“Mrs. Green, could you repeat that please? I didn’t quite get that.”
The teacher slams her book on the desk, jabs an index finger toward David, a student in the back of her sixth-grade classroom, shouts: “Young man, I said it once – I am NOT going to say it again! You need to listen the first time!” David lowers his head, making a mental note not to speak in Mrs. Green’s class again.
This incident happened to my son, many years ago. But it’s far from unique, as adults still often chastise students for “not listening”. They assume the behavior is willful, when, in fact, that child may be struggling with a delay or disorder beyond their control. One such disorder, auditory processing disorder (APD), may be present, but overlooked. The lack of awareness and misinformation about many childhood challenges is still alarmingly high, but auditory processing disorder is exceptionally misunderstood. Auditory processing is a huge and complex topic; experts are still quibbling about precise definitions and symptoms. But down at the clinical trench level, I collaborated closely for many years with a very knowledgeable audiologist, and together, using a variety of testing tools and observations, we were able to peer into children’s listening systems beyond the behavioral level and get to the brain level, pinpointing specific areas of difficulty, and thus suggest the appropriate strategies to help that children process auditory information more successfully. Our partnership was one of the highlights of my career - to this day I could spend hours chatting over coffee about this most fascinating topic! For our purposes today, however, I’d like to offer a quick APD overview: what it is, how to spot symptoms, how to obtain a diagnosis, and how to address it. But I will also provide some great resources if you would like to learn more about APD.
First, what is an auditory processing disorder? The official (and quite technical) definition comes from the American Speech-Language Hearing Association (www.asha.org). For brevity’s sake, let’s just say a good working definition for APD is: “What the brain does with what it hears.” To simplify, think of the brain’s listening system in terms of “left brain”, “right brain” and “cross-brain” skills. In left hemisphere APD, the brain has difficulty rapidly distinguishing speech sounds in sequence. For example, the child may hear “I have a pit bull” for “I have a pimple.” You can see how this might cause the child to respond inappropriately! These children are often left behind in the listening dust as they try to keep up with the conversation. Also, these children may struggle to process auditory information in the presence of background noise. Can left hemisphere APD interfere with social and academic success? Absolutely! Right hemisphere auditory processing disorders involve the ability to process the intonation and the rhythm of language. For example, say the words: “dessert” and “desert” (the place with lots of sand!). Same sounds, same order – but which would you rather eat? A child with a right brain auditory processing problem won’t hear a friend’s sarcastic tone in the sentence: “Oh, sure, Suzie’s always right!”, so she’ll interpret the sentence literally: “Suzie’s correct one hundred percent of the time” instead of getting the “real message” i.e. “Suzie’s a know-it-all brat!” Can this interfere with academic and social success? Absolutely! Some may also have a problem integrating the two hemispheres, thus becoming overwhelmed when too many visual and auditory stimuli bombard their brains simultaneously. For a much more complete, but reader-friendly introduction to APD, I suggest: When the Brain Can’t Hear: Unraveling the Mystery of Auditory Processing Disorders by Terri James Bellis, Ph.D. (www.amazon.com).
Next, how can you spot signs of APD? Here’s a basic “red flag” checklist for children in elementary school:
- Acting as though they can’t hear very well, even when hearing is normal
- Verbal IQ is significantly lower than performance IQ
- Difficulty following multi-step directions
- Trouble understanding sarcasm/tone of voice
- Struggles with reading and spelling
- Better performance with non-auditory tasks
- History of ear infections or head trauma
Of course, many explanations could account for these symptoms. For instance, we see a huge overlap of ADHD and APD. However, studies have shown that although medication may help auditory attention, it doesn’t touch other aspects of the APD syndrome. So, if you have checked one or more APD red flags, your child will benefit most from a thorough evaluation by a team of professionals including a psychologist, speech-language pathologist, physician, and others as needed. For the auditory processing part, you will need to contact a certified, licensed audiologist with experience in APD evaluations. Start with your local children’s hospital. You can also contact the American Academy of Audiologists (www.audiology.org) or the National Coalition for APD ( www.ncapd.org) for further information. Audiologists are the only professionals qualified to diagnose APD, and APD should only be diagnosed as part of a very thorough, interdisciplinary evaluation. Usually, APD will not be the only diagnosis, and therefore, a team evaluation is essential.
If your child has been diagnosed with APD, how can you help? Make sure you sit down with your team and go over all the results. For example, if your child has also been diagnosed with ADHD, follow through with those recommendations because there’s a good chance treatment for other disorders will also help some of the APD symptoms as well. But, based on the APD evaluation results, you can also implement more specific strategies to further enhance your child’s listening success. Here are just a few examples:
- Modifying the child’s listening environment to improve acoustics
- Repeating directions, rephrasing information
- Adding more picture and written cues
- Pre-teaching vocabulary
- Phonemic awareness or prosody training
- Computer-based training
Although this article barely scratches the surface of APD, I hope it has served as a springboard for further education, awareness, and advocacy - so that in the future, when a student like David raises his hand and asks: “Could you repeat that please?” -The teacher will say: “Certainly…”Or, better yet, because his APD has been addressed, David will not even have to ask, because he will get the message - the very first time!
Carol Kauffman, MA/CCC-SLP, is a speech-language pathologist with forty years of experience in diagnosing and treating children with language and learning challenges.