Helping Children with Auditory Processing Disorder

Accommodations are ways of modifying environment to assist with overcoming the challenges of a learning disability. For example, if a person has difficulty hearing when competing noise is present, requiring a quiet environment when working is a way to accommodate this challenge.

Accommodations can be made at home, in the classroom or in the workplace. Below I have described accommodations that are known to assist those who have APD.

Educate the Teacher about APD

The first week of every school year I will bring an auditory processing disorder handout to the teacher. This handout not only explains the disorder, but I customize it to explain the exact areas they will see my son's symptoms express and what they can do to help him cope. You can download the APD Accommodation Handout here and edit it with your own child's information.

Making changes in the classroom can have a huge positive effect on a child with APD. The competing noise and echoing environment of a classroom can make the easiest of instructions a huge struggle for a child who cannot comprehend what is being said. Not every child will benefit from every accommodation. You should take the list to the teacher and discuss and try out the strategies to see what helps most.

Note: These accommodations are not listed in any specific order. Every one of them is a valuable way to assist a child with APD.

The following accommodations are ways to help children who have APD:

1. Preferential seating
Seating your child in the front of the class is where he will have good visual reception of the area where most teaching is done. Avoid seating by open doors or windows. Make sure he can see the teacher's face. Avoid strong shadows which hide the face. Standing in front of windows on a sunny day will hide the face.

2. Reduce Background Noise
Make every effort to eliminate extraneous noise. A noisy background does not need to be loud to create a problem. Even mild noises such as the hum of a fan or the sounds of a quiet crowd may be enough to create a poor listening and learning environment for the child. In the presence of background noise, his behavior might look like: failure to respond when spoken to, incorrect responses when spoken to, distracted, over active, confused or anxious.

3. Consider your distance
When and APD child is spoken to from a great distance (more than 5 feet), he will definitely be challenged to comprehend what is said. Consider moving closer to him when speaking to him. Sound intensity drops quickly over a short distance. Moving closer is a great, easy help.

4. Consider the acoustics
If the room has tiled floor and unfinished walls, there is a high probability a lot of echo occurs in the room. This can exacerbate competing sound situations for the APD. If possible, rug or carpet on the floor can reduce this effect. Decorating the walls with student art or other items that absorb sound will also help a lot. The Classroom Acoustics Coalition provides important information on problems caused by bad acoustics in classrooms. They also offer practical strategies and methods to correct bad acoustics.

5. Obtain visual attention
Get eye contact from a APD child before talking to him. This can be done by touching him on the shoulder or using an auditory prompt (ie. Saying his name). This is very important when introducing a new idea, changing subjects, or giving directions. APD child needs additional prompting in order to have attention focused properly.

6. Slow down speech
Too much information too quickly is challenging for a APD child to comprehend. Speak one idea at a time, and pause so he can take it in and assimilate it, then move onto the next idea. It does not have to be super slow, just pace your words, with a few seconds between ideas to help him take it in better.

7. Make the child responsible for understanding
Encourage him to repeat back what he has heard to make certain he understands. Don't embarrass him by having him prove it in front of the class, do it in a sidebar one-on-one. In addition, remind him to always raise his hand and ask if he doesn't understand. This is an area where the aide can assist to make certain he understands the directions he is meant to follow.

8. Think before criticizing
If the child does not respond, or his response is inappropriate, consider that he has not understood what you have said. The APD child is often not aware that he has misinterpreted what has been said. Ask him to repeat back what he thought he heard before assuming he is doing something "wrong".

9. Simplify directions
Break multi-step directions into one or two parts before continuing on to the next piece. Children with APD need time to take in and process what is said, and often exhibit short-term memory issues. A child with APD will struggle to process was you said 10 seconds ago and isn't always able to continue listening and taken in more information. Space out directions for better understanding and comprehension.

10. Provide additional written or visual material.
Simple words and visual cues that give him an idea of directions will help him keep up. Even just writing out 1,2,3,etc. for steps will remind him how many steps he has to go through. Many kids with APD have impaired short-term memory, so 10 or 20 minutes after hearing instructions, he may need them repeated.

11. Seat him next to helpful students
Children with APD generally enjoy independence, but often they are more open to help from peers than the teacher. In my son's classes, being sat next to a helpful student improved his performance greatly. When he was sat next to students who talked out of turn a lot, or themselves had attention issues, John's performance was definitely affected.

