A u d i t o r y P r o c e s s i n g Di s o r d e r HANDBOOK · W h a t i s A u d i t o ry P ro ce ssi n g D i so rd e r? Auditory processing is defined as what the brain does with

HANDBOOKAuditory Processing Disorder

Table of Contents

What is Auditory Processing Disorder? 4 Auditory Processing Weaknesses and Deficits 4

What is Central Auditory Processing Disorder? 5 CAPD and Early Controversy 5 The Disorder-Deficit Difference 5 “Fire It to Wire It” 5

What is Auditory Processing? 6 How is Auditory Processing Disorder (APD) Diagnosed? 6 What is the Difference between an Auditory Processing Evaluation and an Audiological Evaluation? 6 At What Age Can a Child Be Tested for APD? 6 What are the Early Warning Signs of APD? 7 What are the Most Common Symptoms of an Auditory Processing Disorder? 7 What Causes Auditory Processing Deficits? 8 Is APD a Lifelong Disability? 8 Is There Help for APD? 8 How Do I Know if My Child has APD? 9 Can APD Affect Adults? 9 Can Adults with APD Find Help? 9 How Does A Daily Listening Diet Help? 9

APD as a Piece of the Puzzle 10

The Link Between APD and ADD/ADHD 11 The Foreign Language Analogy 11 Auditory Figure Ground Skills 11

Apraxia and Poor Oral Motor Skills 12 The Importance of Babbling 12 Apraxia and Auditory Processing Disorder (APD) 12 What is Articulation and Phonological Awareness? 12 Common Errors in APD-Related Articulation 13 Auditory Processing and Articulation 13 Early Diagnosis 13 Auditory Decoding Skills 14

Autism Spectrum Disorder 15

Auditory Processing Disorders Handbook ©Shelley Francis 2018 1

Auditory Disconnection and "Tuning Out" 15 "Trigger Words" 15 Selective Listeners 15 Sound and Sensory Sensitivity 16 Asperger’s Syndrome and Auditory Cohesion 16 Daily Listening Diet 16

What is Dyslexia? 17 Social and Emotional Issues 17 More Than Just Reversals 17 Auditory Processing and Dyslexia 18

Building a Language Foundation 19 Auditory Processing Disorder and Language Development 19 Importance of Early Identification and Intervention 19

A Learning Disability with Many Names 21 Poor Listening and Academic Skills 21 From a Strong Language Foundation to Overall Learning Potential 21 The "Swimming with Cement Boots" Analogy 21

What is Working Memory? 22 Trouble in the Classroom 22 Math, Language and Reading Comprehension 22 When Listening Becomes a Challenge 22

Reading is First an Auditory Function 23 Auditory-Visual Integration 23 The Ability to Attach Meaning 23 Actively (Not Passively) Learning Language 23

What is Sensory Processing Disorder? 24 Sensory Processing Manifestations 24 Not Just Behavioral 24 A Wide Range of Problems 24 Neurological Disorganization 24 The Vestibular System 25 Simultaneous Stimulation 25

The APD and Social Issue Connection 26 More Than Learning and Academic Problems 26 Success and Self-Value 26 Learning from Social Exposure 26


Not Just a “Chatterbox” 27 Sense of Self 27

A Daily Listening Diet 28

Auditory Skills to Improve 29

Structured Educational Environment 30 Classroom and Seating 30 Attention 30 Instructions 30 Time 31 Reading 31

About the Author 32


What is Auditory Processing Disorder? Auditory processing is defined as what the brain does with what it hears. Although the ear is responsible for picking up sound and directing it towards our auditory system, it is auditory processing that allows us to differentiate and interpret these signals. Auditory processing is responsible for:

● Sound localization and lateralization ● Auditory discrimination including auditory decoding with a degraded signal ● Auditory pattern recognition ● Temporal aspects of audition ● Auditory performance in the presence of background noise or a competing signal

Auditory Processing Weaknesses and Deficits Auditory processing disorder (APD) refers to a deficiency in one or more of the aforementioned auditory behaviors. A child or individual suffering from an auditory processing disorder may be unable to attend to, discriminate, recognize or understand auditory information to a point where making sense out of what is heard becomes difficult. Auditory processing disorder does not describe a single deficit, but rather encompasses a variety of functions. A child or individual with APD may have normal hearing but may still be unable to adequately use and understand auditory information. Children with auditory processing weaknesses hear normally as they can usually detect pure tones delivered one by one in quiet environments such as a sound-treated room. However, the ability to detect the presence of sound is just one part of auditory processing. Therefore, most children with auditory processing weaknesses do not have a loss of hearing sensitivity but instead a hearing problem in the sense of being unable to process auditory information normally. Left unidentified and unmanaged in the early stages of development, auditory processing weaknesses, delays or deficits can lead to speech and language delays as well as academic problems and social issues. A child can exhibit auditory processing weaknesses in areas including auditory decoding skills, auditory closure, auditory figure ground skills, auditory memory skills and auditory comprehension.


What is Central Auditory Processing Disorder? Central Auditory Processing Disorder (CAPD) is the term originally used to describe a condition in which a person has difficulty hearing despite showing normal hearing sensitivity through audiometric testing. The term “central” was used to describe the location of the disorder, which is in the brain. Central auditory processing is not the same as peripheral hearing. Peripheral hearing instead occurs in the ear - either in the inner ear (cochlea), middle ear (inside the space within the eardrum) or outer ear (ear canal).

CAPD and Early Controversy The late 1990’s brought much controversy over CAPD. Researchers set out to determine what Central Auditory Processing Disorder actually was and if the disorder truly existed. A task force was eventually formed and the outcome was that Auditory Processing Disorder can exist in the presence of normal hearing. Still, controversy remained over exactly where the disorder originated. As a result, the term “central” was dropped from the name. Today, Auditory Processing Disorder (APD) and Central Auditory Processing Disorder (CAPD) are used interchangeably.

