and answers have been compiled to provide clarity and insight into the OtoLing scope of practice vis-à-vis selected topics in communication sciences and disorders:
1. What makes the OtoLing integrated approach to communication unique?
Established January 2006, this is the only practice in the “Chicagoland” area with integrated auditory and speech-language services for auditory processing disorder (APD), receptive-expressive language disorder, and abnormal communication behaviors in a dedicated clinic. These problems may be interrelated with neurobehavioral or neurodevelopmental factors. Specific consideration has been given to the individual patient needs of children, adolescents, and adults.
Professional attire matters. As such, Dr. Hooks strives to present an image that respects the patient, families, and the professions of which he represents. Your experience should be memorable, pleasant, and reassuring insofar that you are in the hands of a master clinician.
2. Is central auditory processing disorder the same as auditory processing
disorder?
The Buffalo Model Questionnaire (BMQ)– Revised (Katz & Zalewski, 2011). The BMQ helps to verify whether specialized diagnostic testing will be required to rule out (central) auditory processing disorder (C)APD), a condition that interferes with the processing of spoken language. Katz (2005), who developed the diagnosis of auditory processing (APD) in 1968, reported that the core of processing occurs within the central auditory nervous system (CANS). More recently, a working group suggested that the processing occurred earlier in the auditory periphery—that is, at the level of the cochlea/inner ear hair cells (ASHA, 2005). All the same, the net effect of auditory processing disorder has been related to decoding, phoneme imperceptibility and/or confusability, working memory, and pattern recognition trouble. It has turned out that APD, CAPD, and (C)APD have become virtually synonymous (ASHA, 2005b) and, therefore, OtoLing has considered APD, CAPD, and (C)APD as synonymous diagnostic designations.
3. What are some possible signs or symptoms of auditory processing disorder?
• Problems in the retrieval and retention of spoken information
• Reading, comprehension, spelling, and word finding difficulties.
• Decoding problems in the presence of background noise.
• Localization problems from linguistic and environmental sources
• Slow language processing secondary to a talker’s speech rate
• Written language expression problems
• A tendency to answer questions quickly, with interruptions.
• A tendency to answer questions slowly, after long delays.
• A tendency to rely on visual speech cues (e.g., speechreading)
• Delays that may be related to oral motor planning.
4. Could a history of middle ear problems be related to APD?
Yes, even a mild hearing loss may produce a significant and adverse effects over time (2 - 4 weeks); leading to impaired auditory processing, speech, and language. Evidence-based practice has shown that certain craniofacial anomalies have been associated with abnormal speech perception and speech production. Some children tend to speak in the manner that they hear (Ling, 1986).
5. Are middle ear infections common in children three years and older?
Yes, up to age seven or eight. Middle ear infections are usually associated with acute respiratory infections, which are among the most common infections in children worldwide (Koch et al., 2001).
By age one, 60 percent of children have been diagnosed with at least one episode of ear infection or acute otitis media. Acute otitis media accounts for more than 30 million office visits in the United States of America (Rothman, Owens, & Simel, 2003).
6. I read that there are several ways to test, classify, or categorize APD. Is this
true?
Yes. The American Speech-Language-Hearing Association (ASHA), reported that there is no “gold standard” method to the evaluation and interpretation of APD, with either subjective measures (e.g., Dichotic Digits Test, Pitch Pattern Sequence Test, Low-Pass Filtered Speech test and the SSW Test) or emerging objective measures (e.g., frequency following response, which may provide relevant predictors of auditory processing disorder.
Some assessments provide evaluators with a diagnosis and insight into a location of a problem, but questions may remain regarding the subjective interpretations of diagnosticians and menu-derived therapeutic solutions. Research to distinguish APD, specific language disorder (SLI), ADHD, and learning disability is ongoing for a one-to-one correspondence between specific brain regions and communication behavior.
7. Why should I consider the Buffalo Model of Auditory Processing Disorder?
Several APD models have been created or proposed over the past four decades. These models include the Ferre-Bellis Model [revised], Frank Musiek, Ph.D. and others (a neurophysiological approach). Still, The Buffalo Model that was pioneered by Dr. Jack Katz Ph.D. has been distinguished by being the first, and most researched model. Dr. Katz began his career as a speech-language pathologist, which provide him with insight into the communication impairment. Other methods have emerged over the years, but The Buffalo Model has withstood the test of time for academic rigor and clinical effectiveness. Further, this model was developed from classic brain and language research studies and has complemented contemporary translational neuroscience research.
