Auditory Processing Disorder (APD) is a diagnosis that has been around for a number of years but has gained a large amount of interest over the last 5 years. This post aims to demystify APD, help you spot a child in your class that may be at risk and give you some ideas and strategies to help you support children with APD.
Children with APD often present with:
Difficulties hearing against background noise especially cutting out other voices when listening to the teacher.
Difficulties with discriminating sounds.
Finds it hard to localise sounds so they may not know where a sound has come from.
Attention levels in class are poor especially when in a listening task.
Ignoring or mishearing instructions.
Often these can be caused by other diagnoses such as Developmental Language Disorder (DLD), Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Conditions (ASC) for example.
How do we know if it’s APD?
As it often co-occurs with other disorders, we should be cautious in giving a diagnosis of Auditory Processing Disorder.
Only a few specialist centres in the UK can give a full diagnosis
Using the term Auditory Processing Difficulties seems more useful as we can talk about a child having DLD with additional Auditory Processing difficulties if some of the indicators cannot be explained by the original diagnosis.
How is a child diagnosed with APD?
A child will have had to have been seen for a hearing assessment to have hearing difficulties ruled out before being assessed for Auditory Processing Difficulties. This is not to say that a child with a hearing loss would not have additional processing difficulties. In fact the opposite is true, a child who has been exposed to a low level of auditory stimulation whilst in the early years due to glue ear or a conductive loss is more likely to have auditory processing needs in the future.
A specialist SLT would be able to assess a child for Auditory Processing Difficulties, they would look at child’s language levels, observe in class and then do some formal and informal assessments specifically looking at a child’s ability to process auditory information. Specialist audiologists can also assess for Auditory Processing difficulties and may work alongside an SLT to help inform a diagnosis.
What are the different types of APD?
Auditory Decoding Deficit
Left hemisphere difficulties
Difficulties hearing in background noise
Difficulties with language (grammar, vocabulary, comprehension)
Difficulties with phonics (sequences of sounds, discrimination of sounds)
Usually stronger Left ear for listening tasks (pathways cross from ear to brain)
Right hemisphere difficulties
Difficulties singing in tune or copying a rhythmic pattern
Misinterprets humour or tone of voice
Finds reading comprehension difficult
Usually stronger Right ear for listening tasks.
Inefficiency of the corpus callosum
Difficulty doing 2 things at once e.g. listening and writing
Difficulty picturing what the teacher describes
Difficulty connecting speech sounds with intonation
How can I help children with APD?
There are general management strategies you can do to help a child you suspect may have Auditory Processing Difficulties in your classroom:
Position the child toward the front of the class if possible.
Call the class to attention and ensure it is quiet before giving instructions. Other voices are especially difficult to cut out when listening to instructions.
Encourage eye-contact when listening (this may be uncomfortable for some children so be careful)
Reduce background noise where possible. Don’t underestimate the noise of a seemingly quiet object. A girl in Year 10 with APD could hear the noise of the whiteboard projector when the teacher was talking and so could not sit directly under it.
Be prepared to repeat what you say. Also go over any important points from assemblies with children. A year 6 boy with a diagnosis of APD admitted that he had heard nothing in assembly since he arrived at the school 4 years previously.
Pause regularly when speaking.
Use an animated speech style. My colleagues often say that I can sound like a CBeebies presenter during groups! An animated speech style helps children with APD listen and pick out key words due to emphasis.
How can a speech therapist help?
There are also specific ideas to help with children who have been assessed for APD, please contact your SLT for advice on these. They include:
Own-voice work. A child may do some work with an SLT using a dictophone so they hear their own voice back, this has been shown to be affective in working on intonation patterns and speech sound difficulties that have been resistant to therapy.
Multi-tasking of skills – Once a child is able to use a skill in class, (e.g. a times table or a speech sound) but doesn’t use it generally or forgets easily; try getting them using it whilst doing another task, e.g. balancing on a balance board, passing a bean bag behind their back, hopping from one foot to another.
An SLT may also recommend a specific sound therapy for the child, this may involve them listening to auditory stimulation via headphones every day for a number of weeks. These programs are designed to help stimulate the underlying processes involved in listening.