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Learning Disabilities Auditory processing disorder http://www.nidcd.nih.gov/health/voice/auditory.asp Auditory Processing Disorder in Children: What Does It Mean? What is auditory processing? Auditory processing is the term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder (APD) means that something is adversely affecting the processing or interpretation of information. Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a chair and a couch are alike" may sound to a child with APD like "Tell me how a couch and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information. APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness." What causes auditory processing difficulty? We are not sure. Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to "hear normally," he or she may have difficulty using those sounds for speech and language. The cause of APD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive development disorder, or developmental delay. Sometimes this term has been mis-applied to children who have no hearing or language disorder but have challenges learning. What are the symptoms? Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to Have trouble paying attention to and remembering information presented orally Have problems carrying out multistep directions Have poor listening skills Need more time to process information Have low academic performance Have behavior problems Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language) Have difficulty with reading, comprehension, spelling, and vocabulary How is it diagnosed? You, a teacher, or a day care provider may be the first person to notice symptoms of auditory processing difficulty in your child. So talking to your child's teacher about school or preschool performance is a good idea. Many health professionals can also diagnose APD in your child. There may need to be ongoing observation with the professionals involved. Much of what will be done by these professionals will be to rule out other problems. A pediatrician or family doctor can help rule out possible diseases that can cause some of these same symptoms. He or she will also measure growth and development. If there is a disease or disorder related to hearing, you may be referred to an otolaryngologist, a physician who specializes in diseases and disorders of the head and neck. To determine whether your child has a hearing function problem, an audiologic evaluation is necessary. An audiologist will give tests that can determine the softest sounds and words a person can hear and other tests to see how well people can recognize sounds in words and sentences. For example, for one task, the audiologist might have your child listen to different numbers or words in the right and the left ear at the same time. Another common audiologic task involves giving the child two sentences, one louder than the other, at the same time. The audiologist is trying to identify processing problems. A speech-language pathologist can find out how well a person understands and uses language. A mental health professional can give you information about cognitive and behavioral challenges that may contribute to problems in some cases, or he or she may have suggestions that will be helpful. Because the audiologist can help with the functional problems of hearing and processing and the speech-language pathologist is focused on language, they may work as a team with your child. All of these professionals seek to provide the best outcome for each child. Current research 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. What treatments are available? Several strategies to help children with auditory processing difficulty are available. Auditory trainers are electronic devices that allow a person 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. Environmental modifications such as classroom acoustics, placement, and seating may help. An audiologist may suggest ways to improve the listening environment, and he or she will be able to monitor any changes in hearing status. Exercises to improve language-building skills can increase the ability to learn new words and increase a child's language base. Auditory memory enhancement, a procedure that reduces detailed information to a more basic representation, may help. Also, informal auditory training techniques can be used by teachers and therapists to address specific difficulties. Auditory integration training may be promoted by practitioners as a way to retrain the auditory system and decrease hearing distortion. However, current research has not proven the benefits of this treatment. Where can I learn more? If you have questions, contact us at the NIDCD Information Clearinghouse. 1 Communication Avenue
Bethesda, MD 20892-3456
Toll Free: (800) 241-1044
TTY: (800) 241-1055
E-mail: nidcdinfo@nidcd.nih.gov
Internet: www.nidcd.nih.gov Contact the following group for information related to audiology and audiology professionals and services. American Academy of Audiology
8300 Greensboro Drive, Suite 750
McLean, VA 22102
Voice: (703) 790-8466
Toll-free: (800) AAA-2336
TTY: (703) 790-8466
Internet: www.audiology.org Or, for information related to audiology and speech-language pathology professionals and services, contact American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852
Voice: (301) 897-3279
Toll-free: (800) 638-8255
Hours: 8:30 a.m.-5 p.m., eastern time
TTY: (301) 897-0157
Fax: (301) 897-7355
E-mail: actioncenter@asha.org
Internet: www.asha.org
NIH Pub. No. 01-4949
Updated August 2003
http://www.nidcd.nih.gov/health/voice/auditory.asp CAPD- receptive language disorder A CAPD is a receptive language disorder. It refers to difficulties in the decoding and storing of auditory information (typically incoming verbal messages). This type of receptive language disorder is a result of genetic factors and/or early otitis media though causal factors may not be able to be found. There are many signs and symptoms of CAPD, however a skilled audiologist would best be able to provide technological testing at age 7 and beyond. Click here for Classroom Suggestions for CAPD Early Signs & Symptoms: Difficulty following verbal directions. Echolalia (repeating back words and phrases without comprehension). Re-auditorization (repeating back what was heard, and then showing comprehension). A child who says "huh" or "what" and requires more repetitions of verbal input messages. Speech sound discrimination difficulties, especially in noise. Highly distractible/active. Unintelligible speech, but with adequate vocal inflection and gestures. Difficulty with memorizing names and places. Difficulty repeating words or numbers in sequence. May have speech or language "delays." This information is copyright free. Readers are encouraged to copy and share it, but please credit the National Dissemination Center for Children with Disabilities (NICHCY). Please share your ideas and feedback with our staff. | Publication of this document is made possible through a Cooperative Agreement between the Academy for Educational Development and the Office of Special Education Programs of the U.S. Department of Education. The contents of this document do not necessarily reflect the views or policies of the Department of Education, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. | NICHCY
