Archive for the ‘auditory processing disorder’ Category

Christmas is that time of year when we traditionally eat too much, exchange presents, and get extended family and friends together. Whilst I’m not going to attempt any dietary or present buying advice, there may be readers who are going to be joining family or friends with a deaf or hearing impaired child in the family. You may not normally get to spend a lot of time with them or maybe they were very tiny the last time you saw them. The following tips will help make communication easier and more enjoyable for you both…

  • Most children who have hearing difficulty will use all kinds of visual clues to help them make sense of what is being said. They will watch your facial expressions and body language, and they may be watching your lips closely (lip-reading). So it’s really important to make sure you have the child’s attention before starting to talk, keep facing the child and try to maintain good eye contact. Try to get down on the same level as them so that they don’t have to look up to you all the time. And if you’re playing together allow some space so that they can see your face clearly. At Christmas the fairy lights can be very pretty and atmospheric but if a child has a hearing loss they won’t easily be able to follow what’s being said in a dark room so try to keep the lights on when you’re talking. And try not to stand with your back to a window as this creates shadow and makes it difficult to read your facial expressions or lipread.
  • Santa may be a lovely fellow who brings some great presents but with that bushy white beard he’s impossible to lip-read. If you’re sporting facial hair consider a festive trim. And don’t try to talk to the child at the same time as munching your way through the mince pies and Quality Street, or when hiding behind the Christmas edition of the Radio Times.
  • Background noise makes it really hard for a hearing impaired child to follow your speech and conversation in groups can be impossible. Since there’s probably going to be lots of conversation  going on around the dinner table try to make sure that any background noise that can be turned off, such as the looped CD of Christmas songs, is.  Make sure members of the group speak one at a time and visually indicate when a different person is speaking so that the child can keep up.
  • When you’re talking there’s no need to shout. This will distort your lip patterns but more importantly appear to the child that you are angry with them, potentially setting up yet another generation of traditional Christmas family feuding. So speak clearly, naturally and at a normal pace.
  • Mostly though, don’t give up! They may not know all the words you use so try a different word with the same meaning and use gestures to show what you mean. Encourage them to tell you if they don’t  understand.

However you celebrate, I wish you a very enjoyable festive period and happy New Year!

If you’re reading this after Christmas, why not contact the NDCS for a copy of their flyer or poster of tips Communicating with deaf children without references to slightly dysfunctional family dynamics (which may have more to do with the authors own rather than widespread experiences).



Updated 19th June 2015 to include new links to useful websites and interesting articles.

In my last post I talked about the importance of acknowledging tinnitus when children mention it for the first time or are upset by it. Although there is rarely a cure for it, learning about and understanding their tinnitus can make managing it much easier.

Tinnitus is very subjective and impossible to measure so we have to rely on what the young person tells us. Tinnitus sometimes interferes with what you’re trying to listen to and often distracts when trying to listen in quiet environments. In noisy environments such as classrooms, the tinnitus isn’t normally noticed but once children start trying to study during quiet periods their tinnitus can be quite distracting.

For children with a hearing loss or auditory processing disorder (APD) the impact of tinnitus should be carefully considered. For many people stress makes their tinnitus worse. One of these stressors may be difficulties in hearing easily. This is cyclical – the harder things get, the worse the tinnitus gets, the more it annoys you and worse it all feels etc. Other stress might include exam periods for example. And tinnitus may cause sleep problems – usually in getting off to sleep – and this may have knock on effects during the day.

The best course of action for each child depends exactly on their circumstances and needs. For some children a simple explanation of tinnitus and knowing that they aren’t alone and lots of people experience it is enough to reassure them. For some children some simple masking or distraction techniques work well. For example, if the main problem is concentrating in the quiet then it can help to introduce some controlled, low-level background noise such as a fan or white noise. Occassionally quiet background music works so long as it’s a music style that you like (listening to classical when your taste is reggae isn’t going to be relaxing) and so long as it doesn’t distract you from what you want to be concentrating on! At bedtime I find it helps to listen to talking books and drop off to those. Some people prefer sounds of the seashore or other relaxing recordings, or plain old white noise. Various bits of equipment that might be of interest can be seen here.

