Auditory processing disorder

Just a mother, but here are some suggestions:

Sit him closest to where you will usually be speaking, preferably away from distractions like the window and the door.

When you ask him a question, begin your request with his name to get his attention.

Anything you want the children to do at home—homework assignments, permission slips returned, etc.—write down on the board; don’t just tell them orally. (If it’s not written down, there is almost no chance he’ll follow the directions.)

When you give directions make them as short and as to the point as possible. (Not: “Now I want you all to settle down and sit down in your chairs. When you have done that, pull out your reader and we will start chapter 5 which is on page 56.” This makes the simple direction “Please turn to page 56 in your readers” a multi-step problem a child with auditory processing deficits would not be able to comprehend.)

These are the usual basics. You can be more elaborate. For example, I’ve heard of teachers giving the child a card that is red on one side and green on the other that he puts on his desk, green side up. When he doesn’t get what you have been saying, he flips it to red as a signal to you to back up and restate what you’ve just said.

Other good things that may or may not be difficult to work into the school day—listening to books on tape to develop his listening skills, with or without reading along in the book.

Many people like The Listening Program (have not used this myself), followed by Fast forward (my experience—the single greatest thing you can for a kid with auditory processing, though expensive.) Earobics is a much cheaper computer program that also can help with auditory processing.

There are different types of auditory processing disorders so you might try to get more information. Most kids benefit from preferential seating. Some need directions repeated, others do better with rewording the same thing. Some kids have a hard time taking notes (listening and writing) and/or copying off the board. Some have a hard time following class discussion. Some kids benefit from seeing and hearing at the same time, others do better doing one thing at a time.

Haven’t I been a lot of help? Mom probably knows her child and I would ask her for a conference early on.

Beth

I am an Audiologist who is just completing my doctorate with an emphasis in the area of APD who diagnoses APD on a regular basis, and I must say that there is a lot of misunderstanding about what APD is and what it is not. I am often skeptical of many APD labels that I or one of my co-workers don’t give. (Sadly I’m not kidding.) Much research on APD has been going on for many years, but many diagnostic centers do not perform evaluations with current tests with valid and reliable norms that have been shown to be evidenced based. They also do not test in a team setting and take cognitive ability and the complications of ADHD into account. The Bruton Conference asserted that “a systematic body of evidence designed to differentially diagnose APD must be employed” essentially to weed out what is and what is not APD. This is often not done.

Also, the designations of APD (breaking it apart into smaller pieces as was referred to in an earlier post) has NOT been accepted by the American Speech Hearing Association (ASHA) and have not been shown through research to be valid and reliable. I’m not saying that there are not different types, but what they are and ruling out certain strategies to help a certain child based on putting them within a certain subgroup has not been substantiated.

One thing I can assert with certainty is that acoustics in classrooms where students are educated are universally poor. If a child cannot hear what is said (and believe me, they all think they can hear so asking them whether or not they can is totally useless) they cannot build upon that insufficient knowledge. My number 1 recommendation for all children who have APD is that soundfield amplification is employed in their classroom. Have the teacher wear a microphone and have her voice amplified to ensure the student can hear. This accomodation helps EVERY child in the class for the same expenditure as a single auditory trainer. I promise I do not work for the company, but the Lightspeed panel speaker with infrared ($1000.00 for the speaker, a teacher mic, and a pass around mic) is the most durable system with the best sound and the best industry warranty (5 years), and is also the easiest to install.

Also, an auditory training program, actively teaching a child to listen, is very important. Look to the research (unbiased with a control group for the study) to find what would be effective to use. Many of the most popular (and most expensive) have NOT been proven by research to help the children who most need help.

Good luck and INSIST ON GOOD ACOUSTICS!

Educational Audiologist

Educational audiologist,

I really hope you will visit this board regularly, as I think your points are excellent and your expertise is needed here. I am a special ed. teacher (hearing impaired and LD) and have a special interest in APD as my child has it in addition to some of my students. We went out of state for APD testing as I knew it was critical to go to an APD specialist as opposed to a regular audiologist.