P.O. Box 1492
Washington, DC 20013
(800) 695-0285 · v/tty
(202) 884-8441 · fax
nichcy@aed.org
www.nichcy.org |
Auditory Integration Training: Additional Information Written by Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon Auditory integration training (AIT) was developed by Guy Berard in Annecy, France to help people with auditory processing problems. According to Dr. Berard, processing problems may occur if one hears some sound frequencies much better than other frequencies. For example, a person may be hypersensitive to the frequencies 2,000 and 8,000 Hertz, but hear all the other frequencies in the spectrum at a normal level. The frequencies to which a person is hypersensitive are referred to as 'auditory peaks,' and these peaks take on the appearance of a mountain range in one's audiogram. AIT is accomplished by a device which randomly selects high and low frequencies from a music source (a cassette or CD player), and then sends these sounds via headphones to the trainee. In addition, if the trainee has auditory peaks in his/her hearing (as evident from an audiogram), those frequencies are filtered out completely (blocked out) or partially (stressed at only a low level) from the music. The trainee receives AIT twice a day, each time for 1/2 hour, for ten days. During the first five hours of AIT, the sound level for both ears is equal. For those individuals who have speech and language impairments, the sound level is reduced in the left ear after five hours of training. Since the right ear is connected more directly to the left hemisphere than the right hemisphere, and since the left hemisphere is responsible for processing speech and language, Dr. Berard believes that a higher sound level in the right ear will stimulate the left hemisphere. An audiotest is conducted prior to the first listening session to determine whether the person has auditory peaks; a second audiotest is given after five hours of listening to determine whether the auditory peaks are still present and whether new peaks have developed; and a third audiotest is given after the completion of the listening sessions. According to Dr. Berard, after completion of the program, all frequencies should be perceived equally well; and the person should no longer have peaks in his/her hearing. One caution: As Dr. Berard informed us and as we have noted independently, some people exhibit unexpected behavioral problems during the 10-day AIT period, such as agitation, hyperactivity, and rapid mood swings. Similar problems are reported for more traditional forms of sensory integration therapy. We are unsure of the reasons for these behaviors. One explanation is that these behaviors are occurring as a direct result of receiving AIT. However, it is also possible that these problems may be a result of changes in the person's eating patterns and activity level during the 10-day period. We have noticed that parents often coax their son/daughter with candy and junk food so they will sit quietly during the listening sessions. To support this observation, we observed such problems in both those individuals who received AIT and those who received a placebo in our pilot study on AIT. At this point in time, we do not have enough data to determine which, if either, of these explanations is correct. Based on our own experience, and our conversations with Dr. Cecile Wuarin, the psychologist who worked with Dr. Berard, we feel that parents/caretakers should receive pre- and after-care consultation so they will be made aware of and be able to deal constructively with possible changes they may see in their son/daughter. For example, one possible change is an increase in attention span. If a person has a short attention span, it may be easy to redirect him/her away from a toy or task. However, if the person's attention span increases, he/she may become more stubborn and more difficult to redirect because his/her attention span is much longer. Other behavioral changes may include an increase in emotional behavior (e.g., anger, crying, reacting to other people crying), independence (e.g., leaving an area without permission), and social growth (e.g., increased interaction). We agree with Dr. Wuarin when she states that if the trainee changes, the family must also change in how they perceive and interact with their son/daughter. This failure to change is evident when a parent reports that their son/daughter is "on their nerves" because they are not acting the way they used to act. One goal of AIT is to get them "to act" more adaptively and age-appropriately. Recognition of this is essential (e.g., an 18-year-old who wants to go to bed at 11 P.M. instead of her current bedtime of 8 P.M.). In general, we believe that since understanding and working effectively with autistic people is much different than understanding and working with people with other disorders (e.g., mental retardation), pre- and after-care consultation should be handled by professionals who have experience working with autistic individuals. At the present time, we do not know exactly how AIT may affect a person's behavior. One possible explanation is that AIT is actually conditioning the person to shift his/her attention more easily. Dr. Eric Courchesne of Children's Hospital in San Diego has recently found that autistic individuals have much difficulty shifting his/her attention from one stimulus to another stimulus. Since high and low frequency sounds are sent randomly to the trainee, AIT may be teaching the person how to shift his/her attention more rapidly and effortlessly; as a result, they may be better able to attend and thus understand the contingencies related to sounds and movement (e.g., hand gestures). Another possible explanation relates to the fact that autistic people are often described as "tuning out" others in their environment. By sending high and low frequency sounds randomly, the person cannot anticipate the sounds; and thus, he/she cannot tune them out. As a result, they are, in effect, being trained to "tune in." If one or both of these explanations are correct, then it is possible that individuals who do not have auditory peaks may also benefit from AIT. Finally, it is possible that the person starts to perceive sounds, especially speech, more clearly; and as a result, he/she will be better able to learn relationships between a sound and a behavior, object, action, and event. Even though all three explanations listed above are hypothetical, they do suggest how a person may possibly benefit from receiving AIT.
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