10 Signs Of Auditory Processing Disorder In Children

[pullquote]Almost 1 in every 20 children has auditory processing disorder due to which their brain cannot process sound properly.[/pullquote]

Auditory processing disorder (APD) or central auditory processing disorder (CAPD) is an umbrella term for any kind of hearing disorder where the brain and the central nervous system cannot process sound properly. Anybody can get APD, but most cases start in childhood. It’s estimated that about 1 in every 20 children is affected by APD to some degree.¹

[pullquote]If your child has learning disabilities, it might be linked to APD. If they are above 7, take them to an audiologist.[/pullquote]

APD in children becomes noticeable after they start going to school as it often leads to learning difficulties. This is because hearing plays a huge role in learning anything that is based on spoken language. But it is difficult even for an audiologist – a specialist who deals with hearing, balance, and related problems – to detect auditory processing disorder in children below 7 because their brain functions are not fully developed.²

Here are some of the common symptoms children with APD experience. But note that not everyone with the condition will have all these symptoms or to the same degree. Try the following exercises³ and tips to deal with or improve the symptoms.

1. They Cannot Locate The Source Of Sound

[pullquote]Exercise: Ask your child to close the eyes and concentrate. Call out to them from different corners of the room.[/pullquote]

People with APD may lack in a skill called auditory localization. This means they have trouble identifying precisely where a sound is emerging from. This skill is essential in most daily activities. Imagine trying to walk through a busy street or crowded marketplace without being able to identify where the sounds are coming from.

2. They Cannot Understand The Order Of Sound

[pullquote]Exercise: Use a simple sound pattern – say, 2 claps-1 whistle-2 claps – and ask your child to imitate it.[/pullquote]

As people with APD may lack a skill called auditory sequencing, they may be confused about the order of sounds. That is because their brain cannot store and recall the auditory stimuli – that is sounds – in the exact order. This would make it difficult for them to learn anything by repetition, say a poem or even music. They would also have difficulty following verbal instructions.

3. They Cannot Tell Similar Words Apart

[pullquote]Exercise: Enunciate that and fat clearly and ask your child if they are same. Keep using different word pairs.[/pullquote]

APD patients may not be able to differentiate between similar-sounding words like crash and cash or eighteen and eighty. This is because they have limited ability for auditory word discrimination and sound discrimination.⁴

4. They Do Not Always Understand Speech

[pullquote]Exercise: Keep the radio humming in a low volume while you speak clearly and slowly. Encourage your child to focus only on your voice.[/pullquote]

If APD patients are lacking in the skill of auditory discrimination, they’d have difficulty understanding speech – especially if more than one person is talking, or there’s noise in the background, or the quality of sound is bad.

This is because they cannot differentiate between sounds of different frequency, duration, and intensity. So they cannot distinguish speech from background noise.

People with APD may also not understand when someone speaks fast. The rate at which we process sound is known as temporal processing. For someone with APD, temporal processing is slow. As a result, there is a bigger time gap between hearing a sound and processing it.

5. They Misinterpret Or Easily Forget Verbal Directions

[pullquote]Exercise: Give a simple set of instructions – 2 claps and a high five – and ask your child to imitate you. Increase the steps gradually.[/pullquote]

APD affects people’s auditory memory or the ability to store sound information and recall them as necessary. Also, as their speed of processing sound is low, they take more time to understand a spoken instruction. They may ask the instructor to repeat or they make do with guessing.⁵

6. They Get Easily Distracted By Noise

[pullquote]Exercise: Keeping the fan whirring in the background, read out a story and tell your child to listen for specific words or names of animals.[/pullquote]

If your child has auditory processing disorder, they may find it difficult to listen in a noisy place. They are easily distracted by noise. This is because they may not be able to identify the primary sound from background noise – a necessary auditory skill known as auditory figure-ground. APD patients also have a short auditory attention.

