Auditory Processing Disorder

How to refer to for an assessment

Referrals for children in West and North Kent should be made to the West Kent Children’s Hearing Service.

For children in The East Kent referral are via a tertiary centre, for example, Great Ormond Street Hospital (GOSH). For more information and criteria visit Auditory processing disorder | Great Ormond Street Hospital (gosh.nhs.uk).

Management of APD

Management strategies can be divided into two categories:

Modification of the listening environment

This includes acoustic changes to the environment to reduce noise and reverberation, consideration of assisted listening FM systems, and recommendations for adaptations that can be made to improve sound quality or volume for the child.

Compensatory strategies

This includes aspects such as improving listening skills, working memory and shared reading.

We don’t suggest trying all of the suggestions, but picking the strategies which may help your child with the areas they find most challenging.

Suggestions for teachers

• Provide preferential seating: Seat the student near the primary sound source. Allow flexibility in seating; the middle of the class towards the front or at the front and to the side favoured by the teacher. This enables the child so see and hear information more easily and turn to see peers during discussions.
• Avoid seating near other sources of noise: Place the student away from competing or distracting noise sources such as outside noise or equipment in the classroom.
• Acoustic modifications may be useful, for example, carpeting, curtains, and other sound absorbing materials.
• Speak in a clear, well-modulated voice. Be careful not to over-articulate.
• Discuss the difference between listening (active process) and hearing (a more passive process) – ‘I can hear but that doesn’t mean I’m listening’. Explain how to be a good listener.
• Try not to talk when your face is not visible to the class or your back is to the class, for example, when writing on a board or looking down.
• Reduce distractions, both auditory and visual.
• Gain attention before giving instructions and regularly check for attention.
• Encourage the student to ask for clarification.
• Frequently paraphrase or summarise key points.
• Give positive feedback.

Strategies to minimise the effects of APD (Schools)

• Acknowledge the problem. Reassure the child/young person that listening is difficult, but there are things you are going to try that will help.
• Consider a trial of an assisted listening device (for example, FM system).
• Seek advice from the specialist teacher of the deaf on improving existing listening conditions
• Seat child/young person close to the teacher so that distance and “noise” do not interfere with their ability to listen to speech effectively.
• Encourage the child/young person to watch and listen so that they have visual as well as auditory clues, and provide visual aids and prompts.
• When addressing the child/young person use their name first so that you gain their attention before giving an instruction.
• Their auditory memory may be weak. The first part of an instruction may be heard, but not the rest. “Chunk” information/instructions. Give clear, concise written directions that they can refer back to, for example, a tick list. Praise each completed stage.
• Give time to process what is heard (thinking time) without prompting straight away.
• Consider delivering spoken tests – particularly mental maths - at a slower pace – for example, 10 seconds instead of five seconds per question. They could be part of a small group with a teaching assistant out of the main classroom to minimise feelings of isolation and being “different”.
• Give them the opportunity to work in a quiet environment where possible with a small group and an assistant.
• The level of concentration needed in order to listen effectively will be high and it will need to be sustained. Greater than average effort is required. This is exhausting and the child may “switch off” and day dream. Allow them to have a break in a quiet place if necessary/possible.
• Give written instructions to support the verbal – but staff should also check their understanding of tasks.
• As the curriculum becomes more complex and demanding, guided use of a laptop computer will help organise and order thoughts and ideas more easily.
• Ask the child/young person discreetly to repeat back what they have been asked to do. This will build comprehension skills and ensure messages have been understood correctly.
• Give written instructions in clear bullet pointed steps.
• Some older students find it helpful to record the lesson for review later – teacher instruction parts only! This is especially useful when new information is being given.
• Teachers help by making it physically, visually and audibly clear when they are about to begin something important.

Games to play at home

• Listening for “same” or “different” sounds.
• Listening missed words in familiar rhymes or stories.
• Playing Silly Sentences:  One person starts a sentence, finishing with a connecting word such as: and or then or when or because, Then the next person finishes the sentence in a silly way, then continues the story or starts a completely new sentence with a new connecting word. g: I was walking sleepily to school when...
• I suddenly realised that I was wearing my princess pyjamas, so...
• I quickly jumped into a prickly bush and hid quietly until...
• Auditory sequencing/memory games such as: “I went to the shops and I bought a….”
• “Simon Says …” But give more complex three or four element instructions. If s/he finds this difficult, reduce the number of elements.
• Gradually increase the number of elements in an instruction; “go upstairs, look in the airing cupboard and bring down the red bath towel and a white hand towel ...”
• Auditory discrimination activities: “What’s that sound?’
• Play mime games such as charades to develop attention and the ability to read visual clues.
• Pass on the message: first in quiet, then introduce background noise and other distractions. Increase the complexity of the “message” gradually.
• Copy that tune! Repeat a simple tapped rhythm or riff (musical phrase) if the child plays a musical instrument.
• Find that noise! Sound location games with eyes closed like Marco Polo.
• Listen to audio books and follow the words.
• Make colourful mind maps for revision.
• Suggest they make their own “teach yourself” audio/visual aids (for example, learn a topic, then “teach it to yourself” by recording the topic so it can be played back.
• Musical Training: learn a musical instrument or join the choir.