The Disorder-Deficit Difference “Disorder” is another term that brings controversy over CAPD. Due to its negative connotation, I like to use the terms “deficit” or “delay” instead in order to show that the problem is a weakness that can be strengthened with the right stimulation or exercise.

“Fire It to Wire It” Just as a muscle needs to be used in order to develop and grow, so does the auditory system need to be stimulated for growth and development. Think about what happens to our muscles if we stop training them. Soon, we begin to lose strength and as a result our muscles weaken. The same is true for the auditory system. For children with auditory processing weaknesses, listening is a lot of work. When listening becomes a lot of work, children simply stop listening. Due to lack of use, the auditory system will continue to weaken. When we think of a disorder, we think of something permanent that can’t be helped. We therefore begin to develop strategies to help cope with the disorder. When we think of a deficit, delay or weakness, on the other hand, then we automatically think of something that can be helped or strengthened. According to recent research in brain plasticity, we can change the way the brain processes information. With repeated stimulation, it is possible to improve processing skills, which can then improve listening skills and in turn improve a variety of related problems.


What is Auditory Processing? Auditory processing refers to what the brain does with sound and the function of the brain after the ear hears it. A developmental function, auditory processing begins development even before birth. There are different types of auditory processing skills that develop at different times and include auditory decoding skills, auditory figure ground skills, dichotic skills, auditory memory, auditory comprehension and auditory cohesion.

How is Auditory Processing Disorder (APD) Diagnosed? Audiologists assess auditory processing development using a variety of tests designed to evaluate different auditory processing skills. However, there is some controversy over exactly what qualifies for the diagnosis of an auditory processing disorder. Individuals may have strengths and weaknesses in terms of their auditory processing abilities so it is important to identify any weaknesses in the development of the auditory processing system. A weakness in even one area can negatively affect the development of a child. For example, a child could have adequate auditory decoding skills, auditory memory skills, auditory comprehension and cohesion skills, but a weakness in auditory figure ground skills. This student may have great academic skills and considered extremely smart, but his or her behavior in the classroom may interfere with his or her ability to learn.

What is the Difference between an Auditory Processing Evaluation and an Audiological Evaluation? An audiological evaluation tests the integrity of the auditory system at the ear level and its ability to detect the presence of sound. An auditory processing evaluation, on the other hand, challenges the auditory system using different listening tasks to determine the effectiveness of the system in terms of interpreting and making sense of the sounds that it hears. The results of an auditory processing evaluation are then compared to normative data to determine if the system is developing on time or if it is delayed in the development of particular skills.

At What Age Can a Child Be Tested for APD? There is a gross misunderstanding regarding the age at which a child can be tested for APD. On one side, the fact remains that it may be difficult to get a true diagnosis of APD in children younger than the age of seven. However, this does not mean that a child cannot be tested before the age of seven. On the contrary, an early diagnosis is extremely important in the treatment of an auditory processing disorder.


A specialist can administer a complete auditory processing battery by the age of five provided that the child has enough speech and language to respond to the testing. An experienced audiologist can also evaluate the auditory processing development of children under the age of five as well as non-verbal children with the use of case history information, observation and both formal and informal testing procedures, where a child can be identified as at risk for an auditory processing disorder. It is crucial that a young child be auditorily connected to his or her environment in order to develop the auditory processing skills essential to the development of speech and language. A child who is not auditorily connected may be described as a selective listener, in his or her “own world” and spacey. Sometimes these children appear as if they have a hearing loss, or what is sometimes called “functionally deaf.”

What are the Early Warning Signs of APD? The most important early warning sign of APD is a child who has a speech and/or language delay. This includes children who are not auditorily connected, not babbling adequately or on time, as well as those who are not developing two-way communication skills. If a child shows significant sensitivity or fear of normal environmental sounds, then this is an early indicator of a possible APD.

What are the Most Common Symptoms of an Auditory Processing Disorder? There are many different auditory processing skills, so weaknesses in different skill areas will produce varying symptoms. In fact, it often becomes confusing when a child can perform some tasks well while struggling with others. A child with a weakness in the area of auditory decoding, for example, will often have difficulty learning to read. If that child is strong visually, however, then he or she may compensate well in this area. A child might also have weaknesses in the area of auditory figure ground skills leading to attention difficulties, being easily distracted and sometimes developing a fear of noisy places or certain sounds (often described as sound sensitivities). Generally, a listener will misunderstand a spoken word or phrase. Auditory processing problems are sometimes most apparent in school when a child has difficulty learning to read, comprehending reading, following instructions or understanding abstract material. Additional symptoms of APD include:

• Difficulty paying attention • Poor listening skills • Trouble carrying out multiple-step instructions • Delayed response time • Behavior difficulties • Difficulty with reading, spelling, vocabulary and language skills


• Anxiety/fears • Easily frustrated • Shyness • Difficulty developing social skills or recognizing social cues • Misinterpreting messages or often misinterpreting one word for another • Slow to develop speech and language skills • Articulation weaknesses • Difficulty with phonemic awareness • Unable to understand sarcasm or the punch line to a joke

What Causes Auditory Processing Deficits? The cause of APD is often unknown. Even if your child can hear normally, he or she may struggle using what is heard to develop speech and language. Communication relies on taking in complicated perceptual information from the outside world, organizing that information and interpreting it into meaningful language. The reasons why a child may have delays in auditory processing development are often difficult to understand, although APD is often associated with:

• Dyslexia • Attention deficit disorder • Pervasive developmental disorder • Autism spectrum disorder • Speech and language disorder • Reading and learning challenges • Other developmental delays

Auditory deprivation is one factor that can cause auditory processing delays, which is often associated with chronic middle ear pathology such as ear infections or chronic fluid. Other factors can include Bio-medical, environmental and genetic factors.

