by Dr. Pamela Cooper, M.A., MBA, Ph.D.
Auditory processing disorder (APD) and central auditory processing disorder (CAPD) are umbrella terms for any kind of hearing disorder where the brain and the central nervous system cannot process sound properly. Most cases start in childhood. It is estimated that about 1 in every 20 students has APD.
Students with APD are unable to process verbal information the same way as other students because their ears and brain are not working together properly. A delay in the brain’s processing of the information coming from what is heard can last 10 seconds or longer. By the time the brain begins to process the first word that was spoken, the person speaking has already said the entire sentence. This means that a student with APD may have heard only the first word, or the first few words, spoken.
Students with auditory processing disorder can have difficulty doing schoolwork, especially if instruction is long or has multiple steps. Processing words and their meanings may be difficult for these students. These students also commonly have speech and language difficulty, as they cannot decipher the difference between similar sounding letters. For example, consonant blends at the beginning of words, such as “pr” and “dr,” may sound the same to these students.
Students with auditory processing disorder also have auditory memory problems and based upon learning styles, rely on visual processing skills. Visual aids in the classroom can help the student learn or know what steps to do next in class.
Misunderstanding students with APD
Unfortunately, students with auditory processing disorder are often thought to be easily distracted, not focused, not paying attention, not caring about what is happening, lazy, disrespectful or in need of medication.
Students who have auditory processing disorder may also suffer from auditory attention problems, especially if there is an abundance of background noise in the home or classroom. It may appear that the student has a hearing disorder, is simply not listening, or that they have attention deficit hyperactivity disorder—a common misdiagnosis—as their brain tries to keep up with processing verbal information.
Possible causes of APD
Researchers are still working to identify the exact cause of auditory processing disorder. Some researchers report that exposure to lead, trauma to the head, heredity, prenatal drug/alcohol exposure or chronic ear infections may be contributing factors.
Proper screening can be conducted by a learning disabilities teacher-consultant (LDT-C), school psychologist, and/or a speech-language pathologist knowledgeable in APD or from an audiologist who specializes in the diagnosis of central auditory processing disorders (CAPD).
Proper diagnosis can help the student succeed in school and at home, as parents, teachers and other aides can work together to provide the right support and services in the home and school.
According to researchers Kathleen Corriveau, Usha Goswami and Jennifer Thompson, there is general agreement that auditory perceptual abilities and language development are interrelated, as are auditory processing skills and preliteracy skills. Researcher Gail Richard found that it can be difficult to separate the influence of auditory and language skills when considering academic demands. Researcher Larry Medwetsky noted that the act of processing speech is complex and involves the engagement of auditory, cognitive and language mechanisms, often simultaneously.
Dr. Pamela Cooper is an educational diagnostician and learning disabilities teacher-consultant in Winslow Township Public Schools. She can be reached at drpamelacooper1@gmail.com.
Understanding auditory processing disorder
Auditory processing difficulties can manifest in various ways—no two students face the same auditory processing challenges. Students may experience difficulties with listening, understanding what is being said and engaging in conversation. They may struggle with social skills. They may have difficulty maintaining a working memory. Executive functioning and poor organizational skills are common with auditory processing disorder in students.
Auditory localization
The student cannot locate the source of sound and may lack a skill called auditory localization. The student has trouble identifying precisely where a sound is coming from. Auditory localization is essential in most daily activities. Imagine trying to walk through a busy hall between class or crowded cafeteria without being able to identify where sounds are coming from.
Auditory sequencing
The student cannot understand the order of sounds. Students with auditory processing disorder may lack a skill called auditory sequencing and may be confused about the order of sounds. Their brain cannot store and recall auditory stimuli, such as the exact order in which sounds arrive. Not being able to store and recall makes it difficult for students to learn anything by repetition, recite a poem or remember music. The student would have difficulty following verbal instructions or understanding the consequences.
Auditory word discrimination and sound discrimination
Students with auditory processing disorder cannot differentiate between similar sounding words like crash and cash or eighteen and eighty. This is due to a limited ability for auditory word discrimination and sound discrimination.
