Auditory Processing

Auditory Processing Disorder (APD) can be a controversial diagnosis with some researchers and clinicians rejecting the notion that it even exists. However, the American Speech and Hearing Association clearly supports the existence of the diagnosis and states that intervention should begin as soon as possible to take advantage of early neural plasticity to thwart long-term negative effects (http://www.asha.org/policy/PS2005-00114/).  

Simplified, the idea is that a child is able to hear (peripheral auditory system) sounds perfectly well, but the brain is unable to accurately process sounds.  This results in a constellation of ​symptoms such as having difficulty hearing subtle differences between sounds, which impedes a child's ability to both learn language initially and distinguish sounds that are critical components of literacy development. Thus, these children can have difficulty learning nursery rhymes, may not remember what has been said and struggle to follow along in conversations.  As the child develops, symptoms compound into downstream challenges, typically in both language and literacy.

While a speech-language pathologist can assess receptive language, phonological processing, and other cognitive skills, an audiologist must provide an auditory processing diagnosis.

Deficits in auditory processing may involve a two-pronged approach including top-down and bottom-up interventions.  Therapeutic interventions to compensate for difficulties in auditory processing as well as interventions to enhance cognitive and linguistic weaknesses fall in the top-down approach category. For example, a child who demonstrates a phonological processing disorder will have difficulty understanding the sound system of language.  This is perhaps the most critical skill for the development of literacy.  In such cases, children's phonological skills will be targeted and strengthened through functional activities that are evidence-based and proven to improve phonological skills.   Further, caregivers are taught to engage their children in simple games that occur in the context of daily life to seamlessly improve their child's function in fun, non-stressful ways.  

Older children should take advantage of compensatory strategies such as preferential seating in the classroom. Other symptoms such as sustaining attention and understanding directions can be challenging for children with an APD diagnosis.  Numerous compensatory strategies exist and can be taught to both caregivers and educators to scaffold attention and receptive language while interventions are directed at improving attention and language.  In addition, treatment should be directed at secondary manifestations of the disorder, typically higher order language skills and reading.

The bottom-up approach addresses the underlying causes of auditory processing disorder.  An early study by Wright et al., (1997) demonstrated that auditory processing is far poorer in children with language and literacy problems compared to non-impaired children.  This suggests that if basic processing of auditory stimuli can be strengthened, a downstream improvement in language and literacy could occur.  Although somewhat controversial, bottom-up methods to improve auditory processing do exist.

If you suspect your child has and auditory processing disorder, please call for recommendations for local audiologists specializing in diagnosis.