Auditory Processing Disorder

As far as develpoing speech was concerned, Lizzie was not at all like my other children and we started to wonder 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 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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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".

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.

It is now over five 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 pages:

"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: 05 May 2010
The same searches were conducted via Google.

"Auditory Processing Disorder", on UK websites returned 69,300 articles compared to 645,000 for "Dyslexia"

An international search returned 981,000 for "Auditory Processing Disorder" and 2,860,000 for Dyslexia

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

Note: it is interesting that the number of articles has changed so much since August 2008!

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

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, following her APD diagnosis it became apparent that Lizzie had problems with spelling and she did not learn to read as easily as her brother and sisters. This inhibited her progress in literacy. She is now an excellent reader but now that she is at Senior School, she is finding it easier to do her home learning on the computer. Spell checks are very helpful to her, but we have noticed she finds it easier to spell correctly using a keyboard than by writing with a pen.

Considering the speech development problems she has in her early years Lizzie is now very articulate, a lot more confident and enjoys reading.

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

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
This lens has been awarded a Squidoo Purple Star!
Purple Star?



According to the Purple Star lens,
they are awarded to Lenses that are:

"Masterpiece lenses. Lenses making a name for themselves.
Lenses trying new things."

What an honour!

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.

You can also find this lens on
The Isle of Squid

You can review this lens on the Isle of Squid:
Auditory Processing Disorder

This lens was submitted to the SquiDirectory - A categorized Squidoo directory featuring an interesting variety of different subjects ranging from arts and literature, shopping, and eco friendly tips, to vehicles for sale, travel, and everything in between.