Children with APD are often misdiagnosed with other disorders such as ADD (Attention Deficit Disorder) ADHD (Attention Deficit Hyperactivity Disorder). Untreated, APD can drastically distort social and educational experiences of every kind. The child retreats into his own head. Disinterest in the surrounding social world that they are unable to reasonably sort out coupled with problems communicating and learning appears to parents, teachers, and doctors alike as an attention problem. To the inexperienced observer, the child’s moodiness, tantrums, social isolation, and peer group clumsiness seem like a behavioral problem.
Although these things can all be symptoms of attention and developmental disorders, they may also be symptomatic of APD which is an inability to develop accurate listening skills caused by the brain’s incomplete or unsuccessful processing of auditory information. A child with APD may have trouble with attention, but it’s because they can’t listen accurately, not because they can’t pay attention. While APD can co-exist in a child with ADD, ADHD or other developmental difficulties, unlike ADD, etc. children with APD only are not usually hyperactive. They may engage in the impulsive behaviors seen in children with those other developmental disorders due to their inability to understand and be understood. The lack of an inappropriate diagnosis and therefore inappropriate intervention causes the lack of progress and increased frustration for the child.
The process of experiencing sound is a two-stage phenomenon.
First, sound vibrations are collected by the outer ear, funneled to the inner ear where they become physical vibrations, and then sent on to the cochlea where they are transformed into electrical impulses. Then these impulses travel along the eighth cranial nerve into the brain.
Through the travel of the auditory information along the auditory pathways beginning from the hearing system and traveling to the right and left hemispheres of the brain, sound impulses are put through a highly sophisticated and detailed battery of analyses and examination contoured by memory, instinct, thought, and various voluntary and involuntary reactions into the sensation we experience as hearing. It’s a complex process – one that simultaneously incorporates multiple locations of brain geography, a system of “feedback” to the cochlea to help narrow the focus of hearing, and a myriad of other analyses, impulses, gateways, and other functions and processes. All this happens in fractions of seconds.
Most people recognize that birth defects, infections, blockages, eardrum punctures, tinnitus from loud noises, and various other things can adversely affect the middle and inner ear parts of the hearing equation. But a lot can also go wrong during a pathway journey along the eighth cranial nerve through the CANS relay stations and inside the Auditory Cortex. APD is a condition that affects that interior trip to the Auditory Cortex and the processing stage that transforms hearing into listening within the Cortex itself.
What isn’t APD?
Since APD symptoms and treatments cover several different specific listening difficulties and have a number of different possible causes, let’s have a look at what APD is not.
APD is not hearing loss.
Hearing loss is the result of problems in the middle ear and inner ear. Anything that goes wrong along the chain of membranes, bones and organs that make up the middle and inner ear can cause hearing loss. Fluid build-up, infection, scarring or blockage in the middle ear, birth defects affecting the middle or inner ear’s anatomy, damage to the hairs within the cochlea – these are all conditions that can cause a temporary or permanent loss of hearing. Some of these conditions can be screened and initially diagnosed by a pediatrician or an otolaryngologist (what used to be called an “ear, nose, and throat” doctor). The type and severity of the hearing loss needs to be gauged by an audiologist. Depending on how severe the hearing loss is and what caused it, doctors, along with an audiologist and a speech-language pathologist, and of course, the parents can decide what course to take. Different types and severities of hearing loss respond to different treatments. Hearing aids, prescriptions, therapy session, corrective surgery and surgical implants can each be used to deal with different kinds of loss of hearing.
APD is not ADD, ADHD, or ASD.
Like a child with ADD, ADHD, or ASD a child with Auditory Processing disorder can be:
Mentally and emotionally exhausted at the end of the day
- Struggling to understand at such a young age is a grueling workout.
- Feelings of helplessness and an inability to communicate breed anxiety and frustration.
Displaying signs of low self-esteem
- First and foremost, children blame themselves when things aren’t right.
Negative about school.
- “It’s just too hard,” becomes the mantra of a school-age child with APD.
Seen as immature for their age
- Children that are cut off from listening tend to stay put emotionally.
