Auditory Processing Disorder Vs Adhd
Did you know that a problem accurately processing sound is often mistaken for an attention problem?
Auditory Processing Disorder and Attention Deficit Hyperactivity Disorder are two distinct clinical conditions with different diagnostic criteria. However, both of these disorders share common characteristics such as distractibility and inattentiveness. It is crucial that the correct diagnosis is made so that the individual can receive appropriate intervention.
Auditory Processing Disorder is caused by an abnormality in the central auditory nervous system that affects a childs ability to understand and remember information presented verbally. Children with an auditory processing disorder will pass a basic hearing test but still have difficulty processing sound. Children with APD often stop paying attention because they are having trouble understanding or they are distracted by background noise. APD can make a child very distractible by noises that most people can easily ignore . This can make it hard to focus on the teacher, and it can easily be mistaken for an attention problem. Children with APD also experience listening fatigue from continuous efforts to process speech and keep up with a class discussion. This can be overwhelming and cause the child to zone out and shut down.
It is not uncommon for children to have been misdiagnosed with ADHD when they actually have APD.
How can one distinguish between APD and ADHD?
Comparison of Symptoms
Understanding Auditory Processing Disorder Vs Adhd
Many disorders share common traits and are often correlated. Because many symptoms of Auditory Processing Disorder overlap with other disorders, children are sometimes misdiagnosed or may have a coexisting condition along with APD. As an example, a child may be diagnosed with ADD , ADHD , PDD , Autism Spectrum Disorder, Sensory Processing Disorder, Receptive Language Disorder, or Mixed Expressive-Receptive Language Disorder, because all of these conditions could affect how a child processes spoken information.
While the underlying cause of APD is not fully known. Some experts debate whether heredity or environment or both are responsible for the condition. While the human auditory system is fully developed at birth, auditory pathways do not mature until the age of 10 to 12. Because of this, early influences such as poor prenatal nutrition, a mothers exposure to cigarettes or alcohol, childhood malnutrition, and chronic ear infections may negatively affect auditory processing. Premature birth, Lyme disease or other brain infections, closed head injury, and exposure to low levels of heavy metals may also play a role. So, whats the good news? The good news is that, because the auditory pathways continue to develop, APD is typically responsive to intervention.
Specific Testing For Auditory Processing Disorder
After reviewing Lindas neuropsychological evaluation results, the Speech & Learning Center recommended that she be evaluated for Auditory Processing Disorder . The Center explained that neuropsychological testing does not assess for APD. In fact, they told us that neuropsychologists are trained to test for areas of cognitive-linguistic difficulty, but not for APD.
The first step in assessing for APD is for an audiologist to administer a full audiological evaluation to rule out hearing loss. The audiologist determined that Lindas hearing was within normal limits.
Next, the audiologist and a speech therapist administered tests for receptive and expressive language, including the Test of Auditory Processing Skills . They determined that Linda met the criteria for a Moderate delay in Expressive/Pragmatic Language and a Mild-Moderate delay in Receptive Language. The primary reason for these delays was that Linda also met the criteria for Auditory Processing Disorder.
Linda was actually relieved at last, there was a diagnosis! Now, perhaps, someone could help her with her communication challenges!
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Identifying Central Auditory Processing Disorder Symptoms
What about the tone of voice that George complained he heard from Diane? The trouble can start in the right temporal lobe, according to clinical neuroscientist Dr. Charles Parker, founder of CorePsych Blog. The non-dominant temporal lobe processes facial expressions, verbal tones, and intonations from others, as well as hearing rhythms and music.
Parker cites the example of an Olympic skier who took a bad fall during practice. Having sustained a head injury and a concussion, his right temporal lobe showed significantly diminished function. Yet he presented with denial regarding deteriorating communication he had with his wife and peers, firmly asserting that he had no problems. In this way, he had much in common with those adults with ADHD who have no perspective about their challenges. For these people, its important to know that therapy emphasizing better communication strategies might not solve the problems.
After reading the skiers SPECT scan, Parker said to him, You are the kind of guy who doesnt get it, and doesnt admit he doesnt get it. The patient took a deep breath and, with a dazed look, responded quickly, No, I get it. Parker pointed out that hed done it again given a pat answer that didnt reflect comprehension and asked the patient to repeat what Parker had just said. He mumbled an intelligent but jargon-filled answer. His wife chimed in: This is what happens all the time.
