auditory processing disorder

Advice that summarizes background research and personal accounts of APD adults to set forth common experiences and impacts

Category: advice

Being Inconsistent

I have been accused of being inconsistent. A friend in college told me she felt I offered “more good and more bad”. A manager said when seeking performance review feedback, most people when asked about a staffer say they have vague impressions, but with me, they seemed to love me or hate me.

I don’t know in the work world to play to my strengths or my weaknesses. If I am going to have more lapses than most people, I know I need forgiveness (more than most people). Perhaps this is the underachievement syndrome some of us face. A neurologist I met said, about his own challenges that might be something along the lines of ADHD, that without them, he would have won a Nobel Prize. So, I think that is what is so confounding for ourselves and others, is that we have moments when everything IS aligned for success, and moments when we muddle along well enough, or better than most, and moments when we may appear to make careless mistakes (which I attribute to an overtaxed short-term memory).

I was trying to forewarn a new acquaintance last night who’d commented about breaking off a personal relationship with someone unreliable that I need acceptance since I value reliability, but cannot always deliver it. The propensity is an issue to be aware of.

. . . Now, a few weeks later, I have watched a sequel to the PBS show that portrays in an easy-to-get fashion what it’s like to have a learning disability (F.A.T. City, for “Frustration, Anxiety and Tension”). The sequel (http://digital.films.com/play/VYGF6S) picks up after around the first 58 minutes . . . in it, Rick Lavoie says about inconsistency that it’s like a room with three clocks that are all running differently — every now and again, they are aligned and all agree — so it is like that, that the human mind may be out of sync but every now and then everything snaps into place.

He also mentioned the concept of “social contract” which is, I think, what leads inconsistent people to feel isolated. I had also read in Katherine Ellison’s “Buzz” (about she and her son being diagnosed with ADHD) that she came to believe trust was at the crux of the issue.

I remember feeling so hurt, peeved, and aggrieved when being accused by a controlling boss that she felt other managers who interfaced with my work didn’t trust me. Maybe it was just because I was inconsistent, so it might be hard to know what to expect, or erratic.

Letting people down — even if unintentionally — breaks that social contract, limits trust, and so people will start to pull away. And, as Lavoie pointed out in the sequel, kids felt strongly that the social bonds mattered way more to them than learning — if they could only fix one of those two things, it’d be the social one.

The only answer I have, which can be hard to keep in mind to do, is to express motive behind a behavior so people don’t read their own opinions into unexpected choices (or occasional lapses). A neighbor who is sometimes scattered and sometimes needs to just chill said she alerts people that she is going into her cave — so they don’t take offense, I guess.

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Resources – Additional Explanations about APD

I have come upon a few explanations about auditory processing disorder that are succinct and clear. One mom of an APD boy posted a couple of topics:

Thanks to Bonzlee for posting those – I hope more people will discover and benefit from them now!

Also, a disabilities ministry in Buffalo, N.Y. has the following list online that seems accurate and clear:

(http://www.buffalodiocese.org/Portals/0/disabilities/Helpful%20Tips%20for%20Central%20%20Auditory%20%20Processing.pdf)
CENTRAL AUDITORY PROCESSING
The basic problem is perceptual or cognitive inefficiency or delay in perceiving, processing,
organizing or responding to what is heard – primarily, and most important in the classroom, it refers to the speed and effectiveness with which a child can process the spoken word.
Five points to know from parents:
1 . My child has trouble listening. Please understand that this is a learning problem and not a
behavior problem.
2. My child needs to hear things more than once to understand them. Please send important material home so that we can review it with them.
3. My child may have trouble filtering out background noise, and may be sensitive to sounds we wouldn’t notice. Please understand that they are trying to pay attention.
4. My child will benefit from being seated in clear sight of you, and having as many visual aids and cues as possible.
5. Please keep the lines of communication open between our home and your program . My child needs all the adults in her life working together.