If you are not already a member of the APD list I am about to give, we could really use another audiologist on there. The origiator of the list is an APD specialist, but he rarely keeps up with the messages. There is one other audiologist who posts occasionally. People get very carried away with some of the unproven therapies on there. They also do not understand that other disabilites will effect the APD testing. There are several parents on there whose children have sensory integration or ADHD issues, for example. Here’s the address of the “CAPD” list:

http://maelstrom.stjohns.edu/CGI/wa.exe?SUBED1=capd&A=1

I completely agree with you on soundfield systems, too. I see some parents insisting on personal FM systems, but I know from experience that kids eventually hate looking different and will not want to wear them.

One more area of agreement, my child does not fit the sub-types of the FL model, so I have doubts about it working for many kids. Auditory memory seems to be her weakest area. I would be very interested to know if you think there is really specific therapy which will help that.

Janis

My son has CAPD. I have Teri James book “When the brain can’t hear” in front of me. She is a well known audiologist specializing in CAPD. I don’t think what she says is gospel but my son fits the integration deficit she discusses rather well. And he fits what she says about what does and does not work with an integration deficit. For example, she discussing that soundfield systems do not always help children with integration deficits because louder does not necessarily help them. We did a six week trial of a classroom system two years ago and it didn’t help him—in fact, he found it annoying. She discussing that most kids benefit by augmentating by multimodality cues. Kids with integration deficits often become overwhelmed and do better with information is presented sequentially. This is my son.

She also says that visual motor and visual auditory integration deficits are often present. This is my son.

My son has bits and pieces of other profiles so I don’t think the divisions are necessarily as clean cut as she presents. But kids with auditory processing deficits are not all alike either.

Beth

Beth,

I agree with you…these kids are all different and that is why most do not fit neatly in one sub-type. Anna has a couple of characteristics of multiple sub-types, too. She has absolutely no visual motor issues at all, yet Dr. J refers to her as having auditory integration problems, too. So even within the field of APD specialists, there is lot of variation in opinions.

Janis

My point again about the subtypes of APD (and it is now APD, not CAPD) is that they have not been proven by normed and referenced research to be valid and reliable in their divisions. I certainly agree that no child is exactly like any other child. That is true whether a child is LD, APD, ADHD, MR, etc.

Just like all pregnant women may have 10 out of 100 possible symptoms of pregnancy, they are all pregnant. One may need to soak their feet, one may need a back massage, one may need pickles and ice cream at midnight, but no matter what tests you administer when the pregnancy is determined, you cannot reliably predict which symptoms they will exhibit, at least not at this time. The same exact thing is true about APD. No divisions of subtypes have reliably and validly predicted for any child concerning which strategies may or may not work. You must try each and see which works or does not work for your child.

There are many learned Audiologists out there with vast experience who believe subprofiles are possible. I agree that they are possible, but they are not definitive at this time and can make effective strategizing more difficult in that a potential helpful strategy may be ignored due to the child not fitting into that category.

I hope there is a definitive blood test some day that says this is or is not APD, here are the strategies that would perfectly accomodate this child, and here are the perfect parenting strategies to make this child go to college, stay away from the wrong crowd, and become a compassionate and responsible adult. Please let me know when you become aware of this as I will have my own child tested.

I will try to tune in to the APD listserve and keep my opinions (which I try to keep close to the current research) out there. Thanks for the encouragement.

Educational Audiologist

Yes, but Educational Audiologist, a LOT of special ed disabilities are not diagnosable by blood tests, probably never will be. Think about autism, these are probably different things with similar symptoms or characteristics; ADHD/ADD some people still claim they aren’t real but I have known parents that had kids, these were NOT six hour ADHD kids— didn’t sleep, couldn’t control themselves, etc. Then there is dyslexia.
etc. etc.

I think there are just some of these types of dxes that will never be perfectly dxed because you can never find a blood test or something to pin them down. That doesn’t mean that the child’s problems aren’t a big deal or anything.

