Interview with Jack Katz, Ph.D.
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Topic: 'A Therapy for Auditory Processing Disorders' - New Book Coming Soon!
CAROLYN SMAKA: Today I have the pleasure of speaking with Dr. Jack Katz. Dr. Katz, welcome back to AudiologyOnline.
Dr. JACK KATZ: Thank you very much Carolyn.
SMAKA: First and foremost, how are you and what are you working on these days?
KATZ: Well, I'm doing very well and I've been extremely busy. I didn't expect that my 75th year would be so busy and so stimulating. The main focus in my professional life right now is my private practice and my patients.
Because I'm working directly with patients instead of supervising students, I see things a bit differently than I did as a professor. Having the responsibility for the welfare of these patients as my only responsibility forces me to dig deeper and to try harder to find answers. Each time a problem is not resolved, I feel it's my responsibility to figure out a more successful approach. Consequently, this has been an extremely productive period of my life.
SMAKA: Tell me about your practice.
KATZ: I see people of all ages with auditory processing disorders. My oldest patient now is in his 80s. At present I don't test children under five years of age, when parents have concerns about their younger children, I try to determine if they may have auditory processing issues based on information provided by the parents and others including basic hearing tests.
Then I sit down with the parents, Speech-Language Pathologists and significant others to offer what I have been able to glean to form a working hypothesis. I share with them what they or the SLPs might be doing to help the children to improve their auditory skills. Hopefully, this will minimize the problem and in fact might obviate the need for further testing or therapy when the children are older.
SMAKA: From the time that you pioneered auditory processing until today, so much has changed. How has the clinical aspect of your practice changed over the years?
KATZ: My own practice has definitely changed as working week after week with the same patients provides lots of new insights. We can delve deeper and deeper into issues and see what works and what does not. But, many of the things that we are doing today in auditory processing have their roots in the work we did many years ago.
For example, 52 years ago in my work as a speech and hearing therapist, I tried out a test and then related therapy for a procedure that I called "Phonemic Synthesis (PS)". I was blown away by what we found. Nearly every child that I was working with who had an articulation problem had poor performance on the PS test. The current PS test is the great, great grandchild of that crude auditory decoding procedure.
I went from conducting evaluations for these children to see what could be done to improve their processing issues. From that point until now;things just evolved. So I've been doing PS and other processing techniques for decades and as we refine the procedures the results get better and better. When I hit a roadblock and see a patient who is not benefiting as much as they should, then I try to figure out what can be done. Sometimes this results in an important addition to the auditory training program.
SMAKA: It is so exciting for our field that you are still providing us with insight in auditory processing after 50 years.
KATZ: You can imagine how exciting it is for me!
SMAKA: Dr. Katz, I heard a rumor that you are working on a book that is going to come out later this year.
KATZ: Ah-ha, yes. They say that there may be some truth to rumors, and in this case that would be correct. I am working on a book entitled "Therapy for Auditory Processing Disorders: Simple, Effective Procedures" - it is simply a labor of love. I am hoping that it will come out by June, in time for Educational Audiology Association's (EAA) summer conference.
It just came to me, out of the blue, that I could write a book with all the clinical techniques and insights that I have developed and used over the years. I thought it might be the best way to share this information with others. While I have published some of it before, this book is definitely the most thorough presentation on how and why to use the techniques. It is packed with what to do and what to do if that does not work. Much of it is in tabular form to help the reader find and understand the information. Each chapter has anecdotes that, I hope, bring the work to life.
Any time you try to teach - and writing a book is teaching - you are the one who ends up learning the most. So this has been a wonderful experience for me. Indeed as I write and explain things, they become clearer in my brain and what I don't know I try to research or figure out.
I am not writing this book independently. There are three people who have helped me with different parts of the book and several people from EAA that are reviewers etc. Their contributions have been significant.
SMAKA: It sounds like a must-have book for auditory processing. Can you give some details as to what it will cover?
KATZ: I would love to. It will have 14 chapters, starting with an introduction to auditory processing. The next chapter focuses on evaluation of auditory processing disorders and categorization of the problem. The third covers principles of therapy which are basic across procedures and are critically important for remediating auditory processing problems. And the following chapters describe the therapy procedures.
The next two chapters discuss decoding problems and introduce two powerful techniques. I think that auditory decoding issues represent the most basic element of auditory processing that we, as audiologists, deal with. Each chapter in this book that describes a therapeutic technique also provides the results that we have obtained with the therapy to date.
