Auditory Processing Disorders in Sherman Oaks, CA
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Auditory processing is not how well a person hears, but instead what the brain does with what a person hears. An individual can get a perfect score on a hearing test yet still have extreme difficulty with auditory processing. There are specific indicators that help you determine if auditory processing issues are present. At Hearing Loss Solutions, we provide screening assessments to determine the probability of auditory processing disorder in Sherman Oaks, CA, as well as a full battery of tests to diagnose auditory processing disorder.
Individuals with auditory processing difficulties will present with specific symptoms. Often they will act as if they have a hearing issue even when they pass every hearing test that is given. There are specific indicators that help you determine if auditory processing issues are present. Read more about symptoms of auditory processing disorder.
A specialized group of tests is required to determine if a person has difficulty with auditory processing. At Hearing Loss Solutions, we provide a screening assessment to determine the probability of auditory processing issues as well as a full battery of tests to diagnose auditory processing disorder. Reading more about the diagnosis of APD.
Research is ongoing to try and understand what causes APD. It has been determined that sometimes APD is genetically passed down from parent to child. In other cases, it is acquired due to a health incident that interferes with or damages the auditory cortex in the brain. Read more about causes of APD.
There are therapies and technologies that help APD, and in some cases improve it significantly. A proper assessment can indicate which therapies would be a good approach. Read more about therapies and technology for APD.
What Is Auditory Processing Disorder?
When we hear, the sound moves through to the inner ear which delivers the sound to the brain. The brain then translates what is heard. How the brain interprets what is heard is auditory processing.
Auditory processing skills include:
- Auditory discrimination (analyzing and interpreting sounds that are heard)
- Auditory attention (ability to sustain focus on auditory information)
- Auditory memory (remembering verbal information)
- Auditory output (organizing what is heard and responding to it)
- Auditory association (attaching meaning to the words that are heard)
- Auditory filtering (focusing on one noise amongst competing noises)
When a person is hard of hearing, or completely deaf, the pathway that delivers the information to the brain is impaired. For a person who has APD, the information is delivered okay, but the part of the brain that processes the information does not translate it properly.
APD does not affect other cognitive functions, so individuals with APD usually have average to above-average intelligence.
“I feel like Dr. Cohen is really fixing my Auditory Processing Disorder. She is teaching me new methods and exercises to deal with background noise and fast speech. She really listens and will give you what you need to succeed.”
– Darcy R.
Symptoms of Auditory Processing Disorder
There are many symptoms that can indicate an auditory processing disorder is present. There are varying degrees of APD, so a person with mild APD may only have a few symptoms while a person with severe APD may have most or all of them.
- May behave as if there is a hearing loss even when testing shows hearing is fine
- May appear to have ‘selective listening’
- May have a short attention span
- Says “Huh?” or “What?” a lot
- Has difficulty keeping up with conversations
- Does not respond to questions or responds with an inappropriate answer
- May have social issues with peers in school
- Misunderstands what is said in the presence of competing noise (air conditioning, in the car, etc.)
- Difficulty with auditory memory
- Difficulty following multi-part directions
- Misunderstands what is said. For example “Please get me the broom.” May sound like “Keys get me your room”
- Confuses similar sounds like ‘m’ and ‘n’ or ‘b’ and ‘d’
- Difficulty with phonics, particularly issues with blending sounds to make words
- Auditory distractibility caused by the inability to filter out sounds
- Sensitivity to loud noises
- May get over stimulated in noisy places (like a birthday party)
- History of ear infections
Other conditions that may be caused by APD:
- Hyperacusis (oversensitivity to loud noises)
- Speech delay
- Expressive/receptive language disorder
- Attention issues that can look like ADD
- Sensory processing issues
Other conditions that may be co-morbid with APD:
- Reading disorder
- Visual processing disorder
- Sensory processing disorder
Issues in school that may be indications of APD:
- Learning to read is difficult, especially blending sounds to make a word. May sight read instead of reading phonetically
- Spelling is poor
- Writing sentences or paragraphs is a challenge
- Cannot follow multi-step directions
- May misunderstand what is said
- May appear to have an attention problem (probably compensating by looking around to see what everybody else is doing)
- May complain about noises like the air conditioning or kids whispering, moving papers, dropping pencils, etc.
- May be very tired or irritable at the end of the school day
- May have social issues misunderstanding rules of games on the playground or simply not talking when in social groups
- May isolate from others during recess periods
Auditory Processing Disorder Subtypes
When diagnosing auditory processing disorder in Sherman Oaks, CA, Dr. Cohen will check for the most common form of APD (auditory decoding subtype). There are a total of 5 subtypes of auditory processing disorder, each with specific symptoms. It is important to know which subtype is present so the proper therapy can be applied to improve auditory function. An individual can have more than one subtype.
Auditory Decoding Subtype (most common):
- May behave like there is a hearing loss even when hearing is normal
- Mishears often, but does not realize it has been misheard and may even argue about what was heard
- Individual has difficulty with auditory discrimination, especially in the presence of competing noises
- Cannot follow along well when the speaker talks quickly and may often say, “What?”