I was diagnosed by the neighborhood kids 45 years ago as being a wierdo. Now there is a useful dx. No blood test for that either. Turns out I have some nonverbal learning disabilities probably aspergers. This is a lot more useful from my point of view, as I can find others who have the same problem; find info about it; etc etc. Might have been useful to me in school to find programs and people knowledgable about it. And useful to my parents for finding programs for me and understanding me better.
I was given other diagnoses but they were not useful in doing what the dx of nonverbal ld/ Aspergers is.

So I think this is the point of CAPD. Is it ever going to be in the blood? Maybe not. But it defines certain things and helps in that way. BTW, for every audiologist that disagrees with CAPD, you’ll find a book written by someone who does.

—des

Educational psychologist:
Categories or classifications are useful only to the extent that someone fits them well. For those people, classifications can provide insight into deficits and appropriate remediations. Other children/adults have bits and pieces of different deficits. The path is not as clear for those children/adults.
I don’t think the fact that everyone doesn’t clearly fit a diagnostic category means there isn’t legitimacy to those categories, although the study of auditory processing clearly is a field without consensus. Some people, like Mel Levine, don’t even believe auditory processing is a distinct deficit.

I am well aware that CAPD is now referring to as APD. It was CAPD when my son was diagnosed three years ago and I am not quick to change!!!

Beth

I’ve been reading this discussion with interest because it demonstrates how research often lags behind methods of diagnosis and treatment. People seem upset about what Educational Audiologist has to say, but I think she is providing important information. She doesn’t seem to be saying that categories of APD don’t exist (or, for that matter that she would only be satisfied if there were a blood test to make the diagnosis). She is merely pointing out that so far there is no research-based consensus on what those categories might be. That is crucial information for parents, who may have heard varying opinions about potential categories and what to do to help these kids.

The truth is that there is a lot we don’t know about how to diagnose and how to treat LD and parents sometimes must choose what to do based on limited information. In those circumstances, we all do the best we can, but we can make better choices if we know when we are on solid ground and when we are making an educated guess. Sometimes we have to act on less than perfect information, but it is important to know when we are doing so. The risk of accepting at face value an opinion about a particular diagnosis or treatment that is not backed by research is that other avenues might not be pursued, to the detriment of the child.

Of course, even well-established, research-supported diagnoses and treatments were once experimental, and sometimes you just have to make a leap of faith. But, knowing that you are making that leap means that if the child does not seem to be progressing, you can move on to something else. Remember, knowledge is power.

Andrea

I’m not upset with him/her. But I think that research isn’t everything. What is sometimes more important when trying to describe a kid and help him/her is having a useful “tag” to hang. I know at one time (and maybe now still) some people do not like labels. But I feel from my own experience that they can be useful.

I am perfectly content with the idea that CAPD or APD or whatever is some artificial construct to help someone understand what’s going on with their kid better. After all learning disabiilties doesn’t tell you what about anything. But if you have a kid that can’t seem to understand you, despite normal hearing— can’t seem to recall auditorially, etc. etc. and does not appear autistic…. Well seems as good as anything for the moment.

If/when eventually someone wants to do some research, well that’s fine. But I still believe that there isn’t going to be a blood test, at least not for some amazingly long length of time. There might be brain differences, etc. but that’s going to be a bit hard to pin down too.

And I also think that Educational Audiologist is going to be disagreed with by some other audiologists, who are going to believe that it is a real thing etc and that there is research to back it up. It reminds me of court battles where there are experts on both sides and there are battles of the experts.

—des

“She is merely pointing out that so far there is no research-based consensus on what those categories might be. That is crucial information for parents, who may have heard varying opinions about potential categories and what to do to help these kids.”

Excellent post, Andrea. I think you understood the point of the audiologist. There is a lot of doubt about APD in the schools due to the fact there are so many different sub-type models out there. I do not use a sub-type when describing my child. I say that she has APD which effects her ability to do this and that. It is very concrete information which is more meaningful to the school than a sub-type name. If a child fits a sub-type very well as Beth’s son does, then I think it’s fine to use the name and say that some audiologists use the term XXX-sub-type for these symptoms. But parents and schools need to understand that these sub-types are basically theories and all children with APD do not fit neatly into one category. As a matter of fact, they can have very, very different issues.

