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Auditory Processing Disorders

What is a Processing Disorder?
Auditory processing is often referred to as "what we do with what we hear.” In other words, it is the ability of the brain to process incoming auditory signals. It is characterized by difficulty understanding and making sense of what is heard. It is different from hearing loss or deafness. Children with processing disorders  may have normal hearing; however, their brains do not process or interpret auditory information correctly. Children may have difficulty hearing the differences between sounds in words, even when the sounds are clear and loud enough to be heard. These problems may become more apparent when the child is in a noisy environment, such as a classroom. An auditory processing disorders (APD) can occur in children and adults, but the prevalence is greater in children - as high as 3 to 5 percent, and twice as prevalent in males. APD is more common than hearing loss (Chermak & Musiek, 1998).

What causes a processing disorder?

There is no single cause. Some of the possible causes are maturational delays in the development of important auditory centers within the brain. Deficits also may be related to differences in the way the child’s brain develops. These usually represent problems that are more likely to persist throughout the individual's life. In other children, the APD can be attributed to neurological problems or diseases (Schminky and Baran, 1999).

What behaviors should a parent or teacher look for if auditory processing disorder or language processing disorder is suspected?
Many of these behavioral characteristics are not unique to APD and also may be observed in individuals with ADHD, hearing loss, behavioral problems, learning difficulties or dyslexia. Diagnosis of an auditory processing disorder should be made through the use of audiological testing.
Children with processing disorders  may:
  • Behave as if a hearing loss is present despite normal hearing,, especially in noisy environments
  • Demonstrate greater difficulty with verbal than nonverbal tasks
  • Be easily distracted by background noise and/or are unusually bothered by loud or sudden noises
  • Have poor reading and/or spelling skills
  • Have difficulty following multi-step directions
  • Have difficulty processing nonverbal information, such as music appreciation
  • Be disorganized and forgetful
  • Be diagnosed with a language delay or disorder
  • Exhibit articulation errors that persist longer than they should
  • Have difficulty remembering spoken information
  • Perform better in quieter settings and/or when auditory information is accompanied by visual or tactile cues
  • Exhibit academic difficulties and be considered “underachievers”
  • Have poor social communication skills or difficulty getting along with peers
Who should be evaluated?
Children 7 years of age or older who exhibit one or more of the behavioral signs, especially if there is a family history of auditory processing difficulties or peripheral hearing loss. Also, a child with a history of otitis media (chronic ear infections) in early childhood, as otitis media can have an adverse effect on the development of auditory processing abilities. Children under age 7 cannot be diagnosed with an auditory processing disorder using formal standardized testing. Children with significant cognitive and/or communication delays may not be candidates for evaluation.

What happens during the evaluation?
Evaluation by both an audiologist and a speech-language pathologist (SLP) is recommended. The audiologist will evaluate a child's hearing, identify any auditory processing and/or attention deficits and may suggest environmental modifications. The SLP will evaluate a child's perception of speech, his/her receptive (understanding) and expressive (production) language use, articulation, attention and pragmatic skills (social use of language).

My child is under 7 years of age and exhibits behavioral signs of an APD. What can be done?

A screening can be performed between ages 5-7 to probe for behaviors that may suggest APD. However, a formal diagnosis cannot be made until at least age 7. The audiologist can assess hearing acuity, middle ear functioning and response to auditory stimuli. The speech pathologist can assess speech, language and cognition. Together, the two specialists can collaborate to identify an at-risk child, establish a baseline of current functioning and recommend therapy or re-evaluation if appropriate.

Is there a treatment for APD?

Yes. Management of APD incorporates three principles: (1) environmental modifications to the home and classroom, (2) working to overcome the disorder (training listening skills, improving communication skills and educating the patient and caregiver regarding management of the APD) and (3) teaching ways to compensates. Therapy is individualized for each child, depending upon his or her specific issues.

What treatment does Robert Wood Johnson University Hospital Somerset offer?

Our Speech & Hearing Department provides individual therapy, as well as computer-based therapy programs such as Earobics. These programs have been shown to improve not only listening skills, but language, reading and spelling as well. Following comprehensive evaluation by both the speech pathologist and audiologist, an individualized plan to manage the APD will be recommended and discussed with the parent and child. If the child does not demonstrate APD, but exhibits speech-language, cognitive or attention problems, traditional speech therapy may be needed. If your child is already receiving speech therapy services at school, we can provide additional therapy as a supplement.

For more information about auditory processing disorders, call the Speech and Hearing Department at 908-685-2946.