The Role of Auditory Processing in Reading and Literacy Donna Geffner/ St. John's University The Role of Auditory Processing in Reading and Literacy Donna Geffner, Ph.D. St. John’s University Jamaica, NY geffnerd@stjohns.edu ASHA Convention 2004

Donna Geffner/ St. John's University Links Definitions Neuroanatomy Impact of training Early deprivation (OME) ASHA Convention 2004

Donna Geffner/ St. John's University Dyslexia Definition It is a learning disability characterized by problems in expressive or receptive oral and written language. These problems may emerge in reading, spelling, writing, speaking or listening. ASHA Convention 2004

Donna Geffner/ St. John's University Dyslexia is a language based learning disability. It accounts for approximately 85% of all people with a learning disability. Dyslexia refers to a cluster of symptoms resulting in people having difficulties with specific language skills, particularly reading. Students with dyslexia may experience difficulties in other language skills such as spelling, writing and speaking. The International Dyslexia Association, (2002) ASHA Convention 2004

Donna Geffner/ St. John's University Dyslexia, the most commonly known learning disability, is the term used to describe difficulty with language processing and its impact on reading, writing and spelling” (NCLD, 2002). ASHA Convention 2004

Donna Geffner/ St. John's University Developmental Dyslexia Developmental dyslexics, individuals with an unexplained difficulty in reading, have been shown to have deficits in phonological processing – the awareness of the sound structure of words and more fundamental deficits in rapid auditory processing. ASHA Convention 2004

Phonological Processes Donna Geffner/ St. John's University Phonological Processes “Phonological processing difficulties include problems storing, retrieving and using phonological codes in memory as well as deficits in phonological awareness and speech production. ASHA Convention 2004

Phonological Awareness Donna Geffner/ St. John's University Phonological Awareness Phonological Awareness is the single most important predictor of success with reading (Adams and Bruck, 1995). Children who are aware of the sounds of speech appear to acquire sound-letter correspondence knowledge and use this knowledge to decode printed words. Those who lack an awareness of the sounds contained in words will have difficulty associating sounds with letters (Adams and Bruck, 1995). ASHA Convention 2004

Donna Geffner/ St. John's University The phonological awareness skills of sound deletion, sound categorization, sound blending and syllable segmentation were identified as effective in the selection of children in need of early intervention (Swank and Catts, 1994). ASHA Convention 2004

Auditory and Visual Processing (Multisensory) Children with dyslexia often exhibit weaknesses in auditory and/or visual processing. They may have weak phonemic awareness, meaning they are unaware of the role sounds play in words. They have difficulty rhyming words, blending sounds to make words, or segmenting words into sounds.

Link One: Definition Individuals with dyslexia exhibit a central difficulty in the processing of speech sound. These difficulties are manifested on such tasks as rhyming, syllable counting and sounding out pseudowords.

Research also suggests that phonological processing deficits may result from the auditory deficit in rapid processing. This may impair the individual’s ability to discriminate auditory cues necessary to distinguish phonemes – the smallest meaningful unit of sound in a particular language.

It is not surprising then that children with CAPD are at risk for reading disabilities. Knowledge of letter-sound associations, which include letter –sound recognition, letter sound recall, and the ability to print a given letter sound, has been identified by Duncan and Seymour (2000) as the best indicator, in the early school years, of later literacy.

Controversy: Auditory Deficit or Speech Perception Deficit The issue is whether difficulties in processing both non-speech and speech tasks are the result of a general auditory deficit, or a speech perception deficit.

Is It Spoken Language Skill? According to Isabelle Liberman, dyslexia is in the spoken language skill of phoneme awareness, and that dyslexics often have problems with other aspects of phonological processing such as name retrieval and verbal short-term memory. This indicates that comorbidity between dyslexia and certain speech and language disorders is inevitable, although not every individual with dyslexia reaches the clinical threshold for a diagnosable speech or language disorder.

Is it Temporal Processing? The temporal deficit hypothesis suggests that persons with developmental dyslexia have sensory impairments, which involve the processing of rapidly changing acoustic information such as that encountered in formant transitions. This deficit is thought to affect the development of reading by disrupting the normal acquisition of phonological representations critical for sound-grapheme associations (Reed 1989, Tallal, Miller & Fitch 1993)

Principal Auditory Components of Temporal Processing Temporal integration – duration and intensity of the stimuli The perception of temporal order (TOJ) – rapidly presented linguistic and nonlingustic stimuli Short-term memory - necessary to recall elements in sequence (Jutras & Gagne et al., 2003) Temporal resolution – interval between two consecutive stimuli, may include gap detection, masking level difference, detection of amplitude modulation, detection of temporal asynchronization (Moncrieff, 04)

Rapid Auditory Processing The auditory hypothesis states that there is a deficit in the processing of acoustic signals entering the nervous system in rapid succession.

