Auditory Processing Disorder

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My Daughter Has APD

Auditory Processing Disorder (APD) is a little known condition that may affect 10% of children, the majority of whom are undiagnosed. APD is a term that is often used to describe people with normal hearing who have listening difficulties.

According to Contact a Family it was first recognised in the USA in the 1960s.

Because my child has APD I can recognise possible symptoms in other children. However, the sad fact is that many people who work with children, including teachers and health care professionals, have never heard of APD and the children who are not diagnosed do not get the help they need.

This lens is a "must read" for any parent who is concerned that their child is not doing well at school, but no one can tell them why.

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Lens of the Day! Twice!! 

Wow o Wow o Wow


 On 10 September 2008, Lizzie's left ear became the most famous ear on Squidoo. To say I was bouncing around like Tigger when I found out, is an understatement!

Then it happened again! On 23 September it made Lens of the Day again! All this bouncing around like Tigger is wearing me out.

Thank you Megan and the Squidoo team for such an accolade.

Thank you everyone who has visited the lens, rated it and left feedback.

Thank you everyone who has emailed the link to their friends - we need to get the word out so ALL children who have this condition get the help and support they need.

Lizzie was very quiet as a toddler 

Not at all like my other children! We wondered if she had hearing problems

When Lizzie was around 20 months old my Mother asked me if I thought her youngest grandchild would ever start to talk - don't you just love the things your Mother says to you? Lizzie's vocabulary consisted solely of "Dada", "Mummmm" and "No".

I calmly responded I was sure that when Lizzie was ready she would amaze us with her conversation and sure enough a few weeks later she astounded us with her first phrase, which was: "Baa black sheep, any wools, three bags full!"

I must admit that despite being outwardly relaxed about it, I was surprised that in a family of utterly compulsive communicators, Lizzie - the youngest of four - was very quiet. At first I put it down to her being completely overshadowed by her sister (older by 21 months), who usually had enough to say for both of them, but as time went on we realised that Lizzie was different to her older siblings in very subtle ways and it wasn't just that she was a lot quieter.

Following her "Baa black sheep moment" Lizzie's speech developed rapidly, although she became a regular Little Mrs Malaprop, frequently mispronouncing words. We did not make a big thing of it, just repeated the correct pronunciation back to her as part of normal conversation. During her time at playschool and nursery no one flagged up any problems and allowances were always made for the fact that as a July baby she was always one of the very youngest in her class. It was not until she joined her Infant class in January in 2003 that her teacher mentioned about Lizzie retreating into what she termed "Lizzie's Bubble". We had begun to notice that sometimes, when we spoke to her, Lizzie did not respond and seemed to be in a world of her own. I called it her going to "Planet Lizzie". She was never a rude child and she would not just completely ignore anyone, so inevitably we started to wonder about her hearing.

Symptoms of APD 

Symptoms are similar to someone with hearing problems

Symptoms include all or a combination of some of the following problems:

  • Lack of understanding when listening
  • Expressing themselves clearly using speech
  • Difficulty reading
  • Understanding spoken messages and/or remembering instructions
  • Staying focussed
  • Hearing and listening in noisy places
  • Becoming tired in the afternoons

    • The Doctor 

    Tests for hearing problems

    Getting referred for a hearing test was easy. Our Doctor arranged it very quickly and we went to the local hospital. I was very surprised when the results came back stating that Lizzie's hearing was perfectly normal. However, the hospital said they would do a follow up test in six months and again the results were "normal".

    I refused to accept that there was nothing wrong, as at times Lizzie did not respond to things that we said to her and we were starting to worry that she was not doing particularly well at school. But, as I have since discovered, like many parents with health professionals insisting that her hearing was normal I just did not know what to do.

    The Teacher 

    Her teacher asked if we thought Lizzie had hearing problems

    Lizzie moved on to Year 1 and within a few days her new Teacher, who was the school's Special Educational Needs Co-ordinator (SENCO), asked to see me after school. She came straight to the point and enquired if I had any worries about Lizzie's hearing. I felt relieved and totally vindicated - I wasn't an over anxious Mum after all!