Janis

I think the idea that anything not proven on a blood test is not proven would certainly throw all of modern medicine on it’s ear.

My son had his appendix out and we still to this day don’t know for sure if he had an appendicitis. There is no blood test you see. I am still glad it is out and don’t really care if it is ever proven one way or the other what his severe abdominal pain was caused by. Even looking at the actual extracted appendix could not yield a definitive diagnosis.

That being said it is only useful to determine specific deficits and treat or accomodate said deficit. You can call it gigglypoop if you want but these children have real problems and there are real solutions that address specific issues.

You can change neural pathways if you address the deficit areas. That HAS been proven in neuroscience.

[quote=”Linda F.”

That being said it is only useful to determine specific deficits and treat or accomodate said deficit. You can call it gigglypoop if you want but these children have real problems and there are real solutions that address specific issues.[/quote]

Excellent point, Linda. I couldn’t agree more.

Andrea

Re page 1 post on this topic, which “learning to listen” programs do you feel have been properly researched?

Great question, Amy! I’d really like to know the answer to that myself!

Janis

I appreciate the clinical side, but I still need concrete ideas to use in my classroom.

Sorry, I guess we veered away from the original question!

Here are some tips for the classroom from Teri Bellis, a prominent APD specialist:

http://www.ldonline.org/ld_indepth/process_deficit/apd_management_school.html

Janis

I really think there are some great ideas in that article. Thank you for your help Janis!

Well, what an interest group of posts! Thanks to the audiologist for given us the research.

As, I believe it was Anita and Linda F, said, the most important part is finding out your child’s unique makeup and trying to prioritize the remediation. We started out with Jami can’t read. Now that she’s 10, I find out that she probably needed a speech and language eval and language therapy. BUT, compared to her reading, her language was GREAT so we missed that gap and at almost 11, I can’t see sending her to speech therapy.

My daughter has EVERYTHING, SID, APD, VPD, ADD, expressive and receptive language disorder, fine and gross motor skill problems - you name it. All l usually say is that she has a Learning Disability/Difference - depending on who I’m speaking with. I often use the word “dyslexia”, which oftentimes incorporates some of the above delays/disorders.

I explain to the teacher where the problem lies, what she can and cannot do, and then accept accommodations. NOT huge ones, but ones that keep her self esteem afloat and allow her to show her knowledge.

She’s never seen an audiologist. Probably won’t at this point. She follows directions well, but can’t remember a nursery rhyme or song to save her life. She makes good grades, she compensates for many things, and knows her limitations. It’s the best I can do.

I find the research very interesting, but b/c each child’s makeup is so unique, it’s hard - at least for us - to pinpoint.

Geez, a blood test would be nice, wouldn’t it?!

Thanks to all who acknowledged or recognized that the blood test comment was simply a wish that, of course, will never be fulfilled. My point about having a blood test to make perfect diagnoses was an analogy to underscore that many labels and therapies are educated guesses at this point, and to say that no one solution works for every child. Each child may need to be accomodated differently. Only by trying all possible strategies and not limiting ourselves to a preprescribed unresearched list to say what will or will not work, will we find what best works for each child.

As to research, it is critical that controlled, properly conducted experiments be conducted to find what is and what is not effective, what is and what is not a guess, but what is a method that works. Try anything with any individual child, but do not limit that child to an accomodation if research has not proven that a limit should be imposed. No, research is not everything, but much time and effort is wasted if unproven therapies are relied upon as the magic pill to fix our children. There is a lot of conjecture out there and rumor about very expensive programs being cure alls for students.

Who has conducted research? What methods were used? What useless strategies did it rule out? Ask these questions when looking to auditory training programs or other types of programs to help our children learn to listen, learn, read, etc. Look for the phrase “evidence based”. Talk to therapists who have used programs with DIVERSE children who have different cognitive abilities and language abilities and attention abilities to determine their effectiveness. If only the company who produced and will profit from the use of their program says its great, its probably not.

