Audiology (Hearing)

Auditory Processing Disorder Testing

What is Auditory Processing Disorder?

Children with auditory processing disorder (APD) have trouble processing sounds. For example, a child with APD may hear a sound but not be able to make sense of it.

Children with APD may:

  • Have difficulty following instructions
  • 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

At school, children with APD may have:

  • Delayed expressive language and comprehension abilities
  • Poor reading, writing and spelling
  • Difficulty taking notes
  • Weak short-term memory
  • Behavioral, psychological and/or social problems resulting from poor language and academic skills

Children with these characteristics and who have normal hearing are candidates for APD assessment.

Diagnosis

Because of the wide range of factors associated with APD, many professionals may be involved in the diagnosis. For example, educators may provide information about academic difficulties and psychologists may assess cognitive skills. Speech pathologists may evaluate written and oral language.

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 assess overall listening ability. As conventional auditory processing protocols are highly influenced by non-auditory factors including memory, attention and language ability, our protocol involves the assessment of listening in noise which is specifically designed to approximate real-world difficulty. In addition, we will assess specific issues with competing information to gain further insight into our ability to prioritize information.

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.

Management Techniques

The management strategies that best suit your child will be determined following the APD evaluation, and will depend on his or her specific skills and difficulties. However, the most common recommendations include:

Classroom accommodations that could include:

Environmental Modifications 

  • Flexible Preferential Seating and away from noise sources like windows, fans, other talkers, etc.
  • Pre-teaching of new material
  • Speaking CLEARLY and SLOWLY
  • Rephrase vs. Repeat
  • Consideration of Learning Styles (visual, kinesthetic, vs auditory)
  • Introduction of compensatory strategies to potentially include:
    – Active Listening Techniques
    – Auditory Closure skills
    – Vocabulary Building and/or Auditory Memory Practice

Improvement of the signal to noise ration which could include the use of:

  • Flexible Preferential Seating and away from noise sources like windows, fans, other talkers, etc.
  • Personal FM systems
  • Classroom Sound field
  • Sound Amp that transforms an iPod, iPad, or iTouch into an interactive listening device, allowing for replay of missed conversation

What are FM Systems?

Listening can be a challenge, especially in less than ideal circumstances. FM systems are one option for improving clarity in the classroom. A personal FM system 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 FM system still uses the microphone-transmitter worn by the teacher but the individual child does not wear a receiver. With a sound field FM 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.

FM 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 management of Auditory Processing Disorder. Seminars in Hearing. 23. 309-317.

https://www.phonakpro.com/content/dam/phonak/b2b/FM_eLibrary/ACCESS_2_Chapter_3_Jennifer_Smart.pdf