    Here was someone else who was not prepared to accept that there was nothing wrong and as we had already had 2 hearing tests done the SENCO suggested that the next step should be an assessment by a Speech Therapist. Lizzie continually mispronounced words and we had noticed that she missed off the ends of words, e.g. "rin" instead of "ring" so this seemed like a logical next step.

    The Speech Therapist 

    Speech problems can be a sign of hearing problems

    In her report the Speech Therapist identified that Lizzie "is a sociable, communicative girl with good language skills". However she went on to state that she "showed difficulty discriminating minimal pair words involving high frequency sounds, e.g. f, s, sh, th. She also had difficulty identifying the difference between sequences of sounds in words and non-words e.g. mist -> mits, fat -> vat".

    The recommendation was that Lizzie should undergo in-depth audiological testing on both ears.

    The Audiologist 

    Further investigations for hearing problems and at last a diagnosis

    We were referred to a Paediatric Audiology Clinic where the Doctor had no hesitation in diagnosing that Lizzie has Auditory Processing Disorder (APD).

    Along with everyone we mentioned it to, we had never heard of APD. The Doctor told me that the condition had only relatively recently been identified. The suspicion was that 10% of children had it and the worry was that many remained undiagnosed. Given that this was 2004 and APD was a "new" condition, we were fortunate to get the diagnosis when we did and that we got it quite quickly - within a year of the investigations starting. Many concerned parents have had to wait a lot longer - in one case I read about recently it was four years, see this Times article.

    Problems the undiagnosed child may experience 

    Undiagnosed sufferers can:

  • be considered lazy at school
  • be accused of not trying hard enough in lessons
  • be told they are rude because they ignore you
  • be regarded as not contributing enough to class discussions.

    In the meantime, the child does not know what the Teacher is complaining about. As far as they are concerned they are trying really hard.

    Another concern is that many children with APD may have other language-learning difficulties such as:

  • Dyslexia - difficulties with reading and/or spelling

  • Attention Deficit Disorder (ADD) and/or Attention Deficit Hyperactivity Disorder (ADHD) - difficulties in concentration or attention

  • Speech and Language Impairment - difficulties in the development and/or understanding of speech and language.

    There is also concern that one condition may be diagnosed, which masks another condition, that may go undiagnosed.

    • The Ear

    What is Auditory Processing Disorder? 

    Not hearing problems - but listening problems

    So what exactly is APD? APD is generally described as a listening rather than a hearing disorder.

    Sufferers have normal hearing but they experience a random inability to process auditory (verbal) information. They hear the sounds but the brain does not always process them. Hearing starts with a complex set of actions within the outer, middle and inner ear. These actions send the sounds to the brain that interprets them so the individual can understand. This set of actions can be defined as 'listening' for which the medical term is 'auditory processing.'

    How badly sufferers are affected can often depend on the immediate environment and noisy surroundings can present huge problems for those affected. Inevitably it can hinder their attainment at school if undiagnosed. Not only can sufferers not distinguish speech sometimes but specific sounds may hurt their ears.

    Drums Alice Covers Her Ears to the Sound of the Drums

    Buy at AllPosters.com



    I remember a firework display that we had to rapidly leave as the noise reduced Lizzie to tears. Her teachers would remark that sometimes in class she would cover her ears if she knew something noisy was about to happen. She also cannot bear anyone clicking their nails.

    According to the Institute of Hearing Research the causes of APD are still unclear and the website for Auditory Processing Disorder in the United Kingdom states that the condition can be part of an "Invisible Disability package", where other disabilities can be present such as Dyslexia or Attention Deficit Disorder.

    The very real danger is that each condition can mask the presence of another. Another concern is that while the majority of research being conducted relates to children, 10% of adults may also suffer from APD and many may never be diagnosed.

    Parents can become desperate to get help for their child 

    Every parent who has a child who has a "condition", whether it be epilepsy, dyslexia, autism, Attention Deficit Disorder (ADD) or APD is understandably anxious, and in some cases, desperate to find a treatment to alleviate the problems associated with these conditions.