Helpful Tips:

  • Background noise may be extremely distracting – a seat near the blackboard or front of class may help.
  • Be ready to repeat things – hearing is not a problem, but absorbing and processing the information can be laborious.
  • Information needs to be presented in a multisensory way – that is, visual, auditory, kinesthetic and tactile. Children with these difficulties have a difficulty in obtaining information through the auditory modality, so it is important that visual materials are used when presenting new learning.
  • Do not expect immediate answers to oral questions, or assume that because the child’s hand is not up, the child does not know the answer – the right answer may be there, but takes time to be formulated.
  • Allow for some measure of frustration – remember that the child may be continuously undergoing a ‘tip-of-the-tongue’ experience.
  • Word retrieval can be aided by providing structure words or the key words which the child is likely to use: this can help them write more purposefully and ease the frustration in trying to access words which they may have difficulty accessing.
  • Let the child know you are aware of their difficulty, and that you are sympathetic – but that you have high expectations.
  • Be specially generous with praise and cautious with criticism. Praise can be a natural motivator as long as the child feels the praise is genuine and deserved. It is important to let the child know why they are being praised rather than just to provide praise. In a behavioral reward system with extrinsic rewards such as stickers or points, the child can easily see why they are being praised. This can be an effective motivator, as long as the rewards are meaningful and appropriate.

I hope these are helpful. (The last one was mentioned in a comment by me on this blog, but I thought it would be good to gather a few resources in a single place.)

Subtypes of APD

From a checklist by audiologist Judith Paton of San Mateo, Calif., whose explanations seem helpful:

Tolerance/Fading Memory” subtype
Symptoms include:

  • Often seems to “ignore” people, especially if engrossed.
  • Hears less well, or is less attentive/productive, in ordinarily busy surroundings.
  • Difficulty following a series of spoken directions.
  • Unusually forgetful of information previously memorized (such as multiplication tables, correct spelling), or of household or school routines and responsibilities, despite frequent reminders.

“Decoding” subtype
Symptoms include:

  • Difficulty with phonics (sounding out words) approach to reading.
  • Confuses similar-sounding words; may learn words wrong.
  • Poor speller: errors phonetically correct (e.g. “littul” for little) or seem random (wrong sounds, sounds/syllables missing/added).
  • Problems with speech clarity or articulation, or with grammar, now or in the past.

“Integration” subtypes
Symptoms include:

  • Marked difficulty reading or writing efficiently, despite knowledge of phonics.
  • Needs to (or should) ask many extra questions to clarify task before starting; “doesn’t get the picture.”
  • Interprets words too literally, becoming confused or suffering hurt feelings.
  • Poor “communicator” -— fails to explain, apologize, negotiate, defend.
  • Speaks or writes “telegraphically” -— omits facts or switches topic, so that audience cannot follow train of thought.

“Prosodic” subtype (often seen with NLD or non-verbal learning disability)
Symptoms include:

  • Absorbs details and facts, but misses the “big picture” — cannot prioritize or summarize information.
  • Insensitive to tone of voice; may misjudge speaker’s mood or be unintentionally tactless.
  • Problems with cause-and-effect reasoning; difficulty surmising the unspoken rules of conversation, play, and other situations.

Another Voice – Auditory Processing is an Invisible Disability

My acquaintance Bonnie just found out eight months ago she developed APD as she was getting her hearing aids adjusted over the course of a couple of years.

She wrote the following letter to her adult kids to try to help them understand, and offered to share it in case it helps others to read how she expressed what she wanted them to know about its effect:

To my dearest children,

I thought I would put in writing what is going on with my hearing. I can explain it verbally, but, sometimes when written, it can be understood better. So here goes:

Auditory Processing Disorder is an invisible disability, a developmental condition that interferes with the processing of speech. Although my hearing is not good (40% loss) I have a problem with perceiving and decoding what people are saying. (Even if I had perfect hearing I would have the decoding problem … it’s not governed by my hearing loss).

Sometimes although the other person knows what they mean or what they’re saying, what I think they mean or saying are two different things. It’s like having poor cell phone reception, where the signal gets static or drops out.

How it affects me:

It’s difficult trying to keep up with conversations or to understand what’s being said, especially when there is “background” noise. This is especially true when I’m on the phone. This means I must spend extra mental effort to unscramble words. Sometimes it’s the decoding where I bog down. What I think I heard and what was actually said seems fine during the blah blah blah part, and then at the “mumble” section, the letters go bad and I have no idea what the words are. My brain goes limp at this point, thus the puzzled look or handing the phone off to someone else. Doing all this decoding takes up working memory. Because I have to attend to what is being said in words, I have less attention for figuring out what is meant in conceptual content. Discriminating between voices and background noises is difficult. Situations with multiple people speaking are especially challenging because all the conversations and background noises keep weaving together.