- Has difficulty distinguishing similar sounds, which may initially show up as difficulty learning to read
- May have issues with: speech delay, reading, spelling, writing, understanding words that have multiple meanings, understanding ‘wh’ questions (who, what, when, where and why)
- Difficulty synthesizing information that is heard. For example, listening to a group of instructions to perform one task, may not know how to take all the information and apply it to the one task
- Difficulty with tasks that require right/left brain integration, such as listening to a lecture and writing notes at the same time
- Often has significant issues learning to read, and even if reading is achieved, comprehension is poor
- May have coordination or fine motor issues
- May have poor visual-motor abilities
- May have difficulty with rhythm
- May have difficulty with phonics, spelling, writing
- Difficulty understanding the unspoken aspects of conversation, such as tone, intonation, pitch, emphasis
- May have a monotone speech pattern
- Pragmatics of speech may be disorganized which can affect communication and social skills
- Has difficulty summarizing large pieces of information and may have difficulty understanding cause and effect
- May be diagnosed as a non-verbal learning disability
- Has receptive language difficulties, especially with the meaning of speech (semantics). May be diagnosed as receptive language disorder
- Interprets words literally and may not understand sarcasm, jokes or metaphors
- Difficulty applying rules of language to spoken speech
- May have significant issues with the pragmatics of speech
- Has difficulty understanding long, complex sentences
- Will often say “I don’t understand”
- Maybe be okay with phonics, but very poor reading comprehension
- Difficulty with relationships between words such as synonyms and antonyms
- Difficulty with words that more than one meaning
- Difficulty with pragmatics (organization) of speech
- Difficulty hearing in noisy situations
- Struggles with expressive language and may be diagnosed as expressive language disorder
- May have speech articulation issues
- Difficulty recalling the proper sequence of information
- Difficulty remembering groups of information, especially if it must be recalled in a specific order
- Difficulty organizing and prioritizing assignments
- Difficulty with long or multi-step directions
Not all audiologists assess for all 5 subtypes of auditory processing disorder. At Hearing Loss Solutions, we have expertise at assessing for each subtype so we can provide a clear profile on the auditory deficits that need to be remedied. Contact us today to schedule an auditory processing consultation.
Diagnosing Auditory Processing Disorder
A series of tests are performed to diagnose auditory processing disorder. Assessments to diagnose APD evaluate:
- Peripheral auditory system
- Binaural integration and separation
- Temporal patterning
- Auditory closure
- Auditory figure-ground discrimination
- Binaural interaction
- Language processing assessment
Before any of these tests are performed a standard hearing test is done to make certain the hearing is not impaired.
The tests used can identify the specific areas of difficulty, including diagnosis of one or more of the 5 subtypes of APD. Once the areas of difficulty are identified, an appropriate course of treatment can be planned.
Diagnosis Under Age 7
The American Audiology Association has a minimum age of 7 years old for a full assessment of auditory processing disorder. The tests required only have comparable data in this age group, and a certain maturity of the auditory system is required for them to be accurate.
However, as with any challenge, early intervention is the key. At Hearing Loss Solutions, we can work with parents and provide a professional evaluation based on symptoms. This evaluation can give us an indication if auditory therapies would be beneficial. We do not diagnose under the age of 7, but this screening process can mean positive results for a struggling child without requiring a full diagnosis.
APD Testing for Autism Spectrum Disorder
APD and autism are often co-morbid; diagnosis of APD can help identify effective therapies for positive improvement. At Hearing Loss Solutions, we specialize in APD diagnosis for individuals on the autism spectrum. We work with the child to complete the testing process easily and effectively. In addition, auditory therapies that we use to improve the APD can often help improve other symptoms of autism.
It is common for a child with APD to have other difficulties that are beyond the scope of an audiology assessment. In those cases, we will refer out for additional evaluations. This may include:
- Speech-language pathologies for speech and language assessment
- Educational psychologist for psycho-educational assessment
- Occupational therapist for proprioceptive, vestibular and sensory assessments
- Behavioral optometrist for visual processing assessment
Researchers are not certain exactly what causes APD, although they have found a strong correlation between many factors. In professional circles there has been a lot of discussion about two possible origins of APD:
- Acquired APD: Something happens to the hearing system that impairs proper development or injures an otherwise healthy auditory cortex.
- Hereditary APD: People are born with APD
Acquired Auditory Processing Disorder
With acquired APD, there is usually some trauma to the brain or some health issue with the ears that reduces stimulation of the auditory cortex.
The most common cause of early childhood APD is excessive ear infections (otitis media), which often causes glue ear in the middle ear. This causes reduced amplification of sound to the inner ear, resulting in reduced stimulation of the auditory cortex. In this case, the auditory system does not develop properly but often responds very well to therapies. Note that not all children with excessive ear infections will develop APD, but those diagnosed with APD often have a history of ear infections.
Other causes of acquired APD can include head injury, high fever, certain antibiotics, allergic reaction to the DPT/DTaP vaccine. In these cases, the auditory system is damaged through trauma.