Roles And Responsibilities Of Audiologists
Audiologists play a central role in the screening, assessment, diagnosis, and management of persons with CAPD as part of an interdisciplinary team. Professional roles and activities in audiology include clinical/educational services prevention and advocacy and education, administration, and research. See ASHA’s Scope of Practice in Audiology and ASHA’s Preferred Practice Patterns for the Profession of Audiology .
Appropriate roles for audiologists involved in the assessment, diagnosis, and management of CAPD include the following:
As indicated in the Code of Ethics , audiologists who work in this capacity should be specifically educated and appropriately trained to do so.
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Why It Could Be Auditory Processing Disorder
While many children with these ADD symptoms end up on medication, most often there is an underlying learning difficulty that is causing these symptoms. And that cause is delayed development of auditory processing skills or APD. Children with APD are unable to process language efficiently. Words sound muddy or unclear. And so listening requires extra effort, all the time, but most especially in noisy places like classrooms. After a while, a child will tune out, which a teacher or parent may misinterpret as ADD.
Muddy listening also impacts phonological awareness, sounding out words while reading. Many children with auditory processing difficulties are able to manage reading, but the effort required is taxing, and so they have no reading stamina just like with ADD.
Is It Adhd Or Auditory Processing Disorder
Todays post comes courtesy of a student I recently evaluated. As a current 7th grader, she was referred to me because she was having trouble paying attention in class and keeping up with her teachers lectures. She was originally diagnosed with ADHD by her family physician in 4th grade and put on various medications to help control it, but her mother wanted a more comprehensive evaluation to determine if something else was going on.
This particular student, like many, was given a diagnosis of ADHD with a very brief assessment of her symptoms. Since there is no single definitive test for ADHD, doctors rely on qualitative as well as quantitative data to piece together enough evidence either to confirm or rule out a diagnosis. Consequently, a brief assessment of symptoms can often times lead to an inaccurate diagnosis of ADHD.
During the initial in-take interview, this student confirmed symptoms of ADHD, including difficulty maintaining focus in class, forgetting to do certain tasks, and the appearance of zoning out in class. Although her grades were very good, she admitted that she does not always enjoy school because it can be difficult. On their own, these symptoms do indeed sound like those of ADHD. Lets take a closer look.
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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 childs 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.
Summary Of Lindas Story Prior To Apd Testing
Linda was a 49-year-old chemical engineer who had worked for a major manufacturing company for almost 30 years. Her job was in jeopardy because of poor written and oral communications. Her supervisor referred her to us for 360 Feedback and possibly for coaching. However, he was almost positive that he would have to let her go.
After an initial interview, we determined that Lindas performance issues were not due to a lack of effort but, in all probability, to a hidden disorder. We provided coaching support services that helped Linda get neuropsychological testing. However, her test results didnt point to a specific disorder. Since the neuropsychologist recommended that Linda work with a speech therapist to improve her communication skills, we also consulted with a university-affiliated Speech & Learning Center.
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What Are Symptoms Of Auditory Processing Disorder
- Appears as though student is not paying attention
- Can seem forgetful
- Has difficulty following auditory directions
- Ability to focus is impacted by loud noises
- Difficulty following conversations and formulating responses
As you can see, the symptoms of APD can look very similar to those of ADHD. Its important to note that the DSM-V does not contain a diagnosis of APD. Instead, APD must be verified and diagnosed by an audiologist. While ADHD is a brain disorder, APD is a weakness in the pathways the connect the ear and the central nervous system that processes those sounds. Therefore, treatment of APD is much different that ADHD and does not require the use of medication.
At the conclusion of the students evaluation, the evidence strongly suggested a diagnosis of APD rather than ADHD. Although I cannot officially diagnose her, I did refer her to an audiologist for further testing. I also made the recommendation that she consult with her pediatrician to determine if continued medication was necessary.
The good news for her is that most adolescents who struggle with APD see their symptoms dramatically reduced by the time they are 13. This mostly has to do with the natural maturation of those pathways between the ear and the central nervous system. In the event that symptoms do not improve, however, there are many steps to take to help.
The Earlier The Better
Dont think of ADD as something you hope your child will grow out of that has to be medicated for the time being. Instead, think of it as a symptom, a clue, that your child has some kind of learning difficulty that in most cases can be targeted and helped.
And in most cases, because all learning in the end comes down to language listening, reading, writing and thinking a learning difficulty is related to how your child processes language. And in most cases, that is a difficulty that, with intense practice, can be dramatically improved.
Gemm Learning uses Fast ForWord software to strengthen auditory processing skills to help inattentive ADD, reading and learning. If you think your child has an auditory processing disorder, call for a free consult.