Ed Audiologist, I’m interested in some programs you feel have been shown to be effective - obviously not for every child at every point in their process to overcome difficulties. For example, I know of a major school district which no longer will approve FastForward because it was deemed insufficiently effective - the criteria of effectiveness I do not know. Very likely an inappropriate measure like reading, which it supposedly doesn’t profess to impact directly. In any case, what’s your experience with auditory processing programs?

They used fast forward in my district after an angry mob of parents forced the issue because their children were not learning to read.

They used it sporadically through untrained teachers and declared it a flop.

This is a district that clings to whole language and reading recovery.

The bottom line is that very few programs if any have been thoroughly studied by scientists outside the company. Many programs were developed to take advantage of existing advancements in the field of neuroscience. Any program designed to change the brain must be used consistantly and intensively. That has been proven.

You really have to understand each child’s [b]specific[/b] underlying deficits beyond the broad labels and use a program that seems to work that area of the brain.

It happens in the world of medicine just like this without blood tests.

Maybe you picked up that I was trying to shy away from mentioning specific programs, but I must say that the I am in agreement that Fast Forward is not the direction to go. Again, look at the research. The company that produced the product is the one who has put out there that it is effective on a widespread basis. Independent research has shown that it tends to help exactly the kids who don’t really need the help, those with higher IQs, no interfering attention difficulties, a good basis in language before they begin, etc. Those with lower IQ’s, severe learning disabilities, ADHD, etc., show little or no effect. Also, much research has been conducted about children working one on one with a human vs. a computer and, of course, human contact wins out every time. Also, the expense is ridiculous.

The teachers (and remember, I am not a teacher, at least not of students) who work with the hearing impaired / deaf students and APD students in my area are happy with Earrobics. The expense is reasonable, the program integrates computer, worksheet, and human interaction oriented work and students seem to make good listening skills progress.

I am a big believer in teaching kids to listen holistically. What areas of listening can be interested and taught? Localization (finding sounds in space), temporal processes (the timing of sounds, by speeding up their presentation), critical listening (telling what type of sound is being made, i.e., a baby’s cry vs. a car horn), auditory discrimination in the presence of others talking, and auditory discrimination in the presence of mechanical background noise. This can be done with CD’s with many sounds on them and addresses what children hear in the classroom every day.

The point about needing to work on listening skills consistently and over long periods of time is an absolute truth. If listening skill development would be part of every classroom for 15 minutes / day, every day, from K through 6, I believe (and will hopefully prove some day with good research) that huge differences in the way children are able to make sense of their auditory environments would be realized.

Oh yeah, plus soundfield amplification so they can hear in the first place, of course!

Educational Audiologist

To momster3333…. I am a mother of a child with APD. She was diagnosed almost 5 years ago…. and every year is a struggle getting the teacher to understand how to help my daughter help herself. I would suggest meeting with the mother to find out exactly what areas he is having the most difficulties in. And things that she has found that work to help him.

It is nice to see a teacher trying to understand the problem instead of just ignoring it, or pretending it doesnt exist. My dd’s second grade teacher would not listen to me telling him why my dd was struggling so much, and would not do anything to help her. Finally after about the first half of the year, I made him sit down with myself, the spec ed teacher, the speech teacher, and the principal to get him to understand she does have a problem, and APD IS a real thing.

You have been given some great ideas. Some things that worked with my dd is having her sitting basically in front of the classroom, not near her closest friend. She was not by any windows to distract her. When speaking to the entire class, every now and then say this childs name to make sure he is looking at you as well as listening to you. Whne assigning homework, have him(or all the kids) write down what they are suppose to be doing, and then walk around the room to make sure everyone has gotten it and understands. During quiet work time, walk around the room, and stop by his desk to make sure he understood what he was to do.

It is my responsibility to educate every child who comes into my classroom regardless of where they are academically, socially, or emotionally. I have a hard time understanding how someone would just ignore a child’s problem. I’m sorry that you had to go through that, but I wish you the best of luck this coming year.
Thank you for the great advice!

My lil boss,

Some of the things that you are pointing out about your daughter are what kids with ADD also do. I know about APD and ADD because my daughter and I have both of them. What I am saying is if your daughter continues to struggle even with accomodations in the classroom one might consider testing her audtitory vigilance and TOVA visual vigilance and if she bombs those she may also have ADD.

