'Auditory processing disorder': a real condition or another middle class excuse for a child who isn't achieving?

What is Auditory Processing Disorder?

 I overheard an older teacher on the train last week say that they were 'fed up these days of hearing about these modern excuses for little Hector or Hermione' not being able to do their work well or achieve better in lessons. He suggested that the parents should spend more time on helping with their homework than researching these possible causes! He wasn't talking to me, he was talking to a younger man who was nodding knowingly but I couldn't just sit there. After I had gulped and reminded myself to be polite, I leaned forwards and managed to say, 'Really, I'm so surprised you say that as most teachers these days look for the reasons behind a child's difficulties so they can help'. 

I am a parent of two children with dyslexia and Auditory Processing Disorder, that's not an excuse but it is the reason they find school difficult and have to try harder.

•      “APD is a deficit in neural processing that is not due to higher order language, cognitive or related factors” (ASHA 2005)

•      However, APD may lead to difficulties with higher level language processing, learning and communicating

•      “APD is characterised by poor perception of sounds, has its origins in impaired neural function, and impacts on everyday life

•      primarily through a reduced ability to listen, and respond appropriately to sounds.”

What are the symptoms?
   
It can affect a child's ability to:

• understand speech – particularly if there's background noise, more than one person speaking, the person is speaking quickly, or the sound quality is poor
• distinguish similar sounds from one another – such as "shoulder versus soldier" or "cold versus called"
• concentrate when there's background noise – this can lead to difficulty understanding and remembering instructions, as well as difficulty speaking clearly and problems with reading and spelling
• enjoy music -Many people with APD find it becomes less of an issue over time as they develop the skills to deal with it.Although children may need extra help and support at school, they can be as successful as their classmates.

What can we do about it?

•         Environmental Modifications:

Preferential seating in the classroom, as close as possible to the teacher, will make facial expressions clearly visible, and maximise the ratio of direct sound to reverberant sound. The seating position should also be away from noisy equipment, such as overhead fans, to maximise the signal-to-noise ratio.

•         Teacher-Directed Strategies

A number of strategies may be implemented by the child’s schoolteacher to assist children with listening difficulties to extract as much information from the auditory signal as possible. These strategies include:

1.       speaking in short, simple sentences

2.      repeating a message if not comprehended

3.      slowing the speed of delivery 

4.      providing visual cues and hands-on demonstrations, as multi-modal cues add to the auditory information so that the whole message can be understood

5.      pre-teaching new information and vocabulary so that the child has a greater chance of inferring missed information from the context of the message

6.      gaining attention prior to speaking

7.      frequently checking for comprehension; using positive reinforcement generously

8.       planning regular listening/concentration breaks to avoid auditory fatigue

A personal FM system may help. This is a wireless system designed to help someone better identify and understand speech in noisy situations and over distances of up to 15 meters (50 feet). The person speaking wears or holds a transmitter microphone. This transmitter picks up important speech sounds and uses harmless radio waves to send these to a FM receiver, which a child wears behind the ear. This results in the speaker’s words going directly directly in their ears, without any distracting background noise.  Unfortunately, most teenagers wouldn't want to do that as they make it their life's mission to fit in and not be different!

It needs appropriate and thorough screening to make sure it is APD and there is not some other reason for the difficulties. Screening using assessments such as a Scan 3 and LISN-S and formal and informal tests of receptive and expressive language are essential.  

If you are concerned about your child, please get in touch, we'd love to help.

To book a screen please click here

Attention!!

I was talking to someone last week about the importance of attention for any form of learning but especially learning for language development. They hadn't heard about the levels of attention to which speech and language therapists constantly refer, so I thought I'd do a quick summary:

There are 6 stages of attention which were identified in the 1970s by Cooper, Moodley and Reynell. No-one has improved on these but the age for the stages are now questionable so that very few children now go to school with mature attention.

