Abstract
This paper aimed to present evaluation and recommendation for Assistive Technology for people, especially children with Central Auditory Processing Disorder (CAPD) and problems with speech perception and reception based on a case study. Description of Assistive Technology products was offered. Human Activity Interface Technology (HAAT) model was used. Recommendations were made for further assistive technology evaluation, follow-ups, follow-alongs, and referral services.
Key words: CAPD, HAAT, Case Study, Assistive Technology Evaluation, Recommendations
Introduction
Auditory Processing Disorder (APD) or Central Auditory Processing Disorder (CAPD) can appear in early childhood or at birth. Hearing is not always affect and it is rather a neurological disorder that involves problems in processing auditory information. People with this disorder have difficulties in the following functions: sound localization and lateralization , auditory discrimination, auditory pattern recognition, temporal aspects of audition, including temporal resolution, temporal masking, temporal integration, temporal ordering, auditory performance decrements with competing or degraded acoustic signals (MI Dep of Ed, 2006).
Focus: Human Activity-Assistive Technology (HAAT)
This is one of the most frequently used models in Assistive Technology (AT) that takes into consideration client’s individual needs and interaction patterns with AT & environment Human Activity-Assistive Technology (HAAT) in a more humane, accurate and holistic approach. In HAAT, human, activity, and environment are seen in context: social environment (familiar peers, non-familiar peers, stranger and the individual alone), setting (the individual’s home, the individual’s interaction in home or group home, employment/work school and community), and physical environment (light, sound, and heat). In this paper, the case will focus on children’s auditory processing disorder (Angelo, 2000 - Cook & Hussey, 2008). So for a nine year-old elementary student, school and sound are important factors as well as interaction, support, and motivation from the social and familial environment (Angelo, 2000).
Client’s Description:
This case study is based on a real person, a student I am currently teaching at a Greek parochial Evening School (after school program) in New York. However, for confidentiality reasons, the name is fictitious and personal data, including student record information has not been released here. It is not necessary anyway, as the emphasis is given on what assistive technology could be considered for a person with the general characteristics of Mary. Mary is a 9 year-old elementary student, a third grader. She is White (race), Greek-American (ethnic origin) and Greek Orthodox (religion). Her family belongs to the working class and they live in a small house in the Riverdale, NY. Mary’s parents are very caring, but obviously cannot afford very expensive AT. For this reason, AT cost and insurance options need to be taken into consideration.
Mary is a highly functioning consumer with high performance in both public school and the Greek parochial school. She is very good in math and art, but she needs special assistance in reading, speaking, and especially listening. Although she is in a honor’s class, she is having speech therapy at school and in past she had special education classes in reading and writing. Although she speaks quite well and she does not have any articulation disorder, her inability to understand instructions and her often misunderstanding of verbal cues and complex speech may result a certain difficulty in learning both a spoken and written foreign language, such as Greek, which a complex and demanding language with different alphabet and pronunciation. For instance, she may read “o” as “ou”, as I observed in our initial interview. Her essays also reflect misperception of spoken language and sounds, which is not an accident as Auditory Processing Disorder is a type of phonological disorders.
Her ENT (Ear Nose and Throat) doctors (otorinolaryngologists) has exclude any ear, auditory nerve or vocal cord problems. As a result, it is rather the brain and in particular Wernicke’s Area, which is responsible for understanding both written and spoken language and probably its networking with temporal (sound and music) and frontal lobes (verbal skills and high association process) (Gillam et al, 2011). Therefore, she needs the use of manipulatives and visual information (manipulatives, audiovisual technology and books with pictures and concrete and specially formatted drills and assessment) in the classroom (MI Dep. of Ed, 2006), which really work for her, as I have observed before and after their implementation of those methods of instruction.
Client’s Service System Involvements and Transitions:
a Early Intervention: Mary saw ENT (no ear/vocal cord damage/speech production problem), audiologist (no hearing problem). She also has SLP (Speech and Language Pathologist aka Speech Therapist) since Kindergarten.
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Special-Education Preschool through High School: Mary had special education classes for reading and writing in the past, but now she is fully mainstreamed and actually even in an honor’s class, but she is still having speech therapy as a third-grader at school.
