Recent years have seen considerable interest in Auditory Processing Disorder. Here, Catherine Routley explains what it is and how classroom practitioners can support children who are affectedAuditory processing is described by Katz, Stecker & Henderson (Central auditory processing: a transdisciplinary view) as ‘what we do with what we hear’.
For children with Auditory Processing Disorder (APD) this seemingly simple process is disrupted. The core problem of APD is an inability of the brain to decode language; it is not a problem with the actual hearing mechanism, the outer, middle, or inner ear. An auditory processing difficulty is suspected when hearing is tested and proves to be within the normal range but those being tested cannot understand the sounds they are hearing.
This inability to decode language appropriately can result in difficulties in the classroom such as poor receptive and expressive communication skills. These, in turn, create problems accessing the wider curriculum.
Although APD can be present in early childhood it moves to the fore as the curriculum becomes more demanding. The young child who doesn’t want to listen to storytime, who would rather play with puzzles or watch videos than interact, who covers their ears when music is played, can develop into the school child who needs many repetitions to remember new concepts, has weak comprehension and can’t remember simple instructions.
There is no firm evidence as to how many children have APD. Estimates range from five to ten per cent. Much of this variance is the result of different diagnostic methods, the consequence of there being no agreed diagnostic ‘gold standard’.
Terri Bellis, a leading authority on APD, argues that only an audiologist can provide an accurate diagnosis of whether or not a child has the condition. Others, such as David DeBonis, question whether an audiological approach is sufficient, calling instead for tests that emphasise executive functioning and cognitive skills. Bellis, in fact, accepts the benefits of a multi-disciplinary approach, with input from teachers, psychologists, and speech and language therapists, but with an important caveat.
As he explains in an article on the ASHA (American Speech Language Hearing Association) website:
Some of these professionals may actually use test tools that incorporate the terms “auditory processing” or “auditory perception” in their evaluation, and may even suggest that a child exhibits an “auditory processing disorder”. Yet it is important to know that, however valuable the information from the multidisciplinary team is in understanding the child’s overall areas of strength and weakness, none of the test tools used by these professionals are diagnostic tools for APD, and the actual diagnosis of APD must be made by an audiologist.
APD and other special needs
One of the difficulties with diagnosing APD is that it is easily confused with a range of other special needs such as dyslexia, ADHD, ASD, and Sensory Processing Disorder. Hence careful diagnosis is needed to ‘tease out’ the main presenting need. There is no argument that pupils with dyslexia, ADHD, ASD etc 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, for example, 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 needing 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 overlearning.
- Requiring 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 when responding to questions.
Helping pupils with APD
The important issue when helping pupils with APD is to remember there is no ‘one size fits all’ solution. Difficulties can be present in one or more of these areas:
- Auditory discrimination (difficulty in comparing and distinguishing separate sounds, i.e eight and eighteen may sound alike).
- Auditory figure ground (inability to disregard background noise, thus focusing 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.
- Remember that extra processing time is needed.
- Ask the student to repeat back instructions silently to themselves or to you.
- Maintain structure and routine so directions are predictable.
- Frequently summarise and emphasise key information vocabulary and topics.
- Chunk information.
- Present directions in short segments, using visual cues if possible.
- Provide written homework instruction.
- Remember extra time may be needed for task completion.
- Ensure the student is seated in an advantageous position in the class, i.e. away from obvious noise.
- Ensure the student is aware of upcoming vocabulary and topics.
- Write key words on the whiteboard.
A quiet environment is essential for all pupils, especially those with any degree of learning difficulty. Competent class control to ensure internal noise is kept to a minimum is vital. Use of Soundfields systems, Hushh-ups placed on chairs, and the use of acoustic board are all useful. There is a tendency to prescribe individual FM systems that transmit the speaker’s voice through an amplifier to the listener. However, research by Lemos et al failed to find, ‘strong evidence supporting the use of personal FM for APD intervention’. Individual FM systems also have the disadvantage of reinforcing a child’s difficulty and risk isolating them from their peers.
Direct intervention programs such as Fast ForWord, or music programs such as The Listening Program, 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.
Having worked with many pupils diagnosed either with APD or APD-like symptoms, interventions concentrating on individual need, although time consuming, 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.
Encouraging independent learning
Schools have an important role to play in helping pupils with APD become independent learners and to help them to develop suitable learning strategies. These include:
- 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 of the class with a clear view of the instructor.
- Using written reminders or lists to compensate for auditory memory problems.
- Always writing down appointments to avoid confusion.
- Asking for background noise, such a music, to be turned down or off.
- Using a voice recorder as an aide-memoire.
- Using a personal visual timetable.