Frequently Asked Questions

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 current COVID-19 pandemic presents some challenges for service delivery, but there are safe options are available at OtoLing (See Coronavirus and Telehealth tabs for more details). 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.   Why is the integrated approach at OtoLing unique from typical practices?

       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.

      This practice is not limited to an auditory-specific approach to communication difficulties.

      Rather the clinical approach is forward-thinking and guided by neuroscience principles—

      adapted and highly-personalized to meet the needs of the patient. Intervention has not

      based on generalized strategies. Rather, pediatric intervention has  been designed from

      formal training in curriculum-based academic content and informed clinical measures.

    

      Professional attire matters. As such, Dr. Hooks strives to present an image that respects the

      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. 2.  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 intervention. You can view everything directly—that is within the

      the therapy room and the adjacent clinician room, which is coupled with an observation

      window, wireless communication, other resources.

2a.  How safe is therapy at OtoLing for the patient during the COVID-19 pandemic?       

       

       From the outset in year 2006, the office, clinical, and evaluation spaces were configured with

       attention to physical distancing—long before the current COVID-19 pandemic. Dr. Hooks is,

       and has been the only practitioner, which means that only patient/family is seen at a time.

       Unlike many clinics, the main therapy room, has been reconfigured for the patient to be seen

       and heard safely wirelessly. A sizable observation glass window creates a buffer or distance

       between the patient and provider. This arrangement allows the patient to see the clinician’s

       face and reciprocally for critical visual speech cues. Clearly, traditional therapy is not as

       effective while wearing a mask.

2b. Is the waiting room and office visit considered safe from infection transmission?

      Yes, from the beginning (i.,e., year 2006) one family has been seen at at time, to reduce

      the likelihood of bacterial and/or viral transmission. Further, a strict sick patient policy has

      been integrated into the clinical policy, to help families discern whether to cancel or postpone

      an evaluation or therapy office visit. Therefore, this practice has been proactive with social

      distancing measures; long before the recent COVID19 pandemic.

      As always, patients have entered through one door and exited through another door to

      increase privacy, and to reduce the likelihood of inadvertent exposure with distancing.

      Families have reported that Dr. Hooks listened to their needs, concerns, and actively sought

      their priorities. His individualized approach to patient and family needs has 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 communication ability—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.

3.   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. A downward  trend

      appears to be characterized partially by generation, and may be associated with experience

      and expertise in certain definite areas (e.g., auditory and visual speech perception). 

3b.  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 diagnostic 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.

4.  What does holistic treatment mean at OtoLing? It’s just speech or hearing—Right?

     This practice has  provided comprehensive evaluations that have been supported by relevant

      academic and professional credentials in audiology, speech-language pathology. Further,

      a degree in K-8 education provides added insight, which cannot be gained from speech

      pathology or audiology.Collectively, these areas connect anatomy and neurophysiology with

      clinical insight and therapeutic application for children, adolescents, and adults.

      Dr. Hooks sees one patient at a time (i.e., no groups), with total attention to both immediate

      concerns and subsequent positive outcomes. Increased social skills require more than role-

      playing scrips and schemes. As such, individual therapy is coupled to interactive family

      education so that parent can apply appropriate expectations from child developmental

      theory and practice.

5. 5. Many practitioners complete an evaluation in just one hour. Why is more time
   

      required at OtoLing?

      Evaluation reports and accompanying strategies require a period of approximately 30 to 32

      days for analysis and test interpretation—not the fastest reporting period, but one that is

      thorough and comprehensive. Universally, families have derived and applied content for

      years beyond the initial evaluation. The extended reporting period has been reflected in an

      individualized case study—not a typical report with a listing of generic games, videos,

      books, and Internet sites of which to visit.

      *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

      (i.e., emotions, feelings, and knowledge acquisition). Therefore, the overall quality of life

      improves for the whole family, not just the patient.

6.   Does OtoLing provide APD evaluations for just pediatric and adolescent cases?   

       Dr. Hooks a holds valid Illinois Teaching Certificate. However, he has not assumed a

       title of educational audiologist, but is uniquely qualified to apply educational principles

       from a B.A. double-major 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 in different 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

       his evaluations. An analysis of complex problems is coupled to specific strategies that

       are realistic and appropriate. Therefore, families gain an understanding of what to do—

       and why they should... Otherwise, follow-up strategies may devolve into busywork.