Is APD a Lifelong Disability? According to neuroscience and brain plasticity research, we can change the way in which the brain processes information. However, although this research shows that we can make these changes throughout or lifetime, this is not to say that we can always make up for what we lost along the way. It is for this reason that early identification and treatment for APD is extremely important. Basically, APD is not a lifelong disability, although its effects on speech, language and learning can be.

Is There Help for APD? An underdeveloped auditory system can improve, and in some cases, catch up, through repeated auditory stimulation. Essential for this process is a daily auditory diet. Individuals


with auditory processing delays find listening to be a lot of work and therefore tend to be selective listeners. Auditory processing development is dependent on being auditorily connected and in developing good listening skills, so poor listeners will continue to fall behind in auditory skill development. In order to improve auditory processing skills, one must first improve listening skills. This can be quite difficult with an auditory processing disorder, which is why fun and motivating listening activities as well as a “daily listening diet” are essential to the improvement of auditory processing.

How Do I Know if My Child has APD? If you suspect that your child may have difficulty processing auditory information, then you should seek a complete auditory processing battery performed by an audiologist. There are many red flags that suggest an auditory processing disorder may be present and many screening devices available. However, since there are so many different auditory processing skills and related factors, a complete auditory processing battery is the only way to identify the specific auditory processing skill in which a child or adult is displaying weaknesses.

Can APD Affect Adults? There are many adults who have grown up unaware of their auditory processing weaknesses. While research that suggests the existence of APD dates back over forty years, it was not until recently that professionals accepted APD as an important factor relating to developmental delays, especially in the areas of speech, language, learning and social skill development. Undiagnosed, APD in adults can manifest as anxiety disorder, depression, fear of failure and social inadequacies.

Can Adults with APD Find Help? According to neuroscience research, there is a brain plasticity that exists throughout our lifetime. Science also suggests that we can change the way the brain processes information. Changing our already-learned behavior or sense of self is more difficult but it is helpful to simply understand if an APD exists as well as how it affects the development of the individual. This understanding is the first important step in the healing process.

How Does A Daily Listening Diet Help? The Listening Lab recommends a daily listening diet that is critical to remediating auditory processing problems. While other types of “therapy” administered once or twice a week can prove helpful, the habit of being a poor listener continues to impede auditory development once the child has left the therapeutic environment. A “daily listening diet" helps by promoting proper listening skills through listening games and exercises that not only strengthen auditory processing skills, but also make listening fun. The daily listing diet is not a replacement for therapy, but instead a supplement that keeps children with auditory processing weaknesses from falling back into old habits on a daily basis once therapy is over.


APD as a Piece of the Puzzle Auditory processing weaknesses are often the cause of, contribute to, or simply coexist with many different types of learning problems and developmental disorders. A healthy developing auditory processing system is essential to the development of good listening skills. Accordingly, it is easy to understand how poor listening skills can be so closely linked to problems such as speech, language and learning delays, attention deficit, autism spectrum disorder, reading problems including dyslexia and other sensory processing deficits. Often, auditory processing weaknesses can be a piece of the puzzle that contributes to learning problems and other developmental delays. In some cases, auditory processing weaknesses can be a small piece of the puzzle and in others it can be a larger piece. Sometimes, auditory processing weakness can even be the root cause. By strengthening auditory processing skills, we can improve not only listening skills but also learning, language, attention, reading and social skills.


The Link Between APD and ADD/ADHD Auditory processing weaknesses are often present in children suffering from Attention Deficit Disorder (ADD). Upon evaluating the presence of an attention deficit, it is interesting to note that most children diagnosed with ADD can, in fact, pay attention. This is especially true if the topic at hand is something that the child enjoys. The truth is that people tend to enjoy doing things that they are good at and tend not to enjoy the things that they are poor at. We know that children with auditory processing weaknesses are not good listeners, which makes them selective in what they listen to. It is not that these children are incapable of listening, but rather that listening is such hard work that these children become choosey (selective) about listening. When faced with a listening task, children with auditory processing weaknesses often exhibit attention issues.

The Foreign Language Analogy A great way for parents to relate to children with auditory processing weaknesses and ADD is through analogies. Consider, for example, listening to someone speak with either a foreign accent or strong dialect. If that person discusses something of interest to you, then you will tune in and listen even though it may seem difficult to do so. If you are not interested in what the person is talking about, on the other hand, then you will find it difficult to pay attention, in which case you may find your mind wandering at times. The task of listening becomes even more fatiguing as the accent becomes stronger, leaving you exhausted after what could have been a simple conversation. This analogy is a perfect example of how a child with auditory processing weaknesses can perform inconsistently in school.

Auditory Figure Ground Skills Children can also exhibit weaknesses in the area of auditory figure ground skills, which relates to the ability to hear in the presence of noise. Children with poor auditory figure ground skills struggle to pay attention in noisy environments, often easily distracted by normal, everyday sounds in the environment. In the presence of noise, children with this kind of weakness may become anxious, overwhelmed or frightened and may even show sound sensitivity issues. It is for this reason, among others, that auditory processing weakness should be considered a piece of the puzzle when a child has difficulty paying attention or staying focused.


Apraxia and Poor Oral Motor Skills Apraxia is a condition related to poor oral motor skills. Children with apraxia find it difficult to plan and produce the precise, highly-refined and specific series of movements of the speech mechanism. Children with apraxia particularly struggle in repeating successions of vowels and consonants. It is often much easier for children with apraxia to repeat simpler motor sounds such as vowels or consonants in isolation.

