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).