ERIC Identifier: ED474303
Publication Date: 2002-12-00
Author: Ciocci, Sandra R.
Source: ERIC Clearinghouse on
Disabilities and Gifted Education Arlington VA.
Auditory Processing Disorders: An Overview. ERIC Digest.
Children who have difficulty using information they hear in academic and
social situations may have central auditory processing disorder (CAPD), more
recently termed auditory processing disorder (APD). These children typically can
hear information but have difficulty attending to, storing, locating,
retrieving, and/or clarifying that information to make it useful for academic
and social purposes (Katz & Wilde, 1994). This can have a negative impact on
both language acquisition and academic performance.
WHAT IS CENTRAL AUDITORY PROCESSING?
When the ears detect
sound, the auditory stimulus travels through the structures of the ears, or the
peripheral auditory system, to the central auditory nervous system that extends
from the brain stem to the temporal lobes of the cerebral cortex. The auditory
stimulus travels along the neural pathways where it is "processed," allowing the
listener to determine the direction from which the sound comes, identify the
type of sound, separate the sound from background noise, and interpret the
sound. The listener builds upon what is heard by storing, retrieving, or
clarifying the auditory information to make it functionally useful.
WHAT IS A DISORDER OF AUDITORY PROCESSING?
APD is an
impaired ability to attend to, discriminate, remember, recognize, or comprehend
information presented auditorily in individuals who typically exhibit normal
intelligence and normal hearing (Keith, 1995). This definition has been expanded
to include the effects that peripheral hearing loss may contribute to auditory
processing deficits (Jerger & Musiek, 2000). Auditory processing
difficulties become more pronounced in challenging listening situations, such as
noisy backgrounds or poor acoustic environments, great distances from the
speaker, speakers with fast speaking rates, or speakers with foreign accents
WHAT ARE THE BEHAVIORS OF CHILDREN WITH APD?
have auditory processing disorders may behave as if they have a hearing loss.
While not all children present all behaviors, Keith (1995) offers the following
examples of behaviors that may be displayed by children who have APD:
* Inconsistent response to speech
* Frequent requests for repetition (What? Huh?)
* Difficulty listening or paying attention in noisy environments
* Often misunderstanding what is said
* Difficulty following long directions
* Poor memory for information presented verbally
* Difficulty discerning direction from which sound is coming
* History of middle ear infection.
WHAT ARE ACADEMIC CHARACTERISTICS OF CHILDREN WHO HAVE
In addition to the preceding behaviors, children may also present a
variety of academic characteristics that may lead teachers and parents to
suspect APD. Baran (1998) offers the following characteristics. Again, all
children will not present all characteristics.
* Poor expressive and receptive language abilities
* Poor reading, writing, and spelling
* Poor phonics and speech sound discrimination
* Difficulty taking notes
* Difficulty learning foreign languages
* Weak short-term memory
* Behavioral, psychological, and/or social problems resulting from poor
language and academic skills.
HOW IS APD DIAGNOSED?
Given the complexity of auditory
processing disorders, it is important to involve a multidisciplinary team
including psychologists, physicians, teachers, parents, and of course,
audiologists and speech-language pathologists. Audiologists diagnose the
presence of APD (hearing and processing problems), and speech-language
pathologists evaluate a child's perception of speech and receptive- expressive
language use. Other team members conduct additional assessments to determine a
child's educational strengths and weaknesses. Checklists that ask teachers and
parents to observe the child's auditory behaviors may be used to determine a
need for the APD evaluation. The parent's description of the child's auditory
behavior at home is an especially important contribution to the diagnosis of
WHAT DOES THE AUDIOLOGIST DO?