The Staggered Spondaic Word (SSW) test, a component of the Central Test Battery, has been supported by over 50 years of research, therapeutic practice, and translated into 16 languages worldwide. The test has widespread appeal and recognition from the American Medical Association (AMA). The SSW has not been considered a “quick” test to administer and/or to analyze. Thus, a thorough analysis has required considerably more time for interpretation and specific (rather than generic) therapeutic application.
Katz (2005) suggested that one must consider two questions when evaluating a patient with preliminary signs of APD: First, Do the results account for the major portion of academic and communication problems (e.g., language form, content, and use)? Second, When recommendations are followed, do the corresponding symptoms or signs improve? In this vein, diagnosis and treatment should be guided by scientific clinical research, evidence-based practice, and theory. We one should attempt to account for relevant predictors in the performance of selected auditory task.
Dr. Hooks was trained by Dr. Jack Katz, in the administration and interpretation of the Buffalo Model. The Buffalo Model has helped to interpret selected signs of APD (e.g., spelling, reading, poor listening skills in the presence of background noise, impaired oral motor planning, and weak vowel sound discrimination skills). Additionally, written language expression has been associated with APD (Berninger, Abbott, Abbott, Graham, and Richards, 2002; Hoien Lundburg, Stanovich, and Bjaalid, 1995 and ). Speech and language have been integral to APD, which is one reason why up-to-date academic preparation should be broad.
8. Do other models of APD consider the same aspects as The Buffalo Model?
No, there are several aspects that other models have not considered as auditory processing. While other APD models have omitted organization and memory from an auditory processing disorder, the Buffalo Model has continued to provide a coherent analysis of auditory processing skills. Specific regions of the brain with APD problems have been categorized into 1) decoding, 2) tolerance fading memory, 3) integration, and 4) organization (Katz, 1992). The model has supported plausible interpretations of language, academic, and psychosocial considerations (not a suggestion of games and activities). Accordingly, Dr. Hooks has supplemented the processing of spoken language with the motor theory of speech perception, and applied research in vision science.
9. Does a speech-language pathologist have a role in the diagnosis of APD?
A speech-language pathologist is the logical and preferred professional to provide follow-up therapy after an APD diagnosis. However, it is not within the scope of practice for a speech-language pathologist (SLP) to conduct an auditory processing evaluation. An SLP can conduct a speech-language evaluation, which can contribute to the interpretation of an APD test battery in several areas including the following:
The SCAN-3 for Children and the SCAN-3 for Adolescents and Adults are valid for both screening and diagnosing APD. The SCAN-3 provides useful information, but it has not been used in this practice to rule out auditory processing disorder. Still, some components have been administered as supplemental testing for more insight.
• Speech articulation (Children speak in the manner that they hear.)
• Phonological comprehension and production
• Written language expression problems
• Comprehension of spoken passages or instructions
• Speech sound decoding and encoding difficulties.
• Oral motor planning—possibly related to apraxia and tachyphemia.
• Pragmatics (text organization, implicature, and referential language)
• Unusual vocal loudness and pitch changes
The evaluator of auditory processing should possess a strong background in normal and abnormal language development. Hearing is one component in the processing of information. However, listening is a hypothetical and complex process, which cannot be reduced to frequency, timing cues, and intensity.
10. At what age should a child be considered for evaluation with The Buffalo
Model of Auditory Processing evaluation?
The Buffalo Model is valid for the evaluation of children who are five years old. However, clinical judgement has been exercised to determine whether a child can follow directions, sustain their attention, and respond verbally. Additional considerations include separation anxiety and cognitive linguistic impairment.
Philosophically, Dr. Hooks has not waited to intervene for child who presents with signs of an auditory perceptual problem. He has tested children who are five years-old according to the Buffalo Model of Auditory Processing Disorder.
11. Are parents and/or families integral to the practices at OtoLing?
Yes! Direct parental and/or family interaction during the evaluation and therapy has been a key component to successful diagnostic and therapeutic outcomes. You are not listening from a distance or imagining clinical activities. You can view everything directly—that is within the main treatment room and the adjacent clinician room, which is coupled with an observation window, wireless communication, other resources.
Families have reported that Dr. Hooks listened to their needs, concerns, and actively sought their priorities. An individualized approach to patient and family needs includes a thoughtful and insightful intake interview from a pharmacological, neurological, physiological, and psychological perspective. This is another reason why academic and research preparation matters concerning competent help for your family member.
