Auditory Processing

Auditory Processing Disorder in Children

What is auditory processing?

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The “disorder” part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.

Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request “Tell me how a chair and a couch are alike” may sound to a child with APD like “Tell me how a couch and a chair are alike.” It can even be understood by the child as “Tell me how a cow and a hair are alike.” These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information.

APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called “word deafness.”

What causes auditory processing difficulty?

We are not sure. Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to “hear normally,” he or she may have difficulty using those sounds for speech and language.

The cause of APD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning.

What are the symptoms of possible auditory processing difficulty?

Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to

Have trouble paying attention to and remembering information presented orally

Have problems carrying out multistep directions

Have poor listening skills

Need more time to process information

Have low academic performance

Have behavior problems

Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)

Have difficulty with reading, comprehension, spelling, and vocabulary

How is suspected auditory processing difficulty diagnosed in children?

You, a teacher, or a day care provider may be the first person to notice symptoms of auditory processing difficulty in your child. So talking to your child’s teacher about school or preschool performance is a good idea. Many health professionals can also diagnose APD in your child. There may need to be ongoing observation with the professionals involved.

Much of what will be done by these professionals will be to rule out other problems. A pediatrician or a family doctor can help rule out possible diseases that can cause some of these same symptoms. He or she will also measure growth and development. If there is a disease or disorder related to hearing, you may be referred to an otolaryngologist—a physician who specializes in diseases and disorders of the head and neck.

To determine whether your child has a hearing function problem, an audiologic evaluation is necessary. An audiologist will give tests that can determine the softest sounds and words a person can hear and other tests to see how well people can recognize sounds in words and sentences. For example, for one task, the audiologist might have your child listen to different numbers or words in the right and the left ear at the same time. Another common audiologic task involves giving the child two sentences, one louder than the other, at the same time. The audiologist is trying to identify the processing problem.

A speech-language pathologist can find out how well a person understands and uses language. A mental health professional can give you information about cognitive and behavioral challenges that may contribute to problems in some cases, or he or she may have suggestions that will be helpful. Because the audiologist can help with the functional problems of hearing and processing, and the speech-language pathologist is focused on language, they may work as a team with your child. All of these professionals seek to provide the best outcome for each child.

What current research is being conducted?

In recent years, scientists have developed new ways to study the human brain through imaging. Imaging is a powerful tool that allows the monitoring of brain activity without any surgery. Imaging studies are already giving scientists new insights into auditory processing. Some of these studies are directed at understanding auditory processing disorders. One of the values of imaging is that it provides an objective, measurable view of a process. Many of the symptoms described as related to APD are described differently by different people.

Imaging will help identify the source of these symptoms. Other scientists are studying the central auditory nervous system. Cognitive neuroscientists are helping to describe how the processes that mediate sound recognition and comprehension work in both normal and disordered systems.

Research into the rehabilitation of child language disorders continues. It is important to know that much research is still needed to understand auditory processing problems, related disorders, and the best interventions for each child or adult. All the strategies undertaken will need to be suited to the needs of the individual child, and their effectiveness will need to be continuously evaluated. The standard for determining if a treatment is effective is that a patient can reasonably expect to benefit from it.

What treatments are available for auditory processing difficulty?

Much research is still needed to understand APD problems, related disorders, and the best intervention for each child or adult. Several strategies are available to help children with auditory processing difficulties. Some of these are commercially available, but have not been fully studied. Any strategy selected should be used under the guidance of a team of professionals, and the effectiveness of the strategy needs to be evaluated. Researchers are currently studying a variety of approaches to treatment. Several strategies you may hear about include:

Auditory trainers are electronic devices that allow a person to focus attention on a speaker and reduce the interference of background noise. They are often used in classrooms, where the teacher wears a microphone to transmit sound and the child wears a headset to receive the sound. Children who wear hearing aids can use them in addition to the auditory trainer.

Environmental modifications such as classroom acoustics, placement, and seating may help. An audiologist may suggest ways to improve the listening environment, and he or she will be able to monitor any changes in hearing status.

Exercises to improve language-building skills can increase the ability to learn new words and increase a child’s language base.

Auditory memory enhancement, a procedure that reduces detailed information to a more basic representation, may help. Also, informal auditory training techniques can be used by teachers and therapists to address specific difficulties.

Auditory integration training may be promoted by practitioners as a way to retrain the auditory system and decrease hearing distortion.

