Auditory Comprehension Weaknesses: An Action Plan for Parents
Part 1 - Understanding the Test Results & Diagnosis
Patti Hamaguchi, M.A., CCC-SLP
You have had the IEP or perhaps received a private report from a speech-language pathologist or psychologist. In it, you see that your child’s “auditory comprehension of language” is below average, or even significantly so. Your first job as a parent is to understand what the tests, numbers and terms really mean. There are many questions you will ask yourself: How far behind is your child? Is auditory processing the same as auditory comprehension? What exactly does my child have? When a child has an autism spectrum disorder, comprehending language, particularly at the sentence or conversational level, is usually a challenge.
Numbers:
Reports can list scores as “age equivalents” which refer to the fact that your child’s performance was more typical for the average child of a certain age. The first number is the year and the second number refers to the month. So a number listed as “4-5” would indicate that your child performed on the test similar to a child who is 4 years 5 months would be expected to perform.
Another number you may see is called a percentile. With this scale, scores range from the 1st percentile (sometimes it is even listed in decimals, such as .5 percentile) to the 99th percentile. A score of 50 would then be the average score for a child, no matter his/her age. Scores lower than the 7th percentile fall into what is called the “disordered” range in United States public education. This system often determines the dividing line in terms of whether or not a child qualifies for services.
Standard Scores are typically reported in numbers that use 100 as the average, with 85-115 being considered within the average range. That said, some test publishers issue their own “standard scores” and so you may see single digits (such as a nine or 11) indicated instead. In these cases, you will need to know that particular publisher’s scale in order to decipher what those numbers mean.
Lingo:
To make matters more complicated, different professionals sometimes use words with “auditory” in them, but not necessarily all labels have universally agreed-upon meaning. The word “auditory” refers to how we hear. If your child is having “auditory comprehension” difficulties, it indicates that your child does not understand the message in a normal way. “Auditory processing” is one of those diagnostic labels that for most people, means the same thing. The words are going in, but the brain cannot translate them. However, for speech pathologists and audiologists, there is a more specific disorder (Auditory Processing Disorder or Central Auditory Processing Disorder) that refers to pathology in the neural pathways before the information reaches the cerebral cortex for linguistic processing. Audiologists perform very specific tests to diagnose APD. These are generally considered to be most reliable after the age of seven. Children with cognitive delays, hearing loss and developmental disabilities such as autism spectrum disorder, are very challenging to reliably test in this regard, and so often professionals will assume that there is some degree of slow processing or inefficient performance of the auditory neural pathways present due to a more pervasive processing/cognitive impairment that is part of these other syndromes or disorders.
There are three terms that are generally interchangeable and refer to how much the child is able to make sense out of what they hear: “auditory comprehension of language,” “receptive language” and “language processing”.
Once you understand the numbers in the report, pay attention to the little sub skills within the receptive language/auditory comprehension umbrella. Are there increased difficulties when the information to be processed is too long? Are there certain types of language structures (Negation? Pronouns? Passive voice? Wh-questions?) that are especially problematic for your child? Is your child’s working memory (“short term auditory memory”) poor? This component can really make holding on to language long enough to be processed, an issue. How about attention span? Is your child having trouble comprehending language because he/she is off-task and paying attention to other things in the environment? Lastly, we often find that this group of children often struggles with other auditory elements, such as reading, writing and spelling. If your child is school age, are there associated issues with these skills?
In putting together your “Action Plan” for this week, focus on becoming informed about your child’s current status, and what sub skills are delayed.