Suspecting Auditory Processing Disorder in Young Children

Lately I have come across a number of people who are new to auditory processing disorder.  These are people who have very small children who exhibit signs that might be indicative of Auditory Processing Disorder (APD).  I remember when my daughter was young and we knew something was not working right for her, but we weren’t sure what to do about it.  It was a scary, stressful time.

When our daughter was two, we noticed that not only did she not speak, but she didn’t seem to understand anything we told her.  She has a twin brother and he was speaking in sentences, telling us stories, and in every way communicating well.  We wanted to believe that she was just a late bloomer, but when she started tantruming from frustration, screaming from noises we could barely hear, and staring glazedly into space – absolutely checking out from reality – we knew something was not right. (When looking back on it, we realized that she actually exhibited signs as early as a newborn, but we didn’t know at the time what we were looking at.)

I started keeping a diary of her life.  I wrote down what she did or didn’t do that seemed unusual to me.  It didn’t take long to see a pattern emerge.  She didn’t understand what people said.  She was afraid of noises and voices.  She not only spaced out regularly, she did other odd things like smell everything, put things in her mouth, keep food stored in her cheeks, walk with her arms out at right angles, stand with her head on the ground down between her legs, play with her tongue in her mouth, constantly wiggle her fingers, not make eye contact, and try to avoid all people other than her immediate family. 

So I started researching and found out about our state’s infant and early childhood program.  It is a program that provides services such as speech therapy, occupational therapy, etc. to infants and children below the age of three.  They sent an evaluator to our home and decided that our daughter qualified for their services, so we started speech therapy and occupational therapy.

From our occupational therapist, we learned about Sensory Processing Disorder and started a sensory diet for our daughter.  This included physical activities as well as special foods that seemed to calm her and help her to not space out so much.  With a strong sensory diet, she made better eye contact, didn’t tantrum or space out so much, did less odd behaviors, and in general was a much happier and accessible child.

Our speech therapist was working actively on trying to get our daughter to speak and to better understand the spoken language.  I felt there had to be a reason that she didn’t understand, so we went to an audiologist to get her hearing testing.  Her ability to hear sounds was completely normal; she had no hearing loss.  So I started to research and found a disorder called Auditory Processing Disorder.  Our daughter seemed to fit this description perfectly.

I contacted a leading specialist in APD and set up a consultation appointment.  What I found out was that she was too young to be officially tested, but he was more than willing to look over my diary of her and meet her for some informal evaluations.  It didn’t take long for him to believe that she most likely did indeed have APD and that although he could not formally give her such a diagnosis, he felt it was accurate to believe she did have it, and we should start working towards helping her as much as possible.  He gave us a lot of information as well as some techniques to use with her such as always making eye contact, speaking in clear short phrases rather than sentences, watching for signs of stress in her particularly in noisy environments, and to realize that she will most likely not be able to understand what is being said if multiple people are talking at the same time- such as in a restaurant or at a family gathering.

With this information, we informed our speech therapist and occupational therapist who immediately researched Auditory Processing Disorder and tried to incorporate their new knowledge into their therapy.  Our occupational therapist started our daughter on a listening therapy program and our speech therapist introduced us to the use of picture cards to assist with communication.  Both of these things proved to be extremely useful.

At age three, our daughter transitioned into the school district’s early childhood special education program.  She went three mornings a week where she had access to a special education teacher, speech therapist, occupational therapist, physical therapist, and direct instruction and experience in socialization.  Although it was stressful for her to go, she did show great improvement by going there – particularly in socializing.

So this was our start to living with Auditory Processing Disorder (and Sensory Processing Disorder).  If I could give any advice to parents of young children who are exhibiting signs that something just isn’t right, I would say start a diary.  Write down what your child is doing or not doing that seems distressing or odd.  In time, you will see patterns.  You can use these patterns to access the services and help you need.  If you live in the United States, contact your state’s infant and early child program if your child is under the age of three; your pediatrician or local school district should be able to give you the contact information.  If your child is aged three or older, contact your local school district.  These agencies have specialists that can help get you started on the path to helping your child.

Auditory Processing Disorder: "A Manifestation of Impaired Neurocognitive Processes" and "One Factor in the Overall Profile of Different Developmental Disorders"

After weeks of intense researching on Auditory Processing Disorder, I finally found an article that takes all that research and makes a cohesive analysis.  Yippee!  I love it.  It is titled "Communication Disorders: Auditory ProcessingDisorders."¹

Why The Intense Research:

So, let’s start from the beginning.  I wanted to research what the current thinking is on Auditory Processing Disorder because it seems to me that my daughter, as well as many of the other children I am learning about through my Auditory Processing Disorder (APD) groups, seems to have more than just auditory processing problems. Moreover, the label Auditory Processing Disorder is controversial and not recognized in the United States as a disability in and of itself.  My concern is that my daughter, and all other people with the diagnosis APD, will not get the accommodations she needs at places such as school (not related to us as we homeschool), college (possibly in the future), and work (when she's an adult).

My daughter has all the usual problems associated with APD: difficulty localizing sounds in space, discriminating sounds, recognizing auditory patterns, responding to the temporal aspects of sounds (integration, discrimination, ordering, and masking), and extracting auditory information in less than ideal auditory environments.  She also has the common attributes of APD of short term memory deficit and auditory recall problems – including word retrieval. 