Thorough and in-depth attention has been directed to the effective integration of neural processes (e.g., hearing and vision) that mediate, cognition, comprehension, expression, and use of language. For this reason, Dr. Hooks provides speech therapy to increase meaningful communication—that is, techniques related to receptive language, expressive language, and language use. In several instances, aural rehabilitation has been structured to help individuals with abnormal hearing loss (i.e., a hearing impairment).
Medical research has been ongoing in several areas including auditory neuropathy syndrome (ANS), autism, and other problems related to the nervous system. Time-honored methods and innovation have been recently coupled to evidence-based practice. This method has served Dr. Hooks and his patients by changing the prevailing dialogue to relevant questions and sensible solutions.
12. Why should I consider OtoLing? Comprehensive preparation and experience?
Adults and children benefit from the advantage of seeing a Ph.D. level professional who is licensed and certified as both in audiology and speech-language pathology. Only 0.04 percent of 203,000 professionals hold certification in both disciplines. There is a slight trend that appears to be associated with professionals that recognize that both speech-language and hearing have been important for holistic understanding of communication problems.
13. Can an audiologist perform treatment that is equivalent to speech therapy?
It is not likely, insofar that a speech-language pathologist is qualified in areas, which are not components in audiology training and practice. Educational audiologists do not typically earn a degree in education. Notably, an Au.D. degree is a clinical doctorate in audiology. Research indicated that speech-language therapy is preferred over various treatments and coupled to substantial clinical outcomes (Pavlick, Zalewski, González, and Duncan, 2010). Further, aural rehabilitation was not considered as a treatment for CAPD.
14. It has been oft quoted, “The auditory system is not mature at seven years of
age.” Therefore, one should wait until beyond the critical period of language
development. Should one wait until the seventh birthday?
No, waiting is erroneous practice. It is not clear why this erroneous and oft quoted statement continues despite established research findings. It turns out that the greatest period of language development is between the ages of two and seven years. Identification of communication delays and auditory perceptual problems is essential during this critical period of language and child development. Yet, some audiologists may not be aware of these language development principles.
Relicated research has shown that the auditory system has been partially attributable to significant increases in speech and language production between the ages of two and seven years. However, Roberts, Burchinal, and Footo (1990). reported a decline in phoneme acquisition during early childhood (1990), which was corroborated by Ruben (1997). Waiting to test until a child reaches seven years appears antithetical because problem should be identified sooner than later.
15. Is it true that the auditory system is not mature at age five? Is auditory
neuropathy related to maturation?
Yes, this is true. Still, the human auditory system does not mature fully until the early 20s
(Thompson, Narr, Blanton, & Toga, 2003). Still it is important to identify signs of abnormal auditory perception and to treat problems that affect the auditory comprehension of language—sooner than later. At the same time, some diagnostic practitioners do not have formal academic preparation in child development or language development. Clinical judgment has been advised, with respect to language development milestones among young children from professionals who understand the implications of critical child development theory.
16. Is the early identification of auditory processing in children something new?
Not really... Over fifty years ago, it was recognized that language comprehension required synergy from several systems—not just the auditory channel (Berry, 1969). She reported that a child’s brains were affected by several factors (e.g., sensory, limbic, and environmental). An APD diagnosis should not assumed for a child with a language delay. Clinical decisions should be based on theory and best practice.
There is a hypothesis that some children exhibit language problems, which may be attributable to an auditory deficit (Tallal & Stark, 1981). As these children develop language skills, they may present with selected signs of APD (e.g., decoding problems, auditory memory, and listening difficulty, in the presence of background noise or competing speech).
Today, evaluations can become meaningful and relevant with current understanding of neuroplasticity (a general term that has been associated with the structure and function of nerve cells and groups and the response to use and disuse). Accordingly, a little knowledge and jargon can be misleading and misrepresentative of one’s training. This is why the report must be intuitive, logical, and represent current trends in translational neuroscience research and clinical significance.
17. Many practitioners complete an evaluation in just one hour. Why is more time
required at OtoLing for evaluation reports?
*Additional academic training and professional expertise correspond to an expectation of additional insight, practical solutions, and attention to detail—especially when time has already been lost with, unintentional, failed approaches and thinking.
There is an ethical imperative for Dr. Hooks to include relevant areas from his multiple professional skills and academic preparation. Therefore, it is logical that the evaluation process encompasses areas that are outside the scope and preparation of others. In the end, the OtoLing evaluation process is not pretentious or ostentatious, but rather a demonstration of comprehensive expertise and insight—that is, more competence and thought.