ATTENTION CONTROL  - developmental stages (Cooper, Moodley & Reynell)

(All age levels are approx)

Stage 1:  DURING FIRST YEAR                                                                   

Extreme distractibility. Child’s attention held momentarily by whatever is the dominant stimuli

Stage 2: SECOND YEAR

Inflexible and rigid attention- child can concentrate for some time on a task of his/her own choice but cannot tolerate adult intervention. Attention level is better where the activity is one of his/her own choosing

Stage 3: THIRD YEAR

Single-channelled attention, but becoming more flexible. With adults help can focus attention. Child can transfer from his task to adult’s direction and back to the task. Attention is still adult directed making it necessary for the teacher, to ensure she has the child’s attention before giving instructions.

Stage 4: FOURTH YEAR

Still single Channelled to one task but the child can now transfer spontaneously. Moves gradually to the stage where she only needs to look at the speaker if directions area are difficult to understand

Stage 5

Two-channelled attention. Where the child is now able to attend to a verbal instruction in relation to the task without actually looking at the adult. Attention can only be sustained for short periods of time.

Stage 6

Mature school entry level. Where integrated attention is well established and well sustained N.B May see fluctuating levels depending on environment, task complexity or health

Many year 6 teachers will be shouting that their children cant keep level 6 for long. We live in such a visually dominant world that auditory stimuli can be harder to deal with. We need to know what level a child is performing at so we can tailor acitivties accordingly and also help to move them to the next stage.

Many children with speech, language and communication difficulties have problems with attention and listening so we may work on this before anything else.

Activities and Tips for Parents to Help Develop their Child’s Speech, Language and Communication Skills.

We currently live in a very fast paced world; sometimes we take for granted the skills we need to be effective and successful communicators. During my pre-school language groups I try to take the time to discuss with parents the importance of means, reasons and opportunities.

In brief, this model is a holistic approach to describe communication, and was devised by Money,D. & Thurman, S (1994).

Means refers to HOW we communicate e.g. speech, signs, pictures, gestures etc.

Reasons is the WHY we communicate e.g. wants/needs, feelings, choices, requesting information, giving information etc. Giving your child choices is really important!

Opportunities is the WHEN, WHERE and with WHO we communicate e.g. time and place, shared communication system, family, friends etc.

Therefore, according to Money, D and Thurman, S; to be a successful and effective communicator ideally you need an element of each aspect. These means, reasons and opportunities are important to bear in mind when interacting with children. Please see below for a few suggestions of things you can do with your child to help them become successful, effective and confident communicators.

Nursery Rhymes and Singing:

·     Working on a child’s language skills. They can hear the rhythm and flow of language, speech sounds, and words; it helps them connect words to actions, to understand and remember words.  They also help attention and listening skills.

·         Increases their confidence. 
·         Helps with their pre-reading skills.
·         You can let your child make a choice of which song to sing, giving a child choice is really important; it gives them a reason to communicate.
·         Use songs that have actions and repeating lines, this helps maintain their focus.
·         Try stopping in the middle of the song and encourage your child to continue with the next action or word.

Daily Routines: Daily routines provide a good opportunity to help your child to learn new words.  Mealtimes and bath-times can give you a chance to reinforce some new words without even thinking about it!  Choose some Key Words that you will use every time – this helps your child learn through repetition. Just like us, children will have some days better than others. Tiredness, behaviour, time constraints etc. can all have an impact on the ability to learn new words.  But as often as you can, try to use these natural routines to help your child learn and use these common words.

Bath Time: During bath time you can use the words ‘wet’, ‘wash’, ‘dry’ etc. lots of times to show your child what these words mean. You can also name body parts e.g. ‘wash your feet’ ‘dry your tummy’ etc. Always make it fun!

Meal Times: offer constant opportunities for learning. Children benefit from the social aspects of eating together; learning how to take turns and sharing. This is a great time to talk about different foods; developing their vocabulary. Meal times can provide an opportunity for your child to use his/her language to request things.  Help your child to repeat some new words ‘more’, ’hot’, ’yummy’, etc. Name things as you put them on the table. Give your child a choice of foods & drink – juice or water?  This gives you child a reason to communicate and helps them to ask for things in a meaningful & functional way.

