Sunday, April 15, 2012

Listening (Auditory Processing Issues)

It sounds easy enough doesn't it. Listening. For some time we have been frustrated about how hard it has been for Josiah with his speech. He has been able to have speech therapy since he was a baby yet even now he has a speech delay, expressive and receptive to the point it is severely disordered. Because Josiah has struggled with his hearing for most of his life, he has had glue ear and seen an ENT Specialist from 18 months old.

For some time we have been noticing that it is more and more difficult for Josiah to understand what we are saying, he is struggling with understanding instructions we have to repeat what we say over and over again. Even though we know he is trying to understand us, he really struggles even though we do our best to help him to understand what we says.

After consulting with WAIDE (WA Institute for Deaf Education) who we helpful in answering my questions, I had always been sure that he had bad hearing as his first normal hearing test was only recently. Having two children with hearing issues I had gotten mixed up with whose hearing was worse.

The path of diagnosis always seems rocky. So we spoke to the audiologist and asked for a repeat hearing test. Now to our delight or dismay his hearing is completely normal which was quite a shock. The answer which seemed easier was not for us. What frustrates me is when I have questions about my children I don't often get suggestions as to why things are happening, what they could be.

So after speaking to my son's psychologist suggested as we have in the past wondering about CAPD or APD Auditory Processing Disorder. What has confused me in the past is that he doesn't fit all of the criteria but quite a lot of it. Because our son has had problems with his speech we have naturally included visual cues for instructions. When Josiah started to read we stumbled upon some interesting things. For some time we had attempted to teach him one phrase it took six months for him to learn one sentence. At school he started learning sight words for something different we used these sight words to create sentences and he understand what we were talking about instantly and understood it completely, 10 minutes compared to 6 months is a dramatic difference.

Since he has started Year One with the different teaching style and relying on instructions and the children being able to understand and complete what is asked for us. Our son is willing and able but really struggles with instructions, in his report as expected when it said following instructions they ticked not developed. Common complaints in our house, I can't hear you, what, he's distracting me, stop talking etc..

What is Auditory Processing Disorder

On the Australian Auditory Processing Disorder website it lists these as indicators of APD

"Children with APD will display some or all of the following signs:
  • Delayed language development
  • Inability to listen effectively
  • Trouble in sequencing the sounds of words
  • Difficulty perceiving high frequency sounds: 't', 'f' 's', 'k', 'p', 'th', 'sh'
  • Confusion when faced with similar sounds: eg. 'da' and 'ba'
  • Extremely poor comprehension in a noisy environment
  • High distractibility, with short attention span
  • Poor speech comprehension, often asking 'What?'
  • Misunderstanding and poor memory for oral messages
  • Inconsistent responses to the same auditory stimuli
  • Inability to follow directions
  • Difficulty in expressing desires, often blaming the other person for not understanding
  • Academic problems, particularly in spelling, reading or comprehension
  • Behaviour problems
  • Social difficulties."
Reading this we can tick most of these boxes except the reading, spelling or comprehension. So at this point I am still processing what this actually means, do I want this to be a part of my son's life, is it what he has. Fortunately we have a paedatrician's appointment soon which may be able to give us some answers.

What I found most helpful was the sub types of Auditory Processing Disorder

"Children may experience:
  • Associative deficit - difficulty associating sounds with written language
  • Auditory decoding deficit - problems recognising sounds and therefore decoding words or messages
  • Auditory integration deficit - trouble combining auditory cues with other sensory cues that contribute to a message (eg. seeing a written word and knowing what it would sound like when spoken)
  • Organisational deficit - difficulty in organising auditory information to effectively decode the meaning of a given message, often as a result of one of the above three problems
  • Prosodic deficit - speaking in a monotone, without rhythm or intonation, and not perceiving these subtleties in other speakers
  • Auditory hypersensitivity - background sounds cannot be ignored"

The path of diagnosis

The difficulty in getting a diagnosis of APD is that apparently the brain does not mature enough until it is 7 to be able to successfully diagnose Auditory Processing Issues. Some of the tests to diagnose APD are:

From what I have read the first step of this process is a routine hearing test to rule out hearing impairment. write a good article on CAPD and it's diagnosis

"The auditory test we use to assess auditory function fall into two major categories: Behavioural tests and Electrophysiological tests." Electrophysiological tests measure "the brain's response to sounds, a special cap with built in sensors is placed on the head of the child for the purpose of measuring the electrical activity that arise from the central nervous system in response to an auditory stimulus."

The other methods of testing is behavioural, of most benefit would be the screening test SCAN this test is used "to identify children who have auditory processing disorders and who may benefit from intervention." There are two tests that can be performed from for the age group 5-11 and another for individuals from 11 to adulthood. Other audiological tests that follow are monaural Low-Redundancy Speech Test and Dichotic Speech Tests.

What to do next

As I wrote before the path of diagnosis is rocky. We began investigating the possibility of auditory processing issues more than a year ago. I enquired about what to do next however because our son is too young, he can't be tested to see if he has it. This is problematic because in the meantime we don't have the specialised help to understand what to do, he can't get help from funding for this at school and we are left waiting up to 2 years wondering if he has it at all. The only thing we can do, is what we have done before which is Josiah participating in a listening program which is an 1/2 music twice a day, which did make a difference unfortunately we are waiting for him to be able to participate in it again as they don't have enough resources at this point.


  1. All good suggestions. The key is a differential diagnosis. Each child with APD will have a different set of strengths and weaknesses. Finding your child's specific weaknesses and setting up targeted interventions in these areas is key for progress.

  2. I just was browsing...I have a 3 year old daughter. She is a selective mute. I thank you for blogging.

    1. No problems Randy I think it helps me process things... I have a Selective Mutism only blog as well check in there if you like.