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Auditory Processing Disorder (APD) in The Times

  (c) The Times 1 March 2008

To read full article on the "The Times" website, click here

My son has Auditory Processing Disorder - APD

Anne Dixey on a little-known disorder that may affect the school progress of one child in ten

When football dad Kai Vacher wants to shout at his son to take the ball up the wing, he has to restrain himself. For, although Ben, 7 (right), can hear, he can’t understand. He has auditory processing disorder (APD), a listening difficulty that could affect 10 per cent of children.

Kai and his partner Anna had wondered about Ben’s hearing since he was little. “Every time he went to playgroup he would say, ‘Something is wrong with my ear; there is always a rushing sound like rain’,” Anna recalls. But when a teacher suggested he might be deaf the hearing tests came out normal.

Anna gave up her job as a secondary school teacher to help Ben. Her shelves are filled with files, letters and research. It has taken Anna and Kai nearly four frustrating years to get a diagnosis for Ben’s condition. They went from GPs near their home in East Sussex to local speech therapists, audiologists and ear, nose and throat specialists until the final, firm diagnosis of APD at Great Ormond Street Hospital, in London.

APD is a listening disorder rather than a hearing disorder; the problem lies in the brain rather than the ear. For any sound to be registered, signals from the ear must be translated by the brain, but children with APD have trouble registering or processing these signals. The exact reason is not yet understood.

Awareness of the condition is comparable to dyslexia 20 years ago. GPs often haven’t heard of it and, although the US has led the way in highlighting the condition, there is no routine test. One of the problems is that experts say it is difficult to diagnose before the age of 7 – a child is changing so fast before that age.

How well an affected child listens seems to depend on the situation he is in, and noisy environments are most problematic. Kai, a former teacher and now an education consultant, describes it as like “living with a child who is periodically deaf”. Communicating one-to-one is fine, but Ben is lost in a crowd. “When he is at a birthday tea with eight or ten kids he hasn’t got a clue what is going on. He will look at the faces and laugh, but there is a slight delay.”

The Vachers, along with Ben’s 12-year-old sister Lizzie, were ecstatic when Ben’s condition was finally diagnosed but then began the struggle to find the right treatment. A breakthrough came with the loan of a radio microphone system from the National Deaf Children’s Society – Ben’s teacher wore a microphone and he had a receiver. During that eight-month period he came home “skipping and laughing.” The teacher’s voice had been distilled out of the background noise.

But since the microphone system had to be returned at Christmas, at the end of the loan period, he has been in a class of 35 without the equipment. Anna says: “Four times a day he gets pain in his ears and has to leave the classroom – the teacher says he is struggling. It is about his wellbeing, too. Now it is awful, he comes in from school and just curls up.”

Ben has an added hearing sensitivity that means he hates the noise of fireworks or even a hairdryer. But his listening problem does not mean that he cannot appreciate music. “He is very musical and plays the violin and piano,” Kai says. “When he hears a song on the radio he will sing the tune perfectly – but he will get the words wrong.”

The family is currently in discussions with the local authorities and hope to get another microphone system for Ben to use at his village state school. They cost about £1,300.

Computer training can help APD sufferers

Dilys Treharne, an APD specialist at Sheffield University, says: “We think about 10 per cent of kids have got it – that’s a lot of children. Some of them cope quite adequately with it but some really struggle. You cannot cure it but a lot of work can be done to ameliorate the problem.”

Options include cutting noise in the classroom with carpeting, radio microphone systems and computer programs. Addison Primary in Brook Green, West London has just joined a handful of other state schools nationally using Fast ForWord (FFW) intensive computer training, aimed at children with APD and other disorders such as dyslexia. The programme uses games that reward learners when they listen carefully, correctly recognising sounds or accurately following on-screen instructions.

Pete Dunmall, the head teacher, had never heard of the condition but, when one pupil was given a firm diagnosis, he decided to use the internal budget to fund FFW for six children who might benefit. “We just want to see what impact this programme has with these children and then evaluate,” he says.

Diagnosis of APD is complicated when children also suffer from other conditions with similar symptoms. Difficulties with reading might be due to dyslexia and problems concentrating because of attention deficit disorder.

Professor Dave Moore, the director of the Institute of Hearing Research, describes it as a “referral lottery” in which a child sent to an audiologist might be told he or she has APD and one sent to a language specialist might be told that they have dyslexia.

To find out more about the problem, the institute is testing the listening abilities of 1,600 children, aged 6 to 11, in Glasgow, Cardiff, Nottingham and Exeter. Professor Moore describes it as “the most thorough research being done in the world on the subject”, and it is attracting international interest. The research will help provide an estimate of the prevalence of ADP, with the ultimate aim of developing an accessible, standard diagnostic test.

