Auditory processing disorder (APD, also known as Central Auditory Processing Disorder) is a controversial topic. NHS choices provides information about auditory processing disorder, yet you might hear a sharp intake of breath if you mention it to your child’s Speech and Language Therapist.
What is auditory processing?
When most people talk about ‘auditory processing’, they are referring to how we listen to and understand sound information.
Whilst we are all aware of the ear’s role in listening to sounds, the brain also has a huge role in listening – by making sense of what the sounds mean (leading to the lightbulb moment!). This hugely over-simplifies the processes involved, but as a starting point it also helps us to identify the roles of professionals in working with children who may be diagnosed with APD.
Audiologist – can you hear the sounds? This is measured using tones or beeps, at different volumes or pitches. Any audiology tests that involve listening to words or sentences add in an element of language or sound processing, so the brain is involved as well as the ear. If you have concerns about your child’s hearing, talk to your GP or health visitor to arrange a hearing test.
Speech and Language Therapist – can you understand the sounds, words and sentences? We look at the brain’s role processing auditory (sound) information.
Other professionals, such as Educational Psychologists or Specialist Teachers, may also be involved to assess the child’s memory skills (including working memory, the brain’s ability to remember sound information long enough to process and understand it).
What difficulties are sometimes assumed to be due to auditory processing difficulties?
- Difficulties listening in background noise
- Not following spoken instructions
- Not understanding or losing track when listening to stories
- Difficulties listening to and identifying speech sounds in words or phrases
Why is Auditory Processing Disorder controversial?
A diagnosis of auditory processing disorder is only suggested if the child has normal hearing levels. The current research concludes that ‘the listening difficulties of children with APD may be a consequence of cognitive, language, and attention issues’ (Wit et al 2016). All of the above symptoms can be signs of a difficulty understanding language, or understanding and manipulating speech sounds, and these difficulties are seen in children for whom other diagnoses would also be appropriate, such as dyslexia (Dawes and Bishop 2009) and language impairment (Sharma et al 2009).
If difficulties in any of these areas are assumed to be due to APD, this may lead to inappropriate or ineffective strategies or interventions being used with the child. This is frustrating for parents and children, as well as being a waste of precious time and resources. If your child has difficulties with any of the areas above, rather than assuming a diagnosis of APD it will be more beneficial to seek an accurate assessment of their strengths and needs across the different areas of language, as well as looking at your child’s attention and memory skills. Any interventions or support should then target their specific needs.
This might include a mix of changes to the environment (such as providing cue cards to support your child’s focus of attention in the classroom) or therapy approaches (such as practice understanding a certain type of instruction or language concept).
The free Iris Speaks language course and higher level language course are 10 week courses designed to help you understand the complexity of the language learning process, and provide you with some starting points to help your child’s understanding of language across a range of language areas. You can see that a couple of environment changes, or an out-of-the-box computer intervention, would not be able to ‘fix’ every child who might receive an APD diagnosis despite some of the claims.
But how can you judge whether a treatment or intervention is right for your child?
- Start with a full assessment of your child’s abilities, including their attention, memory, speech and language skills. This will help you to work out what outcomes you would like for your child, and what you would like any intervention or treatment to target
- Don’t select based purely on a diagnosis. For example, children with dyslexia will have very different reading levels, and children with Autism will have very different social communication needs. Just because your child may have a diagnosis, and the intervention says it ‘works for children with…’, doesn’t mean it will be practicing the right skills, or aimed at the right level for your child. Check what skills the intervention or treatment is targeting, and that these are skills your child is ready to learn.
- Focus on interventions or adaptations that improve your child’s communication skills in everyday environments. Learning and then practicing a skill in the place or time when they will need to use it helps it become part of their communication system.
- Look at the evidence that the treatment or intervention has been successful for other children with similar needs to your child. Whilst the endorsement of other parents (a recommendation at the school gate, or an enthusiastic parent quotation on the website) is encouraging, a research study or academic paper finding that the treatment is effective is more valuable. You can ask your child’s Speech and Language therapist about this!
If you want to find out more about auditory processing, useful information is contained in Chapter 8 of ‘Making Sense of Interventions for Children with Developmental Disorders’ by Bowen and Snow (2017), and in the journal articles referenced below.
Written by Alys Maths, Speech and Language Therapist
Dawes, P., Bishop, D. V., Sirimanna, T., & Bamiou, D. E. (2008). Profile and aetiology of children diagnosed with auditory processing disorder (APD). International Journal of Pediatric Otorhinolaryngology, 72(4), 483-489.
Dawes, P. and Bishop, D. V. (2009) Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique. International Journal of Language and Communication Disorders. 44(4):440-65
Fey, M.E., Kamhi, A.G., & Richard, G.J. (2012). Letter to the Editor. Auditory training for children with auditory processing disorder and language impairment: A response to Bellis, Chermak, Weihing and Musiek. Language, Speech and Hearing Services in Schools, 43(3), 387-392.
Fey, M. E., Richard, G. J., Geffner, D., Kamhi, A. G., Medwetsky, L., Paul, D., Ross-Swain, D., Wallach, G.P., Frymark, T. & Schooling, T. (2011). Auditory processing disorder and auditory/language interventions: An evidence-based systematic review. Language, Speech, and Hearing Services in Schools, 42(3), 246-264.
Kamhi, A. G. (2011b). What speech-language pathologists need to know about auditory processing disorder. Language, Speech, and Hearing Services in Schools, 42(3), 265-27
Sharma, M., Purdy, S. and Kelly, A. (2009) Comorbidity of Auditory Processing, Language and Reading Disorders. Journal of Speech, Language and Hearing Research. 52: 706-722.
de Wit, E., Visser-Bochane, M. I., Steenbergen, B., van Dijk, P., van der Schans, C. P., & Luinge, M. R. (2016). Characteristics of auditory processing disorders: A systematic review. Journal of Speech, Language, and Hearing Research, 59(2), 384-413.