What is an Auditory Processing Disorder (APD)?
When our ears pick up sounds in the environment, those sounds are directed into our auditory system. Auditory Processing allows us to differentiate and interpret these signals. An individual with APD cannot attend to, discriminate, recognize, or understand auditory information, and therefore has trouble making sense of what he or she hears. An individual with APD may have normal hearing sensitivity, but will have trouble successfully using incoming auditory information.
Signs of Auditory Processing Disorder include:
- History of chronic ear infections
- Appearing hearing impaired (while in fact having normal hearing sensitivity)
- Inconsistent or inappropriate responses to auditory information
- Difficulty remembering what was heard
- Distractibility and inability to tune out background noise and understand words in unfavorable acoustical settings
- Difficulty directing, sustaining, or dividing attention
- Trouble discriminating among speech sounds (cat vs. cap; bathroom vs. math books)
- Problems following directions
- Poor organization (difficulty keeping organized or expressing thoughts in an organized manner)
- Trouble recalling a story in proper sequence, or difficulty answering questions about a story
- Behaviors mimicking those of someone with ADHD
- Asking for frequent repetition, saying “What?” often
- Slow or delayed responses
- Misunderstanding nuances in people’s speech
- Low academic performance
- Language difficulties (confusing syllable sequences, problems developing vocabulary and understanding language)
- Behavior problems
- Low frustration tolerance
A child diagnosed with an APD may have difficulties in school as a result of the disorder. Academic weaknesses that might surface include:
- Difficulties with reading
- Difficulties with reading comprehension
- Difficulties understanding verbal math problems (though the child may be very good at math calculations)
- Spelling problems
- Writing problems (written expression, grammar, word endings, poor handwriting)
- Problems with phonics, speech sound discrimination, sound blending, word attack
- Vocabulary, syntax, and semantic skills may be weak
- May be confused in trying to decipher new information and instruction
- Problems understanding rapid speech
- Trouble remembering verbal directions and class lessons
- Trouble filing in missing auditory information
- Trouble taking notes
- Problems listening in the presence of background noise, as in a noisy classroom (noisy HVAC, fluorescent lights, pets in the classroom, computer and equipment noise, noise traveling through open windows and doors)
- Difficulty completing classroom assignments and tests
- Decreased class participation due to difficulty responding to questions or comments without lag time
- Inability to communicate properly with peers, possibly leading to social isolation
Click here to read an article about Auditory Processing Disorders from the Long Island Press
Who Can Be Tested For APD?
Normally, anyone over age 7 with normal hearing sensitivity and normal cognitive functioning can be tested for APD. At H.E.A.R.S., our philosophy for APD evaluations is: WHY WAIT? Most auditory processing problems surface around the 3rd grade. Because learning in school has become more auditory-based and less visual than in previous years, WHY WAIT until your child is struggling in the 3rd grade to have him or her evaluated? An earlier evaluation allows us to identify auditory processing weaknesses sooner. This enables us to provide coping strategies to help your child compensate for the disorder that he or she can begin using earlier in his or her academic life. In order to identify APD and auditory processing weaknesses as early as possible, H.E.A.R.S. provides APD tests for children as young as age 5. These tests are limited and we will not “diagnose” APD at this young age. However, these tests do allow us to identify any areas of weakness by comparing the child’s test results with age-based norms, and we can make recommendations for your child from there.
Children who do not speak English as their primary language, who have unmanaged ADHD*, or who have active ear infections or other middle ear pathologies should not be tested. Children with a permanent hearing loss can be tested with the limited tests that are available for this population. Children with disorders on the autism spectrum are not typically tested because the underlying problem is not APD. In some higher functioning children with autism/PDD, testing can reveal areas of weakness, but prognosis for significant gains in therapy is guarded as a result of the primary diagnosis of autism or PDD.
* ADHD needs to be ruled out and properly managed, if diagnosed, prior to Auditory Processing testing.
What Is Involved in APD Testing?
APD evaluations assess the following skills:
- Auditory Discrimination: Assesses the child’s ability to discriminate, or differentiate, speech sounds
- Auditory Figure-Ground: Assesses the child’s ability to understand speech in the presence of noise. Children with Auditory Figure-Ground problems have trouble putting the background noise in the background! It often gets “jumbled” or confused with the foreground, or primary, message and leads to difficulties understanding the primary message.
- Auditory Closure: Auditory Closure is the child’s ability to fill in and recognize an acoustic signal when parts of the signal are missing or modified. It assesses whether or not the child is able to fill in missing information when the incoming signal is not clear. Children with Auditory Closure difficulties may have problems understanding the incoming message when talking on a cell phone or in a noisy restaurant.
- Dichotic Listening: Dichotic Listening refers to the task of perceiving different signals presented simultaneously to each ear.
- Binaural Integration: This assesses the child’s ability to identify and combine (integrate) two different messages presented to both ears (binaural) at the same time. The child needs to be able to divide his or her attention between the two ears and then put all of the information together. Problems with Binaural Integration may include difficulties listening to two people at the same time, trouble processing more than one modality at a time, and problems with taking notes.
- Binaural Separation: This assesses the child’s ability to listen to a message presented to one ear while ignoring auditory competition coming into the opposite ear. Selective attention, sound localization and lateralization skills are needed to be successful in this area of auditory processing.
- Temporal Processing: This part of the evaluation measures the child’s ability to recognize the order or pattern of nonverbal auditory signals. This involves the timing of the spoken message, and requires accurate ordering, or sequencing, abilities. This relates to the rhythm and pauses found in the intonation patterns and suprasegmental cues found in speech. Problems with Temporal Processing include: misunderstanding conversations, responding inappropriately, misinterpreting the incoming message, and misunderstanding sarcasm.
- Binaural Interaction: This assesses binaural fusion, which is the ability to take incomplete information presented to each ear and fuse the information into an understandable message. Information presented to either ear alone is unrecognizable, and understanding the message depends on the brain’s ability to integrate the information.
- Phonemic Synthesis: This involves the blending of speech sounds (phonemes) into the correctly sequenced word. Difficulties with Phonemic Synthesis are related to decoding skills, or the ability to apply knowledge of letter-sound relationships, including knowledge of letter patterns. Decoding difficulties are generally associated with difficulties in phonics, spelling, and word accuracy in reading.
A child’s response patterns on the APD test battery can give us more information about his or her specific auditory processing difficulties related to:
- Auditory Short-Term Memory
- Auditory Attention
- Ability to Process Rapid Speech