My working and short-term memory are used to process the conversation, rather than to remember what I’ve heard. The result of this is that many times I don’t have a clear idea of what the whole conversation was about, because I’ve not had much extra short-term memory left for storage. This again creates mental fatigue, especially at the end of a day.

Verbal directions can be difficult. I have trouble understanding, recalling and keeping straight a series of commands, i.e. … directions on how to get somewhere, steps involved in figuring a deal etc. … Additionally, many numbers/words sound very similar, frustrating for sure.

I am trying to learn how to cope. Talking one on one in a quiet area is great. When it gets to loud in my office, I can shut the windows on each side of me, or even the door if necessary. Speaking slowly is also important as it gives my brain time to “decode” what’s being said. And, if you notice that I still didn’t get it, try rephrasing what you are trying to say. Tapping me on the shoulder, or calling my name before you speak to me will get my attention and thus I can concentrate on the conversation. Many people think that APD is a volume problem and that talking louder will help, not so. My hearing aides will help with my hearing loss as a whole but they can not help with the APD.

It’s also going to affect my speech response to some degree as I’m trying to “decode” and answer back … it equals a slow response at times or at times I have a problem pronouncing my words properly… sort of like being drunk and trying to talk without slurring.

Meantime, my goal is to learn to lip read so that when the time comes that my brain decides it doesn’t what to decode anymore … I’ll have something to fall back on.

There is no cure for APD. It’s something that I will have to live with and cope with. It will allow me the opportunity to learn more about it and to be better able to find ways to communicate more clearly and more efficiently. Please understand that my conversational difficulties do no affect my motivation or abilities to learn and move forward. I’m stubborn like that.

I’m not looking for pity or want you to feel sorry for me as I’ve been blessed with so many things, i.e. … I can see, talk and get around without any assistance. I’ve been blessed with you all as my children and I couldn’t ask for anything more. I just wanted you to understand what’s going on, or not.

I love you all,

. . . Bonnie adds she has two grown sons, their wives, a grandson and a very supportive boyfriend (as I recall, she is in her 50s). Her journey to a diagnosis was, “I just couldn’t hear well. I had an MRI of my brain to make sure everything was OK and went back to my ear, nose throat doctor for exams of my ears and all was perfect. After my old audiologist retired, I had to get a new one and after much more testing, I was diagnosed. Actually, as we get older, it is something that can be acquired as our brains naturally aren’t functioning at top speed … I’m still having some other difficulties, and I’ll be going back again, as I seem to have some clumsiness about me and my hearing is diminishing more so.. but, that is to be expected from what I understand. I do hope my article helps others and thanks for your support as well.”

APD Can Mean That Being Atypical Challenges Mutual Understanding

On the topic of APD (also known as CAPD) and its impact, the following excerpts and/or paraphrases from an online discussion group for adults with APD rang true for me. We may exhibit idiosyncrasies, but have some commonalities of experience:

  • It’s amazing how complex this disorder is, one recently diagnosed woman observed.
  • Acceptance, understanding and support by family, friends and partners are essential, said a co-moderator.
  • The ability to hear/process sounds and related symptoms varies and is affected by many things, such as fatigue, noise, stress, and hunger, said one member.

She voiced an experience shared by many, saying:

  • It hurts so bad to be ridiculed about something that you have no control over. Many people do not understand APD is permanent and ongoing. Just because it is not visible or I do not reveal it, does not mean I do not experience its symptoms.

Several forum members said:

  • They did, or almost did, have “nervous breakdowns” from the pressure, ending up at a hospital with panic attacks, for instance, when trying to keep up, fit in, perform, and deal with hostility and unsupportiveness for being different all became too much.

