Auditory processing disorder: Unable to understand

Do you ever feel that you hear the words others are speaking, yet blah, blah, blah is all you can compute? No, it isn’t selective hearing. If you or your child can relate, you may have auditory processing disorder in which the brain cannot coordinate the sounds of words even when spoken within hearing distance. It can have a profound effect on academia, relationships, and self-esteem.

What is Auditory Processing Disorder?

Auditory Processing Disorder (APD) is a relatively new concept. There is much controversy around the concept because one or several deficits (language deficits, attention deficits or sensory deficits – to name only three) might be at the source of what is called ADP.

Impaired auditory processing/ comprehension is often a consequence of other impairments and often co-occurs with other disabilities. Thus isolating a truly specific APD, not causally related to memory, attentional or linguistic processes, is very difficult.

Symptoms of Auditory Processing Disorder

Auditory processing disorder manifests as behavioral characteristics that tend to overlap with other common disorders (i.e. ADHD, dyslexia). While it may seem the individual simply has poor listening skills or is purposely being rude, this serious condition is anything but!

• Inattention
• Misunderstanding verbal instructions
• Cannot follow rapid speech or speech given in loud environments
• Misremembering spoken information
• Poor ability to read, write, spell, or learn songs
• Difficulty localizing sound
• Prolonged response time
• Saying “what” or “huh” often
• Inappropriate responses
• Low performance in speech and language psychoeducational tests
• Misinterpreting sarcasm, jokes, and other messages

Causes of Auditory Processing Disorder

The causes of auditory processing disorder are unknown. There is evidence that the condition runs in families. However, researchers have made a few alternative connections. Auditory processing disorder has developed secondary to several illnesses. These include chronic ear infections, stroke, brain injuries due to trauma or meningitis, exposure to neurotoxins such as lead poisoning, and abnormalities of the nervous system like lesions, multiple sclerosis, and seizure disorders.

Prenatal factors also have the potential to cause auditory processing disorder. The prenatal/neonatal factors consist of low birth weight, premature birth, prenatal drug exposure, hypoxia, hyperbilirubinemia, and cytomegalovirus.

Conditions Related to Auditory Processing Disorder

A significant number of the population with auditory processing disorder also have diagnoses like attention deficit hyperactivity disorder (ADHD), dyslexia, and other learning and language disorders. Receiving an accurate diagnosis of one or multiple conditions is imperative to implement interventions that improve functioning. ADHD and dyslexia are by far the most common conditions related to APD.

Dyslexia

Dyslexia is a learning disability impacting the areas of the brain that process language. Difficulty reading, spelling, writing, and speaking are characteristic of the disorder because dyslexia causes problems identifying speech sounds and then connecting those sounds to words.

According to the National Institutes of Health, 25% of children tested for learning disabilities had both APD and dyslexia. Since they are language-based, the disorders share deficits in phonological awareness skills.

Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsiveness. Individuals with attention deficit hyperactivity disorder struggle to pay attention and control impulse behaviors. In many cases, an attention issue is solely auditory processing disorder, but it and ADHD are known to occur together. Signs and symptoms are similar including a poor focus in a noisy environment, not following verbal directions, easy distraction, decreased academic performance, and “zoning out” during the conversation.

Studies show “ADHD children showed poorer performance in auditory processing tasks when compared with age-gender-matched controls” (Lanzetta-Valdo et al., 2017). The aforementioned tasks improved with proper treatment, which is why to implement the appropriate interventions, a thorough assessment is necessary to screen for the presence of additional symptoms unrelated to ADHD.

Autism Spectrum Disorder

Autism spectrum disorder is a developmental disorder of communication and behavior. Someone on the spectrum struggles to interact socially with people. They also exhibit restricted interests and repetitive behaviors. Auditory processing is integral to communication, which is hindered by autism.