Word in your ear

What is auditory processing disorder? Hearing starts in the ear, sounds are sent to the brain and the brain interprets them so we can understand. In a child with APD, the brain has difficulty translating the sounds.

What’s the cause? It might run in families and there could be tiny differences in the way brain cells send messages or are joined together. Middle-ear disease (“glue ear”) may also be a cause.

The symptoms APD sufferers have difficulties understanding spoken messages, using speech, reading and remembering instructions.

The diagnosis GPs will refer patients to speech therapists and audiologists who will use a battery of tests.

The treatment Reducing background noise at school and at home can help; as can sitting the child next to the teacher and checking understanding. There are also hearing training programmes, classroom listening devices or radio microphone systems.

For more information visit apduk.org or defeatingdeafness.org.

Source: MRC Institute of Hearing Research; the British Society of Audiology; APD Steering Group

ADHD

Great to see the relaunch of the HADD website www.hadd.ie. Lots of resources here for parents and teachers who deal with ADHD related issues.

Attention is the big secret to success. Simply by not paying attention you are not going to process information. Get the student to start paying attention then you are unlocking the door for them to succeed. We approach it from a cognitive way, that is, build the attention habit by using exercises that are intense, frequently done, adapted to the student, that are linked to the skills they need (in our case reading and learning) and give timely motivation. It's amazing how a lot of kids after 3 to 4 weeks consistent work start to pay attention and click into learning.

Check out the site its a good one.

Fast ForWord in the Australia Age Newspaper

Fast forward for slow learners

Can online programs really re-wire the brains of children with learning difficulties? Denise Ryan investigates.

MANY students with learning difficulties are either not identified or are misdiagnosed by teachers as being lazy or having behavioural problems, according to speech pathologists and education experts.

Recent brain science research shows the brain is more "plastic" and changeable than previously thought, indicating that students with learning difficulties can be helped in new ways.

But educators say that despite advances in knowledge, children with learning difficulties often get little help. They say this is mostly because schools either lack funding to hire skilled staff to identify the problems and to offer one-on-one assistance, or because they are unaware of what is available to help such children.

In the absence of help at school, many parents are paying speech pathologists or buying interactive online software programs to help their children.

Martha Burns, a US expert in the application of neuroscience to learning, warns governments of the risks of not funding help for such children. "Many children with learning difficulties who are undiagnosed, or are misdiagnosed with behavioural problems, end up in correctional facilities," she says.

Dr Burns, who has worked as a Chicago speech pathologist and university researcher for 35 years, will visit Melbourne next month. She says speech pathologists now get children to use interactive online learning programs as an adjunct to their programs. Some parents are paying software companies more than $2000 a year for the right for their children to use such programs at home.

One of the latest - and possibly controversial - tools being used by speech pathologists and remedial teachers is an American software program called Fast ForWord.

While it is not the only computer program for students with learning difficulties, it is the most popular. It is used by many speech pathologists and is available in more than 5000 overseas schools and a small but growing number in Australia.

Hundreds of Australian children with reading and language difficulties, including some with autism, attention deficit disorder and dyslexia, have been involved in trials of the program. Many speech pathologists such as Dr Burns have found it helps, but some university researchers say more research is needed.

The program gets students to play computer games daily for about 50 minutes for at least 10 weeks. The speech technology slows down words and draws out syllables so that a child can distinguish the sounds. It then gradually speeds them up again. Through repetition, its promoters claim, the program re-wires the brain so that students become less confused about hearing similar sounds or reading similar words.

Sydney speech pathologist Devon Barnes, who sells the American software program through her company LearnFast, says she has used the program with more than 300 children.

A speech pathologist for 40 years, Ms Barnes says many children struggle with reading because of inadequate brain wiring. She says auditory processing, whereby the brain becomes overloaded with information, is a common problem. "If the teacher is doing lots of talking, the brain overloads because of inadequate pathways in listening areas."

Latest brain research using functional magnetic resonance imaging (FMRI) shows that students should move more and talk more during class if their brains are to function optimally. For children with learning difficulties, who often can't understand the teacher's instructions and who may misinterpret written instructions, the demand from teachers to sit still, stay quiet and concentrate for hours every day is a form of torture, says Ms Barnes.

"That's when you get behaviour problems. Those constraints are very distressing for the child. They get absolutely lost."

Debney Park Secondary College in Melbourne, which has been using the Fast ForWord program for three years as an adjunct to its speech pathology program, is aware of this problem.