12. Consider an FM system
And FM system is a broadcast-type device that assists in filtering out background noise and delivering clearer spoken speech to the student. Read the What is an FM System information below.

13. Consider sensory issues
Many children with APD have additional sensory issues that complicate their ability to focus in class. Be aware of these sensory issues so you can accommodate for them as well. For example, my son has trouble with sudden loud noises. At lunch he had issues hitting other students, then the aide realized the aluminum roof/concrete floor eating area amplified noises which aggravated the problem for my son. Moving his eating place to an uncovered picnic table resolved the problem.

14. Say things in a different way
Sometimes the combination of sounds in a sentence are difficult to process for an APD child. If they cannot understand what you are saying, try using different words. For Example, if the child does not understand when you say, "Take out your math workbook and turn to page 22." then try rephrasing it. Instead maybe say, "Get your math book out of your desk. Look at page 22." Simple rephrasing may eliminate specific phonic sounds the child has greater difficult with.

One of the greatest challenges for children with Auditory Processing Disorder is the fact that it is difficult to diagnose. Most audiologist won't diagnose before the age of 7, and many school districts refuse assessment unless just cause can be shown. Even if you go get a private assessment, but law the school does not have to accept the conclusion of an outside assessor. So the parents have to create a convincing case.

How can I get school support for my child?
In order to get support, your school either has to be willing to classify your child under the "specific learning disability" category, or your child has to qualify for some other service. For example, my son was speech delayed, but did not qualify for a diagnosis of autism. So he qualified under speech delay.

Once the child qualifies under one category, a GOOD school district will assist the child in all areas where he/she struggles. A bad school district... well, let's just say you have a fight on your hands (and I say this from personal experience, not from stereotypes).

How do I get the Accommodations listed?
You have to have an IEP meeting with the special education team at your school. They decide what services your child qualifies for. If they agree he/she qualifies, then they will write up a 504 recommendation or IEP, and they will document the specific accommodations that your child must get.

What's the different between a 504 and IEP?
An IEP (Individualized Education Plan) is for a student who qualifies for specialized instruction based on the laws in the Individuals with Disabilities Education Act (IDEA). In an IEP the child's disabilities are more than just learning disabilities, and the child requires greater assistance in or out of the classroom. For example, speech issues would be a physical disability that effects classwork but also general interaction. It would qualify under an IEP, not a 504.

A 504 recommendation is generally for students who have a learning disability that is not so pervasive. For example, dyslexia, ADHD or dyscalcula. The accommodations in a 504 sort of level the playing field so they are not hampered by their learning disability. So if a child has dyslexia, they may receive extra time on a test to make up for their slower reading pace. A 504 could also include mental or physical disabilities such as bipolar disorder or cancer. Accommodations under a 504 are regulated by Section 504 of the Rehabilitation Act

A better explanation than mine...
I know this is all so confusing, so here is the best explanation I have found that explains it: IEP versus 504.

A frequency modulation (FM) system can be used in a classroom to help filter out background noise and bring the teachers' more clearly to a student. The benefits of an FM system for auditory processing disorder have brought mixed reviews. There are some studies that show benefits, but not enough to convince experts that the systems are of benefit [see Frequency modulation (FM) system in auditory processing disorder: an evidence-based practice? paper on PubMed].

Our son tried an FM system in class, and the unit the school district got was so old and horrible that it caused more problems than helped. There was a lot of static, and it often stopped functioning, and in the end we decided it was causing additional distractions rather than helping him hear better. We did not have the $5,000 to buy our own system, so we were at the mercy of what the district would provide.

There are two types of FM systems:

1) Teacher-to-Student system: There is generally a wireless microphone device that the teacher wears that transmits a signal to a box on the student's desk. Sometimes the child could have a wireless earpiece similar to a cell phone hands-free earpiece. These are called personal FM systems.

2) Teacher-to-Class system: With these systems to teacher still wears a wireless mic, but it transmits to a set of speakers in the walls. The speakers are specifically placed to optimize sound transmission in the room. These are called sound-field amplification systems. They have been shown to help all children, even if they don't have APD.

