Auditory Processing Disorder (APD) (previously known as "Central Auditory Processing Disorder" (CAPD) is a disorder in how auditory information is processed in the brain. It is not a sensory (inner ear) hearing impairment; individuals with APD usually have normal peripheral hearing ability. APD is an umbrella term that describe a variety of problems with the brain that can interfere with processing auditory information. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... The inner ear comprises both: the organ of hearing (the cochlea) and the labyrinth or vestibular apparatus, the organ of balance located in the inner ear that consists of three semicircular canals and the vestibule. ... Hearing impairment is a full or partial decrease in the ability to detect or understand sounds. ...

Definitions

The American Speech-Language-Hearing Association (ASHA) published their first definitive Technical Report "(Central) Auditory Processing Disorders" in January 2005 as an update to the "Central Auditory Processing: Current Status of Research and Implications for Clinical Practice (ASHA, 1996)"^[1], and complements the UK's "Medical Research Council's Institute of Hearing Research's" Auditory Processing Disorder (APD) pamphlet, Oct 2004^[2]. In Vedic Sanskrit, Rta literally means the course of things. ... A technical report (also: scientific report) is a document that describes the progress or results of technical or scientific research, or the state of a technical or scientific research problem. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... Year 1996 (MCMXCVI) was a leap year starting on Monday (link will display full 1996 Gregorian calendar). ... Current MRC logo The Medical Research Council (MRC) is a UK organisation dedicated to promot[ing] the balanced development of medical and related biological research in the UK. // Organisation The MRC is one of eight Research Councils and is answerable to, although politically independent from, the Office of Science and... shelby was here 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ...

Auditory processing disorder can be a congenital or an acquired condition (for example; resulting from ear infections and head injuries) which refers to difficulties in the processing of auditory information within the central nervous system, such as problems with: "...sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals." (Quote from: (Central) Auditory Processing Disorders, Technical Report, Jan 2005) A diagram showing the CNS: 1. ... Sound localization is a listeners ability to identify the location of origin of a detected sound or the methods in acoustical engineering to simulate the placement of an auditory cue in a virtual 3D space (see binaural recording). ... Temporal masking occurs when a sudden stimulus sound makes inaudible other sounds which are present immediately preceding or following the stimulus. ... Dichotic Listening is a procedure used commonly in investigating selective attention in the auditory domain. ...

Although the cause is Neurological (eminating from the Central Nervous System), rather than Audiological (associated with ear abnormalities), APD can sometimes be complicated by cochlear (inner ear) dysfunction which may be a separate, co-morbid condition. Therefore, a patient with this disorder might be better understood by a Neurologist, even though a consultation with an Ear Specialist might also be useful to rule out ear disorders. An assessment by a Neuropsychologist could be useful (in making the differential diagnosis) and excluding possible co-morbid Psychiatric or Psychological causes.

APD can manifest as problems determining the direction of sounds, difficulty perceiving differences between speech sounds and the of sequencing these sounds into meaningful words, confusing similar sounds such as "hat" with "bat", "there" with "where" etc. Fewer words may be perceived than were actually said, as there can be problems detecting the gaps between words, creating the sense that someone is speaking unfamiliar or nonsense words. Problems relating what has been said with its meaning, despite obvious recognition that a word has been said, as well as repetition of the word. Separating speech sounds from background noise, pink sound, such as the sound of a radio, television or a noisy bar, it can be difficult to impossible to understand speech, depending on the severity of the auditory processing disorder. Using a telephone can be problematic, due to low quality audio, poor signal, intermittent sounds and the chopping of words can be a problem for someone with Auditory processing disorder to cope with, in comparison with someone with normal auditory processing (hearing).^[3] Many who have auditory processing disorder subconsciously develop visual coping strategies, such as lip reading, reading body language, and eye contact, to compensate for their auditory deficit, and these coping strategies are not available when using a telephone.

