Auditory and Speech-Language Services

 

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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 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 (central) auditory processing

      disorder [(C)APD)], receptive-expressive language disorder, and abnormal

      communication behaviors in a dedicated clinic. These problems may be interrelated with

      neurodevelopmental, neurogenetic, or neurological 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 certain general strategies—for example, following multiple-step commands and

      role playing to increase social communication. In comparison, intervention progress has

      been index to a stepwise approximation of objectives from curriculum-based academic

      content.

     

      Direct parental interaction during the evaluation and therapy has been a key component

      to successful diagnostic and therapeutic outcomes. 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 always included a thoughtful and

      insightful intake interview from a pharmacological, neurological, physiological, and

      psychological perspective.


      Thorough and in-depth attention has been directed to the effective integration of

      multisensory processes (e.g., hearing and vision) that promote the 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). Yet, he

      has not applied aural rehabilitation to patients with CAPD.


      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.


2.   Why should I consider the services from OtoLing?


       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. Approximately

      one-half of one percent (0.51) of 180,000 professionals hold certification in both disciplines.

      Additionally, Dr. Hooks completed formal academic, laboratory, and research training through

      the Michigan State University Neuroscience Program.

              

      OtoLing is a practice that provides evaluations and treatment. This practice has

      provided comprehensive evaluations that have been supported by relevant academic

      credentials in K-8 education, audiology, speech-language pathology. These disciplines

      connect anatomy and neurophysiology with clinical insight and innovative therapeutic

      application for children, adolescents, and adults.  Clinical outcomes have been supported by

      evidence-based practice.


      Dr. Hooks sees one patient at a time, with total attention to both immediate concerns

      and subsequent positive outcomes. The evaluations and analyses have been

      considered longer and more in-depth than most. As such, evaluation reports and

      strategies may require a period of approximately 30 to 32 days for completion of the

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

      and comprehensive with attention to the unique needs of individuals with complex

      psychosocial communication difficulties. The extended period has been reflected in a the

      depth and extent of the document. For this reason, Dr. Hooks has not routinely recommended

      a re-evaluation every three years.  


      This  practice does not provide simple “cookie cutter” solutions to complex problems. This

      is one reason why drill-based and auditory-specific solutions may be insufficient “treatment”

      for  “transfer of learning” rather than audiology alone. This is why speech-language therapy

      (often by covered by insurance plans) has been considered the most-effective means of

      treatment treatment across multiple domains (e.g., cognitive, linguistic, and social emotional) of

      learning and development.


      Dr. Hooks has been committed to solving problems and not assigning yet another

      “diagnostic label” as an 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).

      Further, evidence-based practice and practice-based evidence has shown that patients

      have developed skills to improve the quality of life. Therefore, the overall quality of life

      improves for the whole family.


  1. 3.   Does OtoLing provide evaluation and treatment of (central) auditory processing

       disorder to pediatric and adolescent cases?     

       The answer is yes. There is no “gold standard” to treatment. However, the difference at

       OtoLing is the provision of direct, personalized, and effective speech therapy that is

       linked to immediate improvement for children, adolescent, and adults (See 3b).


       Dr. Hooks a holds valid Illinois Teaching Certificate. 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. Rather, his motivation

       and enthusiasm has been coupled to the expansive volume of skills that patients gain in

       all facets of communication—for example, verbal, written, and auditory.


       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

       Bloom’s Taxonomy of Learning aspects of Common Core Curriculum State Standards

       (CCCSS). Dr. Hooks has demonstrated clinical competence, academic preparation in

       teacher education, and the experience to apply the CCCSS across specific academic

       content areas (e.g., math, reading comprehension, written language expression, and

       science).


       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.


3b.  Does OtoLing provide evaluation and treatment of (central) auditory processing

       disorder or speech therapy services to adults?


       The answer is again, 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.

 

  1. 4.  What is (C)APD therapy and is there just one treatment option?    


       The American Speech-Language-Hearing Association (ASHA) recommended treatment

       (therapy) for (C)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.


       It has also been reasonable to suggest that his formal training in language disorders,

       educational psychology, and child psychology have distinguished him from most diagnostic

       audiologists who offer traditional aural rehabilitation (i.e., treatment to increase one’s

       skills in regaining their hearing and listening).


      A relatively new debate has arisen regarding (C)APD on whether or not auditory

       processing should include structures that are outside of the central nervous system—for

       example, the cochlea (inner ear), with its frequency selectivity, electromechanical

       transduction, and filtering characteristics. Thus, the designation of (C)APD emerged.


       If (C)APD were so easy to understand, then further research would not be needed. Yet,

       time-honored research has shown that  auditory processing and the comprehension of

       verbal language remain incomplete for auditory attention (Broadbent, 1958), working

       memory (Schieder & Shriffrin, 1977), and location of the problem (Katz, 2005), As such,

       strategies that have been derived from direct experience in education and evidence-

       based practice, may facilitate practical and effective treatment options.


  1. 5.   What is aural rehabilitation? Is it a therapy that insurance carriers recognize?


      Aural rehabilitation is a procedure that has been recognized to improve communication

       function for those with auditory-related communication difficulties. 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). 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.


       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. Therefore,

       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.