Meanwhile, it was heartening when, in the comment section of the blog Andrea’s Buzzing About, Laura wrote as a non-APD’er: “Boy, do I feel like crap after reading how hard life is with CAPD. … My husband and I are having severe marital problems … traditional Speaker/Listener exercises are not working … I took his behavior personally … would … explain myself over and over … He construes this as I am … insisting on changing his opinion … I holler at him ‘Listen to me! What I said was…..!’ I experience anger and frustration …” (especially when discussions are lengthy). [http://qw88nb88.wordpress.com/living-with-auditory-processing-disorder/] (1)

Reference:
1. Andrea. Andrea’s Buzzing About: Living With (Central) Auditory Processing Disorder[Internet]. San Francisco: Andrea’s Buzzing About: c2006-2008 – [cited Dec. 30, 2012]. Available from: http://qw88nb88.wordpress.com/living-with-auditory-processing-disorder/ .

 

 

What is Auditory Processing Disorder (APD)?

Auditory Processing Disorder (APD), also called Central Auditory Processing Disorder (CAPD), is a collection of brain-based impairments in the processing of auditory information despite normal hearing levels.

Due to hereditary factors, illnesses such as ear infections as a small child, or other factors (or a combination), someone with APD may lack the ability to rapidly discriminate and process sounds. For instance, tracking conversation in the presence of background noise can be much less successful for an APD’er than a normal person – an occurrence known as the “cocktail party effect”.

Only recently coming into popular awareness, the condition is recognized by audiologists although diagnosis can sometimes be confused with other (possibly co-existing) conditions such as attention deficit.

What Can be Done?

There is no known cure or remedy other than environmental support, such as facing a speaker and sitting close to a lecturer in order to catch more of what is being said (and possibly unconsciously read lips), helping to fill in gaps in perception of what is being expressed. Depending on the degree and exact nature of the problematic neural connections, some APD’ers may opt to try an amplification system as an aid, although others may be hypersensitive to sound and need – to a far greater degree than the average person – quiet settings to be comfortable and able to think calmly.

Like the case with other neural difficulties based in the brain, it may be possible to intensively retrain and strengthen existing neural structures to take over some of the missing function (known as “plasticity”) but audiologists have not endorsed listening-training programs due to insufficient quality and extent of evidence supporting these measures. Little work is being done at academic centers to address coping with this lifelong condition, estimated to affect at least 1 percent of the population. In fact, some listening-program equipment cannot be imported into the United States due to a lack of strong evidence to support its use.

Patterns of Difficulty

People with the condition may have a number of traits in common. For instance, they may receive feedback or determine that they:

  • Appear to not connect
  • Are forgetful due to running compensation strategies through their working memory (that has short-term, limited-capacity storage)
  • Are inattentive to detail and may miss the full meaning of what is being conveyed; sometimes the language impact spills over to writing and reading shortfalls
  • Rely (sometimes seemingly to a fault) on routine and structure, so may not transition well or cope with change as well as unaffected people do
  • Have communication that seems brusque and without preamble, like a telegraph message, or when the speaker tries to open up, is not distilled to a few key points and can be hard to follow
  • Can be somewhat poor spellers or make careless errors, underperforming compared with what would be expected for their intelligence level, although APD’ers are tenacious and can obtain advanced degrees
  • Are able to present information in a prepared talk far better than they can respond to questions in the moment – producing answers on the spot can be difficult
  • Find keeping up with and participating in dynamic group conversations – such as at a dinner party – hard
  • Be likely to miss many social cues in general, being slightly tone-deaf to them
  • May be easily distracted when concentrating and lose the thread when interrupted – affecting ability to focus or multitask
  • Notice that noise and conflicting sensory input or distractions can be unbearable at times – but the APD’er is likely to hide this out of respect for others or an attempt to fit in

In fact, the overwhelming conflicting incoming sensory input to process can cause a feeling of panic or momentary disorientation and lead to the individual “snapping” or feeling somewhat traumatized. Sometimes any conflicting demand for attention can be unduly challenging to a greater or lesser degree, partly because working memory is more taxed than in a normal person.