    The following is a question that was asked on the website Steady Health

    "I was wondering if a stimulant medication such as ritilin or adderall would be an effective treatment for dealing with auditory processing disorder? My reason for asking this, is that some of this disorder's symptoms can be shared with other related disorders, which can also have areas of overlap. Disorders such as acquired brain injury, attention deficits, dyslexia or learning difficulties, hearing loss, and psychologically-based behavioural problems have been linked in relation to APD."

    When I read this I was shocked and to be honest sickened. I believe that the question was asked by a parent. This parent must be absolutely desperate to even ask the question and the statement made shows a possible lack of understanding of the conditions that their child may have.

    Research into APD 

    Article from Medic8.com

    In recent years, scientists have developed new ways to study the human brain through imaging. Imaging is a powerful tool that allows the monitoring of brain activity without any surgery. Imaging studies are already giving scientists new insights into auditory processing. Some of these studies are directed at understanding auditory processing disorders. One of the values of imaging is that it provides an objective, measurable view of a process. Many of the symptoms described as related to APD are described differently by different people.

    Imaging will help identify the source of these symptoms. Other scientists are studying the central auditory nervous system. Cognitive neuroscientists are helping to describe how the processes that mediate sound recognition and comprehension work in both normal and disordered systems.

    Research into the rehabilitation of child language disorders continues. It is important to know that much research is still needed to understand auditory processing problems, related disorders, and the best interventions for each child or adult. All the strategies undertaken will need to be suited to the needs of the individual child, and their effectiveness will need to be continuously evaluated. The standard for determining if a treatment is effective is that a patient can reasonably expect to benefit from it.

    Books about APD that may help you 

    When the Brain Can't Hear : Unraveling the Mystery of Auditory Processing Disorder

    When the Brain Can't Hear : Unraveling the Mystery of Auditory Processing Disorder

    by: Ph.d. Teri James Bellis

    Dr. Teri James Bellis, one of the world's leading authorities on APD explains this sometimes devastating condition and provides case studies that illustrate its effect on the lives of its sufferers. Millions struggle silently with APD. For many of them, holding a simple conversation can be next to impossible. As sound travels through an imperfect auditory pathway, words become jumbled, distorted, and unintelligible. Dr. Bellis notes the most profound impact of this highly specific impediment to auditory comprehension may be on the young. Facing a severely reduced ability to read, spell, comprehend, and communicate, children with APD are subject to anxiety, academic failure, and a damaged sense of self. Often, they are misdiagnosed. Dr Bellis removes much of the mystery from APD. If you or anyone you know has difficulty comprehending spoken language, or if your child is struggling in school, this important book may have the answers you need.

    Adapted from the Amazon description

    Amazon Price: $10.55 (as of 12/10/2009) Buy Now

    Like Sound Through Water : A Mother's Journey Through Auditory Processing Disorder

    Like Sound Through Water : A Mother's Journey Through Auditory Processing Disorder

    by: Karen J. Foli

    The author describes her personal experiences dealing with a child suffering from APD, describing the misdiagnoses and lack of understanding of the condition that hampered her struggle to help her son learn to communicate.

    Adapted from the Amazon description

    Amazon Price: $10.80 (as of 12/10/2009) Buy Now

    Auditory Processing Disorders: Assessment, Management and Treatment

    Auditory Processing Disorders: Assessment, Management and Treatment

    by: Donna Geffner and Deborah Ross-Swain

    This book details the history, definition and behaviors of APD before educating the reader on the most current practices for audiological and speech-language assessment of APD, including its impact on literacy and language processing. Practical rehabilitation and management strategies are covered in detail. This highly practical book designed specifically for practicing clincians, both audiologists and speech-language pathologists.

    Adapted from the Amazon description

    Amazon Price: $77.38 (as of 12/10/2009) Buy Now

    An Introduction to Auditory Processing Disorders in Children

    An Introduction to Auditory Processing Disorders in Children

    by: Teralandur K. Parthasarathy

    This new textbook presents the major advances in the assessment and management of APD. The chapter authors, highly regarded clinicians and researchers from diverse professional groups, contribute an impressive breadth of knowledge to explain and demystify APD. This text will be useful to students of speech language pathology and audiology, as well as professionals in those fields.