Whenever there is a hearing loss present, even a slight one, then the most appropriate action is to have hearing aids fitted. The introduction of amplified everyday sounds that you should be hearing help to mask out the tinnitus. And making listening as easy as we can helps reduce stress levels so FM systems with hearing aids, or the iSense for children with APD are helpful in school.

For those childen who appear to be very affected by their tinnitus then they will be helped by specialist help from a paediatric audiology team with experience of childhood tinnitus. Following assessment they will use a combination of techniques including Tinnitus Retraining Therapy (TRT) and cognitive behavioural therapy combined with providing tools to help children self-manage their tinnitus giving them back some control and reducing the impact of their tinnitus on their day-to-day lives. In Tinnitus – it’s not just ringing in the ears! one mum describes how helpful a referral to a children’s tinnitus service was for her son in understanding and managing his tinnitus.

British Society of Audiology’s Audacity magazine (Issue 2 December 2013) includes two useful articles on childhood tinnitus:
pp26-29 Tinnitus Counselling in Children, Dr Alice Emond and Rosie Kentish
pp30-31 Tinnitus in children: Guidelines for Good Practice, Claire Benton

British Society of Audiology’s Tinnitus in Children; Practice Guidance (March 2015)

UCL run an annual Advanced Audiology Masterclass in Tinnitus and Hyperacusis. The 3 day Masterclass starts with a research update on the current understanding of the mechanisms of tinnitus and hyperacusis. It then addresses the different approaches for the assessment and management of these symptoms in adults, before focusing on paediatric patient management. In 2010 the lectures were recorded and can be watched free here.

Updated 22nd July 2016 to include new links to useful websites and interesting articles.

Parents worried about their child’s hearing often bring them into the audiology clinic only to be told that their hearing test result is well within the normal range of hearing. That there is nothing to worry about can be a great relief to some parents – in many cases the child has been suffering with a bout of ‘Glue Ear’ that has now resolved. For others this can be a very frustrating experience because they know their child doesn’t behave like their normally hearing friends. They may have difficulties with listening, or making sense of sounds that are heard, and this may be particularly bad in environments with a lot of background noise. Some parents realise their child has difficulties with understanding from an early age, but often APD becomes more obvious when children start school. At this point it is helpful to remind ourselves that ‘hearing’ and ‘listening’ aren’t the same thing. The ability to listen involves memory, learning, vision and attention, as well as hearing. If any of these functions are impaired then listening may be affected. One possible diagnosis is Auditory Processing Disorder (APD). Although first described in the 1970’s APD is still a relatively new player in the audiological field. Unfortunately this means that it is not widely understood, there are no universally used test procedures, and many audiology services do not test for the condition or offer any re/habilitation support. Over the years other similar names have been (and still are) used including central auditory processing disorder (CAPD) and obscure auditory dysfunction (OAD) which can make it difficult for families to find information easily. A letter to the editor in the July 2011 edition of the International Journal of Audiology “What’s in a name? APD by any other name would not smell so sweet” outlined some of the problems.

The British Society of Audiology’s APD Special Interest Group published a position statement and practice guidance documents (2011) to help inform audiologists and other interested parties of the latest evidence on APD, provide a consensus interpretation of the evidence, intended to inform current clinical understanding and practice. It’s a bit technical but here goes:

  • “APD is characterised by poor perception of both speech and non-speech sounds. Auditory ‘perception’ is the awareness of acoustic stimuli, forming the basis for subsequent action. Perception results from both sensory activation (via the ear) and neural processing that integrates this ‘bottom-up’ information with activity in other brain systems (e.g. vision, attention, memory). Insofar as difficulties in perceiving and understanding speech sounds could arise from other causes (e.g. language impairment, non-native experience of a particular language), poor perception of speech alone is not sufficient evidence of APD.
  • APD has its origins in impaired neural function. The mechanisms underlying APD can include both afferent and efferent pathways in the auditory system, as well as higher level processing that provides ‘top-down’ modulation of such pathways.
  • APD impacts on everyday life primarily through a reduced ability to listen, and so respond appropriately to sounds. The term ‘listening’ has been used to imply an active process while ‘hearing’ implies a more passive process; it is possible to hear without listening attentively.
  • APD should be assessed through standardized tests of auditory perception. There are currently no generally agreed ‘gold standard’ methods to assess APD, but these are essential to move the field forward. Note that ‘testing’ may include both direct and indirect measures such as questionnaires.
  • APD does not result from failure to understand simple instructions. Primary impairments for which auditory difficulties may be a ‘secondary’ or ‘trivial’ consequence include medical problems not affecting the ‘mechanisms underlying APD’ and generalised medical/psychological problems that render a label of APD impossible, inappropriate or irrelevant (e.g. severe mental impairment).
  • APD is a collection of symptoms that usually co-occurs with other neurodevelopmental disorders. Like other such symptoms (poor language, literacy or attention, autism) APD is often found alongside other diagnoses.”

So what should you do if you think your child has APD?

First of all ask your GP to refer you to a doctor who specialises in childen’s hearing problems. This will probably be a consultant in audiovestibular medicine, a paediatrician specialising in audiology, or a paediatric audiologist.

Children with APD usually have normal intelligence. The cause of APD is often unknown but it is often associated with conditions such as dyslexia, attention deficit disorder, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay.

Where can you get further information and support?

The British Society of Audiology publish a leaflet ‘Auditory Processing Disorder in Children’ (2015)

APDUK is a support group run by adults with APD and parents of children with APD. Their aim is to promote an increased understanding of APD in the UK by both the professional establishment, especially in the fields of education and employment, and the general public. They provide written information, a helpline and a web-based discussion forum. If your child is already at school and you’re having trouble accessing additional support then contact the Independent Panel for Special Education Advice (IPSEA) who provide free and independent legal advice and support in England and Wales regarding educational needs.

Useful websites & interesting articles

British Society of Audiology (BSA) / Auditory Processing Disorder (APD) Special Interest Group for interested professionals

Evolving concepts of developmental auditory processing disorder (APD): A British Society of Audiology APD Special Interest Group ‘white paper’   International Journal of Audiology Vol 52, Issue 1, 2013

British Society of Audiology’s Audacity magazine (Issue 2 December 2013) includes two useful articles on understanding APD and progress towards a gold standard clinical assessment:

  • pp32-35 Auditory Processing Disorder; the pursuit of a gold standard test, Dr Johanna Barry
  • pp36-38 Auditory Processing Disorder; are you keeping up? Dr Wayne J Wilson

Briefing Paper: Auditory Processing Disorder – An Education Response, NatSIP, BSA, & BATOD, May 2015

The Institute of Hearing Research‘s current research studies into APD

American Speech-Language-Hearing Association “Understanding Auditory Processing Disorders in Children”

Auditory processing disorders and auditory/language interventions: an evidence-based systematic review Language, Speech, and Hearing Services in Schools Vol.42 246-264 July 2011.

“The Difference Between Auditory Processing Disorder and Specific Language Impairment”  summary of Ferguson MA, Hall RL, Riley A, Moore DR (2011) Communication, Listening, Cognitive and Speech Perception Skills in Children With Auditory Processing Disorder (APD) or Specific Language Impairment (SLI). Journal of Speech, Language and Hearing research 54 (2):211-227.

Issues in diagnosis and management of auditory processing disorders – including spatial processing disorder lecture by Dr Harvey Dillon recorded at the Paediatric Masterclass 30th April 2016 in Greenwich (organiser Jay Jindal, Director of Audiology Planet)

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