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Special-Education Preschool through High School: Mary had special education classes for reading and writing in the past, but now she is fully mainstreamed and actually even in an honor’s class, but she is still having speech therapy as a third-grader at school.
c Vocational Rehabilitation
Mary systematically sees her School Counselor to discuss educational issues and other concerns she may have that may relate to or affect academics. At age 9 and grade 3, it would be feasible and appropriate for Mary to have for vocational rehabilitation some experience with career Exploration (interests, values, aptitudes-abilities-intelligence). For instance, for intelligence, aptitudes, and abilities, she could have WRAT-4 or Beta III with some more time granted as an accommodation for her disability and more detailed and concrete instruction given to her with questions that request feedback to confirm mutual understanding of the instrument and the procedure. For interests, she could have Career-for-Me for Elementary Students with Special Needs, which explores both career interests and work values. The Mirror Tracing is also good and easy with not much instruction needed and very accessible and it explores manual and finger dexterity as well as spatial perception and manual work skills and aptitudes.
d Post-Secondary Education
Although too early for post-secondary education, Mary has some good aptitudes, such as numerical and spatial, and manual abilities that if she uses and practices them she may have a very good prognosis. Speech therapy may help her also improve her limited areas, but also enhance and strengthen some speech and hearing functional capabilities that may later bring her to the level of being able to pursue even college and even have an ambitious professional career.
e Insurance Coverage
As a minor with disabilities, Mary receives Medicaid (including the Waivers)/Medicare. However, she does not have any other insurance. Her parents are working class people and cannot afford expensive equipment. However, some equipment, such as digital audio recorder could be purchased as tax exempted.
Assistive Technology (Initial) Evaluation
a a. Tasks/Activities:
Mary likes arts/crafts, animals & nature. She has numerical, spatial, and manual abilities that can be effectively used in mathematics, science, and art classes.
b. Psycho/Social/Cultural/ Physical Environments:
Mary comes from a Greek-American cultural/community family, whose cultural characteristics, though her mother is second generation of American, they still carry the cultural barriers that Greeks from agrarian areas of Greece have that is they are high achievers with many demands from their children for academic excellence. Also she comes from working class family which expects her daughter to have a better job with more benefits and higher Socio-Economic Status (SES).
c. Capacities: normal hearing, vision & sensory-motor skills and manual/finger dexterity.
d. Skills: normal speech production & good numerical skills
e. Limitations: speech perception/reception problem; marginal reading comprehension, needs additional instruction/directions, writing coherent sentence structure, and piecing written & speech information together; challenge in second language acquisition/learning a foreign or second language, careless mistakes in reading & writing, learning & performance in music (e.g. voice).
f. Functional Capabilities: cooperative, well-articulated, social/behavioral skills, hearing, eye-hand coordination. She can use those capacities in order to function better and compensate for her limitations or outbalance her limitations, as the term functional capabilities means (Cook & Hassey, ).
g. Possible Extrinsic AT Software:
Primary Software/Devices: Those can be used for everyday life improvement, some of them in the classroom, but most of them can also facilitate independent living and home study.
WYNN by Freedom Scientific comes with two different software packages: WYNN Wizard and WYNN Reader. These programs “are voice output, web browser, and text editor programs intended to help individuals with learning disabilities to read, write, study, and comprehend text more effectively” (Abledata, 2012). It writes and reads aloud in multiple languages and accents, it executes optical character recognitions (OCR), word prediction, web browsing, highlights sentences for study strategies, and offers dictionary services. It is a little pricey as it ranges from $943.00 to $379.00. 
Scan and Read Pro Scan is a software from Readingmadeeez.com that “changes printed text into understandable sound. The program helps you in reading and comprehension by highlighting each word as it's read aloud. Scan and Read Pro's voice can also be turned off if you prefer to focus on the visual input only” (Readingmadeeez.com, 2012). It costs only $149.95 (Readingmadeeez.com, 2012).
Don Johnston Products include software such as Co:Writer, and Read:OutLoud, WriteOutLoud.
Co:Writer 2.0 “is a word prediction software program that uses artificial intelligence to predict words based on subject-verb agreement, grammar rules, word relationships, proper names, frequency, redundancy, frequency, and user preference for individuals who struggle with writing due to physical limitation, language delay, or learning disability” (Abledata, 2012). Write:Outloud is a voice output word processor program that supports students while composing, editing, or revising. The program, like Read:Outloud, features a homonym checker and a dictionary, as well as clear, concise speech output” (Abledata, 2012). Those two are part of the SOLO package. Prices range from $99 to $325 (Abledata, 2012).
Digital Voice Recorder for recording class lessons and verbal instruction. Digital recorders are quite cheap in comparison to software and AT devices and can be found everywhere.
