What are Auditory Processing Disorders
With the arrival of DSM-V-TR, we dive into details about specific diagnoses to help you in your self-advocacy.
As we dive deep in the DSM changes as they relate to autism, it’s important to consider what the possible outcomes are for an evaluation that does not result in an autism diagnosis. In other words, if you or your loved one does not present with all of the criteria necessary for an autism diagnosis, what diagnosis might the evaluation team arrive at? Considering that many neurodivergent people often have problems processing audio inputs, and that the new diagnoses will necessarily consider the place or context in which the difficulties occur, a diagnosis of some form of auditory processing disorder might be the result when all of the criteria for autism aren’t observed.
You see, many of the self-diagnosed within the wider neurodivergent community note in their hashtags on social media that they indeed have issues with auditory processing. They may also note that they depend upon captions to help them consume media. But few elaborate about how, specifically, their auditory processing impacts their experience of the world in the way in which the DSM speaks. In other words, how does their processing difference / disability impact their ability to engage with school or employment (i.e., place).
Thus, this piece will serve to inform the various constituencies who inhabit this space as to the many “flavours,” if you will, of auditory processing disorder.
What are Auditory Processing Disorders
Auditory Processing Disorders (APD) interfere with an individual's ability to analyze or make sense of information taken in aurally (through the ears). This is different from problems involving hearing per se, such as deafness or being hard of hearing. Difficulties with auditory processing do not affect what is heard by the ear (the mechanical signal processing). The "disorder" part of APD means that something is adversely affecting the processing or interpretation of the information within the brain.
According to the University of Central Arkansas Speech and Language Center, the characteristics of this disorder exist despite normal peripheral hearing sensitivity and intelligence. Individuals with an APD have a decreased ability to receive and interpret auditory information in their brain. Children with APD often behave as if they have a hearing loss. They often have difficulty understanding speech in the presence of background noise and have difficulty following spoken instructions. An APD often causes learning challenges in the areas of reading and spelling (e.g., how the disorder affects one relative to place).
Diagnostic Criteria
So what is the evaluation team looking for when considering APD? The diagnostic criteria of individuals with auditory processing disorders include:
difficulty with some or all listening activities
particular problems when the activities occur in less than ideal listening environments
problems with sound discrimination
errors when speaking on a one to one basis especially when there is competing background noise or speech
difficulty understanding information when speakers talk rapidly
difficulty understanding information when they are not devoting their complete attention to the listening task
difficulty with the discussion topic when it is unfamiliar to them
difficulty performing or remembering several verbal tasks in a row
exhibit weak phonemic systems (speech sound memories used in phonics, reading, and spelling)
often appear as though they do not hear well
frequently say, "what?" or "huh?" in response to questions.
not always intimately in touch with the sounds in the environment, hence they do not always grasp exactly what has been said
has a history of middle ear infection
often have lower academic performance
need more time to process information
difficulties with reading comprehension, vocabulary, and spelling
may display behavior problems
Experts agree, and I generally agree with those experts, that people can learn to work around challenges they face when dealing with APD. But APD can present lifelong difficulties if it isn’t diagnosed, properly managed, and adequately accommodated. Here are some classroom skills (place) that are commonly affected:
Communication: Children with APD may not speak clearly. They may drop the ends of words and syllables that aren’t emphasized. They might confuse similar sounds (free instead of three) long after their peers have learned to correct themselves.
Academics: Children with APD often have trouble developing reading, spelling and writing skills. Learning vowels and developing phonemic awareness—the building blocks for reading—can be especially difficult. Understanding spoken instructions is challenging. Kids with APD tend to perform better in classes that don’t rely heavily on listening.
Social skills: Children with APD have trouble telling stories or jokes. They may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response.
Further Key Points
APD is a complex condition. It is sometimes misunderstood because many of the behaviors also appear in other conditions, such as attention deficit hyperactivity disorder (ADHD) and even depression. Symptoms of APD can range from mild to severe and can take many different forms.
An auditory processing disorder does not solely interfere directly with speech and language, it can also affect all areas of learning, especially reading and spelling. When instruction in school relies primarily on spoken language, the individual with an APD may have serious difficulty understanding the lesson or the directions. Teachers, this is one of the many reasons why we should offer multiple ways to engage with directions and lessons (i.e., differentiation).
