A little-known cause for language difficulties in childhood - unpacking auditory processing disorder

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"In class, a child with APD might have difficulty following instructions, maintaining attention and will probably rely on assistance and repetition more than their peers". (Getty Images)
"In class, a child with APD might have difficulty following instructions, maintaining attention and will probably rely on assistance and repetition more than their peers". (Getty Images)

For US mom Rachel Gurevich getting others to understand her son’s auditory processing disorder has proved challenging, especially in the classroom setting. 

She shared her story in 7 Things I Wish People Knew About Parenting a Child With Auditory Processing Disorder, going into detail about one particular teacher who complained that Gurevich’s son wasn’t paying attention or listening during class. 

"To her, this was an act of defiance. I explained that my son has auditory processing disorder (APD). He’s usually a very well-behaved boy, but the classroom was too chaotic and noisy for him. With all the background sound, my son simply couldn’t make out what she was saying to him, no matter how hard he tried," the mom recalled. 

Also read: My child struggles with day-to-day tasks like brushing his teeth. Do they have a sensory disorder? 

Our ability to process sound

According to Heidi Allan, Principal Audiologist and Speech-Language Therapist at Heidi Allan’s Practice in Durban, auditory processing is best understood as "how the ear talks to the brain and how well the brain listens". 

"It is the auditory part of information processing that happens before we start attaching meaning to sounds... It is not only limited to speech sounds but all sounds in our environment," Allan explains. 

Allan says our ability to process sound is made up of: 

  • The ability to know where a sound comes from
  • The ability to identify the difference between speech and non-speech sounds
  • The ability to recognise auditory patterns
  • The ability to identify tone changes
  • The ability to understand auditory information when sounds have been disturbed or distorted in some way 
  • The ability to recognise the presence of a competing signal such as background noise


Red flags 

    The audiologist says an auditory processing disorder occurs when one or more of the above areas are compromised. 

    "When there is a breakdown in... subtle difficulties understanding speech in a noisy environment, identifying differences between sounds, and knowing where sound is coming from to a complete inability to extract meaning from speech, identify environmental sounds, or appreciate music". 

    Other red flags Allan says that may point to auditory processing disorder include: 

    • Frequent requests for repetition – “huh” or “what” or “what do you mean”?
    • Appearing not to hear when hearing is shown to be normal
    • Difficulty following instructions
    • Mishearing words – e.g. thirteen as thirty
    • Difficulty or disinterest in learning songs and nursery rhymes
    • Difficulty with reading, phonics and maths story sums
    • A history of recurring ear infections  

    Allan says that auditory challenges can impact many other areas of a child’s life, from learning to communicate, write and spell to learning how to socialise. 

    The condition carries on into adulthood where, if untreated, may worsen, Allan advises. 

    Also see: 'Information is key': How to help your child who has a learning disability 

    Potential misdiagnosis 

    Local Speech Therapists Ivette Weyers and Annelize Claassens, who run Little Figures of Speech in Durbanville in the Western Cape, highlight that APD is not a form of hearing loss, even though it may seem to be the case. 

    "In class, a child with APD might have difficulty following instructions, maintaining attention and will probably rely on assistance and repetition more than their peers," the duo told us. 

    Allan agrees and advises that a child with APD will more than likely be able to pass a hearing test. 

    The audiologist says another potential misdiagnosis for APD is attention deficit disorder or poor memory ability. 

    "Auditory processing disorders often underlie difficulties in reading and spelling, comprehension, speech sound production and language development...  Because of these difficulties, we may see distractibility or poor concentration, poor task completion and difficulty following instructions," Allan says. 

    Formal assessment 

    Allan recommends getting a formal assessment if you suspect that your child may have auditory processing disorder. 

    "This is usually a comprehensive assessment conducted by an audiologist which assesses that part of the neural pathway that occurs from the ear to the brain, using professional-grade and sophisticated testing materials to challenge different parts of the auditory pathway. An auditory processing assessment is not usually part of a traditional hearing assessment," she explains. 

    Testing can be done from as young as three years of age, and the audiologist suggests seeking assistance as early as possible to prevent learning difficulties.  

    "The earlier one addresses these weaknesses, the greater the likelihood of preventing written and spoken language difficulties at a later stage". 

    Allan says that treatment is provided in the form of auditory training programmes which remedy auditory function and reading ability. Treatment can be provided by either an audiologist or speech therapist or, in some instances, both. 

    "In addition to direct auditory training with an audiologist and/or speech-language therapist, the audiologist will provide guidelines for environmental modifications," Allan says. 

    Here are some tips by Weyers and Claassens for parents and teachers to best accommodate a child who has APD: 

    • In the class, a child with APD should be seated away from windows and close to the board - limit background noise.
    • Use visual cues and give auditory input in more effective ways, e.g. shorter sentences.
    • Don’t try to have a detailed conversation when your child is in another room. Get their attention first.
    • Speak slowly and use simple, short sentences; pause between ideas.

    Find an audiologist near you at Reconnectnetwork.co.za

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