'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

Learning to listen

We take the development of communication for granted but it is actually the best achievement of our lifetime. There, is however,  a very alarming national decline in speech, language and communication skills which means that at least 40,000 children started school in 2009 without adequate spoken language ability (Wright, J., 2009) and a Government report in 2008 showed that this can be as high as 50% of children in some areas (Bercow, J.). The Government’s Communication Tsar Jean Gross, reported that ‘at least’ 1 in every 6 three year olds has a recognised difficulty while many, many more were undetected. Today’s demands of the reception class teacher are tremendous yet the children are starting school without the necessary pre-requisite skills. Spoken language skills are the building blocks for written language and almost every educational task pre-supposes a certain level of ability.

I carried out a study recently involving 100 schools across the country, which showed 100 % Primary Head Teachers were extremely concerned about declining speech, language and communication skills. The main problem they believed was a lack of listening skills.

We live in a very visual, fast- paced age and often the first time a child is required to do any formal listening is when they start school. Many, many children have to be taught to attend and listen before they can begin the demands of the national curriculum. I started my Small Talker groups to try to address this issue.  We work on ‘active listening’.

A lot of parents and staff will 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. 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. We need to treat listening the same way.

Active listening can be broken down in to:

•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 (it’s hard enough for me to wait if I've 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 the first 3 components of 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-desired’ 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 TA’s 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!
www.smarttalkers.org.uk or www.smalltalk-ltd.co.uk

Related articles

• Active Listening - It's Harder Than You Think (ahhamoments.wordpress.com)
• When good habits go bad: active listening (nitpickersnook.wordpress.com)

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)

A total disaster??? Not really!

I was really excited last week as some people from Singapore were coming to observe the groups at one of the local Children's Centres with a view to having a franchise in Singapore. We had been liaising for months about how the groups worked and what the reasoning behind them was etc. They had had video and sessions plans as well as the franchise agreement. I never 'count my chickens' as it were but I was very hopeful. They were, after all, coming all the way from Singapore!!


On the morning of the visit, I had everything laid out and planned with notes for them to follow so they could see what I was doing and why, in a smart presentation pack.


The first group is for 3 year olds to prepare them for school. A group of 6 children came in and everything went to plan....... for 10 minutes, then there was a loud bang as a Father and his 2 year old toddler loudly burst into the room. The father sat down and left his young son to his own devises. He just gave a running commentary about how naughty he was. He then made himself a coffee and gave his son a biscuit from the kitchen, 'to shut him up'! I continued with the group as best as I could, given the huge distraction the man and his son posed to the young children who were trying to do their best to concentrate.


The people from Singapore had obviously never met someone like this man: vest top with numerous tattoos, missing teeth ........ you get the picture! The clash of cultures was almost audible!


The little boy was gorgeous but had only grunts as his means of communicating. His attention span was so short he couldn't sit down for more than 20 seconds. We muddled through the first group as best we could. The next group is for 2 year olds, so was ideal for the little boy. The parents sit on the floor to encourage their little ones to take part. We work on eye-contact, turn taking, sharing, co-operation, attention, listening and vocabulary before the songs, story, bubbles and snack time. Unfortunately his father didn't join the group or retrieve the little boy every time he ran into the toilet which he did every few minutes. The session was, therefore, dominated by me having to get him out of the toilet area,  prevent him from posting things down the toilet  and generally keep him safe from harm. The other mothers were great and kept trying to involve him with the activities. Another mother did the activities while I was otherwise occupied!


The visitors appeared horrified and somewhat traumatised as the father then told them repeatedly, in front of his child about the horrifying drunken antics of the child's mother over the years. At the end, he just wouldn't leave and his level of conversation completely deteriorated! It was quite frankly a complete disaster in terms of 'selling' the groups. The visitors made their excuses and left!


