What is Auditory Processing Disorder?
Children with auditory processing disorder (APD) have trouble processing sounds. For example, a child with APD may hear/detect a sound normally but not be able to make sense of it the same way other children do.
Children with APD may:
- Have difficulty following instructions/verbal directions
- Not know where a sound is coming from
- Have poor memory for speech
- Have trouble understanding speech in a noisy room
- Seem easily distracted
- Find it difficult to understand fast talkers or unfamiliar accents
- Often ask you to repeat (e.g., “huh?”, “what?”) or misunderstand you
- Mishear sounds and words
- Misunderstand and be unable to follow multi-step directions
At school, children with APD may have:
- Delayed expressive language and comprehension abilities
- Poor reading, writing, and spelling
- Difficulty taking notes while listening
- Weak short-term memory
- Behavioral, psychological, and/or social problems resulting from poor language and academic skills
- Struggle with verbal math problems
Children with these characteristics and who have typical hearing are candidates for APD assessment.
Causes
The cause of APD is unknown. However, there is evidence that children with a history of head trauma, chronic ear infections, toxin exposure, family history, and premature birth may be at increased risk.
Diagnosis
Currently, most APD tests are normed for children seven and above. Testing children under the age of seven is not possible due to the wide range of normal developmental differences that exist in younger children. In addition, there is a lack of normative data for our testing materials for children younger than seven.
Role of the Audiologist
Rady Children’s Hospital Developmental Services’ approach to the assessment of children suspected of having issues with auditory processing is to first test the child’s hearing to make sure they can detect sounds normally. The second part of the evaluation involves having the child complete a group of tests that are designed to assess different aspects of auditory processing. Our protocol includes eight specific tests that will evaluate these distinct areas. In order for a child to be able to successfully complete the evaluation, they need to be able to repeat words and sentences and tolerate headphones/earphones.
Management Techniques
The management strategies that best suit your child will be determined following the APD evaluation and will depend on their specific skills and difficulties. However, the most common recommendations include:
Environmental Modifications
- Flexible Preferential Seating and away from noise sources like windows, fans, other talkers, etc.
- Pair verbal presentation with visuals
- Pre-teaching of new material
- Provide written notes/presentations
- Speaking CLEARLY and SLOWLY
- Rephrase vs. Repeat
- Consideration of Learning Styles (visual, kinesthetic, vs auditory)
Compensatory Strategies:
- Teach/encourage active listening techniques
- Teach use of context
- Vocabulary building and/or auditory memory practice
- Teach meta memory techniques such as mnemonics
- Incorporate graphic organizers
- Develop organization skills
Improvement of the signal-to-noise ratio, which could include the use of:
- Flexible Preferential Seating and away from noise sources like windows, fans, other talkers, etc.
- Personal DM Systems
- Classroom Sound field system
- Sound Amp that transforms an iPod, iPad, or iTouch into an interactive listening device, allowing for the replay of missed conversations
- Direct skill remediation includes various auditory training programs, which are recommended based on the type of deficit
What are remote microphone systems (RMS)?
Listening can be a challenge, especially in less-than-ideal circumstances. An RMS is one option for improving clarity in the classroom. A personal RMS has two parts: a microphone-transmitter that the teacher wears and a receiver that the child has. The child’s receiver is worn at the ear much like a hearing aid.
A sound field RMS still uses the microphone-transmitter worn by the teacher, but the individual child does not wear a receiver. With a sound field RMS, speakers are placed in the corners of the classroom, which project the teacher’s voice. This allows all of the children in the classroom to take advantage of this system.
Remote microphone systems allow the child to hear the teacher’s voice more clearly by sending their voice directly to the child’s ear or to the speakers, which can be heard in all parts of the classroom. This helps make the teacher’s voice relative to the background noise clearer without actually amplifying any sounds.
References
- Ferre, J. M. (2002). Managing Children’s Central Auditory Processing Deficits in the Real World: What Teachers and Parents Want to Know. Seminars in Hearing, 23(4), 319-326.
- Rosenberg, G. (2002). Classroom acoustics and personal FM technology in the management of Auditory Processing Disorder. Seminars in Hearing, 23, 309-317.