The Importance of Babbling Children typically begin to develop oral motor skills during the babbling stage. Children babble when auditorily connected and begin to relate cause-and-effect principles. An infant begins babbling by first instinctively making sounds (cooing) and then noticing the different sounds made by moving the tongue, lips or other parts of the mouth. Auditorily connected to those sounds, children are rewarded and therefore continue to make more sounds, thus creating more oral motor movement. The process allows for the continued development of oral motor skills. Being auditorily connected is thus very important to the early development of oral motor skills. Infants who are not auditorily connected or who fail to connect cause and effect principles are often described as being “relatively quiet babies.” Many parents claim that their child “babbled a little bit, but not like [their] other children.”

Apraxia and Auditory Processing Disorder (APD) Upon case history, it is often noted that many children diagnosed with apraxia never babbled, or babbled minimally. Since being auditorily connected is a significant prerequisite to babbling and since babbling is prerequisite to developing oral motor skills, it is often evident that auditory processing weaknesses or delays may be a piece of the puzzle in children diagnosed with apraxia. When evaluating a child diagnosed with apraxia, it is important to note whether or not the child babbled on time or with frequency. It is also important to note whether or not the child appears to be auditorily connected to his or her environment. In the absence of an auditory connection, the child may be at risk for auditory processing weaknesses and should thus seek further evaluation.

What is Articulation and Phonological Awareness? Articulation refers to the accuracy in which an individual pronounces the different sounds and/or sound patterns unique to each language. Phonological awareness, on the other hand, refers to the ability to recognize those sounds and sound patterns. Studies show that many


children with poor articulation often perform poorly during phonological awareness evaluation.

Common Errors in APD-Related Articulation Incorrect placement of the tongue, teeth, lips or soft palate can affect the clarity of speech in a child with poor articulation. Some of the most common errors include:

• Complete omission of sounds in words and sentences. Instead of saying, “I go to school on the bus,” a child with poor articulation may produce the sentence, “I go o coo o bu.”

• Distortion of sounds. “S” sounds may produce a slushy sound. • Substitution of incorrect and/or easier sounds with the correct one. Some of

the most common substitutions include B/D (hab for had), D/T (cad for cat), T/C (tat for cat) and W/L (wove for love).

• Addition of extra sounds or syllables to words. A child may pronounce the word “animal” as “animamal” or reverse sounds in words such as “aminal”.

• Slow, slurred speech or rapid, slurred speech.

Auditory Processing and Articulation Children with auditory processing disorder, or more specifically, children with weaknesses in the area of auditory decoding skills, often struggle with phonemic awareness. No one fully understands what causes articulation problems in children. What we do know is that the problem is becoming more prevalent. We also know that a strong relationship exists between how we hear a sound and how we say a sound. We must first hear sounds correctly in order to pronounce them correctly. The relationship is therefore an important one to consider. Another important element to consider is that children with auditory processing weaknesses often find listening to be a lot of extra work. Many children with weaknesses in auditory processing are thus described as being selective listeners. Through selective listening, children with this type of weakness often deprive their auditory system from the repetitive sound patterns in their native language, thus further slowing down the development of sound pattern recognition (phonological awareness). This concept may contribute to the number of children exhibiting articulation problems.

Early Diagnosis Once we can recognize the direct relationship between how we hear and how we speak, we can then begin to help by providing the proper auditory stimulation in a fun and motivating


way. By implementing the principles of brain plasticity, we can change the way the brain processes sounds and begin to develop stronger and more accurate auditory decoding skills. When we improve auditory decoding skills, we improve phonemic awareness, which can then improve articulation skills. It has to first go in before it can come out.

Auditory Decoding Skills Auditory decoding skills are often the easiest auditory processing skills to address and improve upon. Planet Hearwell incorporates many games and activities focused on improving auditory decoding skills. Auditory decoding skills are the building blocks to developing a strong auditory processing system. By first developing good, strong auditory decoding skills, we can then build to improve overall listening skills. Improved overall listening will ultimately lead to improvements in many other areas of processing and learning.


Autism Spectrum Disorder A neurological disorder that affects how the brain processes sensory information, Autism is often characterized by impaired communication and social interaction. Since a strong auditory processing system is essential to language development, and because language is the foundation of communication and socialization, auditory processing disorder is often a piece of the puzzle connected with Autism Spectrum Disorder. Contrary to popular belief, auditory processing disorders are fairly common among children diagnosed with Autism. For a better understanding of APD and Autism Spectrum Disorder in children, imagine listening to a foreign language. You are able to hear sound patterns within that language, although those patterns fail to provide any meaning to you. Unable to connect the sound patterns to meaning, you are likely to tune it all out. As a result, the sound patterns would simply become background noise.

Auditory Disconnection and "Tuning Out" Many children diagnosed with Autism are not auditorily connected and many may even be auditorily defensive. A child who is not auditorily connected may appear to have hearing loss, often failing to respond to their name or to other auditory input. The same child may respond to nonverbal sounds such as music or the sound of a piece of candy being unwrapped, but not to speech. It may appear that the child is tuning out the sound of speech and in many cases, this is entirely true.

"Trigger Words" Consider also words that may sound familiar to you, such as a name or a place that you can recognize. These words are called “trigger words” which grab your attention because these words provide meaning. For a child with auditory processing disorder, trigger words may include the names of a favorite toy, treat or television show. Unable to assign meaning to words other than those trigger words, a child may become “lost” just as a person listening to a foreign language would.

Selective Listeners The foreign language example would surface in a severe case of auditory processing disorder. In a more moderate case of APD, the process would more closely resemble that of listening to a person speak with a strong foreign accent. Although you can follow along with what that person is saying, it often takes extra work, which can be especially tiring. In this instance, you would become more of a selective listener, choosing when to listen and when not to listen. Many children suffering from auditory processing disorder and Autism become selective listeners.