Reading Books: Story-time is a routine which is enjoyable for you and your child. It is a rich language activity, it can help develop your child’s attention and listening, their understanding, extend their vocabulary and; develop their reasoning skills.  It also provides a fantastic opportunity to introduce your child to literacy; letters and written words and the concepts of beginning and end.

Books aren’t just for bed time; they are great for any time of the day! Again, give your child the opportunity to choose a book and show you what he/she finds interesting to talk about. Again incorporate some Key Words e.g. – book, again, finished, my turn etc.

Play: Is a fantastic opportunity for you to interact with your child, and is an enjoyable way for your child to learn:

·         They can become familiar with objects, touching, textures, looking etc.

·         They can practice new skills

·         Improve motor skills and co-ordination

·         Integrate many of the senses i.e. touch, sight, smell etc

·         Learn about communication i.e. turn taking, asking questions etc.

·         Learn about language i.e. vocabulary

·         Learn about other people

·         It is a safe way to release excess energy and reduce the build up of any frustration.

General Hints and Tips:

During play and day time routines these tips can really help your child:

·         Comment on what your child is doing but, try not to ask too many questions

·         Show your child that you are listening and interested in what they are saying by repeating what they say.

·         Follow your child’s lead during play activities

·         Play pretend games e.g. tea parties

·         Allow your child plenty of time to respond

·         Talk to your child about what you are doing every day e.g. when you are in the car, doing the washing, cooking etc.

·         Try not to put too much pressure on your child to talk or say words they find difficult

·         Try not to criticise or directly correct your child when he/she makes an error with his speech sounds, just give them the correct model.

·         Get on your child’s level when playing; don’t be afraid to get on the floor with them.

·         Try and get your child’s attention by saying their name first, or tapping their arm before you ask them to do something, or are making comments about things around them.

·         Use simple repetitive language

·         Make learning language fun!!!!

   By Georgina White

Is it ADHD, ASD or SLI?

The overlap of ADHD symptoms and autism symptoms have confused many families. When a child can’t sit still for homework or a meal, or stay in his chair in class, when he fidgets or talks too much and too insistently, most parents and practitioners think, “This child must be hyper-active!”

The first explanation most doctors arrive at is also attention deficit hyperactivity disorder (ADHD). The condition is familiar, it’s been around for a long time, and there are effective strategies to manage it. It is important to remember, however, that almost any psychological or developmental disorder of childhood can look like ADHD, with or without the hyperactivity. Children under stress, due to learning disabilities, anxiety, depression, communication based difficulties, specific language impairment (SLI) or sensory integration problems, may exhibit the same symptoms. It takes a skillful evaluation to tease out explanations for the behaviors.

The biggest part of our case load have had an ADHD query at some point but with time getting to know them, listening to parents and careful assessment show those who do and those who just have attention control issues.

www.private-speech-therapy.co.uk

Attention & Listening

I spend hours each day working on attention and listening. I cannot stress how important these skills are to learning and to language development. One of the nurseries I visit weekly (I wont say where!) really don't apprecitae this for example, one of the worst listeners in the group keeps wandering off or walking aawy mid-sentence. They keep saying how intelligent he is and cant see whats wrong with him being allowed to do this, but what is the point of being really bright if you cannot attend to a task? The Talking Point Website is excellent and has many resources I can use to help get the message across to them. This one is good:

www.talkingpoint.org.uk

Hear hear!!

I was very concerned about the poor listening skills of children in primary schools so I decided to seek the views of colleagues in education. This was to reveiw an earlier study in the 1990s which I had been done with a colleague at the time, Sue Gowers. This is a brief report on the findings:

The Problem?

