Auditory Processing Disorder

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Auditory Processing
By Valerie Dejean, Director, Spectrum Tomates Center and Certified Tomatis Consultant

How Does Auditory Processing Relate to My Child?

Auditory processing provides the foundation for learning language and for learning language-based academic skills, such as reading, spelling and writing. When auditory processing abilities are not well developed, an individual is at risk for language and learning disabilities. Children with auditory processing disorders may have difficulty following multi-step verbal directions.

They may mishear and therefore misunderstand what is said to them. For example, a request such as "Put the dishes in the sink and then go to the bathroom to get ready for bed" may end up with dishes in the bathroom sink.

A question such as "How old are you?" may be heard, as "How are you?" These children may say "what?" or "huh?" frequently. They often need directions repeated. Their responses in conversation may be delayed and at times absent. They may not understand jokes and may have trouble finding the words to express themselves verbally or on paper. In more severe cases speech and language may be delayed, as these children are unable to quickly discriminate and attach meaning to the words spoken to them. Children who don't process sounds properly don't respond to verbal cues. They therefore don't experience the pleasure and power of opening and closing circles of communication, and thus don't attempt to communicate. They can mispronounce words because they have misheard them. Their social skills can be affected, as they are not processing auditory information at a sufficient speed to respond promptly in two-way verbal exchanges.

Over time, this lack of verbalization deprives the ear of the stimulation it needs for continued fine-tuning: children learn to focus on the human voice above all other sounds by hearing their own voice repeatedly. The human voice may become too complex or difficult for them to process, and so they continue to tune it out. After a while, they are disconnected from the outer world. Children with auditory processing difficulties who develop language may still misunderstand verbal instruction, or mis-communicate their desires.

They often become frustrated that others do not understand them or that they do not understand what is going on. Language-based academic skills are often difficult for these children. Learning to read phonetically is dependent on auditory decoding and synthesizing, and is therefore difficult for children with auditory processing disorders. Spelling can be equally challenging, as they don't hear the words accurately and therefore are unable to reproduce them. Often reading comprehension is impaired because they are working so hard to decode what they have read that there is no room left for understanding. Although these children may learn to read, they may never do so for pleasure. Classes that are dependent on language and reading skills, such as social studies, English and foreign language, may be very difficult. Subjects such as math and science, which in the early grades may have been easier, become more challenging, as these subjects become increasingly language based. By the time these children enter forth grade, the majority of their lessons are presented orally. By middle school they must learn to "tune in" to verbal directions from many different teachers. They often start to daydream and "tune out" because their auditory systems are simply overloaded. Moreover, as class size becomes larger there is more background noise competing for their attention, making listening increasingly difficult. What is Auditory Processing? Central auditory processing disorders are described as the inability to attend to, discriminate, recognize, and comprehend information presented through the auditory channel, despite normal hearing and intelligence. At the Spectrum Tomates Center we often refer to Auditory Processing as "Listening."

Dr. A. A. Tomatis distinguished between hearing, which he described as the passive reception of sound, and listening, which he described as the active ability, intention, and desire to focus on sounds. It is possible-and even likely-to have normal hearing, yet poor listening. Auditory processing relates to how the ear makes sense of what it hears. The auditory system is required to interpret all the sounds of spoken language and attach linguistic meaning to them. For example, a dog is able to hear as well or better than humans, yet the dog's ear isn't able to separate the speech stream into meaningful words that he can understand. This requires auditory perception and auditory processing; together they provide the foundation for understanding and using oral and written language. Sound waves arrive from outside the body to the inner ear where the cochlea analyzes them and that information is sent to the processing centers in the brain.

We determine what each sound is, if it is important, and whether or not we wish to respond to it. We have to discriminate sounds, which often involves "filling in the gaps" as we rarely receive a clear auditory signal. We have to tune in to one signal and distinguish it from background noise. We have to compare and share the differing auditory information we receive from each ear. All this information has to be shared and integrated with the sensory information coming from our eyes and body.

Development of Auditory Processing

Our ability to analyze sound develops in the womb. The inner ear is the first sensory system to fully develop in utero. The fetus learns to tune in the salient sounds of his mother's voice and ignore background noise.

During this stage he learns to recognize the sounds (phonemes) that make up language. Research shows that an unborn fetus will respond with a different movement, to each of the phonemes (building blocks of language) spoken by the mother. This early listening in the womb plays a vital role in the later development of language. At birth a baby is already familiar with and responsive to all spoken sounds; in other words he is essentially "wired" for language development. Born with an ear already attuned to language sounds, the baby is ready to make rapid progress in attaching meaning to the sounds he hears. Language is not taught to infants; it emerges just as sitting and crawling, if the baby is given a language environment. The important ingredient for language to unfold naturally is normal auditory processing. The foundation for this is established in the womb. Other than developmental reasons, another way that auditory processing can be interrupted is by repeated ear infections in early childhood. Ear infections, medically entitled otitis media, result in fluid accumulating in the middle ear. Fluid can remain in the ear for up to several months following an infection. This can result in intermittent hearing loss during a critical time for language acquisition. The transmission of high frequency sounds is what is most commonly compromised when there is fluid in the middle ear.

These high frequencies provide much of the meaning to spoken language. When our ear misses sounds such as "th, f, s, sh, t, k, and p," it is difficult to understand the content of what is being said. "Ship" may be heard as "ip" and "that" as "at, for example. There are critical periods of development when the baby's ear is best able to discern certain sounds. If there is fluid in his ear at those times, it may be difficult for him to discriminate those particular sounds even when his hearing returns. This distortion of perception may compromise more abstract expression of sounds. For example, if we can't perceive the "th" sound, we may not be able to pronounce it, read it, or spell it. In this way an auditory processing disorder may negatively impact higher order learning. The Vestibular Cochlear System Movement and sound are closely linked as exemplified in the example of the fetus moving in response to the phonemes spoken by his mother. That is because both movement and sound are perceived by the inner ear: the vestibular cochlear system. The vestibule analyzes longer wavelengths generated within the body by our movements and body position; the cochlea analyzes shorter wave lengths (sound waves) generated outside the body. The ear, then, is responsible for making sense of virtually all the sensory information received by the body, and functions as the body's link between the outer and inner world.

Many experts, including Dr. Alfred Tomatis, feel that these two systems are actually one, with the related function of the analysis of vibration. The vestibule and the cochlea are anatomically joined, sharing a common wall and common fluid. In addition, the systems lie closely together throughout the nervous system, allowing for many close neuronal associations. Since these two systems are so closely linked, it is logical that one would have a direct impact on the other and vice versa.

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Call the Spectrum Tomates Center at (845) 915-3288, for additional information or to schedule an initial assessment. You can contact us at; Spectrum Tomates Center, Route 17, Suite 4, Tuxedo Park, NY 10987 Copyright 2010 William J. Kennick