Signs of Auditory Processing Disorder-Term Life

There is a story occasionally recalled by the American comedian and chat show host Rosie O’Donnell that should arguably be told to every parent on the planet.

It begins during a visit to the barber with her then six-year-old son Blake. The youngster asks for a “little haircut”, and when pressed on precisely what he means, he repeats the phrase before falling quiet. Presuming, ‘little’ means ‘short’ the barber gives him a crew cut. It’s only in the car later that it becomes apparent there was a misunderstanding. When Rosie asks if Blake likes his new style, he bursts into sobs. It slowly emerges that by “little haircut,” Blake had meant he wanted just a little bit of hair to be cut. He wanted a trim.

“I pulled off the freeway and hugged him,” Rosie writes. “I said: ‘Blakey, I’m really sorry. I didn’t understand you. I’ll do better.’ It took him 10 minutes to calm down.”

This wasn’t a child overreacting. Blake had been uncommunicative since being a toddler. He struggled with his speech to the extent a therapist had to be hired – though with no tangible results. Of late he’d been becoming withdrawn and had started getting into a bit of trouble with teachers. All this despite having an apparent thirst for learning and above average intelligence.

So, Rosie – best known for hosting Emmy award-winning The Rosie O’Donnell Show – took him to see a language-speech therapist in New York. There, after a series of tests, the concerned mother was told that her son was suffering from a little-known condition called auditory processing disorder – APD.

Nobody knows exactly what causes this – although America’s National Institute on Deafness and Other Communication Disorders (NIDCD) says scientists are conducting brain-imaging studies to learn – but essentially it meant that while Blake could hear perfectly well, he struggled to distinguish between certain words. Others came with fuzzy meanings.

This lack of comprehension, in turn, reduced his ability to pay attention, follow instructions and learn vocabulary. His whole world, 
in short, was becoming frustrating.

The diagnosis solved the mystery and allowed the family to start helping Blake. Eight years on, the 14-year-old is doing well at school and expected to go to college. Weekly therapy sessions and other measures – such as reducing background noise in the home – have helped him lead a regular life. Rosie, meanwhile, has never forgotten the therapist who helped him when other experts were foundering. She calls her “an angel”.

In fact her name is Lois Kam Heymann and today she is with Friday at the The Developing Child Centre in Jumeirah, an organisation that helps unlock children’s potential by advancing their learning and development through building and honing their skills and overcoming challenges. She’s here, she tells us, on a mission to draw attention to this little-known, little-thought-of and little-heard-about condition that Blake was diagnosed with.

How many children suffer with APD is an unanswered question. Yet there is a growing concern across the globe – and here in the UAE – that far more youngsters may have the condition than previously realised.

In the US – one of the few countries that keeps figures – it’s been estimated that up to five per cent of children may suffer. NIDCD says this will be a conservative estimate and anecdotal evidence suggests it may be right. How often, after all, do we, as parents, tell children to listen up or pay attention? How often do we say they should speak more clearly? More worryingly, perhaps, how often are children who display the symptoms Blake did – struggling to distinguish between certain words, having trouble paying attention, not following orders, low academic performance, poor vocabulary, disappointing behaviour – diagnosed with life-altering conditions such as attention deficit disorder (ADD) or autism and wrongly placed on prescription pills?

Could it be youngsters with APD are going undiagnosed or being misdiagnosed? Could these kids simply be unable to process what they are hearing? Ultimately, by not linking the symptoms to listening difficulties, could society be condemning these youngsters to struggle through their formative years, leaving them with difficulties with everything from speech to social interaction? And could this hold them back their whole lives?

Lois believes it could. That’s why she’s come to Dubai from New York, fought jet lag with a quick snooze and delivered a barnstorming, sell-out, two-hour seminar on language and listening. But she’s so keen to discuss APD she’s still made time for Friday. In the eight years since her ground-breaking diagnosis of Blake, Lois has become the West’s most celebrated language-speech therapist.She has become a regular on US TV appearing on shows suchGood Morning America and ABC News; been appointed director of The Auditory Processing Centre in Manhattan; and has seen her book, The Sound Of Hope, sell in the hundreds of thousands.

Now, she’s on a self-set mission to educate parents, teachers and clinicians across the world about APD. Which is what’s brought her to Dubai’s The Developing Child Centre.

She’s become an international partner in the not-for-profit institution – which offers courses for children with learning and development difficulties – after directors asked her to share her expertise on APD.

Following a trans-continental meeting of minds via Skype, she agreed to visit Dubai to both help the centre create a diagnosis protocol for the condition and host a series of free seminars for parents.

“I want to make people aware that if a child has a problem listening – whether that be because they have processing difficulties or, actually, they’ve just never been taught how to do it properly – that’s going to effect everything,” she says.

“Vocabulary development, social interaction, spelling, phenology, understanding of subjects, establishing of relationships, everything. If a child has a problem listening, which isn’t diagnosed, it will impact on their whole life because listening is so important in everything we do.”

So what should a parent do if they believe their child may be having auditory processing difficulties?

The first thing is simple: they should make sure they have actually taught their child to listen properly. Sometimes – as with Blake – struggling to comprehend what’s being said can be because there are issues between what experts called “the pathways”. That means that somewhere between the ear and the brain, something goes awry, leading to APD.

But sometimes children may display APD symptoms for no other reason than parents have simply never encouraged them to listen.

“We think of hearing and listening as the same thing,” says Lois. “But they’re not. Children are born with hearing – unless they have a hearing loss – but listening has to be nurtured. “What we have lost in the States – and I think it’s true here, too – is that, as women have left the home to go to work, and mums and dads are getting busier, and as technology as increased, we have lost this ability to really connect with our kids. We have less time for that.

