Auditory Processing Disorder (APD)
Auditory Processing Disorder (APD) is a hearing disorder in which the ears process sound normally but the hearing centres and circuits of the brain don’t correctly process incoming auditory information. Sounds are jumbled during neural processing in the brain.
People with APD do not have a sensory hearing loss so APD cannot be identified from a regular hearing test but requires specialised audiological assessments. (Children with a hearing loss may also have poor auditory processing, however, the term APD is not used for these cases).
- How does auditory processing disorder (APD) affect learning?
- How do I know if a student has APD or they are just not listening?
- What school and classroom strategies can help students hear?
- What should I do if I suspect a student has APD?
- What support is available through the Ministry of Education?
- What is the school support?
- What if specialist assistive technology is required?
- Would my student be eligible for specialist assistive technology?
- Eligibility through Ministry services
- Trial of the RMHA system
- Making a RMHA application
- Can RMHA be used at home?
- What happens when a student transitions between schools?
Students with APD may have difficulty hearing a single voice in noisy classroom situations. Understanding spoken information in difficult listening situations or when the information is not clear or concise. APD can also affect the clarity of the sound heard by the student.
Little research has been completed to date that looks specifically at the effect of APD on learning outcomes. The research evidence gathered so far shows that APD often occurs along with a variety of learning difficulties. It is not yet clear if the learning difficulties are directly caused by the APD or if APD is one part of a range of difficulties experienced by some students.
What is clear is that students with severe APD struggle to hear their teacher’s voice in some classroom situations and are likely to miss whole class verbal instructions. Further, and more importantly, students with severe APD will struggle to hear even in smaller group situations if there is competing background noise.
APD can only be diagnosed by specialised paediatric audiologists. There are some factors to help you decide if a referral to a specialist is appropriate. As with many conditions a student may have mild or severe APD. Some students will be on the margin between normal auditory processing and having APD.
Students with APD may miss both highly rewarding instructions as well as instructions that they may wish to avoid. If there are any concerns about APD and/or attention, formal assessment is recommended.
If a student has APD they may:
- miss some class instructions and have to watch or ask others what to do after verbal instructions are given
- ask for instructions to be repeated even though they appeared to be focused and trying to listen the first time
- have difficulty retaining information when it is only given verbally
- appear overwhelmed in noisy classroom situations especially when there are a lot of different noises at the same time
APD often coexists with other learning difficulties and can have similar presentations. For this reason it can sometimes be difficult to identify the cause of learning difficulties.
Students with a diagnosis of APD need more help than can be offered by just improving classroom acoustics. For some students with mild to moderate difficulty hearing, simple changes can be useful.
Poor acoustics found in many older style classrooms can greatly influence learning, particularly for young children.
The Ministry of Education provides an Innovative Learning Environment tool and encourages boards of trustees to self-assess classrooms and judge whether their acoustic performance needs to be improved. Improvements, such as installing acoustic ceiling tiles and acoustic wall linings, can be carried out.
The board of trustees can use the property grant to install classroom sound field systems. These systems distribute the teacher’s voice throughout the classroom (via speakers) and can benefit a number of students by improving the level of the teacher’s voice relative to background noise at the student’s location in the classroom.
There are also a number of classroom strategies that can support an individual student who has some difficulty with auditory processing. These include:
- seating the student to minimise background noise, such as away from fans, computers, heaters and road traffic
- checking that the teacher’s voice is clearly heard wherever the student is in the classroom
- taking care to gain the student’s attention before giving verbal instructions (e.g. “whakarongo mai”)
- giving clear, concise, well-spoken instructions (e.g. speak at the pace of a newsreader, but also use intonation and pauses to help convey the message)
- giving short snippets of information where possible
- checking students’ understanding by asking them to rephrase
- presenting verbal information in at least one other format to support comprehension, such as adding images, written instructions, graphic organisers or multimedia presentations
- teaching and reinforcing the learning of specific listening skills and behaviours, such as active listening, questioning, restating
- allocating a peer or buddy to support the student with listening difficulties and encouraging them to use the buddy to check their understanding of tasks and instructions
- using other teaching strategies such as pre-teaching vocabulary, providing keywords and allowing time for students to process spoken information.
APD can only be diagnosed by a specialised paediatric audiologist. Before this step is taken it is important to have a standard hearing test to make sure that the student does not have a sensory (peripheral) hearing loss.
If the standard hearing test shows normal hearing but you suspect that the student is having difficulty with auditory processing it may be useful to keep a log to track specific instances that concern you. You could also ask others to do the same so that you can see if this problem occurs in multiple environments or is specific to one situation.
If APD is still suspected the family/whānau should make a referral to a qualified paediatric audiologist for a full auditory processing assessment. If the diagnosis is confirmed the audiologist will recommend a range of management strategies to help the student to develop their auditory processing skills.
The Ministry provides specialist support based on the student's individual educational needs. There are Ministry of Education services available to those with high levels of need.
A medical diagnosis of APD alone will not automatically result in the allocation of additional learning support.
If a student with APD is identified by their school as having additional learning needs, the school can allocate extra resources to support them.
