I know you hear me, but do you understand?

A look at Auditory Processing Disorder (APD)

Midway between ages 3 and 4, my daughter began something new. As we watched evening TV and she played in the floor, she would suddenly look at the screen and laugh uproariously at a comment that had no ounce of comedy to it. When questioned, she would say the person was “being silly” then say the word she thought she’d heard. Her word always started with the same letter and had the same number of syllables as the character’s, but was a completely different word.

Friends and family told us that she was little and not to worry. Her pediatrician gave us the same advice.

For Valentine’s Day, between ages 4 and 5, she wanted to address Valentines for daycare. We started in the evening, and it would have been much faster to do it myself, but she was insistent. I’m so glad she was.

As I spelled out loud each child’s name, I noticed something peculiar. Each name that she’d seen before, she wrote perfectly on the envelope. Each name she hadn’t seen, she wrote exactly upside down and backward. Again, perfectly, if held to a mirror and rotated 180 degrees.

The next morning I made an appointment with a new pediatrician.

Something else I’d noticed between these puzzling incidents was her ability to understand instructions. She was always cooperative, but if told to brush her teeth, she would more likely brush her hair. And if given a couple of things to do, the first would always be done as asked, but remaining tasks would likely not. Her regular response was, “I didn’t hear you say that.”

When the pediatrician tested our daughter’s hearing, it was fine. However, he diagnosed her as exhibiting an auditory processing disorder (APD).

Signs of Auditory Processing Disorder

According to Casey Newman, AuD, clinical audiologist at the Tulsa County Health Department, signs that may help identify a child with an auditory processing disorder include:

• difficulty following multiple step instructions
• inconsistent responses to auditory information
• slow or delayed response to verbal stimuli
• frequently requests repetition of what is said
• easily distracted by auditory and visual stimuli
• difficulty listening in background noise
• memory deficits, both long and short term
• language deficits
• relies on visual cues when attempting to communicate
• difficulty localizing source of sounds
• academic difficulties, particularly with reading and spelling, despite normal intelligence

“A multidisciplinary approach is critical to fully assess and understand the problems exhibited by children with APD,” Newman said. “Usually an audiologist, speech pathologist, and a psychologist are among those that work together to formulate a treatment plan. Treatment is highly individualized. There is no one approach that is appropriate for all children with APD. Some considerations include: changing the learning environment, using compensating mechanisms to help in the learning process, and using electronic devices to assist in the learning environment.”

Because my daughter was not yet in kindergarten, the pediatrician suggested waiting for teacher input. Also, she was too young for definitive testing. But after her kindergarten teacher offered a spontaneous comment acknowledging her good attitude about school but inability sometimes to take instruction, we saw an audiologist the following year.

Newman and other audiologists refer to the testing procedure as “listening games.” But it can be quite lengthy, so she suggested some tips. “It is beneficial if the child goes into the appointment with a good attitude. Breaks are usually given in between testing, so factors like fatigue don’t affect results. Some tests can be quite difficult, so tell the child that even though some of them may be challenging, that you just need to your best.”

The closest clinic testing for APD is the John W. Keys Speech and Hearing Center in Oklahoma City, (405)271-4214, and Dr. Barbie is testing audiologist. Newman suggests that concerned parents first start by getting a child tested in school for a learning disability and/or language delay. Then if APD is suspected, the early results can be helpful to the testing audiologist.