The following chapter, #8, deals with memory and sequencing. It is a bit humorous for me to be working on memory and sequencing, because those are my own limitations. I have always been very weak in memory and sequencing. I can surely empathize with the kids.
SMAKA: You? Really?
KATZ: Yes. It's interesting, a week ago I was working with a 15-year-old boy and he was very discouraged because he was having so much difficulty with auditory memory. So when we reached a point of frustration, I tried to think of something to get us back on track. So I said, "You know, memory and sequencing have always been very difficult for me as well so why don't you test my memory?"
SMAKA: [laughs].
KATZ: So I gave him the memory test sheet and he, very nicely, presented the test items to me. In the past I was only able to remember four digits and would you believe it;now I am up to five digits!
By golly, I have avoided memory and sequencing therapy because it is so stressful for me but, it looks like, the work that I have been doing with my patients in the last year has turned out to be therapeutic for me. Since I have to listen to the children and have to write down what they say, it looks like my auditory memory and sequencing have actually improved as well!
SMAKA: He must have enjoyed going home to tell his Mom, "I got to test my audiologist today!"
KATZ: [laughs] Yes, I think he did and he probably pointed out "and he's not much better than me". We often do the "Turnabout" procedure for that reason. In this case, it was in desperation to bring him back to task, because this particular child has such a burden on his shoulders with his auditory processing and other issues that he can get quite frustrated.
With regard to the book, another area that's covered that I want to mention is localization of sound. Localization of sound is closely related to, for example, speech in noise difficulty. And localization of sound, like all other auditory skills, is trainable. So I developed a simple system to evaluate a person's localization skills, and then we turn it around and we make it into a therapy program to improve localization difficulty.
SMAKA: Dr. Katz, do your patients have hearing loss?
KATZ: Most of the people I work with do not have hearing loss and their hearing is roughly the same in each ear, and yet many of them have issues with localization. As you evaluate and plot out their localization abilities, you see that certain areas are way off in one direction, while the other regions may be off in the other direction. But it is definitely a trainable skill.
I started out working with localization with one of my granddaughters. Her localization was quite a bit off but within two sessions (less than 30 minutes), she reduced her errors by 50% which shows how trainable it is.
However, the book does have a chapter on hearing impairment and cochlear implants. Some years ago, an ENT doctor contacted me and said, "Is it true that a person who has a hearing loss can't have auditory processing problems?" I said, "No, that's not true, any time a person can hear he or she can have an auditory processing problem."
And then she said, "Is it true that a person who has a unilateral hearing loss has to have an auditory processing problem?" I said, "No, not necessarily. They have limited information because they only hear from one side, so they have a greater challenge than those who have auditory processing problems." The symptoms may be similar but often more severe.
There are similarities and differences between hearing loss and auditory processing disorders. I suspect that we rarely see people with both hearing loss and auditory processing disorders in the clinic because professionals just assume whatever difficulty the person is having is due to the hearing loss. But the problem could very well result from poor auditory processing plus having a hearing loss (Katz, 2009).
SMAKA: Now, why are cochlear implants your favorite, Dr. Katz?
KATZ: Because the people who are prelingually deaf have never really used their auditory systems for auditory purposes (or just in a minimal way). So we are treading on territory that's brand new, and we are not improving the person's skill, we are pretty much teaching it from the beginning.
The first person with a cochlear implant with whom I worked was prelingually deaf. He had been using the implant for about a half-year and was considered "the star" performer at that large cochlear implant center.
But when I started to do simple auditory processing tasks with him, such as phonemic synthesis, that a four- or five-year-old child could do, he was stymied. He wasn't able to hold two sounds in memory to form a word because this brilliant man didn't have the auditory decoding abilities of even a young child.
So we started to work at a very basic level and within a week or so, he came in with a complaint. He said "I have noticed that my lip reading is not as good anymore." And I said "That is fantastic." That's because I had no doubt in my mind that the auditory areas of his brain were being used by his visual system instead of being used to process what he was hearing. Now that he was using the auditory cortex for its intended purpose, the visual components were being pushed out (as they rightfully should).
Recently I saw a research study on this in one of the journals. The study used brain imaging and found that in those with cochlear implants you see this type of change in brain function.
SMAKA: Brain plasticity and neural reorganization is just fascinating to me.
KATZ: And it is to me as well. So I very much enjoy working with people who have cochlear implants. I treat them as though they have profound auditory processing deficits, but some of the post lingual patients are much less severe.