This support could be directly from the school or through other services such as Resource Teachers Learning and Behaviour (RTLB) or speech language therapy.
In severe cases, students with significant learning needs who are diagnosed with APD may be advised by their audiologist to trial a personal remote microphone hearing system (RMHA) to see if it will make a difference for them in their noisy classroom situations. RMHA systems should be considered as a part of a comprehensive management plan and not as the sole management strategy for students with APD.
Personal RMHA listening devices allow the student to hear one voice (via a microphone) directly into their ears (through receivers). This is different from a classroom sound field system that distributes sounds throughout the room via speakers.
The personal RMHA system can only receive one voice at a time so does not help with general hearing. Modern personal RMHA systems do not block the ear so the student can hear other students speaking in the classroom in the normal way, but the teacher wearing the microphone will be the most audible. These systems are useful for hearing only one primary speaker. This includes situations such as whole class and small group teaching or during formal discussions or speeches.
The personal RMHA system is allocated through the Ministry’s assistive technology funding when the student needs this support to overcome their specific barriers to learning. If a student with a diagnosis of APD is learning well, and not receiving additional adult support in class they will not be eligible for this Ministry of Education support.
To be eligible for consideration of a personal RMHA system under the Ministry of Education assistive technology, an individual student must;
- have a formal diagnosis of APD from a specialised paediatric audiologist.
- be receiving additional learning support to address their learning needs through one of the Ministry’s services (see below)
- show that the use of an RMHA system makes a difference to their learning outcomes.
Note: Retrospective funding is not available.
Students are eligible to apply for assistive technology if they are receiving additional learning support through any of the following Ministry of Education Learning Support services:
- Ongoing Resourcing Scheme (ORS)
- Speech-language (communication) service
- Behaviour and Support services (BSS)
- In-class support (ICS)
Or be receiving additional learning support in their school. The student must meet all of the following requirements;
- Has a current individual learning plan and;
- Be receiving ongoing monitoring /support by school leader of additional learning e.g. SENCo, Learning Support Coordinator and;
- Be working at least one level below the expected NZ curriculum level and;
- Is receiving additional adult support in class for a minimum of two hours 1:1 (individual) or four hours (small group) per week i.e. from teachers, RTLB, RTLit, teacher aides or a combination of all. This additional learning support needs to have been in place for at least three months.
Assistive technology support is available only for individual students (not groups of students). The assistive technology fund supports a student’s presence, access to participation/engagement, and learning.
In addition, the student must be attending a registered school (compulsory education) or be formally exempt from school but residing in New Zealand.
Once you are sure the student is eligible please contact your local Assistive Technology Coordinator to confirm an application to the Ministry of Education is appropriate.
A trial of a personal RMHA system is undertaken to ensure the RMHA system makes a significant difference to learning behaviours and outcomes. The school-based trial may be arranged by school staff or an audiologist but always includes the school team, which includes the teacher and specialist support staff (such as the Speech Language Therapist, RTLB, ORS teacher and SENCO/LSC).
Schools who wish to initiate a trial for an eligible student should contact their local Ministry office for support to trial the RMHA system and set up data collection systems.
Before the trial the team will identify the learning behaviours they expect the RMHA system to support. During the trial, school staff will monitor use of the equipment and the targeted learning behaviours to document what difference the RMHA system is making for the student's learning outcomes. In cases where APD specifically affects speech discrimination in background noise, it is likely that changes in learning behaviours will be evident immediately.
The length of the trial is usually between two to four weeks but longer trials are sometimes necessary to ensure that the technology is making a difference, showing accurate listening benefit and results. If no significant changes to the targeted learning behaviours are noted after the trial period the device would be returned to the Ministry of Education.
If the trial is successful, an Assistive technology – Auditory Processing Disorder application form [DOCX, 160 KB] is completed so that the personal RMHA system can be allocated to the school to support the individual student.
Items allocated through the Ministry’s assistive technology service are allocated to, and owned, by the school. RMHA systems can go home as long as there is an agreement between the school principal and parents/whānau.
Each school has an insurance cover to at least the equivalent level of that provided by the Ministry of Education’s ‘Risk Management Scheme for School Contents’ policy. This insurance policy covers all assistive technology while it is being used for educational purposes at school as well as off-site, in transit and at home.
The principal may also make an agreement with parents about the responsibilities for the care and safety of equipment when it is at home. This is more likely if the items have previously been lost or broken at home and have been replaced.
Please refer to our insurance and repairs fact sheet for more information about the Ministry’s ongoing support in case of loss or damage.
Students with RMHA systems who are changing schools should take their allocated assistive technology with them.
The transition should be planned so that information about the purpose of the specific assistive technology and the way it is used is shared with the new school, including a copy of the original APD application form. With permission from the family/whānau, this might include specific examples of the purpose and use of the RMHA system.
For more ideas and resources:
- Inclusive Education Online Knowledge Centre guide(external link) – managing times of change.
- The New Zealand Guidelines on Auditory Processing Disorder(external link) – guidance to professionals supporting children and young people with Auditory Processing Disorder.
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