Auditory Processing Disorder
Raymond Shred, PhD
One of the running jokes in my family is that whenever someone says something like, “Did you hear . . .?” the other person answers, “What?” We try and catch each other off guard and get them to repeat themselves. While this is fun for us, it is no fun having a hearing loss or a problem that interferes with understanding what is being said to you.
Auditory Processing Disorder (APD) is a listening problem rather than a hearing problem. To diagnose an APD, the first step is to rule out a hearing loss. An APD often manifests itself as difficulty in discriminating between different speech sounds. For example, some people (children or adults) hear “thing” when “sing” is spoken.
Auditory Processing problems may be the result of problems with the muscles involved with hearing. We need to stretch and relax the muscles that control the tympanic membrane (i.e., the eardrum) and other structures in our ears in order to discriminate between sounds. You can demonstrate this by tightening or loosening the top of a drum – you get sharper or duller sounds depending on how much the skin is stretched. The ear can be retrained to make the missing distinctions if given appropriate practice. This tends to work better with younger children.
To assess auditory processing, I use a test that takes about ½ hour to administer. It looks at several listening skills: 1) the ability to make discriminations between speech sounds when some of the lower frequencies are filtered out; 2) the ability to make discriminations between speech sounds when there is competing background noise; and 3) the ability to make discriminations between speech sounds when there are two competing sources of speech sounds.
An APD can be an underlying reason for reading or spelling problems. It would be very hard to learn how to spell words beginning with a “th” or an “s” if those sounds appear to be identical to you. Similarly, learning how to pronounce two words like sing and thing would be difficult for someone who cannot tell the difference between the sounds. It would be hard to figure out how to say or understand new words that begin with “th” and “s.”
When I have diagnosed an Auditory Processing Disorder and the child has received appropriate treatment, I have seen major gains in their reading levels, when the APD was the reason for the problem. In one case, the young boy went from a beginning Grade 1 reading level in late March of his Grade 3 year to being at the end of Grade 3 level in June. His teacher could not understand why he was having problems because he seemed very bright and he worked really hard. Everyone was pleased when the hard work paid off.
Auditory Processing problems can also lead to behaviours that look very much like Attention Deficit Hyperactivity Disorder (ADHD). A child who tries to listen in a classroom setting but who is not successful will quickly give up. Not being able to follow what the teacher is saying, the child may then be distractible and engage in “off-task” behaviours.
Caregivers (teachers, parents, and others) need to know to address the child with an APD directly (i.e., face to face). They need to ensure that the child has understood the intended message. The child should be asked to repeat what they were asked to do if there is any question about whether they understood. There are remedial programs available for Auditory Discrimination training that can be used with children. They are computer-based and relatively inexpensive.
It is important to distinguish between ADHD and APD because the treatment options are very different. As many people are aware, the symptoms of ADHD can often be improved or eliminated with a method such a Cogmed Working Memory Training. Stimulant medications such as methylphenidate may help as well. However, an APD is best treated with a combination of education and remediation. Of course, it is possible for a child to have both ADHD and APD and they may benefit from treatment for both.
There is an organization that can provide more information for parents, teachers, and health care providers: National Coalition on Auditory Processing Disorders. It can be accessed on the internet at: http://www.ncapd.org
Dr Raymond Shred
Nanaimo, British Columbia
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