This practice does not provide simple “cookie cutter” solutions to complex problems. This is one reason why drill-based and audiology-specific solutions may be insufficient “treatment” for transfer of learning (i.e., outside a therapy visit). This is why speech-language therapy (often by covered by insurance plans) remains the most effective means for credible treatment across multiple domains (e.g., cognitive, linguistic, and social emotional) of learning and development (ASHA, 2005).
The OtoLing philosophy underscores that one’s quality of life should be addressed sooner than later; to overcome failures, guilt, frustration, fear, and anger. This clinic has considered it paramount to help the whole person, in both the affective and cognitive domains—that is, emotions, feelings, and knowledge acquisition. Accordingly, the overall quality of life improves for the whole family, not just the patient.
18. Does OtoLing provide APD evaluations for just pediatric and adolescent
cases?
No. At the same time, he is a licensed educator through the Kane County Regional Office of Education and able to provide services in public schools. At the same time, he has not assumed a title of educational audiologist (Dr. Hooks applied formal training and experience from a double-major degree B.A. degree in elementary education and speech therapy. Further, formal training in education (e.g., educational psychology and specific method courses in reading, language arts, mathematics, and special education) have enhanced his ability to apply credible academic principles for transfer of learning across several content areas.
This commitment to education has afforded his younger patients with an added benefit of gaining both literacy and language and not simply ear training. Dr. Hooks has not been motivated by the volume of patients seen—this is a small practice.
As a speech-language pathologist (SLP) in public and private school settings, Dr. Hooks has applied child development and learning theory to practical strategies that reinforce a child’s individual academic and curriculum needs whether they receive academic instruction through, public, parochial, private, or a home-school setting. In several instances, universal academic principles have been applied through Bloom’s Taxonomy of Learning.
Clearly, auditory perceptual problems should not be relegated to untested solutions. Some computer applications (“apps”) may look good, but caution should be exercised in this era of quick and slick fixes to problems that have evolved over a lengthy period. Therefore, it is important to make an informed decision, regarding projected academic, social, and cognitive outcomes from computer apps.
With scheduling availability, Dr. Hooks has provided direct therapy for proper follow-up to evaluations. An analysis of complex problems is coupled to specific strategies that are realistic and appropriate. Accordingly, families gain an understanding of what to do—and why they should... Otherwise, follow-up strategies may devolve into busywork.
19. Does OtoLing provide evaluation and treatment of auditory processing
disorder or speech therapy services to adults?
The answer is yes. Several adult patients have reported difficulties after the completion of military, corporate, or professional transfers and promotions, whereas others noticed problems during and after their university undergraduate and graduate programs.
Problems may have been exacerbated by specific employment requirements (e.g., conference phone calls, listening during distance learning, and greater information processing demands on the auditory system. Selected circumstances have triggered a need for diagnostic and therapeutic intervention with an evaluation of auditory skills and/or speech-language skills.
In special cases, adults have been referred to OtoLing for intervention following a cerebral vascular accident (CVA) or a brain attack. Traumatic brain injury (TBI) and progressive aphasia or dementias, which have contributed to impairment in certain definite areas—for example, compensatory memory skills, auditory comprehension verbal expression, dysphagia (i.e., difficulty with chewing and/or swallowing), and family education.
20. What is APD therapy and is there just one treatment option?
Several treatment options have been available to the public. Yet, it is important that one make an informed decision. The American Speech-Language-Hearing Association (ASHA) recommended therapy for APD from a speech-language pathologist (ASHA, 2005). The clinician should be skilled, experienced, and knowledgeable in basic science. To this end, Dr. Hooks received graduate school academic courses and laboratory training in auditory neurophysiology, neural anatomy, psychology, pharmacology, and neurobiology. These aspects have reinforced his insight into cases with complex medical needs.
Still, one should be wary of prepaid “treatments” which lock you into a series of exercises or lessons that may not apply to your family member. A fixed number of lessons suggests an approach that presumes certain characteristics that may or may not apply to your loved one. Aural rehabilitation is not considered an appropriate method at OtoLing, based on evidence-based practice and described below in item number 6.
Further, one should exercise caution in accepting treatment schemes that fall outside medical insurance coverage. Aural rehabilitation may be an inexact application for auditory processing disorder—especially for one whose auditory problems are related to language.
An SLP is uniquely qualified with theoretical and practical training in phonetics, language development, and language disorders. In comparison, a clinical audiologist typically provides aural rehabilitation to improve speech and understanding with strategies that may include amplification, visual cues, therapeutic drills, counseling, and family education.
