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
      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 represents a departure
      from traditional aural rehabilitation—that is, techniques used with individuals who have 
      been diagnosed with an abnormal loss in hearing sensitivity (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. 

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. Less 
      than one percent of over 150,000 professionals in communication disorders and sciences
      have certification in both disciplines.  Additionally, Dr. Hooks completed formal academic, 
      laboratory, and research training through the Michigan State 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, and neuroscience. 
      These areas have served collectively to connect neurophysiology with clinical insight and 
      innovative therapeutic application for children, adolescents, and adults and supported by 
      the outcomes from evidence-based practice. Therefore, one shou

      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 21-24 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. 

      This  practice does not provide simple “cookie cutter” solutions to complex problems. This 
      is one reason why drill-based auditory-specific solutions may insufficient “treatment” a for 
      “transfer of learning” (i.e., a construct from educational psychology) 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.

  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 his earned 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 credibility and professional integrity to translate and apply academic 
       principles from evidence-based practice. 

       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 and the Common Core Curriculum State Standards 
       (CCCSS). Dr. Hooks has demonstrated clinical competence and experience to apply the
       CCCSS across specific academic content areas (e.g., math, reading comprehension, 
       written language expression, and science). This approach has differed from a simplistic  
       application of games, questionable web sites, and toys to treat complex communication 

       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
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, 
       K-8 education, 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.

       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. 
       Passive learning, from some apps, have served only to pacify a children and occupy 
       potential productive time. Therefore, it is important to make an informed decision, 
       regarding projected academic, social, and cognitive outcomes from computer apps.

       Finally, many PPO insurance plans recognize speech therapy as a reasonable and
       necessary option for reimbursement when a licensed and certified speech-language 
       pathologist performs skilled intervention.

5.    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.
6.    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

       Typically, neurological disorders such as Parkinson’s disease, cerebral palsy, 
       Huntington’s disease, and Alzheimer’s disease affect several aspects of communication 
       and swallowing. 

7.  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.

8.    What are some possible signs or symptoms of central auditory processing

       •  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

 9.  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.

10.  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).

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

Why the Buffalo Model?

        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 researched the most.
        Newer methods have emerged over the years, but the Buffalo Model has withstood 
        the test of time and academic rigor and clinical effectiveness. Further, this model was 
        developed from classic brain and language research studies and has complemented
        translational neuroscience research. 

        The Staggered Spondaic Word (SSW) test, a component of the Central Test Battery, 
        has been supported by over 48 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 practical 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.

        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 audible 
        language with the motor-speech theory of language, and vision research. Applied
        learning theories have been consistent with his formal training and experience in 
        educational psychology child development theory, and several education
        method courses.

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

        Yes. 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.

13.    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 teenage 
        years—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 aural comprehension of language—sooner than later. 
        Clinical judgment has been advised, with respect to language development milestones
        among young children. 
14.   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.

15.   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—
        against established conventionalism—The auditory system is not mature 
        enough for a CAPD evaluation until age seven.

        Recently some practitioners have reversed themselves by testing children—even 
        younger than five years-old. Yet, the approach at OtoLing has remained consistent, 
        principled, and coherent. 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
        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 can provide every speech-language 
        evaluation tool that has been recommended in his evaluation reports, with knowledge, 
        insight, and practice—not simply a list of tests.

16.  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. 

17.  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 

       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.

18.  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 auditory-specfic 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 and 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.

19.    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. Therefore, 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 speech.

         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.

20.   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.

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


         The speech evaluation is based on a comprehensive battery of standardized tests to 
         assess vocabulary, grammar, written expression, auditory memory, verbal expression, 
         voice, articulation, auditory comprehension of language, hearing screening, and 
         auditory processing disorder screening (if appropriate). Tympanometry is a procedure
         to screen for middle ear dysfunction—especially for those with a history of problems.

         The evaluation of children and young adults with autism includes the assessment of 
         preverbal and verbal strengths and needs. The assessment instruments include
         observation, in the context of functional interaction (e.g., vocal, verbal), language 
         sampling, standardized assessment, parent and teacher profiles, and an assessment of 
         auditory perceptual function. 

         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.


         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.

22.    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 

          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 

          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.                     

23.   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 

         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. 

24.     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
          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. 

25.    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 good 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, nor does it obligate 
         families to sustain any protracted or timed commitments to therapy. 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.

26.    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.”

27.   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.

28.   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.*

29.   How does a stroke affect speech and hearing?

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

30.  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

Auditory and Speech-Language Services


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