Difficulties encountered in diagnosing APD

APD is recognized as a major cause of dyslexia^[4]. As APD is one of the more difficult information processing disorders to detect and diagnose, it may sometimes be misdiagnosed as ADD/ADHD, Aspergers and other more severe forms of autism, but it may also be a comorbid aspect of those conditions if it is considered a significant part of the overall diagnostic picture. APD shares common symptoms in areas of overlap such that professionals who were not aware of APD would diagnose the disabilities as those which they were aware of. APD can also be confused with Language Processing Disorder. Unlike APD, LPD is more specifically a problem associated with the linking of words, both written and spoken, to semantics (meaning) and someone can have both APD and LPD. Unlike those with LPD, those with APD can usually get the meaning of language from written words where those with LPD show problems with both heard and read words, demonstrating that the basic issue is not an auditory one. This article is about developmental dyslexia. ... Attention-Deficit/Hyperactivity Disorder (ADHD) (sometimes referred to as ADD for those without hyperactivity) is thought to be a neurological disorder, always present from childhood, which manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control, and distractibility. ... Asperger described his patients as little professors. Aspergers syndrome (ASD), is a pervasive developmental disorder commonly referred to as a form of high_functioning autism. ... Autism is classified by the World Health Organization and American Psychological Association as a developmental disability that results from a disorder of the human central nervous system. ... In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ... LPD or lpd has several meanings: In naval warfare, LPD can mean Landing Platform Dock, a type of warship. ... The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ...

People with APD intermittently experience an inability to process verbal information. When people with APD have a processing failure, they do not process what is being said to them. They may be able to repeat the words back word for word, but the meaning of the message is lost. Simply repeating the instruction is of no use if a person with APD is not processing. Neither will increasing the volume help.

People with APD have an Auditory (Verbal) Processing Disorder, and text is only verbal code, and so the Auditory Processing Disorder is extended into reading and writing as this auditory code. As a consequence, APD has been recognized as one of the major causes of dyslexia.

There are also many other hidden implications, which are not always apparent even to the person with the disability. For example, because people with APD are used to guessing to fill in the processing gaps, they may not even be aware that they have misunderstood something.

In many instances, APD comes as part of an 'invisible disability' package, and in some instances, the other disability may mask the APD. This multiple disability scenario indicates that a transdiscipline approach to research, diagnosis and treatment is of the utmost importance, especially when APD can mimic many of the other 'invisible disabilities'. Research is a human activity based on intellectual investigation and aimed at discovering, interpreting, and revising human knowledge on different aspects of the world. ... In general, a diagnosis (plural diagnoses) has two distinct dictionary definitions. ... Look up Therapy in Wiktionary, the free dictionary. ...

Behavioral manifestations

Some of the manifestations below may be observed in individuals with other types of deficits or disorders, such as acquired brain injury, attention deficits, hearing loss, psychologically-based behavioral problems, and learning difficulties or dyslexia. Common behavioral characteristics often noted in individuals with APD include: DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... Hearing impairment or deafness is decreased or absent ability to perceive auditory information. ...

1. Difficulty understanding what people are saying when there's background noise, such as noise at a party
2. Difficulty comprehending more than one piece of information at a time or following long monologues
3. Difficulty hearing or understanding conversations on the telephone
4. Preferring to learn a foreign language (or challenging vocabulary words, or difficult last names) by learning to read and write the words first, and then learning to hear and speak the words, and then only when the words are spoken slowly
5. Difficulty remembering spoken information (i.e., auditory memory deficits)
6. Difficulty taking notes
7. Difficulty maintaining focus on an activity if other sounds are present; person is easily distracted by other sounds in the environment
8. Difficulty with organizational skills
9. Difficulty following multi-step directions
10. Difficulty in dividing attention
11. Difficulty with reading and/or spelling/dyslexia
12. Preferring to watch movies with the subtitles or closed-captioning on/Preferring to either read subtitles with no voice-over or vice versa, but not able to cope with both subtitles and voice simultaneously
13. Sensitivity to certain sounds, particularly sudden or high frequency sounds: a condition called "Hyperacusis" and/or inability to separate sounds (e.g., inability to "tune out" a television on in the background while "tuning in" a conversation with a person), referred to by psychologists as the inability to process "The Cocktail Effect"
14. Difficulty picking out one musical instrument from a band or orchestra