21. What is aural rehabilitation? Is it a therapy that insurance carriers recognize?
Aural rehabilitation is a therapy option that has been recognized to improve communication function for those with hearing impairment and deafness. However, a speech-language pathologist (SLP) is uniquely qualified and trained to provide language therapy to individuals with congenital hearing loss, and those with acquired hearing loss (e.g., hearing loss from disease, trauma, or a progressive syndrome).
Aural rehabilitation from an audiologist is not equivalent to therapy from an SLP. Speech-language pathologists are uniquely qualified to diagnose and treat language impairment exacerbated by CAPD and Insurance carriers recognize aural rehabilitation and have distinguished between aural service from a speech-language pathologist and an audiologist.
It turns out that the reimbursement is higher for a speech-language pathologist than for an audiologist. Even so, clinical decisions should be based on medical necessity. One should consult with an insurance representative to determine the extent of your benefit and to determine whether the therapy scope meets your family needs and/or goals.
In the end, be wary of prepaid “treatment” that may not be covered by insurance, and suggestions of repeated treatment without seeing results.
22. Has there been research to compare different therapy models for (C)APD?
Yes, Pavlick, Zalewski, González, and Duncan (2010) analyzed six prevalent therapeutic approaches to treat patients with auditory difficulties. It turned out that aural rehabilitation was not among the approaches. Despite this, speech-language therapy was the most common approach with 63 percent improvement, followed by reading (e.g., The Wilson Reading Program) at 58 percent improvement.
At best, over-generalized therapy schemes have been dubious—for example, phonics and phonological awareness at 28 percent improvement. It was clear that sensory-integration (18%) and auditory training—an aural rehab variant—(16%) have not been relevant to account for the major hallmarks of (C)APD. Intensive phonics was under-reported, which may have been related to measuring imprecision for both therapy and academic outcomes. To be sure, an overuse of generic strategies has not been effective outside of a therapy setting—for example, “following incremental multiple-step commands, with fading cues.”
23. What is a neurobehavioral disorder?
Neurogenic refers to a condition that arises from, is caused by, or controlled by the nervous system. Some examples of a neurobehavioral disorder include attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and dyslexia.
Some brain-specific conditions have been associated with various communication difficulties—some that are unusual, for example, Landau-Kleffner syndrome (LKS), agenesis of the corpus callosum (ACC), auditory processing disorder (APD), and periventricular leukomalacia (PVL).
In several instances, a neurobehavioral communication disorder has been associated with specific problems (e.g., oral motor planning difficulties that affect speech articulation, swallowing, reading failure, voice, and receptive-expressive language impairment).
24. What are some effects of autism spectrum disorders on communication
skills?
Heflin and Alaimo (2007) noted that normal language development is affected because of difficulty in several areas including:
• Motor Imitation (imitating actions exactly as they are seen)
• Joint Attention (inability to attend or identify with others)
• Object Play (inability to use one object to represent another)
Additionally, individuals with autism may have auditory perceptual problems, that may interfere with the comprehension of spoken language and language expression.
25. Who is qualified to provide treatment for an auditory processing disorder?
Even, if a child is too young for a diagnostic evaluation, Dr. Hooks has targeted speech language therapy to address CAPD. As such, an early diagnosis should be coupled to a clinician with academic preparation and training in language development, language disorders, and child development. Dr. Hooks is qualified to administer and interpret every speech-language evaluation tool that he has recommended.
“Speech-language pathologists are uniquely qualified to delineate the cognitive-communicative and/or language factors that may be associated with APD.” (American Speech-Language-Hearing Association [ASHA], 2005, p.1). Further, academic preparation and training in the areas of neurophysiology, cognitive neuroscience, auditory neuroscience, and neuropsychology is essential if one is to engage in the intervention and diagnosis of APD (American Speech-Language-Hearing Association, 2005b).
Dr. Hooks has the integrity, academic preparation, and professional purview to report auditory processing disorder, in the context of speech-language development, curriculum-based academic skills, applied learning theory, and neuroscience principles.
He does not “manage” APD-related problems or any other communication difficulty. Rather, he works to solve problems and to overcome obstacles in certain areas—for example, academic skills, written language expression, affective communication skills, and compensatory strategies.
26. Does APD occur alone as a separate disorder?
No, auditory processing disorder may coexist with other neurodevelopmental communication disorders, and conditions (controlled by the nervous system)—for example, attention deficit hyperactivity disorder, (ADHD), autism spectrum disorders, periventricular leukomalacia (PVL), Down syndrome, learning disability, specific language impairment, and Fragile X syndrome.