Auditory training works beautifully for them whether they were post or pre-lingually deaf. Some people with organic disorders, such as strokes or hearing loss, may also present major challenges, but in general the same procedures work for them.
SMAKA: After cochlear implants and hearing impairment, what is covered in the new book?
KATZ: Well there is one chapter on people with mental challenges. Now maybe I misled you when I said that people with cochlear implant patients were my favorite patients, because people with mental challenges are also my favorites.
When you work with people with mental challenges, clinically things may move at a slower pace, especially when you first get started;as compared to your other patients. But, in my experience, if you keep on providing therapy, they keep on making progress.
One of my favorite patients was a man who was 24 years old and had an IQ of 31. I worked with him for four years. When I met him, he had essentially no speech and language and he didn't know what the world was about. Eventually he learned to speak, he learned to read and he could sing a little bit. He also enjoyed joking with me. He became a totally different human being than he was before. The auditory training approach is definitely not limited to kids in school with listening problems.
The following chapter covers group therapy. One of the nice things about auditory processing training is that whoever is listening and is engaged can benefit from the therapy. Very often, children come in for treatment and their parents have similar kinds of problems. So I have the parents pull up their chairs to the therapy table so they can benefit as well.
Because of the economic situation and the fact that auditory processing is such a wide spread problem, it would be very expensive if not impossible to provide one-on-one services for everyone who needs it, it makes sense to provide therapy in groups. If we work in either large groups or whole classes, then we might provide therapy to everyone who needs it.
Auditory training would help so many children that, just like physical education, whole classes could be trained in kindergarten or first grade. I believe the benefits will be seen in speech, reading, spelling and oral comprehension.
SMAKA: Then everyone benefits.
KATZ: Exactly, that's the idea. And finally the last chapter of the book is on monitoring progress and re-evaluation.
SMAKA: You mentioned several interesting patients today. Are their similar kinds of cases mentioned in the book?
KATZ: Over the years working in auditory processing there were so many interesting cases that I've had the opportunity to see. I've tried to share anecdotes in each chapter to support specific points and bring the therapy to life.
SMAKA: And you mentioned the book will somehow benefit EAA?
I once attended an EAA conference and a member stopped me. She said: "I was hoping to see you, because I wanted to give you this [sheet of paper]. It simplifies scoring perseverations on the Staggered Spondaic Word (SSW) test".
I took a look at it, and I said: "I am amazed! This is fantastic! Thank you so much. Please tell me your name, because I'm going to share this with other people and I would like to give you credit." But she refused to give me her name, saying "No, no, I'm not important - it was no big deal, I just wanted you to have it". I replied: "This is a big deal, this is great!"
But I had to name the procedure after EAA, since she refused to give me her name!
[KATZ and SMAKA laugh]
KATZ: They say that one good turn seems to elicit another, and I see that all the time in that wonderful organization. I was so pleased that EAA decided to have their summer conference this year in New Orleans.
New Orleans needs a lot of help;they've been struggling to recover from Katrina. We lived there for three years - I taught at Tulane Medical School - and we were very, very fond of that city. Sadly the recovery has been so slow. I was pleased that by having the EAA summer conference in New Orleans this year, in some small way we are bringing business to that area and helping out a bit.
SMAKA: I'm looking at the conference's amazing line up of speakers including you, keynote speaker Frank Musiek and featured speakers Teri Bellis, Linda Hood, Robert Keith, Gail Richard, and Linda Thibodeau and a long list of other renowned experts. Wow!
KATZ: So let's get registered, reserve your seats, go to a wonderful conference, and support New Orleans!
[SMAKA and KATZ laugh]
SMAKA: We should mention it's July 18 - 21, 2009 and more information can be found at www.edaud.org.
Dr. Katz, I also wanted to mention the three seminars you'll be doing this summer on AudiologyOnline on the SSW on July 31st, August 7th, and August 14th.
KATZ: Yes. The SSW has been my baby for many years. It actually coincided with the birth of my son 48 years ago. Though he's no longer a baby, the term "baby" for the SSW is not too far off the mark.
I have gotten many questions about the SSW test over the years - how to use it, how to score it etc. It is a brief test that evaluates auditory skills in a number of ways. To use it effectively it requires more knowledge than for many audiology tests, but most agree that there is a good payoff for the additional training. Although many people have taken SSW workshops, many others would like to obtain the information. I thought it would be a great opportunity to communicate with audiologists through an AudiologyOnline "virtual SSW conference".