Baran & Schminky 1999

Causes of APD

We still do not understand a lot about APD. It is possible that APD can run in families. Parents of children with APD often report they have difficulties listening and hearing which may have started when they were young. Some children with APD may have tiny differences in the way that brain cells (called ‘neurons’) are joined together, or send messages to each other. This may make it hard for sounds to be passed on to the areas of the brain which help the child understand language. The ear "hears" sounds, whereas the brain "interprets" these heard sounds to form messages or meaning. It is possible that brain cell abnormalities or damage may cause APD. It can occasionally be caused by long term middle ear disease (Otitis or ‘glue ear’) or even by limited access to communication. Neurons (also called nerve cells) are the primary cells of the nervous system. ... Neurons (also called nerve cells) are the primary cells of the nervous system. ... Italic text // ahh addiing sum spiice iin hurr`` For other uses, see Brain (disambiguation). ... The middle ear is the portion of the ear internal to the eardrum, and external to the oval window of the cochlea. ...

In some cases, injuries to the head may cause APD. Traumatic Brain Injury, caused by an insult to the brain, or any Acquired Brain Injury, resulting from infection, chemical poisoning or neuro-toxicity may also cause neurological dysregulation, resulting in APD. Over-stimulation of the Immune System (either by infection or certain pharmaceutical drugs) can cause a "hit and run" type Brain Injury and damage the delicate balance of the healthy brain. Thus adults can suddenly develop APD. This type of Brain Injury may be of the Diffuse Axonal type which would not manifest on an M.R.I. brain scan. Because the Immune and Neurological Systems are so interlinked, the common areas of the brain affected by various neuro-immune disorders sustain an injury, frequently resulting in APD.

Is APD related to other difficulties? It is likely that many (but not all) children who have language-learning difficulties may also have APD. Professionals use different names to describe these difficulties. The following points aim to help clarify the differences: The manner in which a child acquires language is a matter long debated by linguists and child psychologists alike. ...

• APD means the child finds it difficult to understand when LISTENING
• Dyslexia means the child has difficulties with READING and or SPELLING
• Attention Deficit Disorder (ADD) and/or Attention Deficit Hyperactivity Disorder
• Attention Deficit Hyperactivity Disorder (ADHD) means the child finds it difficult to CONCENTRATE or ATTEND
• Speech and Language disorder means the child has difficulties developing and or understanding SPEECH and LANGUAGE

It is possible that difficulties with concentration may cause both APD and dyslexia or that these conditions may cause difficulties with concentration. We do not know, but scientists are conducting research in this area, and so hopefully we will be able to say in the not too distant future.^[5] This article is about developmental dyslexia. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... For a List of scientists, see: List of anthropologists List of astronomers List of biologists List of chemists List of computer scientists List of economists List of engineers List of geologists List of inventors List of mathematicians List of meteorologists List of physicists Scientist pairs List of scientist pairs See... Research is a human activity based on intellectual investigation and aimed at discovering, interpreting, and revising human knowledge on different aspects of the world. ...

What it is like to have APD

Persons with this condition often:

• have trouble paying attention to and remembering information presented orally; cope better with visually acquired information
• have problems carrying out multi-step directions given orally; need to hear only one direction at a time
• appear to have poor listening skills, and need people to speak slowly
• need more time to process information.

It appears to others as a problem with listening. Somebody with APD may be accused of "not listening".

One adult, who has had the disorder since childhood, writes:

My hearing is fine, but what I hear is often garbled initially by my brain. Shortly later, I often figure it out. In conversation, about the same time I say "huh?', I figure out what it was that I just heard. Like the three-legged dog, I am told that my visual skills, in compensation, are much stronger than normal. My bottom line is: I do better with what I see than what I hear.

Another woman states:

I've been tested with an IQ of 148 and yet many people have referred to me as an airhead. This has caused me a great deal of anxiety and pain. I do fine in one on one conversations and am perceived as interesting, funny and smart but if you put me in the middle of a party or chaotic social setting, I appear confused and disorganized. I feel very embarrassed. As a kid, the school lunchroom was my worst nightmare and I would often sit next to a wall in my classrooms. The wall, I later learned absorbs excess sound which is why kids with CAPD tend to intuitively choose to sit next to it.

Coping skills and work-arounds

Adults who discover disabilities such as APD late in life have provided some insight into coping skills they have found helpful. These include: A coping skill is a behavioral tool which may be used by individuals to offset or overcome adversity, disadvantage, or disability without correcting or eliminating the underlying condition. ...