Auditory discrimination
The student with auditory processing delays does not always understand speech. They are lacking in the skill of auditory discrimination, having difficulty understanding speech when more than one person is talking, there’s noise in the background or the quality of sound is bad. This is because the student cannot differentiate between sounds of different frequency, duration, and intensity and cannot distinguish speech from background noise. The student may not understand when someone speaks fast. The rate at which we process sound is known as temporal processing. For a student with APD, temporal processing is slow. As a result of slow temporal processing, there is a bigger time gap between hearing a sound and processing it.
Auditory memory
APD affects auditory memory or the ability to store sound information and recall them, as necessary. When the speed of processing sound is low, students take more time to understand spoken instruction, directions or commands. The student may ask that information be repeated, or they form a habit of guessing.
Auditory figure-ground
The student with APD gets distracted easily by noises, self-distractions and/or environmental distractions. They find it difficult to listen in a noisy place, classroom, hallway, school bus, etc. The student may not be able to identify the primary sound from background noise, a necessary auditory skill known as auditory figure-ground. Students with auditory processing disorder may also have a short auditory attention span.
Auditory fatigue
Students with APD become tired easily and may be observed with their head down on their arm, pretending to be involved in the lesson, eyes closed or staring. A noisy place can be tiring due to the increased need to put in more effort to listen above the noise or not be distracted. In fact, the daily effort of listening may become so strenuous that the student may just stop trying to adjust. This is known as auditory fatigue.
Auditory closure
Students with auditory processing disorder may not perform well at school. 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 example, 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 auditory closure to understand what is being said. Students with APD might constantly have to rely on auditory memory and auditory closure. Since the student with APD needs to allocate extra mental resources (energy) just to understand what is being said, they are often left with a reduced capacity for other schoolwork, homework or socialization.
APD impact on spelling, reading, recall and singing skills
Students with APD have poor spelling, reading, recall and singing skills. While instructing a student with APD to spell or read, make sure to speak in a clear, distinct way with pauses and repetitions. Students with APD mispronounce words and leave out syllables. While singing, they might change both the lyrics and the tune. Learning to read, spell or sing depends on auditory skills as identifying and joining syllables, attaching meaning to sounds, and remembering the sequence of sounds and words. Students with APD lack these basic skills, they perform poorly in any area that is dependent on hearing and display limited vocabulary.
APD impact on holding conversations
Students with APD struggle with holding conversations and may speak in ways inappropriate to the moment or their age. They may say too much or too little, use inappropriate language, fail to follow a conversation, or have difficulty organizing their thoughts or staying on topic.
Accommodations for students with APD
Students with auditory processing delays will need help from a speech-language pathologist to stay at the same speech and language level as their peers. These students may need help from a friend or help from an aide in the classroom when organizing schoolwork in the classroom or to bring home in their backpacks.
Classroom seating, materials, and routines
- Provide a quiet area for independent work.
- Let the student sit near the teacher and away from auditory distractions, like doors and windows.
- Check in frequently to make sure the student understands the work.
- Give extra time for testing.
Giving instructions and assignments
- Give step-by-step instructions, and have the student repeat them.
- Use attention-getting phrases like “This is important to know because…”
- Decide with the student on a nonverbal signal to show that a key point is being made.
- Say directions, assignments and schedules aloud, and rephrase as needed.
- Repeat key information throughout the lesson and rephrase as needed.
- Use visual tools, images and gestures to enhance and support spoken lessons.
- Break down test or classwork instructions into short, written steps.
- Highlight key words and ideas on worksheets.
- Adjust quantity of homework. Give written homework instructions.
Introducing new concepts/lessons
- Speak clearly and slowly when presenting information.
- Give material on a new concept to the student before it is taught to the whole class (so the student can become familiar with the material ahead of time).
- Give a list of or highlight key vocabulary and concepts for upcoming lessons.
- Give a brief review or connection to a previous lesson before teaching something new.
- Give the student an outline of the lesson.
- Grade based on the student’s completion of the lesson goal. (For instance, do not grade spelling errors if that is not what the student was supposed to learn.)
- Consult with the learning disabilities teacher-consultant and/or speech pathologist for additional support and strategies.