“How many parents do you know who still read their kids a bedtime story? So many just put a computer in front of them. We are a more visual society through iPads and cell phones – which is all wonderful – but what we are losing or what we are forgetting is to really interact with our children. And it’s through that interaction they learn the art and the value of listening.

“That’s my biggest message: as parents, we must balance our lives and engage with our children so we can support their listening skills. I mean, even in my office, you have parents coming in because they think their child may need therapy but, while they’re in the waiting room, the parent will give this two-year-old a phone to play with. And they wonder that something’s wrong.”

She reckons a significant proportion of all cases could be solved by nothing more complex than better engagement with a child at a young age.

“I’m not saying parents have to be at home all the time,” she says. “I was a working parent, too. But the time you do spend with them, make it count. How much time do you spend discussing things? How much time do you spend in social engagement? Fifteen minutes of real discussion is worth two hours at the mall.”

The real concern comes when parents have engaged thoroughly but still something isn’t quite clicking with their child. That’s when APD may come into play. There are certain red flags every parent should be aware of. Children saying ‘what?’ a lot is an obvious one. Leaning forward to listen better is another.

Both show a youngster is alert to sound but not comprehending. Struggling to say certain words (because they don’t hear them properly in the first place) should also raise concerns, while a tot having difficulty following simple directions could be symptomatic of an issue.

A relatively simple instruction like ‘go upstairs and put on your pyjamas’ becomes a mammoth decoding task to a three-year-old who can’t effectively process what they are hearing.

One example I had,” says Lois, “is a teacher brought out a book to read to four-year-olds, and she said: ‘Tomorrow we’re going to read this, it’s called Caps For Sale’. And the next day, when the teacher brought out the book again, this child – he couldn’t hear the difference between T and P so he thought the teacher said Cats For Sale – he raised his hand and asks ‘Where are the cats?’

“It’s a simple example but the first thing the teacher thinks is not that this child has ineffective auditory discrimination. It’s ‘Hm, that’s a little off-topic’. Eventually, the kid gets bogged down in what he can’t understand while the book is being read, and he starts looking out the window. And the teacher thinks he’s not paying attention. It spirals.

“It could be that this ends up being diagnosed as an attention deficit disorder or behavioural problems when it’s APD.”

A parent should, likewise, be aware of certain audio-milestones a child should be achieving.

By six months, babies should be able to recognise the direction a noise is coming from and the difference between mum and dad’s voice. By 18 months, vocabulary should be coming along; and by two years, following simple one-step directions should be manageable. A year later, relatively complex, three and four step instructions should be within grasp. If any of these appear to go unfulfilled, notes Lois, it’s worth keeping an eye on. And if, after that, things don’t seem to improve, it may be worth seeking experts.

That’s where The Developing Child Centre comes in again. The Dh300 million complex was founded 18 months ago by Dubai-based entrepreneurs (and mothers) Dalya Tabari and Nof Al Mazrui. They wanted to provide a space where children with a variety of learning or development difficulties could go to receive tailor-made courses and classes to complement regular schooling.

The emphasis was on making things enjoyable for the child. So far so good, too. Some 500 youngsters are currently signed up and the eight classroom centre is now having an eight-room extension built. And while that physical growth comes to fruition, Lois has been working with Dalya and Nof in order to extend services with regard to language-speech issues. The trio are currently coming up with that diagnosis protocol for children thought to be suffering APD.

It means parents who fear their children may have the condition, can take them there to see a team of specialists and get a diagnosis. It will be one of the first such systems in the UAE.

“This is a service that can help many parents in Dubai,” says Dalya.The bad news if a child is found to have APD is that there isn’t one sure-fire method of treatment. Cases are highly individualised. The good news is it’s very much a manageable condition. The Speech-Language-Hearing Association (SLHA) – US based but international in scope – promotes three areas to focus on: “changing the communication environment, recruiting higher-order skills to help compensate for the disorder and remediation of the auditory deficit itself.”

The first of these means simply making it easier for your child to hear speech.

Reduce background noise. Ask other siblings to keep music down. Get a quieter washing machine. Lower the air conditioning. Stop doors slamming. Shut windows if you live near traffic. “They are simple techniques which worked for Blake,” says Lois.

The second way of managing the condition is to stretch the child’s other cognitive functions to compensate for listening difficulties. Children with APD pushed this way are often found to have exceptional memories and problem-solving skills, according to the SLHA.

And the final suggestion – remedy – refers mainly to therapy. This will again be offered by The Developing Child Centre. “The type and frequency of this should be tailor-made to the child’s needs,” says Lois. “The fact that this will be available in the UAE is a real boost for parents out here. It’s right that attention is drawn to the condition. Just because it is hidden doesn’t mean it doesn’t exist. And being better informed about it is being better prepared.”

It is surely something Rosie O’Donnell would agree with. As she learned, it’s worth parents always looking – and listening – for the signs.

What it is

Children suffering with APD may exhibit a variety of symptoms including but not limited to:

  • Difficulty understanding speech in noisy environments.
  • Difficulty discriminating between similar-sounding speech sounds.
  • Difficulty in saying certain words – as they haven’t heard them correctly in the first place.
  • Behaving as if hearing loss is present in some ways – asking for things to be repeated – yet able to hear general sounds such as music in other rooms.
  • Difficulty with immediate understanding of information presented verbally – yet more than able to complete tasks and do work independently once they know what is expected of them.

Parents should not assume all language and learning difficulties are down to APD. Diagnosis should only come through a fully trained audiologist. Visit a GP first who will be able to recommend audiologists.

Hospitals that have specialist audiology departments include Al Zahra Hospital in Dubai and Sharjah, and the future Cleveland Clinic in Abu Dhabi.

The Developing Child Centre is creating a diagnosis protocol for children thought to be suffering.Log on to