WHAT WE DO
Auditory Processing
Simply put auditory processing is what we do with what we hear. As sounds enter the ear they travel through the outer ear to the middle ear and then to the inner ear. This is known as our peripheral hearing. If there is a difficulty in one of these three areas the individual is considered to have a hearing loss in the traditional sense.
After leaving the inner ear they enter the lower part of the brain and then finally to the higher centers of the brain where language processing occurs. The area prior to this language processing is responsible for determining the loudness, timing, intonation, and frequency of sounds. This processing must be correct for the higher centers to correctly interpret what is heard.
Children with central auditory deficiencies are generally youngsters with normal hearing in the usual sense. That is, they usually have the ability to hear very faint sounds (normal hearing sensitivity). So their hearing test results say "normal hearing". They usually have normal or above normal intelligence. They simply cannot use auditory information efficiently and may not learn well by listening alone.
In general, children with auditory processing deficits typically demonstrate one or more of the following problems:
1. Poor auditory attending skill-trouble paying attention to what they need to hear.
2. Deficits in foreground /background discrimination ability (also called a deficit in figure/ground or integration problem)- difficulty listening to, or maintaining attention, speech that is delivered in a complex environment, like with noise in the background, speech that is not spoken clearly, or speech that is delivered in a "busy" environment with many visual and auditory distractions.
3. Limitations in auditory memory and retrieval.
4. Delays in receptive auditory language development.
5. Problems in telling the difference between similar sounding words like "mat" and "map".
A child who displays any of the above characteristics should undergo a hearing test; if results indicate normal hearing, a battery of other tests (including electrophysiological testing if needed) can be administered to determine whether a central auditory processing disorder exists. Many basic skills are necessary to understand spoken language and to make use of what was heard. These include, but are not limited to, auditory memory, auditory sequencing, auditory attention, auditory closure, and auditory discrimination. Some of the skills are inter-related. An auditory processing test battery generally examines several of the skills, but usually does not assess all of them. Speech and language tests, along with psycho-educational and ADHD testing, may also examine some of these skills. Sometimes the names of these abilities vary from test to test. Recent research suggests that a deficit in more than one of these areas is usually the case.
The child with auditory processing difficulties generally has problems with several specific auditory skills, and may perform below age and/or grade level on auditory processing tests if the appropriate skills are examined. Performance on these tests generally improves with age (up to a point), as the central auditory nervous system (parts of the brain that handle auditory information) matures. It is possible that the child may eventually "catch up" and achieve age-appropriate test scores. Regardless of the test scores, it is likely that the child's academic performance can be improved through the use of special teaching techniques and activities.
TAKE NOTE:
Many children with auditory processing difficulties have significant difficulty hearing in the presence of background noise.
Typical Behaviors of Children with Auditory Processing Problems
1. Most are male (75%).
2. They have normal pure tone hearing thresholds (i.e., normal "peripheral" hearing).
3. They generally respond inconsistently to auditory stimuli. At times, they seem unable to follow auditory instructions.
4. They have short attention spans and fatigue easily when confronted with long or complex activities.
5. They are distracted by both auditory and visual stimulation. Brutten et al describe these children "as being at the mercy of their environment." Unable to block out irrelevant stimuli, they must respond immediately and totally to everything they see, feel, or hear, no matter how trivial. According to Rampp and Plummer, in a survey of 174 children with auditory processing disturbances, 90% were hyperactive.
6. They may have difficulty with auditory localization skills. This may include an inability to tell how close or far away the source of the sound is, and an inability to differentiate soft and loud sounds. There have been frequent reports that these children become frightened and upset when they are exposed to loud noises, and often hold their hands over their ears to stop the sound.
7. They may listen attentively but have difficulty following long or complicated verbal commands or instructions.
8. They often request that information be repeated.
9. They are often unable to remember information presented verbally, for both short-term and long-term memory. They may have difficulty in counting or in the alphabet, or remembering the days of the week and months of the year, or addresses or phone numbers.
10. They may have difficulty with the rhythm of speech.
11. They have normal intelligence.
Fact:
Comorbidity, or co-existence, of attention deficit (hyperactivity) disorder (ADD), Auditory Processing Disorder (APD), Asbergers and/or a speech-language deficit is the rule and not the exception.. If there is another diagnosis present it should be addressed first since state law does not at this time allow direct services in the school environment for and APD diagnosis.
A child who displays any of the above characteristics should undergo a hearing test; if results indicate normal hearing, a battery of other tests (including electrophysiological testing if needed) can be administered to determine whether a central auditory processing disorder exists. Many basic skills are necessary to understand spoken language and to make use of what was heard. These include, but are not limited to, auditory memory, auditory sequencing, auditory attention, auditory closure, and auditory discrimination. Some of the skills are inter-related. An auditory processing test battery generally examines several of the skills, but usually does not assess all of them. Speech and language tests, along with psychoeducational and ADHD testing, may also examine some of these skills. Sometimes the names of these abilities vary from test to test. Recent research suggests that a deficit in more than one of these areas is usually the case.