6.    What is a neurogenetic disorder?

           

         A neurogenetic disorder arises from hereditary or genetic causes and also adversely

        affects the nervous system. Several neurogenetic disorders—for example, Pierre-Robin

        syndrome, Fragile X syndrome, and Down syndrome. These conditions have been

        associated with auditory perceptual and speech difficulties.

               

7.    What is a neurodevelopmental communication disorder?


       Neurogenic refers to a condition that arises from, is caused by, or controlled by the

       nervous system. Some examples of a neurodevelopmental 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), central auditory processing disorder (C)APD), and

       periventricular leukomalacia (PVL).

       

        In several instances, a neurodevelopmental 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 disorders such as Parkinson’s disease, cerebral palsy,

       Huntington’s disease, and Alzheimer’s disease affect several aspects of communication

       and swallowing.


8.  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  (C)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.


9.    What are some possible signs or symptoms of central 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


10.  Could a history of middle ear problems be related to (C)APD?


        Yes, even a mild hearing loss may produce a significant and adverse effect over time

        (2-4 weeks); leading to impaired auditory processing, speech, and language.



11.  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, Melbye, Sørensen, Hømøe, Madsen, Mølbak, Hansen, Andersen,

       Hanhn, and Garred, 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).



12.  I read that there are several ways to test, classify, or categorize (C)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 (C)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 (C)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, a (C)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 (C)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.


13.  Why should I consider the Buffalo Model of Central Auditory Processing Disorder?


        Several (C)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 (C)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 (C)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 (C)APD (Berninger,

        Abbott, Abbott, Graham, and Richards, 2002; Hoien Lundburg, Stanovich, and Bjaalid,

        1995 and ). Speech and language have been integral to CAPD, which is one reason

        why up-to-date academic preparation should be broad.


14.   Do other models of CAPD consider the same aspects as The Buffalo Model?


        No, there are several aspects that other models have not considered as auditory

        processing. While other (C)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 (C)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.

      

15.   Does a speech-language pathologist have a role in the diagnosis of (C)APD?


        Yes, a speech-language pathologist is the logical and preferred professional to provide

        follow-up therapy after a CAPD diagnosis. However, it is not within the scope of practice for a

        speech-language pathologist (SLP) to conduct a central auditory processing evaluation. An

        SLP can conduct a speech-language evaluation, which can contribute to the interpretation of

        a (C)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 central 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.



16.    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.

   

17.   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). A CAPD 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 (C)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 up to date knowledge 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.



18.   At what age should a child be considered for (C)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.


        Still, there are some diagnosticians who evaluate children at 4.5 years-old. The approach

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

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

        which has not been based on trendy (à la mode, au courant) strategies.


        Even, if a child is too young for a diagnostic evaluation, Dr. Hooks has targeted speech

        language therapy to address (C)APD. As such, an early diagnosis should be matched 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.


19.  Who is qualified to provide treatment for a central auditory processing disorder?


       Clearly, the evaluation and therapeutic intervention for (C)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

       (C)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 (C)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” (C)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.

    


20.  Does (C)APD occur alone as a separate disorder?

       

       No, central 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

       (C)APD.


       In isolation, low self-esteem may not appear to be a direct consequence of (C)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.



21.  I read that there is a clear distinction between linguistic processing disorder and

       central 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 (C)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 to auditory processing

       (Price, Thierry, Lamp; Griffiths, 2005). For some, a separation of hearing and language

       appears to have created more uncertainty, because of time-honored neural principles—

       for example, labeled line, plasticity, association, and working memory.


        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 (C)APD.


        Recent research has shown that processing problems may be related to humoral control        

        and variations in dietary intake (Zhang, Ren, Avsian-Kretchmer, Luo, Rauch, Klein, and

        Hsueh, 2005), mood (e.g., low self-esteem, depression), and neurotransmitter release

        (Gopal, Carney, & Bishop, 2004; Kähkönen, Ahveninen, Pennanen, Liesivuori,

        Ilmoniemi, & Jääskeläinen, 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 (C)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.


22.    Are CAPD 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

         CAPD 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.


23.   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.


24.   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 central 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 (C)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 Central 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,use).


         The (C)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.



25.    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

          central 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                   



26.   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). Still, 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.      


         Pediatric therapy has been structured to integrate Bloom’s Taxonomy of Learning (e.g.,

         affective, cognitive, and psychomotor domains) and specific application of Common Core

         Curriculum State Standards (CCCSS). 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.


         An open and transparent office environment expedites and enhances family input

         during the counseling, evaluation, and therapy phases. Families can observe office visit

         therapy sessions and take notes. However, for privacy and copyright reasons,

         videotaping and audio recording without the prior written consent of OtoLing is

         strictly prohibited.

           


27.     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.



28.    What is central auditory processing therapy?


          There is no simple answer to this question since therapeutic approaches vary with the

          results of the (C)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 (C)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 CAPD

          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 (C)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.



29.    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 a central auditory processing disorder evaluation

         is due when the service is rendered. Please see “methods of payment.”



30.   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.


31.   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.*



32.   How does a stroke affect speech and hearing?


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



33.  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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*Various sources: National Institute on Deafness and Other Communication Disorders; Centers for

  Disease Control and Prevention, American Academy of Audiology