    Adapted from the Amazon description

    Amazon Price: $39.95 (as of 12/10/2009) Buy Now

    Central Auditory Processing Disorders: New Perspectives

    Central Auditory Processing Disorders: New Perspectives

    by: Gail D. Chermak, Frank E. Musiek, Chie Higuchi Craig

    Amazon Product Description

    Washington State Univ., Pullman. Text linking the neurobiology of central auditory processing with language and cognitive systems. For professionals. Softcover.

    Amazon Price: $76.95 (as of 12/10/2009) Buy Now

    Books about APD for UK visitors 

    Link to Amazon UK

    Treatment of APD 

    According to the American Speech, Language and Hearing Association and Greatschools.net
    there is a wide variety of treatments available to address specific auditory problems. However, it is important to undertsand that there is no single treatment that will suit everyone who has APD. Each sufferer needs to be assessed and then an individual programme devised to help them.

    Treatments can include the following:

  • Computer-assisted programmes
  • One-to-one training with a therapist
  • Home-based programmes
  • Therapy sessions at a clinic
  • Auditory trainers

    According to the website for the National Institute on Deafness and other hearing disorders Auditory trainers are:

    electronic devices that allow sufferers of APD to focus attention on a speaker and reduce the interference of background noise. They are often used in classrooms, where the teacher wears a microphone to transmit sound and the child wears a headset to receive the sound. Children who wear hearing aids can use them in addition to the auditory trainer.

    The degree to which there will be any improvement cannot be determined in advance. Some children with APD experience complete elimination of their difficulties or seem to "grow out of" APD, others may have some residual degree of processing problems forever.

    However, with the correct guidance and support, all children with APD can learn to help others help them, rather than become helpless victims of an invisible problem. To give an example, within weeks of being diagnosed, Lizzie had learned to immediately tell her Teacher when she had not understood something and she no longer retreated into her "bubble".

    • Strategies to help with Auditory Processing Disorder 

    These strategies helped Lizzie with her APD

    Lizzie's Paediatric Audiologist suggested some very simple strategies to help her, which included:

  • reducing noises and distractions while giving instructions
  • sitting her at the front of the class
  • providing seating away from distractions, such as open windows, doorways etc
  • avoiding multiple commands or excessive gestures when speaking to Lizzie
  • saying her name to alert her before giving an important message
  • making allowances for auditory exhaustion - sufferers can get tired and tasks need to be alternated with less demanding work
  • be supportive - sufferers can lack self confidence.

    The strategies were so successful that in the space of one academic year Lizzie went from under achieving to doing brilliantly in her SATs at the end of Year 2.

    Unfortunately, that was not the end of the story. During Year 1 and 2 it became obvious that Lizzie was developing her own very unique phonetics when writing and she did not want to read. We had a suspicion that she was also dyslexic and indeed, although in her report the Educational Psychologist avoided the phrase, she confirmed that Lizzie has "a mild specific difficulty with phonological awareness".

    An additional set of strategies was agreed, which again have made a difference, but ironically Lizzie is achieving too well at school to qualify for extra specialist help.

    • Some shocking statistics about Auditory Processing problems 

    APD is still a relatively unknown condition

    It is now four years since Lizzie was diagnosed as having APD and Family Doctors remain unfamiliar with the condition, as do teachers and others working with children either professionally or in a voluntary capacity. I have lost count of the number of times Doctors and Teachers "go blank" if I mention it.

    I Googled the phrase "Auditory Processing Disorder", on UK websites on 11 August 2008, I found 289,000 articles compared to 2,370,000 for "Dyslexia".

    An international search, on the same day, produced the following number of "hits":

    "Auditory Processing Disorder" = 2,200,000
    "Dyslexia" = 7,940,000

    Yet, far more children (10%) are suspected to have APD than Dyslexia - between 4% and 5% according to Dyslexia Action.

    However, even more astounding is that a search on the UK's National Health Service website (conducted on 11 August 2008) returned NO RESULTS on either APD or Auditory Processing Disorder!

    Equally shocking was that another search of The UK Government Department for Children, Schools and Families' website also returned NO information, while there were over 100 results for Dyslexia.

    Update: 20 February 2009
    The same searches were conducted via Google.

