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Auditory Processing Disorders



Auditory processing is defined as how an individual processes or interprets auditory stimuli.  Children with auditory processing disorders (APD) experience auditory difficulties despite normal hearing acuity. Classrooms are auditory/verbal environments with listening serving as the basis for learning.  Children with auditory processing deficits may have communication or learning problems because of difficulties with listening tasks. It is believed children with auditory processing disorder have a breakdown in auditory information as it travels from the hearing nerve to centers in the brain responsible for language learning.  Children with normal auditory processing skills are able to understand speech in a wide range of listening conditions and can adapt to distorted auditory signals in day to day listening situations.  Children with auditory processing delays have difficulty understanding speech presented in unfavorable acoustic conditions.  Impaired listening skills contribute to poor academic performance for children with auditory processing disorders because such children as always trying to catch up with the ongoing stream of speech in the classroom.


APD is somewhat controversial – much debate continues among scientists today about diagnostic criteria for APD, and whether it should be considered a distinct disorder at all.1

Given these issues, estimates of APD’s prevalence rates vary considerably, from 0.5 to 7 percent of the population and even more.2 APD’s symptoms (see more below) also overlap with that of other conditions and disorders, including attention deficit hyperactivity disorder (ADHD or ADD) and learning disabilities.

Auditory Processing Disorder Symptoms

Individuals with APD experiences difficulties in these four areas of auditory skill, according to the National Center for Learning Disabilities3:

  1. auditory discrimination: the ability to distinguish distinct, separate sounds in words (a necessary skill for reading)

  2. auditory figure-ground discrimination: the ability to focus on specific sounds in noisy/competing backgrounds

  3. auditory memory: the ability to recall, in the short-term and long-term, information that is presented orally

  4. auditory sequencing: the ability to understand and remember the order of sounds and words

Common signs of APD, according to the American Academy of Audiology4, include:

  • difficulty hearing speech in noisy environments

  • difficulty maintaining attention

  • problems locating the source of a sound

  • difficulty following directions

  • commonly asking for information to be repeated

  • inability to detect subtle changes in tone

  • distracted and inattentive behavior

  • difficulty learning to read

  • academic difficulties, including poor reading and spelling

The symptoms of APD can impact listening and communication skills, and they may make academic success difficult to achieve. The same applies to adults with APD, who may show difficulties with telephone conversations, following directions, and other issues in the workplace 


Auditory Processing Disorder and ADHD

There is considerable overlap between APD and ADHD symptoms. They include:

  • distractibility

  • inattention

  • poor listening skills

  • academic difficulties

  • difficulty following directions

Tests of auditory processing are designed to simulate listening tasks encountered in the real world, such as the normal classroom.  These tests stress the auditory system by distorting, degrading, filtering or time altering the auditory signal.  Children with auditory processing disorders will have difficulty comprehending an auditory message when distorted.

The auditory processing assessment includes a comprehensive audiologic evaluation to be sure your child’s hearing sensitivity is normal.  The auditory processing battery consists of a series of recorded materials presented through earphones.  The auditory processing assessment tests the auditory skills areas of: figure ground, maturation, closure, phonemic synthesis, and pitch patterning.


Auditory Figure Ground: is the ability to discriminate words in the presence of competing stimuli.  This skill involves selective attention, or the ability to attend to a speaker and ignore background sounds.  The inability to understand speech in the presence of background noise is one of the most common auditory complaints of children who have language and learning problems.  The ability to pay attention and ignore distractions in the classroom is controlled by figure ground skills.  This skill is assessed using recorded words presented with multi-talker background noise.  The child is asked to repeat a list of words presented in background noise individually to each ear.


Auditory Maturation: is assessed using dichotic speech tasks. A dichotic task involves presenting different speech stimuli to each ear simultaneously including tasks of binaural integration and binaural separation.


Binaural Integration:  skills involve combining or incorporating information being presented to each ear.  This skill is assessed by presenting two numbers simultaneously to each ear.  The child is asked to repeat all four numbers heard.