Logically, auditory perceptual problems may interfere with linguistic competence and performance. These aspects of linguistics include the subconscious understanding of language rules and the use of language—that is, spoken production with hesitations, halting speech or false starts, and grammatical errors may be related to certain signs of APD.
In isolation, low self-esteem may not appear to be a direct consequence of APD. However, the disorder may contribute to a lag in the initiation of conversation and the participation in novel games and activities, which may be more enjoyable when the spoken rules or requirements have been understood.
27. I read that there is a clear distinction between language processing disorder
and auditory processing disorder—is this true and why?
Some researchers believe that there is a distinction... However, there is overlap between the two disorders (if one can actually isolate them). Comparative neurology has shown that mammalian brain circuitry is quite complex, with auditory connections for reflexive movement, emotions, recurrent communication behaviors, and for several integrative functions.
Yet, a prevailing thought has been that APD is a specific auditory problem (ASHA, 2005). This view may be somewhat spurious (in the context of neural integration), and inconsistent with research and writings from the areas of perception (Wickens,1992), information processing (Palmer, & Kimchi, 1986 and Treisman, & Davies, 1973), and auditory-visual integration (Massaro, Cohen, & Smeele, 1995
Taken together, one may not be able to distinguish language processing from auditory processing. That said, selected brain regions have been associated with language processing (Haarmann, Kolk,1992; Martin, 2003) and specific auditory processing differences between the brain hemispheres (Thierry, Giraud, & Price, 2003). Distinctions between language processing have created more uncertainty based on emerging research principles—for example, recurrent neural connections and cross-modality processing (Tremblay & Dick, 2016).
A current trend or forward-thinking view (from neuroscience research) has shown that auditory and language processes have been synthesized (combined) at the neural level (Beauchamp, 2005; Blumstein & Milburg, 2000). Empirical research has shown cross-modality processing between the auditory and visual systems (Hubbard, Arman, Ramachandran, and Boynton, 2005). Therefore, a holistic view of auditory processing may require a consideration of several perceptual channels—not just one.
Stated differently, auditory processing may not be modality-specific to just only the auditory system (perhaps, an inclusive view). Other sensory modalities may be recruited for the comprehension and interpretation of oral language. Therefore, language comprehension, and some psycho-social problems may be attributable—partially—to signs and symptoms of APD.
Recent research has shown that processing problems may be related to humoral control and variations in dietary intake (Zhang et al., 2005), mood (e.g., low self-esteem, depression), and neurotransmitter release (Gopal, Carney, & Bishop, 2004; Kähkönen et al., 2002).
The approach at OtoLing has been derived from a phenomenological perspective—that is, language involves an integration of auditory, visual, and tactile perceptual patterns and processes. This means that APD may not be a pure “auditory-specific” problem. As such, Dr. Hooks has structured intervention systemically to increase communication skills in the context of the whole person and from a broad base of communication sciences and disorders, child development theory, learning theory, and translational neuroscience research.
28. Are APD reevaluations needed every year or every two years?
No, evidence-based practice (from this clinic) has shown that a re-evaluation of auditory processing skills has not been automatic or necessary to “monitor” auditory skills or to “manage” auditory processing skills.
It turns out that some practices may recommend a re-evaluation every year, and every two years automatically regardless of the outcome. OtoLing is a practice that does not seek return business from repeated APD evaluations. With intervention—through speech-language therapy and collaborative approaches—a re-evaluation has not been warranted. Dr. Hooks seeks to provide patients and families with a maximum benefit and return from one, comprehensive, and penetrating analysis that encompasses strengths and needs across several academic content areas.
At the same time , re-evaluations (at OtoLing) have been conducted when initiated by a medical referral or for a valid second opinion medical inquiry. Similar to some medical tests, a screening test may indicate whether a full diagnostic test is “medically necessary after a year or two. Still, it is important to note that a screening test is not a substitute for a diagnostic evaluation.
Annual diagnostic speech-language evaluations have been instrumental for Dr. Hooks to form a coherent analysis of a patient’s progress in selected areas—especially those that have been adversely affected by an auditory processing disorder. A thorough survey of hearing and language has been key to all evaluations, rather than just hearing or language. Accordingly, it may be better to consider a person from a perspective of the whole brain and the relative importance of vision, hearing, writing, reading, and language.
In the end, a relevant baseline and index for progress should be based on whether the patient has (1) become a better speller, (2) increased reading comprehension, (3) improved their written language expression, and (4) developed more confidence. Another battery of audiometric tests may not yield specific information to determine whether one has gained skills in areas associated with academic, speech-language, or psychological assessment respectively.
