The term “central auditory processing disorder” or (C) APD has been defined in many ways. Some refer it to as an “auditory perception disorder” while others refer to it as “auditory processing disorder”, omitting the word “central” and suggesting that the disorder is not of central origin but involves other auditory processing centers. One thing that seems to be agreed upon as shown by several definitions of auditory processing disorder is that hearing is not the problem. The problem is with the ability of the brain to handle the information the peripheral nervous system transmits to it. Where does this lead to? This makes it clear that is a central nervous problem hence the significance of the word central.
One of the many available definitions of Central Auditory Processing Disorder is that it is the presence of problems in the perceiving and processing of audio information by the Central Nervous System (CNS). The condition is manifested in form of difficulties in doing such tasks as differentiating between different types of sounds (ASHA 1996, pp.41-46 ). There is debate over the differences between Central Auditory Processing Disorder and Attention Deficit Hyperactivity Disorder (ADHD). Much of this controversial debate is based on the fact that most of the symptoms that are evident in people suffering from Central Auditory Processing Disorder are also present in those suffering from Attention Deficit Hyperactivity Disorder. The question, therefore, becomes whether Central Auditory Processing Disorder is merely a case of medical description instead of being diagnostic (Nowell 2009, p.1).
Nevertheless, audiologists maintain that the condition of (C)APD would present with problems of one or more of the following auditory tasks: sound localization and lateralization which is the ability of an individual to know where a sound has occurred in space; auditory discrimination or the ability to distinguish one sound from another; auditory pattern recognition which is also the ability to determine similarities and differences in patterns of sounds, and temporal aspects of audition that include resolution, masking, integration, ordering that refer to the ability to sequence sounds, integrate a sequence of sounds into words or other meaningful combinations and perceive sounds separately when they quickly follow one another. Other challenged or impaired aspects in people with auditory processing disorder are auditory performance decrements with competing for acoustic signals which is the ability to perceive speech or other sounds when another signal is present, and auditory performance with degraded acoustic signals which is the ability to perceive a signal in which some of the information is not present (Young, & Protti-Patterson, 1984, pp. 43-48). These skills assist in deriving standardized tests that could assist in treatment/management plans and remediation strategies to assist each child, and in particular, to be administered for controlling acoustic environments.
The factors that lead to the etiology of (C) APD are not yet fully understood, but research in this area has indicated that the condition has been observed throughout for a long time especially among young children. Generally, typical behaviors or telltale signs of (C)APD include poor listening skills; difficulty learning through the auditory modality; difficulty following auditory instructions; short-term memory span deficiencies; difficulty understanding in the presence of background noise; frequently asking “What?” or saying “Huh?”; misunderstanding what is said to them or “mishearing” the word or the message, difficulty understanding speech when it is muffled or distorted, requesting information to be repeated, poor auditory attention and unable to stay focused on an auditory event; and experiences fatigue after a period of intense listening (Geffner & Ross-Swain, 2007, pp.35-39).
However, for many individuals exhibiting the condition, some may display only a few of the above behavioral traits, while others may display almost all the traits listed above. Notably, some individuals show varying displays of (C) APD. Therefore, the behavioral traits listed above should be cautiously interpreted and should be taken as a general guide. They can be useful in trying to determine the risk of a child developing (C) APD. This is because some of the above behavioral traits that are attributed to auditory perception can also be associated with and sighted in disorders such as attention-deficit hyperactive disorder (ADHD), autism, dyslexia, receptive language disorders as well as other associated learning disabilities (Geffner & Ross-Swain, 2007, pp.36-39). As noted elsewhere in this paper, this is part of the confusion that still exists in the classification of Central Auditory Processing Disorder given its sharing of symptoms with attention deficit hyperactivity disorder (Nowell 2009, p.1). (C)APD is not necessarily evident only in children, but in adults as well – for this paper, however, the concentrated population with (C)APD will be focused on children, with primary reference to the 14-year-old boy in the essay question who was told he may be suffering from (C)APD.