The second seminar studies the SSW from a macro level. Information that was not obvious when scoring items comes out when looking at the performance on the entire test, or for example, comparing performance on the first parts of items vs. the last parts.
The third seminar brings the 20 different diagnostic elements together to determine if an auditory processing disorder is present and what are the problem areas. Because we look at the aggregate of the indicators there is generally strong evidence to support the evaluation. However, we also use an immediate validity check and a delayed check.
The immediate check is to compare the questionnaire and case history form information to be sure our findings are consistent with what the teachers and parents see. The long term validity check is to determine what happens with therapy to address the specific problems that were noted in the evaluation. We expect to see progress in the problem areas and after therapy expect that the presenting symptoms have been improved as well as the initial academic and communicative issues.
SMAKA: We are very excited about this series and already have people waiting to register. You know, as I'm speaking with you today I remember what someone said to me in graduate school many years ago.
KATZ: What's that?
SMAKA: They said, "Why test auditory processing since there's nothing that can be done about it anyway?". It makes me realize how far we've come.
KATZ: I'm glad you mentioned that. In audiology, we started as a rehabilitative field after World War II, and then we switched almost completely to diagnostic work.
With dispensing hearing aids and counseling, things have started to roll in the other direction again. I hope audiology will never go so completely toward diagnostics or rehabilitation. We are a much healthier profession when we can see patients, diagnose the disorder and then remediate the problems.
I think our highest level of achievement is in providing a complete service to our patients. I think it would be very, very healthy for our profession to continue to move further in the direction of therapy.
KATZ: Yes, yes. And I see more and more audiologists doing that. I also think that the younger people, this new generation, is very compassionate. I see it in students that I meet and even in my patients.
Oh, a funny thing happened yesterday. I was working with a 12 year old child and I started to cough (bronchitis).
The child was concerned by that and she said, "Oh Dr. Katz, why don't you drink some water?" I saw that she was trying to help me and of course I followed her advice and drank water. Then every time it looked like I might start a coughing jag, she'd gently say "Oh Dr. Katz, please have some more water."
I thought, what a compassionate child. So I said to her, "You are so kind and caring maybe one day you will want to become a nurse?" But she wrinkled her nose and nodded no.
So I said, "Well, maybe an audiologist?". That thought that sounded a little better to her.
[SMAKA and KATZ laugh]
SMAKA: Dr. Katz, I also wanted to congratulate you on the sixth edition of the Handbook of Clinical Audiology that just came out! What an amazing year - two books, a busy private practice, lecturing, traveling and everything else that you are involved with. Thank you for making time for AudiologyOnline and for our interview today. It has been a pleasure.
KATZ: It has been so much fun Carolyn talking with you, thank you so much for having me.
References
Katz, J., Medwetsky, L., Burkard, R. F., Hood, L. (Eds). (2009). Handbook of Clinical Audiology (6th ed.). PA: Lippincott Williams & Wilkins.
Katz, J. (2009). Central auditory influences in adult audiologic rehabilitation. In J. Montano and J. Spitzer (Eds.). Advanced Practice in Audiologic Rehabilitation. San Diego: Plural Publishing Co.
Dr. JACK KATZ: Thank you very much Carolyn.
SMAKA: First and foremost, how are you and what are you working on these days?
KATZ: Well, I'm doing very well and I've been extremely busy. I didn't expect that my 75th year would be so busy and so stimulating. The main focus in my professional life right now is my private practice and my patients.
Because I'm working directly with patients instead of supervising students, I see things a bit differently than I did as a professor. Having the responsibility for the welfare of these patients as my only responsibility forces me to dig deeper and to try harder to find answers. Each time a problem is not resolved, I feel it's my responsibility to figure out a more successful approach. Consequently, this has been an extremely productive period of my life.
SMAKA: Tell me about your practice.
KATZ: I see people of all ages with auditory processing disorders. My oldest patient now is in his 80s. At present I don't test children under five years of age, when parents have concerns about their younger children, I try to determine if they may have auditory processing issues based on information provided by the parents and others including basic hearing tests.
Then I sit down with the parents, Speech-Language Pathologists and significant others to offer what I have been able to glean to form a working hypothesis. I share with them what they or the SLPs might be doing to help the children to improve their auditory skills. Hopefully, this will minimize the problem and in fact might obviate the need for further testing or therapy when the children are older.
