January 8, 2011

Symptoms of Auditory Processing Disorder (in pictures)

This is a continuation of an earlier post on what is an Auditory Processing Disorder (APD) and the behavioural symptoms of APD. (See: Learning Disabilities: Symptoms Checklist.)

Today we'll talk about how to spot APD by looking at your child's writing.

The child with APD has difficulty with spelling due to their inability to hear clearly. They have trouble discerning similar-sounding sounds. For example, when the teacher says "ba", sometimes they hear "ba" and sometimes they hear "da". Or maybe they even hear "pa". So they are never really sure whether "b" sounds like "buh" or "duh" or "puh". When asked to spell "bad", they might very well write "dap".

For the same reason, the APD child also struggles with reading. Because they don't know what a letter sounds like (especially letters that sound similar, like b and d, v and f, etc.), when asked to read a new word, they are unable to, even if it's the simplest of words. This is because they are unable to associate a specific sound with a specific letter because they hear that letter pronounced differently every time.

Let's say you ask them to read "pen". They can read that. Now change one letter, make it a nonsense word: "pem". Now, any child who has learned to read can read this because they know that the letter "m" represents an "mmm" sound, so they read "pem". The APD child will not be able to read this. For two reasons: First, they don't know what the sound of "m" is. Sometimes they hear it as "nnn", sometimes they hear it as "mmm". They're not really sure. They can't read it. If you prod them, you might hear something strange, like "pet" or "ping". (They are simply tossing something out there because you forced them to.) Most children with APD would not be able to say anything at all, not even to make a wild guess.

The second reason why they can't read this is because they don't really read, they regurgitate. When they read "pen", they have merely repeated a sound that they had memorised. When presented with a word that they have already been taught, they can repeat it. However, when you present them with a word that they have never seen before, they cannot read it because this word does not exist in their memory. They are unable to sound out the different letters to make a word, which is what reading really means.

Hence the APD child always falls behind their peers when it comes to reading because they have to memorise the sound of EVERY SINGLE WORD they were taught, instead of learning to make the sounds according to the letters in the word. (Whether they understand what they read is another matter, we are talking about whether they can say out loud the words on the page.) There is no learning, there is only memorisation. As such, most children with learning disabilities manage to scrape by in their first few years at school when they still have multiple-choice tests, but when it comes to writing, there is just no way around that. This is why many children with learning disabilities are diagnosed so late in Malaysia.

If your child is struggling with reading and spelling and has fallen behind in his studies, you are probably wondering whether he/she has simply not received adequate instruction, or perhaps they have an incompetent teacher. So you send your child for extra tutoring. And yet the problem persists. Now, unfortunately, many parents stop here because they feel that teachers nowadays are poorly trained and incompetent, so the poor children are sent to every teacher and tutor in town. Some richer parents even transfer their kids to private schools. Some have no faith in any teacher and quit their jobs to teach their children themselves. And still the problem persists...

So, how would you know if your child has simply not been taught well, or that he really has trouble hearing clearly?

Here is one way to tell - just look at his writing. APD children always struggle with spelling.

Below is the writing of a child who has not learned the correct way to spell. Perhaps he has not yet been taught these words, or he was not paying attention in class. Notice that his spelling reproduces the sound of the words correctly; he has simply not learned the correct way the word is supposed to be spelled.

Here is how an APD child spells. Notice how he has difficulty reproducing the sound of the word. Sometimes he substitutes a letter for another that sounds similar. Some sounds are completely missing. This is a peek into his brain - it shows you what he really heard (not what you think he should have heard).

The more severe the APD, the more 'gibberish' the spelling.

Here, you see a child having difficulty discriminating the ending sounds of words:

A child (or adult) with APD has difficulty remembering a sequence of spoken words. While a child of say, age 9 can remember 6 words at one go, a child with APD might remember, say, only 2 or 3. You might notice that when you ask your child to do three things, she only heard one.

In school, when given the spelling of words, she only catch the first few letters, or if the teacher dictates a sentence, she only catches the first few words. Since teachers don't have the time to repeat themselves over and over all day long, the child compensates by writing down the few letters that she heard and remembered and making up the ones that she didn't catch. The worse the APD, the worse the mistakes. Do you see spelling mistakes like these in your child's writing?

Could this be because English is such a difficult language? Well, if you can't hear clearly, you can't hear clearly, it doesn't matter what language you are hearing.

Here are some examples in Malay. Here, you see the same problems, like substituting a letter for a similar-sounding one. The less resemblance the spelling of the word to its actual sound, the more severe the hearing problem.

Here are some writing samples of an 11-year-old boy. (Ignore the grammatical errors, just focus on the spelling.) Can you tell what is his level of severity? (Click for bigger pics.)

How can a child learn if this is really what he is hearing?

Now, if that isn't enough, people with APD also struggle with organisational problems. This is the greatest impediment to learning because they cannot organise all the words in their heads to form an idea. They can understand every word in the sentence, but they cannot understand what the sentence means.

In the example below, an 11-year-old girl was asked to rearrange some words into a sentence. Although she knew the meaning of every single word, she was simply unable to organise them into a meaningful sentence. (This exercise was one year below her grade level.)

Here, a 12-year-old girl with an organisational problem writes an essay.

Below, she does a more coherent job, but notice the sequence of events.

This child has a sequencing problem as well, one commonly encountered in APD. You might notice this if you ask your child to narrate a sequence of events, for example, "What did you do yesterday?" and your child replies, "In the morning, we went to the park, then we had dinner and watched a movie, then in the afternoon we went fishing."

These are all problems with how the brain processes and organises sound, or rather, electrical signals sent from the inner ear. It has nothing to do with whatever language enters the ear, and thus it cannot be remedied by additional tutoring in a particular language. Simply put, this is not due to a lack of education or lack of instruction - it is a problem with how the brain processes sound.

If you can't hear clearly, you can't learn, no matter who teaches your child. When you can hear clearly, then you can learn absolutely any language that you like!

Treatment options for APD have been detailed in Learning Disabilities: Symptoms Checklist.

See also:

The Experience of Dyslexia

Half of Children with Learning Disabilities Have Auditory Processing Disorder

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