Auditory and Language Processing

Auditory Processing Dysfunction – A receptive language disorder affecting the way sound input is interpreted by the brain. There is a loss of information between what is being said and what the brain perceives.

Language Processing Dysfunction – An expressive language disorder is a problem arising in transferring thoughts to the outside world.

Hyperacusis – Reduced tolerance to moderate to high intensity sounds originating in the central auditory nervous system; these sounds may be bothersome, annoying, uncomfortable, or even painful.

Central Processing of Sound

Central Auditory Processing Dysfunction – the inability to understand spoken language in a meaningful way in the absence of what is commonly considered a hearing loss.

Central Processing of Sound occurs mainly in the brainstem. In order to process auditory inputs, this component must be functioning properly. Included in this system is the afferent auditory pathway, which tells the brain what a sound is and where it came from. Since the ears are several inches away from each other, location can be determined by distinguishing which ear heard the sound first and louder. A sound coming from the left would thus reach the left ear first and be louder in the left ear than in the right. What seems so simple here can be very complicated in the brain if it is not functioning properly. The brain stem still has several other functions. It must integrate sound with the rest of the body, so that an individual can respond to sound physically. If you hear a car horn while riding your bike, you might turn to be further off the road while also looking to see what the car is honking at. The brainstem also integrates visual processing to sound, as well as body mapping, auditory spatial mapping, and visual spatial mapping. Two other features of the brainstem are the ablility to enhance important sounds while dampening background noise, and tone discrimination.

The left and right brain have specific functions when it comes to auditory language processing. The left brain analyzes temporal sound and sequential patterns of sound, while the right brain integrates spatial properties of sound. There is a twist to this organization; sound coming into the right ear goes to the left brain, and sound coming into the left ear goes to the right brain. This serves to assure that both left and right brain functions synchronize together. More specifically than above, each side of the brain has these roles:

Symptoms/Signs of Central Processing Dysfunction

• Difficulty answering questions
• Poor sequential skills
• Poor memory
• Poor auditory discrimination
• Difficulty with reading, spelling, and/or language
• Poor concentration
• Easily distracted
• Often misunderstands what is said
• Difficulty hearing in noisy environment
• Difficulty following directions
• Low academic motivation
• Short attention span
• May initiate more often in order to avoid answering questions

Typical Assumptions

• The child does not listen
• The child cannot remember
• The child does not understand
• The child must be mentally “slow”
• The child cannot hear well
• The child is ignoring you
• The child is being stubborn
• The child does not care about what is going on around them

Causation:

Auditory Processing disorders are thought to be caused by middle ear problems. Sounds entering the ear may be degraded or distorted before reaching the nervous system, thereby not allowing the child to develop proper processing functions. This lays the foundation for poor listening skills.

Evaluation/Treatment:

By an audiologist –

SCAN: composed of four tests, evaluating performance with filtered words, auditory figure ground, competing word test, and competing sentence test.

• Filtered words – The child is asked to repeat 20 distorted words presented to each ear.
• Auditory Figure Ground – The child is asked to repeat 20 single-syllable words presented toeach ear with no distortion. There is constant babble presented in the same ear at a slightly lower volume.
• Competing Word Test – The child is asked to repeat 15 words presented to both ears at the same time. For the first set, the child repeats only those words presented in the right ear. For the second set, the child repeats only those presented to the left ear.
• Competing Sentences Test – The child is presented with 10 pairs of sentences played into both ears at the same time. The child is again asked to repeat the sentences heard in the right ear for the first set, and left ear for the second set.

Management Strategies may be given by an audiologist or speech and language pathologist to help the child be successful in school and at home:

• Classroom Placement – Consider noise levels and proximity to distractions such as the water fountain, hallway, etc.
• Gain Attention – Before new material is presented, the instructor must make sure they have the child’s attention
• Check Comprehension – Ask the child questions to make sure the child understood the conceptor direction.
• Rephrase and Restate – The child needs to feel comfortable telling the instructor when a statement was not understood. The instructor may need to rephrase the statement; keeping directions short may help.
• Self-Reliance – The child needs to learn skills to modify and manipulate his environment in all situations, where a trained adult may not be present
• Watch Discipline – Make sure the child knows rules and why or what behavior is being punished
• Quiet Study Areas – Make a study area that is quiet and free of distractions
• Conferences – Parents and teachers must communicate often to compare progress

An audiologist or speech and language pathologist may also recommend the use of a classroom FM system or a personal FM system.

By a speech therapist –

General treatment approaches by a speech therapist include training auditory and listening skills such as:

• Auditory Discrimination
• Localization of Sound
• Sequencing of sounds
• Identifying a target sound in a noisy background
• Answering questions
• Auditory discrimination
• Using visual and expressive stimuli to enhance language skills and develop practical strategies to facilitate the processing of language
• Rhyming
• Following directions