Auditory Processing Disorder

(APD)
or:
central auditory processing disorder (CAPD), auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness

Katherine Parker Natalie Ramsey

Beginnings

Bocca, Calearo and Cassinari (1954)- made the observations that patients with temporal lobe tumors complained of hearing difficulties, despite the presence of normal hearing thresholds and normal speech recognition.
Myklebust (1954)- proposed central auditory function ought to be assessed in children with communication disorders.

Beginnings

Last 20-30 years- Increased recognition that impaired structure and/or function of the brain may have little or no effect on hearing thresholds, but may cause deficits in other aspects of the hearing process.

These deficits are collectively referred to as an:

AUDITORY PROCESSING DISORDER (APD).

What is it?
An auditory processing disorder interferes with an individual's ability to analyze or make sense of information taken in through the ears.

Difficulties with auditory processing do not affect what is heard by the ear, but do affect how this information is interpreted, or processed by the brain.

Symptoms of ADP
Individuals with ADP may have difficulty:
-following a lengthy conversation -listening in noisy surroundings -spelling and/or reading -following multi-step directions -conversing on the telephone -taking notes -organization skills -learning different voc. words/foreign languages -remembering spoken information

Deficit Areas
Phonological Awareness:
Language is made up of individual sounds (phonemes) which are put together to form the words we write and speak. Decoding problem example: Ghoti

Gh as in laugh is the sound /f/

O as in women is the sound/i/

Ti as in nation is the sound /sh/

Thus, the word is "fish."

Auditory sequencing
Auditory sequencing is the ability to remember or reconstruct the order of items in a list or the order of sounds in a word or syllable. Example: Saying or writing "ephelant" for "elephant.

Auditory blending
Auditory blending is the process of putting together phonemes to form words. Example: The individual phonemes "c", "a", and "t" are blended to from the word, "cat".

Auditory Memory
Ability to receive, process, store, and recall auditory information.
May not be able to follow instructions given verbally or may have trouble recalling information from a story read aloud.

Auditory Discrimination
Ability to distinguish between sounds and words that are similar.
Example: Do you have the car keys?" You may hear that sounding like "Do you have the tar teys?

http://www.ldonline.org/multimedia

Auditory Attention ability to maintain focus

and concentration during listening tasks
Example:There will be a test in two days," and some children next to the child with auditory selective attention difficulties said, "Lets get together tomorrow and study," the child with the APD attention problem may process the message as "There will be a test tomorrow, so study.

Auditory Temporal Processing ability to analyze the timing and pattern of sounds Compare the two utterances: "The cat sat" vs.. "The cats at Sound Localization ability to identify the source of sound

Identification
Multidisciplinary Team Approach:
-Parent (behavior concern)
-Teacher (academic difficulties) -Psychologist (cognitive functioning) -Speech-Language Pathologist (written and oral language)

Audiologist:
-Series of Tests ( identify possible processing problems)

Possible Causes of ADP

Recurrent ear infections (most common) Middle ear fluid Pregnancy complications Labor and delivery complications Genetics Lead, mercury and other environmental poisons Exposure to loud sounds and toxic noise Auditory deprivation Brain trauma

Early Intervention
Newborn testing Early diagnosis:
-intervene before low self-esteem -plasticity in CAP

Music for Babies (Mozart)

Treatment
Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD. The type, frequency, and intensity of therapy, like all aspects of APD intervention, should be highly individualized and programmed for the specific type of auditory disorder that is present.

Interventions/Strategies
Write down instructions Use lists Teach note-taking Use mnemonics Repeat or rephrase information to your child Ask for your child to repeat the information back to you Use visual and tactile cues whenever possible Eliminate competing sounds Reading aloud Use graphic organizers Play games that require auditory inputs Play charades, hangman, and scavenger hunts Listen to nature sounds and identify their location Learn to play the piano Teach active listening and whole body listening skills Use short simple verbal information

Environmental Modifications

Auditory Trainers Mode of delivery of information Reduce background noise Seating, classroom acoustics Familiarity Tape record classes Visual aides Repetition Ear plugs

Remediation
Direct therapy to train specific auditory and listening skills to change the way the brain processes auditory information.

Computer assisted One-on-one training with therapist Rhyming games (phonological awareness) Auditory discrimination (telling the difference between peas and bees) Sorting games can help build auditory memory Tomatis Method (auditory stimulation)

Compensatory Strategies
(strengthen central resources to help overcome APD)

Take responsibility through active listening and problem solving techniques

Language building skills

Classroom Strategies

Sit close to the teacher in a quieter area of the room with minimal distractions Try an assistive listening device Make instructional transitions clear Allow your child to have notes from the teacher or another student Pre-teach information(familiarity)

Suggestions for Parents

Remember home and school are different Dont expect the same type of focused effort at home ( relax) Encourage strengths Know weaknesses Understand education system

Helpful Books
Like Sound Through Water: A Mother's Journey Through Auditory Processing Disorder By: Karen J. Foli, Edward M. Hallowell, MD Parenting a Child With Sensory Processing Disorder: A Family Guide to Understanding & Supporting Your Sensory-sensitive Child By: Christopher R. Auer, Susan L. Blumberg Teaching Students With Language and Communication Disabilities By: S. Jay Kuder When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder By: Teri James Bellis

Web Sources
National Center for Learning Disabilities: http://www.ncld.org http://thelearningcenter.net/visual_perceptual_disabilities

www.asha.org/public/hearing/disorders/understand-apd-child.htm
http://www.ncapd.org/php/index.php?menuoption=step5 http://www.nidcd.nih.gov/health/voice/auditory.asp http://www.psychology.org/
http://www.ldonline.org/glossary http://www.dyslexia-australia.com.au/What%20they%20see.htm http://www.ualberta.ca/~jpdasddc/das_research/cogart.html http://www.articlesforeducators.com/dir/learning_disabilities/understanding_the_brain.asp http://jarmin.com/demos/course/dyslexia/03-1b.html

References
Greenberg, J. et al (1998). Chuck close up close. New York, NY: DK Publishing. Heine, C., & Slone, M. (2008). The Impact of Mild Central Auditory Processing Disorder on School Performance During Adolescence. Journal of School Health, 78(7), 405-407. Hoover, J. et al (2008). Methods for Teaching Culturally and Linguistically Diverse Exceptional Learners. Upper Saddle River, NJ: Pearson Education, Inc. Howard, A. (2007) Coding for learning disabilities. For The Record, Vol. 19 No. 15 P. 43 Rosenthal, W. (1972). Auditory and linguistic interaction in developmental aphasia: Evidence from two studies of auditory processing. Papers and Reports on Child Language Development, No. 4.
Ross-Swain, D. (2007). The Effects of Auditory Stimulation on Auditory Processing Disorder: A Summary of the Findings. International Journal of Listening, 21(2), 140-155.

Turnball et al., A. (2007). Exceptional Lives: special education in todays schools. Upper Saddle River, NJ: Pearson Education. West, T. G. (1997). In the mind's eye. Amherst, NY: Prometheus Books.