    "Auditory Processing Disorder", on UK websites returned 56,800 articles compared to 1,400,000 for "Dyslexia"

    An international search returned 371,000 for "Auditory Processing Disorder" and 9,830,000 for Dyslexia

    The main UK National Health Service website still has NO INFORMATION about APD!! Neither does the UK Government website.

    To summarise the key points about APD 

    The American Speech, Language and Hearing Association summarises the Key Points to remember as follows:

  • APD is an auditory disorder that is not the result of autism, mental retardation, attention deficits, or similar impairments

  • Not all learning, language, and communication deficits are due to APD

  • No matter how many symptoms of APD a child has, only careful and accurate diagnosis can determine if APD is, indeed, present

  • Although a multidisciplinary team approach is important in fully understanding the cluster of problems associated with APD, the diagnosis of APD can only be made by an audiologist

  • Treatment of APD is highly individualised. There is no one treatment that is appropriate for all children with APD.

    • Another problem looms but we'll get there! 

    APD is incurable but fortunately in Lizzie's case it is manageable - the key for her was getting both diagnoses (the APD and the problems with phonetics) relatively quickly. Lizzie is lucky, she does not have APD acutely and simple strategies have helped her enormously, so much so that the majority of people who come into contact with her are completely unaware that she has a difficulty.

    However, over the last couple of years it has become apparent that Lizzie's spelling is becoming more of a problem, which is inhibiting her progress in literacy, so we are now on the road to addressing this - this may result in another lens!

    But to finish on a positive note Lizzie is now very articulate, a lot more confident and enjoys reading - currently she is wading her way through Harry Potter and The Order of the Phoenix - not bad for a 9 year old!

    More books that may help with related learning difficulties 

    Children who have APD may also have dyslexia

    Dyslexia is a condition that it is thought is part of a group of "invisible conditions" that may be related. Lizzie has mild dyslexia as well as Auditory Processing Disorder
    The Gift of Dyslexia: Why Some of the Smartest People Can't Read... and How They Can Learn

    The Gift of Dyslexia: Why Some of the Smartest People Can't Read... and How They Can Learn

    by: Ronald D. Davis, Eldon M. Braun

    Amazon Price: $10.37 (as of 12/10/2009) Buy Now

    How To Reach and Teach Children and Teens with Dyslexia: A Parent and Teacher Guide to Helping Students of All Ages Academically, Socially, and Emotionally (J-B Ed: Reach and Teach)

    How To Reach and Teach Children and Teens with Dyslexia: A Parent and Teacher Guide to Helping Students of All Ages Academically, Socially, and Emotionally (J-B Ed: Reach and Teach)

    by: Cynthia M. Stowe M.Ed.

    Amazon Price: $19.77 (as of 12/10/2009) Buy Now

    Keeping a Head in School: A Student's Book About Learning Abilities and Learning Disorders

    Keeping a Head in School: A Student's Book About Learning Abilities and Learning Disorders

    by: Melvin D. Levine

    Amazon Price: (as of 12/10/2009) Buy Now

    A Workbook for Dyslexics

    A Workbook for Dyslexics

    by: Cheryl Orlassino

    Amazon Price: $28.75 (as of 12/10/2009) Buy Now

    It's Called Dyslexia (Live and Learn Series)

    It's Called Dyslexia (Live and Learn Series)

    by: Jennifer Moore-Mallinos

    Amazon Price: $6.99 (as of 12/10/2009) Buy Now

    Books on Dyslexia - UK Visitors 

    Link to Amazon UK

    Getting help for auditory processing problems 

    Good websites about APD

    These are some of the websites I have found that will give you more details about APD and there's also information on where you can get help.
    Auditory Processing Disorder UK
    This group may be based in the UK but has a very useful website and an online forum.
    Contact a Family
    Another UK based organisation which helps parents of children with all sorts of conditions and disabilities, including APD and Dyslexia.
    The Institute of Hearing Reseach
    The IHR is conducting a lot of research into APD - very easy to read pages about the research they are doing to help sufferers of APD.
    Wikipedia
    The Wikipedia article on APD
    The Davis Centre
    What is The Tomatis Method? Tomatis was developed approximately 50 years ago by Dr. Alfred Tomatis, a French physician. He discovered the connection between the voice, the ear, and the brain and found that the voice produces what the ear hears.
    Vice Chariman of APDUK (dolfrog) RPC Bookmarks on Delicious
    A collection of online research papers on APD and Dyslexia
    Auditory Processing Disorder in the UK (APDUK) on Facebook
    Welcome to the official Facebook Page of Auditory Processing Disorder in the UK (APDUK). Get exclusive content and interact with Auditory Processing Disorder in the UK (APDUK) right from Facebook.