Children with language impairments have difficulty in discriminating and sequencing rapidly presented auditory information. When the stimuli are short tones, short vowels, or short transition consonants in combination with brief interstimulus intervals, SLI children have trouble discriminating and sequencing them. Because such differences occur in speech and non-speech stimuli, the underlying notion of a deficit in audition was proposed.

Listeners show deficits on tests tapping the discrimination of basic acoustic dimensions, including frequency discrimination, detection of frequency modulated tones, and binaural release from masking. Abnormal mismatch negativity was seen in the dyslexia group in response to changes in tone frequency. Griffiths et al. (2003)

Dichotic Listening/ Interaural Asymmetry Other studies linking auditory skills to reading include the work of Moncrieff and Musiek (2002) in which a Dichotic Digits Task, a measure of temporal integration, was utilized to differentiate dyslexic readers from normals. Results of the Dichotic Digits Test indicated control subjects to be within normal limits for both ears, while the dyslexic group demonstrated more interaural asymmetry, particularly due to the right ear performing better than the left.

Duration and Frequency Frequency Pattern Test (FPT) & Duration Pattern Test (DPT) have been used to measure APD for cortical deficits and learning difficulties. On a measure of durational patterning and frequency patterning, Walker et al., (2002) found that on tasks of temporal processing, individuals with reading disorders generally display deficits in discriminating between rapidly presented acoustic stimuli.

Studies have suggested that adults with reading disorders also demonstrate difficulty with phonemic discrimination tasks, decoding skills and phonological processing.

Temporal Order Discrimination When 2 groups of adult listeners completed two tasks examining the rapid auditory processing of sequential stimuli, adults with dyslexia showed poor levels of literacy and phonological processing when compared to a group of age- and IQ-matched students without dyslexia. Griffiths et al., 2003

Auditory processing deficits may be present in dyslexic children, but temporal processing deficits are not necessary to cause language and reading disorders. Not all children with reading disorders will demonstrate similar deficits on any one auditory processing task.

LINK TWO – Neuroanatomical/ Neuroimaging Some of these controversies are being resolved with the current use of electromagnetic resonance studies. Functional fMRI- neuroimaging- and Positon Emission Tomography (PET) have been used to study dyslexic adults and children to see functional organization of the brain.

From a review of neuro-imaging studies, dyslexics show a disruption in white matter connectivity between posterior and frontal regions. These results give support for a neurobiological etiology of developmental dyslexia. It has been shown that developmental dyslexics have brain disruption responses to phonological and rapid auditory processing demands, as well as white matter abnormalities (Elise Temple, Department of Human Development, Cornell University May, 2002).

In spite of the neurobiological and genetic influences on dyslexia, there is a biological basis for the disorder. Neuroimaging data indicate that brain processes related to sound structure of language are disrupted in dyslexia. Disruptions in both phonological and auditory processing in dyslexia are linked to abnormalities in neural processing.

Neuroimaging studies of phonological processing in adult dyslexics who were performing rhyme detection tasks show a reduction or absence of activity in the left hemisphere temporoparietal cortex. (Temple et al., 2001, Temple et al., 2002, Shaywitz et al., 1998)

Neural Disruptions Neural disruption in phonological processing is observed among a variety of age groups, explicit or implicit tasks, ability levels, analysis techniques, languages. All studies show decreased activity in left hemisphere posterior language regions-temporoparietal cortex in dyslexic subjects, as compared to normal reading subjects.

Shaywitz et al., (1998) using fMRI found decreased activity in temporoparietal regions-superior temporal gyrus and angular gyrus, during phonological processing of both letter and pseudo rhyme.

Neurology An fMRI study by Bernal & Altman (2003) included 17 abnormally delayed speech children and 35 age-matched children without delayed speech. The preliminary results indicated that children with unusually delayed speech tended to have higher levels of right brain lobe activity than children without delayed speech, who tended to use the left side of their brains when they listen.

