Friday, November 24, 2017

Auditory Processing Disorder (APD)


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Auditory Processing Disorder (APD) is a disability that affects how the brain processes spoken language and represents a major factor in the difficulties affecting people with communication disorders. People with APD have difficulty interpreting, storing and accessing auditory information despite normal hearing. In addition to hindering speech and language development, APD can affect other related areas of learning, particularly reading and writing.

People who have auditory processing deficits have difficulty interpreting the messages being sent to the brain. There is clearly a neurological basis to APD, but although those affected with APD may or may not have hearing loss, most do have normal intelligence.

Central Auditory Processing Disorder (CAPD) refers to a disorder in which there is damage to the Central Auditory Nervous System, such as lesions, tumors, etc; this condition is rather rare. What most of us see in the children with whom we work are a combination of deficits in one or more of the auditory processes that are essential in the development of normal communication skills.


What causes Auditory Processing Disorders?

APD may have a wide range of etiologies. One important factor is delayed auditory development; and this is often due to recurrent Otitis Media. Otitis Media is the most prevalent illness in children. We give a person antibiotics, which may get rid of bacteria, but doesn’t get rid of fluid – which means the child still has a 30 dB hearing loss during the time of fluid in the ears. In addition, Amoxecillin has been proven to be 83% ineffective. Unfortunately, when we increase antibiotics, it increases candida in the body, which has been known to leads to increased allergies and a disbalanced digestive system, which leads to a disbalanced brain. There are many natural remedies for Otitis Media, with less harmful effect.


Who suffers from Auditory Processing Disorders?

Auditory processing difficulties, or language formulation disorders, are commonly found in children with Autism Spectrum Disorders, Attention Deficit/Hyperactivity Disorder, Learning Disabilities, Dyslexia, and a wide range of Speech and Language disorders. In fact, recent research found that 75% of people with Learning Disabilities and Attention Deficit/Hyperactivity Disorder also have Auditory Processing Disorders. This is not to say that all learning or attention deficits are due to auditory problems. And of course, not all people with auditory processing problems have other diagnoses, such as Autism or Learning Disabilities, or Dyslexia. Many children and adults who have auditory processing disorders do not have other disabilities, and have never been identified or received a diagnosis. They are often the people about whom parents, teachers, or friends say, “I just can’t figure out what’s wrong!” Whenever we hear this from a parent or teacher, it is important to check out auditory processing abilities, the “invisible disability.”



What are the Auditory Skills necessary for Learning Language?

Auditory information processing involves all of these skills simultaneously. However, it is important to know what constitutes the ability to process auditory information, so that we can look at each area to determine if it is functioning properly.

  • Localization – to localize to the source of sound. This is the best indication of auditory development. If a child cannot determine from where the sound is coming, their whole world will be very confused.
  • Discrimination – to differentiate among sounds of different frequency, duration, or intensity
  • Auditory attention – to pay attention to auditory signals, especially speech, for an extended time
  • Auditory figure/ground – to identify a primary speaker from a background noise.

    Sound in Noise – Our acoustic environment is different everywhere. There is always some ambient noise present – especially for children. Therefore in the presence of noise, we usually raise our voice above the ambient noise level. However, sound depletes quickly as we move to the back of a room. We find that many children with APD (and certainly a child suffering from Otitis Media) can’t hear above the noise level.

    Ability to selectively listen (or Modulation difficulty). A child with poor attention may not necessarily have true Attention Deficit Disorder. Rather, that child may have APD with auditory figure/ground disturbances. In fact, this is the most common difficulty in people with auditory processing deficits

