Screening Tests Reveal High Risk Among Adjudicated Adolescents of Auditory Processing and Language Disorders

Reimagining From Abroad: Speech-Language Pathologists as Interprofessional Partners Supporting Justice-Involved Youth in America

PURPOSE

With application to the United States, this tutorial explores barriers in the American juvenile justice system for justice-involved youth (JIY) with cognitive-communication disorders (CCDs). It outlines models from abroad and reimagines the American juvenile justice system to include speech-language pathologists (SLPs) as interprofessional practice partners.

METHOD

Interprofessional (i.e., criminal justice, speech-language pathology) literature from the United States and overseas is reviewed and summarized to explain the American juvenile justice system, outline areas of concern for youth with CCDs, and describe potential solutions.

RESULTS

The application of speech-language pathology services within the juvenile justice system is explained and visually depicted. This framework was informed by intervention models and approaches from international examples.

CONCLUSIONS

There is an opportunity to embed speech-language pathology services from intake into court action and through disposition for JIY with cognitive-communication impairments. This includes interprofessional education and development, SLPs providing direct intervention, and multidisciplinary screening efforts. Speech-language pathologists as interprofessional advocates and practice partners can improve life chances and outcomes for youth with CCDs in the juvenile justice system.

Affording autism an early brain development re-definition

The national priority to advance early detection and intervention for children with autism spectrum disorder (ASD) has not reduced the late age of ASD diagnosis in the US over several consecutive Centers for Disease Control and Prevention (CDC) surveillance cohorts, with traditionally under-served populations accessing diagnosis later still. In this review, we explore a potential perceptual barrier to this enterprise which views ASD in terms that are contradicted by current science, and which may have its origins in the current definition of the condition and in its historical associations. To address this perceptual barrier, we propose a re-definition of ASD in early brain development terms, with a view to revisit the world of opportunities afforded by current science to optimize children's outcomes despite the risks that they are born with. This view is presented here to counter outdated notions that potentially devastating disability is determined the moment a child is born, and that these burdens are inevitable, with opportunities for improvement being constrained to only alleviation of symptoms or limited improvements in adaptive skills. The impetus for this piece is the concern that such views of complex neurodevelopmental conditions, such as ASD, can become self-fulfilling science and policy, in ways that are diametrically opposed to what we currently know, and are learning every day, of how genetic risk becomes, or not, instantiated as lifetime disabilities.

An optimal dichotic-listening paradigm for the assessment of hemispheric dominance for speech processing

Dichotic-listening paradigms are widely accepted as non-invasive tests of hemispheric dominance for language processing and represent a standard diagnostic tool for the assessment of developmental auditory and language disorders. Despite its popularity in research and clinical settings, dichotic paradigms show comparatively low reliability, significantly threatening the validity of conclusions drawn from the results. Thus, the aim of the present work was to design and evaluate a novel, highly reliable dichotic-listening paradigm for the assessment of hemispheric differences. Based on an extensive literature review, the paradigm was optimized to account for the main experimental variables which are known to systematically bias task performance or affect random error variance. The main design principle was to minimize the relevance of higher cognitive functions on task performance in order to obtain stimulus-driven laterality estimates. To this end, the key design features of the paradigm were the use of stop-consonant vowel (CV) syllables as stimulus material, a single stimulus pair per trial presentation mode, and a free recall (single) response instruction. Evaluating a verbal and manual response-format version of the paradigm in a sample of N = 50 healthy participants, we yielded test-retest intra-class correlations of rICC = .91 and .93 for the two response format versions. These excellent reliability estimates suggest that the optimal paradigm may offer an effective and efficient alternative to currently used paradigms both in research and diagnostic.

Auditory processing disorders in incarcerated youth: A call for early detection and treatment

BACKGROUND

Numerous reports have linked language impairment, academic underachievement, and attention disorder to misbehavior in adolescence. Recent studies have found an association between deficits in hearing and auditory processing and involvement in the juvenile justice system. In fact, the existence of an auditory processing disorder (APD) is a risk factor for adolescent delinquency even in the presence of normal hearing. The nexus between APD, low academic achievement and offending behavior in teens has prompted recommendation for early screening of school children for abnormalities in auditory processing. Using a variety of diagnostic tools, investigators have found an increase in the frequency of APD in cohorts of confined youthful offenders. The present investigation evaluates the prevalence of APD in a group of incarcerated youth residing in a detention center.

METHODS

A total of 52 incarcerated adolescents (8 females and 44 males; age range 13-20 (M = 16.0), residing at a juvenile detention center in Pittsburgh, Pennsylvania and determined to have normal auditory acuity were included in the study. All participants were screened for APD using two dichotic listening tests, the Randomized Dichotic Digits Test (RDDT) and the Dichotic Words Test (DWT), evaluative modalities to identify deficits in auditory processing. The prevalence of APD in the study group was compared to previously published normative data for non-offending age-matched youth.

RESULTS

On the RDDT, 23.1% of participants demonstrated normal auditory processing, while 77% had abnormal test results. On the DWT, 75% of subjects exhibited normal auditory processing, while the scores were abnormal for 24.9%. When the results of the RDDT and the DWT were combined to establish a pattern for the purpose of interpreting a deficit, 21.1% of the participants produced results that were within normal limits, while 17.3% qualified for a diagnosis of APD, with abnormal results on both tests. Previous studies have estimated the prevalence of auditory processing disorder in the general adolescent population as being between 2% and 7%.

CONCLUSIONS

This study found a higher prevalence of auditory processing disorder in a cohort of incarcerated youth compared with age-matched controls. Diagnostic screening protocols that identify at-risk children have been developed, as have effective therapies to improve auditory processing function. Teachers, pediatricians and psychologists should consider APD in children and adolescents with behaviors that may increase their risk for juvenile justice involvement. Studies on optimal timing and strategies for assessing and treating APD in children and adolescents are needed, including youth caught up in the juvenile justice system.