Secondary software: Treatment software that focuses on treating disability itself and its limitations, teacher’s applications and also alternative software and software that can be used in the classroom or it can help with music and auditory processing challenges.
Dragon Dictation from Dragon Systems “is a voice input, voice output and voice input text editor program designed for use by individuals with spinal cord injury or upper extremity, vision, or learning disabilities. This voice recognition application allows hands-free operation of an Apple iPhone, iPod Touch or iPad. The program allows the user to speak and instantly see the text of what is said appear in the document, email message, or other input area” (Abledata, 2012). The most interesting with this product in Mary’s case is that it is for free and it can be downloaded from the Dragon Systems website (Abledata, 2012). 
SoundSmart is “a cognitive skills tutorial program and auditory training activity designed to improve listening skills, following directions, phonemic awareness, working memory, mental processing speed, and impulse control” (Abledata, 2012). It consists of the Attention Coach and the Math & Memory Coach, with the first one more important for Mary, especially for practicing listening skills. Price is provided only after contacting manufacturer..
Other devices and software are the Activity Table, though it is rather for younger children, it still could probably be good for auditory stimulation combined with visual cues for Mary’s treating limitation (auditory) by using her functional capabilities (visual) (price info upon contacting manufacturer) and the Foundations in Speech Perception CD-ROM for auditory training and future risk of hearing loss that can be used in the classroom, home or speech therapy. Price is given upon contacting manufacturer. 
Also, Hearit SE-Model 560 is “The Hearit SE 3 Step Training Kit, model 560, is an auditory training activity designed for use with individuals with dyslexia, attention deficit disorder (ADD), attention deficit/hyperactivity disorder (ADHD), or hearing or auditory processing disabilities. This kit includes the Hearit SE, accessories for Speech Therapy/Bilingual Kit and Broadcaster (see entries) to facilitate individual, small group, or classroom work. Price is not provided, but most product of this series by Banana Speech Therapies are usually very expensive that can be used by speech therapist and be purchased by the school, though (Abledata, 2012).
h. AT devices based on related Functional Capabilities: teaching material with visual stimuli and large legible fonts and easy-to-understand cues.
i. Devices’ Potential Effects on Client’s Environment: high cost that may not be covered by insurance
j. Possible Abandonment Issues: 1) financial reason; 2) lack of motivation, 3) frustration using the device as excessive instructions/guidance are needed due to reception disorder (most probable) & 4) device as stigma identifier resulting use of device avoidance in front of peers or relatives or even device abandonment in the long run.
Recommendations/ Conduct/Extended Evaluation
We will measure performance before and after implementation in an interval of six months or one year.
Referral and consultation (SLP, review IEP with Specal Education teachers at a school visit or over the phone and obtaining IEP via fax; contacting the same way the School Psychologist to review Psychometric tests and likewise contacting the school counselor to discuss Mary’s academic issues and how they interfere with her disability limitations as well as discuss early transition, career exploration and future vocational rehabilitation. Child neuropsychologists can provide neuroipsychological evaluation that may crucially affect decision upon AT selection and neurologists may provide medical evaluation which is very important as Mary’s disability relates rather to the brain and the neurophysiology of listening and auditory processing. Also audiologiscal evaluations should be carefully reviewed in order to rule out any latent hearing interference or risk of future interference with auditory processing and getting updated with Mary’s audiology follow-ups.
Conclusion
In conclusion, it is rather crucial to have a comprehensive assessment in collaboration with the parents, teachers and other specialties. Also very crucial is the careful review of past evaluations, services/referrals, past history and early interventions. Follow up should take place right after implementation. Annual follow along should take place every school year throughout Mary’s school years.
References
Abledata (2012).
Angelo, J. (September/October 2000). Factors affecting the use of a single switch with assistive technology devices. Journal of Rehabilitation Research & Development 37 (5), 591 – 598.
Cook, Albert M., Polgar, Jan M. & Hussey, Susan M. (2008). Assistive technologies: Principles and practice (3rd ed.). St. Louis, MO: Mosby/Elsevier.
Gillam, R.B., T.P. Maarquardt & F. N. Martin (2011). Communication Sciences and Disorders: From Science to Clinical Practice (4rd ed.). Sudbury, MA: Jones and Barlett LLC.
Michigan Department of Education (2006). Michigan Speech-Language Guidelines: Auditory Processing Disorders.