  • Phonologic awareness: Identifying sounds in words, the number of sounds in a word, and similarities among words; may show up in spelling, writing, and reading difficulties.
  • Auditory Discrimination – to discriminate among words and sounds that are acoustically similar
  • Auditory Closure – to understand the whole message when part is missing
  • Auditory Blending – to synthesize isolated phonemes embedded in words
  • Auditory Analysis – to identify phonemes or morphemes embedded in words
  • Auditory sequencing – to store and recall auditory stimuli of different length or number in exact order
  • Auditory Memory – storing, or retaining, pertinent auditory information; may affect ability to follow oral directions, participate in discussions, and spell.
  • Auditory Association – to identify a sound with its source
  • Decoding of Speech – In learning to understand speech, we have to be able to form a memory for sounds and words. These are called auditory templates. Enough of the template must be stimulated in order to recognize word, etc. If something occurs (like where you don’t get consistent input), those templates are not going to develop as strong engrams. If you can’t get the phonemes, you can’t get the words. This is the basic skill required in learning to read. So being able to read begins as soon as we begin to hear sounds/phonetic elements.

What is Temporal Processing – an Essential Auditory Processing Skill for Language and Reading?

Another essential skill in auditory processing is Temporal Processing – the rate at which we can process auditory information. A person must be able to process auditory information at a rapid pace in order to develop appropriate listening and language skills. Audiologists have recognized this in people with sensori-neural hearing loss for a long time, and have referred to this concept as the “temporal window”. We know that if a person’s “temporal window” is too large, that is, the time period required to process sound is too long; it becomes more difficult for them to understand speech. Any brief change in the speech signal then becomes difficult to perceive and the communication is distorted.

If someone is walking by a very small window, you will see him or her for just a brief period of time. In order to recognize them, you will have to be very quick in your skill. If you are not so quick, you will need a longer window; that is, you will need more time to figure out whom that person is that you saw.

You can see slow auditory processing in the child who is asked a question, and he sits there and looks at you and takes quite a while to respond, or maybe he says “What” or “Huh” and you repeat the question. Then finally he answers. He may not be saying “What” because he didn’t hear you, (and that makes you really mad because you know he heard it!). He may need you to repeat it again because he needs that extra time for the first statement to process in his mind before he can come out with an answer.

In fact, researchers have discovered that many language and learning disabilities may be due to a split-second delay in the brain’s ability to process input from certain senses. Dr. Paula Tallal, of Rutgers University, first reported in the 1980’s that “the data are overwhelming now that learning disorders are neither visual nor phonic.” Studies reported that there are “Structural brain differences in areas involved in the rapid processing of hearing, vision and touch in affected people, and that people with these speech and learning disorders require 300 milliseconds to process basic speech sounds, where normal processing takes about 25 milliseconds.” Tallal said, “Dyslexia is at root not a visual or ordinary hearing problem, as many have thought, but a flaw in a specific brain circuit that handles rapidly flowing auditory information.” She added that neurological tests show affected children are normal in all aspects of the brain except sensory processing.

This critical work by Dr. Paula Tallal and later collaboration with other researchers, Dr. Michael Merzenich, Dr. William Jenkins, and Dr. Steve Miller, led to the development of Fast ForWord. Fast ForWord products are computerized language learning programs that help children rapidly build oral language comprehension and other critical skills necessary for improved communication and reading. They are based on the concept that Temporal Processing deficits are an essential difficulty in APD and on the concept of Neural Plasticity – that the brain can learn new processes through repeated intensive practice.


What are some characteristics of Auditory Processing Disorders?

  • Easily confused by instructions
  • Misinterprets questions, comments
  • Does not pay attention (listen) to instructions
  • Says “huh?” and “what?” at least five or more times a day
  • Difficulty focusing on a task; short attention span; daydreaming
  • Difficulty listening in the presence of noise or easily distracted by noise
  • Difficulty answering questions or following directions given through the auditory sense
  • Difficulty with phonics
  • Problems with sound discrimination
  • Trouble recalling a sequence student has heard
  • Forgets what is said in a few minutes
  • Slow or delayed response to verbal stimuli
  • Problems with organizing and integrating thoughts
  • Difficulty with pragmatics, or social conversation
  • Unable to successfully negotiate a conversational exchange
  • Obsesses on one topic or idea
  • Over talkative or “motor mouth”; maybe normal at 2, but by 5 or 6 should engage in listening and turn-taking
  • Easily fatigued
  • Flat monotone or shrill voice
  • Weak vocabulary or nonverbal
  • Singing out of tune
  • Low tolerance for frustration
  • Disorganized body schema; “can’t sit still”; dyspraxic or motor planning difficulties

How can I get my child tested for Auditory Processing Disorder?

