Auditory processing disorder
Auditory processing disorder affects how the ears process sound. Learn more about what it is and what support is available to students with it.
- What auditory processing disorder is
- How APD affects learning
- How APD is diagnosed
- Strategies to help students with APD
- Support for students with APD
- Assistive technology for APD
- More information
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 auditory processing disorder (APD) do not have a sensory hearing loss, so APD cannot be identified from a regular hearing test. An APD diagnosis requires specialised audiological assessments.
Children with hearing loss may also have poor auditory processing, however, the term 'auditory processing disorder' is not used for these cases.
There is little research showing the effect of APD on learning outcomes but the evidence 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.
Students with APD may have difficulty:
- hearing a single voice in noisy classroom situations
- understanding spoken information in difficult listening situations
- understanding spoken information that is not clear or concise
- hearing in small group situations if there is competing background noise.
APD can also affect the clarity of the sound heard by the student.
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.
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.
Factors for referral
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.
Making a referral
If APD is suspected, 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.
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.
We provide an innovative learning environment tool and encourages your school board to assess classrooms and judge whether their acoustic performance needs to be improved. You may choose to carry out improvements such as installing acoustic ceiling tiles and acoustic wall linings.
Your board can use the school's property grant to install classroom sound field systems. These systems project the teacher’s voice throughout the classroom via speakers. They 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 a number of classroom strategies that can support an individual student who has some difficulty with auditory processing.
- seating the student where there is minimal background noise (for example, 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 (for example, “whakarongo mai”)
- giving clear, concise and well-spoken instructions (for example, speak at the pace of a newsreader and 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 1 other format to support comprehension (for example, 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.
We provide specialist support based on the student's individual educational needs. There are 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 as having additional learning needs, your 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).
RMHA systems may make a difference for students in noisy classroom situations because:
- Personal RMHA listening devices allow a student to hear one voice (the speaker wearing a microphone) directly into their ears through receivers
- Modern personal RMHAs 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.
RMHA devices should be considered as a part of a comprehensive management plan and not as the sole management strategy for students with APD.
Eligibility for RMHA allocation
Personal RMHA systems are allocated through our assistive technology funding in instances where a student needs this support to overcome their specific barriers to learning.
If a student with a diagnosis of APD is learning well and does not receive additional adult support in class they will not be eligible for an RMHA.
To be eligible for consideration for a personal RMHA under Ministry-funded assistive technology, a 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 our services
- show that the use of an RMHA system makes a difference to their learning outcomes.
Retrospective funding is not available.
Trialling an RMHA
A trial of a personal RMHA system makes sure the device makes a significant difference to learning behaviours and outcomes.
The school-based trial may be arranged by school staff or an audiologist. It must always include 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 2 to 4 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 will be returned to the Ministry of Education.
Apply for an RMHA
If the trial is successful, an APD application form will need to be completed.
Can RMHA be used at home?
Items allocated through our assistive technology service are allocated to and owned by the school.
RMHAs can go home as long as there is an agreement between the principal and parents or whānau.
Each school has an insurance cover to at least the equivalent level of that provided by the our risk management scheme. 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.
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