7.  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 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.These aspects 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.

 

8.    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.

9.    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 has been trained to provide therapy to individuals with congenital hearing loss, and

       those with acquired hearing loss (e.g., hearing loss from disease, trauma, or a progressive

       syndrome).

       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 and the expertise of a clinician.    

       Therefore, insurance members should consult with their insurance representative to determine

       the extent of their benefit and to determine whether the therapy scope and sequence meets

       their family goals.

10.    Has there been research to compare different therapy models for (C)APD?

           

          Yes, Pavlick, Zalewski, González, and Duncan (2010) analyzed six prevalent therapuetic

        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., Wilson) 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 have not been effective outside of a therapy

        setting—for example, “following incremental multiple-step commands, with fading cues.”

               

11.    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).

       Typically, neurological and neurodevelopmental disorders such as Parkinson’s disease,

       cerebral palsy, Huntington’s disease, and Alzheimer’s disease affect several aspects of

       communication and swallowing.

12.  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, which

        interfere with the comprehension of spoken language and language expression.

        •  It may not be so important that one receives a diagnosis of APD, but it will be

           important that the patient receives appropriate intervention. This is another reason

           why one should consider an individual as a whole rather than just parts—ears, eyes,

           nose, etc.

13.    What are some possible signs or symptoms of auditory processing

       disorder?

       •  Problems in the retrieval and retention of spoken information (e.g., instructions)

       •  Reading, comprehension, spelling, and word finding difficulties.

       •  Problems with auditory speech perception, in the presence of background noise.

       •  Sound localization problems from linguistic and environmental sources

       •  Slow processing of spoken language (complaints of people talking too fast).

       •  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 or lipreading)

       •  Delays that may be related to oral motor planning and quiet rehearsal difficulties

14.  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

       have a tendency to speak in the manner that they hear (Ling, 1986).

15.  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).

16.  I read that there are several ways to test, classify, or categorize APD.

       Is this true?

 

       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 objective measures (e.g., 

       Biological Marker of Auditory Processing (BioMARK™), which is a variation similar to

       auditory brainstem response (ABR).

Objective Testing

       Objective tests (e.g., BioMARK™) provide evaluators with a diagnosis and insight into a

       location of a problem, but questions remain regarding the subjective interpretations of

       diagnosticians and menu-derived therapeutic solutions—after a “biological marker” has

       been identified. 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.

        Yet, brain circuitry has been characterized by diffuse and variable connections. Several

        brain areas have been partially influenced by neuroplastic changes from genetics, the

        environment, and learning. Accordingly, an APD diagnosis (with or without a biological

        marker) has required additional insight into language and learning. This is why language

        development has been shown to contribute to cognition, but not the other way around

        (Leonard, 1983).

        An audiologist has been the recommended evaluator to rule out APD. However, this

        targeted treatment has not been typical for many clinical audiologists, Further, ASHA has

        maintained that an audiologist with a strong background in speech-language, neuroscience,

        and neurophysiology is “desirable.” It follows that a clinician who has been ASHA-certified

        licensed in speech-language pathology is the recommended professional for therapy or

        treatment.

17.  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. 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? Therefore, 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.

        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.

18.   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.

      

19.   Does a speech-language pathologist have a role in the diagnosis of APD?

        Yes, 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:

        •    Speech articulation (Some individuals speak in the manner they hear speech sounds.)

               Phonological comprehension and production (e.g., rule-governed sound)

        •    Written language expression problems   

        •    Comprehension of spoken passages or instructions—for example, math operations

        •    Speech sound decoding and encoding difficulties

        •    Oral motor planning—possibly related to apraxia and tachyphemia

        •    Pragmatics (e.g., text organization, implicature, referential language, and deixis)

        •    Unusual vocal loudness and pitch changes during conversational speech

  

        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.