SMAKA: From the time that you pioneered auditory processing until today, so much has changed. How has the clinical aspect of your practice changed over the years?
KATZ: My own practice has definitely changed as working week after week with the same patients provides lots of new insights. We can delve deeper and deeper into issues and see what works and what does not. But, many of the things that we are doing today in auditory processing have their roots in the work we did many years ago.
For example, 52 years ago in my work as a speech and hearing therapist, I tried out a test and then related therapy for a procedure that I called "Phonemic Synthesis (PS)". I was blown away by what we found. Nearly every child that I was working with who had an articulation problem had poor performance on the PS test. The current PS test is the great, great grandchild of that crude auditory decoding procedure.
I went from conducting evaluations for these children to see what could be done to improve their processing issues. From that point until now;things just evolved. So I've been doing PS and other processing techniques for decades and as we refine the procedures the results get better and better. When I hit a roadblock and see a patient who is not benefiting as much as they should, then I try to figure out what can be done. Sometimes this results in an important addition to the auditory training program.
SMAKA: It is so exciting for our field that you are still providing us with insight in auditory processing after 50 years.
KATZ: You can imagine how exciting it is for me!
SMAKA: Dr. Katz, I heard a rumor that you are working on a book that is going to come out later this year.
KATZ: Ah-ha, yes. They say that there may be some truth to rumors, and in this case that would be correct. I am working on a book entitled "Therapy for Auditory Processing Disorders: Simple, Effective Procedures" - it is simply a labor of love. I am hoping that it will come out by June, in time for Educational Audiology Association's (EAA) summer conference.
"I am working on a book entitled "A Therapy for Auditory Processing Disorders: Simple, Effective Procedures" - it is simply a labor of love."Two years ago at EAA's summer conference, Linda Cox said that she would like members to think about what they could contribute to the profession that could be distributed by EAA to help raise needed funds for the organization.
It just came to me, out of the blue, that I could write a book with all the clinical techniques and insights that I have developed and used over the years. I thought it might be the best way to share this information with others. While I have published some of it before, this book is definitely the most thorough presentation on how and why to use the techniques. It is packed with what to do and what to do if that does not work. Much of it is in tabular form to help the reader find and understand the information. Each chapter has anecdotes that, I hope, bring the work to life.
Any time you try to teach - and writing a book is teaching - you are the one who ends up learning the most. So this has been a wonderful experience for me. Indeed as I write and explain things, they become clearer in my brain and what I don't know I try to research or figure out.
I am not writing this book independently. There are three people who have helped me with different parts of the book and several people from EAA that are reviewers etc. Their contributions have been significant.
SMAKA: It sounds like a must-have book for auditory processing. Can you give some details as to what it will cover?
KATZ: I would love to. It will have 14 chapters, starting with an introduction to auditory processing. The next chapter focuses on evaluation of auditory processing disorders and categorization of the problem. The third covers principles of therapy which are basic across procedures and are critically important for remediating auditory processing problems. And the following chapters describe the therapy procedures.
The next two chapters discuss decoding problems and introduce two powerful techniques. I think that auditory decoding issues represent the most basic element of auditory processing that we, as audiologists, deal with. Each chapter in this book that describes a therapeutic technique also provides the results that we have obtained with the therapy to date.
"I think that auditory decoding issues represent the most basic element of auditory processing that we, as audiologists, deal with."The next therapy chapter has to do with speech in noise. Speech in noise, of course, may be an issue for anybody with an auditory problem, whether it is a hearing loss or central auditory processing disorder. This therapy is most effective with recorded speech. The WINT CD program is the speech in noise technique that I use in my practice.
The following chapter, #8, deals with memory and sequencing. It is a bit humorous for me to be working on memory and sequencing, because those are my own limitations. I have always been very weak in memory and sequencing. I can surely empathize with the kids.
SMAKA: You? Really?
KATZ: Yes. It's interesting, a week ago I was working with a 15-year-old boy and he was very discouraged because he was having so much difficulty with auditory memory. So when we reached a point of frustration, I tried to think of something to get us back on track. So I said, "You know, memory and sequencing have always been very difficult for me as well so why don't you test my memory?"
SMAKA: [laughs].
KATZ: So I gave him the memory test sheet and he, very nicely, presented the test items to me. In the past I was only able to remember four digits and would you believe it;now I am up to five digits!