Binaural Separation: skills involve attending to the information coming in one ear while ignoring information coming in simultaneously to the other ear.  This skill is assessed by presenting two sentences at the same time, one to each ear.  The child is asked to repeat a sentence heard in one ear and ignore what is heard in the other ear.


Auditory Closure: is the ability to perceive the “whole” message when parts are missing.  Auditory closure skills are necessary for comprehending speech presented in less than ideal listening conditions, such as speech that is compromised by a poor acoustic environment, a rapid speaking rate, an accent of dialect, or a speaker with his or her back turned.  Auditory closure skills are assessed using filtered words.  The words are filtered to reduce their high frequency content.  High frequencies are necessary for consonant recognition.  Filtering causes the words to sound “muffled” to the listener.  This is considered a test of auditory closure as the child is required to identify the whole word although part of the word is acoustically missing.


Phonemic Synthesis: is a measure of phonemic decoding abilities.  The Phonemic Synthesis Test is sensitive to auditory processing difficulties for speech sounds (phonemes). A series of words are broken down into their individual phonemes and the child is asked to blend the sounds together to form a meaningful word.  The Phonemic Synthesis task requires good phonemic decoding skills or phonemic awareness.  It requires recognizing the sounds heard and blending them with previous sounds heard.



Auditory Processing Disorder Treatment

While interventions are available for individuals of all ages with APD, experts agree that early diagnosis and treatment are better for symptom outlook, given the brain’s increased plasticity at young age4.

Auditory training includes a variety of exercises that target specific deficits directly, or via “compensatory” strategies. Therapy can range from computer-assisted software programs, like Fast ForWord and Earobics, to one-on-one training with a speech and language therapist. Some therapy techniques include3:

  • listening to a variety of auditory inputs within a sound booth, with interference introduced and controlled to train the auditory pathways on differentiating sound

  • training to distinguish between similar speech sounds (like the b and p in buy and pie)

  • learning to identify the location and direction of a distant sound

  • playing auditory games (like musical chairs and Simon Says)

  • attempting to predict elements in a message by using context

Treatment schedules vary, but many clinicians meet patients for therapy about four times a week for up to half an hour11.

Possible APD accommodations for the classroom, the office, and at home include 4912 :

  • improving the acoustics: closing a window, shutting a door, adding a rug to help absorb sound

  • sitting closer to the source of sound and away from others (i.e. in the front of the classroom)

  • installing a stereo system in the classroom or lecture hall

  • eliminating other sources of sound from the immediate area

  • emphasizing clear speech; asking others to repeat themselves

  • being provided with written instructions (on paper, a whiteboard, via e-mail, etc.)

  • using assistive technologies (like headphones)

  • being provided with note takers or written summaries of classroom discussions/work presentations

  • for teachers: making frequent checks of comprehension

  • asking for information to be rephrased in simpler terms

  • being provided important information only in the absence of noise or other distractors (like the TV)

1. Practice Sequencing with Sounds

Ask your child to cover her eyes with her hands while you make a noise such as closing the door, sneezing, or playing a key on the piano. Have your child first identify the noise. Then try two noises, one after the other. Your child will then identify the two sounds in sequence. Add the number of sounds in the sequence until your child gets tired with the game. Some ideas for noises are:

  • Whistling

  • Snapping fingers

  • Sharpening a pencil

  • Hammering

  • Tearing paper

  • Slamming a book closed

  • Ringing a bell

  • Blowing a whistle

  • Clapping

  • Coughing

  • Drumming with fingers

  • Crumpling paper

  • Unwrapping candy


2. Name the Mistake

Recite or read aloud a familiar text, poem, or rhyme changing the words or wording. Your child should raise her hand and shout out whenever she hears a mistake. You can even change the words, grammar, sound and meaning. Also, you can swap the word order or word parts. Here are a few examples:

  • Once a time upon…

  • Old McDoodle had a farm…

  • Twinkle, twinkle little car… 

3. Clapping Syllables

Start out by pronouncing each family member’s name by clapping it syllable by syllable. Then ask your child to say and clap the name along with you. Each clap represents a syllable. After each name has been clapped ask, “How many syllables did you hear?” You can also have your child place two fingers under her chin, so that she can feel her chin drop for each syllable. This also allows your child to feel the vibration of each syllable.  


