TREATMENT

Auditory Processing Disorder is more able to be corrected than some hearing losses. The dysfunction is in the brain, and the brain is able to learn new skills and lay down new neural pathways. This is called neuroplasticity. Because of neuroplasticity APD is very treatable. Some treatments address the hearing disorder itself, and some treat the language and learning consequences that result from not having heard correctly in the past.

APD treatment requires a team approach

No single profession can provide all the treatment and support necessary to optimally manage APD in children. An audiologist is required for diagnosis, auditory training, and fitting of remote microphone hearing aids if required. A speech language therapist is required for some assessments and for language therapy including phonological awareness training. An Education Adviser experienced in special education is required to observe and assess the child in the classroom, to work with the teacher on an education plan and teaching strategies, and to facilitate the use of remote microphone hearing aids which require the teacher to wear a transmitter microphone. Various other professionals may need to be involved depending on an individual child’s needs.

SoundSkills employs a specialist team to assist each child. The team consists of an audiologist, a speech language therapist, and an Education Adviser who goes to the child’s school and works with the teacher, child and parents.

Helpful advice

The first thing parents need if their child is diagnosed with APD is information. Just understanding the cause of their child’s difficulties can be helpful to both parents and child. Next they need to know simple strategies on how to communicate effectively.  From there information about treatment is required.  As much information as possible is provided in individual consultations, but SoundSkills’ free monthly seminars on APD are very helpful to parents wanting to learn more about APD.  Apart from the seminar with audio demonstrations and ample time for questions, parents can also learn from the experiences of others in the audience.

Free APD Seminars

Hearing skills training

Some hearing skills can be improved by “auditory training”.

Amblyaudia, where one ear is weak, can be improved by a course of four weekly training sessions.  Along with two centres in the United States SoundSkills is part of an experimental programme working with a new therapy for amblyaudia.  The results to date are very positive.   The one hour weekly sessions consist of 20 minutes training, 20 minutes rest, then another 20 minutes training.  The training involves attending to speech signals in the weak ear while competing speech is slowly increased in volume in the dominant ear.

Some people with APD have difficulty with “spatial hearing”, distinguishing and separating sounds from different directions.  SoundSkills offers a newly released home software programme using a game format that has been shown to effectively improve the ability to hear against background noise with twelve weeks of training.

Many other auditory training programmes are available though their value is less clearcut.

Remote microphone hearing aids

The first priority with a hearing disorder is to help the person to hear better.  This is especially important for a child struggling to hear in school. Most children with APD benefit from the use of remote microphone hearing aids, sometimes referred to as “personal FM systems”.  These are different from conventional hearing aids and from the personal FM systems used by children with other hearing disorders. The parent or teacher wears a transmitter microphone and the child wears discreet miniature hearing aids that also incorporate radio receivers so that the voice of the person speaking into the transmitter is amplified and is transmitted directly into the ears.  Remote microphone hearing aids reinforce the speaker’s voice and greatly reduce distracting interference from background noise.

Whilst the primary purpose of remote microphone hearing aids is to immediately help the child to hear better, a fascinating recent finding from a number of research centres (Christchurch, Auckland, Florida) is that use of the hearing aids actually improves hearing skills. After a few months use of remote microphone hearing aids children achieve improved scores on tests of auditory processing and show improved ability to hear against competing background sounds, even without the hearing aids.  That is consistent with local experience that children may not need remote microphone hearing assistance long term, perhaps only for a couple of years.  Our clinical experience at SoundSkills also confirms these research findings.  Of course results differ for individual children.

Listening therapy

Speech language therapists have a variety of techniques to teach skills to help with maintaining attention to auditory information, and recalling what has been heard.

Language therapy

Children with APD usually have deficient phonological awareness, that is, they may not recognise or be able to differentiate all of the sounds of language.  This often needs specific remediation.  Poor phonological awareness may underlie poor spelling, poor vocabulary, and reading and language disorders.  A speech language therapist can assess the areas of deficiency and implement a therapy programme to address them all.

