Listening difficulties

How many times have you had to say to your child over the past week

*“Listen to me…”

*“You’re not listening…”
*“ How many times do I have to tell you…”

*“I’m not going to tell you again…”

If your answer is “ too often” or to the point of frustration, then it is possible that your child may have an auditory processing difficulty or disorder.

How do I know if my child is having auditory processing difficulties?

First step: Get your child’s hearing checked. This may be the problem.

If your child’s hearing is normal then check out the following list against your child’s listening behaviours.

Does your child have normal hearing but :

• Often has difficulty listening and paying attention
• Frequently drifts off into their own world and loses concentration
• Frequently misunderstand spoken information or instructions
• Frequently asks “what?” when spoken to
• Needs to have instructions repeated more frequently than others
• Has difficulty following more than one or two instructions at a time
• Gets easily distracted by background noise
• Has trouble hearing similarities and differences in sounds
• Has poor phonic skills in reading and / or writing
• Has speech problems
• Appears to be overly sensitive to certain sounds

If the answer is “yes” to one or more of these questions, then your child may have an auditory processing difficulty or disorder which is affecting his ability to understand spoken language.

After testing hundreds of children over the past seven years, I have found that many children with learning and behavioural difficulties do in fact have an underlying auditory processing difficulty or disorder contributing to their difficulties.

These children have normal hearing but cannot always make sense of what they hear. The speech sounds that they hear are not processed accurately in the language centre of the brain.

What is auditory processing? How is auditory processing different from hearing?

* “Hearing” is the perception of sound.

* “Auditory processing” is what our brain does with what we hear once the sounds have arrived.

HEARING

Hearing occurs in two ways. ( This might surprise you!)

1. Hearing begins when sound waves, moving towards us through the air, enter the ear and travel via the ear canal, past the ear drum ( tympanic membrane) , though the small bones in the middle ear ( malleus, incus and stapes) and eventually arrive at the cochlea.

2. Simultaneously, sound waves also travel to the cochlea via bone conduction. The sound waves from outside the body, as well as those created inside our own bodies by our own voices, vibrate the bones of the head. These vibrations travel via the bony structures of the skull to the cochlea.

The cochlea, the snail like organ in the inner ear, receives the sound waves and converts them to electrical signals which are transmitted via the cochlea nerves to the brain for processing.

AUDITORY PROCESSING

The auditory processing centre in the brain sorts out the sound signals as they arrive and makes sense out of them. Once this has been done the listener then understands what has been said and can respond appropriately.

All of this takes place in milliseconds!

There are many auditory processing tasks that our brains do every day to enable us to understand spoken language. Some of the most important of these for successful learning and literacy are:

• Auditory Discrimination: the ability to tell the difference between similar sounding words and sounds.This skill enables us to hear the differences between the vowel sounds as well as other similar sounds such as “sh” and “s” as is ship and sip, “d” and “b’ as in “dog” and “bog”.Many children with spelling difficulties cannot hear the differences between the vowels and therefore cannot spell words correctly.
• Auditory Analysis: the ability to be able to quickly identify the individual sounds which make up words.Most children from the age of 5 years can hear and analyse the components of compound words. For example “ sun” and “ shine” combine together make up sunshine.Older children develop the ability to hear for example the two sounds of “gr” and “ape” which together make up “grape”, and the “p”, “l” and “ay” which together make up “ play”. This skill is very important for spelling.Many children also cannot hear the sounds in blends, and therefore cannot spell them properly. For example they persist in writing “sping” for “spring”, “bock” for “block”, and “sing” for “ string” even though they may have learned the words correctly in a spelling test.
• Auditory Closure: the ability to fill in the gaps when there is some sound information missing.This can occur when speech is unclear such as when a person is speaking very softly, or rapidly, has an accent or has turned their back to you, such as a teacher turning their back to write on the board while continuing to speak.Auditory closure is a kind of “ sounds like…” skill, which the processing centre of the brain performs to make sense out of these incomplete sound messages.Poor auditory closure often results in misunderstandings. For example the child might hear the word “frog” as “fog” and then not be able to answer a question about frogs because they simply did not process the word accurately. It is hard to respond appropriately if what you have heard does not make sense. This creates difficulties in both the learning and the social environments, and can lead to frequent misunderstandings, conflict and/ or withdrawal from social situations.It can also contribute to inconsistent spelling: one day the child can spell a word and the next day they cannot. Their perception of the sounds in the words varies according to the circumstance and their processing centre is not able to fill in the gaps.

• Auditory Figure Ground: the ability to hear a speaker’s voice over the background of speech babble.This is the skill we use in a noisy café when we are having a conversation with a friend. Children must use this skill every day at school because there is often background noise in a busy classroom environment.Children with poor auditory figure ground skills will often misunderstand instructions, lose concentration and focus, become restless and sometimes become disruptive simply because they cannot understand what their teacher is saying. This is a very common problem.
• Auditory Memory: the ability to hold something which has been heard in the memory until it is needed. For example, a list of instructions ( “put your writing book on my desk, go to your desk, take out your maths book and open it to page 37” ), a sequence of numbers ( e g as in telephone number) or a sequence of events in a story. At first the sounds need to be received and decoded accurately. Then the information must be understood and then held until needed( short term , long term and working memory).Children with poor auditory memory will sometimes forget what they have just been asked to do.They may forget what to do for homework, or that they have a spelling test tomorrow.They may also habitually forget which day to bring their PE gear to school.When sent on an errand to the shop for bread, milk and vegemite, they will come home with bread and milk but not the vegemite ( or maybe the vegemite and milk but not the bread, which was the first item on the list).

