When we talk about hearing issues, most of us tend to think of hearing impairment, hearing loss, or deafness. Even as a sound engineer, when I think about the perception of sound (psychoacoustics) I don’t think about what could go wrong in that process.
How the Brain Struggles with APD
SLP Lois Kam Heymann is a leading expert on Auditory Processing Disorder. She’s written a book on APD called The Sound of Hope, which is geared for children under 8. Heyman helped Rosie O’Donnell’s son who was diagnosed with APD at 8 (and the book includes some of those stories and interventions that helped their family). She explains the brain can have three issues related to APD:
- Receiving information. It’s like a cell phone that’s breaking up from poor reception. The person on the other end is speaking clearly but somewhere in the signal you miss information (or misunderstand it). Someone might be calling you to pick up 13 cupcakes and you mishear and buy 30.
- Analysis of information. The brain may have trouble blending sounds to understand a word and therefore doesn’t store it properly. Heymann uses the example, “The sound of C-A-T does not translate to a type of animal.” Temple Gradin, a well-known author and speaker about autism, says she hears two tones played with a pause as one because of how her brain incorrectly processes it.
- Processing the meaning of language. This is like going to the grocery store and seeing the new trendy vegetable that looks very much like something else but you have no idea what it’s called. You’ve probably heard the word “Kalette” or “Romanesco” but in the moment, you have no idea what it is. For a child, they might be struggling to recall the word for something as basic as a cat.
Auditory processing disorder is when your your brain doesn’t receive, store, or use the information it receives from the ears properly. Someone with auditory processing disorder (or APD) may pass a hearing test with flying colors but still struggle to understand people or words.
Diagnosing Auditory Processing Disorder
The difficulty with diagnosing auditory processing problems is the symptoms look similar to other issues or they overlap with other development issues. A child who shows signs of struggling with language (like confusing similar sounding words) may be viewed as having language disorder. An attention issue may look more like ADHD but could actually be APD.
According to the Child Mind Institute, there are four skills involved in auditory processing and children may be weak in one or more areas:
- Auditory discrimination. Children may not be able to tell subtle differences in sounds like ‘cake’ and ‘take’ or have trouble rhyming (because their brain doesn’t recognize words that sound the same).
- Figure-to-Ground Discrimination, or the ability to pick out a voice or important sound when background noise is too loud. This is something that’s harder for children to do than adults regardless if they have APD (and gets better with age); but if a child can’t do this as well as their peers it may be a reason to look into APD further.
- Auditory Memory, or the ability to remember what we’ve heard (short term and long term). Signs this may be an issue are trouble remembering song lyrics, nursery rhymes, or reciting something from memory.
- Auditory Sequencing. Just as it sounds, this is the ability to recall the order of sounds. Children may have trouble following instructions in a sequence or mix up the sequence of words or numbers.
Children experiencing these difficulties are usually referred to a speech-language pathologist (SLP) or educational therapist. There are audiologists who can test for Auditory Processing Disorder but it is somewhat a new area of study. Dr. Matthew Cruger of the Child Mind Institute notes that these interventions are widely accepted as a way of helping children although there isn’t a “good body of real world research to back that up.” It’s probably hard to test because it overlaps with other development issues and the auditory system does mature with age. But, if you suspect a child could have APD, it’s worth looking into (versus waiting it out) because it can be frustrating for children and their learning/development may suffer in the meantime. There are Facebook groups devoted to Auditory Processing Disorder with members with the disorder and also following the latest research results related to APD.