TBy Susan Yaff e-Oziel, M.M.S., CCC-A

Do You Hear What I Hear?Understanding Auditory Processing Disorder

The easiest way to commu-nicate with your child is to say something and wait for a reply, right? That is unless your child has an auditory processing disorder, an often misunderstood prob-lem. If that’s the case, she may hear you, but certain words may sound muffl ed or drowned out by other noises in the room, or some words may sound like other words and make your remarks meaningless to her. When that happens, you might suspect that she isn’t paying attention or is just being diffi cult. You might even think that she has a hearing loss. In many cases, you may suspect her of having low intelligence or not caring about what you say to her.

Some children with auditory processing problems often have diffi culty sounding out words, they may be sensitive to sounds or have diffi culty remembering

what they are told, and they may get important messages wrong or have diffi culty carrying out multistep directions. These are just a few behaviors noted by parents of children who have a diagnosed auditory processing disorder. Many of these behaviors may also appear in other condi-tions, such as learning disabilities, attention defi cit disorder, behav-ior problems or speech, language and hearing problems. Some children are able to compensate for these problems and overcome them by adulthood, while others may struggle to learn without coping strategies throughout childhood, resulting in anxiety, behavior problems, stress and frustration.

What Is Auditory Processing?

Auditory processing is sometimes described as how we manipulate and utilize sound

signals. In other words, how the brain responds to and interprets what the ear hears. It does not refer to how sensitive our hear-ing is, such as how softly we can hear a sound, but rather how we process sound once it has been heard and passes through the outer, middle and inner ear. Most children with auditory processing problems have normal hear-ing and intelligence. There are a variety of skills that are important for processing what we hear. Some of them include auditory memory, auditory discrimina-tion, sound localization, sound discrimination and auditory fi gure-ground, which refers to the ability to extract important infor-mation spoken in the presence of competing noise. Most language is learned by listening. Therefore, in order to learn, children must be able to attend to, listen to and separate important speech from

all other noises at school and in the home. If a child’s auditory skills are weak, she may experi-ence auditory overload which makes learning more challenging.

What Is an Auditory Processing Disorder?

According to the American Speech-Language and Hearing Association, an auditory process-ing disorder (APD) is a sensory processing defi cit that com-monly impacts listening, spoken language comprehension and learning.

Diff erent factors can cause auditory processing problems. They may include head trauma, delayed neurological develop-ment, structural abnormalities in the brain or a serious illness. In many cases the exact cause is not known. It sometimes runs in fami-lies, and there is some research to support that children who have

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multiple ear infections may be more likely to have an auditory processing problem.

Is Testing Necessary?

It takes specialized testing to identify an auditory processing disorder. These tests can help detect problems and describe a child’s auditory functioning so that her learning strengths and weaknesses are recognized. Testing children with a suspected problem should also include an in-depth evaluation of speech

and language, since there is a strong relationship between speech, language processing and auditory processing. The speech-language testing is generally performed by a speech-language pathologist, whereas the audi-tory processing evaluation is provided by an audiologist. (An audiologist is a professional who is qualifi ed to diagnose and treat hearing loss and hearing-related problems.)

Other reasons for conduct-ing an APD evaluation are to

determine if there are medical concerns that may require treat-ment, to identify the disorder, to help determine the need for educational support and to have awareness of the disorder, which may help minimize psychologi-cal factors that may be aff ecting the child who is having diffi culty learning. In some cases, either prior to or after the evaluation by the audiologist and speech pathologist, it may be important to have the child evaluated by an occupational therapist and psychologist to rule out any be-havioral, emotional, cognitive and sensory factors.

Prior to testing, there are a number of factors that need to be considered. Depending on the audiologist, an APD evaluation may or may not be recommend-ed for children younger than 7 or 8 because of their immature auditory nervous system. There

are, however, some screening tests for younger children. The child should have hearing in the normal range, as most auditory processing tests are only de-signed to be given to those with normal hearing. It is recommend-ed that the child has normal IQ function so her performance is not aff ected by cognitive inability. The child should be articulate and intelligible, since many of the tests require her to repeat words and information she hears.

What Are the Treatment Approaches?

Most children will benefi t from intervention. Management should be based on the child’s specifi c problems by modifying the listening environment, pro-viding compensation strategies to teach her how to maximize use of auditory information and

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Open House: January 9th 2-4 p.m.Open House: January 9th 2-4 p.m.

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week Colonial Camp for ages 8 to 12 with her ongoing fascination with history. “We really got to im-merse ourselves in the [colonial] experience,” she says, through food, music, dance, stitchery and fi eld trips. She has attended every summer from the time she was 8, and she became a junior counselor two years ago. “Now I get to help provide that experi-ence for the young campers,” says the ninth grader, adding that befriending other history-buff counselors has been a big bonus to the camp.

Says Isabel’s mother, Shannon Toole, “The DAR staff and [camp director] Pat Sowers are terrifi c and ab-solutely bring history to life.” Over the years,

Toole has seen her daughter’s interest fueled by family trips to Colonial Williamsburg, American Girl books and dolls and historic fi ction, as well as her DAR camp experiences.

“History’s not just in textbooks,” says Isabel. “It’s not just impor-tant dates. I really like seeing and thinking about how people lived back then.”

Walk a (metaphorical) mile in colonial shoes. The DAR Museum gives young visitors that opportu-nity along with a chance to play quoits, churn (pretend) butter and marvel at how schools have

changed.

Mary Quattlebaum is an award-winning children’s author, freelance journalist and history buff who enjoys visiting Washington sites with her family. maryquattlebaum.com

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Do You Hear What I Hear?

History Outside the Book

by teaching her remediation techniques. Some of these techniques are designed specifi cally to change the way the brain processes sound. New therapy tech-niques are continuously being developed. Some are implement-ed by audiologists and clinicians in offi ces, and some are available commercially. The best inter-vention approach is one that is individually designed for the child and her specifi c needs. The activi-ties need to be age-appropriate and targeted toward the child’s language and interest levels.

There is more research needed to understand APD problems and the best intervention for each child. Our understanding of how the brain functions and pro-

cesses auditory input has greatly improved due to more advanced imaging and electro-physiologic technology. Findings about the brain and its function have provided us with hope that in the future we will have the knowl-edge to treat auditory processing problems by actually changing the function of the nerve path-ways in the brain.

Susan Yaff e-Oziel is director of The Family Hearing Center at TLC-The Treatment and Learning Centers (ttlc.org), a Rockville-based non-profi t organization serving the community since 1950.

An auditory processing disorder is a sensory process-ing defi cit that commonly impacts listening, spoken language comprehension and learning.

Boys are always surprised to learn that their colonial counterparts wore dresses until the age of 6 or 7.

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