Sound and Sensory Sensitivity Auditorily defensive children also often exhibit sound sensitivity issues. This can lead children to cover their ears or become wild and behavioral in certain noisy environments. The degree to which a child is affected by these areas also plays an important role in the diagnosis. Children diagnosed with Autism Spectrum Disorder tend to have issues with sensory integration organization across many different sensory areas. In fact, auditory processing is just one of the sensory processing areas with vulnerability. Additional processing areas include visual, tactile, proprioceptive, vestibular, smell and taste, among others.

Asperger’s Syndrome and Auditory Cohesion Auditory cohesion is the ability to understand meaning, inference, abstraction and intention of conversation and music. A higher order function involving tone, facial expressions and body language, auditory cohesion is a major skill associated with auditory processing. Poor auditory cohesion skills are often present in children with Asperger’s Syndrome.

Daily Listening Diet The first step in treating children with auditory processing disorder and Autism Spectrum Disorder is to identify the disorganized sensory areas. We can then put together a sensory diet designed to help the sensory system reorganize itself and begin to make sense of the outside world. Fortunately, children with auditory processing disorders and Autism can find help through various techniques and technologies. By improving the auditory processing ability of a child with Autism, we can improve the way in which the child connects with his or her environment.


What is Dyslexia? Dyslexia is a disorder that affects the way an individual learns and processes language. Dyslexia has been around for a long time but has most recently become more prevalent. Originally thought to be a reading disability characterized by the reversal of letters in words, dyslexia today encompasses a wide range of symptoms that primarily affect children of normal intelligence. Children with dyslexia not only fail to attain language skills in the areas of reading, writing and spelling but also struggle to use language for learning and understanding abstract concepts. Dyslexia is a neurological, brain-based disorder that can have lasting effects on not only reading but also learning as well as social and emotional development.

Social and Emotional Issues Many children with dyslexia exhibit normal as well as above-normal intelligence. Dyslexia can go undiagnosed in the early years, often leading to emotional issues, feelings of inadequacy and poor self-esteem. The effects of dyslexia can be very frustrating for children, especially when learning to read. Children with dyslexia tend to struggle more once their peers start to pass them by. Once learning starts to revolve around abstract concepts, children again become quite frustrated with their inability to keep up with their peers. When feelings of inadequacy start to take hold, behavior difficulties often develop. Behavioral problems can easily carry over into adult life, often manifesting in fear of failure and underachievement.

More Than Just Reversals Letter and number reversals are quite common with dyslexia, but the disorder can go beyond that. The most common problems associated with dyslexia include:

• Difficulty copying from the board • Problems with handwriting • General disorganization • Difficulty remembering content • Trouble with spatial relationships • Confusion with left/right and before/after • Fact memorization • Trouble learning to tie shoes • General awkwardness

As it relates to language and learning, children with dyslexia often have difficulty with:

• Early speech and language development • Vocabulary


• Phonemic awareness • Learning letters and sounds of letters • Manipulating sounds in words • Sequencing • Direction following • Recalling words and names • Understanding concepts and relationships • Identifying words that rhyme • Early reading skills

Auditory Processing and Dyslexia The primary problem associated with dyslexia is language. We learn language by first learning to listen. Accordingly, anyone can see how auditory processing development can play an active role in the diagnosis of dyslexia. An auditory processing evaluation can be quite helpful in putting the pieces together and thus developing a plan of action. Children diagnosed with dyslexia often exhibit auditory processing weaknesses, specifically with auditory decoding skills and dichotic skills. Auditory decoding weaknesses may include deficits in the areas of temporal processing (delays in timing or delay in processing speed), auditory closure (filling in for missing information), phonemic blending (blending individual sounds together to make words) and phonemic segmentation (removing different sounds patterns from words). Dichotic skills represent the ability to integrate auditory information from both hemispheres of the brain. Many children with diagnosed dyslexia show left ear dominance when testing for dichotic skills. Test results that show left ear dominance may indicate right hemisphere dominance for language, or more likely, a neurologically-based language and learning disability consistent with the diagnosis of dyslexia. If an auditory processing evaluation displays weaknesses in these areas, then a "daily listening diet" of exercises targeted at auditory decoding and dichotic skills can prove very helpful.


Building a Language Foundation Auditory Processing Disorder, including any deficiency, delay or weakness in the auditory processing system, affects the way we learn to listen. For children and adults with developmental delays in the auditory processing system, language problems begin when listening becomes a lot of work. As you could imagine, anyone who finds listening to be a lot of work, especially a child, will become selective in their listening. Unfortunately, any child or adult who exhibits selective listening will inevitably miss out on the acquisition of a strong language foundation. Problems with early speech and language development that are related to delays, deficiencies or weaknesses in the auditory processing system oftentimes may not be evident until a child reaches the age of 8 or 9. It is at this stage of life when learning becomes more language-based in which the ability to understand abstract concepts becomes essential in the learning process.

Auditory Processing Disorder and Language Development The acquisition of language is one of the most outstanding accomplishments seen in infancy and early childhood development. Babies tend to speak their first words around the age of one and typically learn about 1,500 words by age four. Around the same time, children begin to use language not only to get their needs and wants met, but also to socialize. It is critical to understand, especially in cases of children with auditory processing disorder, that we initially learn language by listening. A well-developed auditory processing system is thus fundamental to learning a good, strong language foundation. The language skills learned in the preschool years serve as an important foundation for learning in school. Children with a solid language foundation tend to develop strong skills in both reading and writing. On the contrary, children with auditory processing weaknesses tend to develop poor listening skills that ultimately slow the healthy development of language.