Neuroimaging of Rapid Auditory Stimuli Event related potentials suggest that neural processing of rapid auditory stimuli is disrupted in dyslexics. During fMRI, rapid and slow temporal changes characteristic of speech nonlinguistic syllables, were presented. Dyslexic adults showed a disruption in the neural response to rapid auditory stimuli. Temple et al., 2001

Normal readers showed activation in the left prefrontal cortex, middle and superior frontal gyri during rapid stimuli. Dyslexic readers showed no left prefrontal response to the rapid stimuli. Temple et al., 2001

Left prefrontal response to rapid stimuli was correlated with rapid auditory processing ability. The better the individual’s rapid auditory processing ability, the greater the response of the left prefrontal cortex to rapid stimuli as opposed to slow stimuli (Temple et al., 2001).

MEG Breier et al., (2003) compared 12 children with dyslexia and 11 children without dyslexia during a simple speech task. Magnetoencephalography (MEG) highlighted precise activity in participants’ left and right temporoparietal (TP) language areas while the children discriminated between spoken pairs of syllables.

Donna Geffner/ St. John's University While distinguishing between sounds, the nonimpaired readers showed more relative activity in the speech part of the left TP area. During the same task, after a slight delay, impaired readers showed a sharp peak of relative activation in corresponding (but functionally indeterminate) areas on the right side. The poorer the child’s performance in phonological processing, the more their right brains “lit up” during that task. ASHA Convention 2004

Pugh et al., (2000) at Yale University Medical School, showed dysfunction at the posterior brain regions centered in and around the angular gyrus in the left hemisphere. Functional connectivity between the angular gyrus and related occipital and temporal lobe sites was seen across a series of print tasks that varied in demands on phonological assembly. Results indicate that for dyslexic readers, a disruption in functional connectivity in the language-dominant left hemisphere is confined to those tasks that make explicit demands on assembly.

Diffusion Tensor Imaging in White Matter Imaging Using a new imaging technique, Diffusion Tensor Imaging (DTI) provides information regarding white matter microstructure. Dyslexic adults showed a disruption in temporoparietal white matter, a region of white matter connecting left hemisphere language areas to more frontal and posterior brain areas.

Summary Developmental Dyslexia has a neurobiological etiology (Temple, et al., 2001). Neuroimaging studies show us that the dyslexic brain has functional disruptions which are visible during phonological and rapid auditory processing. This supports a neural basis for both of these behaviors.

Ectopias Similarly in dyslexics, ectopias reside in the left temporal lobe around the medial-superior temporal gyrus. There are large ectopic areas in the left brain with abnormal symmetry of the planum temporale. Asymmetry and abnormalities on the left side of the brain occur in APD. The International Dyslexia Association (2000)

Brain imaging scans of the children who participated in the training showed that critical areas of the brain used for reading were activated for the first time and began to function more normally. Additional regions of the brain were activated in what researchers believe the dyslexics use as a compensatory strategy as they learn to read more fluently.

Neuroimages of Evidence Based Practices Using fMRI, and scans of brains of 20 dyslexic children 8-12 years of age while they performed a simple rhyming task, enabled researchers to identify active regions of the brain. Changes in blood oxygenation, a process that occurs in parts of the brain where neurons are active, provided information. Temple, et al., 2003

During the rhyming task, children with normal reading showed activity in both the language-critical frontal and temporal regions of the brain. Dyslexics struggled with the task and failed to activate the temporal region, and showed only some activity in the frontal area. Temple, et al., 2003

Following treatment, children with dyslexia showed increased activity in multiple brain areas, along with increases in left temporal-parietal cortex and left inferior frontal gyrus, bringing brain activation in these regions closer to that seen in normal children. These children showed a correlation between magnitude of increased activation in the left temporo-parietal cortex and improvement in oral language ability. Temple, et al., 2003

LINK FOUR – Effects of Auditory Deprivation on Reading Evidence exists that mild to moderate hearing loss can interfere with literacy development, creating delays in reading comprehension and other language academic skills. (Blair, Peterson, and Viehweg, 1985).

Summary Activation of the left temporo-parietal cortex/ superior temporal gyrus is seen during reading tasks, but absent or present in the right cortex in children with dyslexia. Developmental language disorders have been associated with disorders of temporal processing, an auditory processing task.

There are neuro-anatomical linkages that indicate shared properties and ectopias in similar areas of the brain responsible for phonemic decoding and rapid auditory processing. There is also evidence linking training in auditory processing tasks to improved temporal processing, phoneme segmentation, speech perception and reading and language.