Auditory Processing – is it a valid diagnosis?

In recent years there has been a considerable amount of interest in Auditory Processing Disorder (APD) Stecker explain it as ‘what we do with what we hear’ (1992). The main problem with APD is the inability of the brain to decode language, it is not a problem with the actual mechanism of the hearing process, the outer, middle, inner hear. When hearing is tested and proved to be in normal limits but understanding of the sounds is not present, an auditory processing difficulty is often suspected.

Although it resembles a hearing loss in its presentation – inability to decode language appropriately in the classroom as results  in  poor receptive and expressive communication skills, resulting in problems with curriculum access.

Although APD can be present in early childhood it comes to the fore as the curriculum becomes more demanding, the young child who doesn’t want to listen to story time, would rather play with puzzles or watch videos than interact, covers ears when music is played can develop into the school child who needs many repetitions to remember new concepts, has week comprehension, can’t remember instructions, poor vocabulary

There is no firm evidence as to how many children have APD, figures can vary from between 5 to 10% much of this due to the method of diagnosis, of which there is no actual ‘gold standard’.

Terri Bellis a leading authority on APD, believes that it is only an audiologist who can provide a true diagnosis of whether or not APD is the cause of the child’s problem by using an audiological approach to the diagnosis.  This has been disputed by amongst other i.e. DeBonis (2015) believes that the presentation of a variety of sounds by an audiologist is insufficient evidence for a diagnosis and has called for testing which emphasis on executive functioning and cognitive skills.  However, this approach also has critics in that it raises the question – what are you testing, cognition, memory or simply listening skills. ?

APD and its existence with other special needs

One of the difficulties with APD is its being confused with a range of other special needs such as dyslexia, ADHD, ASD, Sensory processing disorder. And careful diagnosis is needed to ‘tease out’ the main presenting need.  There is no argument that pupil with Dyslexia, ADHD, ASD can present with difficulties which would point to APD but with true APD the cause is an inability to process what people are saying whereas with ADHD there’s an underlying issue with focus.     

APD in the classroom

The presentation of APD in the learning environment has been well documented and includes:

  • Difficulty in listening in noisy environments
  • Frequently needs to ask for repetition or clarification;
  • Difficulty with oral and written expression;
  • Difficulty making inference;
  • Poor reading comprehension;
  • Sequencing problems;
  • Paucity of vocabulary;
  • Forgetting information despite over learning;
  • Requires increased processing time to respond to questions and to complete written tasks
  • Difficulty understanding speech in noisy environments;
  • Difficulty following directions;
  • Difficulty discriminating between similar sounding speech sounds and numbers
  • Need for Extra processing time responding to questions

Helping a Pupil with APD – Strategies

The important issue when helping pupils with APD is to remember there is no ‘one size fits all’         method.  Difficulties can be present in one or more of these areas

  • Auditory discrimination (difficulty to compare and distinguish separate sounds. i.e eight and eighteen may sound alike)
  • Auditory figure ground (inability to disregard background noise, thus focus on the speaker is a problem)
  • Auditory memory (forgetting information despite overlearning)
  • Auditory sequencing (difficulty in recalling order of sounds and words)

There are four strands to assisting a pupil with APD, which are also helpful for others with any degree of learning difficulty

1. Teacher strategies

  • Remembering that extra processing time is needed
  • Asking the student to repeat back instructions silently to themselves or to you
  • Maintaining structure and routine so directions are predictable.
  • Frequently summarising and emphasising key information vocabulary and topics
  • Chunking information
  • Presenting directions in short segments, using visual cues if possible.
  • Providing written homework instruction
  • Remembering extra time may be needed for task completion
  • Make sure pupil is seated in an advantageous position in the class, i.e. away from a noisy corridor
  • Ensuring the student is aware of upcoming vocabulary and topics
  • Providing written homework instruction
  • Writing key words on the whiteboard

  2. Classroom modifications

A quiet environment is essential for all pupil, especially those with any degree of learning difficulty. Competent class control to ensure internal noise is kept to a minimum is essential.  Use of sound field system, hushups placed on chairs and acoustic board are all useful. There is a tendency to prescribe individual FM system  which bring the speaker’s voice through an amplifier/type ofx hearing aid to the listener. However, research by Lemos (2009) concluded, “strong evidence supporting the use of personal FM for APD intervention was not found”. This also has the added disadvantage of reinforcing the child’s difficulty and risking isolation from peers

3. Individual strategies

Direct intervention programs such as ‘Fast Ford Word’, or music programmes such as the ‘Listening Intervention Programme’, promise great improvements in listening and concentration.  Despite the attraction of a ‘easy fix’, it is questionable whether they (a) have any positive effect on children’s overall language and learning abilities (b) take into account the individual’s needs (c) make learning transferable to the classroom.

There is not just one type of APD and intervention strategies need to be focused on individual need and, although these are  time consuming do  provide a valuable alternative.  These would include practice in

  • Following instructions
  • Remembering information from text
  • Drawing from a description
  • Working memory
  • Extending vocabulary
  • Identifying the main idea in a piece of text
  • Recall from listening exercises
  • Practice in inferencing
  • Prompt cards/story bubbles for story writing
  • Identifying the important words in a sentence

4. Encouraging independent learning

The school have an important role in helping the pupil with APD to become an in dependent learner and to help him develop strategies including:

  

  • Using the practice of rephrasing what someone says to halt the conversation and using that time to better process what was said and think of a response;
  • Asking speakers to repeat or clarify utterances;
  • Remembering to sit in an advantageous position, i.e. near the front with a clear view of instructor
  • Using written reminders or lists to compensate for oral  memory problems;
  • Always writing down appointments to avoid confusion;
  • Asking for background noise, such a music, to be turned down or off;
  • Asking for a copy of the presentation notes