How would an FM system help my child?
Many children do benefit from the systems, but you will not know if your child will be helped unless you try. The benefits these kids see include:

• Better perception of speech from the teacher
• Longer attention span
• Better auditory focus
• Fewer disruptive behaviors
• Improved academic performance

There are studies that have been done that show that an FM system helps all students (if it is the sound field type that runs through loud speakers).

Does an FM system help APD?
After prolonged use, some children showed better speech perception even without the unit, which indicates use of an FM system may actually improve the symptoms of APD. I could not find any research studies that substantiate this, but there are anecdotal case studies that show measurable improvement.

1. Reduce Background Noise
If you are trying to have a conversation with your child, quiet is the best way to do this. If you are unable to have quiet environment, then understand that the child may not be able to hear what you have said. Being patient, and even using sign language, will assist in communication. This is particular true in situations like parties, shopping malls or places where there are multiple noises occurring at once. Also, turning off the TV while talking is a must for kids with APD.

2. Consider your distance
How far away you are makes a huge difference in the ability to hear. Being within 3 feet helps defer extraneous noise. Don't shout information or request across the room, and definitely don't shout them from another room. Again, if your child doesn't do what you ask, remember there is a good change he did not understand what you said.

3. Obtain visual attention
This one helps my son so much. I get eye contact from him by tapping him on the shoulder and asking him to look at me. This really improves our communication. I believe he may have learned to read lips a bit, and so he uses that when looking at my face. Note that looking at lips instead of the face is a symptom of autism, which is probably why my son was sometimes considered to be autistic.

4. Slow down speech
This doesn't mean super slow. It just means to talk at a consistent pace and pause between ideas.

5. Make the child responsible for understanding
Ask your child to repeat back what you said so you can confirm he understood you correctly. So often we just assume the child got it, and you would be surprised how often he mishears things.

6. Create a homework space
Auditory distractions are so huge for kids with APD. Homework is very difficult if there are even small noises like a fan or lawnmower outside. Consider this when creating your child's homework space. If there are noisy siblings, keep them in other areas of the house, or arrange for them to participate in activities outside the house. Most importantly, your child may need to do homework in several small 5-10 minutes sessions because the energy required to focus is intense. Give your child leeway and don't expect them to sit for 30-60 minutes if they are really struggling with it.

7. Think before criticizing
When your child does not respond, or the response is not what you wanted, please remember that it's highly likely your child did not hear you correctly. Before getting angry and punishing, remember this, and try to clarify instructions before jumping to conclusions.

8. Simplify requests
Break multi-step directions into one or two parts before continuing on to the next piece. Children with APD need time to take in and process what is said, and often exhibit short-term memory issues. A child with APD will struggle to process was you said 10 seconds ago and isn't always able to continue listening and taken in more information. Space out directions for better understanding and comprehension.

9. Consider sensory issues
Many children with APD have additional sensory issues that complicate that cause them to get overstimulated. In this state their APD is aggravating and listening and focusing are even harder. Be aware of this at home. Our son cannot deal with a lot of loud noise. If his brother is being too rambunctious, he will seek out the quiet of his room. While we live in a small house, we made a point of making a space that was his so he could retreat to it whenever he felt overwhelmed.

10. The end of the day will be the hardest
After a full day of focused processing your child is going to be very tired. Take this into consideration when planning evening activities. Don't expect your child to be able to do homework late, and be accommodating if he would rather just spend some time alone or doing quiet activities.

11. Create a signal for important information
All children have some degree of challenges when it comes to paying attention and listening. The child with APD has this even more so. An effective tool is to have some sort of signal that indicates to the child that you have to talk to him about something important. For example, perhaps you have to go over the morning schedule because something about it has changed. Consider the following signals that can indicate to your child that they should listen, then repeat back what you said so you know they have understood:

• The sign for "stop".
• Laying a hand on his shoulder
• Count 1, 2, 3 with your fingers.
• Ask your child what signal he/she would like to use

12. Rephrase what you are saying
Sometimes the combination of sounds in a sentence are difficult to process for an APD child. If they cannot understand what you are saying, try using different words. For Example, if the child does not understand when you say, "Please brush your teeth and wash up so you can get ready for bed." then try rephrasing it. Instead maybe say, "It's time for bed. Use your toothbrush and clean your hands and face." Simple rephrasing may eliminate specific phonic sounds the child has greater difficult with.