These are many other auditory processing tasks performed by the brain . These are a few which we know impact learning when they are not functioning well.

How Do I Find Out If My Child Has Listening Difficulties?

Firstly, it is very important to get a hearing test to rule out a hearing loss.

Your can request a free hearing test via your GP who can refer you to the audiology clinic at the hospital. This referral process can take up to 2 months in some areas. If your child’s hearing is normal but their listening behaviour is not, then you can request a further auditory processing assessment which may be available at the hospital. Alternatively take your child to a private, child friendly audiologist for a hearing test.

If your child’s hearing is normal then you will need to look for a private clinic which specialises in auditory processing assessments and sound therapy.

A number of private clinics in NZ are now offering Listening Tests and other tests for auditory processing difficulties. These clinics have learning difficulties practitioners with additional training in assessing listening in your child ,and will also be able to advise you on appropriate therapy to help reduce the impact of your child’s listening difficulty.

What Can Be Done To Help?

I highly recommend auditory retraining therapy (sound therapy) to treat children with auditory processing difficulties and disorders. This is the only therapeutic intervention available which makes any difference. It is not available through audiologists as a rule. You will need to find a learning difficulties practitioner trained in this area.

Sound Therapy Programmes – Background

Sound therapy programmes available in NZ are based on the pioneering work of Dr Alfred Tomatis – a French ear, nose and throat specialist. Dr Tomatis discovered The Tomatis Effect: that we cannot say sounds which we cannot hear. He also identified the important distinction between hearing and listening.

Dr Tomatis discovered that good listening is the key to effective learning and attention. Listening re-training via sound therapy can dramatically improve posture, attention, communication, memory, energy levels, achievement in literacy and numeracy, and is very helpful for those with learning or emotional regulation difficulties, poor social skills or generalised immaturity.

Sound therapy programmes are used to treat auditory processing disorders and are also used for children with sensory integration difficulties, ADHD, Aspergers Syndrome and other related conditions. This therapy should only be carried out under the supervision of a fully trained and certified sound therapy provider. Contact me at info@developlearning.co.nz for the name of a therapist near you.

What are these programmes designed to do?

• Train the brain in the auditory skills needed to effectively listen, learn and communicate.
• Retrain the auditory system so that it is easier to discriminate one sound or frequency from another.
• Sensitize the listener to frequencies which they may not be sensitive to due to damage to or immaturity of the auditory pathways. This damage can be caused by accident, head injury or ear infections in early childhood.
• Decrease the over sensitivity to certain sounds common in children and adults with sensory integration difficulties.
• Overall, enhance the child’s ability to make sense of the spoken language at school at home and with friends.

SOUND THERAPY RESEARCH

A recent pilot study has been completed in NZ to assess the effectiveness of sound therapy for New Zealand children identified with literacy difficulties. The results are as follows.

DEVELOPMENTAL LEARNING CENTRE / GREENPARK SCHOOL

SOUND THERAPY RESEARCH STUDY

AIM:

To establish the effects of sound therapy on children with literacy difficulties, using the Integrated Listening Systems Home™ sound therapy system.

RESULTS:

Mc Kenzie Sentence Reading Test :

Sound therapy group increased their reading age by an average of 15 .5 months, while the control group increased by only 6 months( the length of time of the programme) well over twice the improvement of the control group.

The Neale Reading Test:

— Reading Accuracy

Sound therapy group showed 10 + month increase in reading age in reading accuracy, compared to a 5.5 month change in the control group.

— Reading Comprehension

Smaller increased gains were also seen in the therapy group in the Neale comprehension.

Schonell Spelling

Sound therapy group improved by an average of 11 months compared to 7 months in the control group.

AUDITORY PROCESSING SKILLS

SCAN C Test for Auditory Processing Disorders in Children

Subtests include:

• Filtered Words : the ability to fill in the gaps when speech is slightly unclear.
• Auditory Figure Ground: the ability to listen to a speaker over background speech babble.
• Competing Words: the ability to accurately process two words heard at the same time.
• Competing Sentences: the ability to listen to one speaker and block out another , when two speakers can be clearly heard at the same time.

The Auditory Figure Ground subtest scores showed an average improvement of 18 percentile points in the therapy group , compared to a 7 percentile improvement in the control group.

Filtered words subtest scores improved 8 percentile points in the therapy group compared with a loss of – 1 percentile point.

Competing Words subtest scores showed improvement in the therapy group of 10 percentile points compared to less than 2 percentile points in the control group.

Competing Sentences subtest showed an increase of 13 percentile points compared to less than 1 in the control group.

TAPS (Test of Auditory Processing Skills)

Subtests used included:

• Word Discrimination: telling the difference between similar sounding words
• Phonological Segmentation: perceiving the sounds within words
• Number Memory Forward: auditory sequential memory
• Number Memory Reverse: auditory memory with reverse processing

Results show improvements of between 10-27 percentile points in all areas including word discrimination, phonological segmentation and auditory memory for numbers backwards in the therapy group.

TEACHER OBSERVATIONS

The iLS Listening Checklist was filled out by the teachers for each child before and after the study. This checklist included behaviours typically seen in children with poor auditory processing in the areas of Sensory / Motor , Auditory /Language , Social /Emotional and Cognitive/ Attentional / Organisational.

These scores show approximately twice the improvement in the sound therapy group in all areas assessed, including:

• motor skills
• balance and coordination
• receptive language and listening behaviours
• social and emotional behaviours
• academic and cognitive performance.

Useful Websites

For more information on auditory processing and sound therapy see

www.tomatis.com

www.developlearning.co.nz

www.integratedlistening.co.au