        189 Early Years Departments including Head Teachers, class Teaches, early years co-ordinators and special needs co-ordinators contributed their feelings. The 94% return rate for a questionnaire probably speaks for itself about the level of concern as typically, a response of around 32.5%

All of the schools were extremely worried: children generally have shorter attention span and most have difficulty listening. The problem is getting worse with children entering school ill-prepared for the demands of the classroom.

Many respondents blamed the constant blare of 24 hour TV with increased background noise causing children to switch off. Others felt that children’s senses were being over loaded with non-auditory stimulation. Most expressed a concern about the time children spend watching television & DVDs or playing computer type games. All felt that too much screen time including TV was partly to blame because children could just watch the pictures and didn’t need to listen.

On the whole respondents blamed parents for children’s poor attention and listening skills. Perhaps it’s the pressure of today’s busy lifestyle that necessitates leaving them in front of the TV as surrogate babysitter with little time set aside for conversation. 75% felt there were no social status differences.  Could it be that all families experience pressure but for different reasons? ‘Middle class’ parents are busy working to pay the mortgage, cars and holidays so they don’t have time to interact with their children, while others don’t realise they ought to?

Consequences?

As a result of poor attention and listening skills the class teacher has to begin by teaching them to listen. Unfortunately, it is assumed that children are equipped with the necessary abilities to learn but most school staff found that a great deal of time is taken up directing and re-focussing. In the 1970s it was felt that by the time a child arrived at school they had almost fully developed attention so that they could be drawing whilst listening to and understanding a completely separate instruction (Cooper, Moodley & Reynell 1978). These days the Teacher would have to ask them to put down their pencils, turn to the teacher, give the instruction and then tell them to continue the task.

As listening is a learned skill, children with learning difficulties will take longer than their peers to acquire it. Often extra work is needed for this group within the mainstream classroom. 
Probably as a result of poor auditory skills, there are many more speech and language problems in mainstream schools. Estimates vary but it is generally accepted that 7% of any class is likely to experience specific difficulty. Jean Gross Government Communication Tsar identified 1 in 6 3 year olds with identified difficulties but ‘many, many more’  with delays which hadn’t been picked up. Delays are almost becoming the norm. Bercow (2008) found up to 50% had communication difficulties which would impact on the children’s learning in school.

The Solution?

Ideally, one of the solutions is parental guidance when the children are younger which is why I set up Smart Talkers pre-school groups. One of the main aims is to show parents how to use ‘active listening’. We tend to think of listening as a passive skill but it actually an active learning task involving several aspects: good sitting, good looking, good waiting and good thinking. These were identified by Maggie Johnson who has done a great deal of work on this area including with children who have ADHD. Each part needs to be worked on in order. Realistically, however, the task of sorting the problem falls to the class teacher.

When working with children with short attention spans, learning activities have to be restructured so that only short periods of concentration are required with many different activities designed to retain interest and attention. Maggie has written ‘How to get them to hang on to your every word’ which has some great class room techniques for all ages. However, the following general strategies will be useful:

General Strategies ·        Ensure you have full attention and eye contact ·        Keep the instructions short & simple so that the key words are kept to a minimum ·        Speak as slowly, clearly and naturally as possible ·        Give the child time to understand/process the information/instruction. It may be necessary to repeat even simple instructions several times in order for the child to process the information ·        Check they have understood what is expected of them ‘Comprehension monitoring’ ·        Try to develop the child overall confidence by praising him for things he is good at. Also try to make communication as pleasurable an experience as possible. When a child is nervous or anxious the ability to understand may be adversely affected ·        Keep external distractions to a minimum whist giving instructions ·        Use gesture and other non-verbal cues whenever possible e.g. facial expression pointing etc ·        Use visual clues and cues e.g. pictures of the tasks, picture timetable

 

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Pay Attention!!

Many people are surprised me when I say I work on attention skills as a speech and language therapist but I feel that it is an important part of my work. If children can't attend and listen then they can't learn. Smart Talkers Pre-School Communication Groups actively seek to develop this aspect.


