We are so often asked to assess children who are struggling at school. Whatever else may be the problem, the majority will have difficulty in this area and will not progress unless this is taken into account. This is an easy assessment to do.

A response from a Paediatrician.

The APAK is a screening instrument to assist in the assessment of children with disruptive behavior, literacy underachieve-ment, speech and language difficulties, mild intellectual difficulty or attention deficit hyperactivity disorder.

APAK

This kit is useful for understanding the rate of progress of this area of development in children. Norms are provided for children from 5-15 years of age and utilization of simple communication strategies has been shown to significantly improve disruptive behavior and improve literacy outcomes for those with difficulties.

Children with delay in this aspect of development struggle to learn unless those communicating with them take their level of functioning into account. They are easily overloaded with information and do not recall what has been said. When overloaded, they may:

  • guess what they think has been said,
  • recall only part of the information,
  • not recall any of it.

The assessment comprises two parts:

  1. Sentence length recall
  2. Digit span

The sentence length recall is affected by both familiarity with language, as well as the child’s rate of development. This has clear implications for length of instructions. The sentences in the test are simple in grammatical structure and syntax, so if children cannot recall 8-word sentences then if they were faced with less familiar or more complex language their effective sentence length recall would be less.

The digit span gives an indication of recall of unrelated pieces of information such as number of instructions, items on a list, sounds in a word, or different ideas in an answer.

The assessment within the APAK is a screening test identifying those at risk and provides an assessment of how they are functioning. For example, children who are unfamiliar with the language may perform poorly on sentence length but perform at an age-appropriate level on the digit span. If parents and teachers take this into account when communicating with them, the children can progress rapidly in their learning of the new language and ‘catch up’ with the sentence length score over a year or two. If they are delayed in both digit span and sentence length the learning of a new language is more difficult and the strategies need to be in place longer.

Children come for assessment for concerns about inattentiveness, ‘not listening’, disruptive behavior, poor language development, poor progress in literacy development, school refusal etc.  As part of the general assessment, it is very commonly found that these children are delayed in development in this area and this has a major impact on many aspects of learning, including language and literacy development. This test does not provide a diagnosis of central auditory processing (CAP) but those with such difficulty inevitably do not do well on these assessments. CAP requires specialized audiological assessment.

The assessment is simple. The implications for management are obvious, and for many common conditions such as Attention Deficit Hyperactivity Disorder, Speech and Language delay, Mild Intellectual Disability, isolated difficulty with processing auditory information in children with normal intelligence or in children with a functional delay due to lack of familiarity with the language, the management strategies are necessary, but may not be sufficient, in the overall management.

APAK for Pediatricians

Pediatricians are commonly required to clarify the reasons why a child may be disruptive and unhappy at school. If the child does have difficulty with processing auditory information, the strategies for communication may be sufficient to resolve the disruptive behavior as the child may not have understood what was required. The strategies will be necessary and may also be sufficient to allow the child to progress with their learning.

If these strategies are not sufficient, and if the child is very inattentive and fulfills the criteria for ADHD then medication combined with appropriate communication will be necessary. Most children with speech and language difficulties will also have difficulties with auditory processing capacity as will children with mild intellectual difficulty. The majority of children with this difficulty have normal intelligence and they are very frustrated that they can do many things well, but they struggle to follow and understand long instructions.

It is a very quick, simple and therefore useful screening test. If a child does not have any difficulty with processing auditory information, but has behavioral difficulties, assessing relationships and environment can be more productive. If there is a difficulty, additional assessments by a psychologist or speech pathologist may be required.

APAK for Speech Pathologists

As the majority of children with speech and language difficulties also have difficulty processing auditory information, this kit provides accurate norms for a standardized recorded assessment. If a child does have difficulty it is important for those administering tests to ensure that instructions are not delivered too quickly and without pauses, but instead slowing, pausing and giving time to process the information. If this is not done the tester will not know whether the student does not know the answer, or did not recall what the question was in order to be able to respond. Significant variations in the results of the same assessments can occur, depending on how the same questions and instructions are delivered.