It is important to seek out a qualified Speech/Language Pathologist or Audiologist who has had experience with auditory processing disorders and understands its many different ramifications. There are many different test batteries, and different professionals will use different approaches. Therefore it is important to assure that you feel comfortable with the professional’s qualifications.

When a child is administered auditory processing tests, we may not be able to rule out auditory processing problems if the child being tested “passes” the tests. We sometimes find that a child whose verbal skills are good may also have well-developed compensatory skills and know how to test well under ideal conditions. Some children may experience auditory processing difficulties, which are hidden or masked by their overall intelligence, or confounded by a previously existing diagnosis such as ADHD, or Autism Spectrum Disorder. A test battery that includes both auditory processing tests and comprehensive language tests is often necessary when evaluating a “complex” child or a highly verbal, bright child. It often takes some diagnostic digging, on the part of many professionals, to really figure out what the problem is.


How can we help people with Auditory Processing Disorder?

There are many suggestions for classroom management that will help such a child deal with the symptoms. The teacher is encouraged to basically treat the child as you would a child with a hearing loss.

Parents and teachers can use the specific strategies below to help avoid breakdowns in auditory processing:

  • Seat child away from visual, auditory, and motor distractions, such as fans, heaters, windows, doors, and pencil sharpeners.
  • Make sure light is on the speaker’s face, not his.
  • Allow him to move to a quiet area when doing silent reading and independent work.
  • Wait for the room to become quiet before giving instructions or directions.
  • Enforce appropriate speaker-listener manners for all children in class – one person talks at a time; others listen quietly.
  • Gain child’s attention before giving new work or directions.
  • Speak clearly, with a moderate rate, and stand in one place, facing child.
  • Allow child a longer time to respond, beyond what you might consider normal, when asking questions.
  • Simplify/explain new vocabulary; encourage child to ask questions for clarification.
  • Give concrete, interesting examples, demonstrations, and written or pictorial information when presenting new concepts orally.
  • Break complicated directions into fewer parts and give child time to complete the first step before going on to the next part.
  • Prior to a discussion, write down two or three main points for child to listen for; then check for memory and understanding of those points.
  • Use child’s strengths to convey information (e.g., if your child is a good reader, give reminders in writing; use · closed captioning during TV or video programs.)

Your child can also use strategies to avoid auditory processing breakdowns. Have child try these:

  • Keep your eyes on the speaker, and try to get eye contact.
  • Use good listening behavior — quiet body and closed mouth.
  • Ask to have directions repeated or clarified when you feel confused or unsure of what to do.
  • Re-auditorize, repeat information quietly to yourself, after directions or information are presented orally.
  • Ask someone to explain what words mean, or use a dictionary or electronic thesaurus, when you aren’t sure.
  • Visualize – make a picture in your mind, to help you remember important points.
  • Wait until your parent or teacher finishes giving directions and answers questions before starting a task.
  • Write down your assignments at school to help you remember what you’re supposed to do when you get home.

There are also environmental aids, such as auditory trainers or assistive listening devices, either individual or group, that can be used in the classroom. However, the efficacy of this modification has not been proven.

Speech/Language Therapy will often improve many types of auditory processing deficits, provided you use a therapist with experience in this area. Similarly phonemic training and other reading methods are very beneficial.


What are Sensory Integrative Interventions?

The above methods are strategies we teach a child to deal with the problem. Since auditory processing disorders are neurologically and sensory-based disorders, we will be most successful in our work if we treat directly the sensory systems in distress. Therefore, we at Innovative Therapies have chosen to use a variety of very successful programs that create an optimal learning environment for brain plasticity, and have proven successful in changing the brain’s ability to process auditory information.

These programs include Fast ForWordThe Listening ProgramSAMONAS Sound Therapy, in addition to otherSensory Integrative techniques