APD as a Specific Learning Disability
In a general sense, the eligibility (diagnosis) will not be APD. APD is a specific learning disability. Thus the eligibility for special education services / employment accommodations will be SLD. Under the IDEA (Individuals with Disabilities Education Act 2004) in the United States, a Specific Learning Disability is defined as:
"(i) General. The term means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.”
"(ii) Disorders not included. The term does not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. ([34 C.F.R. 300.7(c)(10)]”
Important Point: The definition of “a specific learning disability” under IDEA 2004 remains unchanged from IDEA of 1997. However, under the new provisions under IDEA 2004, “a local educational agency is not required to take into consideration whether a child has a severe discrepancy between achievement and intellectual ability in oral expression, listening comprehension, written expression, basic reading skill, reading comprehension, mathematical calculation or mathematical reasoning. In determining whether a child has a specific learning disability, a local educational agency may use a process that determines if a child responds to scientific, research-based intervention as a part of the evaluation procedures” (U.S.C. sec 614(b)(2)(3)).
APD is an umbrella term. There are very specific types of ADP. They are listed below with definitions and examples.
Specific Types of APD
Auditory Association Processing disorder - Definition: An auditory processing disorder specifically associated with difficulties in relating to orally presented material (words and concepts) in a meaningful way. Explanation: A student with Auditory Association Processing Disorder will often have great difficulties organizing and associating aurally presented material in a meaningful way. For example, when speaking to this child, he/she does not appear to understand what is being said, needs you to repeat information, and frequently asks “what did you say? Or “could you repeat that?”
Auditory Blending Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in processing or putting together phonemes (the smallest phonetic unit in a language that is capable of conveying a distinction in meaning) to form words. Explanation: A child with Auditory Blending type Processing Disorder has difficulties tying letters together to form a complete word. As a result, even though he/she knows the “b” sound, the “a” sound, and the “t” sound, the child struggles with putting them together as a whole to form the word “bat.”
Auditory Closure Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in combining sounds that are presented orally to make words. Auditory closure is the term used to describe the ability to understand the whole word or message when a part is missing. Explanation: In every day life, when pieces of a word are deleted, we automatically fill in the missing sounds to decode the word. For example, if we hear elephan, we can close off the word, knowing that it was elephant. However, if a child with Auditory Closure Processing Disorder hears “auto –o-bile” , they may not be able to identify it as automobile; “ase-ball” as baseball, ”acoroni” as macaroni, “tele-ision” as television, and “air-pla” as airplane. Because students with Auditory Closure Processing Disorder have difficulties closing off words, sentences or phrases, they may lose total comprehension of what being discussed both in and outside of the classroom.
Auditory Discrimination Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in recognizing differences in phonemes (sounds). This includes the ability to identify words and sounds that are similar and those that are different. Explanation: A student with Auditory Discrimination Processing Disorder often experiences difficulties acquiring, understanding, and/or using spoken language. Auditory discrimination processing problems can lead to problems telling the difference between similar sounds. For example, this student may hear what he thinks is the word “mall” when it was actually “wall”; "seventeen" instead of "seventy"; “finger” instead of “ringer”, “boat” instead of “bat”; or hearing an angry rather than a joking tone of voice. It’s the processing of the words that are problematic for the student, not the ability to hear the words themselves.
Auditory Figure Ground Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties attending to a designated aural stimulus due to being focused by background sounds. It is the inability to attend to one sound against a background of sounds (e.g., hearing the teacher's voice against classroom noise). Explanation: A student with Auditory Figure Ground Processing Disorder often experiences difficulties with following oral instructions, as he/she may not be able to separate the instruction from background conversations. For example, a teacher may tell her students to take out their pens and open to page 152. The student with Auditory Figure Ground Processing Disorder may not process this information, not because he is not paying attention, but rather because he is focused on the background noise of a fan in the room or the ticking of a clock. This child may be unable to process that the telephone is ringing when he/she is listening to the radio, or have difficulty hearing someone talking at a party when music is playing.
Auditory Language Classification Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in classifying objects by category when presented aurally to an individual. Explanation: Auditory language association and classification difficulties can lead to difficulties with holding two or more concepts in relationship to one another, being able identify and verbalize concepts, and/or learning to classify or categorize concepts. For example, a student with Auditory Language Classification Processing Disorder may have difficulties answering the following questions:
Would “bat” go with “ball” or “mitten?”
Would “bird” go with “airplane” or “car?”
How are a dog and a cat alike?
