Auditory Processing Disorder

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information. Auditory Processing Disorder is an impaired ability to attend to, discriminate, remember, recognize, or comprehend information presented auditory in individuals who typically exhibit normal intelligence and normal hearing (Keith, 1995). This processing disorder can interfere with speech and language skills and academic performance, especially reading, writing and spelling. Katz, Stecker and Henderson (1992) described auditory processing as "what we do with what we hear." It involves the ability to remember what is heard, sequence or recall what was heard in the exact order that it was presented, follow directions appropriately or fill in missing pieces of the information in order to complete the message. Children with Auditory Processing Disorder often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request, "Tell me how a chair and a couch are alike" may sound to a child with Auditory Processing Disorder like, "Tell me how a couch and a chair are alike." It can even be understood by the child as, "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a child with Auditory Processing Disorder is in a noisy environment or when he or she is listening to complex information.

There is no one cause of Auditory Processing Disorder. In many cases, it can be related to maturational delays in the development of the important auditory centers within the brain. In others, the deficits are related to benign differences in the way the brain develops and are more likely to persist throughout a person's life. Auditory Processing Disorder can also be caused by trauma, tumors, viral infections, lead poisoning, lack of oxygen and auditory deprivation. The prevalence of Auditory Processing Disorder in children is estimated to be between 2 and 3% with it being twice as prevalent in males (Chermak and Musiek, 1997). Even though a child seems to "hear normally," he or she may have difficulty using those sounds for speech and language. It can often coexist with other disabilities. These include speech and language disorders or delays, learning disabilities, attention deficit disorders and social and emotional problems.

The following is a checklist of warning signs that may signal Auditory Processing Disorder in preschoolers:

Ð'* Demonstrate delayed speech and language abilities or articulation errors that are not consistent with age or that suggest acoustic confusions (such as substituting d for g)

Ð'* Have difficulty following directions at school or at home that other children the same age are able to follow easily (e.g., "Put your crayons away and line up for play time.")

Ð'* Ask for repetitions frequently, such as "Huh?" or "What?"

Ð'* Demonstrate signs of frustration or confusion, running the gamut from refusing to participate to staring back with a completely blank face, when confronted with new instructions or activities

Ð'* Perform better when a visual example of the expected activity or behavior is provided

Ð'* Have greater difficulty understanding instructions or orally presented stories when the environment is noisy

Ð'* Have difficulty learning nursery rhymes or simple songs, including singing the ABC's

Ð'* Show a complete lack of awareness that books have words and words are made up of letters, even after extended exposure to the topic (e.g., having no interest in having books read to them)

Ð'* Demonstrate social communication difficulties, such as hurt feelings or frequent misunderstandings, more often than other children

Ð'* Avoid talking to other children or adults

Ð'* Are highly distractible, especially in noisy situations

Ð'* Have easier time with "nonverbal" concepts such as color matching and counting

Ð'* Fail to exhibit steady progression in production and/or comprehension of more complex language and new vocabulary (Bellis, 2002, pp. 94 Ð'- 96).

A common complaint of teachers and parents of preschoolers is often that they just do not seem to "get it;" that the connections just do not appear to be happening as expected. Assessment by appropriate professionals can determine the underlying nature of the difficulties; however, diagnosis should never be made by observation alone. Unless a clear abnormality is present in auditory electrophysiology or other physiologic measures, diagnosing Auditory Processing Disorder in preschool is not possible using current behavioral tools. However, with a multidisciplinary collaboration of teachers, parents, and speech and language therapists, an educated hypothesis can be made that a child is exhibited Auditory Processing Disorder, allowing intervention to begin at a very young age, even before formal diagnosis can be made. As a child grows and begins to learn new academic skills in school, we are able to draw from a larger arsenal of auditory diagnostic test tools once the child reaches the age of eight or nine and become more neurologically mature.

Management of Auditory Processing Disorder should incorporate three primary principles:

1) Environmental modifications

2) Remediation techniques (direct therapy)

3) Compensatory strategies

All three of these components are necessary for Auditory Processing Disorder intervention to be effective. In addition, the details of each component should be deficit specific; that is, they should be developed specifically for the person with Auditory Processing Disorder and the unique circumstances of his or her learning or communicative difficulties and needs (Bellis, 2002, p. 225). The first component of Auditory Processing Disorder management should be to modify the environment in the child's classroom. Children with Auditory Processing Disorder should be seated where