There are two types of "hearing" problems that a person may have – peripheral loss or central auditory processing disorder.

A peripheral loss is one that is caused from a disease or disorder in the ear. This type of loss is often designated by degree as a mild, moderate, severe or profound loss.

A “central" auditory processing problem (or auditory processing disorder) is not caused from a disorder in the ear itself, but instead seems to be due to a disorder in how the brain (central auditory nervous system) perceives the information about sounds that it receives from the ear. This system is responsible for sound localization, discrimination of differences between sounds and words, detection of the timing gaps or intervals between sounds and the ability to hear in background noise. In other words, auditory processing is how the brain makes sense of what it hears.

Children with central auditory deficiencies are generally youngsters with normal hearing in the usual sense. That is, they usually have the ability with which to hear very faint sounds (normal hearing sensitivity). They simply cannot use auditory information efficiently and may not learn well by listening alone.

In general, children with APD typically demonstrate one or more of the following characteristics:

• Poor auditory attending skill. That is, trouble paying attention to what they need to hear.
• Deficits in foreground /background discrimination ability (also called a deficit in figure/ground or integration problem). This is difficulty listening to, or maintaining attention to, speech that is delivered in a complex environment. For example, speech with noise in the background, not spoken clearly, or delivered in a "busy" environment with many visual and auditory distractions.
• Limitations in auditory memory and retrieval.
• Delays in receptive auditory language development.
• Problems in telling the difference between similar sounding words like "mat" and "map".

APD testing includes a thorough case history of a patient's auditory problems and deficits, comprehensive audiologic testing and specialized test procedures, which are specifically designed to diagnose a central auditory processing disorder.

Many basic skills are necessary to understand spoken language and to make use of what was heard. These include, but are not limited to, auditory memory, auditory sequencing, auditory attention, auditory closure, and auditory discrimination. Some of these skills are inter-related.Specialized APD test batteries generally examine several of these skills, but usually do not assess them all. Speech and language tests, along with psychoeducational and ADHD testing, may also examine some of these skills and provide supplemental information when determining a diagnosis. Recent research suggests that a deficit in more than one of these area is often the case.

The child with APD generally has problems with several specific auditory skills, and may perform below age and/or grade level on auditory processing tests if the appropriate skills are examined. Performance on these tests generally improves with age (up to a point), as the central auditory nervous system matures. It is possible that the child may eventually ‘catch-up’ and achieve age-appropriate test scores. Regardless of the scores, it is likely that the child’s academic performance can be improved through the use of special teaching techniques and activities.

• Most are male (75%).
• They have normal pure tone hearing thresholds (i.e., normal peripheral hearing).
• They generally respond inconsistently to auditory stimuli. At times, they seem unable to follow auditory instructions.
• They have short attention spans and fatigue easily when confronted with long or complex activities.
• They are distracted by both auditory and visual stimulation.
• They may have difficulty with auditory localization skills. This may include an inability to tell how close or far away the source of the sound is, and an inability to differentiate soft and loud sounds. There have been frequent reports that these children become frightened and upset when they are exposed to loud noises, and often hold their hands over their ears to stop the sound.
• They may listen attentively but have difficulty following long or complicated verbal commands or instructions.
• They often request that information be repeated.
• They are often unable to remember information presented verbally, for both short-term and long-term memory.
• They may have difficulty in counting or in the alphabet, or remembering the days of the week and months of the year, or addresses or phone numbers.
• They are often allergic to various things in the environment.
• They often have a significant history of chronic otitis media (i.e., middle ear infections).
• They have normal intelligence.

A comprehensive management approach is necessary when dealing with a child experiencing an auditory processing disorder or difference, as preferred by many. Current theory believes the best method of managing a child's listening difficulties involves a combination of direct intervention, compensatory strategies and environmental modifications/accommodations.

Direct intervention, or remediation, is usually provided by a speech-language pathologist or audiologist with expertise in this area. This intervention focuses on specific deficits (such as, difficulty remembering multi-step directions) and teaches compensatory strategies to be used in the classroom.

Compensatory strategies are essentially coping skills and repair strategies so the child can best learn auditorally presented information. Lastly, environmental modifications/accommodations (such as, the child studying in a quiet area away from background noise) both at school and home should be implemented in order to enhance the child's weak listening abilities and improve the listening environment.

The preceding information is a very general overview of an appropriate management program for a child with an auditory processing problem. For further information, please contact our office and we would be happy to refer you to other professionals in the Bloomington-Normal area who provide direct intervention. Following are lists of compensatory strategies for school and home use which have been borrowed from the Audiology Desk Reference, Volume 1, by Drs. Gus Mueller and James Hall. These strategies should not be used "generically" for all children, but, instead selected according to each child's specific needs.

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