Dad's and Birth Defects

Dads and Birth Defects: The Inside Story
by Christina Jeffery

It used to be thought that only the mother controlled the health of her unborn child so that if any problems in fetal development arose, they must be traced to her alone. New studies, however, have broadened this idea, showing that the blame for some problems in fetal development can also be placed on the father. A male's lifestyle, such as the use of alcohol, cigarettes, and other drugs, as well as exposure to certain industrial chemicals, has been shown to affect characteristics of sperm cells in ways that harm the fetus.

Alcohol

Recently, there has been much emphasis on a birth defect called Fetal Alcohol Syndrome. This defect results when a mother drinks during pregnancy, causing malformation in the development of the fetus. A question has been raised on what role a father plays in causing FAS. Can a male's drinking result in the embryo being exposed to alcohol at fertilization, and therefore get FAS? The answer to that question is, "no." Research done so far has sown that there isn't a way for a growing fetus to obtain FAS by means of the father. This does not mean, however, that the baby isn't affected by its father's drinking.

Alcohol consumed by the male can lead to a variety of problems in the reproductive system. Unlike females, whose eggs are all made during pre-birth development, males continuously make sperm throughout their lives. Some studies have shown that alcohol consumed by the male can enter the testicles through the bloodstream. The drug then seems to mutate some characteristics of the sperm. After exposure, they can end up with deformed heads or tails, hindering their mobility. Alcohol could also be transported to the ova via the semen and expose the embryo to levels of this toxicant. In addition, alcohol-affected semen could alter embryo maturation.

These mutations can lead to birth defects, miscarriage, or illness in the resulting baby. When children with fathers who are heavy drinkers and non-alcoholic mothers are compared with those with FAS, the children of the drinking fathers are not grossly malformed, but they do have certain intellectual and functional deficits, and they are also more likely to be hyperactive.

A number of studies involving animals have been carried out, looking at the effect of paternal alcohol consumption on the offspring. Studies have shown that exposing a male animal to alcohol can lead to changes in embryonic and fetal development, litter size, offspring viability, and increased susceptibility of the offspring to infection. Infant malformation and mortality also resulted from paternal alcohol consumption.

A series of rat studies have exemplified these results. Compared to normal rats, male alcohol-sired rats had significantly lower levels of testosterone, as well as disturbances in hormonal function, less beta endorphin, and lighter seminal vesicles. Female offspring from fathers who were exposed to alcohol had abnormal baseline levels of certain stress-related hormones, and responded differently to stress than normal control rats.

Another study showed that a father rat that is exposed to alcohol, and then had a drug free period with enough time to restore normal hormonal status, still produced male and female offspring suffering abnormal development. This information shows that alcohol, even alcohol use after a limited time, could have some residual effect on the success of the future father. In his report, "The Effects of Paternal Exposure to Alcohol on Offspring Development," Dr. Theodore J. Cicero says that "it seems clear that paternal pregestational alcohol administration can produce adverse effects in the offspring." Alcohol also seemed to affect the male user's sexual performance, on top of causing problems with fertility, viability of offspring, and maturation of the fetus and newborn.

Dr. Cicero sums it all up when he suggests the possibility of three factors which could be affected by male alcohol consumption. First, alcohol could affect characteristics of the sperm - perhaps mutating genetic material. Second, sperm may be "chosen" in such a way that only a few are intact following exposure to alcohol. Third, alcohol could alter the chemical composition of the semen, which may influence the activity of ejaculated sperm. In any of these ways, the sperm is harmed by alcohol, which in turn, causes a negative impact to the development of the fetus.

Even with all this evidence before us, it is still difficult to conclude the exact effects of alcohol consumed by the male. Comparing some studies is difficult because of limited subjects and loose controls. Also, a study carried out in England showed paternal drinking to be unrelated to predicting birth weight in humans. Dr. Sterling Clarren, a top researcher in the field of studying the effect of alcohol on a fetus, says that "it is possible but not yet proven, that alcohol does alter sperms."

With all this said, a male should still really think twice before reaching for that mug of beer or glass of wine. Not only are you hurting your body, but you could be affecting the lives of any future children. Alcohol consumed by the male before conception can cause birth defects, so plan ahead if you are wanting to father a healthy child. You could be doing more harm, both to yourself and others, than you think.

Smoking

In America, smoking is a pressing problem. Many times, teenagers become hooked, and then continue smoking throughout their adult life. Most everyone has seen the Surgeon General's warning saying that lighting up could cause lung cancer and other health problems for the smoker. There is a new focus on how smoking can affect the next, unborn generation.

