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Auditory Processing disorder

Background

To be able to hear well we need to have a normally functioning hearing system - outer, middle and inner ear, hearing nerve and part of the brain that deals with sound. We need to be able to hear day-to-day sounds, and speech in various listening environments. This involves extracting speech from other sounds, such as background noise, sensing subtle changes in speech sounds, loudness and pitch discrimination. Having two ears help us to locate a sound source and sense movements of sound. When in a noisy environment separating sounds coming from different directions helps us to focus on one sound over the others. If these functions do not work normally, this can lead to an auditory processing disorder (APD).

Credits

Text written October 2014 by Dr T Sirimanna, Consultant Audiological Physician, Great Ormond Street Hospital, London and Mrs P Grant, Chair of the British Society of Audiology APD Special Interest Group and Lead Consultant at Listen to Learn. Last updated December 2016 by Dr T Sirimanna, Consultant Audiological Physician, Great Ormond Street Hospital, London, UK.

Although great care has been taken in the compilation and preparation of all entries to ensure accuracy, we cannot accept responsibility for any errors or omissions. Any medical information is provided is for education/information purposes and is not designed to replace medical advice by a qualified medical professional.

What are the symptoms?

Patients with suspected APD present with:

  • difficulties with hearing and listening in noisy places
  • understanding when listening (can also be due to a language processing disorder)
  • mishearing and asking for repetition in spite of normal hearing tests
  • poor academic performance
  • difficulty understanding spoken messages and/or remembering instructions (can also be due to poor short-term memory)
  • difficulty staying focused
  • poor attention or day dreaming (can also be due to attention deficit or poor hearing)
  • disruptive behaviour in class.

Many children with APD may have other co-existing language and learning difficulties such as:

What are the causes?

In most, APD is considered to be due to a neurodevelopmental disorder, such as dyslexia. In a small percentage, APD is acquired following some form of brain injury or secondary to a condition that  leads to a fluctuating hearing loss, such as glue ear, especially in the first few years of life. Sometimes APD can occur alongside other neurodevelopmental disorders, such as dyslexia and autism.

How is it diagnosed?

Studies have suggested that up to 5% of children may have some level of APD. There are a number of hearing and listening tests to diagnose APD and currently these are available to children at least 6 years of age in a small number of specialist centres across the country, although some centres prefer to wait until the children are at least 7 years of age. If there are suspicions of a language disorder or cognitive difficulty, these should be assessed before requesting an APD assessment.

How is it treated?

There is usually no cure for APD but there are a number of strategies that would  help an affected child. Also, Auditory training software could improve certain specific types of APD (e.g. Spatial Processing Disorder)

Audiologists, teachers of the deaf and speech and language therapists can offer advice about:

  • auditory training programmes, exercises and strategies to help the child become a better listener
  • minimising the effects of APD at home and school.

General suggestions to help at school:

  • the child should sit close to the teacher to hear better, lip read and use other cues to aid understanding
  • provide written information to consolidate verbal instructions
  • create a more favourable listening environment by adding carpet and soft furnishings (bean bags for example) and replace worn rubber feet on table and chair legs. These simple adjustments that will minimise the background noise level and reverberation
  • assisted FM listening devices make it easier to hear the teacher (e.g. iSense, Phonak Roger devices, ReSound minimicrophone) by making the teacher's voice level relatively louder than the background noise (improving speech to noise ratio)
  • dynamic class soundfield systems can help tokeep speech to noise ratio at a favourable constant level, but quality of soundfield speakers need to be very good, otherwise sound from the room speakers simply can add to the 'noise'
  • listening to good quality recorded material through personal headphones with good acoustic output  in mental maths tests and foreign language aural lessons and examinations
  • younger children will be helped by a visual material and other visuals to support spoken instruction.

In the home:

  • encourage the child to do listening and learning exercises at a regular time
  • check that the child is looking and listening when necessary
  • reduce background noise (such as TV or radio) when speaking.

Inheritance patterns and prenatal diagnosis

Inheritance patterns
There is a possibility that APD may run in families, but further studies are required in this area.

Prenatal diagnosis
None.

Is there support?

APDUK

Tel: 01442 214555 (6-10pm)
www.apduk.org.uk

The Group is a largely internet-based network, established in 2002. It offers support and information to those affected by APD, their families and interested professionals. The Group aims to raise awareness and understanding of the condition, particularly among professionals, and works to improve diagnostic testing.

Group details last confirmed December 2016.

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