    Message from the Vice-Chair of APDUK 

    Posted in the guestbook

    APDUK is a UK-based organisation that provides a lot of information on APD. There is also a forum, which often has very lively discussion about the help you can get (or not in some cases) and the research currently being conducted.

    This is what the Vice-Chair of APDUK had to say about this lens:

    dolfrog
    great information about APD.
    to clarify an issue from an early comment.
    Obscure Auditory Dysfunction or AOD is now part of APD and AOD was only one of the main 4 sub types of APD.

    best wishes

    dolfrog
    vice Chair APDUK
    Posted September 02, 2008 03:17 PM

    The Isle of Squid 

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    Auditory Processing Disorder

    Update - AJ has Otosclerosis 

    Is this a coincidence?

    In July 2008 I was diagnosed as having a disease of the middle ear called Otosclerosis.

    In September 2008 my eldest daughter had a hearing test that confirmed hearing loss in her right ear. She has been referred to a specialist and will undergo further tests.

    As Otosclerosis can be hereditary, we will be looking to have Lizzie and my other two children checked out as well.

     

    13 August 2009
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    • Reply
      hotbrain hotbrain Nov 23, 2009 @ 1:39 am
      I had several kinds of speech and auditory problems when I was a kid. I had speech therapy starting in pre-school through 4th grade.. When I was a preschooler, my speech was so bad that people had trouble understanding me... It is all corrected now to the point that people can't tell that I even had a problem!

      This is an important topic and your lens handles this topic very well! Thank you for sharing your story!

      Often people who have weaknesses or delays in one area of development also have strengths in other areas... Einstein had speech difficulties. The brain is an amazing thing!
    • Reply
      aj2008 aj2008 Nov 23, 2009 @ 3:45 am
      Yes, the brain is amazing. In LIzzie's case she has a brilliant eye for detail as far as art work is concerned and the most hilarious wit and sense of humour. So yes, I agree where there's difficulties, there's always compensations.
    • Reply
      Kate-Phizackerley Kate-Phizackerley Oct 29, 2009 @ 4:13 pm
      Surprised I'd not visited before. AJ at her very best. Blessed of course.
    • Reply
      dolfrog dolfrog Oct 28, 2009 @ 9:24 pm
      Hi AJ

      Your APD lense looks very good.
      We have just launched an APDUK Page on Facebook, still using the duck logo.
      There is also a new APD group and Facebook, and I have also acquired the (Central) Auditory Processing Disorder (C)APD group on Facebook as well.

      I have been researching Dyslexia for the last few months as part of summer project to help edit the Wikipedia Dyslexia article which has now become a series of article to include the in depth information required.

      I have recently collated a series of online research paper collections about both Dyslexia and APD, and the related issues. I have used the Delicious online bookmarking facility to provide the links to most of these collections and even to creat some collection where the research papers come from more than one online research paper library. Most of the collections can be located via http://delicious.com/dolfrog/RPC there will be a new Audiology collection later this week

      best wishes

      dolfrog
    • Reply
      Spook Spook Oct 16, 2009 @ 12:11 pm
      Hope all is going well with your daughter and that she continues to make progress. An outstanding example of Squidoo at it's best. Blessed by an Angel.
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    Lensmaster aj2008 has been a member since July 10 2008, has rated 3,234 lenses, favorited 800, and has created 70 lenses from scratch. AJ donates their royalties to Save the Children. This member's top-ranked page is "Bullying At Primary School". See all my lenses

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    My daughter suffers from a relatively unknown complaint called Auditory Processing Disorder (APD).






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