The audiologist assesses the
peripheral and central auditory systems using a battery of tests, which may
include both electrophysiological and behavioral tests. Peripheral hearing tests
determine if the child has a hearing loss and, if so, the degree to which the
loss is a factor in the child's learning problems. Assessment of the central
auditory system evaluates the child's ability to respond under different
conditions of auditory signal distortion and competition. It is based on the
assumption that a child with an intact auditory system can tolerate mild
distortions of speech and still understand it, while a child with APD will
encounter difficulty when the auditory system is stressed by signal distortion
and competing messages (Keith, 1995). The test results allow the audiologist to
identify strengths and weaknesses in the child's auditory system that can be
used to develop educational and remedial intervention strategies.
HOW SHOULD TEST RESULTS BE INTERPRETED?
As with any kind of
evaluation, test results should be interpreted with caution. The effects of
neurological maturation may influence test results for children under the age of
12 years. A true diagnosis of APD cannot be determined until that time (Bellis,
1996). However, there are much younger children whose auditory behaviors,
language, and academic characteristics indicate that APD is a strong
possibility, and even without a formal diagnosis, these children would benefit
from intervention. Remediation should address their strengths and areas of need
based on available speech-language and psychoeducational testing.
IS THERE A RELATIONSHIP BETWEEN APD AND ADHD?
of children with APD and ADHD may be very similar, especially with regard to
distractibility. Given what is presently known, APD and ADHD do not appear to be
a single developmental disorder. Each can occur independently, or they can
coexist. This is a prime example of where the team approach to evaluation is
critical, as the team can rule out the presence of ADHD or determine its
contribution to the potential educational impact on the child.
WHAT CAN BE DONE TO HELP CHILDREN WITH APD IN THE
Traditional educational and therapeutic approaches can be
employed to remediate areas of need in language, reading, and writing. Many
techniques that have shown to be effective with children with APD would be
beneficial to all children, with and without APD, if the strategies employed are
specific to the child's areas of need (Bellis, 1996; Chermak & Musiek, 1997;
Sloan, 1998). Some of these are described below:
* Modify the environment by reducing background noise
and enhancing the speech signal to improve access to auditory information:
- Eliminate or reduce sources of noise in the classroom (air vent, street
traffic, playground, hallway, furniture noises, etc.).
- Use assistive listening devices (ALDs) such as a sound field amplification
system or an FM auditory trainer.
- Allow preferential or roving seating to ensure that the child is seated as
close to the speaker possible.
- Allow the child to use a tape recorder and/or a peer note taker.
- Ensure that the speaker gets the child's attention before speaking, and
considers using a slower speaking rate, repeating directions, allowing time for
the child to respond to questions, pausing to allow the child to catch up, and
presenting information in a visual format through overheads, illustrations, and
Teach the child to use compensatory strategies, "meta" strategies, or executive
functions to teach how to listen actively. The child should:
- Learn to identify and resolve difficult listening situations.
- Develop skills to understand the demands of listening: attending, memory,
identifying important parts of the message, self-monitoring, clarifying, and
- Develop memory techniques: verbal rehearsal (reauditorization), mnemonics
(chunking, cueing, chaining).
- Encourage use of external organizational aids: checklist, notebook,
- Develop vocabulary, syntax, and pragmatic skills to facilitate language
Provide auditory training to remediate specific auditory deficits:
- Children who have poor reading, writing, and spelling skills may benefit
from phonological awareness activities.
- Auditory closure activities may assist children in filling in or predicting
the information they are listening to in the classroom and conversations.
- Instruction in interpreting intonation, speaking rate, or vocal intensity,
and in the relationship between syllable and word may assist children in
determining important parts of the message.
- When the child has demonstrated success on the above tasks in a quiet
environment, give the child practice engaging in the same tasks in an
environment that includes background noise.
- Explore the use of commercially available computer programs designed to
develop the child's attention to the phonological aspects of speech. These
should be recommended by a professional who can determine their applicability to
the child's needs.
American Speech-Language-Hearing Association.
Task Force on Central Auditory Processing Disorders. (1995). Central auditory
processing: Current status of research and implications for clinical practice.
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Bellis, T. J. (1996). Assessment and management of central auditory
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