The child with auditory processing difficulties generally has problems with several specific auditory skills, and may perform below age and/or grade level on auditory processing tests if the appropriate skills are examined. Performance on these tests generally improves with age (up to a point), as the central auditory nervous system (parts of the brain that handle auditory information) matures. It is possible that the child may eventually "catch up" and achieve age-appropriate test scores. Regardless of the test scores, it is likely that the child's academic performance can be improved through the use of special teaching techniques and activities.
Management of Auditory Processing Disorder:
A comprehensive management approach is necessary when dealing with a child experiencing an auditory processing disorder. Current theory believes the best method of managing a child's listening difficulties involves a combination of compensatory strategies and environmental modifications/accommodations. At times, direct intervention may be recommended. However, this is typically only the case if a language processing disorder is also present. This intervention focuses on specific deficits (such as, difficulty remembering multi-step directions) and teaches compensatory strategies to be used in the classroom. Compensatory strategies are essentially coping skills and repair strategies so the child can best learn auditorally presented information. Lastly, environmental modifications/accommodations (such as, the child studying in a quiet area away from background noise) both at school and home should be implemented in order to enhance the child's weak listening abilities and improve the listening environment.
The preceding information is a very general overview of an appropriate management program for a child with an auditory processing problem. Following are lists of compensatory strategies for school and home use which have been borrowed from the Audiology Desk Reference, Volume 1, by Drs. Gus Mueller and James Hall. These strategies should not be used "generically" for all children, but, instead selected according to each child's specific needs.
CHILDREN WITH CENTRAL AUDITORY PROCESSING PROBLEMS
SUGGESTIONS FOR PARENTS
A child with auditory processing problems seems to hear inconsistently. If your child seems to hear some things, but not others, do not assume he or she is purposely ignoring you.
You will have greater success in communicating with your child if there are no other activities (other children or adults laughing or talking, television or radio playing, dishwasher or vacuum cleaner running, etc.) competing with you.
During communication, learn to control your child's environment by providing a quiet setting. Take the child to a quiet room, shut off the TV, ask others to be quiet for a moment, etc.
Delay important conversation until a quiet time can be found.
Make a point of finding "quiet conversation periods" on a regular basis during the course of each day.
Simplify your language level if your child does not seem to understand.
Try slowing down your rate of speech if your child continues to have trouble understanding. One way to accomplish this is to pause between utterances, especially after your child has finished talking and before you respond.
If you have to repeat something for your child, try saying it in a different way (different words, different type sentences).
Do not try to have discussions when you and your child are in separate rooms.
When conversing, allow the child adequate time to respond.
Your child may need time to rest and recuperate after school. Allow time for relaxation before asking him or her to do chores, homework, and so on.
Read aloud to your child and discuss what you have read.
Praise any accomplishment (academic or otherwise) that represents even small improvements over previous levels. It is not helpful to compare his or her performance to other children.
Suggestions for Teachers
Students with central auditory processing problems will respond to changes in their environment and teaching program in a variety of ways. Some of these suggestions will help some students but of no benefit to others. Some students will appear to be helped by most suggestions; others will be difficult to help, no matter what is tried. The best suggestion is to try these ideas and carefully observe the student to see what works. The goal is to help the student become more comfortable and learn better in his or her educational environment. Parents, administrators, and educational staff can work together as a team in determining what appears to be in the best interest of a particular student.
Reduce Distractions: Avoid extraneous noises and visual distractions, especially when giving instructions and teaching new concepts. Before giving instructions, stand close to the student and call the student's name or touch his or her shoulder to make sure you have his or her attention. Use of the student's name during teaching time will also help hold his or her attention. Traditional classrooms are generally less distracting than open-style classrooms. Reduce motor activities during verbal presentations (i.e., in P.E., avoid giving complicated directions during calisthenics; avoid explanations while student is drawing or coloring).
Preferential Seating: Provide seating away from known auditory and visual distractions such as open windows, pencil sharpeners, doorways, air conditioners, computers, and learning centers. You may have to experiment to find the best location for each student.
Delivery Style: Avoid multiple commands. Presenting instructions in the simplest form possible. Gestures that enhance the message may be helpful, but extraneous gestures and excessive movement while delivering the message may be distracting. Speaking at a slower than normal rate will improve auditory comprehension skills. Speak clearly and at a comfortably loud level, using words within the student's vocabulary. Research has shown that background noise is often equal to or louder than the teacher's voice.
Instructional Transitions: By reviewing past material before beginning new lessons, the teacher will give the student a feeling of success. In addition, the student will be better prepared to assimilate new information. Preassigned readings and home assignments will also help when introducing new concepts and topics. Try to use "pretuning" techniques to focus the student's attention on the subject coming up. Words such as "Listen," "Ready," and "Remember this one" seem to be effective for signaling an important message.
Attenuate Distractions: Sound-attenuating ear muffs and earplugs may help the student tune out distractions during seatwork. If several pairs of ear muffs are made available to the class, the student with auditory processing difficulties will not be singled out.