However, the little boy and his dad are exactly the sort of family that I want to work with in the children's centres. I know that we can do wonders with the little boy and show his dad how wonderful an achievement language really is. I'll set ground rules and discus what we're trying to achieve and why, with ideas to try at home. They are typical of many families these days, where parents just don't know how to interact with their children. They are doing the best they can in stressful circumstances. They are feeding and clothing their little ones but don't know they should be listening to and talking with them. This is creating thousands of children a year who have speech, language and communication delay for no other reason that they are not receiving sufficient stimulation. Without intervention, they start school at a disadvantage and this gap is often not closed by the time they leave. There is frightening evidence  to show that the standard of living for these young   people and their expected long term socio-economic outlook is poor. This is the whole reason why early intervention is necessary and why I set up the Smart Talkers groups.


So, it was a disaster in terms of the people from Singapore but I know that ultimately, I'm there for little boys and girls like this one and that is much more important than selling franchises to Singapore or anywhere else! 

There'll be other opportunities but the little boy needs a chance more than anything.

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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)

Are you really a good listener?

People today have difficulties listening and it's not just the children. This is a real problem and one of the issues the Small Talkers Groups, in the Smart Talker Range are designed to address. 

The key to being a good listener is to get the person with whom you are talking, to talk.  I  was reading 'Raising Happy Children' by Parker, J., & Stimpson, J. (1999) and I realised that I fall into some of the communication traps, when I should know better.

How many do you do?? Are you a good listener? 

It may help to check that you are not doing something else instead:

• Advising - “Tom wouldn’t let me play with him today.”   “I’d take no notice if I were you, go and play with Peter tomorrow instead”.
• Criticising - “Joe took my book and lied and said it was his and my teacher believed him!”   “Well I told you not to take it to school”.
• Dismissing - “Emily broke my bracelet.”   “Oh, it doesn’t matter. We can just get another one when we go shopping”
• Correcting - “It wasn’t fair at tea time, you are always nicer to Sally than you are to me!”  “You mean Breakfast time.”
• Ignoring - “I need mummy to take me to Claire’s house after school.”  “Come and help me to do the dishes”
• Distracting - “I’ve not been picked to be on the netball team and all my friends have.”   “Come and look at what I brought at the shops today and try not to think about it.”
• Reassuring - “I’m scared of the monsters under my bed.”  “There’s nothing to be scared of.”
• Praising - “I hate it when she comes into my room.”  “I’m sure you don’t mind because you are such a good big sister.” 

Everyone falls into one of these traps from time to time, but using replies such as these won't get the same results as really listening. Sometimes parents use these communication traps because they have run out of patience or time  or sometimes because they dont know any better. Whatever the reason, they can be very effective at stopping a child from talking.

Listening has the opposite aim - it encourages your child to talk. Encouraging your child to talk will help them to become a confident and effective communicator, a skill that will help them for their whole life. 


  

It takes two....

'My speech problem, Your listening problem, and our frustration': 

An Australian study published this month by McCormack J, McLeod S, McAllister L, Harrison LJ. from the Charles Sturt University, reveals that a child's speech problem is just as much a listener problem:

They looked at the experience of 34 children and their family members to get a thorough understanding of the problems faced by both sides. 

There were three conclusions 1. The family were frustrated by the child's difficulties 2. The child was frustrated with their listening partner and 3. Mutual frustration caused by the speaking and listening problems. The authors looked at the solutions participants used to overcome the problems. These included: a) strategies to improve the child's speech sound accuracy (e.g., therapy, opportunity to practise), and b) strategies to improve the listener's understanding (e.g., using gestures, repetition, visual clues). 

They concluded, as we already knew, was that successful communication is dependant on the skills of speakers and listeners not just the child. 'Intervention with children who experience speech impairment needs to reflect this reciprocity by supporting both the speaker and the listener, and by addressing the frustration they experience'. The Therapists at Small Talk Speech and Language Therapy have always been mindful of this and work closely with families of children with speech difficulties.

What are your experiences of this? Are you as frustrated as your child? Does your child get fed-up of repeating himself?