Dr. Bu-Tian Ji has conducted research in China which shows the connection between a father's smoking and childhood cancer. China is a nation in which men smoke more than women. His team isolated families with no past history of cancer where Dad smoked and Mom didn't. The team concluded that the children of men who had smoked at any point in their lives were thirty percent more likely to have cancer than children of fathers who didn't smoke. Past smoking habits still seemed to affect the health of the child, so the hypothesis was made that perhaps the environment of the sperm is damaged by male smoking, causing possible damage to fresh sperm, or hindering the body's ability to protect the new sperm. Dr. Ji's study did not include the possibility of the culprit being second hand smoke inhaled by the mother, but other studies have shown that the rate of cancer was not affected when it only was the mother who smoked. Therefore, it is reasonable to believe that the sperm may be the cause of this health problem.

Like alcohol and other drugs, cigarettes harm the human body. In males, smoking has been shown to affect the sperm. The deformed sperm are more likely to cause miscarriage and problems for the fetus. Studies in the 1960's showed that fetuses with fathers who smoked were more likely to struggle for their lives than the offspring of non-smokers. The studies also showed that the death rate was forty percent higher among a group of subjects with smoking fathers.

Smoking can cause even more problems, both for Dad and the baby. The bodies of males who light up can produce free radicals, or molecules which damage cell parts and the chromosomes in sperm. Lower birth weight and increased risk of disease in babies has been connected with a father's smoking. Cigarettes that are smoked by a male can contribute to infertility by causing varicocele, a swelling in the veins of the scrotum, which can cause a miscarriage. Smoking half a pack or more a day has been shown to reduce sperm count by as much as twenty percent.

If you are planning to start a family, a good way to begin would be to quit the puffing. It not only hurts your own body, but can have an effect on the health of your unborn child.

Chemical Exposure and Other Substances

Can a male's job affect his ability to reproduce? Studies have shown that it can. A male's exposure to lead has been associated with his partner's miscarriage. This substance and others, such as Ethylene oxide, the pesticide DBCP, and ionizing radiation can negatively affect human reproduction. They may adversely affect the male reproductive system, and sperm count, which can lead to infertility, miscarriage, or still birth.

In addition to problems from chemical exposure at work, when a male ingests cocaine before conception, the cocaine has been found to bind the sperm cells and thus expose the baby at fertilization and cause numerous problems.

Conclusion

The secret to a healthy family is in the hands of the father as well as the mother. The new research that has been carried out has shown how much a father can affect the life of his unborn child. Alcohol consumed months before conception can cause defects in the sperm. Since sperm cells are made continuously throughout a man's life, they are at more risk of mutation, thus increasing the chance that the baby may have problems. A male should plan ahead for a healthy family. Good steps would be to quit smoking, drinking, and using drugs, and also do as much to protect oneself from exposure to harmful chemicals at work. Such actions will not only lengthen a person's life span, but will also increase the possibility of having healthy children in the future.

Bibliography

Cicero, Theodore J. "Effects of Paternal Exposure to Alcohol on Offspring Development,: Alcohol Health and Research World, Vol. 18, No. 1, (1994) pages 37-41.

Clarren, Sterling. E-mail message to the author. 21 May 2000.

Passaro, Cristi Tolo, Little, Ruth E., Savits, David A., Noss, John and the ALSPAC Study Team. "Effect of Paternal Alcohol Consumption Before Conception on Infant Birth Weight," Teratology, Vol. 57 (1998) pages 294-301.

Williams III, Burney. "Toxic Dads," Parenting, (October 1998) pages 95-06, 99, 101-102.

-----. (undated)._Beginning at the Beginning: Understanding the Biological Basis for FAS [Online]_. Available: http://www.fasalaska.com/basis.html

-----. (undated)._Fetal Alcohol Syndrome Information Sheet [Online]_. Available: http://www.hss.state.ak.us/dada/fas/fas.htm

-----. "Men Have Babies Too: A Guide for Fathers to Be," Brochure of the March of Dimes Birth Defects Foundation, (1996).

Part II: Why Brain Training Academy?

Many children struggle with communication and learning issues. A major reason for these struggles is related to underdeveloped brain systems that are crucial for the development of communication and learning. For many children, it is difficult and often impossible to effectively communicate and to remember or retain classroom instruction or parents’ directions. Each individual’s brain develops at a different pace. If the brain is not prepared to receive and retain information that is developmentally appropriate, then social and emotional communication and academic learning suffers. These are the children that seem to be consistently “Out-of-Sync” with their peers.

