Auditory processing difficulty

What is auditory processing?

Auditory processing is the ability to break down speech (strings of sound) up into words, groups of sounds and individual phonemes. The problem is not with hearing, but with making sense of what you are hearing.

What is it like to have an auditory processing difficulty?

Imagine if you found yourself in England at the time of Shakespeare. The language is English, but in a strange accented style with different constructions and meanings. You may recognise enough of the words to get the gist of what people are talking about, but much of the meaning is lost.

Diagnosis of auditory processing disorder

At Sheffield Children’s Hospital, the audiology department do not provide a diagnosis of auditory processing disorder (APD), as this can often not be separated out from other issues, such as certain learning and language difficulties. This policy is in line with the British Society of Audiology position statement on APD.

The audiology department have a listening difficulties clinic where they can do an audiological assessment. Results of the tests will then be discussed with the patient and family and a full report summarising test results and recommendations will be sent out by audiology.

Some families wish to attend to receive a diagnosis of auditory processing disorder, but this is not something that can be conclusively diagnosed at the moment. It is recommended that other cognitive, learning and language difficulties are ruled out before considering auditory processing.

Families often find having the test results and advice useful.

What difficulties do children with auditory processing problems have?

Auditory figure-ground problems

Auditory figure-ground problems are the difficulty distinguishing between foreground and background noise. This makes listening to the teacher in a noisy classroom environment very difficult for many children.

Auditory memory problems

Auditory memory problems can make it hard to remember information presented orally, such as lists and directions. It can exist as:

• immediate basis (“I can’t remember it now”)
• delayed basis (“I can’t remember it when I need it later”)

Auditory discrimination problems

Auditory discrimination problems affect their ability to hear the difference between sounds or words that are similar, such as “coat” and “boat”, or “sh” “ch” sounds. This will influence your child’s ability to follow directions, read and spell.

Auditory attention problems

Auditory attention problems affect their ability to maintain focus on an auditory stimulus, such as listening, long enough to complete a task.

Auditory cohesion problems

Auditory cohesion problems are the difficulty with higher-level listening tasks such as making inferences from conversations, interpreting abstract information, and understanding riddles.

Auditory sequential memory

Auditory sequential memory can make it hard to retain information in sequence. This may be at a sound, word or sentence level. This will influence your child’s ability to:

• follow instructions in order
• identify the order of sounds in words they are trying to spell
• retain and make sense of the order of sounds in words they are trying to read
• remember sequences of numbers such as phone numbers

Implications of auditory processing difficulties

The following features may be seen in children with auditory processing difficulties:

• difficulty localising sound sources
• short attention span
• poor listening skills
• requests for frequent repetitions
• may attend well but still fail to follow long or complex instructions
• takes a long time to answer questions
• inconsistent response to speech
• sometimes responding appropriately at other times failing to follow commands
• easily distracted by visual and auditory stimuli
• difficulty in perceiving the relevant sound such as speech in a background of noise
• problems following directions and instructions
• difficulty in retaining auditory sequences in short and long term memory. This may effect sounds in words, counting, learning the alphabet, days of the week, months of the year and so on
• difficulty identifying stress patterns in speech, which influence meaning
• difficulty identifying speech sounds within syllables, words, phrases
• problems linking words with their written form
• speech and language difficulties
• behaviour problems such as aggression or withdrawal

What causes auditory processing difficulties?

Nobody knows. There is no evidence of brain damage. Birth and developmental histories are often unremarkable. Ear infections may be a factor for some children. Many children present with speech or language difficulties as a result, and for most children, despite normal intelligence, they are working below their ability at school and having difficulty at home.

How can we help children with auditory processing difficulties?

General strategies

• Where possible try to create the best listening environment by reducing background noise. Even mild noises as the hum of a fan can be distracting.
• In school, ask for your child to be seared in the front of the class so they easily see any visual teaching aids being used. Ear plugs may help the child during quiet study periods, and slow down the rate of presentation and use simpler language.
• When introducing new ideas, or giving directions, make sure your child is looking at you. Encourage them to repeat back when you have asked them to do.
• Where possible, give them additional written or visual material such as outlining spoken instructions.
• Be brief. Long sequences of commands and information are difficult to follow.
• Allow more time for your child to process instructions and information.
• Help your child to become actively involved by encouraging them to notice when an environment is noisy, and, if possible, more to a quieter one.

Skill building areas

Children with auditory processing difficulties can be helped through development of their auditory discrimination skills and their sequential memory, by focusing on the following targets:

• developing a sense of rhythm
• developing an awareness of rhyme
• developing an awareness of syllables
• developing an awareness of sounds within words. Literacy work focuses very much on this area, but many older children may not have the foundation skills of rhythm and rhyme fully developed.