Disability co-ordinator Lynn Bentley says if a teacher says, "Good morning class. Open your books. Turn to page 63 and read paragraph four", it is now known that students with learning difficulties might hear "Good Morning" and possibly "Open your books".

"They would figure out to turn to page 63 from watching other students, but wouldn't know what they should be doing," she says.

The only way teachers can deal with these students, Ms Bentley says, is to repeat the instructions many times. Many teachers don't recognise the need to do this, and for those who do, she says, it is "incredibly time-consuming and difficult" when there are 25 or more children in a class.

Ms Bentley says Fast ForWord claims to tweak the brain so that it can process faster - and from her observations it appears to help.

In the computer games, students listen, for example, to sounds such as "ba ba" and must hit the button when they hear "da".

"These students don't hear the 'b' sound change to 'd' for a long time. But after lots of repetitions they do," Ms Bentley says.

She says students with learning difficulties often see the first and last part of a word but not the middle. For example, they might read the word "decided" as "dead".

"Many of these children have normal intelligence. They know they are not dumb but they also know they cannot do the work that the other children can do. They get very frustrated. If it is not addressed they are doomed to not coping in an academic environment."

Bronwyn Parry-Fielder, a speech pathologist at the Royal Children's Hospital, was the first to introduce the Fast ForWord program to Melbourne, in the late 1990s. She says the hospital used the program for two years at an annual cost to parents of about $1600 a child.

Ms Parry-Fielder says the Royal Children's Hospital recorded the results of 58 children who used the program in the late 1990s. She says a few, who had medical problems, showed no improvement. But children with auditory processing problems made two to three-year gains on standardised tests after two to three months. A group of autistic children made six-month gains in their language development based on standardised tests within three months, and some language-disordered children made a 12-month gain in a few months.

"There has been a lot of discussion internationally about the claims made," Ms Parry-Fielder says. "Not everyone is positive. Some researchers think the results have more to do with the intensity of the program than the program itself."

A 2001 study, which examined five earlier studies of Fast ForWord, concluded that the improvements in language abilities were not from changes in temporal processing and that more research was needed.

But a recent Stanford University study using FMRI concluded that the program helped children with dyslexia. A West Australian trial of 144 students at four primary schools for 10 weeks last year also showed gains for some children.

Genevieve McArthur, a research fellow at the Macquarie Centre for Cognitive Science, recently reviewed 15 published studies on Fast ForWord. She concluded that only two of them had the necessary controls and that they didn't conclusively show benefits to reading or language.

Lynn Bentley attributes the gains made by the 13 children identified with severe language disorder at Debney Park to using Fast ForWord as part of a broader speech pathology program.

"I don't know anywhere else that is getting such students to age-appropriate levels," she says.

Parents may feel confused by these conflicting claims but for many, paying for help is the only option. Ms Bentley says many students who need help miss out because it is so difficult to get individual funding through the state education department to provide intensive daily therapy.

The State Government used to fund such students if they scored 70 or below on two language tests but, she says, this was cut three years ago to assist only students who scored 55 or below. The average person would score 85 to 115 on such tests.

When the funding was altered, the Government related funding to the number of students in years 7 to 9. "The only way to get individual funding is to score 55 or below and demonstrate a critical educational need, but that is difficult to achieve as the criteria isn't published," says Ms Bentley.

Clearly, more funding is needed if schools are to keep pace with the latest research on learning difficulties.

A study by Caroline Rae, a professor of brain sciences at the University of New South Wales, aims to improve the reading ability of children with different types of dyslexia. Her study is using FMRIs of children aged 8-10 to study which parts of the brain are activated when reading.

Professor Rae warns that the type of dyslexia must be correctly identified before using any computer learning program. Most children have phonological dyslexia, which means they have a preference for spelling words phonetically, whereas lexical dyslexics prefer the written word and have problems with phonetics. Lexical dyslexics are less common, she says, and certain computer programs won't help.

Professor Rae called for government investment in assistance for children with dyslexia as it is harder to help children after the age of 10.

"We know that dyslexics are over-represented in jail," she says.

BRAIN BOX

� Students can work on Fast ForWord at a speech pathologist's clinic, schools can buy the program or parents can buy it to use at home. It is available in Victoria through two companies, LearnFast in Sydney and Sonic Hearing in Perth.

� LearnFast and Sonic Hearing both charge $2200 for two programs, which students do at home for 50 minutes a day, five days a week for about 12 weeks, with ongoing support provided. If schools obtain a site licence, the cost per student is lower at about $100.

� LearnFast will host a conference, Re-wiring the brain for academic gain, in Melbourne next month.

Irish Examiner Article

Here is an article on our centre and also on a school using Fast ForWord. Both of us are getting great results with kids who have issues with dyslexia.

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