How do we hear
Most of us can hear well so, we do not give much thought to how complex the process of hearing and understanding is. It starts with a series of mechanical actions inside the ear when a sound strikes the ear drum. The ear converts the mechanical sounds into electrical waves that are taken to the brain via hearing nerve. The brain helps us understand the meaning of the sound, based on the information stored in the memory.
What is auditory processing
Our hearing (auditory system) allows us to listen to sounds, words and sentences and our brain works together with our ears to process and work out the meaning of these sounds. It is vital that our ears and brain work together and co-ordinate fully to achieve the effective processing of these sounds. For example, after hearing a series of sounds /t/, /e/, /b/, /l/, brain knows that it refers to an object called ‘table’. Although, it happens without any special effort in a normal hearing person, the brain works very hard to ‘process’ the sounds in order to make sense out of it. It has to correlate the sounds with memory and emotional systems, for example, to make sense of the sounds. This is what we call ‘listening’ and the medical term for this is ‘auditory processing’. Auditory processing essentially refers to what happens when the brain ‘recognises’ and ‘interprets’ the sounds around us. Simply put- it is ‘what we do with what we hear’.
What is auditory processing disorder
When ears are working well and hearing is within normal limits, we can easily make sense of what is being said. However, some children and adults have something that adversely affects the processing or interpretation of the information they hear, even when their hearing is within normal range. Difficulty in listening even when the hearing is normal, is called ‘auditory processing disorder’ (APD).
Symptoms of APD
The ability to make sense of what we hear at home, school, work or in our everyday environment is crucial if we are to carry out a wide variety of tasks effectively. If the brain appears to be having difficulty working out the meaning of sounds properly (especially the sounds composing speech) –then the ears and the brain are not coordinating fully. This results in one or more of the following symptoms:
- Difficulty distinguishing one sound from another (phonemes)
- Difficulty identifying similarities and differences in sound patterns (rhyming)
- Difficulty blending, isolating, or separating sounds in words (decoding words).
- Poor auditory memory
These difficulties with auditory processing may manifest in the following ways:
- Poor listening skills.
- Difficulty following oral instructions or classroom discussions.
- Frequently say, “huh?” or “what?”
- Difficulty with phonics or letter-sound correspondences, sound blending or segmentation.
- Difficulty decoding unfamiliar words.
- Poor spelling.
- Slow fluency of reading.
- Poor reading comprehension.
- Difficulty understanding in the presence of background noise.
- Poor attention, day dreaming, high distractibility (may seem like an attention disorder).
- Give slow or delayed responses to oral questions.
- May be prone to behavior problems due to frustration or boredom (inability to follow the class).
- Avoidance of reading or other difficult tasks.
How can we recognise the need for specialist APD testing?
Questions which teachers/parents should ask in class or at home are:
- Is the child easily distracted or unusually bothered by loud/sudden noises?
- Are distracting environments upsetting to the child? (background noise)
- Does the child find it easier to cope in quieter settings?
- Does the child have difficulty following multi-step oral instructions/directions, whether simple or complicated? (needing to hear only one direction at a time)
- Does the child have reading, spelling, writing or other speech-language difficulties?
- Is abstract information difficult for the child to comprehend? Are verbal maths problems difficult? Is the child disorganised and forgetful?
- Are conversations hard for the child to follow? Does the child take longer time to process information?
How can we help children with APD?
There are many strategies which can be applied at school and at home to ease some of the difficulties associated with APD. Some of which are outlined below:
- Acknowledge that child’s auditory difficulties are REAL – and not within child’s control. Boost self-confidence by giving students positive feedback.
- Reduce background noise at home/ school – as this can distract listening tasks. Seat child towards front of classroom away from windows – where teacher is most likely to be aware of any confusion or lack of comprehension. Provide child with a quiet place for reading and independent work. Provide additional aids for study, like an assignment pad or a tape recorder.
- Ensure that the child looks at you when you are speaking – gain their attention. Always pairing ‘listening with looking’ — i.e. give written or graphic explanations to a learning task as well as the spoken instruction.
- Review the first few items of the task at hand to help keep students focused. Watch for signs of inattention or decreased concentration. Intervene with questions to keep students focused.
- Provide pre-assigned readings and homework before introducing new material and/or topics. Keep parents and resource teachers informed of the upcoming topics and lessons.
- Allow students to read quietly or repeat directions to themselves (sub-vocalize). Preview and Review consistently and summarize all new and previous lessons including vocabulary words and concepts. Relate new material to previous lessons and experiences.
- Allow extended time to complete the task for students with APD
Some implications of information that we have on APD:
- APD is for life, as with other invisible disabilities.
- APD cannot be cured but with the correct diagnosis, remediation and strategies, APD sufferers can learn to cope with their disability with the help of those around them.
- Those who have APD may find groups of more than 3 or 4 people threatening as they unable not process multiple auditory (verbal) input.
- APDs find following social interaction difficult especially with new people, and those with good adversarial debating skills.
- Those who have APD may have problems filling in textual forms Problems processing what the meaning of the questions mean will in turn cause problems when trying to process an answer.
- Those who have APD who have a high IQ are more difficult to diagnose, as they are very good at developing their own coping strategies.
- APDs really find life difficult to cope with when leaving the relative safe confines of the education system if they have not come to terms with their disability and how best to cope with it. They can become very isolated.
- 2015. Central auditory processing disorder (CAPD) tests in a school-age hearing screening programme – analysis of 76,429 children. Skarzynski PH, Wlodarczyk AW et al. Annals of Agricultural and Environmental Medicine 2015, Vol 22, No 1, 90–95. Full text article of available at: http://aaem.pl/fulltxt.php?ICID=1141375 retrieved in Mar 2015
- 2015. Children and auditory processing disorder (APD) – information and research update. Retrieved August 2015. http://www.nhs.uk/ipgmedia/national/deafness%20research%20uk/assets/childrenandauditorypr ocessingdisorder(apd)%E2%80%93informationandresearchupdate.pdf
- 2012. Children’s Hospital Medical Center Language. Health Topics. Language/auditory processing disorder. Retrieved August 2015. http://www.cincinnatichildrens.org/health/a/auditory-processing/
- 2011. British Society of Audiologists (2011). Position statement on Auditory Processing Disorders March 2011. Retrieved in July 2015 http://www.thebsa.org.uk/wpcontent/uploads/2014/04/BSA_APD_PositionPaper_31March11_FINAL.p df
- 2010. American Academy of Audiology (2010). Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. Accesses in Jan 2015
- 2001. Florida Department of Education. Technical Assistance Paper 10967: Appendix C. Suggestions for successful management of students with central auditory processing disorder (CAPD): Tips for the teacher. Retrieved September 2012. http://shs.asu.edu/files/ASU-SHS-Clinic_CAPD-TipsForTeachers.pdf Cincinnati