By Dr. JJ 11/15/2021
How Auditory Processing Disorders Impact Communicative Exchanges
In most of the children for whom a diagnosis of auditory processing disorders is evident, one of the specific deficits identified is Tolerance-fading Memory. This deficit speaks to the child’s ability to (a) tolerate the sounds occurring at the same time as attempting to understand speech (speech-in-noise processing), and (b) recall auditory information in the short-term and make meaning (auditory working memory). This is all a bunch of jargon to say:
If you give a child with auditory processing disorders a set of verbally expressed instructions, chances are they may not remember what you said. They may only execute a portion of the instructions you gave them. They may leave the room as if they are going to do the tasks requested of them, but they may not come back.
Learning Communication Strategies
To target this auditory difference, we introduce to our patients and parents what are called communication strategies. These strategies may seem easy and straight forward, but they provide a wealth of relief to both communication parties.
When a child says, “I forgot”/ “I can’t remember”/ “I don’t know”, then:
- First, ask them to give you their best guess as to what was said.
- “I think I heard _________________________.”
- Then, have them ask you for help.
- “That’s all I can remember. Will you please repeat the rest?”
Step one is vital to helping strengthen those auditory working memory pathways. Because children with auditory processing disorders usually have typical hearing sensitivity, we know that they did hear what was said. However, because of the auditory processing disorder, a combination of events may be happening that lead toward such apparent forgetfulness. For example, because they are not sure about what they heard, they may become fearful about the consequence.
Will the communication partner (e.g., parent, teacher) become angry? Will the child get in trouble?
The fear can then present itself as anxiety, defiance, or even aggression. In response to these feelings, children may resort to what comforts them the quickest. A lot of times, that’s just saying, “I don’t know” and acting out in some disruptive way.
Example
By using this communication strategy (or some variation), we can help the child acknowledge and understand their feelings. When I first start listening therapy with my patients, I often see a lot of listening tension. Their shoulders rise. Their fists clench. Sometimes, they cry. Listening therapy is hard. My response will often look like this:
Dr. JJ: “So, Joe, I’ve asked you to repeat these words. I’m looking at you, and you’re clenching your fists. You seem frustrated.”
Joe: “I just don’t know what you said.”
Dr. JJ: “This is hard for you, and that’s okay. I want to help make this easier for you. Can you try something for me?”
Joe: “Sure.”
Dr. JJ: “I want you to give me your best guess – your very best guess: What do you think I said?”
Joe: “I don’t know.”
Dr. JJ: “I know that’s how you feel. But still, give me your best guess. Even if you can only remember part of it, even if you only remember one word. What do you think I said?”
At this point, the patient is usually able to recall far more than just one word. Sometimes, the patient even recalls everything with 100% accuracy. Whatever amount it is they’re able to recall, we use the opportunity to celebrate and help them see what they’re capable of. Auditory processing disorders can be harmful to a child’s self-image. It doesn’t help that a lot of professionals do not understand auditory processing disorders and can unintentionally make children feel bad about themselves when they are not able to recall and respond in the way that is expected of them.
Communication strategies help work around those responses (“I forgot”/ “I can’t remember”/ “I don’t know”), which can cause a lot of frustration for parents and teachers. By asking the child to give their best guess as to what was said, parents and teachers can then get a better understanding about what the child is experiencing. In almost every case, the child isn’t trying to ignore you, they just need a little coaching to recall and make meaning out of what was told to them.
Things to Do to Help
While children are mastering use of communication strategies, some accommodations can be helpful in the interim. These include:
- Use of remote microphone by teacher or primary communicator if/when the child is fit with hearing aids. Alternative accommodations, if remote microphone is not acceptable by the school, can be an on-ear FM receiver. Sound-field speakers are not an acceptable accommodation.
- Listening buddy or note taker to relieve the child from the burden of needing to listen and retain auditory information in sequence.
- Testing in a separate, quiet environment.
- Frequent listening breaks to help the child “reset” their listening when they begin to lose focus or show signs of agitation.
Auditory processing disorders can be treated, and children can learn communication strategies that help offset the burden they can experience while listening. If your child has an auditory processing disorder, start making these strategies second nature in your home. Don’t let your child get away with those escape phrases. Validate their frustrations while listening and create an environment in which they can give their best listening guess without fear of unwanted consequences. Patience is key.
Are you concerned that you or your child has an auditory processing disorder? Call us! (801) 996-7510 and check out our previous blog. We’re here for you!