Auditory Processing Disorders
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Contents
What is an Auditory Processing Disorder
Auditory processing in the broadest terms refers to what we do with what we hear. It represents a very broad set of skills that are required in order for the brain to process incoming auditory information. These skills include but are not limited to:
Sound localization and lateralization
This is the ability to know where a sound has occurred in space.
Auditory discrimination of sounds
This refers to the ability to distinguish one sound from another, typically this refers to speech sounds, such as the phoneme form the phoneme.
Temporal aspects of sound
This refers to the ability to sequence sounds, integrate a sequence of sounds into words or other meaningful combinations, and perceive sounds as separate when they quickly follow one another.
Auditory performance with competing sounds
This refers to the ability to detect sounds when another sound is present. The other sound may be noise or another similar speech signal which is either loud or soft.
Auditory performance with degraded signals
This refers to the ability to perceive a signal in which some of the information is missing. This may be where parts of a sound spectrum have been deleted for instance the highest or lowest frequency components of the sound are removed.
An auditory processing disorder is any deficit in the processing of audible signals that cannot be attributed to impaired peripheral hearing sensitivity or intellectual deficits. Any breakdown in any of the skills will result in challenges with auditory processing. Due to the nature of auditory processing deficits and their coexistence with other deficits, there are often a number of other issues which need to be addressed in conjunction with the auditory processing deficits. Treatment often requires and integrated approach.
Types of Auditory Processing Disorders
There are four main profiles of Auditory Processing Disorders. Not all individuals with auditory processing deficits can be classified into one of these profiles.
Decoding Deficit
Individual’s with an impairment classified under this category have deficits with phonemic skills, phonics, articulation skills, understanding directions, reading skills and spelling skills.
Tolerance- Fading Memory
Difficulties with signal-to-noise ratios during listening tasks which appears as though they are ignoring people. These individuals exhibit similar characteristics of those with ADHD. Difficulties with short-term memory skills and following a series of spoken directions.
Integration Deficit
Difficulties integrating auditory information with other functions such as visual or nonverbal aspects of communication. In general they are poor communicators. Similar profile to dyslexia in that they demonstrated severe reading and spelling deficits. Difficulties with word finding skills, phonetic skills and handwriting skills.
Organization Deficit
This profile is characterized by reversals and sequencing errors and poor organization skills. Difficulties with task planning, initiation and follow through (executive functions). Discourse errors present in oral and written sequencing.
Common Symptoms
Individuals with auditory processing deficits typically have normal hearing and normal intelligence scores. They share several characteristics with other disorders such as ADHD and Language Processing Disorders. Often these diagnoses can co-occur making treatment more challenging. Treatment methods require an integrated approach to address the multiple areas which are impacted differently by different systems. Individuals who struggle with auditory processing delays will not demonstrate all the characteristics. Based on the diagnostic profile some features will be more predominant than others. Common characteristics of auditory processing disorders include:
- Normal hearing acuity
- Difficulty following directions
- Difficulty understanding in the presence of background noise
- Difficulty paying attention
- Difficulty learning through the auditory modality
- Frequently says “Huh?” or “What?”
- Seems to mishear what is said to them
- Trouble locating sounds
- Gives the impression of not listening even when looking at the speaker
- Slow or delayed responses to verbal stimuli
- Poor auditory memory
- Poor tolerance for loud noises or noisy environments
- History of otitis media
Co-Morbidities
There are several conditions that may occur with CAPD and it can be difficult to distinguish these condition from CAPD. The most common co-morbidities include:
Common Co-morbities
- ADHD
- Learning Disabilities
- Reading Deficits
- Language Disorders including Language Processing Disorders
- Dyslexia
- Hearing Impairments
- Autism Spectrum Disorders
- Dementia (adults)
ADHD Co-morbidities
Of these co-morbidities, ADHD shares the most behavioral characteristics with CAPD. Behaviors most commonly associated with ADHD are:
- Inattention
- Distractibility
- Hyperactivity
- Restlessness
- Impulsivity
- Interruptions/Intrusions
- Academic challenges
CAPD Co-morbidities
Behaviors associated with CAPD that are most often seen include:
- Difficulty hearing in background noise
- Difficulty following directions presented orally
- Poor listening skills
- Inattentiveness
- Hyperactivity
- Distractibility
- Academic challenges
Risk Factors
It is difficult to determine the exact cause of an auditory processing deficit. There are several characteristics or traits that have been described in the literature as contributing to the occurrence of an auditory processing deficit. Some of these, which can be identified at the preschool age level, suggest that an individual may be at risk for later identification of an auditory processing disorder.
- Infant auditory stimulation experiences
- Environmental deprivation
- Genetic factors
- Neurological risk factors (perinatal and childhood)
- Delayed or disordered receptive and/or expressive language skills
- Delayed or disordered speech skills
- History of frequent or chronic ear infections (conductive hearing loss)
- Difficulties with rote memory or recall of repetitive rhymes such as the ABC song
- Delayed onset of reading skills
- Academic struggles
- Family history
Treatment
There are various techniques and procedures for the clinical management of auditory processing deficits. Treatment can be very successful when the proper diagnostic tools have been used to identify the skills that need to be addressed. Many treatment approaches used for auditory processing delays will be administered in conjunction with other treatment approaches which will target co-morbid problems that are impacting the individual. These treatments may include speech and language interventions, memory training, executive function training, attention training, reading and writing skills intervention, and sensory integration intervention.
The most commonly used auditory training techniques for auditory processing delays include:
- Use of auditory trainers for sound field amplification
- Auditory-Visual training
- Speech perception training
- Noise tolerance training
- Analytic non-speech tasks
- Analytic speech tasks
- Synthetic speech tasks
- Auditory cohesion training
- Pragmatic training with speech and non-speech tasks
- Auditory integration training
- Auditory memory training
- Dichotic listening training
- Training for temporal patterning
- Auditory discrimination training
- Auditory synthesis training
- Auditory closure training
- Auditory figure ground tasks
- Auditory binaural integration
Neurofeedback
Fast ForWord
Several research-based auditory training programs have been successful in remediating auditory processing skills. One of the most effective programs used to treat auditory processing delays while targeting the many co-occurring delays in language, reading and attention is Fast ForWord.