Why the “Out-of-Sync” Child?

Research shows an almost 4000% increase (yes, that is 4000%!) in medical doctors prescribing childhood medications for various diagnoses such as ADD/ADHD, Autism, Anxiety, Depression, Oppositional-Defiant Behavior Disorders, and Bi-Polar Disorders. Why has this occurred?

Disconnect Between Child Development and Educational Curriculum Demands

The educational demands on children and their development is “out of sync”. The revised developmental milestones for children have a few startling changes. In the past, the ages of 9 to 12 months was the expected time for walking. Now it is 12 to 15 months. In the past, crawling was seen as a key milestone. There is now serious discussion of dropping crawling as a milestone. Research on developmental milestones, especially sensory-motor development, has found that children of 30 years ago were doing at age three years what children today are doing at age five years. How did today’s children fall two years behind in their sensory-motor development within one to two generations?

We know that during the past thousands of years, humans used much more physical activity to get from one place to another or working more with their hands to generate their incomes. In 1900 the majority of people were using walking and horse and buggies for transportation. My own grandmother came to Kansas in a covered wagon at the age of four. When she passed away in 1969 at the age of 83, man had walked on the moon.

By the mid 1950’s, we still, as a society, were more interactive with the natural environment. Mothers would tell their children to go outside and play. And we did. The whole day was spent exploring, laying in the grass looking at clouds, eating fresh foods grown from our gardens, playing made-up games with neighbor children, and staying out until supper. We were active kids who also had to learn to negotiate our own disputes among neighborhood kids. There were not as many organized sports leagues for children not yet in high school. Therefore, we had to be creative in our play and creative in how to settle disagreements.

Kindergarten was a half day. It was a curriculum that taught children how to share with other children, how to play interactive and physical games, how to color and how to paint and how to sing in a group. Children recited chorally rhymes and songs often while marching in a group. First grade was when we were introduced to formal alphabet and number symbols. Our bodies and brains were allowed to physically develop before we had to move to abstract symbol systems that represent reading, writing, spelling and arithmetic.

Our babies had become “containerized”. What is a containerized baby? Because of the strong consumer safety movement and the fact that the majority of families no longer have one parent remaining home to raise the children, our babies are placed in safe and convenient containers for a large part of the day. Babies are placed in an infant seat that can be transferred to a car seat that can be carried into the store while the caretaker shops or babies are carried into daycare and may remain in the container as long as they are quiet and content. When the baby is brought home it is convenient to keep the baby in the carrier while the caretaker does chores. Without realizing it our babies spend the majority of their time in a container. This results in our babies having significantly less motor movement. Without motor movement to explore their environment, the development of all seven senses is delayed. Without exploring their environment the senses of touch, sight, hearing, smelling, tasting, balance and proprioception (a sense of where one is in relationship to the environment or spatial relationships) are all delayed. We also have more toxins in our environment so many babies battle ear infections (middle ear) that delay the acquisition of speech, language and balance (inner ear).

In tandem with changes in child development, our economy and our culture has become very aware of the “global economy”. We are competing with Japan, India and China. As leaders and thinkers begin to predict the outcome of our place in the world’s economies, they look at the education systems of other countries. It is determined with the help of researchers that “earlier is better”. Early education was seen as a way to get a “jump-start” for our children in being able to compete with the other world economies. We began to replace half day kindergartens with full day kindergartens. Once a full day kindergarten was implemented, the time had to be filled; and after all, earlier is better! And because most educators are focused on written learning such as reading, spelling, writing and arithmetic, the result is that kindergarteners are now being introduced to reading, spelling, writing and arithmetic at about age five years.

We have containerized babies moving into a “containment of children” school system. The majority of these children have had limited opportunity to move about and explore their world as we did in previous generations. These children are being asked to attend school for seven hours a day, five days a week (and some children spend as much as two hours a day on buses to and from school). Research is showing us that these kindergarten children at age five are at a motor and sensory developmental level where three year olds were a generation ago. BUT, we are asking our five year old children to do academically what seven year old children did a generation ago. The past generations had much better developed sensory systems that supported academic learning. Past generations had better eye-hand coordination and visual tracking coordination and visual convergence abilities because they were exposed daily to the natural environment. Today’s children are not as experienced with navigating the natural environment or exploring and problem solving situations they may encounter. One reason is that the recreational activities are so organized. Kids today are mostly in organized sports where the adults manage how everything is played, how to negotiate disputes, how to learn a specific skill, etc. In the past, kids were told to go outdoors and entertain yourself. If there was a dispute usually the kids worked it out. Kids came up with made-up games and made their own rules. And they discovered that some kids were not good at sharing, so they learned to negotiate or make decisions about who they would or would not play with in the future. Now kids are told all of that via the coaches or teachers or daycare workers as the priority is to manage a group of kids. And we wonder why these children are inattentive? We wonder why some children are throwing tantrums? We now have a generation of children who start out at least two years behind developmentally. And when a person, no matter the age, is in a stressful situation they will look for something to comfort them. Video games are very comforting to some. Food is very comforting to some. Drugs are very comforting to some, especially adults who have to deal with a severely “out-of-sync” child.