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Three Disorders In One
Jack Katz, M.D., a pioneer in the field of auditory processing disorder, says that APD comprises three distinct conditions that often overlap but may occur in isolation.
Sound discrimination problems. When children learn to talk, they mimic the sounds they hear to produce speech. A child with APD may not speak clearly, using similar rather than exact sounds long after peers have corrected themselves. Typically, children with faulty sound discrimination will run words together and drop word endings and unemphasized syllables when speaking. Reading and spelling may also be affected.
Auditory memory problems. This part of the disorder makes it difficult for a child to memorize numbers and facts, and also affects his reading and language skills. Children with auditory memory problems typically take longer to learn their telephone numbers and addresses, and have difficulty remembering basic math facts. Verbal instructions and lists are similarly tough to retain.
Language processing problems. This component of APD is the most troublesome. It affects a childs abilities to understand whats 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.
Is Apd Linked To Adhd
Opinion is currently divided on whether there is a direct linkage between APD and ADHD. While they share some symptoms and APD is often a comorbidity of ADHD, scientist have not identified a genetic or other causal linkage between the two conditions. While both conditions can cause sensory processing challenges, these can originate in different parts of the brain. The main difference between ADHD and APD is that people with APD will show signficiantly more difficulties with tasks involving sound.
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Is It Auditory Processing Disorder Or Adhd
In my last article, How a Hidden Disorder Can Affect Your Life, I wrote about a client named Linda whose boss referred her to us because of her difficulties with written and oral communications. In this article, Ill finish telling Lindas story about how she learned that she had a condition known as Auditory Processing Disorder .
Note: Auditory Processing Disorder is sometimes referred to as Central Auditory Processing Disorder .
Do You Hear What They Hear
While APD isnt as well known as ADHD, it is becoming increasingly common. Roughly 7 percent of children have some type of auditory processing difficulty.
But what is it exactly? At its most general, APD is a glitch in the brains ability to filter and process sounds and words. An APD child doesnt have difficulty hearing in fact, in most cases, her hearing is good. Rather, her brain perceives the sounds incorrectly, affecting the childs ability to distinguish between similar sounds .
Some children with APD also have trouble screening out background noise, so they pick up bits of surrounding sounds. The echo in a gymnasium or the hum of the air conditioner in the classroom interferes with the conversation at hand. Its like listening to the radio with interference from other stations garbling the reception.
A child with the disorder typically tries so hard to understand whats being said that she forgets parts of the conversation or doesnt pick up on the nuances or subtleties of the words. Combine APD with ADHD, and a childs abilities to listen and remember are severely compromised.
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How To Tell The Difference Between Adhd And Apd
Auditory processing disorder is thought to be a central nervous system dysfunction involving the way the brain processes auditory input. Children with APD primarily experience difficulty interpreting speech because they are unable to recognize important differences between word sounds. For example, a child with APD may confuse the meaning of the words ball with wall or bat with cat, especially when they are in environments with background noises, such as playgrounds, cafeterias and classrooms.
Symptoms of APD in children include:
- Being easily distracted, forgetful and disorganized
- Problems following directions in school and at home
- Acting upset or unsettled in noisy places
- Academic difficulties particularly involving subjects that require the child to hear and interpret a teachers instructions
Signs of auditory process disorder are often misdiagnosed as signs of ADHD because many symptoms of both conditions overlap. However, ADHD is not a central nervous system disorder but a neurodevelopmental and behavioral disorder that does not involve problems with the way the brain processes auditory information. Instead, children with ADHD are hyperactive, have poor impulse control and procrastinate when given a task to complete. ADHD is impairment of the brains executive functioning area found in the prefrontal lobe of the brain.
Speech With White Noise Test
This test evaluates the ability to identify monosyllabic words presented at 40dB HL, with 5dB above white noise intensity to each ear. Children were instructed to repeat the words which they understood regardless of background noise. The SN test assays the selective auditory attention and auditory closure and is measured by number of correct responses.13
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How Is Auditory Processing Disorder Diagnosed
If you think your child is having trouble hearing or understanding when people talk, have an audiologist examine your child. Only audiologists can diagnose auditory processing disorder.
The most common way to diagnose APD is to use a specific group of listening tests. Audiologists often look for these main problem areas in kids with APD:
Most traditional APD tests require a child to be at least 7 years old. So, many kids aren’t diagnosed until first grade or later. Newer electrophysiology tests can give some early information about the central auditory system in kids younger than 7.