Importance of Early Identification and Intervention It is crucial to diagnose and address auditory processing weaknesses as early as possible. Parents can learn to identify the most common signs of an auditory processing weakness, including:

• A child who is late reaching his or her speech and language milestones. • A child who appears to be a selective listener. • A child who is not auditorily connected to his or her environment. • A child who appears unusually frightened by, or overly sensitive to, sounds.


Left untreated, auditory processing weaknesses tend to diminish even further. Eventually, untreated auditory processing weaknesses can manifest into Auditory Processing Disorder, complete with language, learning, attention and/or social and emotional issues. If a parent, teacher or audiologist successfully detects and addresses an auditory processing weakness early enough, then a child can quite often acquire the listening skills required for auditory development and thus lessen the learning challenges associated with an Auditory Processing Disorder. It may be difficult to formally diagnose a child with an Auditory Processing Disorder before the age of seven, but it is never too soon to recognize the early warning signs of an auditory processing weakness and address those weaknesses through listening exercises to strengthen overall listening skills. A “daily listening diet” is essential to this process.


A Learning Disability with Many Names An individual with a learning disability has difficulty learning in a typical manner. Learning disabilities surface in adults and children alike due to problems in the brain’s inability to successfully acquire and process information. The term “learning disability” goes by other names including “learning difference”, “learning disorder”, “learning difficulty” and “learning delay”. There are many different types of learning disabilities but among the most common is what is referred to as a language based learning disability.

Poor Listening and Academic Skills A language based learning disability can negatively impact reading, writing, math, speech, language, listening and a host of other academic skills. This type of learning disability is commonly linked to children with auditory processing weaknesses who are often challenged by poor listening skills.

From a Strong Language Foundation to Overall Learning Potential We know that the development of good listening skills is important to the development of a strong language foundation and that language is critical to learning. Therefore, a healthy developing auditory processing system is essential not only to the development of a strong language foundation but also overall learning potential. This is the reason why strengthening auditory processing weaknesses in children is so very important.

The "Swimming with Cement Boots" Analogy When we address a learning disability without treating the auditory processing component, we are simply treating the symptom without addressing the underlying weakness. This is like swimming upstream, running a race while attached to a rubber band or learning to swim wearing cement boots. In the example of learning to swim, the treatment of the learning disability may keep the child’s head above water but it never allows the child to swim on his or her own. We never close the gap and this essentially makes it difficult for the child to reach his or her true potential.


What is Working Memory? Children with poor working memory are often misunderstood. Poor working memory in children leads to attention problems as well as trouble following directions. Working memory is the memory that we use to keep information immediately in mind so that we can complete a task. Adding numbers together in your head or processing driving directions without writing them down are two examples of the ways we use working memory. Essentially, working memory is the “mental workspace” where we manipulate information, perform mental calculations and form new thoughts.

Trouble in the Classroom Working memory capacity varies from child to child, just as RAM varies from computer to computer. One way to estimate a child’s working memory is to give a verbal instruction such as, “Please give me the blue pencil, then pick up the red eraser and put it in the green box.” Some children might find these instructions simple to follow while others might lose track of the details along the way. Poor working memory often leads to trouble in the classroom as many children with poor working memory appear as though they aren’t paying attention. Children with poor working memory fail at assigned tasks after repeating or skipping words, letters, numbers or whole steps. Many abandon tasks completely because they are simply unable to keep track of what they are doing. These children may appear lazy or uncooperative when truthfully there is just an underlying problem with working memory.

Math, Language and Reading Comprehension These problems typically surface in math and also in language. A child with poor working memory might struggle to write sentences. After writing down the first few words, the child may then forget what he or she intended to say next. Reading comprehension is another problem associated with poor working memory as children lose the overall gist of the text after working so hard to decode the written words.

When Listening Becomes a Challenge Auditory processing weaknesses can adversely affect the development of working memory skills. In the presence of an auditory processing weakness, listening becomes challenging. An individual with an auditory processing weakness has to work at listening, or think to listen, instead of thinking about what they are listening to. When the energy is placed at the level of listening, often comprehension is affected, which in turn affects working memory and perhaps the early building blocks essential for developing a strong working memory. Good listening skills are an important piece in helping to develop a good working memory.


Reading is First an Auditory Function Interestingly, reading is first an auditory function. Reading actually requires children to attach appropriate visual representations of sounds but children must first be able to recognize the sound. After a child can recognize sounds in isolation it is then necessary to be able to recognize sound patterns. Essential at this stage is a healthy-developing auditory system, specifically in the areas of auditory decoding and temporal processing.

Auditory-Visual Integration After a child can correctly recognize sound patterns, the next step is to be able to connect the appropriate visual pattern. This process is known as auditory-visual integration and a healthy-developing visual system is essential at this stage.

The Ability to Attach Meaning The ability to attach meaning to what is read is the third step to learning how to read. A good foundation in language is critical at this stage, which brings us back to the importance of a healthy-developing auditory processing system.

Actively (Not Passively) Learning Language We already know that language is initially learned by listening and with a typical-developing auditory processing system, a child or individual can learn passively simply through exposure. Listening should be a passive process but it becomes a lot of work in children and individuals with auditory processing weaknesses. For these children and individuals, frequently described as being selective listeners, listening is no longer passive. Instead, they are learning language actively. Active language learning causes children and individuals to learn language in chunks, hindering the development of a good, strong language foundation. Listening only when it is important or motivating so as to get their needs and wants met, these selective listeners often miss out on social language as well as inference and the abstract.


What is Sensory Processing Disorder? Sensory processing disorder is a condition commonly associated with autism, but children without autism can experience it, too. Children with sensory processing disorder may be hypersensitive (overly sensitive to stimuli) or hypo sensitive (under responsive to stimuli) or they can have a combination of both hyper and hypo sensitivity. When this occurs, it can dramatically change the way a child relates to his or her environment. Children with sensory processing disorder are super sensitive and often display intense reactions to sight, sound, smell and touch.

