Auditory Processing Disorders in Children Post-Institutionalization

By

Jay R. Lucker, Ed.D., CCC-A/SLP, FAAA

Certified/Licensed Audiologist

Specializing in Auditory Processing

Among the many concerns families have regarding the children they have adopted is whether communicating with the children is successful. Additionally, since communication serves a basis for developing academic skills, reading, and socialization, parents are especially concerned how well their children take in the verbal messages they receive and accurately and efficiently use this information. We can refer to the taking in and using of verbal information as auditory processing, and problems in these processes as Auditory Processing Disorders or APD.

For many children who have spent part or most of their early lives in orphanages in Eastern Europe, Russia and other states of the former Soviet Union, auditory processing may be disordered, undeveloped, or inappropriately developed. These children may be having communication difficulties, social problems, learning deficits, language disorders all because they lack development of normal auditory processing skills. Yet, with appropriate assessment, proper management and intervention when necessary, these children can improve how they process and deal with auditory-verbal information.

Auditory processing may be thought of as the internal processes a person uses to make sense out of verbal messages. Auditory processing has been described by Jack Katz as "What we do with what we hear." (Katz, Stecker, and Henderson, 1992). Additionally, Frank Musiek described auditory processing as "How the ear talks to the brain." (Chermak and Musiek, 1997). For a long time the term Central Auditory Processing Disorder or CAPD was applied in this area. However, in view of recent conceptualization regarding what is involved in auditory processing, the term Auditory Processing Disorder or APD is currently being used.

One way to view auditory processing is to see it as a series of steps beginning after a person hears or "receives" an auditory signal at the ear and proceeds through the ear to the auditory nerve where the information passes to through the central nervous system to the brain. As such, the entire ear, auditory nerve, and central nervous system are involved in processing verbal messages. Additionally, the efficient and accurate processing of verbal information sets the basis for our processing written text (reading and writing) as these may be considered auditory overlaid areas. That is, problems in auditory processing can have profound, negative effects on the normal development of reading and writing skills. This has led many in the field of dyslexia (or reading disorders) to view reading problems as primary auditory-language deficits.

The ultimate goal of auditory processing is to extract the important relevant information from the on-going stream of auditory messages one receives. In this process, we must take in what we have heard, extract information, store the information in working memory, make decisions about what bits of information we should save and what we can discard, put the bits of information together to form unified wholes, convert these bits into mental images and modify these mental symbols as new information is processed, and establish a plan for acting on the information comprehended whether merely to think and reflect on it or do something specific. Last, we take our actions, modifying what we do based on new information we receive and process. All of this is done in a matter of seconds while the stream of on-going auditory information rapidly flows past our ears requiring us to utilize many processes.

When we consider the complexity of this task, we need to consider that effective and efficient processing involves auditory systems, language knowledge, application of linguistic rules, attention factors, memory storage and later recall, decision making about the information we have received, and internal organization and planning. Considering all of these processes, we are tapping into auditory systems, language systems, cognitive systems and others. These others involve our emotional state at the time we are processing information, what experiences and familiarity we have with the information and topics of the messages presented, how well these experiences are stored and can be recalled, and how flexible we are in our decision making and problem solving when problems occur. Thus, auditory processing is not just an auditory phenomenon when viewed as outlined above.

Why is this important for us to understand? Because children can have problems in one or more of the many systems and processes critical for appropriate auditory processing to take place. For example, the mere development of auditory skills requires proper stimulation. Research has demonstrated that children as young as a few months can discriminate and distinguish between their mothers’ voices and those of other people, even women with voices of similar pitch to the mother. At the same age of 2-3 months, infants can discriminate changes that differentiate sounds of speech such as "bah" vs. "gah" or even "pah" vs. "bah." Yet, these infants cannot produce the "p," "b," or "g" sounds or can merely produce sounds that are "p," "b," or "g" –like in their reflexive babbling. However, the ability to make these auditory discriminatory distinctions is critical for later development of a speech sound system (called a phonological system). Furthermore, this phonological system serves as a base for phonics in reading.