1. Teach the child clarification techniques
A child with APD never knows when he hasn't heard something right. Teach your child to verify information in a non-interfering way. For example, say "I just want to make sure I understand the rules. We do this..., right?". In this way the child will make certain he has understood correctly. Role play various clarification techniques, especially after your child has had a bumpy social experience.

2. Teach your child to be okay when he mishears
Children can be very unkind. It's important to talk to your child and explain to him the reason he seems to not get what his friends are saying. With my son children at his old school were very unkind about his mishearing things, and they called him stupid and excluded him from games. It's important to help your child understand that they are their choices, and they clearly don't know how to be unkind when somebody is a bit different. Encourage your child to talk about these events so he can express the emotions and learn new ways to handle these challenges.

3. Role play social situations before and after they happen
Role playing is an excellent way to help your child learn appropriate social behavior but in a quiet environment. Busy school yards bring a lot of auditory input and can be overwhelming and confusing for the child. It's hard enough to learn social skills, but with an overwhelmed auditory system it's nearly impossible for an APD child to learn even the basics. Social Stories (see next module) are an excellent way to teach this information. Choose stories that reflect the same experiences where your child struggles.

4. Teach your child other ways to perceive what is going on
This is going to be more beneficial for older children, but we began using this techniques when our son was 5. Teach your child to look for facial expressions, body posture or body movements. Also, tone of voice, loudness of voice can also be good indicators of how the person is feeling. While this may not give the specifics of a conversation, it will help with sensing the general mood of the conversation. Our son used to jump into play with kids who were fighting because he thought they were wrestling and having fun. Thankfully he was never hurt, but we knew we needed to teach him ways to figure out what was going on.

5. Praise your child when you see him getting it right
Always take the opportunity to reinforce positive behavior. Whenever you see your child with appropriate social interactions, point it out and offer positive words to reinforce the accomplishment.

6. Prompt your child when social opportunity arises
Find ways to help your child through social situations that your child may usually avoid. Maybe you go to the park and there is another child to play with. Encourage your child to initiate contact, and give him prompts as to what he should say. Stay close and provide additional prompts throughout the interaction. This helps the child move through the social situation with you as a coach to encourage appropriate behavior.

7. Point out positive examples of good social skills
There are many times you will see great examples that can help your child learn. This might be in the real world, in a book or on TV. Take the time to point out to your child what you see and how it is an example of good social skills.

We do not realize how much information we take in through incidental hearing. A child with APD does not having a hearing issue, but their understanding and comprehension of what they hear is clearly impaired.

More often than not a child with APD will have social challenges. My own son had big social obstacles in his old school where the children were not kind and patient when he clearly did not comprehend game rules on the playground. The children would even use his disability against him, saying he lied about what he heard, or that he never remembers so he remembered an event wrong. He was often called stupid when he clearly didn't understand the rules of a game. It is very helpful to read social stories to children with APD so they can learn social information that they are missing in live social situations.

What are Social Stories?
A social story is just a simple story that explains some rule about being social. Originally developed for autistic children, they have become a fabulous way to help all children learn proper social behavior. Carol Gray from The Gray Center was the original creator of social stories. From her work a whole variety of books and tools have been made to help develop social skills in children.

Social stories can also be used to teach your child how to behave in certain situations. For example, if he has trouble lining up at the door when it is lunchtime, a social story about how being out of line distracts others and prolongs the process could help you child understand what he should be doing in that situation.

From my travels through APD support groups I have heard that sign language helps some APD kids but many parents don't have time/inclination to learn it. Our own son used sign language from early on, and for all of us it was a lifesaver to communicate when noise levels were high. Now 8, he continues to use sign language every so often.

So I guess the short answer is, chances are sign language will help your child communicate. Of course it's only helpful if others know the sign language as well. It takes a bit of time to acquire a basic vocabulary, but it can be a lifesaver in situations where your child really cannot comprehend what is being said.

You can buy poster shown from Amazon.com.

Signing Families has great online classes and Skype classes to help you learn sign language. They have classes just for kids as well as adults. Their classes are unique because a component of them happens live, over Skype, so you can actually practice signing and get feedback on how well you are doing.

Classes are taught by Louise Sattler, is a Nationally Certified School Psychologist with specializations in linguistics and multi-cultural education. She has been teaching American Sign Language for more than 20 years. Visit Signing Families to register.

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