Impact of the Condition and Feelings it Elicits

Along with limitations of the impairment are reactions it evokes in the affected person and those around them. APD’ers will tend to try to avoid making errors, choosing actions that can still engender resentment. These effects include:

Treatment by others:

  • Socially or within families, the APD’er may tend to feel belittled, criticized, pressured, and/or avoided – there is a sense something is subtly off that might make the APD’er’s motivations, competence, or sense of etiquette distrusted; acquaintances feel let down, burdened, or miffed

Feelings:

  • APD’ers can feel frustrated, despair of overcoming issues, and have some self-contempt or sorrow about innate limitations to managing the condition
  • APD’ers generally try as best they can, so can sometimes be accused of appearing defensive when confronted with perceived shortcomings

Behaviors that may be typical for coping:

  • Withdraw
  • Rely on written expression
  • Seem tense, vigilant, anxious
  • Possibly bottle things up and be indirect to avoid creating confusion due to difficulty talking things through in the moment; “people-please” and have difficulty self-advocating or receiving credence for unseen problems
  • Transitions can be extremely difficult, so the APD’er may appear resistant

Physical:

  • Have a tendency to get emotionally exhausted more easily than most. Coping can be draining by the end of the day

Recognition of the Problem

Some aspects of the condition can be frustrating for everyone due to its subtle but pervasive symptoms that may escape immediate notice, but emerge as patterns or an unusual “style” or approach to things.

An APD’er personality may be unusual with quiet and sweet surface traits and strong-minded convictions under the surface, a combination that may have developed as a way of coping with the deficit.

With a bright individual, it may be hard for others to accept that he or she is challenged, with the challenges masked by development of complex coping mechanisms – but he or she does suffer all the same, and generally over time the nature of the difficulties will emerge and be more apparent, which can lead to harsh treatment in the workplace or ruptured relationships and a lack of sorely-needed support and acceptance without an intent on fixing the impediment.

However, rest assured that due to their limitations and vulnerability, APD’ers are among the least likely to intend to slight anyone and are managing the best they can, doing better when not stressed by ill-will or hostility.

The communication difficulty and invisibility of the condition make it hard for them to be good self-advocates. It may be helpful to compare it to a mental limp and treat them with the same consideration as someone trying to keep up while on crutches, to not take their challenges as an affront.

Aids for Interacting with an APD’er

Supplement spoken instructions with written ones.

Allow someone with APD to take notes – even in personal discussions this can aid memory, the ability to capture the essence of what is being said, and clarity.

Wait to say something until in the same room and facing each other, and be mindful of trying to talk over nearby background noise, such as a running dishwasher.

Realize the APD’er cannot control the consistency in which they are functioning – the degree of success may be spotty.

Be willing to entertain more follow-up questions than with a normal person. The APD’er may have trained him- or herself to not ask clarifying questions in order to be accommodating, but does appreciate the opportunity for understanding.

If APD’ers suspect they are socially tone-deaf they may enlist the opinions of support persons when assessing how to handle a situation. This does not mean overall they are naïve or immature, just that they are compensating for anticipated blind spots.

As with all unrecognized invisible disabilities, try to avoid blame and shame. This condition is one the APD’er lives with everyday without hope of improvement, and they have encountered their fair share of mistreatment as a result, so may harbor a store of hurt feelings as a result. Simple, nonjudgmental human kindness and plenty of forgiveness for frailties can go a long way to making the burden a little easier to bear and the individual feel a little more comfortable with human contact.

Recognize the APD’er may feel overtaxed at times and unable to keep up with the schedules of someone without the condition. With breaks to rest and recharge, an APD’er can still be fairly productive and competent in their own way.

Accept that structure and predictableness help the APD’er feel more relaxed, secure, and able to perform. Encouragement to get out of a rut, have a change of scenery, or to plan toward goals or contingencies may also help if the APD’er is overcautious or preoccupied with daily functioning.

Realize that despite their limitations they are generally well-meaning and sympathetic to others’ struggles, stemming from their own personal experience.

References

  1. APDUK. http://www.apduk.org.uk/ (experiences of people with the condition)
  2. Wikipedia. “Auditory Processing Disorder” http://en.wikipedia.org/wiki/Auditory_processing_disorder (intervention)
  3. National Institute on Deafness and Other Communication Disorders. “Auditory Processing Disorder in Children” http://www.nidcd.nih.gov/health/hearing/Pages/auditory.aspx

CAPD chart – Audiologists who specialize in this screening describe in a one-page table impairments along the auditory pathway, the associated symptoms, and advice for each of the four main subtypes  (most cases are mixed, with one subtype dominant).