Auditory processing disorder

Auditory Processing Disorder (APD) (previously known as "Central Auditory Processing Disorder" (CAPD)) is not a hearing impairment, but a random inability to process what is heard.

Definitions

The "American Speech + Language - Hearing Association" (ASHA) have recently published the first definitive (Central) Auditory Processing Disorders Technical Report, Jan 2005, which complements the UK's "Medical Research Council's Institute of Hearing Research's" Auditory Processing Disorder (APD) pamphlet, Oct 2004.

Both of these documents provide the first comprehensive definitions of APD in the respective countries, and a platform for future research and development of diagnostic systems and support programs. (There are links to both documents included in the External Links section below.) They cover the various causes of Auditory Processing Disorder including both the genetic causesand the acquired causes(such as severe ear infectionsand severe head injuries).

Aspects of auditory processingwhich may be affected by CAPD include "auditory discrimination", the ability to distinguish between similar sounds or words; "auditory figure-ground", the ability to distinguish relevant speech from background noise; and "auditory memory", the ability to recall what was heard.

Difficulties encountered in diagnosing APD

APD is recognised as a major cause of dyslexia. As APD is one of the more difficult information processing disorders to detect and diagnose, it has previously been misdiagnosed as ADD/ADHD, Aspergersand even autism. APD shares common symptoms in areas of overlap such that professionals who were not aware of APD would diagnose the disabilities as those which they were aware of.

APD sufferers intermittently experience an inability to process verbal information. When APD's have a processing failure, they do not process what is being said to them. They may be able to repeat the words back word for word, but the meaning of the message is lost, and not processed. Simply repeating the instruction is of no use if an APD is not processing. Neither will increasing the volume help.

APD's have an Auditory (Verbal) Processing Disorder, and text is only verbal code, and so the Auditory Processing Disorder is extended into reading and writing as this auditory code. As a consequence, APD has been recognised as one of the major causes of dyslexia.

There are also many other hidden implications, which are not always apparent even to the sufferer. For example, because APDs are used to guessing to fill in the processing gaps, they may not even be aware that they have misunderstood something.

In many instances, APD comes as part of an 'invisible disability' package, and in some instances, the other disability may mask the APD. This multiple disability scenario indicates that a transdiscipline approachto research, diagnosisand treatmentis of the utmost importance, especially when APD can mimic many of the other 'invisible disabilities'.

Behavioral manifestations

Some of the manifestations below may be observed in individuals with other types of deficits or disorders, such as attention deficits, hearing loss, psychologically-based behavioral problems, and learning difficulties or dyslexia. Common behavioral characteristics often noted in children with APD include:

1. Difficulty hearing in noisy situations
2. Difficulty following long conversations
3. Difficulty hearing conversations on the telephone
4. Difficulty learning a foreign language or challenging vocabulary words
5. Difficulty remembering spoken information (i.e., auditory memory deficits)
6. Difficulty taking notes
7. Difficulty maintaining focus on an activity if other sounds are present; child is easily distracted by other sounds in the environment
8. Difficulty with organizational skills
9. Difficulty following multi-step directions
10. Difficulty in dividing attention
11. Difficulty with reading and/or spelling

Causes of APD

While there is no one cause, the disorder will occur in various locations along the path, followed by acoustic signalsas they are received, transition into neural signalsand then ultimately pass through neural networksfrom the ear to the brain for additional analysis (before the ultimate recognition or comprehension and response).

In many children, the development of important auditory centerswithin the brain is linked directly to maturational delays which result in this disorder. In others, variations in brain developmentcan lead to benigndifferences and create the deficits. For many, this is a genetic disorderwhich is inherited and runs in families. Sometimes, the disorder may relate to neurological problemscaused by tumors, trauma, surgical mishaps, disease, viral infections, oxygen deficiency, lead poisoning, auditory deprivation, or anything along these lines.

What it is like to have APD

Persons with this condition often:

• have trouble paying attention to and remembering information presented orally;
• have problems carrying out multi-step directions given orally;
• have poor listening skills; and
• need more time to process information.

It appears to others as a problem with listening. A child with APD may be accused of "not listening".

One adult, who has had the disorder since childhood, writes:

"My hearing is fine, but what I hear is often garbled initially by my brain. Shortly later, I often figure it out. In conversation, about the same time I say "huh?', I figure out what it was that I just heard. Like the three-legged dog, I am told that my visual skills, in compensation, are much stronger than normal. My bottom line is: I do better with what I see than what I hear."

Coping skills and work-arounds

Adults who discover disabilities such as APD late in life have provided some insight into coping skillsthey have found helpful. These include:

1. Get directions and instructions in writing.
2. Do not take notes yourself when information comes from others orally, as this may interfere with your processing strategies, but ask others to provide notes for you.
3. Many APDs use body language, lip readingand eye contact as a coping strategy.
4. Rewrite text using multi-coloured text options to provide visual guide to changes in meaning or for new sentences, or use a set of coloured highlighters.
5. Use closed captioningwhile watching television.
6. Place with teachers whose speaking style is clear and organized, who are "good explainers," and who encourage questions, so that the person with ADP does not have to decode complex verbiage. Rules of language activities, including writing, need to be made overt and very explicit.

Remediations and Training

No one program is a cure or help all for APD.

APD is about creating coping strategies to meet the challenges, life presents and using the various strengths each of us may have.

• Management of Auditory Processing Disorders(includes the use of many programs)
• Lindamood-Bell Learing(particularly, the Visualizing and Verbalizing training)
• Neuro-linguistic Programming (NLP)
• Brain Gymor Edu-Kinesthetics
• Physical activities which require frequent crossing of the midline (e.g. occupational therapy)
• Auditory Integration Training(AIT)

External links

• ASHA APD Technical Report Jan 2005(An Acrobat download of 20 pages of A4) This report is the result of some 5 years discussion to find a unified definition of APD for the USA, which was started by the first Bruton Conference in 2000.
• UK Medical Research Council's APD pamphlet Oct 2004The UK MRC published this pamphlet as a working document to define APD for the UK to herald their first 5-year APD research program, funded by the UK government. The links provides either a download of the pamphlet, or it can be read online.
• Auditory Processing Disorder in the UK (APDUK)web site includes online and downloadable copies of the UK Medical Research Council's APD pamphlet and much more information about APD (with input from Adult APDs) and related invisible disabilities.
• National Coalition on Auditory Processing Disorders (NCAPD)Relaunched website of a US non-profit organisation, containing a lot of information, including a directory of US Audiologistswho can diagnose APD.
• Information Center on Disabilities and Gifted EducationOverview on Auditory Processing Disorder.
• Central Auditory Processing Disorders as a key factor in Developmental Language DisordersA review of APD by SLT and audiologist, Rosalie Seymour.
• AudiologyOnline The Hearing Journal Auditory processing disorder: An overview for the clinician, by Gail D. Chermak.
• OldAPDs: Adult APD ForumA forum for Adult APDs to exchange experiences and provide mutual support. There is also an online research project participation.
• KidsHealth.org: Central Auditory Processing Disorder
• Autistics.org: Central Auditory Processing Disorder
• Two articles, written for Learning Disabilities Online by audiologist, Judith Paton:
  • Central Auditory Processing Disorders
  • Living and Working with a Central Auditory Processing Disorders
• Auditory and Language Processing Disorders, by Kristen Jacobsen, MS CCC-SLP
• University of Massachusetts - Overview of Assessment and Management Practices

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Auditory+processing+disorder Wikipedia article Auditory processing disorder.