ABOUT CENTRAL AUDITORY PROCESSING DISORDERS

It is becoming increasingly acknowledged that, despite normal hearing sensitivity, some children (and adults) appear to have hearing problems. These children are often described by teachers and parents as having “selective hearing” and difficulty hearing in noisy environments. They frequently have trouble following directions, forget what they were asked to do, or misunderstand conversation. For these children, an Auditory Processing Disorder (APD) may be suspected. A precise definition of APD has not yet been universally agreed upon; however, auditory processing can simply be summarized as, “what we do with what we hear”. Many children, when in unfavorable listening conditions (i.e., noise/distraction/unclear speech), are not able to “piece together” what they hear in order to make sense of what has been said. These children often express confusion, or request that information be repeated (“what”, “huh”). They may be slow to respond when asked a question, are easily distracted, and often have difficulty with reading, writing, spelling, and general academic achievement. Children with APD may be extremely sensitive to loud noise.

APD can have significant effects on academic and social achievement, and even on emotional adjustment, as children may feel that they are “different” from their peers, or that they are always a step behind. They often become frustrated in school, and can develop behavioral issues. Although APD may occur in isolation, it is commonly seen in conjunction with other disorders, including: language delays, reading disabilities, dyslexia, attention deficit disorder or learning disabilities. Unfortunately, manifestations of these conditions often mimic one another, and the procedures available to evaluate children who “do not seem to hear well” do not always adequately differentiate between the disorders. The actual cause of APD in an individual child often remains unknown; however, medically speaking, APD is usually a benign condition. It can be caused by several factors, including delayed maturation of the auditory system, head trauma, lead poisoning, or neurological issues. Many children that present with Auditory Processing Disorders have a significant history of ear infections.

Testing for Auditory Processing Disorders begins with the Audiologist obtaining a complete case history of the child, and performing an audiological evaluation (i.e., hearing test). Once normal hearing sensitivity is confirmed, APD testing involves administration of a battery of tests, some of which require the child to repeat sentences, words, digits or tones when presented in difficult listening situations (i.e., background noise, filtered speech, competing messages, etc.). The tests are conducted in sound-treated rooms, typically using pre-recorded CD’s, and are usually scored according to the child’s age. Other tests assess physiological function (i.e., eardrum movement, middle ear reflexes, inner ear integrity), and do not require the child to respond at all. Once results are scored, they are interpreted by the Audiologist, and a report and recommendations are provided. Diagnosis is important for several reasons, including parental/teacher awareness of the disorder, educational planning (also helps reduce social/psychological factors), ruling out medical issues, and monitoring change/progress over time.

Management of Auditory Processing Disorders requires a team effort, often involving the Audiologist, Speech-Language Pathologist, neuropsychologist, classroom educator, and of course, the parents. Recommendations may include manipulations of the child’s listening environment and physical placement in the classroom. Assistive listening devices may be prescribed to overcome background noise, and compensatory strategies may be suggested to assist the child in the classroom. Specific therapies or personal tutoring may be recommended.

Due to the nature of the tasks involved in APD testing and the available normative data, it is recommended that children be a minimum of 6 years of age for testing. Sound Therapeutics provides complete audiological assessments and Auditory Processing evaluations for children and adults.

Jamie Barbera, Au.D.
Doctor of Audiology

©2002