Hi all on this thread

I am chairman of the UK voluntaty organisation which has been set up to sek recognition of APD in the UK, APDUK. We have been following the information regarding APD from various countries especailly the USA. Unfortunately there seem to be too may professionals only willing to promote there own models of APD rather than agree on the common ground, and then carry on with there own research issues. (I understand that the series of Bruton conferences may resolve these issues eventually) Which did not help us here in the Uk in our attempts top pursuade Uk professionals to take APD seriously, and therefore get the help our children need.

APD is now recognised in the UK and APDUK is working with a group of UK professionals to find a single definaition of APD for the UK. An APD study group has been set up , and they are holding their first APD Workshop for professionals in October 2003, this forum is being c sponsored by 2 London univeristies and a London hospital and input is being invited from around the UK.

As part of APDUKs attermpts opt provide some practical help for existing sufferers we created a few handouts which were made availble onour web site in the APD information setection, and one had the tilte which is mentioned above regarding IEPS fro APDs, this was created to help the teachers of our children understand their disabilityand provide some pointer as how help could be provided. the main APDUK web site address is http://www.apduk.org and there is also our UK professional web page at http://www.apduk.org.uk

>>I am a big believer in teaching kids to listen holistically. What areas of listening can be interested and taught? Localization (finding sounds in space), temporal processes (the timing of sounds, by speeding up their presentation), critical listening (telling what type of sound is being made, i.e., a baby’s cry vs. a car horn), auditory discrimination in the presence of others talking, and auditory discrimination in the presence of mechanical background noise. This can be done with CD’s with many sounds on them and addresses what children hear in the classroom every day. <<

I am very interested in these CD’s and the research showing their effectiveness. Where can I find out more about them?

Nancy

Many of those skills are included in the Earobics cd’s.

Janis

I always recommend getting hold of a book called Educational Care by Mel Levine. It’s filled with good strategies to help students with learning differences and the book is organized by the different learning issues.

I’d certainly agree with other posters who suggest having the student sit near to where you are as you teach and while patience is always a virtue, it’s doubly virtuous when working with students whose learning differences can make it harder for them to ‘go with the flow’. My students with auditory processing issues are often unable to process when instruction has begun and they continue to chat with their friends. They need some visual clues along with your patience. They benefit from handouts and drawings. Write/draw things on the board.

If you want to simulate what it might be like to have an auditory processing issue, stuff your ears up with cotton and put the radio on loud, have someone mow the lawn with the windows open, and then have someone try to teach you something you don’t know while yours ears are stuffed, the lawn mower roars, and the radio distracts.

Good luck.

What about CAPD and college? I was diagnosed with CAPD 3 years ago, at the age of 15 (also dyslexic, elementry school). I’m currently 18 and facing my senior year of high school, and just began the college search just as thousands of others students my age. It’s always been a struggle and I’ve have developed my own routine to make up for the discrepency as much as possible. However, I have had the benefit of small classes of a private schols (max 15 kids, for the past six years) and teachers who are very aware and helpful, all I need to do is ask. I remember my time in public school with 25+ students in a class and practacially failing out. My concern now is how to make the adjustment to college, were I won’t always have the luxury of small closure, and execptionally caring teachers and numerous times go out of their way to assist you. Of course my biggest fear is large lecture halls, though at this point trying to advoid all large universities as possible. What else can I do besides prefered seating, notetakers (very visual still need to take my own notes two, because the processing of writing them, helps me retain the information.) and tape recorders is there? I’m too old for Earobics, plus I can’t ask all my teachers to were headphones. I’d rather were a hearing aid myself, but don’t know if it can be done for a CAPD case. Also, special hearing aids are supposed to becoming better at filtering out backround noise. Does any of this makes sense or possible from a medical or more specifically too an audiologist view? Because anything on this board and that I found thus found on other websites in in regards to helping children only. My question essentially what else can be done to aid college age and older, especially in a large setting like a lecture hall?