Auditory Processing Disorder (Central APD)

The inability or impaired ability to attend to, discriminate or understand auditory information even when the hearing is normal and the person has normal cognitive ability.

There are a number of possible causes. The main causes being: neurological disorders, genetic traits and a history of frequent middle-ear effusions [glue-ear] in early life.

What are the indicators?

  • saying 'huh' or 'what' frequently
  • often misunderstanding what is said
  • frequent requests for repeats
  • poor auditory attention
  • easily distracted
  • difficulty following verbal instructions
  • difficulty listening in the presence of background noise
  • difficulty with phonics and speech sound discrimination
  • poor auditory memory
  • poor receptive and expressive language
  • slow or delayed response to verbal stimuli
  • reading, spelling and other academic problems
  • learning poorly through verbal instruction
  • behaviour problems

Note that many of these indicators can be associated with a medical ear condition and for this reason a full hearing test is required to differentiate between hearing loss [peripheral hearing loss] and potential auditory processing disorders.

If these indicators sound familiar, it is best to have a full hearing test, if the audiologist finds that the ears are working well [normal hearing] it can be possible to investigate auditory processing further. There are more tests that can highlight if a person has difficulty processing the information that they hear. Such tests typically measure the ability of a person to use both ears at the same time, or to cope with poor acoustics and people not speaking clearly. The tests are more involved than a standard hearing test [90 minutes typically versus 30 minutes for a standard hearing test] and require a good level of concentration and attention. For these reasons audiologists often try to find out about a child's listening abilities by giving the caregiver and teacher a questionnaire to complete. Once the questionnaires are returned to the audiologist, a decision is made about whether a test for auditory processing is needed. It is important to note that children with attention problems are not always suitable for the test and this is why audiologists like to use the questionnaires before arranging an auditory processing test.

It is possible for adults to have auditory processing problems too. Questionnaires are not required in this situation, but again a full hearing test is the first step for investigating these problems.

What happens next?

The auditory processing test can highlight particular areas of difficulty. The audiologist will then recommend a plan to help improve the situation. In some cases specific training and tasks can be recommend, to help teach a child to use their existing abilities to compensate for their areas of weakness. Referral to speech-language therapists for listening skills training could be recommended. Occasionally using devices like personal listening systems can be recommended.

Common recommendations for helping a child:

  • If a child has auditory processing difficulties, it can help to minimise noises and visual distractions, especially when teaching new concepts. Preferential seating in the classroom near the area where the teacher spends most of their time talking, is helpful.
  • When giving instructions getting the child's attention first like saying "listen" or "are you ready".
  • Directions should be given in a clear well-spoken way. Information should be presented in small well-defined segments. Important information should be rephrased and restated to help the child to understand.
  • Asking the child to repeat what you have said in order to check that the message goes through and that they understand what was said.
  • If the child has writing or spelling difficulties reduce the amount of written responses required of them, but teach the child to visual information.
  • Various seating arrangements in the classroom should be tried such as seating away from noisy areas like traffic, doorways. Avoid open classroom placement.
  • Move into new material gradually, while reviewing old material so that the child feels comfortable and can experience some degree of success.
  • Using visual information to back-up verbal information.
  • Allowing a child to have a lesson, plan to help them focus and follow through the lesson.
  • Teach listening skills. When to listen for meaning rather than exact repetition. Teach the child to wait until instructions are completed before beginning a task.
  • Give the child time to think and to respond to verbal instructions and questions.
  • Allow a buddy system that the child can use to check on homework assignments and to confirm what the teacher has been saying. Children with hearing problems should be encouraged to use these tactics. To follow the teacher rather than to be discouraged or punished for not paying attention.
  • Give the children praise and reinforcement for even minimal improvement. Encouragement and support are key factors in developing patterns of success.
  • In particularly severe cases consideration should be given to using an FM radio system to improve the signal to noise level for the child. Soundfield amplification [speaker + microphone] systems should also be considered.

By using these strategies a child can begin to compensate for their auditory difficulties, by encouraging the child they will keep motivated in learning. With time the child will develop abilities to use their strengths to compensate for their weaknesses. Through using strategies like asking the teacher for confirmation, the child will gain confidence to become more active in solving their own problems.

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