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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
ForWord, The
Listening Program, SAMONAS Sound Therapy, in addition
to other Sensory Integrative
techniques and a program of overall well-being through
proper nutrition.
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