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AUDITORY PROCESSING DISORDER
An Auditory Processing Disorder can be defined as: A breakdown in auditory
abilities resulting in diminished learning (e.g. comprehension) through hearing,
even though peripheral auditory sensitivity is normal (Gail Whitelaw, 1997).
An auditory processing difficulty can be considered a difficulty in a child’s ability
to fine tune their hearing skills in order to locate separate and distinguish sounds in
the environment despite normal hearing acuity. In terms of understanding speech
there are a number of specific skills used to distinguish the many sounds that are
present in the ongoing stream of speech in a conversation.
Children need to be able to discriminate between sounds such as ‘n’ and ‘m’ so
they can identify the difference between words such as ‘mine’ and ‘nine’or ‘sum’
and ‘sun’. They also need to be aware of the variation in timing of speech. For
example the difference between the sounds ‘t’ and ‘d’ is the timing of the onset of
the vibration of our vocal cords. We begin to vibrate our vocal cords earlier for ‘d’
than for ‘t’ so to hear the difference between the words ‘deer’ and ‘tear’ we need to
be able to detect this difference in timing. Understanding timing differences is also
important in ‘juncture’. Juncture is the way we separate words in sentences with
very short pauses to change its meaning e.g. “Look at the cargo.” vs “Look at the
car go.” When we listen to sentences we rely on our auditory processing systems
to detect these very subtle differences so we can correctly interpret the meaning of
the sentence.
Combined Therapy Consultants
March 2004
WHAT ARE AUDITORY PROCESSING SKILLS?
Detection: Can the child identify the presence or absence of sound?
Discrimination: Can the child distinguish the difference between sounds that are
high and low, long and short or loud and soft?
Localisation: Can the child tell where a sound is coming from?
Auditory attention: Can the child direct their attention to a sound or to speech and
maintain that attention for an age appropriate amount of time?
Auditory figure-ground: Can the child identify a sound or speech that they need
to listen to when there is other competing noise around them?
Auditory discrimination: Can the child tell the difference between sounds and
words that sound similar (e.g. thin/fin, fan/van)?
Auditory closure: Can the child understand a word or message when part of it is
missing? Can they fill in the gaps accurately?
Auditory synthesis: Can the child blend sounds together in order to form a word
(e.g. t – o – p = ‘top’)?
Auditory analysis: Can the child identify individual sounds or grammatical
markers within words? Can they tell the difference between ‘worked’ and ‘works’
or tell you how many sounds are in a word and what they are?
Auditory association: Can the child listen to a sound or word and associate it with
what or who made it or what the meaning of the word is?
Auditory memory: Can the child recall new information that they have learned
auditorily?
Auditory short-term memory: Can the child immediately recall information they
have been told?
Auditory sequential memory: Can the child remember information in the exact
order that it was told to them?
Combined Therapy Consultants
March 2004
ATTENTION & MEMORY
Children who have auditory processing difficulties may also weaknesses in
important associated processing systems such as attention and memory that
enhance the auditory message.
Attention
If we are not attending to a message we will not hear it!!!
There are a number of aspects of attention that a child must be skilled at in order to
be successful in the classroom.
Auditory attention : Children need to be able to recognise and focus on auditory
information within the classroom.
Selective attention: Children need to be able to focus and attend to the most
important auditory information in the classroom (e.g. the teachers voice).
Sustained attention: Once a child has directed their attention to the auditory
information they must be able to maintain their attention and not get distracted by
other competing noise.
Auditory ‘vigilance’: As the continuous flow of speech races by, children need to
be ‘on the alert’ for important key words that they know will mean that they need
to listen (e.g. ‘homework’).
‘Switching’ attention: Children need to be able to ‘switch’ their attention from
one task to another and then be able to come back to the exact same point that they
left the first task.
