The term auditory processing means ‘what you do with what you hear’. It is estimated that 5-10% school children and many adults have undue difficulty in understanding speech and/or follow instructions, even though their hearing ability is perfectly within normal range. This could be a result of what’s known as ‘auditory processing disorder’ or APD. Often, children with APD will struggle with their speech/language abilities and/or academic performance. At the same time, adults will suffer from issues in listening in noisy environment at home or work.

In its very broadest sense, APD refers to how the brain (central nervous system or CNS) uses auditory information. However, the CNS is vast and also is responsible for functions such as memory, attention, and language, among others. To avoid confusing APD with other disorders that can affect a person’s ability to attend, understand, and remember, it is important to emphasize that APD is an auditory deficit that is not the result of other higher-order cognitive, language, or related disorder.

APD may coexist with some other problems such as ADHD, autistic spectrum disorder and dyslexia. For many children and adults with these disorders and others – including intellectual developmental disorder and sensory integration dysfunction – the listening and comprehension difficulties we often see are due to the higher-order, more global or all-encompassing disorder and not to any specific deficit in the neural processing of auditory stimuli per se.

Most of us can hear well so, we do not give much thought to how complex the process of hearing and understanding is. It starts with a series of mechanical actions inside the ear when a sound strikes the ear drum. The ear converts the mechanical sounds into electrical waves that are taken to the brain via hearing nerve. The brain helps us understand the meaning of the sound, based on the information stored in the memory.

Our hearing (auditory system) allows us to listen to sounds, words and sentences and our brain works together with our ears to process and work out the meaning of these sounds. It is vital that our ears and brain work together and co-ordinate fully to achieve the effective processing of these sounds. For example, after hearing a series of sounds /t/, /e/, /b/, /l/, brain knows that it refers to an object called ‘table’. Although, it happens without any special effort in a normal hearing person, the brain works very hard to ‘process’ the sounds in order to make sense out of it. It has to correlate the sounds with memory and emotional systems, for example, to make sense of the sounds. This is what we call ‘listening’ and the medical term for this is ‘auditory processing’. Auditory processing essentially refers to what happens when the brain ‘recognises’ and ‘interprets’ the sounds around us. Simply put- it is ‘what we do with what we hear’.

Our hearing (auditory system) allows us to listen to sounds, words and sentences and our brain works together with our ears to process and work out the meaning of these sounds. It is vital that our ears and brain work together and co-ordinate fully to achieve the effective processing of these sounds. For example, after hearing a series of sounds /t/, /e/, /b/, /l/, brain knows that it refers to an object called ‘table’. Although, it happens without any special effort in a normal hearing person, the brain works very hard to ‘process’ the sounds in order to make sense out of it. It has to correlate the sounds with memory and emotional systems, for example, to make sense of the sounds. This is what we call ‘listening’ and the medical term for this is ‘auditory processing’. Auditory processing essentially refers to what happens when the brain ‘recognises’ and ‘interprets’ the sounds around us. Simply put- it is ‘what we do with what we hear’.

When ears are working well and hearing is within normal limits, we can easily make sense of what is being said.  However, some children and adults have something that adversely affects the processing or interpretation of the information they hear, even when their hearing is within normal range. Difficulty in listening even when the hearing is normal, is called ‘auditory processing disorder’ (APD).

The ability to make sense of what we hear at home, school, work or in our everyday environment is crucial if we are to carry out a wide variety of tasks effectively. If the brain appears to be having difficulty working out the meaning of sounds properly (especially the sounds composing speech) –then the ears and the brain are not coordinating fully. This results in one or more of the following symptoms:

• Difficulty distinguishing one sound from another (phonemes)
• Difficulty identifying similarities and differences in sound patterns (rhyming)
• Difficulty blending, isolating, or separating sounds in words (decoding words).
• Poor auditory memory

 

These difficulties with auditory processing may manifest in the following ways:

• Poor listening skills.
• Difficulty following oral instructions or classroom discussions.
• Frequently say, “huh?” or “what?”
• Difficulty with phonics or letter-sound correspondences, sound blending or segmentation.
• Difficulty decoding unfamiliar words.
• Poor spelling.
• Slow fluency of reading.
• Poor reading comprehension.
• Difficulty understanding in the presence of background noise.
• Poor attention, day dreaming, high distractibility (may seem like an attention disorder).
• Give slow or delayed responses to oral questions.
• May be prone to behavior problems due to frustration or boredom (inability to follow the class).
• Avoidance of reading or other difficult tasks.

To diagnose APD, the audiologist will administer a series of tests. These tests require listeners to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Other tests that measure the auditory system’s physiologic responses to sound may also be administered. Most of the tests of APD require that a child be at least 7 or 8 years of age because the variability in brain function is so marked in younger children that test interpretation may not be possible.

Questions which teachers/parents should ask in class or at home are:

• Is the child easily distracted or unusually bothered by loud/sudden noises?
• Are distracting environments upsetting to the child? (background noise)
• Does the child find it easier to cope in quieter settings?
• Does the child have difficulty following multi-step oral instructions/directions, whether simple or complicated? (needing to hear only one direction at a time)
• Does the child have reading, spelling, writing or other speech-language difficulties?
• Is abstract information difficult for the child to comprehend? Are verbal maths problems difficult? Is the child disorganised and forgetful?
• Are conversations hard for the child to follow? Does the child take longer time to process information?

It is important to understand that there is not one, sure-fire, cure-all method of treating APD. Notwithstanding anecdotal reports of “miracle cures” available in popular literature or on the internet, treatment of APD must be highly individualized and deficit-specific. No matter how successful a particular therapy approach may have been for another child, it does not mean that it will be effective for your child. Therefore, the key to appropriate treatment is accurate and careful diagnosis by an audiologist.

There are many strategies which can be applied at school and at home to ease some of the difficulties associated with APD. Some of which are outlined below:

• Acknowledge that child’s auditory difficulties are REAL – and not within child’s control. Boost self-confidence by giving students positive feedback.
• Reduce background noise at home/ school – as this can distract listening tasks. Seat child towards front of classroom away from windows – where teacher is most likely to be aware of any confusion or lack of comprehension. Provide child with a quiet place for reading and independent work. Provide additional aids for study, like an assignment pad or a tape recorder.
• Ensure that the child looks at you when you are speaking – gain their attention. Always pairing ‘listening with looking’ — i.e. give written or graphic explanations to a learning task as well as the spoken instruction.
• Review the first few items of the task at hand to help keep students focused. Watch for signs of inattention or decreased concentration. Intervene with questions to keep students focused.
• Provide pre-assigned readings and homework before introducing new material and/or topics. Keep parents and resource teachers informed of the upcoming topics and lessons.
• Allow students to read quietly or repeat directions to themselves (sub-vocalize). Preview and Review consistently and summarize all new and previous lessons including vocabulary words and concepts. Relate new material to previous lessons and experiences.
• Allow extended time to complete the task for students with APD