1. Ask people to speak slowly, especially on the telephone.
2. If someone is giving you several pieces of information together, repeat each one aloud as you hear it. This allows the brain the necessary time to assimilate the last message before receiving a new one.
3. Get directions and instructions in writing.
4. When given a unit of information e.g. a number, immediately form a mental picture of it. Visual messages are much easier for APD sufferers to store in memory.
5. Do not take notes yourself when information comes from others orally, as this may interfere with your processing strategies, but ask others to provide notes for you.
6. Many APDs use body language, lip reading and eye contact as a coping strategy.
7. Rewrite text using multi-coloured text options to provide visual guide to changes in meaning or for new sentences, or use a set of coloured highlighters.
8. Use closed captioning while watching television.
9. Place with teachers whose speaking style is clear and organized, who are "good explainers," and who encourage questions, so that the person with APD does not have to decode complex verbiage. Rules of language activities, including writing, need to be made overt and very explicit.

This article or section is in need of attention from an expert on the subject. ... Lip reading, also known as lipreading, speech reading, or speechreading, is a technique of understanding speech by visually interpreting the movements of the lips, face and tongue with information provided by the context, language, and any residual hearing. ... A commonly-used symbol indicating that a program or movie is closed-captioned. ...

APD and Dyslexia

Auditory Processing Disorder may also be an underlying cause of dyslexia. "auditory performance in competing acoustic signals" (including dichotic listening)).^[6] Image File history File links Unbalanced_scales. ... This article is about developmental dyslexia. ... Dichotic Listening is a procedure used commonly in investigating selective attention in the auditory domain. ...

The UK Medical Research Council which is UK Government funded. Describes these issues as

"The single biggest complaint people make about their hearing is that they have difficulty in noisy places such as classrooms, parties, bars and railway stations. It is perfectly normal to have at least some problem hearing speech in these circumstances because the noise physically ‘masks’ the speech. This is not the same effect you would find if you detuned your radio or TV and tried to make yourself heard over the background noise, as "white noise" is a (potentially comforting and calming) combination of frequencies. However, human hearing has developed various special abilities to help deal with these problems. One is called ‘grouping’, a brain process where similar sounds are heard as belonging together. Thus, a particular voice can be heard against other voices because it has certain properties (e.g. pitch of voice, accent) that are continuous over time. The healthy brain copes well with "the Cocktail Party Effect" and can easily tune in or out with regard to speech of specific individuals in a noisy environment. Binaural hearing – combining the information from the two ears – helps to separate sounds that come from different directions. Somebody talking to you from the front can then be separated from someone talking to the side. When using a telephone, the loudspeaker facility is therefore much more efficient and less taxing on the brain than holding the receiver to one ear only. Lip reading (now correctly called ‘speechreading’) also helps, even in normally hearing people.

These and other processes thus improve our ability to hear in difficult circumstances. But they can go wrong. People who have a hearing loss in the ear almost always have an additional problem hearing in noise. This may sound surprising, as you would expect the hearing loss to reduce the level of both the ‘target’ sound AND the noise. But cochlear hearing losses also impair other aspects of hearing, including the ability to separate sounds of similar pitch and sounds occurring close together in time. Other problems with ‘central auditory processing’ can contribute to poor speech-in-noise hearing. These include binaural hearing and grouping. It is likely that both sources – ear and brain – contribute to the often reported difficulty of many elderly people to hear well, especially in noise. Current hearing aids fitted in modernised NHS hearing services provide more benefit to people than earlier hearing aids did in this situation, and research continues in this area."^[7].

Remediations and Training

No one program is a cure or help all for APD. There are no research supported treatments for APD available, however a variety of treatments have been offered commercially in the absence of solid empirical research support for their efficacy.

APD is about creating coping strategies to meet the challenges life presents and using the various strengths each of us may have.