29. Do I need a physician referral for evaluation and therapeutic services?
Yes. The office will assist you with the physician referral prior to the services.
An appointment should be canceled if the patient is experiencing an active upper respiratory infection, because both audiometric and speech-language evaluation findings could be affected negatively; regardless of an adult, adolescent, or child patient.
Speech-Language Pathology
30. What comprises your evaluations for speech-language and audiology?
The speech evaluation is based on a comprehensive battery of standardized tests to assess vocabulary, grammar, written expression, auditory memory, verbal expression, voice, articulation, auditory comprehension of language, hearing screening, and auditory processing disorder screening (if appropriate). Tympanometry is a procedure to screen for middle ear dysfunction—especially for those with a history of problems.
The evaluation of children and young adults with autism includes the assessment of preverbal and verbal strengths and needs. The assessment instruments include observation, in the context of functional interaction (e.g., vocal, verbal), language sampling, standardized assessment, parent and teacher profiles, and an assessment of auditory perceptual function.
The evaluation of children and young adults with autism includes the assessment of preverbal and verbal strengths and needs. The assessment instruments include observation, in the context of functional interaction (e.g., vocal, verbal), language sampling, standardized assessment, parent and teacher profiles, and an assessment of auditory perceptual function.
A dynamic assessment is structured to determine barriers to verbal communication, auditory comprehension, and pragmatics. The assessment addresses language in the context of cognitive linguistics, emotional development, and maladaptive behaviors.
In the end, the evaluation is comprehensive and linked to goals that center on the patient’s “zone of proximal development” (ZPD). Therapy goals are designed to promote a person’s use of their natural voice, with functional language—for example, verbs, interrogatives, and self-knowledge. Therefore, expectations and targets are raised to higher levels with subsequent language experiences.
Audiology
The evaluation procedures and results are compiled and reported in an auditory processing disorder evaluation report, which has been formatted and designed as a case study. The study provides a diagnostic opinion, an in-depth explanation of the procedures, results, and recommendations. The report has structured with support from peer-reviewed research and evidence-based practice to determine practical and functional strategies for speech-language therapy—that is, no gimmicks. Additionally, strategies for academic, workplace, and home settings are formulated for the processing of spoken and written language (e.g., form, content, and use).
31. How much time should I allow for an evaluation?
The evaluation time varies with the age of the patient and tolerance for testing. You should allow between 2.0 and 2.5 hours for the evaluation of speech and language or auditory processing disorder. Older patients usually require less time for an evaluation. A good night of rest and breakfast are recommended before the administration of an
evaluation. Alternatively, fatigue and hunger may compromise the results of the evaluation.
In some cases, an insurance pre-authorization and/or pre-certification is required before a speech evaluation. Therefore, please call to re-schedule an evaluation if more time will be needed for an eligibility determination.
32.What are some distinguishing characteristics of speech therapy at OtoLing?
Philosophically and practically, the approach at OtoLing has been incompatible with Applied Behavioral Analysis (ABA) methods and schemes. Accordingly, the Picture Exchange Communication System (PECS), picture schedules, and augmentative and alternative communication modalities are not used at OtoLing. Rather, an emphasis has been placed on selected strategies to (1) facilitate the emergence of language (2) increase purposeful language, (3) increase self-knowledge, without the insertion of value-laden praise and prompts—for example, “Good job!”
There are no catchy names, acronyms, or alphabets to describe the clinical approach! The patient’s uniqueness defines the evaluation and intervention (See Philosophy).
The therapeutic approach is not traditional, with a heavy emphasis on drills, drill-play, and games that are not related to learning concepts. However, time-honored techniques include moto-kinesthetic methodology (Young and Stinchfied, 1955), which was a forerunner to Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT). Moreover, moto-kinesthetic feedback remains an effective strategy.
In spite of that, Dr. Hooks has applied the integration of sensory coordination from the cerebellum and the synchronous processing of phonemes (Ackermann, Graber, Hertrich, Daum,1999). This conceptual approach has emerged from neuroscience studies.
Pediatric therapy has been structured to integrate Bloom’s Taxonomy of Learning (e.g., affective, cognitive, and psychomotor domains) and specific application of applicable academic strategies based on parochial, private, public, or home school settings. In comparison, adult therapy has been structured to apply physiological phonetics, increase vocal intensity and frequency range, process spoken language.