Hereditary Auditory Processing Disorder
With hereditary APD the auditory system in the brain is hardwired in a way that impairs auditory processing. Usually, when there is a hereditary component, there will be several family members who have similar symptoms. It is common for a parent to diagnose their own communication difficulties when seeking help for their child. There is no genetic test available to identify hereditary APD.
Note there can also be a hereditary tendency to acquire APD, in which case it can sometimes be confusing if it hereditary or acquired. For example, there may be a hereditary tendency to get excessive ear infections which then leads to APD.
The only way to know if the APD is acquired or hereditary is to have a full evaluation done by our qualified audiologist.
Auditory Therapy takes advantage of the brain’s plasticity and uses modified sounds in cognitive training of the brain. Auditory therapy could be used in rehabilitation of APD, Autism, ADD, stress, and anxiety disorders. This kind of therapy has proven beneficial in the acceptance and use of hearing aids in clinical studies.
At Hearing Loss Solutions, we have researched and chosen the best therapies for auditory improvement. We currently provide:
- The Listening Program (TLP) (link to Auditory Therapy services page)
- Earobics (link to Auditory Therapy services page)
- Listening and Communication Enhancement (LACE) (link to Auditory Therapy services page)
Accommodations for APD
While therapies can help improve auditory processing disorder, they do take time. In the process, it is good to employ accommodations to makes things easier for the individual with APD.
Accommodations at home:
- Stand closer: The further away you are talking, the more possibility of echoing and sound interference. For example, shouting a request from another room is unlikely to be understood properly. It’s best to be standing right in front of the individual when talking
- Obtain eye contact: To make sure the person is focused on what you are saying, obtain eye contact. This can simply be a light touch to the shoulder so the person turns and looks at you
- Talk slower: Slowing the speech gives extra time to process each word
- Use simpler sentences: The more you say, the more processing is required. Try using simpler sentences. For example, instead of “Could you take out the garbage because it’s overflowing and starting to smell,” say “Please take out the garbage”
- Rephrase if necessary: If the first attempt does not work, do not simply repeat what you already said. Try saying it in a different way. For example, “The garbage needs to go out”
- Reduce background noise: Competing noises are a big issue for individuals with APD. Whenever possible eliminate noise by moving to another room, shutting doors or windows or asking others to be quieter
- Have the person repeat back: If you are giving instructions, it is helpful to ask the person to tell you what they understood. This is a life skill for this with APD which they should use on their own to clarify they have heard properly
- Think before criticizing: When a person with APD misunderstands, they usually don’t realize they have misinterpreted what was said. Assume first they misunderstood before assuming they are simply not going along with what you said
- Create quiet space for homework: Auditory distractions are often a huge issue for children with APD. It’s a good idea to create a quiet corner in a separate room where homework can be done with the least amount of distractions
Accommodations at school:
Communication tools recommended for the home can also be effective in helping an individual in a school environment:
- Stand closer
- Obtain eye contact
- Talk slower
- Rephrase as necessary
- Have the person repeat back
- Think before criticizing
But school creates a unique environment where other accommodations will also be required:
- Preferential seating: Seating the child near the front of the class often makes it easier to hear the teacher. Make sure the child is away from the classroom door where outside noises are a big distraction. Also, try to seat the child away from air conditioning units
- Seat next to helpful students: Since a child with APD often does not understand verbal directions, helpful students may be a good way to keep the child on task
- Reduce background noise: This can be a tricky accommodation, especially in a classroom of 30+ children who are dropping pencils, whispering or crinkling paper. Often this accommodation means moving the child to a resource room in order to provide a quieter environment. Use of noise-canceling headphones or earplugs can also help reduce the background noise
- Consider the acoustics: Classrooms with hard surfaces will amplify all noises which create a lot of distractions for the child with APD. Carpet or rugs can help reduce the echo effect. Artwork or other decorations of the walls can also help reduce the echoing of classroom noises. The Classroom Resources Coalition provides resources for optimizing acoustics in classrooms
- FM System: Consider getting an FM system to help amplify the teacher’s voice will muting the background noises. We can provide a variety of FM systems that are very effective for classroom use
- Simplify instructions: A child with APD often has difficulty with multi-step instructions. It is best to provide one step at a time or offer a visual tool to help track the steps to be completed. When a child with APD does not follow instructions, assume first the child did not understand rather than the child is acting out
- Provide written instructions: For children who can write, a written list of instructions can be a valuable way to keep them on track
- Learn clarification techniques: The individual with APD should learn to verify they have understood correctly. Simply saying, “I just want to be certain I understood you correctly…” and then repeat back what they understood. For children, it is helpful to role play this skill so they can practice it
- Use visual teaching method: Whenever possible, use visual props to help illustrate lecture material. Children with APD tend to be stronger visual-spatial learners and visual input helps keep them engaged in information that is delivered verbally
Schedule Your Consultation for Auditory Processing Disorder in Sherman Oaks, CA
To learn more about APD or to schedule your Hearing Loss Solutions Consultation, call our friendly office at 818-989-9001 or click here to use our convenient online form. Your appointment includes a review of your medical history, a discussion of your concerns and goals, and an explanation of our process.
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