• Management of Auditory Processing Disorders (includes the use of many programs)
• Lindamood-Bell Learning Processes (particularly, the Visualizing and Verbalizing program)
• Fast ForWord (development of cognitive skills including auditory processing)
• PACE-Processing and Cognitive Enhancement
• Neuro-linguistic programming (NLP)...
• Brain Gym or Edu-Kinesthetics
• Physical activities which require frequent crossing of the midline (e.g. occupational therapy)
• Samonas Sound Therapy
• Auditory Integration Training (AIT)
• Sound Field Amplification

Auditory Integration Training - ASHA Position Statement 2004 American Speech language Hearing Association ASHA Position Statement on Auditory Integration Training which includes references to the auditory integration therapies (AITs) Tomatis, Samonas Sound Therapy, and The Listening Program, and refers to correspondence with Advanced Brain regarding these products. To date, according to the ASHA 2004 statement, these treatments fall outside the range of safe, evidence based interventions. ASHA states: "However, well-designed, institutionally approved research protocals designed to assess the efficacy of AIT are encouraged. It is recommended that this position be re-examined should scientific, controlled studies supporting AIT's effectiveness and saftey become available." Fast ForWord is a family of reading-intervention software products that build learning capacity by applying neuroscience principles to strengthen cognitive skills. ... // Frogs into Princes by Bandler and Grinder introduced NLP. Neuro-linguistic programming (NLP) is a personal development system developed in the early 1970s by Richard Bandler and John Grinder, in association with Gregory Bateson. ... The Brain Gym® program was designed to develop the brains neural pathways the way nature does – through movement. ... Occupational therapy refers to the use of meaningful occupations to assist people who have difficulty in achieving occupationally balanced lives. ... Auditory Integration Training or AIT is a program designed to treat disorders associated with Auditory Processing such as CAPD. AIT typically involves 20 half-hour sessions of listening to specially modulated music over a 10- to 20-day period. ...

References

External links

• American Speech-Language-Hearing Association (Central) Auditory Processing Disorders, Technical Report, Jan 2005. This report is the result of approximately 5 years discussion to find a unified definition of APD for the USA, which was started by the first Bruton Conference in 2000. PDF version HTML version
• Medical Research Council - Institute of Hearing Research APD pamphlet Oct 2004. The UK MRC published this pamphlet as a working document to define APD for the UK to herald their first 5-year APD research program, funded by the UK government. PDF version APDUK Formated HTML version
• Auditory Processing Disorder in the UK (APDUK) web site includes online and downloadable copies of the UK Medical Research Council's APD pamphlet and much more information about APD (with input from Adult APDs) and related "invisible disabilities".
• National Coalition on Auditory Processing Disorders (NCAPD) Relaunched website of a US non-profit organisation, containing a lot of information, including a directory of US Audiologists who can diagnose APD.
• AudiologyOnline The Hearing Journal Auditory processing disorder: An overview for the clinician, by Gail D. Chermak.
• Central Auditory Processing Disorders as a key factor in Developmental Language Disorders A review of APD by SLT and audiologist, Rosalie Seymour.
• Two articles, written for Learning Disabilities Online by audiologist, Judith Paton:
  • Central Auditory Processing Disorders
  • [http://www.ldonline.org/ld_indepth/process_deficit/living_working
• OldAPDs: Adult APD Forum A forum for Adult APDs to exchange experiences and provide mutual support. There is also an online research project participation.
• SchwabLearning.org: Auditory Processing Disorder in Children
• Information Center on Disabilities and Gifted Education Overview on Auditory Processing Disorder.
• KidsHealth.org: Central Auditory Processing Disorder
• Autistics.org: Central Auditory Processing Disorder

.html Living and Working with a Central Auditory Processing Disorders] An audiologist is the professional specializing in disorders of the auditory and vestibular portions of the body; an audiologist diagnoses and treats hearing and (balance) problems. ...

• Auditory and Language Processing Disorders, by Kristen Jacobsen, MS CCC-SLP
• J. Baran & M. Schminky. 1999. University of Massachusetts, Communication Disorders Dept. Amherst, MA. University of Massachusetts - Overview of Assessment and Management Practices
• a-p-d group: professional discussion of Auditory Processing Disorders A listserv for Speech-Language Pathologists and Audiologists
• Auditory Processing Disorders in Children Article and links
• Math Professors Solve 'Cocktail Party' Problem Researchers have found a way to cull individual human voices from recordings of a noisy environment
• Auditory Processing Disorder therapy software for home or clinic use was created and tested by speech pathologists.