Expectations of these children are consistently out-of-sync with their development. Why is it that Kindergarten children are expected to read and do beginning math? If their sensory systems are developed now at about where three year olds were 50 years ago, there is a grave disconnect between what these Kindergarten children’s brains are capable of processing. In Many Western European and New Zealand schools formal reading and math is not introduced until age seven. This results in fewer learning, attention and discipline problems because the brains are ready.

From the 1950’s to the 1990’s our economy, and thus our culture was making a major shift from the slower pace of previous generations to an attitude of faster, bigger, more intense was better. To achieve the new standard of living both parents often were working. Thus, children had to be placed somewhere. By the 1990’s several cultural changes had occurred. Our economy was no longer tied to the industrial-agrarian society. It was the information age. Books such as Future Shock, Megatrends, 1984, Animal Farm to name a few warned of the loss of individuality and becoming out-of-sync with our own bio rhythms and our natural environment. A cult classic video of the 1970’s provided a visual and audio story of how out-of-sync civilization was becoming. The movie was Koynasquati. Check it out for the sensation of losing touch with ourselves and our natural environment.

We're Back! Part 1 of a 3 Part Series!

It has been busy at Swank Enrichment Center but new blog entries are coming! We would like to start off with a 3 part series by Dr. Linda Swank.

Part I: Training the Brain

Case Study Sam was a second grade boy who had been referred because his teachers and parents had described him with the following characteristics:

1. Oppositional
2. Hyperactive
3. Anxious-Shy
4. Perfectionism
5. Social Problems
6. Psychometric
7. Emotional Lability
8. Hyperactive-Impulsive

Neuropsychological testing identified him as having a superior IQ. He was diagnosed with ADHD. Occupational Therapist diagnosed him with deficits in motor planning, reflex integration, self-regulation, ocular pursuits, grapho-motor, visual motor, proprioceptive and balance. Speech and Language testing identified significant delay (5th percentile or lower) in following directions, expressive language and word retrieval.

Sam came to our center for approximately one year. He averaged 2 sessions per week for 90 minutes per session of brain training therapy for eight months. The last three months he came only one time per week for about 90 minutes. He completed two brain training protocols that targeted (1) attention and concentration and (2) reading and auditory processing.

At his exit interview Sam was now in 3rd grade making A’s in all of his subject areas. He had friends and was seen as a peer that was compassionate with others. He was now at grade level for following directions. His expressive language was now within 6 months of his chronological age. His word finding had gained 25 percentile points to be in the average range. The parents said they would testify that this therapy had changed their son’s life.

Brain Training at Swank Enrichment Center

The brain-training programs used at our Brain Training Academy have proven highly effective in changing the “out-of-sync” child. Brain training interventions optimize the brain. The brain training helps each individual child develop the skills needed to succeed communicatively, academically, socially and emotionally. The specific brain training techniques used in our program stimulates the development of new neural pathways that enhance the brain systems for improved memory, attention, auditory processing, logical thinking and speed of response for improved word retrieval, reading and math fluency. These newly developed neural pathways facilitate learning to make it easier to learn new skills and to communicate with others.

Brain training is based on the “plasticity” of the brain and its ability to build new neural pathways. Our program develops targeted areas of the brain that through behavioral assessments indicate delays or possible deficits. Our brain training techniques also target the more developed areas of the brain to acquire a balanced brain development.

At Swank Enrichment Center we are continuing to see excellent results from our brain training program! This is exciting for us as well as our clients. Brain training is often preferred as an alternative to medications or aides in decreasing need for medication when dealing with ADHD, ADD, Autism Spectrum Disorder, and Bipolar Disorder in children, and more.

I strongly recommend watching the 2008 Frontline program on this subject. The link is: PBS Frontline: Medicated Child