What is an Auditory Processing Disorder?
APD refers to difficulty with listening and processing what we hear. This has an impact on everyday life and may include difficulties understanding both speech and environmental sounds.
The processing of sound by the ear and nerve pathways between the ear and the brain is highly complex. Recent research shows that the brain can influence the way incoming sounds are processed. So it is a two way process and it all happens very quickly.
Other factors can also affect the way we process sound such as our language ability, memory and attention. This is because even a simple task like following the instructions of a teacher requires that all these different abilities work together. As a result APD often co-occurs with other childhood developmental delays such as language, attention and memory difficulties, as well as dyslexia and autism. APD is thus a complex disorder and is different in each child.
Children referred for APD assessment typically have a normal audiogram but present with characteristics that may include:
· .difficulty hearing spoken language in the background of other sounds, including speech (the most common presenting complaint)
· .difficulty hearing in reverberant acoustic environments, or when speech is rapidly presented or degraded in some way
· .mishearing speech and similar sounding words (‘shoulder’ versus ‘soldier’)
· .responding inconsistently or inappropriately to spoken language and auditory information
· .taking longer to process spoken language and auditory information
· .frequent requests for repetition
· .difficulty hearing on the phone
· .poor attention to and/or memory of spoken language and instructions.
There may also be reports of impaired speech, language, phonological awareness, literacy, attention and academic performance.
How is APD identified and assessed?
There are a number of checklists (questionnaires) that may be completed by parents for initial identification of listening problems. In the clinic, the first step is a detailed case history followed by routine hearing tests. These will ensure that the child does not have a hearing loss. Further tests of auditory processing can then be done by an Audiologist, and should include both speech and non-speech stimuli. A speech and language screen and further assessment from a Speech and Language Therapist may be advised and should include an analysis of spoken and written language. Teachers of the Deaf or Educational Audiologists are able to provide an assessment of the educational setting and make appropriate recommendations, which may in some cases include the fitting of an assistive listening device.
Management
Following assessment, an individualised management plan will be drawn up and may include:
Strategies for developing better listening skills
Strategies for improving the listening environment at school and home
Strategies for the teacher/speaker (e.g. slow down rate of speech, use succinct sentences with pauses between sentences, and ask child to repeat what they have heard)
Trial and/or fitting of an Assistive Listening Device (also known as Remote Microphone or FM). This wireless system consists of a very small microphone worn by the teacher and a small device worn on the ear of the child. It helps to cut out background noise and reverberation regardless of where the teacher is positioned in the classroom.
Auditory training, using programmes or computer-based software
Compensatory strategies like inner rehearsal (e.g. repeating instructions to yourself using your ‘inner voice’ to reinforce what was heard)
Building self-esteem and developing an understanding of what APD is
Management of any co-occurring difficulties such as dyslexia, autism or impairments in memory, language and attention.
From The British Society of Audiology
Further information and practical handouts in relation to APD and co-existing disorders can be found here ‘Practical handouts’
Useful links
https://www.nhs.uk/conditions/auditory-processing-disorder/
https://www.gosh.nhs.uk/medical-information-0/auditory-processing-disorder/
https://www.neuronlearning.com/auditory-processing-disorder/