By golly, I have avoided memory and sequencing therapy because it is so stressful for me but, it looks like, the work that I have been doing with my patients in the last year has turned out to be therapeutic for me. Since I have to listen to the children and have to write down what they say, it looks like my auditory memory and sequencing have actually improved as well!
SMAKA: He must have enjoyed going home to tell his Mom, "I got to test my audiologist today!"
KATZ: [laughs] Yes, I think he did and he probably pointed out "and he's not much better than me". We often do the "Turnabout" procedure for that reason. In this case, it was in desperation to bring him back to task, because this particular child has such a burden on his shoulders with his auditory processing and other issues that he can get quite frustrated.
With regard to the book, another area that's covered that I want to mention is localization of sound. Localization of sound is closely related to, for example, speech in noise difficulty. And localization of sound, like all other auditory skills, is trainable. So I developed a simple system to evaluate a person's localization skills, and then we turn it around and we make it into a therapy program to improve localization difficulty.
SMAKA: Dr. Katz, do your patients have hearing loss?
KATZ: Most of the people I work with do not have hearing loss and their hearing is roughly the same in each ear, and yet many of them have issues with localization. As you evaluate and plot out their localization abilities, you see that certain areas are way off in one direction, while the other regions may be off in the other direction. But it is definitely a trainable skill.
I started out working with localization with one of my granddaughters. Her localization was quite a bit off but within two sessions (less than 30 minutes), she reduced her errors by 50% which shows how trainable it is.
However, the book does have a chapter on hearing impairment and cochlear implants. Some years ago, an ENT doctor contacted me and said, "Is it true that a person who has a hearing loss can't have auditory processing problems?" I said, "No, that's not true, any time a person can hear he or she can have an auditory processing problem."
And then she said, "Is it true that a person who has a unilateral hearing loss has to have an auditory processing problem?" I said, "No, not necessarily. They have limited information because they only hear from one side, so they have a greater challenge than those who have auditory processing problems." The symptoms may be similar but often more severe.
There are similarities and differences between hearing loss and auditory processing disorders. I suspect that we rarely see people with both hearing loss and auditory processing disorders in the clinic because professionals just assume whatever difficulty the person is having is due to the hearing loss. But the problem could very well result from poor auditory processing plus having a hearing loss (Katz, 2009).
"I suspect that we rarely see people with both hearing loss and auditory processing disorders in the clinic because professionals just assume whatever difficulty the person is having is due to the hearing loss. But the problem could very well result from poor auditory processing plus having a hearing loss."So I think that's an important population to mention. And then cochlear implants are my favorite. I love working with these patients, most of my work in this area has been with adults.
SMAKA: Now, why are cochlear implants your favorite, Dr. Katz?
KATZ: Because the people who are prelingually deaf have never really used their auditory systems for auditory purposes (or just in a minimal way). So we are treading on territory that's brand new, and we are not improving the person's skill, we are pretty much teaching it from the beginning.
The first person with a cochlear implant with whom I worked was prelingually deaf. He had been using the implant for about a half-year and was considered "the star" performer at that large cochlear implant center.
But when I started to do simple auditory processing tasks with him, such as phonemic synthesis, that a four- or five-year-old child could do, he was stymied. He wasn't able to hold two sounds in memory to form a word because this brilliant man didn't have the auditory decoding abilities of even a young child.
So we started to work at a very basic level and within a week or so, he came in with a complaint. He said "I have noticed that my lip reading is not as good anymore." And I said "That is fantastic." That's because I had no doubt in my mind that the auditory areas of his brain were being used by his visual system instead of being used to process what he was hearing. Now that he was using the auditory cortex for its intended purpose, the visual components were being pushed out (as they rightfully should).
Recently I saw a research study on this in one of the journals. The study used brain imaging and found that in those with cochlear implants you see this type of change in brain function.
SMAKA: Brain plasticity and neural reorganization is just fascinating to me.
KATZ: And it is to me as well. So I very much enjoy working with people who have cochlear implants. I treat them as though they have profound auditory processing deficits, but some of the post lingual patients are much less severe.
Auditory training works beautifully for them whether they were post or pre-lingually deaf. Some people with organic disorders, such as strokes or hearing loss, may also present major challenges, but in general the same procedures work for them.
SMAKA: After cochlear implants and hearing impairment, what is covered in the new book?
KATZ: Well there is one chapter on people with mental challenges. Now maybe I misled you when I said that people with cochlear implant patients were my favorite patients, because people with mental challenges are also my favorites.