There are 6 levels of attention which were recognised in the 1970s by Cooper, Moodley and Reynell. They identified ages by which the stages were achievable and by aged 6 it was felt that a child would have fully integrated attention so that they might carry on with an activity while listening to and assimilating information about something different e.g. listening to an instruction about playtime while colouring in a picture. These days this is certainly not expected and an inadequate attention level is one of the biggest problems when children start school.


This ICan Video is interesting and worth sharing.

Toddlers' learning 'hit by noise'

This was brought to my attention by the Royal College of Speech & Language Therapists from Yahoo news:

Young children are starting nursery school unable to speak and listen properly because of continuous noise and poor conversation at home, an Ofsted report has found.Skip related content

RELATED PHOTOS / VIDEOS

Toddlers' learning 'hit by noise'Enlarge photo

Constantly switched on televisions, noisy brothers and sisters and raised voices are increasingly hampering children's language skills, it says.

The study, on how the best schools teach children to read, says some schools report spending days or weeks educating parents and improving children's social skills.

In some cases, children arrive at nursery still in nappies and with dummies in their mouths.

It says: "The majority of the schools visited that had nursery classes commented that, increasingly, children joined unprepared for learning and with poor listening and speaking skills. Read more on:

http://uk.news.yahoo.com/21/20101114/tuk-toddlers-learning-hit-by-noise-6323e80.html

This is exactly why we created Smart Talkers Pre-School Communication Groups. We owe it to our children to make sure they are ready for school in more ways than one! 

We work on attention, listening, vocabulary, auditory memory, narrative skills, simple reasoning and so much more. Without these skills children will not be able to start to read and write. Spoken language abilities are the building blocks for written language

www.smarttalkers.org.uk

Related articles

• Children unable to speak properly when they start nursery school (telegraph.co.uk)
• Toddlers' learning 'hit by noise' (mirror.co.uk)

Active listening

We tend to get quite poor results if we say "Behave!" to our little ones. It means very little, whereas if we describe the behaviour we want. they are more likely to understand what we require of them and then we might have some chance of them doing what we've asked. For example, if we want them to be quiet, sit still and not run around in the GP waiting room it better to tell them that than ask them to 'Behave!' Many parents and lots of teachers know this and act accordingly. However, we often and repeatedly say "Listen!" But what does that mean to a 3 year old?
Listening is not a passive skill, it's an active one and therefore one that needs to be learned. Just like behaviour we need to break it down and describe what we want from them.
Active listening is actually:

• good sitting
• good looking
• good waiting
• good thinking

You wouldn't expect good thinking until school age and it's very hard to do good waiting as a 3 or 4 year old (its hard enough for this 47 year old to wait if she's got something to say!) Which is why they find it hard to wait for their turn or to let others answer a question to which they know the answer.

Our Small Talker groups (for 3 and 4 year olds) work on active listening. We use a puppet to demonstrate 'not good' sitting so that he actually mirrors some of their behaviours e.g. picking the carpet to picking their noses. They are asked to help the puppet 'because he's not naughty, he's just got to learn'. They have to look for the 'un-required' behaviour and say 'stop, do good sitting'. They are usually excellent at identifying the behaviour in the puppet although they may still be doing the same themselves for a while. Afterwards. I put the puppet where he can 'watch' them do good sitting so he can learn by example. I then monitor the behaviour in a  very positive way so that I praise good sitting (and the wriggly ones usually sit up in  an aim to please) or if that doesn't work I ask the wriggly ones to help the puppet by showing him 'good sitting'. If they are constantly nagged to sit still or to listen, they will switch off. It's amazing how well they respond to this approach. I have had a few run-ins with TAs and parents who have been completely peed off with  my approach because they are itching to dictate 'Will you sit still, now!' However, I've asked them to trust me and watch what happens even if I am irritating them....  we've had some great results!

Maggie Johnson has done a great deal of work with listening skills especially with children with ADHD. I can wholeheartedly recommend her book: 

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• Listening -- a Barrier to Communication (human-resources-management.suite101.com)