Sensory Processing Manifestations Sensory processing disorder manifests in a number of ways. For example, a child may insist on having the tags cut out of all of his or her shirts due to extreme sensitivity. A child who doesn't like touch may have meltdowns while getting dressed before school. The same child might be distracted all day because he or she never habituates to the feeling of clothing on the body. Another child who is hypo sensitive to touch may be in constant motion seeking touch, or be overly aggressive, and in some cases appear to have a high tolerance for pain.

Not Just Behavioral Typically, parents and teachers focus on the behaviors associated with the disorder and may not recognize that these behaviors are quite simply reactions to sensory stimuli processed through a disorganized central nervous system. When we fail to recognize the sensory basis for these types of behaviors, we immediately and incorrectly label the child as behavioral.

A Wide Range of Problems When a child is unable to process everyday sensory stimuli, a range of problems may surface. Motor clumsiness, behavioral problems, anxiety, depression, social isolation and school failure are all closely linked to sensory processing disorder.

Neurological Disorganization Children with this type of disorder are generally misunderstood and misdiagnosed. In many cases, children with sensory processing disorder are unfairly disciplined because teachers interpret their actions as “bad” behavior and not what it actually is – a neurophysiological problem. The term “neurological disorganization” is a good way to describe this condition. Since auditory processing is a neurological function, children with sensory processing difficulties may also have involvement in the area of auditory processing.


The Vestibular System Many children with diagnosed sensory processing disorder have vestibular issues. The vestibular system is responsible for connecting us to the environment with balance and spatial awareness. The vestibular system is part of the inner ear and processes stimuli similar to the way the cochlear system does. Both are responsible for processing movement. The vestibular system processes movement from inside the body (physical movement), and the auditory system processes movement from outside the body (molecular movement or sound waves). When one of these areas exhibits developmental delays, spillover into the other area of development is quite common.

Simultaneous Stimulation When we treat one of these areas with sensory integration therapies, we often have spill over in benefiting the other area, too. This is why many therapists that work with children with sensory processing disorder will treat the auditory system with different types of listening programs simultaneously with sensory motor activities. The auditory piece is quite often a very important part of the intervention with children with sensory processing disorder or sensory integration deficiencies.


The APD and Social Issue Connection Many children with auditory processing delays also struggle with social and psychological issues. In fact, there are many different types of social and psychological issues currently linked to auditory processing delays. Fear of failure, low self-esteem, depression, anxiety and feelings of not belonging or inadequacy can all surface in a child with auditory processing delays. Behavioral problems including substance abuse and juvenile delinquency have also been linked to auditory processing delays.

More Than Learning and Academic Problems In some cases, the social and psychological issues associated with auditory processing weaknesses can present a much greater problem than typical learning and academic problems. In some ways, these problems may all be related. Children with learning disabilities - and especially undiagnosed learning disabilities - often experience failure. Faced with repeated failure, these children start to accept failure as inevitable regardless of how hard they try to succeed. These children often accept the notion that they are not smart and that failure is a part of who they are. This can cause a child to simply give up.

Success and Self-Value Children spend most of their waking hours in school. Many children form their own self-value based on their ability to succeed in school. Unless a child is placed in an environment in which he or she can be successful, these children often form a low self-value and ultimately develop low self-esteem. Low self-esteem in children often transfers over into adult life, which can manifest into difficulties in both career and interpersonal relationships. Issues with failure can create a vicious cycle for both children and adults, which can further support their own feelings of inadequacies. Feelings of failure can spiral downward towards depression, anxiety and social isolation, which in turn can lead to additional problems including substance abuse and other addictions.

Learning from Social Exposure Auditory processing delays and weaknesses can also greatly affect the development of social skills. Much of what we learn in the area of social development comes from processing both auditorily and visually the way people react with one another. Many of the social mannerisms that we learn come from simple exposure. If a young child hears a person say “thank you” every time someone holds a door open for them, then he or she will eventually thank someone who holds the door for him or her. A child who sees and hears compliments given to others will soon learn to compliment others as well. We even learn to read body language and facial expressions, all through exposure.


This same type of sensory input bombards children with sensory processing deficits all throughout the day. Children eventually have to shut out and disconnect with the world around them simply to cope with this overwhelming sensory input. These children thus miss out on the passive learning that takes place in social situations such that social skills must be taught to them.

Not Just a “Chatterbox” Children with auditory processing weaknesses find listening to be a lot of work. As a result, many quickly discover that if they spend more time talking, then they don’t have to listen as often. “Chatterbox” is a term that is often used to describe a child with auditory processing weaknesses. Interestingly, talking a lot and listening very little is a common strategy that many poor listeners use to cope with their issue.

Sense of Self Aside from poor listening, children with sensory processing deficiencies who have trouble processing and connecting to the world around them often develop poor fine and/or gross motor skills. Since many social skills are learned by simple exposure, children with APD have not only social and psychological issues but also problems with sense of self.


A Daily Listening Diet When auditory processing deficits become a piece of the puzzle, a “daily listening diet” can prove quite helpful. In fact, a daily listening diet is a critical element in remediating an auditory processing problem. Therapy administered once or twice a week is effective, but the poor listening habits that return once a child has left the therapeutic environment tend to impede auditory development. The key to successfully treating auditory processing weaknesses is to engage children with fun and motivating listening activities. The reality is that so much of today’s learning is done through the visual system, which often leaves the auditory system under stimulated. Children who spend a lot of time engaged in visual activities such as television, gaming systems and computers learn to compensate with strong visual learning skills. As a result, these children neglect to engage the auditory system and thus develop poor overall listening skills.

