Central Auditory Processing Disorders

What is auditory processing and what is an auditory processing disorder?

"Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. The 'disorder' part of auditory processing disorder [APD] means that something is adversely affecting the processing or interpretation of the information."
National Institute on Deafness and Other Communication Disorders (NIDCD)

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, "Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The 'disorder' part of auditory processing disorder [APD] means that something is adversely affecting the processing or interpretation of the information."

The NIDCD corrects a common misconception, noting that APD is not a disorder of the ear or hearing per se, but that "...children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request 'Tell me how a chair and a couch are alike' may sound to a child with APD like 'Tell me how a couch and a chair are alike.' It can even be understood by the child as 'Tell me how a cow and a hair are alike.' These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information." Also according to the NIDCD, children with auditory processing difficulty typically have normal hearing and intelligence.

"APD goes by many other names," explains the NIDCD, adding, "Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called 'word deafness.'"

Common symptoms of an auditory processing disorder
Five primary subtypes of APD have been identified (Bellis, When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder, 2002), and each subtype presents its own challenges and specific symptoms. According to the NIDCD, children with auditory processing difficulty have been generally observed to:
    * Have trouble paying attention to and remembering information presented orally
    * Have problems carrying out multistep directions
    * Have poor listening skills
    * Need more time to process information
    * Have low academic performance
    * Have behavior problems
    * Have language difficulty (confuse syllable sequences, have problems developing vocabulary and understanding language)
    * Have difficulty with reading, comprehension, spelling, and vocabulary

How common is the crossover between dyslexia and APD thought to be?
Up to nearly three quarters of those with language impairment and/or reading disorder dyslexia are thought to also experience auditory processing deficits. A recent study (June 2009, Sharma, M, Purdy S, and Kelly, A) reported by the American Speech-Language-Hearing Association in their Journal of Speech, Language and Hearing Research (Vol.52 706-722) showed that "language impairment and reading disorder commonly co-occur with APD. Attention and memory are linked to performance on some auditory processing tasks but only explain a small amount of the variance in scores." This comorbidity (simultaneous presence of two conditions in one person) was previously explored in a 2003 study by the Department of Speech and Hearing Sciences, at Ohio State University, Columbus (King WM, Lombardino LJ, Crandell CC, Leonard CM). The study sought to "investigate the extent of comorbid auditory processing disorder (APD) in a group of adults with developmental dyslexia." Although the study universe was relatively small, at the time it yielded some intriguing results:

"Approximately half of the participants with developmental dyslexia showed clinically significant diminished performance on the FPT and DPT indicative of APD. These results indicate that the percentage of persons with developmental dyslexia and comorbid APD may be substantial enough to warrant serious clinical considerations."

Does the State of Minnesota recognize APD?
The State of Minnesota does not recognize APD as a Specific Language Disorder (SLD), and as a result, students cannot qualify for an IEP solely on the diagnosis of APD. However, APD is a related language disorder that can affect the child's ability to learn to read, connect socially, function fully in the classroom and communicate effectively. As a result, if a child has an additional qualifying SLD that affects any aspect of reading or language processing (expressive or receptive language disorder, encoding /spelling, decoding, fluency. comprehension, writing, et al), the IEP must accommodate for, and offer "educational management and intervention strategies related to, the specific APD deficits identified for that specific child." This is something that IEP teams often do not fully understand.

    MDE's Auditory Processing Information Paper and APD Flow Chart

The Minnesota Department of Education (MDE) offers a terrific resource to help both parents and IEP teams understand APDs and the process of incorporating accommodations, and instructional and educational management strategies into the IEP. The state's Auditory Processing Information Paper can be found by clicking on the images above. This 21-page document describes: the evaluation process for determining eligibility for special education when auditory processing disorders are present; the role of the audiologist and other team members in the evaluation process; and some educational management and intervention strategies for educators of children who exhibit behaviors and characteristics of APDs. Sharing a copy of the state's Auditory Processing Information Paper document, and its APDs Flow Chart found on page  10, will help your IEP team to better understand the process and their legal responsibilities.

The MDE's APD informational document also describes the five general subtypes/profiles of APD as defined by Teri James Bellis, Ph.D., noted researcher and author of When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder (ISBN 0-7434-2864-1).

Assessment versus screening: Knowing the difference is critical
It is important for parents and IEP teams to understand that in order for an APD to be diagnosed or ruled out, a full assessment (not a simple screening) must be done by a qualified audiologist. Minnesota has a limited number of such individuals, but each are well qualified. IDA-UMB maintains a list of current CAPD resources for the entire Upper Midwest. It can be found here.

APD Overview
by Sherry Landrud, Intermediate District 287 (MN)
Sherry Landrud, Deaf/Hard of Hearing program facilitator, reading coordinator and APD specialist for Intermediate District 287 (MN), recently presented an informative IDA-UMB speakers series discussion on the role of schools in educating children with Auditory Processing Disorder in December of 2009. Ms. Landrud covered what services Minnesota schools should be providing in all aspects of the educational process, including the school's role in evaluating APD, determining special education services, suggested IEP accommodations, as well as advocacy tips for both parents and students. She has graciously allowed us to post her presentation here.

The Educational Lens of Auditory Processing Disorder (APD)
IDA-UMB Speaker Series Event, December 3, 2009 (Pdf format)

In 2009, Landrud was selected as the Intermediate District 287 Minnesota Teacher of the Year nominee. An educator for 34 years, Ms. Landrud also provides in-service consultations to school teams in the area of Auditory Processing Disorders. She is the reading coordinator for Intermediate District 287's site-based programs, and teaches in the deaf education/educational psychology graduate program as an adjunct faculty instructor at the University of Minnesota.