The Ultimate Guide to SLCN

Auditory Processing Disorder

Auditory Processing Disorder (APD) is a condition which affects how the brain interprets sounds. People with APD are able to hear sounds in the normal way, and there usually is not any hearing impairment, but they struggle with processing and making sense of the sounds they hear. This can impact on how well a person is able to focus their attention, particularly in noisy environments, and can cause difficulties understanding spoken language which arise from problems understanding the sounds of the message, rather than a difficulty understanding the meaning of the words. The difficulties experienced by a child with APD can vary considerably between individuals, so it is sometimes thought of as a spectrum condition.

The causes of APD are not yet well understood, however it is thought that there may be a genetic component as some parents have reported having similar difficulties to their children, despite not having a diagnosis themselves. Recurrent episodes of glue ear in early childhood, which may have affected the organisation of the developing brain, may be the cause of APD in some instances. Some cases are also thought to be linked to brain damage arising from acquired injuries, illnesses or traumatic birth.

APD is a lifelong condition and it continues to affect people in adulthood. Despite this, many people find that the impact of the disorder lessens over time as they develop skills and strategies to manage their difficulties. APD can impact on the development of communication skills, academic attainment and social skills.

Diagnosis of APD is generally not considered before at least 7-8 years old. Assessment from a specialist audiologist is required and usually investigations from SaLT and Educational Psychologists will also be required to determine the nature of the child’s difficulties and rule out alternative diagnoses. There are very few specialist clinics in the UK which are able to carry out the range of assessments necessary to diagnose APD.

Top Tip

Be aware that noisy environments may cause particular problems (cafeteria, gym, computer rooms etc).

Prevalence

An estimated 5-7% of school-aged children are affected by APD, although the extent of their difficulties varies. Evidence suggests that it is diagnosed twice as often for boys than for girls. It is thought that up to 50% of children with dyslexia also have APD.

What to look for

Children with APD have difficulty filtering out noises and are most likely to struggle in an environment where there is a lot of background noise such as a classroom or in the playground. Concentrating and understanding spoken language, especially in a noisy environment, presents a challenge. This is in contrast to the child’s abilities in quiet or 1:1 environments where they will typically not display the same difficulties.

Children with APD are likely to have difficulty following commands and decoding words. They may also have difficulty organising information efficiently to decode the meaning. Making inferences may be problematic and socialising can be challenging.

Our ability to hear and to process what we have heard are essential foundation skills for speech and language learning. Poor processing of speech can lead to language problems. Children with APD may have difficulty appreciating some of the aspects of language which are not stressed in speech, such as tense endings, plural markers and pronouns, and this may impact on their written and spoken language output.

You may notice that a child has problems with rhythm and pitch in music activities, and possibly also in their speech which can result in a monotone quality of voice. Difficulties with auditory processing can also impact on reading and spelling. The problems that a child is having may be at odds with their perceived cognitive ability.

Difficulties

• Difficulty responding to sounds and distinguishing between similar sounds. Children might confuse similar sounding words and may not speak clearly.
• Problems filtering out background noise.
• Difficulty understanding what has been said.
• Difficulty concentrating, especially when there is background noise (as is typical in a classroom).
• ‘Mishearing’ auditory information, or misunderstanding messages – especially when the meaning is conveyed by stress patterns or intonation such as in jokes.
• Social skills can be impacted, as children with APD can have trouble telling stories and jokes, and they may avoid conversations with peers because processing what has been said and responding appropriately is challenging.
• Taking longer to process and respond to auditory information.
• Poor auditory memory – particularly having difficulty retaining several spoken instructions at once.
• Difficulty expressing themselves clearly when speaking or in writing.
• Difficulty developing literacy skills including reading and spelling due to poor ‘sound awareness’.

Myth Busting

Is APD a hearing impairment?

APD is a problem with processing and interpreting sounds, not hearing sounds. Most people with APD have no hearing loss. Speaking more loudly to a person with APD won’t necessarily help them to understand what you’ve said, although it can help them to concentrate on what you’re saying and differentiate between your voice and background noise.

Are children with APD less intelligent than their peers?

APD is not related to intelligence. Most children with APD have average or above average intelligence. However, the difficulties caused by APD can make a child appear to be ‘slow’ – because it’s difficult for them to process new sounds and spoken information, they can, for example, be slow to respond to questions and appear unable to follow spoken instructions. There can be a significant impact on educational attainment as a result of APD if the appropriate support is not put in place, and children often perform better in classes which don’t rely heavily on listening. While children with APD may need extra support in the classroom, they can be just as capable and successful as their peers in the long term.

Does APD only affect activities related to speaking and listening?

APD affects a person’s ability to distinguish between sounds and words which sound similar, and the impact is especially severe in an environment with lots of background noise (such as a typical classroom). This is an important foundation for developing literacy skills such as reading, writing and spelling. Many children with APD will struggle in this area.

Strategies

• Sit the child near the front of the class close to the teacher.
• Ensure that you gain the child’s attention before speaking.
• Reduce ambient classroom noise as much as possible. Closing windows and doors will help to reduce noise from outside. Soft furnishings in the classroom can improve acoustics.
• Use visual support including the written word for older students.
• Check understanding as you go along. Asking the child to repeat back what you have said can be helpful.
• Speak clearly and at a slightly slower pace. Use intonation in your voice to highlight important points.
• Provide instructions one step at a time, using simple language. For older children who are required to follow multi-step processes, consider providing written instructions.
• For some students, you may need to consider using assistive technology, e.g. FM radio system (radio aid) with the teacher wearing a microphone and the child wearing a portable receiver. This can help amplify the teacher’s voice and ‘tune out’ background noise.

Role of SaLT

SaLTs are usually involved in the process of diagnosing APD, either assessing the child before they are referred for a specialist assessment or as part of a multi-disciplinary team assessing the child jointly. The purpose of assessment by a SaLT is to rule out any language difficulties which might better explain the child’s needs. A SaLT is not able to diagnose APD independently – this requires an audiologist – but SaLTs can make observations which might lead to a referral. SaLTs can also provide advice and strategies for supporting a child with a diagnosis of APD and they may be involved in providing interventions to support the child.

Further Information

Auditory Processing Disorder UK – www.apdsupportuk.yolasite.com

National Deaf Children’s Society – www.ndcs.org.uk

Read more about APD in The Link magazine, issues 7 & 13