Like many children with APD, she has also been given additional diagnoses that coincidentally are the same diagnoses given to many other children also diagnosed with APD:  Mixed Receptive-Expressive Language Disorder, Phonological Disorder, Attention Deficit Hyperactivity Disorder (ADHD) - only inattentive type, Sensory Processing Disorder, Visual Processing Disorder, Dyslexia, and the very broad term neurologically atypical.  She was also suspected of Autism when younger by two pediatricians and ruled not Autistic by a pediatric psychologist. 

Like a lot of children with special needs, she has had a variety of diagnoses and probably could have a variety more if we only brought her to the right specialist who would somehow find a way to make her fit the categories he or she is looking for.  Personally, I find all these labels just weird little note tags at this point that all say: She has a problem with her brain and it affects her academically and socially.  We notice it affects these particular areas and we don’t know what causes it or what to call it.  It seems similar enough to these diagnoses and not similar enough to these.

Moreover, when researching each of these specific diagnoses, it is readily apparent that there is a lot of overlap among them.  So how can one really differentiate where one begins and the other ends?  This has been a question that has plagued me for some time. 

How This Article Helps To Shed Light On the Confusion:

Now, on to this article which seems to make sense to me:  Karen Banai and Rachel Yifat, the authors of the article, “Communications Disorder: Auditory Processing Disorder,” have gathered the loads of research results from various testing being done on APD as well as similar disorders around the world, and written their interpretation.  To my understanding of their article, it seems that APD is most likely a “manifestation of impaired neurocognitive processes”² and it seems to mostly be related to impaired attention processing and impaired context processing.³   APD relates to ADHD in the impaired attention processing.⁴   APD relates to Dyslexia and other language disorders, such as Specific Language Impairment (SLI), in impaired context processing.⁵

Furthermore, it is believed a possibility that APD is “one factor contributing to the overall profile of symptoms in different developmental disorders.”⁶   This makes huge amounts of sense to me as it seems to me that many children with APD also have other issues, i.e. Sensory Processing Disorder, Visual Processing Disorder, Autism Spectrum Disorder, and those that seem to overlap with APD such as ADHD, SLI, and Dyslexia.

All of this research, in my opinion, suggests that it does not matter what diagnosis you give to a child and that perhaps the diagnoses themselves are flawed and limited in their criteria.  What matters is that you do what you can to provide the interventions and support each child needs to be as successful as possible at academics, as well as living life in general, including socializing.  As Banai and Yifat put it, “The reservations… concerning the necessity of the separate diagnosis of APD should not obscure the troubling fact that no matter what diagnosis they have received, the outcomes for many children with learning disabilities (estimated at 25% by Hatcher et al., 2006) even following gold standard interventions are not encouraging.” 

My Lesson Learned as a Parent:

The experts haven't figured it all out and really don't understand the brain and its processes well enough at this point to agree upon proper labels, categories, causes, etc.  So, stop worrying about the diagnoses and concentrate on helping my child academically, socially, and with life in general.  Look at her particular needs and address them on an individual basis.  When she gets ready to go to college, get a job, or do anything else that requires us getting special accommodations, well, let's hope the rules are less stringent than they are now, and they'll look at her as an individual and what she can/cannot do, rather than as a list of diagnoses.

Citations:

^{1Banai K, Yifat R. 2011. Communication Disorders: Auditory Processing Disorders. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/249/}

^{2”Another option is that what appears as APD is merely a manifestation of impaired neurocognitive processes such as auditory attention or memory which lead to difficulties in challenging listening conditions.”}

^{3”Taken together, it seems that auditory processing deficits are part of the clinical picture of several developmental disorders, including dyslexia and SLI, even though causal relationships are poorly understood. Theoretically, this clinical picture suggests several possibilities. One option is that poor auditory processing is one factor contributing to the overall profile of symptoms in different developmental disorders (Dawes and Bishop, 2009). Another option is that what appears as poor auditory processing actually reflects a problem in other cognitive processes such as attention or context processing.”}

^{4”Finally, the findings of one study suggest that children diagnosed with APD were distinguishable from children diagnosed with ADHD in terms of their verbal memory spans (Maerlender, 2007), but neither auditory attention data, nor information on other aspects of performance were provided. Therefore, the lower memory spans in the APD children could have been a part of a more general disorder involving both language and attention. Indeed, it has been shown that both ADHD and APD are associated with high incidences of inattentive and distracted behaviors (Chermak, 2007).”}

^{“However, a careful analysis of performance on the auditory tasks revealed that poor performance typically results from poor auditory attention, rather than from a specific deficit in the spectral or temporal analysis of sound (Ferguson, Riley, Ratib, Edmondson-Jones, and Moore, 2009).”}

^{5”Furthermore, there are few apparent differences between children diagnosed with APD and those diagnosed with dyslexia or language problems on measures of both auditory and language processing (Dawes et al., 2009; King, Lombardino, Crandell, and Leonard, 2003)”.}

^{“In particular, individuals with dyslexia perform poorly on tasks in which performance in the general population benefits from the consistent presentation of repeated anchor stimuli, consistent with the idea that individuals with dyslexia are not making as efficient use of the context of recently presented stimuli as does the general population (Ahissar, Lubin, Putter-Katz, and Banai, 2006).”}

^{6”Taken together, it seems that auditory processing deficits are part of the clinical picture of several developmental disorders, including dyslexia and SLI, even though causal relationships are poorly understood. Theoretically, this clinical picture suggests several possibilities. One option is that poor auditory processing is one factor contributing to the overall profile of symptoms in different developmental disorders (Dawes and Bishop, 2009). Another option is that what appears as poor auditory processing actually reflects a problem in other cognitive processes such as attention or context processing.”}