Auditory Processing Disorders: An Overview (continued)

What does the audiologist do?

The audiologist assesses the peripheral and central auditory systems using a battery of tests, which may include both electrophysiological and behavioral tests. Peripheral hearing tests determine if the child has a hearing loss, and, if so, the degree to which the loss is a factor in the child's learning problems. Assessment of the central auditory system evaluates the child's ability to respond under different conditions of auditory signal distortion and competition. It is based on the assumption that a child with an intact auditory system can tolerate mild distortions of speech and still understand it, while a child with APD will encounter difficulty when the auditory system is stressed by signal distortion and competing messages (Keith, 1995). The test results allow the audiologist to identify strengths and weaknesses in the child's auditory system that can be used to develop educational and remedial intervention strategies.

How should test results be interpreted?

As with any kind of evaluation, test results should be interpreted with caution. The effects of neurological maturation may influence test results for children under the age of 12 years. A true diagnosis of APD cannot be determined until that time (Bellis, 1996). However, there are much younger children whose auditory behaviors, language, and academic characteristics indicate that APD is a strong possibility, and even without a formal diagnosis, these children would benefit from intervention. Remediation should address their strengths and areas of need based on available speech-language and psychoeducational testing.

Is there a relationship between APD and ADHD?

The behaviors of children with APD and ADHD may be very similar, especially with regard to distractibility. Given what is presently known, APD and ADHD do not appear to be a single developmental disorder. Each can occur independently, or they can coexist. This is a prime example of where the team approach to evaluation is critical, as the team can rule out the presence of ADHD or determine its contribution to the potential educational impact on the child.

What can be done to help children with APD in the classroom?

Traditional educational and therapeutic approaches can be employed to remediate areas of need in language, reading, and writing. Many techniques that have shown to be effective with children with APD would be beneficial to all children, with and without APD, if the strategies employed are specific to the child's areas of need (Bellis, 1996; Chermak & Musiek, 1997; Sloan, 1998). Some of these are described below:

• Modify the environment by reducing background noise and enhancing the speech signal to improve access to auditory information:
  • Eliminate or reduce sources of noise in the classroom (air vent, street traffic, playground, hallway, furniture noises, etc.).
  • Use assistive listening devices (ALDs) such as a sound field amplification system or an FM auditory trainer.
  • Allow preferential or roving seating to ensure that the child is seated as close to the speaker possible.
  • Allow the child to use a tape recorder and/or a peer notetaker.
  • Ensure that the speaker gets the child's attention before speaking, and considers using a slower speaking rate, repeating directions, allowing time for the child to respond to questions, pausing to allow the child to catch up, and presenting information in a visual format through overheads, illustrations, and print.
• Teach the child to use compensatory strategies, "meta" strategies, or executive functions to teach how to listen actively. The child should:
  • Learn to identify and resolve difficult listening situations.
  • Develop skills to understand the demands of listening: attending, memory, identifying important parts of the message, self-monitoring, clarifying, and problem solving.
  • Develop memory techniques: verbal rehearsal (reauditorization), mnemonics (chunking, cueing, chaining).
  • Encourage use of external organizational aids: checklist, notebook, calendar, etc.
  • Develop vocabulary, syntax, and pragmatic skills to facilitate language comprehension.

• Provide auditory training to remediate specific auditory deficits:
  • Children who have poor reading, writing, and spelling skills may benefit from phonological awareness activities.
  • Auditory closure activities may assist children in filling in or predicting the information they are listening to in the classroom and conversations.
  • Instruction in interpreting intonation, speaking rate, or vocal intensity, and in the relationship between syllable and word may assist children in determining important parts of the message.
  • When the child has demonstrated success on the above tasks in a quiet environment, give the child practice engaging in the same tasks in an environment that includes background noise.
  • Explore the use of commercially available computer programs designed to develop the child's attention to the phonological aspects of speech. These should be recommended by a professional who can determine their applicability to the child's needs.

Resources

American Speech-Language-Hearing Association. Task Force on Central Auditory Processing Disorders. (1995). Central auditory processing: Current status of research and implications for clinical practice. Rockville, MD: Author.