Listening and language therapy does not directly address the underlying hearing problem as do auditory training and the use of remote microphone hearing aids.  But they are nonetheless critical in addressing the consequences of the poor hearing and as such are an integral part of the management of APD.

The SoundSkills team includes a speech language therapist.

School guidance

For children, optimising the learning environment is critical.  And if remote microphone hearing aids are trialled in school it is critical to have an expert involved at the school throughout the trial to ensure they are used optimally.  The SoundSkills team includes an Education Adviser, experienced in special education, who works on site with the school’s Special Education Needs Coordinator (SENCO), the teacher and other education staff who are involved, as well as with the child and parents.  She facilitates introduction of remote microphone hearing aids, carries out classroom observation of the child to ascertain the difficulties the child encounters, provides guidance on communication and teaching strategy, and assists with Individual Education Plans, goal setting, monitoring and funding applications.

Software packages

Many software packages, usually employing a game format, are promoted as home-based treatments for APD.  Mostly they deal with one or only a few specific aspects of the problem.  Most address consequences of APD but not the hearing problem itself.  Not all are well supported by research evidence.  Experience shows that left to their own devices with game-based software, children will choose to work in the areas they enjoy most and at less demanding difficulty levels than is optimum, rather than working on the most important tasks and at the optimum difficulty level for learning. (Some programmes do automatically optimise the difficulty level.)  These factors illustrate the point that software is most effective where employed as part of a more comprehensive treatment programme with a therapist directing which software to use and which areas to work on.

Evidence-based treatment

SoundSkills is committed to using evidence-based diagnostic and treatment methods.  That means that our methods are supported by independent, peer-reviewed, published scientific research, usually from respected university departments internationally.  SoundSkills has links with APD experts and researchers internationally and is involved in the international “Pathways” APD Special Interest Group.  In particular SoundSkills has links with the Universities of Auckland and Canterbury, Macquarie University, Sydney and the University of Pittsburgh.

Many treatments for APD are promoted but not all are endorsed by the relevant qualified hearing professionals (audiologists) and not all meet the criterion of a scientific evidence base that is independent, peer-reviewed, published and replicated.

Parents should be aware that there is no strong audiological evidence that hearing disorders are remediated by programmes of physical exercises or motor activities.  Nor is there good evidence that programmes involving listening to specially processed music (such as “Auditory Integration Training”) remediate hearing disorders.

The American Speech Language Hearing Association (ASHA) says;

 “…AIT has not met scientific standards for efficacy that would justify its practice by audiologists and speech-language pathologists.”

Click here for the full ASHA statement

The American Academy of Audiology says;

“Commercially available alternative sound-based treatment programs that purport to

address central auditory processing problems (as well as a range of other disorders including

autism) are frequently promoted by practitioners from related professions (e.g., occupational

therapy). These treatment programs (e.g., Berard Auditory Integration, Tomatis Approach,

Listening Program) have not been supported by the major professional associations

representing audiology and pediatrics due to the lack of evidence demonstrating efficacy,

questionable scientific foundations, poor research designs, and potential to cause harm due to

lack of acoustic rigor and controls (e.g., excessive noise levels) (AAA, 1993; AAP, 1998;

ASHA, 1994, 2004; EAA, 1997; Gravel, 1994; Hall & Case-Smith, 2007; Sinha et al., 2006).”

Click here to read the American Academy of Audiology Position Statement on Auditory Integration Training (AIT) October 2010

Review

Progress should be reviewed at least annually in the first year or two of APD treatment. A school visit by an Education Adviser at the beginning of the school year (if there is a new teacher) is often helpful. If progress is very good the use of remote microphone hearing aids may not need to be continued.  We have seen APD test results improve to within normal limits after one year of treatment though the children concerned have not been ready to relinquish use of their remote microphone hearing aids in class at that point.

Hear For Families APD Support Group

A national support group for people living with APD has been established. It is called Hear For Families.  The association plans to develop helpful resources, hold events at which families can meet others with similar challenges, and advocate for improved services and funding for APD. New members are very welcome.

Click here to make contact with Hear For Families