Memory
In order to be able to work with information and make decisions about what hear
we need to be able to hold information in our short-term or ‘working’ memory. If
a child has difficulty in this area they will frequently miss key information in
lessons and instructions and struggle to transfer and organise their memories. This
means they will find it stressful timing to keep up the fast flow of information
presented in one day and feel that each day all the information presented is new
and unfamiliar. This will impact on their ability to consolidate skills and build
knowledge.
Combined Therapy Consultants
March 2004
OVERLOAD & FATIGUE
Children who present with auditory processing difficulties it a challenge find just
listening to the teacher in the classroom!
This puts them at a distinct disadvantage especially when research suggests that
approximately 60% of classroom learning involves verbal communication
(Rosenberg & Blake-Rahter, 1995).
Children with auditory processing difficulties have to put more effort into listening
than other children. In a school day this means they need to be concentrating as
hard as they can for 3 to 4 hours a day. Consequently children with auditory
processing difficulties often become very tired from listening and can lose
attention easily especially as it gets later and later in the day.
As children with auditory processing disorders are using all of their resources just
to listen, they have little resources left over to direct to the other many tasks
required of them in a normal day. Therefore when information becomes more
complex or demands increase they can suffer from auditory overload.
What can cause auditory overload?
 When the length of the signal or its components is very short which requires
rapid and accurate processing.
 When the rate of speech is fast, especially if the information is new or
unfamiliar.
 When the words presented are phonetically complex (e.g. words have many
consonant cluster or have multiple syllables).
 When the words used sound very similar to each other.
 When information is presented out of context. The system will become more
and more overloaded as the amount of information increases.
 Poor listening conditions (e.g. lots of other distracting noises inside and outside
the classroom).
 When the children are uncertain of what they need to do in a task
 When there is a demand for memorising information word for word or recalling
information word for word.
Combined Therapy Consultants
March 2004
AUDITORY PROCESSING & LITERACY
Reading and spelling require visual symbols (ie. letters) to be attached to a
previously acquired auditory language. Before beginning to learn to read a child
learns language almost exclusively through listening and interacting with their
parents and friends in an auditory environment
Auditory processing not only affects a child’s ability to learn language but also
their ability to develop key phonological awareness skills critical for literacy
development. Phonological awareness skills have been identified in current
research as strong predictors of later reading and spelling success.
Phonological awareness refers to the child’s ability to attend to, identify and
manipulate the sounds in spoken words. These skills require the child to analyse
the sound structure of a word rather than its meaning. The word ‘phonological’
comes from the term ‘Phonology’ which refers to the organisation of the whole
sound system in spoken language. It incorporates a wide range of aspects of speech
such as intonation, rhythm, stress, syllabic beats, rhyming as well as individual
sound identification. Phonological awareness skills therefore incorporate
‘phonemic’ awareness skills, which relate only to the identification and
manipulation of individual sounds in words.
Following are some examples of tasks a child with an auditory processing disorder
may exhibit difficulty with which can influence their ability to develop adequate
reading and spelling skills;
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determining the similarities and differences between sounds
discriminating vowel sounds, especially short vowels (e.g. bin, ben, bun)
breaking words into syllables
perceiving similarities in words (ie. rhyming words – fat/pat/cat)
breaking words into individual sounds
blending sounds together to make a word
hearing individual sounds within consonant blends
relating the visual components of words (ie. letters) to their auditory
counterparts
 holding sounds and syllables within ‘working’ memory in order to make
matches and blends
Combined Therapy Consultants
March 2004
Combined Therapy Consultants
March 2004
ASSESSMENT
To differentially diagnose an Auditory Processing Disorder many factors regarding the child’s academic and social
performance need to be considered and therefore a multidisciplinary team approach is warranted. A child’s profile of
strengths and weaknesses needs to be assembled through assessment by a number of professionals so all factors that
may be impacting on their auditory behaviours can be considered.
