When Your Brain Is Hard of Hearing

Is a conversation with your child filled with a stream of "huh" or "what?" In crowded surroundings does your child seem lost and off topic? Is teaching phonics and clear speaking an ongoing struggle in your home? You think there is a problem with hearing, but the tests come back normal? There may not be a hearing issue; there may be a sound processing issue. You may be dealing with Auditory Processing Disorder (APD), formerly called Central Auditory Processing Disorder (CAPD).

Auditory Processing Disorder (APD) is a processing disorder of the brain. The ears hear, but the brain does not translate or interpret that information correctly. There are several sub-types that make up APD (see below). APD is like a half-heard song or a radio filled with static: only parts of the song get through, and you lose some understanding of the message. This is made worse by ambient noises and distractions.

For example: You say: "It's time to go. Get your coat on."

Your child hears, "It's dime to (rustling of purse and coat together drowns out part) tote on."

Your child stands there doing nothing. After a minute or so he responds, "What?"  

This seems like disobedience from the parent's point of view. After all, it is reasonable to think most children are able to put on a coat and get ready to leave. We don't understand that the child was confused by what was just said and is now frustrated that he or she is getting in trouble for not obeying. Understanding APD is the first step to correcting this problem and helping your child get back on track! 

Gabriel, my son, had problems with his hearing on and off. He seemed to fail a hearing test and then pass the next, only to repeat the same thing at his next yearly appointment. We found that if he was tested in the loud, distracting doctor's office he failed, but in a quiet audiologist's testing room he passed. Frustration marked our early struggles with APD. Gabriel's speech was slurred, but we were assured that typically boys' speech developed slowly. However, when he reached 5 years of age and could barely be understood by us, his parents, we knew it was time to ask for help.  

Children who appear to have APD need some basic testing. First, you need to have your child's hearing tested. Have your child's doctor check for organic problems, such as fluid in the ear, hearing loss, etc. before testing for APD. APD testing is rather involved and expensive. This is a decision you should discuss with your pediatrician, speech therapist, or audiologist; their input can help you make a wise decision. One factor you should keep in mind is that currently a child cannot definitively be tested for APD until he is about age 8 or 9 years old, although your child's problems will probably be obvious long before that.

An APD diagnosis is still rather "new," and a clear path of treatment has not been established yet. Some suggestions and methods of teaching have resulted in an improvement in an APD child's ability to successfully process auditory input. Treatment is generally broken down into environmental modifications, remediation (direct therapy), and compensation.

Environmental factors can be easily and sucessfully addressed by homeschoolers. Turn off all ambient noise, such as a fan or television in a nearby room. If you have other children, schedule one-to-one time to tackle new or challenging subjects. If you go to a co-op or church, seat your child near the speaker or directly in front of the speaker so that your child can lip-read. APD kids can unconsciously learn to lip-read, so take advantage of this skill!

Remediation is directly applied therapy. If you are blessed to live near an audiologist who specializes in APD, he can provide therapy. You will most likely actually be dealing with a speech therapist who has experience with helping children who have been diagnosed with APD. There are also software programs you can get for use at home. Fast ForWord (http://www.scilearn.com/) is expensive, but it worked well for my son. We also used Earobics (www.earobics.com), which is available separately for elementary, middle school, and teen/adult levels. Earobics is less expensive and easy to use at home, and on their site they have additional free games that you can try. Intensive sound therapy can help keep your child's skills on track.

Compensation essentially refers to an understanding of the fact that your child's hearing is different and therefore you need to make adjustments. This is not just a way to say you're giving up! When you give directions, keep them clear and simple, and speak directly to your child. You should try to speak slightly slower so that your child has time to process the input and understand you. The key is to let your child hear, think, and respond at a pace that works for him.

Gabriel's treatment started with direct therapy. We used a speech therapist. She was able to work with Gabriel's articulation problems and his phonemic awareness skills. He had fallen behind in learning to read because of his weaker listening skills. We worked for three years with a speech therapist, used software, and kept working on phonics and listening skills.

There were several things we were able to do to assist Gabriel to stretch his skills. First, I would read to him every night. When we started, I was able to read only a paragraph or two before he lost interest or fell asleep. Now he is attentive and comprehends the content successfully when I read an entire chapter in a large book. This took time. At one point, we realized that if he had seen the movie he was better able to understand the book and enjoy it. Redwall was wonderful. We also work hard on sight words, since phonics is not one of his strengths. Homeschooling allows your APD child the much-needed practice with phonics skills but at his pace.

The future is bright for your APD child. Therapy, development of stronger skills, and determination will help your child be successful. As he grows, you may be able to use technology to assist his ability to listen in public. Assistive listening devices similar to what is used by a hard-of-hearing person are being used to help people with APD. Your child will be able to dream big and work hard to get there. We as parents need to work hard now to open as many opportunities as possible for our children in the future.

APD is a processing disorder that affects your child's ability to listen. Think of it like this: your child's brain is hard of hearing. You can help by adjusting your environment for learning, choosing wise therapy options, and making wise compensations. Persistence will pay off, and your child will be able to control and guide his own APD as he matures. Your homeschooling may take a different path because of APD, but the journey will be just as wonderful.

The 5 Types of APD

1. Auditory Decoding Deficit—This is the classic APD type. A child with this will act like he has a hearing loss although the normal hearing tests show satisfactory hearing. Problems occur with background noise, rapid speech, and telling the difference between sounds.

2. Auditory Integration Deficit—This type is where the brain is not working as a whole. The biggest problems will be seen when dealing with reading/reading aloud and taking notes. They have problems listening and understanding fast enough to write out the important words for note-taking or comprehension.

3. Auditory Associative Deficit—This is closely related to a receptive language disorder, simply put, "a black-and-white thinker to an extreme." You say, "I'm beat," and this child would think you are injured rather than tired. This is a listening comprehension problem.

4. Auditory Output-Organization Deficit—This is closely related to an expressive language disorder. The words do not form correctly or in the right order when the child speaks. There may also be some speech problems with this type.

5. Prosodic Deficit—This is a problem with speech volume, intonations, and level of emotional intensity. Think Ben Stein: his intonation is oddly monotonous. This does go both ways; your child may not be able to understand other people's tones correctly and over- or under-react.

Heather Laurie is a happy wife and homeschooling mom to five wonderful children. Heather and her children have a genetic disorder that causes a variety of medical and learning disabilities. Through their experiences God has uniquely trained Heather and her husband Chris to minister and encourage others who are walking the road of special needs learning. She can be found at her site: Special Needs Homeschooling, The Company Porch Special Words for Special Needs, or http://homeschoolblogger.com/gfcfmomofmany/.  

Copyright 2010. Originally appeared in The Old Schoolhouse Magazine®, Summer 2010. Used with permission.

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