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Auditory Processing: ADHD is not always the reason

  • Chantra
  • Jan 7, 2022
  • 4 min read

In recent years, there has been a notable increase in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in children ages 2 – 17. In fact, in the United States, there are an estimated 6.4 million children with this diagnosis, a staggering 53% increase over the last 10 years. 1 But is ADHD always the reason for lack of focus and attention in the classroom? What is Central Auditory Processing, and what is its impact on attention and, ultimately, learning?



Hearing is a complex process that involves the translation of acoustic signals into neural impulses. Sound waves enter and travel through the ear canal to the eardrum. Vibrations cause fluids to ripple, which in turn causes hair cells to bend. As they bend, channels open up, creating electrical signals that auditory neurons carry to the brain, turning them into sounds that we recognize and understand.2 That’s just physical hearing. Auditory processing is the next step, and it is one of the hardest jobs we ask our brains to do because, to be effective, processing must occur in microseconds.


Auditory Processing begins at the brainstem and makes its way up to the cerebral cortex. Right ear information is directed to the left temporal lobe, and left ear information goes to the right temporal lobe. In addition, there is a transfer of information from one side of the brain to the other. In most people, the left side of the brain processes speech and complex language functions, whereas tonal stimuli and music are deciphered by the right side of the brain.


A person is diagnosed as having a Central Auditory Processing Disorder (CAPD) when there is a deficiency in the perceptual processing of auditory information in one or more of the following areas: auditory discrimination; auditory pattern recognition; temporal processing; auditory performance in degraded acoustic signals; and auditory performance in the midst of competing acoustic signals. What does all this mean, and, more significantly, how does this deficiency interfere with speech and language, reading and spelling?


Auditory discrimination is the ability to discern discrete variations in sounds, a crucial skill in spelling. While having difficulties discriminating between n/m, b/p, t/d sounds is fairly commonplace, those with CAPD also have particular difficulty with discriminating among short vowel sounds: a/e; o/u; e/i. Should a child have an unreliable visual memory of a written word, he must have proper sound-symbol association in order to spell reliably if using a phonics based alphabet. If he cannot, he will struggle with spelling, which, in turn, will have an impact on his reading. For this reason, any spelling program for a child with CAPD must also include work on auditory processing.


While auditory discrimination ability affects spelling and, by extension, reading, temporal processing affects overall listening comprehension. I recall going to a seminar over 15 years ago where the work of Paula Tallal3 was discussed. In one study, two groups of children were tested and evaluated: one with CAPD and one without this diagnosis. The average time it took to process individual phonemes c-a-t and integrate into the word “cat” was measured to be 8 milliseconds. For a child with CAPD, the same processing took up to 40 milliseconds - 5 times longer. Imagine if, instead of using the word “cat,” the word “catatonic” were to be used at the beginning of a sentence. A child with CAPD could still be processing the first syllable, “cat,” even after the teacher finished the final word in her statement. As a result, the student with CAPD would need context or visual reinforcement to fill in the blanks. In an intense auditory environment such as a lecture or class room discussion, a child with CAPD often feels overwhelmed and, as a result, shuts down prematurely. When he shuts down, it is often manifested as losing focus. But is it his attention that is in deficit – or is it his auditory attention?


Acoustic signals also have an impact. Children with CAPD tend to have difficulty with both rapid speech and with unusually slow speech. In other words: pacing matters. Additionally, students with CAPD tend to struggle with competing acoustic signals. The car traveling down the road is not just “white noise.” It is as loud as the teacher’s voice for these children. The competing sounds become distracting.


So, what do we as parents and educators do? If a child were to struggle in the areas of spelling and listening to directions but focuses remarkably when performing tasks like creating Lego models, drawing, or fishing, is the issue really an attention deficit? Perhaps he should be administered a Central Auditory Processing (CAP) Test to see if, in fact, the reason behind the inattention – and learning difficulty – is CAPD.


In addition, parents and educators are advised to be mindful of the following:

  • Speaking too fast is as overwhelming as speaking too slowly.

  • Those with CAPD have difficulty with processing, not hearing. There’s no need to keep repeating. That in itself is distracting.

  • Face those with CAPD when you speak to them.

  • Give directions one step at a time. Remember: it can take up to 5 times longer for someone with CAPD to process what is being said.

It is important to note, however, that while these accommodations may be useful, they are not remediation. Should it be determined that the child has CAPD, remediation must be integrated into his education:

  • Whole language is not recommended. He needs to be taught phonics and spelling rules.

  • He needs constant auditory drills to efficiently discriminate phonemes.

  • Ultimately, the key is in creating a multisensory education environment in all classes: see it - speak it – hear it - write it.

After over two decades in education, I’ve come to appreciate that learning is so complex. When we see a juxtaposition – she is bright but struggles to read; he focuses when creating a design but shuts down during discussions; she can reproduce a Mozart melody after hearing it once but can’t recite Newton’s Laws of Physics after hearing it repeatedly – the onus is on us to ask “why.” The reason is surely not simple, and its remediation must take time and hard work.


Reference


2 Bamiou,DE; Musiek, FE; Luxon, LM, Archives of Disease in Childhood; London; Vol. 85, Iss. 5 (Nov. 2001)


3 Tallal P, Piercy M. 1974. Developmental aphasia: rate of auditory processing and selective impairment of consonant perception. Neuropsychologia 12, 83–93 (doi:10.1016/0028-3932(74)90030-X)


Dr. Tallal on Temporal Processing:

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