Diagnosing Auditory Processing Disorder

Normally, a parent or teacher observes the behavioral signs and symptoms of auditory processing disorder. The evaluation process begins with audiology if the individual meets the following criteria: minimum age of 7 years old, normal cognitive functioning consistent with their age range, adequate speech production, skills, and no presence of hearing loss.

An audiologist is a hearing specialist who performs hearing tests in a soundproof room, such as having the patient press a button upon hearing a projected sound to measure:   

• Sound localization
• Auditory pattern processing
• Auditory discrimination
• Dichotic listening
• Auditory temporal processing
• Auditory performance

Further screening also entails behavioral procedures.

Social Effects of Auditory Processing Disorder

The delayed ability to understand speech has a vast influence on socialization. Children and adults with APD cannot keep up with the conversations of their peers. Once they have processed what was said, the conversation has taken on a new subject and their slowed response is frequently inappropriate.

This causes them to remain aloof—rarely participating in social interactions. In school or work settings, they may refrain from giving their input, answering questions, or befriending peers and colleagues in fear of humiliation. As a result, they do not receive the normal amount of social stimulation and the perceived unacceptance of peers degrades their self-esteem.

Auditory Processing Disorder In Adulthood

APD is not strictly a childhood disorder. Adults suffer from symptoms too. Adult cases are typically caused by stroke, tumors, or head trauma associated with post-concussive syndrome. Although adults and children display similar symptoms, APD in adults manifests as miscommunication with family, friends, and coworkers, whereas children are more affected in the realm of learning and academics. Work interference due to the inability to process what was previously heard has a significant effect on mental health. Most adults encounter this issue.

Treatment for Auditory Processing Disorder

There is no magic pill to treat auditory processing disorder. Managing the condition requires a series of behavioral and lifestyle modifications. Support from family and friends, teachers, and medical professionals lead to successful patient outcomes.

Speech Therapy

Speech therapy implemented in auditory processing disorder is intended to improve reading and language comprehension. Through speech therapy, individuals with APD are taught by a speech therapist how to execute the sounds of words more clearly. Developing listening skills and learning how to use language in social situations are secondary benefits to speech therapy.

Interventions in the Home

For children with an auditory processing disorder, interventions in the home managed by parents are key to favorable functioning. Families must ensure background noise is at a minimal level if possible and move to quieter areas when listening is required. Other interventions include:

• Use simple sentences
• Speak slowly 
• Repeat directions back to the person who is speaking
• Write notes for reminders 
• Maintain general scheduling 

Classroom Support

Children spend the majority of the day at school. But a learning environment quickly becomes frustrating when the child cannot understand what teachers and students are saying. Classroom accommodations can go a long way. Examples are creating a customizable seating plan, providing extra notes (i.e. tape recorder, etc.), and educating with instructional strategies. An Individualized Education Program (IEP) or 504 plan guarantees the accommodations are abided by. 

Teachers can further assist students with auditory processing disorder by enhancing the acoustics in the classroom—like incorporating bookshelves and carpeting. During lessons, speaking with a microphone headset is helpful.

Lifestyle Changes for Auditory Processing Disorder

Sustaining a healthy lifestyle is important for any human being, but especially for those with APD. The brain cannot coordinate the sound of words. As a result, keeping the brain healthy is a useful factor in managing the disorder. This entails consuming a diet of healthy fats, engaging in daily exercise, and consuming a diet with vitamins, minerals, and healthy fats that support brain health.

References

Edelson, S.M. (N.d.). Auditory Processing Problems in ASD. Retrieved from https://www.autism.org/auditory-processing-asd/

Lanzetta-Valdo, B. P., Oliveira, G. A., Ferreira, J. T., & Palacios, E. M. (2017). Auditory Processing Assessment in Children with Attention Deficit Hyperactivity Disorder: An Open Study Examining Methylphenidate Effects. International archives of otorhinolaryngology, 21(1), 72–78. doi:10.1055/s-0036-1572526

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.