Auditory Processing Disorder

Children and adults with auditory processing disorder (APD) have problems comprehending speech. The concept of APD is often difficult for parents, educators and other professionals to understand. A child with an auditory processing disorder has normal hearing and intelligence, but impaired ability to attend to, recognise, analyse and interpret information that they hear. This is probably because of the way the child's central nervous system is "wired". No one really knows why this deficit in sensory processing in the brain occurs. Previously, APD was often called Central Auditory Processing Disorder (CAP-D).

Children with APD will often appear to misunderstand instructions, ask for questions to be repeated, and respond slowly when asked. They may appear easily distracted or "dreamy". Often they will have difficulty picking up on the phonics basis of reading. Not all APD children have the same problems. Some have problems sequencing speech sounds; others have problems understanding speech in background noise, and in some the timing appears off.

APD becomes more apparent in poorer listening environments such as open classrooms and where there is background noise. Children may not show the problem until they begin school. Classrooms are often busy and noisy, and teachers give a great deal of information in words, requiring the child to listen actively with much background noise. Children with APD find it had to "sift" what they are hearing to pick out the important bit of noise. This inefficiency in processing means that they are working harder to process and interpret what they hear.

Teachers can assist children with APD to grasp auditory information:

• Reduce background noise. Open classrooms are a very poor environment for these children. It has been found that small, enclosed classrooms work best as long as they are in a quiet part of the building away from traffic and other noises. Sometimes the child will need to have time in a quiet space to work.
• Seat the child in the front of the class. Avoid seating in the middle of the room or by doors or noisy heaters or air conditioners. Make sure the child can see the speaker's face. Avoid standing in front of windows on a sunny day or strong shadows which hide the face.
• Insist on quiet from the rest of the class when giving information to the group.
• Move closer and obtain the child's visual attention (by touching the child or giving a prearranged signal or cue) when new ideas are being introduced or when giving instructions.
• Ask the child to repeat instructions to check for understanding.
• Provide additional visual cues, such as outlines of material to be presented verbally.
• Allow the child to use earplugs, headphones, or an IPod (on silent!) during quiet work periods. The earplugs will reduce extraneous noise and may allow the child to concentrate on the work. If several children in a class can use them, then it will prevent one child from being singled out as different. Other students could have music quietly playing in their headphones.
• After professional assessment, listening devices are sometimes provided to the child in the classroom.

Since homes are also noisy places, parents can apply the same basic rules as for the classroom:

• Make sure you have your child's attention before giving instructions
• Get rid of background noise and other distractions. Studying with the television or radio playing in the background is not recommended for children with APD.
• If your child is not paying attention or asking for information to be repeated, make sure he or she is looking at you and focusing on your words before speaking.
• Don't try to carry on a conversation across large rooms, while the TV is playing, or if your child is in another room. This will only frustrate both of you. If you want to carry on a conversation, be in the same room with the same purpose - to talk with each other.

If a child is unable to follow simple commands or directions - be specific:

• Break down instructions into simple, concise, concrete actions. "Wash your hands" may be better than "Go and get ready for dinner."
• Be brief. Long sequences of commands may be too much. Don't say, "Go into the house, put your bag down, but don't turn on the TV, Mrs. Green wants you to do those spelling words first and I'll help you when I've got the shopping unpacked......" Instead, tell your child to do one or two things then return to you for more instructions.
• Slow down how quickly you talk, and give more time between sentences. APD children need more time to process and organise the information they hear.
• Check that instructions were understood. Get your child to repeat what you have said before they set off. Don't simply repeat the message in a louder voice, or using other words.

Away from home, be aware of the environment:

• In noisy places, such as a shopping centre, your child may not hear your instructions on where to be at what time. It is better to minimize background noise by moving to a quiet place rather than yelling.
• Your child may have problems at indoor swimming pools, scout halls, shopping centres and large buildings. Many halls have hard, reflective walls resulting in reverberations. The normal auditory system will merge reverberations into a single "auditory image". The APD child may not be able to do this. Look at the suggestions given above for the classroom for ideas.
• Talk to people like swimming coaches and scout leaders about your child's particular needs. It may be easier to describe your child as having a "hearing loss", which most people understand.
• Your child may not like to go to parties, assemblies, concerts and other gatherings because they find these are difficult and frustrating. Avoid subjecting your child too often to this type of situation.

Ideally, an assessment is undertaken by a speech pathologist or audiologist who specialises in APD, after a psychology assessment to rule out other explanations for the child's difficulties. The APD assessment investigates the child's ability to process auditory information and suggests appropriate accommodations and interventions.

In Adelaide, this can be arranged by contacting the Flinders Medical Centre Speech Pathology and Audiology Department (Ph: 8204 5933). There is often a long waiting list for public patients. Private assessments and auditory processing therapy are also available at cost to parents: I can provide the contact names for private services.

Further support for teachers is available in DECS schools from the Hearing Impairment Services in each district and from the school's Speech Pathologist. Students in independent schools will need to access private Audiologists and Speech Pathologists. Please contact me if you would like any further information.

Written by,

Jenni Pearce, Psychologist (2009)
Child & Educational Psychology
6 Edward Street, NORWOOD 5067 South Australia, Australia.

Telephone: 0407 726 332
Fax: (08) 8362 0332