Is It ADHD or Auditory Processing Disorder?

Does your child struggle to block out background noise, follow conversations or pronounce words correctly? Is she hypersensitive to sound? She may have an auditory processing disorder in addition to, or mistaken for, ADHD.

Is it ADHD or APD?, Part 2

Language processing problems. This component of APD is the most troublesome. It affects a child's abilities to understand what's being asked of him and to socialize with peers. A child with this cognitive glitch has trouble taking oral tests and becomes confused when reading and telling stories with lots of characters and events. He will often pass up a chance to hold a conversation because of the time it takes to process words being spoken and to formulate responses.

Christina suffered from all three elements of APD. She never sang as a small child, even though she clearly enjoyed listening to music and to others' singing. "Christina could never put everything together — the words, the rhythms, the tunes," says her mother, Tricia. "Her hearing was fine — exceptional. But put her into a circle of kids singing nursery rhymes and playing spoons and tambourines, and all she wanted was to get away!" When Christina was finally diagnosed with APD, Tricia was relieved.

Diagnosing APD

"Not all language problems are due to APD, and not all cases of APD lead to language and learning problems," cautions Bellis. APD isn't diagnosed by checking off a laundry list of symptoms.

The only way to diagnose the condition is with a battery of tests, performed by an audiologist who monitors the child's hearing. A child listens to words and sentences as background noise is slowly increased and to instructions spoken at faster speeds, to determine if the ability to listen decreases.

A child should be at least 6 or 7 years old before undergoing testing. "The symptoms you commonly see in a 3- or 4-year-old are sound sensitivities and difficulties discriminating between sounds, which you'll hear in their speech," explains Wendy Tepfer, a speech and language pathologist in New York City. "They need to work with an expert in APD."

When a child reaches school age, however, Tepfer advises that APD may begin to compromise academic success. "At that age, I would recommend evaluation for APD," she says, "because now, it's not only the language but also his performance in the classroom. To manage the disorder, the student may need remediations other than speech and language therapy. A full evaluation will help you know what those are."

The treatments

APD can be treated from childhood through adolescence — when the auditory pathways stop developing — and even later, although experts agree that the earlier the diagnosis and treatment, the better. As with ADHD, a combination of professional, school, and home therapies is most effective.

Working with a professional

Treatment includes a wide variety of exercises that target specific auditory deficits. Therapy can range from computer-assisted software programs like Fast ForWord and Earobics to one-on-one training with a speech and language therapist. Here are some common approaches:

  • To overcome sound discrimination problem, a professional trains the child's brain to differentiate sounds — first in a quiet environment, then with increasingly louder background noise.
  • To sharpen auditory memory, an audiologist uses sequencing routines — having the child repeat a series of numbers and directions — to exercise the listening "muscles."
  • To manage language-processing problems, a therapist will train and encourage a child to ask a teacher, adult, or peer to repeat or rephrase an instruction or comment. The therapist and child might also work on developing a customized note-taking system that enables him to capture the information being taught in the classroom.

At School

Classroom accommodations can often include:

  • Improving the acoustics — closing a window, shutting a door, adding a rug — can help an APD child "hear" the teacher.
  • Seating a child in the front of the classroom, away from students who might be disruptive, will also enhance a child's ability to listen.
  • Asking a teacher to face a child, speak slowly, and use simple sentences when giving assignments can help an APD student retain the information. Writing instructions on a blackboard or a piece of paper can reinforce what was said.

At Home

The following tips will increase your child's ability to listen when he or she is at home:

  • Don't try to have a significant conversation when your child is in another room, watching television, or listening to music - or when an appliance is running.
  • Before you start a conversation, be sure your child is ready to listen (finished with what she was doing). Also, face her directly and make sure she's looking at you.
  • Speak slowly and use simple, short sentences; pause between ideas.
  • Encourage your child to ask you to repeat something that he doesn't understand.

Christina, now 11, has learned to use the latter strategy — asking questions until she grasps what's being said — with friends, parents, and teachers. "It's been successful for her," says Tricia. Eight years of speech and language therapy have helped her daughter accomplish many of her social and academic goals.

But Christina did something that her mother thought she'd never achieve — joining the chorus. "There she was, on stage, at the parents' day assembly, singing her heart out, and playing drums!" says her mother. "She was so proud of herself, and I was the only fourth-grade mom with tears streaming down her cheeks."

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This article comes from the October/November 2004 issue of ADDitude.

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