When you work with people with mental challenges, clinically things may move at a slower pace, especially when you first get started;as compared to your other patients. But, in my experience, if you keep on providing therapy, they keep on making progress.
One of my favorite patients was a man who was 24 years old and had an IQ of 31. I worked with him for four years. When I met him, he had essentially no speech and language and he didn't know what the world was about. Eventually he learned to speak, he learned to read and he could sing a little bit. He also enjoyed joking with me. He became a totally different human being than he was before. The auditory training approach is definitely not limited to kids in school with listening problems.
"The auditory training approach is definitely not limited to kids in school with listening problems."Then there is a chapter on other populations including neurological disorders, ADHD, autism and foreign dialect.
The following chapter covers group therapy. One of the nice things about auditory processing training is that whoever is listening and is engaged can benefit from the therapy. Very often, children come in for treatment and their parents have similar kinds of problems. So I have the parents pull up their chairs to the therapy table so they can benefit as well.
Because of the economic situation and the fact that auditory processing is such a wide spread problem, it would be very expensive if not impossible to provide one-on-one services for everyone who needs it, it makes sense to provide therapy in groups. If we work in either large groups or whole classes, then we might provide therapy to everyone who needs it.
Auditory training would help so many children that, just like physical education, whole classes could be trained in kindergarten or first grade. I believe the benefits will be seen in speech, reading, spelling and oral comprehension.
SMAKA: Then everyone benefits.
KATZ: Exactly, that's the idea. And finally the last chapter of the book is on monitoring progress and re-evaluation.
SMAKA: You mentioned several interesting patients today. Are their similar kinds of cases mentioned in the book?
KATZ: Over the years working in auditory processing there were so many interesting cases that I've had the opportunity to see. I've tried to share anecdotes in each chapter to support specific points and bring the therapy to life.
SMAKA: And you mentioned the book will somehow benefit EAA?
"All of the proceeds from this book will go to the Educational Audiology Association".KATZ: Yes. All of the proceeds from this book will go to EAA. I am so amazed by this organization - both the members, and the officers. They are a remarkably caring and giving group of people. I'm just incredulous by their commitment to their students and by the commitment they show to EAA. They are not doing it for money, or thanks - they do what they do simply because they want to help others.
I once attended an EAA conference and a member stopped me. She said: "I was hoping to see you, because I wanted to give you this [sheet of paper]. It simplifies scoring perseverations on the Staggered Spondaic Word (SSW) test".
I took a look at it, and I said: "I am amazed! This is fantastic! Thank you so much. Please tell me your name, because I'm going to share this with other people and I would like to give you credit." But she refused to give me her name, saying "No, no, I'm not important - it was no big deal, I just wanted you to have it". I replied: "This is a big deal, this is great!"
But I had to name the procedure after EAA, since she refused to give me her name!
[KATZ and SMAKA laugh]
KATZ: They say that one good turn seems to elicit another, and I see that all the time in that wonderful organization. I was so pleased that EAA decided to have their summer conference this year in New Orleans.
New Orleans needs a lot of help;they've been struggling to recover from Katrina. We lived there for three years - I taught at Tulane Medical School - and we were very, very fond of that city. Sadly the recovery has been so slow. I was pleased that by having the EAA summer conference in New Orleans this year, in some small way we are bringing business to that area and helping out a bit.
SMAKA: I'm looking at the conference's amazing line up of speakers including you, keynote speaker Frank Musiek and featured speakers Teri Bellis, Linda Hood, Robert Keith, Gail Richard, and Linda Thibodeau and a long list of other renowned experts. Wow!
KATZ: So let's get registered, reserve your seats, go to a wonderful conference, and support New Orleans!
[SMAKA and KATZ laugh]
SMAKA: We should mention it's July 18 - 21, 2009 and more information can be found at www.edaud.org.
Dr. Katz, I also wanted to mention the three seminars you'll be doing this summer on AudiologyOnline on the SSW on July 31st, August 7th, and August 14th.
KATZ: Yes. The SSW has been my baby for many years. It actually coincided with the birth of my son 48 years ago. Though he's no longer a baby, the term "baby" for the SSW is not too far off the mark.
I have gotten many questions about the SSW test over the years - how to use it, how to score it etc. It is a brief test that evaluates auditory skills in a number of ways. To use it effectively it requires more knowledge than for many audiology tests, but most agree that there is a good payoff for the additional training. Although many people have taken SSW workshops, many others would like to obtain the information. I thought it would be a great opportunity to communicate with audiologists through an AudiologyOnline "virtual SSW conference".