In some instances, a child displaying (C) APD is often not initially diagnosed with (C) APD but referred to other professionals such as speech-language pathologists or psychologists because of associated disorders such as ADHD, and other learning and language disabilities that have behavioral manifestations similar to (C) APD (Young, & Protti-Patterson, 1984, pp.251-257). Typically, individuals with (C) APD who are referred for auditory assessment have difficulty hearing or listening, and their complaints are usually similar to those with peripheral hearing losses (Henderson & Stecker, 1992, pp 117-124). In other instances, parents and teachers are the first ones to recognize these behavioral traits within the classroom and often associate these behaviors with inattentiveness, laziness, fatigue, among other non-serious childish actions. While other teachers and parents seem to acknowledge the displaying condition, they too have been apprehensive about its diagnosis, treatment, and management, as there have been many competing theories.
An Explanation of (C) APD to a 14-Year-Old
Making the fourteen-year-old understand what he may be suffering from and the implications are major steps in enabling him in learning to deal with the problem if it turns out to be present. The task will require the careful simplification of the language to make him understand what it means to be suffering from Central Auditory Processing Disorder. After sitting down with the boy and making him feel at ease, I will begin as follows:
Auditory comes from the word audio which means to hear or anything to do with hearing. Processing is the integration of information or data. It also means to make use of. Therefore auditory processing means making use of information. A disorder is a problem of difficulty experienced in doing something. Therefore auditory processing disorder means that there is a problem with the processing of information that one gets through hearing. The problem can affect everyone. Not just children of fourteen years or just boys. It affects men and women as well as boys and girls.
There are two forms of auditory processing disorders. One form originates from the working of the brain. In this form, the outer ear is always working well and it traps all the sound waves properly and transmits them to the brain. But the particular part of the brain that processes these sound waves experiences problems and the information becomes meaningless. This form of auditory processing disorder is called Central Auditory Processing Disorder. Central, in this case, means that it is related to the central nervous system and the brain is the main organ in the central nervous system (CNS).
The other form of auditory processing disorder is related to the ability of the outer part to collect information. This takes place with the help of the outer ear through the trapping of information in form of sound waves and transmitting the same to the brain for processing. when the outer senses related to hearing are not working properly, there are no sound waves that can be sent to the brain for processing. This is related to the outer system as we have already mentioned and the outer system is referred to as the periphery. This gives this form of auditory processing disorder the name peripheral auditory processing disorder (PAPD). How serious is APD?
Auditory processing disorder is not a life and death issue. So there is no need for anyone who has auditory processing disorder to fear. Some ways have been tested and found to help enable people with auditory processing disorder to lead a normal life. Such processes include simple tasks such as listening to simple sounds (Moore 2006, pp.4-10). There is also a need for all those who have the disorder to come out and not only speak about it but encourage others with a similar problem and seek interventional measures.
The Test Battery in Diagnosing (C) APD
Several tests can be carried out. But first, before implementing a test battery for a child with (C) APD, one of the major factors that are vital for consideration is that the test protocol will have to be carried out by a qualified audiologist who can carefully diagnose the presence of (C) APD and subsequently recommend the appropriate treatment or management strategies where necessary (Moore 2006, pp.5-9). Another important factor is that the audiologist will have to keep in mind the fact that every child with (C) APD can be different and it is, therefore, possible for them to show as few or as many of the behavioral signs or symptoms mentioned elsewhere in this essay. There are several differences in the people with (C) APD and a test battery must be developed to meet the unique features and needs of each child. According to Stecker, audiologists will need to be flexible to account for individual auditory complaints when evaluating various levels of the central auditory nervous system (Henderson & Stecker 1992, pp.118-125).
A standard form or criterion for testing would be particularly useful for comparison across audiology practices and in the development of auditory skills, particularly in assessing (C) APD. However, according to Whitelaw, until today, there has been a lack of a standardized test battery (Madell & Flexer 2008, pp.145-151). Whitelaw argues that in the absence of a clear and well-developed test battery that is agreed upon by audiologists, all the personnel who are involved in the testing of children suspected to be having APD must have a proper understanding of the people or the children to be tested in terms of population characteristics. They must also have sufficient experience in dealing with matters about both central or peripheral auditory processing disorder as well as attention deficit hyperactivity disorder to be able to tell the difference (Madell & Flexer 2008, pp.146-153).