20.    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

        —long past the critical period of language development (Thompson, Narr, Blanton,

         & Toga, 2003). The greatest growth in language development occurs between two and

         seven years of age. It is important to identify signs of abnormal auditory perception and

         to treat problems that affect the auditory comprehension of language—sooner than later.

         Clinical judgment has been advised, with respect to language development milestones

         among young children.

   

21.   Is the early identification of auditory processing in children something new?

        Not really... Over forty years ago, it was recognized that language comprehension

        required synergy from several systems—not just the auditory channel (Berry, 1969). 

        She reported that children’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.

22.   At what age should a child be considered for APD intervention and 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.

        There are some diagnosticians who evaluate children at 4.5 years-old. The approach

        at OtoLing has remained consistent, principled, and coherent with normal child and language

        development. Families can trust that they will receive appropriate intervention from Dr. Hooks,

        which has not been based on trendy strategies or those with demonstrable transfer of

        learning.

        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.

23.  Who is qualified to provide treatment for an auditory processing disorder?

       Clearly, the evaluation and therapeutic intervention for APD is a team effort, which

       may require the input from several disciplines including, medicine, neuropsychology,

       education, occupational therapy, speech-language pathology, and audiology.

       However.... “Speech-language pathologists are uniquely qualified to delineate the

       cognitive-communicative and/or language factors that may be associated with

       APD.” (AmericanSpeech-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.

    

24.  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.

25.  I read that there is a clear distinction between linguistic 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 an 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.

26.    Are APD re-evaluations 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. With intervention—through speech-language

         therapy and collaborative approaches—a re-evaluation has not been warranted.

         It turns out that some practices may recommend a re-evaluation every year, and

         some every two years. OtoLing is a practice that does not seek return business from

         APD evaluations. Rather, this practice 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.

         Yet, 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.

27.   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.

28.   What comprises your evaluations for speech-language and audiology?

Speech-Language

         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.

         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 auditory processing disorder evaluation is comprised of a battery of tests

         including hearing sensitivity test, tympanometry, acoustic reflexes, oto-acoustic

         emissions, word discrimination (quiet vs. noise), the  Staggered Spondaic Word test

         (SSW), and the Phonemic Synthesis Test. The Phonemic Synthesis Test has been

         distinguished from other APD tests by the direct  measurement of phonemic

         decoding—essential for reading and spelling. 

         Gap detection tests have been used to help identify individuals with temporal

         processing problems. Temporal processing has been exceedingly important for reading

         and language. Optional testing may include the Time Compressed Sentence Test, The

         Pitch Pattern Test, and others. Recent peripheral audiological tests (from licensed

         audiologists) have been accepted by OtoLing, to decrease the assessment fee and to

         add to the differential diagnostic information.

         The evaluation procedures and results are compiled and reported in a 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).

         The APD evaluation results have been reported in a school and layperson-friendly

         presentation of facts—not in unintelligible jargon, meaningless percentages, and vague

         talking points. Unequivocal language has underscored recommendations, intervention,

         and follow-up strategies from Dr. Hooks (or another SLP), teachers/instructors, reading

         workplace supervisors, or others who may benefit from relevant information. In most

         instances the reports have been written with an insight into communication, neural

         physiology, and cognitive linguistics.

29.    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.

           Further, an appointment should be canceled if the patient has an active upper

          respiratory infection, because the audiometric and speech-language evaluation

          findings could be affected negatively.

          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.                    

30.   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, and

         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. 

        This 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.

    

31.     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 another distinguishing aspect of

          OtoLing. For your comfort a waiting room is available, however.

          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.

32.    What is auditory processing therapy? (See numbers 5 and 6)

          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 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!”

          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.

          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.

         OtoLing does not sell any commercial products and programs, or require families to commit

         their time and resources a select number of office visits. Each case has been considered

         different with varied requirements. *Fast ForWord (FFWD) has been recommended

         conservatively and has not been a mainstay of this practice. However, FFWD has been

         beneficial in certain definite areas—that is, memory, attention, processing, and sequencing.

33.    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.”

34.   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.

35.   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.*

36.   How does a stroke affect speech and hearing?

        A stroke can impair swallowing, language, auditory reception, and auditory processing.

37.  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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