I thought it would be a great opportunity to communicate with audiologists through an AudiologyOnline "virtual SSW conference".The first seminar will look at the construction of the SSW and focus on accurately scoring the individual items. This covers specific scoring procedures and sensitizes the audiologist to important behaviors that provide free and invaluable insights into auditory processing disorders.
The second seminar studies the SSW from a macro level. Information that was not obvious when scoring items comes out when looking at the performance on the entire test, or for example, comparing performance on the first parts of items vs. the last parts.
The third seminar brings the 20 different diagnostic elements together to determine if an auditory processing disorder is present and what are the problem areas. Because we look at the aggregate of the indicators there is generally strong evidence to support the evaluation. However, we also use an immediate validity check and a delayed check.
The immediate check is to compare the questionnaire and case history form information to be sure our findings are consistent with what the teachers and parents see. The long term validity check is to determine what happens with therapy to address the specific problems that were noted in the evaluation. We expect to see progress in the problem areas and after therapy expect that the presenting symptoms have been improved as well as the initial academic and communicative issues.
SMAKA: We are very excited about this series and already have people waiting to register. You know, as I'm speaking with you today I remember what someone said to me in graduate school many years ago.
KATZ: What's that?
SMAKA: They said, "Why test auditory processing since there's nothing that can be done about it anyway?". It makes me realize how far we've come.
KATZ: I'm glad you mentioned that. In audiology, we started as a rehabilitative field after World War II, and then we switched almost completely to diagnostic work.
With dispensing hearing aids and counseling, things have started to roll in the other direction again. I hope audiology will never go so completely toward diagnostics or rehabilitation. We are a much healthier profession when we can see patients, diagnose the disorder and then remediate the problems.
I think our highest level of achievement is in providing a complete service to our patients. I think it would be very, very healthy for our profession to continue to move further in the direction of therapy.
"I think our highest level of achievement is in providing a complete service to our patients. I think it would be very, very healthy for our profession to continue to move further in the direction of therapy."SMAKA: I spoke with Pat Kricos a few months ago, and she said exactly the same thing in talking about audiologic rehabilitation (www.audiologyonline.com/interview/). She said rehab is really our roots, and things are sort of coming full circle now in audiology as we are turning more to rehab again.
KATZ: Yes, yes. And I see more and more audiologists doing that. I also think that the younger people, this new generation, is very compassionate. I see it in students that I meet and even in my patients.
Oh, a funny thing happened yesterday. I was working with a 12 year old child and I started to cough (bronchitis).
The child was concerned by that and she said, "Oh Dr. Katz, why don't you drink some water?" I saw that she was trying to help me and of course I followed her advice and drank water. Then every time it looked like I might start a coughing jag, she'd gently say "Oh Dr. Katz, please have some more water."
I thought, what a compassionate child. So I said to her, "You are so kind and caring maybe one day you will want to become a nurse?" But she wrinkled her nose and nodded no.
So I said, "Well, maybe an audiologist?". That thought that sounded a little better to her.
[SMAKA and KATZ laugh]
SMAKA: Dr. Katz, I also wanted to congratulate you on the sixth edition of the Handbook of Clinical Audiology that just came out! What an amazing year - two books, a busy private practice, lecturing, traveling and everything else that you are involved with. Thank you for making time for AudiologyOnline and for our interview today. It has been a pleasure.
KATZ: It has been so much fun Carolyn talking with you, thank you so much for having me.
References
Katz, J., Medwetsky, L., Burkard, R. F., Hood, L. (Eds). (2009). Handbook of Clinical Audiology (6th ed.). PA: Lippincott Williams & Wilkins.
Katz, J. (2009). Central auditory influences in adult audiologic rehabilitation. In J. Montano and J. Spitzer (Eds.). Advanced Practice in Audiologic Rehabilitation. San Diego: Plural Publishing Co.
Jack Katz, PhD, CCC-A/SLP
Jack Katz has been involved in the study of central auditory disorders for over five decades. He has developed effective tests and therapy procedures to evaluate and remediate this prevalent problem. He has editied several books on this topic and has written many articles and chapters and has presented on this topic nationally and internationally. He has just completed a book focusing on therapy for APD that will be distributed by Educational Audiology Association. Dr. Katz has spent 50 years developing the SSW test as a measure of central auditory function.