Auditory Long Term-Memory Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in retaining and recalling general and specific long-term auditory information. Explanation: Long-term auditory memory is the ability to remember something heard some time ago. A child with Auditory Long Term-Memory Processing Disorder may not be able to retain orally presented information learned on Monday for a test on Friday. He/she may have difficulties remembering homework assigned on Wednesday morning for Wednesday night. When asked about an event from last year, the child may appear confused and have no recollection of the event itself.
Auditory-to-Written Expression Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in reproducing orally presented material or experiences in writing. Explanation: An example of Auditory-to-Written Expression Processing Disorder can be seen when a child is asked orally spell the word “cat.” They will have no problem saying the letters are c-a-t. However, when asked to spell cat by writing the word on paper, the student has tremendous difficulty. Here, repeating it verbally is not the issue. The difficulties are in processing what they heard into a written form of expression.
Auditory Sequential Memory Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in recalling prior auditory information in the correct order or sequence. Explanation: Individuals with Auditory Sequential Memory Processing Disorder often experience difficulties remembering and/or reconstructing the order of items in a list or sounds in a word or syllable. Their problems lie in putting together the sequence of events or items presented to them orally. Examples of Auditory Sequential Memory Processing Disorder include:
Confusing multi-digit numbers, such as 74 and 47.
Confusing lists and other types of sequences, e.g. when given the numbers 3–4–7–9 and asked to repeat them, the student may either not remember the numbers or give them in the incorrect order, such as 7–3–9–4.
Remembering the correct order of a series of instructions.
Auditory Short-Term Memory Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in retaining and recalling general and specific short-term auditory information. Explanation: Short–term memory is the part of the memory system where information is stored for roughly 30 seconds. When you are trying to recall a telephone number that was heard a few seconds earlier, the name of a person who has just been introduced, or the substance of the remarks just made by a teacher in class, you are calling on short-term memory, or working memory. Individuals with Auditory Short-Term Memory Processing Disorder may have difficulties following verbal instructions or have trouble recalling information from a story read aloud. Auditory short-term memory difficulties can lead to difficulties retaining or recalling auditory experiences or directions. Some find it hard to recognize auditory stimuli they have heard before; others remember hearing the stimuli but cannot reproduce it accurately.
Auditory Visual Integration Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in accurately relating an auditory sound with a visual symbol.Explanation: Individuals with Auditory Visual Integration Processing Disorder often experience difficulties relating what they hear to the corresponding item that makes the specific sound associated with it. For example, suppose you were to show a picture card with four items on it. The pictures on the card were of a car, a window, a bell, and a horn. Then, you play the sound of a bell and ask the child to point to the picture associated with the sound they just heard. The child with Auditory Visual Integration Processing Disorder may either have serious problems performing this task or even be unable to do so. They have tremendous difficulties relating what they hear (the sound of the bell) to the corresponding item that makes the specific sound associated with it (the picture of the bell). Auditory visual integration difficulties can potentially present difficulties with spelling tests, since students are required to put the correct letters with the corresponding sounds.
Auditory Verbal Reproduction Processing Disorder - Definition: An auditory processing disorder specifically associated with difficulties in verbally reproducing orally presented material or experiences. Explanation: A student with Auditory Verbal Reproduction Processing Disorder may have serious difficulties orally repeating a series of words, sentences, instructions, or learned information when asked to do so by a teacher. However, the same student will have no problems reproducing this same information when asked to do so in writing. For example, if given a series of five numbers, 2-6-7-8-4, and told to “write down what you hear”, the student should have no problems with this task. However, if given the same series of numbers but told to “orally repeat back to me what you hear”, the student will have significant difficulties in performing this task. Students with Auditory Verbal Reproduction Processing Disorder have significant difficulties establishing a connection between what is heard and then repeating that same information.
Again, it should be noted that any medical problems associated with a child’s hearing should be been ruled out as the primary cause of the child’s difficulties. The difficulties described above are related to the internal processing of information, not due to a hearing impairment.
Conclusion
A proper diagnosis is helpful in establishing a baseline of functionality. If you / your loved one is not able to receive one, I hope this article provides enough information for you to be able to pinpoint where the issues lie. Often, it’s a breakthrough to just know the official name for the symptoms / experiences you’re having. Once you have that name, you can begin your quest for information in a very specific, targeted way.
Thanks again for your continued support. If you feel so moved, please feel free to comment below.