Researching Combined Interventions, Effectively Addressing Attention and Auditory Processing in School-Age Children by Julia Harper, OT and Aimee Levin Weiner, AuD,
Advance OT Magazine, January 4, 2010
This clinical report is written by Julia Harper, OT and Aimee Levin Weiner, AuD, describing their treatment of 29 children diagnosed with auditory processing disorder. The children underwent a combined therapy of iLs and the H.O.P.E. Method, a unique sensorimotor program developed by Ms. Harper, at Therapeeds Center in Ft. Lauderdale, Florida.
Co-Author Dr. Weiner’s Comments:
“I have been looking at auditory processing disorders now for 28 years, and until recently, I have never seen auditory processing skills really get better. While there may be some improvement with age, the initial processing issues seem to persist. But over the last two years, while quantifying iLs and HOPE Method (sensori-motor program) results, I’ve watched children come in with auditory processing problems and leave without them…
In our data on the 29 children diagnosed with APD, all 29 went from below normal limits to at or above normal limits in the area of auditory decoding skills. These skills include listening to soft speech, listening to filtered speech (being far away from a speaker), auditory figure ground discrimination (listening in noise), and auditory sound blending (important skill for learning to read by phonics).
While all of the children showed some improvement in the other areas of auditory processing, 22 of the 29 tested at or above normal limits in ALL areas of auditory processing (auditory decoding, prosodics, integration, organization, and association) after the program…..Combining this iLs program with the HOPE Method… I just think the results are startling… I am beside myself!!”
- Pre-testing indicated that 0 of the 29 children had intact vestibular processing skills measured by the PrN and functional skills. On post-testing, all 29 were within normal limits.
- Pre-testing showed that 28 of the 29 demonstrated ocular-motor deficits in the areas of visual pursuits, saccades and convergence/divergence skills. Post intervention, 25 of the 29 demonstrated intact ocular motor skills.
- Post-intervention, 22 of the 29 children had auditory processing skills that were completely within normal limits in every area.
- Seven of 29 children began this therapy on medication for attentional concerns. By the end of the program, the medications for all 7 had all been discontinued.
- Parents and teachers reported improvements in social skills, language, improved grades in reading and math, with most of the kids showing definite improvement in reading comprehension.
The report as published by Advance Magazine was abbreviated and did not show the Binaural Summation graph below. We are including it here for those interested.
Binaural summation is the aspect of ABR Testing (Auditory Brain Stem Response) which measures the transmission of sound from the ears to the low, middle and high portions of the brainstem. This is an objective measurement which tells us if the ears are coordinating with each other.
There should be a significant benefit to listening “in stereo” as opposed to listening monaurally. Sound quality, localization ability, and auditory figure-ground discrimination are all enhanced when the ears are working in tandem. ABR results on pre-testing showed that while sound was traveling at the right speed from the ears through the brainstem, in 27 of the 29 children there was poor coordination of the ears at the brainstem level, giving them no benefit from listening with both ears.
ABR results on post-testing were startling. Where there had been only small differences in the size of the waveforms on pre-testing, there were now robust differences between the waves generated when listening with both ears compared to those generated with each ear individually. Along with this marked electrophysiological change in auditory brainstem coordination were concomitant improvements in every area of auditory processing at the cortical level.
The significant improvement in binaural summation is a new finding since the addition of the iLs program to the H.O.P.E. method, and is thought to account, at least in part, for the extensive improvement noted in the auditory processing ability within the cortex on post-testing. The above graph depicts the changes in binaural summation (the difference between the size of the waveforms when listening with both ears compared to the size when listening with each ear individually) from pre- to post-testing for each of the 29 children. A size difference of 1.0 uV is considered within normal limits.