Therapy progress has not been augmented with extrinsic reinforcements—for example, motivational stickers, stamps, candies, or toys. Chewy toys, tubes, flavored jellies, soapy bubbles have also been excluded from therapy. As such, this perspective may exclude several potential cases. Yet, transformative changes have been demonstrated with evidence-based practice, thoughtful and compassionate introduction of intrinsic skills.
his clinic is a soap bubble-free zone! The clinical setting is also free of cookie-cutter gimmicks and evanescent schemes to facilitate desired communication behaviors.
A fresh, open, and transparent office environment expedites and enhances family input during the counseling, evaluation, and therapy phases. Families can observe office visit therapy sessions (directly) and take notes. However, for privacy and copyright reasons, video and audio recording without the prior written consent of OtoLing is strictly prohibited.
33. Should I stay in the waiting room during the evaluation?
The direct answer is no. One cannot gain insight from sitting in a waiting room or listening to test proceedings from a distance. That is a significant distinguishing characteristic of OtoLing.
Observation and interaction (during evaluations) has provided families and Dr. Hooks with addition insight. The OtoLing experience accentuates the scope and sequence of practical strategies to increase speech, language, and auditory skills. Sure... questions, during the course of an evaluation session, may prolong the office visit. Yet, it has been important for the evaluator to interpret communication behaviors, in an accurate context.
The clinic is family-friendly, with surroundings designed for structured opportunity to participate and facilitate the clinical process. The unique open clinical environment (1) helps to reduce evaluation-related anxiety, (2) provides families with an insightful understanding of the evaluation and therapeutic procedures, and (3) promotes skills for
parental advocacy.
34. What is auditory processing therapy? (See numbers 20 through 22.)
There is no simple answer to this question since therapeutic approaches vary with the results of the APD evaluation. Although, speech-language pathologists may provide specialized treatment in a variety of areas (depending on their expertise and the patient’s needs). Other disciplines (e.g., occupational therapy, vision therapy, educators) provide significant support to a team approach.
Generic or general approaches (e.g., toys, workbooks, and computer games) may be beneficial for some signs of APD. Yet, for certain definite areas of language (e.g., language comprehension, production, and written expression), a systematic and integrated approach will bridge the gaps between diagnosis and treatment.
Dr. Hooks, who earned a degree in elementary education, has practiced with a keen understanding that children do not need someone to constantly tell them “Good Job! in order for them to succeed. Rather, “It has probably been more important to provide skills that stick with children (for a lifetime) rather than placing a sticker on them until the next time… for empty praise. Accordingly, the therapeutic emphasis at OtoLing has been placed on an increase in academic and communicative gains—not simply playing games!”
There are several workbooks and programs that have held some promise of APD intervention, but it has been unlikely that one programmed method or commercial product will solve related problems in visual speech perception, language production, speech sound decoding, and written language impairment. This is why the American Speech-Language-Hearing Association (ASHA) has recommended that a practitioner possess a broad range of basic science and clinical expertise—not just diagnostic expertise. Networking clinicians (with disparate skills) may confound expectations.
Further, a list of well-intentioned suggestions may be insufficient for the complexities of APD. Therefore, one should consider a long-term solution that is multifaceted for audition, language, vision, and cognitive processing.
Dr. Hooks has applied his background in elementary education to the Common Core Curriculum State Standards (internationally benchmarked) to support the needs of instructional teams and students (K-12). Adults receive strategies to meet the needs for academic skills and professional goals.
35. Will my insurance cover the cost of the services?
The answer depends on your insurance plan. in many cases insurance plans include speech and language therapy. As a courtesy, we will initiate a claim for speech therapy services—for selected insurance companies. Please see “background page” on expediting your insurance benefit.
The payment for an auditory processing disorder evaluation is due when the service is rendered. Please see “methods of payment.”
36. What is a stroke?
A stroke is a “brain attack” that is associated with nerve damage and cell death. A stroke may be the result of a blood clot or a hemorrhage, which reduces or stops blood flow to specific brain regions.
37. Is a stroke a common occurrence in the United States of America?
Yes. On the average, someone in the United States suffers a stroke every 53 seconds; every 3.3 minutes someone dies of a stroke.*
38. How does a stroke affect speech and hearing?
A stroke can impair swallowing, language, auditory reception, and auditory processing.
39. What are the warning signs of a stroke?
• Sudden numbness or weakness of face, arm or leg, especially if on one side
• Sudden dimness or loss of vision, especially if in one eye
• Sudden loss of speech, trouble talking or comprehension; difficulty swallowing
• Sudden unexplained headache
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