● Auditory Decoding: The ability to understand the meaning of spoken words and to make sense of sounds.

● Auditory Closure: The ability to decode a whole word after hearing only part of it. Weak auditory closure skills are common among children and adults with language disorders and dyslexia.

● Auditory Figure Ground: The ability to attend to one sound against a background of sound. An example of auditory figure ground skills is the ability for a child to hear a teacher’s voice against classroom noise.

● Auditory Memory: The ability to take in information presented orally, process that information, store it in one’s mind and then recall what was heard.

● Dichotic Skills: The ability of selective attention or the ability to attend to one thing and ignore others. Dichotic listening occurs when two messages are presented to separate ears.

● Auditory Comprehension/Cohesion: The ability to combine auditory words into a meaningful sentence unit.


Auditory Skills to Improve Auditory training with an emphasis in the area of auditory processing is recommended to address various auditory processing weaknesses, deficits or delays. Retraining the brain to quickly and accurately perceive the sounds of speech is found to improve language, reading and academic performance in children with auditory decoding deficits. Auditory therapy designed to achieve these goals may include work on:

● Auditory discrimination (distinguishing between similar sounding phonemes) ● Sound letter association ● Phonemic analysis and synthesis ● Auditory closure (missing word exercises, missing syllable exercises, missing

phoneme exercises and vocabulary building in quiet and noise) ● Auditory memory ● Auditory figure-ground discrimination (speech comprehension in noise)


Structured Educational Environment A highly structured educational environment can also prove extremely beneficial to children suffering from auditory processing weaknesses, deficits or delays. In the classroom, teachers can take several steps to aid children with auditory processing weaknesses in learning successfully. A student with auditory processing weaknesses will respond to changes within their environment and instructional program in a variety of ways. While we recommend preferential classroom seating for all children with auditory processing weaknesses, further suggestions depend on the unique and individual auditory processing strengths and weaknesses of the child.

Classroom and Seating ● Seat the child near the teacher/speaker and away from noisy fans, windows, doors,

hallways and other potential auditory distracters. ● Provide the child with a quiet study/work area, especially for test-taking and tutoring. ● Structure the classroom to reduce background noise and distraction. ● Seat the child at the front of the room or in front of maps, graphs and other visual

aids.

Attention ● Gain both the visual and auditory attention of the child before giving directions. ● If possible, provide note-taking assistance as it is difficult for children suffering from

auditory processing weaknesses to watch the teacher and take notes at the same time. ● Vary vocal inflections and volume to increase attention. ● Use words such as “listen”, “ready” and “remember” to regain attention.

Instructions ● Speak slowly and clearly, but do not over-exaggerate speech. ● Use natural gestures that will clarify information. ● Provide both written and verbal instructions to aid the child in following directions

and completing tasks. ● Give directions in a logical, time-oriented sequence using words that make the

sequence clear. These words include “first”, “next” and “finally”. ● Emphasize key words when speaking or writing, especially when presenting new

information. Offering pre-instruction with an emphasis on the main ideas to be presented may also prove effective.

● Avoid extraneous noises and visual distractions, especially when giving instructions and teaching new concepts.


● Paraphrase instructions and information in shorter and simpler sentences, rather than by only repeating.

● Check comprehension by asking the child questions. You can also request a brief summary after presenting key ideas to make sure the child understands.

● Encourage the child to ask questions for further clarification of information. ● Make instructional transitions clear. ● Review previously learned material. ● Give positive feedback to insure understanding and avoid showing frustration when

the child misunderstands a message. ● Reinforce all work performance to boost self-confidence.

Time ● Understand that students with auditory processing disorder fatigue much more easily

than their peers do. Recognize these periods of fatigue and allow breaks as necessary.

● Students with auditory processing disorder should have adequate time to comprehend and complete tasks. Allow these students extended time for tests, quizzes and assignments.

● Students with auditory processing disorder need more time to formulate responses to verbal questions. Be sure to give these students adequate response time.

Reading ● Children with auditory processing weaknesses, particularly in the area of auditory

decoding, often have trouble learning to read. The truth is that reading is first an auditory function. Therefore, if a child has trouble hearing and perceiving the difference in sounds, it becomes very difficult for the child to learn and associate the appropriate visual representation for the auditory pattern. It is very important to work with a “bottom-up” approach when addressing reading issues in children with auditory decoding deficits and to first address the auditory weakness. The key to addressing these weaknesses is through auditory decoding therapy.

● School performance should always be monitored to determine if there is a need for additional support services. One of the most important things that both a parent and teacher can do is to realize that APD is real. It is crucial to understand that the symptoms and behaviors of auditory processing disorder are not within the child’s control. What is within the child’s control, on the other hand, is the recognition of these problems and the application of strategies learned in therapy. Remember that a positive, realistic attitude and healthy self-esteem can work wonders for a child with APD.


About the Author

Shelley Francis is the author of No Child Left Unwrapped. She was inspired by the challenges her brother faced growing up with an undiagnosed learning disability. Shelley’s brother not only suffered challenges and failures growing up in school, but also bouts of depression and fear of failure later in his adult life. In 1992, Shelley Francis opened her practice East Meadow Hearing and Speech Center in 1989 and in 1992, she began devoting her practice to understanding, diagnosing and helping children with auditory processing disorder. Today, Shelley remains motivated by both her passion to help children and her unique perspective in the area of Auditory Processing Disorder. Through speaking engagements and consultations, Shelley notably shares her empathy, compassion and knowledge. To learn more visit http://meetshelley.com.


http://meetshelley.com/

Documents

A u d i t o r y P r o c e s s i n g Di s o r d e r HANDBOOK · W h a t i s A u d i t o ry P ro ce ssi n g D i so rd e r? Auditory processing is defined as what the brain does with