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Auditory Processing Difficulties (APD)

Best practice guidance

Introduction and background

The aim of this guidance document is to develop an understanding of Auditory Processing Difficulties(APD) and to support best practice in Plymouth. The key principles of this are a whole school approach to high quality teaching and employing strategies to support pupils who experience APD.

The guidance is based on the most up to date research from the UK.

APD can be met at a universal level in schools through high quality teaching and managing the environment. Children and young people can also learn self-help strategies to cope with APD.

In 95% of cases, APD occurs alongside other diagnoses.

APD may contribute to childhood learning difficulties but its status as a distinct leaning disability is controversial. Other more commonly agreed disorders such as Developmental Language Disorder (DLD), Autism, Dyslexia and Attention Deficit/Hyperactivity Disorder (ADHD) should take diagnostic precedence.

Any child or young person, who appears to be experiencing difficulties suggestive of APD, should have their hearing checked to rule out a hearing loss. If this has not already taken place, a referral to Audiology can be made by any professional.
 

Definitions and categories

Auditory Processing Difficulties affects how the brain interprets sound rather than how sound is carried through the ear to the brain.

The cause of APD is not fully understood and there is ongoing research in this field. APD is characterised by poor perception of speech and non-speech sounds.

APD is an assortment of symptoms that usually co-occur with other neurodevelopment disorders.

APD can be difficult to diagnose and frequently co-exists with conditions such as Developmental Language Disorder (DLD), Dyslexia, attention deficits, Autism and learning difficulties.

APD may reflect an underlying cognitive, language or attention difficulty rather than a distinct auditory processing difficulty.
 

Four part cycle: Assess, Plan, Do, Review

The purpose of identification is to meet the needs of children and young people (CYP) by providing appropriate support and effective intervention rather than finding a label.

The Special Educational Needs (SEN) Code of Practice January 2015 sets out statutory guidance, for schools, to follow in assessing and supporting CYP with special educational needs.

Where a CYP is identified as having SEN, schools must take action to remove barriers to learning and provide effective provision. This SEN support should take the form of a four- part cycle through which actions and decisions are revisited and revised. This cycle, known as the graduated approach, will reflect an understanding of the CYP's needs and secure effective outcomes.
 

Strategies for schools and settings

Room acoustics

Is it possible to reduce reverberation?

Carpets, curtains and anything soft such as pin boards (preferably uncovered) or the installation of sound absorbing panels or other acoustic treatment will reduce sounds bouncing around a room and reduce reverberation.

Is it possible to improve signal (voice) to noise ratio?

Reducing noise (unwanted sound) will make it easier for your voice to be heard clearly.

  • Shutting doors and windows will reduce unwanted sound from coming into the room
  • Double glazing
  • In rooms without carpets, do chairs legs have a 'rubber shoes' or a product such as 'Hush-Ups' to reduce 'scraping' sounds?
  • Are electronic devices such as projectors and computers switched off when not in use?

See also: Building Bulletin 93, 2015

Teacher/speakeradaptations

When speaking to a CYP with APD it is beneficial to:

  • Ensure he/she is seated near the front of the class
  • Gain their attention before speaking
  • Face them whilst speaking
  • Speak clearly
  • Use brief instructions - CYP with APD are likely to find it hard to process large amounts of information and will respond better to short 'chunked' sentences
  • Check that verbal instructions have been understood
  • Support spoken information with visual/written clues
  • Repeat and rephrase instructions and information
  • Allow more time to process what has been heard
  • Provide a quiet table/area to help process information more easily 
Improve listening skillsDevelop/teach an awareness that listening is an active process that requires the CYP's involvement rather than hearing which is a passive process
Develop the CYP's self-awareness

Raising self-awareness of CYP:

  • Listening strengths/skills
  • Listening situations that are more challenging
  • Awareness of strategies that help them. 
    • Moving to a quieter area
    • Moving to a position closer to the teacher
    • Using visual clues
Assistive Technology

Soundfield Systems

The teacher wears a microphone that transmits 'their voice' to 'loudspeaker(s)'. These systems are designed to deliver the teacher's voice at an even level throughout the room - but not to amplify it. This reduces the impact of distance and increases signal (voice) to noise ratio (i.e. makes it easier for the teacher's voice to be heard clearly).