Children who have been institutionalized may have undergone auditory deprivation. How can they learn to distinguish one voice from another when the sounds of their world, in the orphanage, are a jumble of many children and infants crying or, perhaps, music played randomly without purpose other than to, hopefully, soothe the children. For many, the music can serve as auditory stimulation, but stimulating what processes? This can lead to underdeveloped or malformed processing capabilities in many.

Is the situation hopeless? No. If it were hopeless, you would not have given all of your love and support to your children. And you can help you children even if they have APD. When a child seems to mishear or not respond appropriately to auditory messages, consider that the child has some auditory processing problems and may not just be misbehaving. Some of the symptoms include:

• Inability to follow multistep requests, directions, commands
• Repeating inaccurately what was said to the child
• Following through on only part of a verbal message
• Difficulties with early reading and writing skills
• Errors in speech such as problems producing "r," "er," and "l"
• Sensitivity to sounds, especially sounds that others might say are not too loud or are not annoying (like ticking clocks, beeps from microwaves and computers)
• Sensitivity to soft sounds such that the child hears and is overly aware of sounds that others barely hear or you are not even aware of until the sound is closer (such as a child who hears a car turning the corner one street away and asks "Is that daddy driving home?" and it isn’t until daddy’s car is visible from the house that you realize the child heard daddy’s car turning the corner)
• Fluctuations in hearing so that sometimes the child seems to hear fine and other times seems not to hear well at all (often associated with chronic middle ear infections and fluid)
• Slow development of oral language skills especially understanding or receptive language abilities

If your child shows these symptoms or you suspect he or she has auditory processing problems, you should consider having a comprehensive auditory processing evaluation done. Since, as described above, auditory processing involves auditory factors, language factors and cognitive factors, all three areas should be assessed if they have not been done. Cognitive areas are assessed by psychologists, neuropsychologists, or some educational specialists who hold degrees in psychology. The language assessment should look at both language knowledge (often referred to as receptive and expressive language abilities) as well as language understanding or processing that looks at patterns of errors in order to determine specific areas of language that are deficient such as the lexical (word meaning) level, the morphological level (word parts), sentence (syntax or grammar) level, and sentential understanding (semantic) level as well as language use (pragmatic level). Language testing is usually accomplished by certified and licensed speech-lanugage pathologists. Last, a comprehensive audiological evaluation should be completed to rule out any possible hearing problems as well as determine how your child takes in an deals with auditory-verbal messages that have been distorted, altered or presented in unusual ways purposefully to assess auditory processing abilities.

The outcome from a comprehensive and appropriate assessment of all areas of auditory processing abilities can lead to your understanding how your child processes what he or she hears and what your child is and is not able to handle. Perhaps it is the rapid rate of on-going verbal information that is causing the problem and slowing down the rate, providing pauses between ideas or sentences for complex processing time to elapse, and using simpler language to make processing less demanding can help your child. Maybe the problem is the overload of too much auditory stimuli with a child who does not yet know how to select what is and what is not relevant for processing. Applying technology to help the child could mean a child seen by teachers as having severe attention problems vs. a child for whom the world of sound is less chaotic. In the end, getting your child properly assessed and having auditory processing appropriately diagnosed can lead to significant improvements in interpersonal communication, learning, and academic development. And, what is even better, we can help our children succeed and meet their fullest potentials as adults.

 

Author’s Bio: Dr. Jay R. Lucker is a certified/licensed audiologist and speech-language pathologist in private practice specializing in auditory processing. He currently is associated with Dr. Ronald Federici practice, Psychological and Neuropsychological Associates, P.C., in Alexandria, VA. He may be reached at (703) 548-0721 or via email at drj@ncapd.org. If you would like to learn more about Dr. Lucker, visit Dr. Federici’s website at www.DRFEDERICI.com or the NCAPD website at www.ncapd.org where you can also learn more about auditory processing disorders and view a simulation of these problems.