Nicole Eglinton, Director and Principal Audiologist, Little Ears
What is Auditory Processing (AP)?
Auditory processing refers to how well we detect, discriminate and process auditory (verbal) information. It is often thought of as the brainwork of hearing, or in other terms "what we do with what we hear". An Auditory Processing Disorder (APD) (also referred to as a Central Auditory Processing Disorder) refers to an inability to make optimal use of what we hear. Children diagnosed with an APD typically have normal hearing and normal intelligence however have difficulties listening, particularly in the presence of background noise (e.g. the classroom).
Typical behaviours of a child with an Auditory Processing Disorder include;
Not all children with APD present in the same way. Some children may have an APD in combination with other difficulties (e.g. language impairment, attention deficit hyperactivity disorder (ADHD), Autism Spectrum Disorder (Aspergers Syndrome), a Sensory Processing Disorder, anxiety, specific learning disability etc.). This highlights the importance of obtaining a detailed history to ensure your child's auditory processing assessment and management is tailored most appropriately.
How does an Auditory Processing Disorder affect a child in the classroom?
Children are required to attend and follow instructions in the classroom, often in the presence of competing background noise (i.e. other students talking). This can be extremely challenging and tiring for a child with an APD and as a result they may develop avoidance type behaviours, withdraw from classroom activities and/or become physically restless (i.e. fidgety). Children with an APD may also show slower progress academically. This is because they spend more time in class working out what is required of them, rather than practicing a new academic skill. Consequently, these children often lose confidence in their ability to succeed and become concerned about their own academic abilities. In the classroom this if often observed when they 'opt out quickly' or become reluctant to 'have-a-go' ('fear-of-failure'). Building self-esteem must be incorporated in any management program. Children with good self-esteem are confident in trying new things, take healthy risks with their learning and develop good problem solving skills.
Who should assess a child for an Auditory Processing Disorder?
A qualified Audiologist is the recognised professional to diagnose a child with an APD. Audiologists are post-graduate (Masters) university trained professionals who have an in-depth understanding of the auditory system and are specifically trained to perform comprehensive hearing assessments and provide aural rehabilitation as required. Paediatric audiologists have a good understanding of child development and provide a family focused approach in the assessment and management of children with hearing loss and/or listening difficulties. Other allied health professionals may screen a child for an APD, but when concerns are identified should refer to an Audiologist for a definitive assessment. An audiologist will ensure that a child has no middle ear problems (e.g. glue ear) and that the child has normal hearing at an ear level prior to doing more comprehensive tests.
How is a child assessed for an Auditory Processing Disorder (APD)?
At Little Ears the assessment of a child's auditory processing abilities is carried out over two appointments. This is to ensure it is appropriate to assess the child and to minimise the effects attention and motivation may have on a child's test results. Parent and Teacher Questionnaires are used to obtain a listening profile for each child. Occasionally following a child's first appointment it may be recommended that they be assessed by another medical / allied health professional prior to continuing (e.g. psychologist, speech pathologist).
The second assessment involves a number of auditory tests (listening games) that target different auditory processing skills. Many children find these listening games challenging. It is important than short breaks are provided as needed to ensure results accurately reflect a child's listening abilities.
What if my child is found to have an APD?
Management advice and recommendations made for a child are highly dependent on their presenting difficulties and their listening strengths and weaknesses identified at their assessment. As mentioned above, APD may coexist with other disorders and in these cases careful diagnosis is required as part of a multidisciplinary team. Recommendations made must be considered in combination with strategies already suggested/implemented by other professionals involved in a child's care.
For example; if a child is found to have a Spatial Processing Disorder (SPD) (an auditory skill involving the use of binaural cues to focus on one talker while ignoring competing talkers, i.e. background noise) listening training using a computer based cd specifically targeting this skill may be recommended, along with the trial of a listening device for use in the classroom.
A Frequency Modulation (FM) system (listening device) makes it clearer and easier for a child to hear in the classroom. FM systems maximises the clarity and volume of a teacher's voice and reduce a child's awareness of background noise. The set-up involves a teacher wearing a small microphone (transmitter) with the child wearing a small wireless receiver (as seen below, photo courtesy of Phonak Pty Ltd).
In a recent study on the use of FM systems for children diagnosed with dyslexia (a specific learning disability) the use of FM systems was found to significantly improve the brains processing of acoustic information. Furthermore, this improved auditory processing was directly linked to improvements in reading and phonological awareness (Hornickel J et al. 2012 available www.ncbi.nlm.nih.gov/pubmed/22949632)
Does my child need a referral?
Parents, teachers, medical and allied health professionals may all refer a child for a hearing assessment or an auditory processing assessment (a written referral is not required).
For auditory processing assessments
For further information see www.littleears.com.au
P (08) 8418 3844
F (08) 8471 4599
A 67 King William Rd, Unley SA 5061