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Auditory Processing Disorder

The American Speech and Hearing Association defines central auditory processing as the efficiency and effectiveness with which the central nervous system uses auditory information. In other words, it’s what the brain does with what the ears hear.
Auditory Processing Disorder (APD, sometimes called CAPD) occurs when the central nervous system has problems processing information that comes through listening.

Children with auditory processing problems are weak in basic skills for decoding and remembering what they hear. They often miss, or misunderstand, information that’s conveyed through verbal instructions or conversations.

APD manifests itself in a number of ways, some of which look like other learning difficulties. Examples include poor performance in listening tasks, understanding speech, developing language, and learning in general, affecting the ability to absorb content presented verbally and utilizing phonemic and phonics strategies when reading and spelling.

Research suggests that 3% to 20% of children have APD and that a significant number of those children also have attention issues, such as ADHD. (It is rare that a child will present with only one, singular learning disability, although they may only be diagnosed with one. Any kind of therapy or intervention, including medication, must focus on the larger issues first.)

These children often need things to be restated, or often ask “what?” They seem to miss things in conversations. From testing we know that their hearing is working properly and receiving the appropriate auditory signals. But there are glitches where the brain is not assigning meaning—or the right meaning—to that signal.

There are four basic skills involved in auditory processing.

1. Auditory Discrimination:  the ability to notice and distinguish between distinct and separate sounds. This is crucial in being able to differentiate similar but different words, such as bat and pat, or sixty and sixteen. Those with auditory processing difficulties might miss information or misunderstand what you say because they mishear words. They can’t identify the subtle differences in sounds. It will be harder to learn to read and to express themselves clearly. They may confuse similar sounds because they can’t separate the phoneme sounds—'befs' instead of 'best'—and they may drop syllables out of words. Kids with processing difficulties also have trouble rhyming, because their brain is not detecting that these words sound the same. They may only be able to tune in to the beginning sound of the word, and not the end.

2. Figure-to-Ground Discrimination:  being able to differentiate important sounds from background noise; to follow verbal instructions or pick out one voice from the auditory clutter. In a classroom, a child who is weak in this area might have trouble being able to focus on what the teacher is saying because other sounds in the classroom are too distracting. It’s a filtering problem: attempting to distinguish between the white noise and the teacher’s instructions. Or the child may not be able to discern where the teacher's voice is coming from: the back of the room? the front? on my left?

3. Auditory Memory: Auditory memory includes the ability to remember things we hear, in both the short-term and the long-term. Children weak in auditory memory have trouble remembering nursery rhymes and song lyrics, learning things through recitation, and remembering information unless it’s written down.

4. Auditory Sequencing: This is the ability to understand and recall the order of sounds. A child with a weakness in auditory sequencing will mix up numbers with the same digits (84 and 48) and may switch the sequence of sounds in a word (ephelant instead of elephant) or leave out syllables from some words. They may also have trouble recalling information presented in lists, and difficulty following sequential, multi-step instructions.

Some who are diagnosed with APD early, may also grow out of their problems as the auditory fibers or pathways in the mind develop, which strengthens the capacity to process signals from the ear within the brain. Since these fibers and connections aren’t finished developing until adolescence, it’s possible that for some, APD is a delay in development, rather than a deficit. (However, delaying the necessary help will still place the child far behind his peers in the classroom.)

Helping with weak auditory processing skills is a combination of building supports into their environment, and intensive training to beef up skills they haven’t developed automatically, as most kids would.

Simple classroom accommodations can include:

Preferred seating. Arrange for the child to have seating that will make it as easy as possible for him to tune into what the teacher is saying. That usually means the front of the classroom, to minimize interference with the teacher’s voice, and get the most access to the teacher’s visual cues.

Using visual cues. Ask your child’s teacher to use visuals in instruction, and be sure your child is looking when giving directions or convey other important information.

Emphasize key words. Teachers and parents can help kids with auditory processing weakness by using intonation and slower speech to emphasize what is important.
Give kids a heads up when something important is coming. Use catchphrases to give kids a signal that you’re about to say something they need to pay attention to. It could be something as simple as, Are you ready? or Listen closely, please.

Help with sequencing. Use words that trigger or help a child to sequence events. Words like first, second, then, last help kids follow sequences, and teaching them to use these transition words in writing or telling a story helps them to organize their thoughts and their language.

Assistive technology. For kids who need extra help following the teacher’s voice in a noisy classroom, there is technology that can help. The student wears headphones that reduce background noise, and the teacher wears a microphone wirelessly connected to his headset.

Additional interventions:

The most common kind of professional help for kids with these difficulties is speech-language therapy, in which kids get explicit training to improve their skills at distinguishing sounds, remembering sounds, and sequencing sounds. When a child doesn’t automatically pick up on the skills for taking in language, the goal is to provide instruction that’s more frequent, more systematic, and more rigorous.

When kids who get intervention show improvement, it’s difficult to know whether it’s the result of the therapy or the child’s auditory pathways maturing over time. But waiting to see if a child’s problems will go away over time can leave kids feeling frustrated and suffering from impairments. That can take a toll on their emotional and social development, as well as their learning.

Educational therapists help kids who are struggling with learning to develop strategies to manage frustration, build on their strengths, and compensate for their weaknesses. They look for ways to bolster a child’s specific weaknesses—for instance, using multi-sensory learning for a child with an auditory processing condition who is struggling with reading. And they work on bolstering the confidence of kids who are discouraged because learning seems harder for them than other kids.

There are several “brain training” computer programs designed to build skills in identifying sounds and remembering auditory information, including FastForWard and Earobics.

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