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 practices 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 learning disability is controversial. Other more commonly agreed-upon 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 affect 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, and 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), the installation of sound-absorbing panels, or other acoustic treatments, will reduce sounds bouncing around a room and reduce reverberation. Is it possible to improve the signal-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 chair legs have '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 skills	Develop/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 about 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 the signal-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, radios, 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 that 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, in 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

More information

Auditory Processing Difficulties Best Practice Guidance (PDF) [242KB]

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