The Audio-Psycho-Phonological Assessment

Methodological document of the Centre du Langage of Dr Alfred Tomatis. Practical manual of the Audio-Psycho-Phonological Assessment intended for APP practitioners.

Introduction

Every educational undertaking carried out in the services of a Centre du Langage is preceded by an Audio-Psycho-Phonological Assessment. This assessment calls upon investigations concerning, on the one hand, the listening of the subject; on the other, his psychological universe; and finally his linguistic and phonetic — that is, vocal — postures. These intimately linked elements compose an overall picture characteristic of the relational tensions of the being with his environment.

It allows the practitioner who concludes the assessment, in function of the results obtained, to present to the subject concerned the range of therapeutic or educational solutions that the centre is in a position to propose.

This complete journey — which lasts about two hours — is conducted in three principal stages:

The opening of the file (case history).
The administration of the tests.
The final consultation.

I — The opening of the file (case history)

This introductory phase makes it possible to establish a first contact with the subject, who — according to his age, his difficulties — comes alone or accompanied by certain members of his family. In the course of this first interview, the practitioner gathers in writing the information concerning the subject’s life experience and organises — according to a sequence of headings relating to his childhood, his schooling, his behaviour, and so on — a picture liable to bring out the development of the individual, his evolution on the plane of communication, his relational universe.

Main headings (case of a child)

The chronological order of human development structures the case history. Here are the main headings:

Civil registration — surname, first name, age, date of birth, address, telephone of the parents.
Recommendations — how were those consulting directed to the Centre (family, acquaintance, radio/TV, press, lecture…).
Accompanying persons — specify who is present (parents, mother alone, father alone, siblings, other person in charge).
Date of the APP assessment.
Reason for the consultation — nature of the difficulties and their current manifestation (dyslexia, dyslaterality, deafness, behavioural disorders, language delay, stammering, absence of language…).
Family situation — profession of the father and mother, ages, any deaths, divorce, remarriage.
Siblings — rank of the child, first name, age, activity and family situation of each brother and sister.
Intra-uterine life — course of the pregnancy, material and psychological conditions, behaviour of the mother, any disorders, shocks or disturbances.
Birth — course of the delivery, term, difficulties (forceps, caesarean), cyanosis, first cry, Rh problem, desired sex.
Early infancy — affective life, breast or bottle feeding, duration, weaning. Sleep. Presence of the mother, mode of care. Crying, smiles, first word.
Psychomotor development — head control, sitting position, standing, walking, toilet training.
Evolution of language — first babblings, first word, first sentences, any delays.
Laterality — left-handed, right-handed, ambidextrous, lateral thwartings (writing, etc.).
Medical history — childhood illnesses, otitis, operations, hospitalisations, traumas.
Schooling — entry into kindergarten, primary school, feelings, levels reached, year repetitions, difficulties encountered by subject.
Character and behaviour — sociability, autonomy, fears, aggressiveness, interests, sport, reading, television.
Sleep and appetite.
Previous treatments — speech therapy, psychotherapy, psychomotricity, physiotherapy, etc.

During the interview, it is not always desirable to ask certain questions directly, particularly when these risk troubling or blocking the child. It is then preferable to leave certain parts in suspense and to consider completing the file in the child’s absence — for example while he is taking the tests. Whatever the nature of the questions, these must of course always be approached with great tact and discretion.

Case of an adult

An adult who comes to consult alone does not react in the same way to this type of investigation. He often even manifests signs of reticence in speaking of a life experience which, on the one hand, appears to him distant and forgotten, and which on the other hand seems to him to have no immediate connection with the problem for which he is consulting. The headings of the adult case history are similar, but their order and their relative weight differ — the emphasis being placed on adult life, current professional and relational contexts, with the infantile history being approached with delicacy.

II — The administration of the tests

Following the first interview, the subject is brought to take the following tests.

a) The listening test

This is a capital investigation, composed of several enquiries which make of this test the most important of the assessment: the one which must determine the listening possibilities of the subject — self-listening and listening to the other.

The listening test consists in:

investigating the thresholds of minimal intensity perceived for each frequency, by air conduction and by bone conduction;
establishing the capacity or incapacity to situate the different pitches of sounds (selectivity);
noting the possibilities for the ear to locate sound in space.

This test, which would at first sight be easy to confuse with an audiogram, in fact pertains in its interpretation to a wholly different domain. The audiologist is concerned to know whether the subject hears; the audio-psycho-phonologist is concerned to know whether he listens*, and in what manner.*

b) The laterality test

It consists in investigating the laterality of the subject — that is, his tendencies to position himself relative to right and left, both on the motor plane and on the sensory plane. This trial allows the gathering of elements relating to the structural organisation of the subject and the determination of his temporo-spatial universe.

Particular attention is paid to audio-laterality measurement, which allows the assessment of the listening desire of the subject by determining his auditory laterality — which does not reduce to a simple observation, but pertains to a dynamic, a posture before the life of relation.

c) The other tests

Other trials may be inserted in the assessment, such as the tree test and that of the family, which allow the gathering of precious indices of a psychological order. Also proposed in certain cases are tests and measurements bearing on:

the voice: phonograms, sonagrams;
the cortical responses: electroencephalography (EEG);
the level of intelligence: IQ;
and so on.

III — The final consultation

Coming in extension of this series of investigations, a consultation arranged at the terminal phase allows the practitioner — after the study of the complete file (interpretation of the case history and of the various tests) — to engage in a dialogue with the patient and to observe the functional posture he adopts in his life of relation.

Equipped with the results of the various investigations and qualified to synthesise them, the practitioner is in a position to furnish the person with:

explanations as to the difficulties that handicap him;
the exposition of the solutions that the centre is in a position to propose;
in the event of an education under the Electronic Ear: all the conditions in which this undertaking must be carried out (frequency of sessions, total duration foreseen, commitment of the subject and the family, programming envisaged).

The sense of the assessment

The APP assessment is not an examination in the traditional medical sense — it is a cartography of listening. It endeavours to grasp how the subject is inserted in the sonic world that surrounds him: how he listens to himself, how he welcomes the voice of the other, how he orients himself in time and in acoustic space. It translates into objective data a broader relational posture.

On the quality of the assessment depends the whole subsequent course of care: it is the compass which will guide the sonic programming, the rhythm of the sessions, the adjustment of the Electronic Ear, the eventual placing in parallel cure of the mother, the parental and pedagogical accompaniment. It is therefore not exaggerated to say that the assessment inaugurates the therapeutic work as much as it organises it.

— Methodological document of the Centre du Langage of Dr Alfred A. Tomatis (practical manual of the audio-psycho-phonological assessment). Structured synthesis from the internal document intended for APP practitioners.