These systems have the added benefit of helping everyone in the room, including the teacher who no longer needs to raise their voice, to be heard clearly, reducing vocal strain.

Personal Listening Devices

Again, the teacher wears a transmitter that sends their voice to devices that fit behind the CYP's ear and feed the sound directly into the ear. An example of this is the Phonak Roger Focus

It is advisable to trial any assistive technology before purchasing.

 

Strategies for home

Managing noise around the home

Carpets, curtains and any soft furnishings will reduce sounds bouncing around a room and reduce 'reverberation', making it easier for your child to make sense of what they hear.

Reducing noise (unwanted sound) will make it easier for your voice to be heard clearly.

  • Closing doors and windows will reduce unwanted sound from coming into the room
  • Double glazing
  • Reduce background noise from electrical equipment such as TV, radio, washing machines, etc. In many situations this can be achieved simply by closing the door to the room with the piece of equipment in

Awareness/strategiesfor parents/families

  • Make sure you establish eye contact before speaking to your child and that you are standing still
  • Use short sentences
  • Check your child has understood your instructions
  • Speak at a normal rate but with slight pauses between your sentences to allow your child to process what you have said
  • Repeat and rephrase what you have said if your child has not understood
  • Regular routines are often very helpful
  • Use a visual timetable to indicate the order and timing of activities through the day/week
  • Encourage your child through praise
  • Maintain contact with playgroup, nursery or school

Self-Awareness

As your child gets older, it is important that they become increasingly aware of strategies that help them in difficult listening environments. This will build your child's self-esteem. Encourage them to think about:

  • Moving to a quieter environment i.e. moving away from sources of noise
  • Referring to visual timetable, diaries and calendars
  • Making clear notes to refer to i.e. lists or mind maps
  • Asking for repetition of instructions or information
  • Positioning themselves in an optimal place to see the face of the speaker whilst being able to scan the other people easily and quickly
  • Planning short breaks in his/her work e.g. short physical activity

 

Transitions

It is important that transition processes are as smooth as possible to enable continuity of provision where this is needed.

Primary to secondary school

Primary schools should highlight CYP with SEN, including those experiencing APD, to receiving secondary schools to enable support strategies to be carried through. There is a clear Plymouth transition protocol.

Secondary to further/higher education

When making applications for courses it is important to encourage students to make known any additional needs they have. This will allow appropriate support to be put in place. The students may have also developed their own ways to overcome APD.
 

References

  • BSA APD SIG. 2011. Position Statement: Auditory Processing Disorder (APD).
  • BSA APD SIG. 2018. Position Statement and Practice Guidance: Auditory Processing Disorder (APD).
  • NatSIP. 2015. Briefing paper: Auditory Processing Disorder. An Education Response. UCL. Department of Neuro-otology 2015. Auditory processing disorder: A guide to help your auditory perception.
  • Royal Berkshire NHS Foundation Trust. 2016. Paediatric Audiology Department: Auditory Processing Disorder information leaflet.
  • GOSH. 2014. Auditory Processing disorder information sheet. Ref: 2014F1485.

Acknowledgements

This guidance was compiled by:

Steve Kendall

PATSS Advisory teacher for Deaf children

Sharon Pennack

PATSS Advisory teacher for Deaf children

Sue Lock

CIT Advisory teacher for SLCN

Jo Robinson

CIT Specialist support worker

Sharon Donaghy

Livewell Southwest Speech and Language Therapist

Debbie Shotter Linda Robins

Senior Educational Psychologist Educational Psychologist

Trudi Skinner Stuart Harris

SENCO: Stoke Damerel Community College Lead Paediatric Audiologist, Derriford Hospital

Kelvin Wakeham

Deputy Clinical Director, Chime Social Enterprise

 

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