4. Sound Sort

Make picture cards using magazines or computer art. Glue the pictures on index cards and laminate them if you want to. Spread selected pictures in front of your child and ask her to find the picture whose name begins with a certain sound. As each picture is found, have your child name the picture and the initial sound. For example, you can say, “what picture begins with the sound /s/?  Your child might respond – “snake, /s/.” Then repeat using middle and ending sounds.


5. Picture Guess

Using the same pictures, place them in a bag. Pick out a picture from the bag and don’t show it to your child. Pronounce the name of the picture, sound by sound. For a picture of a cat, you will say /c//a//t/. Then your child guesses what the picture is from your isolated sounds. Take turns guessing each other’s picture.


6. Listen for Sounds

Have your child sit on the floor, close her eyes and identify sounds that you make. You can drop a pencil, bounce a ball, tap on the window, use a stapler, cut with scissors, sip on a cup of coffee, or type on your computer. Trade roles and then let your child make different sounds that you have to identify.


7. Outside Noises

Sit under a tree with your child. Listen for various sounds like birds chirping, airplanes flying overhead, cars driving by, voices of children, etc. You can have a little notebook on hand and keep a list of all of the different sounds you both come across. 


8. Repeat After Me

Sit across from your child and clap your hands to a rhythmic pattern alternating between slow and fast tempos. Have your child repeat the pattern. You can also use various instruments, play a drum, or bounce a ball to a variety of rhythms. Switch roles and let your child be the sound leader as well.


9. Hide and Seek

Hide a metronome or a ticking clock somewhere in your home. Have your child find it by locating the sound. Another variation of this game can be played outside. You can hide somewhere and blow a whistle. Your child will then follow the sounds to find where you are hiding.


10. Practice Focusing

Read a very simple story to your child with soft music playing in the background. Before reading the story, tell your child to listen for specific pieces of information in the story (for example the main character’s name). You can gradually increase the difficulty of the information you want your child to listen for.


11. Comprehension Check

Read an unfamiliar story to your child. Afterwards ask your child questions about the sequence of events. What happened first, who went to the game, etc. Continue to ask questions until the events in the story have been reviewed. You can also ask your child to predict likely events in the story.


12. Play the Game – What’s Next?

First, give your child one instruction. “Go into the kitchen.” Next, give your child two instructions. “Go into the kitchen and grab a spoon.” Then give your child three instructions, “go into the kitchen, grab a spoon and hide under the table.” Build up the instructions over time. Then switch so that your child gets to give you instructions to follow as well.


13. End of the Day Review

Every night as you tuck your child into bed, discuss the events of the day. Have your child try to remember all the wonderful (or not so wonderful) things that happened that day. Can your child recall the events sequentially?


14. I Went to the Market and I Bought…

This is a family game and can be played around the dinner table. Start with, “I went to the market and I bought an apple.” The second person says, “I went to the market and I bought an apple and a banana.” The third person says, “I went to the market and I bought an apple, a banana, and a bag of chips.” Etc., etc…


15. Listen to Music and Memorize the Lyrics

Have your child listen to a song and learn to sing the lyrics. Give your child a song that they are unfamiliar with or one that they do not know the words to already. Replay the tune often until your child can sing the entire song.


16. Memorize a Poem

Have your child memorize a poem and recite it to you. Aim for memorization of at least four to eight short poems during the school year. Keep reciting the old ones and build up a repertoire. Try to pick poems that the child has read and enjoyed. This can begin with simple fun ones and then eventually increase to some rich and deep poetry too.

When you improve auditory processing skills in your child, remember to make it a fun experience for both of you. Just a few minutes each day doing some of the above mentioned activities will hopefully make a big difference.




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