Behaviours of children considered “at risk” of Auditory Processing Disorder
 child acts like they have a hearing difficulty even
though their hearing is fine
 they are often misinterpret or are confused by oral
directions or questions
 they may be able to answer questions but take a long
time to respond
 has trouble following instructions that involve more
than one step
 performs better in the classroom when it is very
structured and routine
 has trouble keeping up with class discussion and may
respond inappropriately
 better performance on activities that rely on visual
rather than auditory processing (ie. basic maths sums)
 has difficulty reading and spelling accurately
 have more difficulty hearing when there is other
noise around them
 may have a history of chronic middle ear infections
(ie. glue ear)
Children’s auditory processing systems are still developing through the primary school years up until they turn 11 or 12
years old. This must be taken into consideration during assessment especially when the children are under 7 years old
as their performance can vary significantly.
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Combined Therapy Consultants
March 2004
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Speech Pathologist assesses:
 receptive and expressive
language skills
 motor speech skills
 phonological awareness
Paediatrician:
Assesses growth and
development
Conducts physical
examinations
Investigates underlying
medical conditions
Optometrist
assesses:
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vision
Class Teacher /
Learning Support
Teacher assesses:
 Academic
acheivement within
a classroom setting
across subject
areas
 Reading and
spelling skills
Combined Therapy Consultants
Audiologist assesses:
 Hearing acuity
 Specific auditory
processing skills
Diagnostic categories to consider:
Physiotherapist
assesses:
Auditory Processing Disorder
Learning disability
Intellectual disability
Speech language impairment
Dyslexia
Attention Deficit Hyperactivity Disorder
Sensori-neural hearing loss
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Occupational Therapist assesses:
Visual-perceptual skills
Visual – motor skills
Motor planning
Self care skills
General organisation and planning
March 2004
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Gross motor
skills
Co-ordination
Psychologist evaluates:
learning abilities,
cognitive skills
academic achievement
emotional / behavioural
adjustment
motivation / self-esteem
SPECIFIC AUDITORY PROCESSING ASSESSMENTS
Dichotic Listening Tests: Children listen to two words or sentences where one is presented
in the right ear and one in the left ear. They are then asked to repeat either both words or
sentences or the word or sentence from one ear only.
Low Redundancy monaural speech: Children wear headphones and listen to words or
sentences that are distorted. There may be parts of the word/s missing, the words may be
presented in noise, or they may be presented very quickly. These tasks are done in each ear
separately.
Temporal Processing: Children listen to three different sounds presented at different
frequencies. After hearing the sounds the children must repeat the sequence by either saying
high-low-high for example or by humming the sequence.
Binaural Interaction: Children listen to either two words that are presented in each ear in a
sequence or a word or sentence where part of the message is presented in one ear and the
other part in the other ear. They then have to repeat either both words or the whole word or
message.
Combined Therapy Consultants
March 2004
T
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LANGUAGE TO LITERACY MODEL
D
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Children are able to read material and
understand it. They can recall facts as
well as make inferences, predictions, and
conclusions about the information.
COMPREHENSION
B
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DECODING & SPELLING
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Decoding / reading: translating letter symbols into
speech sounds
Encoding / spelling: translating speech sounds into
letters
PHONICS
U
P
Ability to make the link between sounds and letters.
‘a’ is for ‘apple’
PHONOLOGICAL AWARENESS
Ability to attend to, identify and manipulate the sounds in spoken words. It
includes phonemic awareness. Skills such as segmenting sentences into words,
words into syllables, identifying and generating rhyming words as well as
identifying individual sounds in words.
ORAL LANGUAGE
Speaking and listening skills : understanding the meaning of words, using grammar,
constructing sentences, following instructions, telling stories, using appropriate language
with different people.
AUDITORY PROCESSING & SPEECH PERCEPTION
auditory closure
auditory synthesis
auditory figure ground
Combined Therapy Consultants
auditory attention
localisation
auditory analysis
auditory discrimination
auditory association
auditory analysis
March 2004
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