7. They Get Tired Easily

[pullquote]Tip: Keep the exercise fun with visual cues. Say, when asking the child to identify two similar-sounding words, use images to show the contrast.[/pullquote]

A noisy place can tire out people with APD as they need to put in a lot of effort to listen above the noise or not be distracted. In fact, the daily effort may become so much for them that they may just stop trying to adjust. This is known as auditory fatigue.⁶

8. They Have Poor Spelling, Reading, And Singing Skills

[pullquote]Tip: While teaching a child to spell or read, make sure you are speaking in a clear, distinct way with pauses and repetitions.[/pullquote]

Children with APD mispronounce words and leave out syllables. While singing, they might change both the lyrics and the tune. This is because learning to read, spell, or sing depends on auditory skills like identifying and joining syllables, attaching meaning to sounds, and remembering the sequence of sounds and words. As children with APD lack these basic skills, they perform poorly in any area that is dependent on hearing. For that reason, they also have a limited vocabulary.

9. They May Not Perform Well At School

[pullquote]Exercise: Read out a story your child knows and leave out parts. Ask your child to fill these gaps. This will help develop their auditory memory.[/pullquote]

Sometimes, when a part of a sentence is missing or garbled, we make sense of the context and fill the gap using common sense. For instance, in the sentence, “The __ rises in the east,” we can easily fill in the missing word, sun, from what we know. This is known as auditory closure. We all use it to some extent to understand what’s being said.

Kids with APD, however, might have to rely on it constantly. Since they need to allocate a lot of their mental resources just to understand what’s being said, they’re often left with a reduced capacity for other school work.⁷

10. They Cannot Hold Conversations

[pullquote]Tip: Be very patient. Maintain eye contact. Speak clearly. Repeat often.[/pullquote]

The kids may speak in a way inappropriate for their age, either saying too much or too less. They may have difficulty organizing their thought and veer off topic.

What Causes APD?

The exact reasons for APD are yet unknown. But certain triggers have been identified.

[pullquote]Your genes, a childhood episode of glue ear, brain injury, or aging are all linked with auditory processing disorder.[/pullquote]

• A genetic component may be at play as APD seems to run in families.
• Children who’ve had recurring episodes of ear-related problems such as glue ear (where the middle ear retains fluid) at a young age may be susceptible. Even when the condition has been sorted out, it might have impacted how sound is processed by the brain.
• APD has been linked to brain damage due to a tumor, stroke, head injury, or meningitis.
• Changes related to age and conditions like multiple sclerosis which affect the nervous system are also associated with APD.⁸

APD Is Not Hearing Loss, ADHD, Or Autism

Although it is a hearing-related disorder, APD is not the same as hearing loss – in fact, it may not even register as hearing loss in an audiogram or other routine tests. The problem here is beyond the ear and is related to the brain circuitry. [pullquote]Children with APD often act as though they are hearing impaired. They also have a short attention span. But APD is not the same as hearing loss or ADHD.[/pullquote]

Some of the symptoms of APD are also common to other conditions. For instance, people with attention deficit/hyperactivity disorder (ADHD) and autism may also have trouble with understanding what’s being said or remembering it. However, in these cases, the symptoms can’t be traced to the faulty processing of sound in the central nervous system. Also, APD could occur along with other disorders like ADHD. Therefore, it’s important to confirm that the difficulties with understanding speech are actually due to APD. An audiologist can conduct tests and give you an accurate diagnosis.⁹

Managing Auditory Processing Disorder

There’s no cure as such for APD but you can manage it by modifying the environment in which communication happens, using other skills to compensate, or making remedial changes that address the defect itself.

1. Try Auditory Training Exercises

Some activities can teach your brain to deal with sound better. Try the exercises we have mentioned above. You can try them at home or a professional can help you. Computer programs and CDs that are tailored to APD can also help.¹⁰

2. Change The Environment

Help children with APD work in a quiet area without the distraction of a TV or any kind of background noise. Make a classroom as noise-free as possible with curtains and carpets to magnify sound. Change the seating arrangement such that children with APD can sit closer to the teacher and away from sources of noise like windows and fans.¹¹

3. Use Aids For Better Hearing And Comprehension

Give children with APD notes before class. Pay them extra attention in class or proactively teach them new words, using visual aids like graphs and pictures. They can also use a frequency modulation system. This has a transmitter and a receiver, which magnifies the sound of the speaker, say a teacher, and sends it wirelessly to the receiver so what’s being said can be heard above background noise.¹²

With a little care and the appropriate interventions, auditory processing disorder is a condition that can be managed, so stay positive and don’t let it put a crimp in your step!