Auditory Processing Disorder – What parents need to know!

What is Auditory Processing Disorder (APD)?

There is a significant difference between hearing and listening: Hearing is a sense and listening is a learned skill. Children need good listening skills to develop speech and language and to learn how to read, write and spell. Learning and academic successes depend on a child’s ability to receive, extract and attribute meaning to what he/she hears. Auditory processing disorder (APD) refers to the breakdown of the process in the brain which allows us to recognise and interpret sounds we hear. In short, the brain cannot make sense of what the ears hear. APD can therefore negatively affect a child’s listening behaviour.

What are the symptoms of APD?

APD often becomes more obvious when a child starts school. Teachers are often the first to suspect APD, especially if a child has trouble learning to read. Children with APD may have difficulty recognising subtle differences between sounds in words (for example, b vs d) and with understanding and remembering auditory information, such as verbal instructions. Children with APD may behave as if they cannot hear and they may often ask for repetition. Hearing and listening in noisy places can be especially difficult for children with APD.

Children with APD may present with the following:

• Difficulty paying attention to information presented verbally
• Problems remembering and performing multi-step instructions
• Poor listening skills
• Need extended time to process information
• Poor academic performance
• Behavioural problems
• Language and speech difficulties
• Difficulty with reading, comprehension, spelling, and vocabulary

What causes APD?

APD may be caused by long-term middle ear infections, by limited access to communication and in rare cases head injuries, however, the exact cause of APD is still unknown. Listening is an active process of comprehension which involves a child’s motivation and emotional state, attention and concentration, language ability and cognition. A deficit in any one of these areas can result in listening, reading, spelling difficulties and poor academic progress. Furthermore, there are many disorders which affect a child’s ability to understand auditory information, such as attention deficit disorder, autism and other global deficits. Disorders such as these often affect a child’s ability to attend to and interpret auditory information because they usually affect the same areas of the brain, which can make differential diagnosis challenging. Children with these disorders may or may not also have APD.

How is APD assessed?

It is necessary for an audiologist to test hearing and to use several tests to determine a diagnosis of APD. This involves the use of non-invasive objective tests, listening tests and teacher and parent questionnaires. Children from the age of seven years can be assessed for APD. Children aged between five and six years can be assessed to determine if they are at risk for developing APD.

Because other disorders and deficits may demonstrate similar symptoms, it is critical that a multi-disciplinary team assess a child suspected of having APD. This team may include a speech-language therapist, occupational therapist, educational psychologist, teacher, paediatrician, paediatric neurologist and other related professionals.

How is APD managed?

Implementing intervention and support for APD as early as possible can prevent later language, learning and reading difficulties. A treatment approach is tailored to each individual child’s needs as there is no one treatment approach that is appropriate for all children with APD. Below are some common strategies to help children cope with APD. These may include:

• Auditory training: Direct treatment of APD aims to remediate the disorder itself through activities to train the brain to interpret sound better and improve functional listening skills. This includes home-based computer programs and/or speech-language therapy sessions.
• FM System: This assistive listening device improves the listening environment by minimising background noise and allowing the child to hear what the speaker says clearly. The speaker wears a microphone and the child wears wireless earpieces to hear speech clearly at all times.
• Environmental modifications: Changes are made to improve the listening environment, for example, changing classroom seating placement and classroom acoustics.
• Compensatory strategies: This consists of suggestions for improving language, problem-solving, memory, attention and othercognitive skills to overcome the APD. A variety of active listening and problem-solving techniques can be suggested.

Have a look at this information from the American Speech-Language Hearing Association:
http://www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children/

For the skills that are affected by APD, refer to this article from understood.org:

https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/auditory-processing-disorder/skills-that-can-be-affected-by-auditory-processing-disorder