In any audiological testing of (C) APD, the first essential step is to conduct a comprehensive case history (Madell & Flexer 2008, pp.149-151). Whitelaw suggests that data or information that the audiologist obtains should deal with the circumstances surrounding the birth of the child to be tested, the subsequent development, the presence or absence of difficulties in learning or communicating within the family of the child or person to be, the history of medical issues in the family, the educational background of the family and information about everyday behavior of the child as well as emotional and social characteristics (Madell & Flexer 2008, pp.148-155). How is this information useful? This information is crucial in that it will help in understanding the problems the child is facing. In other words, this information will help the audiologist or the professional administering the test put the child’s behavior into context.
Second, the assessment of peripheral auditory function is vital in evaluating (C) APD. Pure-tone audiometry for the assessment of air- and bone-conduction thresholds are supposed to be carried out to eliminate the possibility of conductive and sensorineural hearing losses, which are having an impact on central auditory processing test results (Henderson & Stecker 1992, pp.119-126). Immittance testing should also be performed to rule out middle ear pathology (Henderson & Stecker 1992, pp.119-126) In addition to the above, ipsilateral and contralateral acoustic reflex thresholds can be done to know the functioning of the working of the lower part of the brainstem (Henderson & Stecker 1992, pp.138-139)
Leaving the above aside, a study on the appropriate test battery reported that the participants preferred the inclusion of behavioral tests in the test battery. These would then be supplemented by electroacoustic testing as well as electrophysiological testing (Jerger & Musiek 2000, pp.467-474.) Numerous test batteries can be utilized in the testing or assessment of (C) APD. Here are a few of the tests that will be undertaken on the 14-year-old boy in this paper: low-pass filtered speech
dichotic listening tests, the Speech-in-Noise tests, and the Masking Level Difference (MLD) test. As it has already been mentioned elsewhere in this essay, it is important to note that (C) APD is not homogenous, and therefore a selection of tests and testing protocols will have to vary for each individual (Henderson & Stecker 1992, pp.136-139).
Screening for (C) APD
Aside from audiological testing, in the past, many schools have been performing hearing screenings to address concerns such as (C) APD and using its outcomes to identify and label children as having APD (Jerger & Musiek 2000, pp.467-474.) Several questionnaires and checklists have been used for screening purposes; however, there is a lack of consensus on how the model procedure should be structured and what tasks it should contain. Interpreting the disorder from screening methods alone is improper and should not be considered as a comprehensive analysis or substantial claim for determining the diagnosis of (C) APD. In addition, because of the variability in personnel conducting the screenings, the environments in which screening is performed, and the limited scope of test protocols, any concern related to the hearing should be strongly referred to an audiologist for a comprehensive diagnostic evaluation (Madell & Flexer 2008, pp.148-155).
Despite the limitations of the screening program, there is no preventing future research into implementing a more appropriate and effective procedure, if acceptable psychometric standards and variables are considered (Henderson & Stecker 1992, pp.135-140). The need for early identification, better screening, and remediation programs for (C) APD should be implemented, for the sole purpose of gaining a better understanding of the child’s behavior or poor performance in various environments.
Treatment and Recommended Management Strategies for (C) APD Cases as Well as the Compensatory Handling of the 14-Year-Old Boy
It has been proposed that early identification by professionals, parents, and school teachers can help generate more positive attitudes toward that child (Henderson & Stecker 1992, pp.135-140). Also, states that early identification can lead to remediation to minimize the educational deficits so often seen in these children by controlling the environment, use of amplification, auditory training, developing compensatory strategies, and appropriate educational placement (Henderson & Stecker 1992, pp.135-140). For the fourteen-year-old boy, putting him in from of the class where the sound waves from the instructor can reach his ears easily can help. Writing on the chalkboard most of the time will also make a difference. Also, issuing assignments and other instructions in writing will come in handy as the boy receives audio training to remedy the hearing problem (Haynes, Pindzola & Moran 2006, pp.200-204). This will make it possible for the boy to handle classwork as well as other aspects of life as normally as possible
In conclusion, (C) ADP is well handled by a trained professional. For the 14-year old boy, compensatory handling and audio training will help after it has been confirmed that he has (C) APD through a test battery.
References
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