By Carol Atkins, MA, CCC-A, Clinical Audiologist

Many children are referred to me to evaluate their auditory processing skills. The test results dictate the type of recommendations best suited the child’s needs.  Many of the children on the Autism Spectrum or those with delayed language development demonstrate a DECODING AUDITORY PROCESSING profile. These children often mishear or hear vague approximations of what is being said. The goal for this child is to make speech clearer for better understanding and eventually better expression of their wants and needs.

There are many ways to get the speech to be heard more clearly such as speaking into their ear using a normal volume, face them so they can take advantage of facial and body language cues, and to speak in a nature, concise manner. However, even then some children miss portions of the message and act confused or as if they did not hear at all.

Another solution is to use an assistive listening device also called an auditory trainer that transmits frequency modulated (FM) signals through the air and not be hard wired between the person transmitting the information and the child receiving the information. These systems work well indoors and outdoors up to approximately 50 feet and the signal sounds as if the person speaking is about 6 inches from the child’s ear. It enables the child to receive the teacher’s voice at any time without difficulty even in loud background and ambient noise conditions. This has the advantage of improving the signal to noise ratio to overcome the negative effect of chaotic auditory conditions often found in classrooms, restaurants and when riding in a car.

There are personal auditory trainers and group auditory trainers. A personal system requires the child to wear the receiver a small device that looks like a hearing aid, earphones, or headphones, on one or both ears. A group trainer sends the instructor’s voice to a small speaker on the student’s desk or wall-mounted speakers. There are many systems from a variety of companies available. Phonak is releasing a miniaturized behind the ear receiver called an EduLink with a user volume control that may increase the teacher’s voice up to 20 dB louder.

Parents of children who have used these devices say:

• My child increased from hearing 2-3 words in a sentence to 7-8 words in the sentence
• My child is discriminating better between multi step directions
• My child is responding more appropriately
• My child’s ability to access and respond to verbal prompts has greatly improved
• My child is more focused and engaged throughout group sessions
• My child appears to understand better in class
• My child is less tired at the end of a school day

Assistive listening devices are fit with a 10-30 day trial. Parents and teachers rate the child’s behavior before use of a trainer and at the end of the trial period. The trainer may be returned within 10-30 days for a refund if the device does not show language or social changes. Assistive devices are dispensed from audiologists and speech language pathologists often offer the auditory training.

By Carol Atkins, MA, CCC-A, Clinical Audiologist

Many children have difficulty listening or remembering multiple step directions, listening in quiet, ask "huh?" often, give slow or delayed responses, and have trouble maintaining auditory focus. This may not be an indication that they are hard of hearing, but they may have weak listening skills. When does a parent need to be concerned? All children develop theses listening skills at differing rates. Research tells us that all listening difficulties are normal when children are very young but improve as they go into the primary grades. Teachers often ask the student’s parents if the child has a hearing loss, although kindergartners are require having their hearing screened. This may be a tip that the child's listening skills are not up to par.

An auditory processing evaluation may be needed if your child passes a hearing screening but:

• has difficulty following directions
• has difficulty learning to read
• has difficulty comprehending spoken language
• has difficulty locating where sound is coming from
• mishears words in context
• seems confused in noisy places

What does an Auditory Processing Evaluation entail? The Auditory Processing Evaluation is an assessment of the child's hearing and listening skills. An audiologist who has a specialization in auditory processing testing conducts the assessment. Information from a speech language pathologist and/or psychologist is also considered with interpreting the test results. The audiologist obtains information about each ear separately and compares the results to normal performance for that developmental or chronological age.

The auditory nervous system is a combination of complex auditory processes that develop at different rates. For example, the right ear is more efficient in processing auditory information at an early age in comparison to the left ear. This is called the RIGHT EAR ADVANTAGE and is typical for right-handed children. Performance of the left ear is more like that of the right ear when the child is 10-12 years of age. Auditory processes include auditory-figure ground, temporal discrimination, sound localization, auditory discrimination, auditory pattern recognition, and listening with competing and distorted signals. Auditory tests are recorded so the same stimulus is present to all children, and norms are developed from 5 years of age to adulthood, depending upon the test.

At what age can this test be performed? A 7-year-old is able to complete the stressed listening tests that cover almost all the auditory processes. However, children as young as 5 years of age may be tested using a limited number of tests appropriate to their age to establish a baseline of their auditory processing skills. However, the parents are cautioned that there are limitations for testing children as young as 5 to 6 years of age. Development of the auditory nervous system is measured by re-testing annually using competing stimuli such as numbers or words.

Limited testing for five to six year olds is appropriate if the child is:

• able to follow brief directions
• able to repeat words and sentences
• able to speak clearly as to be understood by an unfamiliar listener
• willing to tolerate wearing earphones

What benefit is there to having an auditory processing test? The outcome of the hearing and listening tests provide the audiologist with information to formulate appropriate recommendations for formal and informal activities to improve auditory skills. The evaluation process may also trigger referrals to investigate a child's speech and language, visual processing, and sensory integration skills, and/or neurological status.