APD cannot be treated with drugs or surgery.
The symptoms of ADD and the family of attention based disorders are often successfully treated with prescription drugs. In many cases hearing loss responds well to the recommended treatments like hearing aids, surgery and the miraculous evolving technology of cochlear implants. Thus far there is no known prescription or medical procedure that lessens the severity of APD.
Correct diagnosis and targeted interventions are the recommendations to follow to successfully help a child who is struggling with APD.
LANGUAGE CHALLENGES Which may be the result of Auditory Processing Disorder
- Often says “huh” or “what?”
Asks people to repeat what they said, but hearing is normal
- You have to look them in the eye to give instructions
- Asks the teacher, “what am I supposed to do again?”
Needs constant clarification
- Can only follow one direction at a time
May require more time to process spoken words
- Cannot recall key details from verbally presented material
- Can’t follow conversations
- Receives information but can’t respond
Has difficulty finding the right words when talking and may use placeholder words like “um”
- Can’t put words together
Doesn’t have complete thoughts
- Has difficulty sequencing events from a life event or story
- May use vocabulary below the level of other children the same age
- Poor expression
- Tone doesn’t match words
While every child develops in their own time and at their own pace, there are a few signs you can watch for to see if their receptive and expressive language is developing or if there are potential gaps.
How I explain APD to parents using the three N’s.
Our children arrive in this world with their own unique natural abilities and capabilities. We, their parents are there for them, ready to teach, love and guide them. If our child is not developing their speech-language skills in a typical pattern we seek out knowledge from a speech-language pathologist, an audiologist or other qualified professionals.
Over several decades of working with children, parents, teachers, and caregivers I’ve found it helpful to look at the “how” of parenting, teaching and growing a child’s listening and language skills as a three part use of what I call “the three N’s” – Nature, Nurture and Knowledge.
People taking care of a child with an Auditory Processing Disorder need to:
- Understand the nature of the child’s condition through diagnosis and testing.
- Offer patient, nurturing attention to help a child with APD over the developmental walls, hurdles, and speed bumps that APD creates.
- Knowledge of how home and school environments can make it harder or easier for a child with APD to learn.
Through nature, nurture and knowledge, a caregiver can have an enormous impact on a child’s language development and ability to listen.
- Babies come into this world equipped to turn what they hear into listening.
- Reading together bonds child and parent in the real world by letting them share their imaginations.
- Children have an innate ability to learn language A solid vocabulary rich in quantities of words and connections between them is one of the best things a child can bring with them to school.
- Social skills and listening skills go hand in hand. The benefits of well developed social skills parallel the benefits of being able to listen effectively.
- The physics of sound and the nature of listening can offer many challenges for children with an APD.
- Playing and interacting with your child to increase their word power is easy and adaptable to the activities you do together anyway.
- There’s a big difference between arriving at school with an understanding of 2800 words and 13,000 words. Your interactive attention with the child can help them meet the goal of the appropriate vocabulary for their age.
- Children learn social communication at the same time and over the same period in which they learn how to listen.
- Make time and space for reading. Share a love for books.
- A parent needs the information and ability to recognize potentially troublesome noises and sounds in the environment that will affect their child’s ability to access auditory information. Make common-sense recommendations to alleviate the negative effects of noise which will interfere with the child’s comprehension of information at home and school. The adults surrounding the child must act as advocates on their child’s behalf in social situations and in the community.
- As a child grows from birth to age five, it is important for the parents to be aware of a child’s stages of development. Parents should know about and participate in activities, and share information to ensure that their child attains their individual physical, cognitive, communication, social, and academic potential.
- Understanding the particulars of how hearing becomes listening and how listening development affects a child’s school and social experiences are vital to effectively treating an APD.
- A child’s ability to learn, add and connect words grows as they nears school age.
- Understanding the connection between listening, language, conversation, and successful social interactions is essential to your child to enable them to take the fullest possible advantages of their experiences.
- Teachers, coaches and other parents need to understand what they can do to assist a child with APD to get the most out of their time together.