Understanding Auditory Processing Disorders

Learning another language provides a glimpse into the struggles our children with auditory processing difficulties experience with language processing. In preparation for my upcoming trip to Italy, I am using the Rosetta Stone computer program to learn Italian. The program presents four picture choices with an audio stimuli; my task is to click on the picture that matches the spoken sentence. It all begins simply enough: phrases or single words are presented with unambiguous pictures. For example, "bambino" gives me a choice of a baby, an adult and two objects (perhaps a car and a table). I've learned from constructing research tasks that these unrelated choices are called "fillers"-responses that the subject is unlikely to choose due to their easily identifiable differences.

As the program progresses, the audio stimuli becomes longer and more complex. The rate of presentation also becomes faster. In addition, the choices are not as visually apparent. I find myself hitting the "repeat" button frequently, straining my brain to make sense of the information. Often I hang on to snippets of information, but let go of the words that connect the message. I realize, for example, that they are giving directions to the train station, but not sure if I should go straight or turn at the corner. If only they would say it SLOWLY and SIMPLY! The pictures are providing contextual cue, but I'm not sure which picture to focus on. If the visual cues were more concrete, I know I would understand! After about fifteen minutes I am losing my concentration and my attention begins to wander. When a half hour elapses, my brain is fatigued and I must turn the program off.

And then it hits me: this is exactly what many of our students with auditory processing difficulties experience when processing language. They understand the individual words, but when the pace is increased, sentences become more complex, and the contextual cues do not support the language, comprehension suffers.

We've had many parents speak to us about auditory processing difficulties. Results of educational testing batteries often reveal deficits, and produce characterizations such as "working memory" or "attention". It is wonderful that schools are beginning to recognize the importance of auditory processing skills, but there is a problem when superficial information is passed along to concerned parents. The result is often panic and misdirection in therapeutic intervention.

Auditory processing refers to a broad area of skills that affect language and literacy skills. Further, auditory processing is closely related to higher level cognitive skills that are under the domain of "executive function" skills. Executive function skills include memory and attention. It is no wonder then, that children with attentional deficits are usually diagnosed with auditory processing deficits. But what does all this mean in terms of treatment? Here's where the complexity of the disorder leads many parents into a maze of confusion.

First, there is a difference between processing language and processing other stimuli such as visual stimuli or discrete sounds. For example, I am having difficulty processing the Italian language. When I hear a long sentence, I have difficulty holding onto information at the beginning of the sentence and integrating it with information presented at the end of the sentence (this is called verbal working memory). Does it make sense for me to engage in a computer program that presents a series of individual sounds? If my difficulty lies with verbal working memory, does it make sense to engage in a computer program that presents pictures to improve my visual working memory?

The other piece of this puzzle is that auditory processing skills are defined differently by different professions. The most glaring difference is between the educational arena (which includes speech-language pathologists and audiologists) and psychologists. Many psychologists deal with auditory processing as it relates to broad areas of working memory, including visual and temporal (speed of discrete sounds) processing. In response, this sector of the field has conducted a body of research that deals primarily with nonverbal processing of information. The danger is in the assumption that nonverbal skills are correlated to verbal skills (please realize that a correlation does not mean cause) and therefore correlated to academic skills. Simply put, there is no empirical evidence that this is the case.

It is well documented, however, that auditory processing as defined as language processing/verbal working memory supports academic skills (including reading, speaking, writing and comprehension). This makes intuitive sense. Children with auditory processing deficits must reshape their language processing systems as well as build their verbal working memory skills. Unfortunately, there is no quick solution. Effective auditory processing therapy must be consistent and sequential but based in language. Children must also learn to judge nonverbal cues that are contextually based to the auditory message, that is they must learn to read body language, gestures, facial expressions and select clues in the environment that help facilitate the message. Since they are not strong auditory learners, they must also learn to capitalize on their visual strengths and create effective compensatory strategies.

If your child has been diagnosed with an auditory processing deficit, make sure they are receiving the proper therapeutic intervention. This is usually through a reputable speech-language pathologist with experience in auditory processing deficits. Be cautious of computer-based programs and intervention methods. These are often very costly with no evidence of effectiveness.

Daria O'Brien, MS CCC-SLP is the director of Pompton Speech Plus in Pompton Plains, New Jersey, a center focusing on communication, auditory processing, and social skills groups for children with language-based learning difficulties. Visit http://www.pomptonspeechplus.com for more information about Ms. O'Brien and her practice.

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