Visual Aids: Visual aids, including overheads, opaque projectors, and computers may be utilized to supplement the teacher's oral presentations as well as to provide an alternative mode to the auditory channel. Combining the visual and auditory modes of learning may benefit all students in the classroom. Written instructions may be provided in conjunction with verbal instructions to aid the student in following directions.
Auditory Exhaustion: Students with auditory processing problems tend to fatigue or exhaust more easily due to the external distractions of the classroom. Teachers may want to consider special adaptations to allow for this fatigue. These might include avoiding demanding auditory tasks when the student is already fatigued. This might be accomplished by presenting auditory tasks early in the day or by alternating lessons requiring a higher amount of auditory processing with less demanding study periods. Physical activity can be used for reduction of the stress. Keeping such a child in from recess should be used with caution.
Check Comprehension: The teacher should watch for signs of inattention, decreased concentration or understanding. Instructions may need to be repeated and/or simplified for the student. To check for understanding, the student should be asked to repeat the instructions in his or her own words. Besides being a good check, this will also improve his/her listening habits since the student knows he or she will be expected to do this occasionally. To help with reading comprehension, the student may be allowed to subvocalize while reading until such time as this is unnecessary.
Be Supportive: Many students with auditory processing problems experience a lack of self-confidence or diminished self-worth due to comparisons made by self or others concerning their performance versus classmates. Demanding performance that is comparable to other students is not recommended. Professionals working with the student should reinforce all work performed successfully to help alleviate this problem.
Buddy System: A buddy system can be started by having one student, who appears to be strong in auditory processing, help the student who is having difficulty. Various methods may be tried to find what seems to be the most beneficial. Assistance may include note-taking, assistance with instructions, small group projects, and tutoring.
Classroom Adaptations: Class lessons or instructions can be recorded so the child can hear the material again at a later time. Mild amplification might be used to assist the student in attending to the teacher. This should be done with caution, and only with the assistance and supervision of an audiologist. The classroom may be sound treated to reduce the background noise by adding drapes, carpets, and sound-absorbing materials. The teacher may wish to structure the classrom in a more traditional format to reduce background distractions. Written directions and assignments should be given, along with verbal instructions. The student should be encouraged to ask for repetition of instructions, if needed. When repeating instructions, rephrase and reword the instructions. Verbal information should be presented in a brief, concise, and clear fashion. Another compensatory practice would be teaching the student good note-taking skills. Small group and individual instruction is very helpful whenever possible.
Strategies for Dealing with the CAPD Child at Home
SUGGESTIONS FOR THE HOME
Limit extraneous noise.
During homework: provide a quiet place, ear muffs, turn TV and/or radio off, limit visual distractions.
Your child will have greater success communicating if there are no other activities going on (children/adults talking, TV, radio, vacuum cleaner, dishwasher). This kind of noise seriously interferes with your message regardless of how hard your child attempts to listen. Listening under these conditions is simply more difficult for a child with CAPD compared to others.
Control your child's environment by making it quiet by any means available. (Take child to quiet room, shut off TV, ask others to be quiet.) If you cannot control the auditory environment, it is better to delay conversation.
Members of the family should make a point of finding quiet conversation periods on a regular basis during the day.
Don't attempt to talk from another room or when your child is preoccupied with other thoughts or activities.
Using ear plugs in car often settles children.
Put structure in your child's life. With knowledge of what to expect, your child will be better able to anticipate speech content.
Set controls on daily activities. Structure all activities so that your child has fewer opportunities to be confused.
Have daily routines, a schedule. Your child will perform better if he or she knows what to expect.
In disciplining your child, be sure to indicate what specific behavior is being punished and why.
Be certain you avoid punishing a behavior which your child could not help. It is important to set enforceable and realistic rules.
When reprimanding, choose a time when you have your child's attention. Make sure your child knows exactly why he or she is being reprimanded. Also, do this in private so you don't embarrass your child and damage your child's self-esteem and self-image.
Other
Use simple language, shorter words and short sentences, and state one idea at a time. Get your child's attention first, either by saying his or her name or by touching him or her. Children may also attend better if from time to time they repeat back the instructions. In this way, the adult can also monitor where the message may have broken down and then repeat the parts the child missed. Do not ask, "Did you hear me?" Rather, ask specific questions about the instructions.
Move on to areas of new learning gradually so that your child knows what is expected of him or her and what is coming next. Review the areas that your child knows.
Multiple-part directions instructions should be given one part at a time with a slight pause (long enough for the adult to mentally repeat each part back to him- or herself) in between the parts to allow your child time to receive the message and comprehend each part.
Put the person speaking on the side of your child's "strong ear."
Conversations at the dinner table may be difficult for your child. Make sure that your child is a part of the conversation.
You may wish to write important chores or instructions on a blackboard.
For now, settle for limited success by praising often any accomplishment that represents an improvement over your child's previous levels.
Visual tasks may be your child's strongest ability and visual cues should be used whenever possible to supplement auditory understanding.
