Sign Language Interpreters and Auditory Processing Disorder

Students with Auditory Processing Disorder: Debunking Misperceptions and Providing Access

Students with auditory processing disorders (APD) will regularly describe difficulty with understanding fast-paced lectures and what was said during noisy discussions. The barriers regarding communication access seem very similar to those faced by deaf students, but most individuals with APD do not have ear-related hearing loss. With little resources available on how to effectively accommodate students with APD, the National Deaf Center shares lessons learned for colleges and universities to consider when providing communication access to this population of students.

What is Auditory Processing Disorder?

In the United States, auditory processing disorder (also sometimes referred to as central auditory processing disorder) is seen as a complex disorder of the brain’s ability to process and interpret sounds. There are different types of APD which can manifest in different ways. Generally, APD can cause people to experience difficulty discriminating between similar sounds, remembering what was said, discerning speech in noisy situations, struggling to interpret meaning from someone’s tone, or drawing inferences from a conversation. The estimated prevalence of APD in the adult population is approximately 0.5-1%.

How is APD disagnosed?

A formal diagnosis can only be obtained by a licensed audiologist through a formal APD assessment. While other medical professionals (including speech language pathologists and/or psychologists) may suspect an auditory processing disorder or identify an auditory processing delay, these individuals still do not possess the expertise to make a formal diagnosis of APD.

APD is diagnosed through audiological assessments including hearing tests, auditory processing tests, language screening, and cognitive assessments. This means that APD is a hearing disorder, and individuals with APD will experience similar barriers with communication access as deaf individuals.

What barriers exist for students with APD?

People with APD experience difficulties with perceiving and understanding audio information across multiple learning situations. Some examples of challenging auditory tasks could include discerning speech when there is background noise, localizing sound sources, hearing on the phone, processing rapid speech, following directions, and discriminating sounds in a foreign language. Similar to deaf individuals, people with APD also experience listening and comprehension fatigue.

Navigating through these barriers, whether it is in a college classroom or in a job interview, these students face the similar attitudinal barriers that exist for deaf students. However, for students with APD, the lack of support, awareness, and resources surrounding APD can be tied to increased stress and mental health challenges.

What are common misperceptions about APD?

As APD affects a small population of the general public, there are many assumptions about what APD is and what it is not. Listed below are common misperceptions about APD:

People with APD are just lazy and/or they do not try hard enough to understand sound
APD only exists in childhood
Students with APD do not need accommodations related to communication access because they have the ability to hear

Many of these misperceptions may stem from the fact that APD often co-occurs with other disabilities such as learning disabilities, ADD/ADHD, traumatic brain injuries, etc. It may also come as a surprise that deaf people can experience auditory processing challenges, especially for those who lose their hearing later in life.

As APD often co-occurs with other disabilities that may also have specific language and communication issues (e.g. a person who has APD and also ADHD may struggle to pay attention in noisy situations due to the symptoms of both disorders). When APD is diagnosed in the presence of another co-occurring disability, it is often ideal for a multidisciplinary team of professionals to work together to ensure that all areas of challenge can be addressed appropriately.

It is common for school-aged children to be diagnosed with APD, simply because there are more intervention services and resources available within the K-12 school system. Even with interventions, such as auditory training and classroom modifications, children with APD continue to experience listening difficulties that last well into adulthood as a result of changing environments and new demands for communication. Since professionals are often unaware of how APD presents in adults, they may not refer someone for APD assessment when needed.

Many commonly held assumptions about APD are pervasive and harmful, which can cause further delays for students seeking support and accommodations. One student shared with NDC their experiences with APD:

My being hard of hearing may not stem from my inner ear or auditory nerve, but I still struggle everyday with basic communication. Just because one hears someone talking, does not mean they understand what is being said. APD individuals also are unlikely to self-advocate due to discrimination and bullying since they are unable to process a discussion as it unfolds rather fill in the gaps later, which is something I experience personally.

What accommodations may be needed for students with APD?

It is important to remember that the Americans with Disabilities Act (ADA) defines a person with a disability as someone who has a physical or mental condition that substantially limits one or more major life activities, having a record of such disability, or is regarded as having a disability. By this standard, students with APD may be entitled to receive accommodations to ensure access to effective communication.

Since students with APD vary in their communication preferences and learning needs, engage in an interactive process to identify individualized strategies for access. Similar to deaf students, students with APD may need different accommodations depending on the classroom environments.

Listed below are some commonly requested accommodations by students with APD. Keep in mind that this is not an exhaustive list as the accommodations will vary depending on student needs and experiences.

Preferential Seating: This allows the student to sit away from auditory distractions and closer to the instructor with a direct line of vision.
Speech-to-Text Services: STTS can be used to reinforce understanding of speech through realtime transcription during class.
Assistive Listening Systems: Amplification can assist with minimizing background sounds and other auditory distractions.
Captioned Media: Captions on audiovisual media offers additional visual support to reinforce the auditory information.
Note Taking Services: Notes allow students to reserve their energy to focus on the auditory information during class.
Test Accommodations: The use of extended time and/or the use of headphones/white noise can help students to maintain their focus by controlling or reducing external distractions and background noise.
Clear Face Masks: Providing access to clear face masks for instructors and students can assist in visual access to lip-reading and facial expressions to further support language comprehension.

Instructors can also implement strategies to streamline access for students with APD. Some ideas for classroom instructional strategies are listed below.

Provide access to lecture notes and design PowerPoints to contain the same talking points that are made during lecture.
Reduce background noise and echoing by closing doors and windows.
Set a classroom protocol to identify the speaker and to encourage students to take turns while speaking and to take pauses between questions and comments.
Check in regularly with students to receive feedback on classroom instruction or to provide additional modifications as needed.

Instructors may also find that the information presented in NDC’s Instructional Strategies for Deaf Student Success e-learning course to also be relevant for students with APD.

What are other ways that colleges and universities can support students with APD?

As many students with APD may be unaware of their rights to access and/or possible accommodations in the classroom, encouraging students to learn self-advocacy skills that can help them navigate how to request accommodations and manage access barriers.

Students with APD experience many similar barriers that deaf students face. This means that colleges and universities may find it beneficial to seek out partnership with staff and service providers who are familiar with accommodating deaf students as a resource when providing accommodations for students with APD. Also, many of the same initiatives that can be used to support deaf students (e.g. centralized funding systems and greater access to mental health services) can be beneficial for students with APD.

Citations:

Del Zoppo, C., Sanchez, L., & Lind, C. (2015). A long-term follow-up of children and adolescents referred for assessment of auditory processing disorder. International Journal of Audiology, 54(6), 368–375. https://doi.org/10.3109/14992027.2014.972523

Hind, S. E., Haines-Bazrafshan, R., Benton, C. L., Brassington, W., Towle, B., & Moore, D. R. (2011). Prevalence of clinical referrals having hearing thresholds within normal limits. International Journal of Audiology, 50(10), 708–716. https://doi.org/10.3109/14992027.2011.582049

British Society of Audiology. (2011, October 17). Practice Guidance: An overview of current management of auditory processing disorder (APD).

CISG: The Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012, December). Canadian Guidelines on Auditory Processing Disorder in Children and Adults: Assessment and Intervention.

Heine, C., & Slone, M. (2019). Case studies of adults with central auditory processing disorder: Shifting the spotlight! SAGE Open Medical Case Reports, 7, 2050313X1882346. https://doi.org/10.1177/2050313X18823461