TREATMENT STRATEGIES FOR
AUDITORY PROCESSING DISORDERS
Diagnosis of and treatment for APD are debated. There are several treatment theories and strategies, however some argue that treatments are ineffective. Because of the widespread connectivity of the nervous system, it is difficult to tease apart how much of a person's APD symptoms are related to the auditory system and how much is related to supportive and co-modulating systems of language, executive function, attention, memory, and other sensory and motor processes. If APD is suspected as a diagnosis or as being involved in learning difficulties, the following outlines several treatment approaches that have been shown to be clinically useful.
The standard and most typically accepted treatment approach is a three-pronged program that includes: 1. environmental modifications, 2. compensatory strategies and teacher/teaching modifications, and 3. direct therapeutic intervention. These techniques focus on: 1. reducing background noise and, if necessary, using a personal FM listening system to provide the child who has APD more accessibility to speech, 2. encouraging teachers to pre-teach important concepts and vocabulary, to face the child when speaking, to provide visual cues and multi-sensory instruction, and to provide intensive work in phonemic awareness, phonics, reading comprehension, and writing, and 3. direct therapy (typically by the speech language pathologist) to include training in the areas of fine auditory discrimination, temporal processing, memory, and sequencing. Direct therapy should also bolster typically weak linguistic areas of vocabulary, "wh" questions, prediction, reasoning, and inference. Additional supportive work in phonemic awareness, phonics, and comprehension are also goals of direct therapeutic instruction.
Therapy for APD can be be divided into two categories: Top Down approaches and Bottom Up approaches. Top Down therapy is deductive and focuses on concept driven, cognitive, knowledge-based activities. It addresses higher order processes of attention, memory, language and information processing. Bottom Up therapy is inductive and addresses perceptually-based interventions. It focuses on training in specific listening, discrimination, and recognition activities that target the perception of the auditory signal. Typical Bottom Up training may include drills and strategies for: a) recognizing and discriminating "minimal pairs," eg: lit vs. lick, pair vs. tear, etc.; b) recognizing and copying patterns, eg: copying tapping or clapping patterns; or c) identifying "which one is different," out of a series of words, sounds, or intonation patterns. Another area of direct therapeutic intervention focuses on metacognitive skills. Metacognitive instruction addresses teaching self awareness, self monitoring, and self control through personal reflection and self initiated actions.
Audiologists may also intervene with neuro-cognitive and neuro-acoustic exercises. Neuro-cognitive training targets a child's processing speed and integration with the help of brain-games and auditory-verbal-motor activities. Specific neuro-auditory skill training in areas of dichotic training, speech-in-competition practice, and weak ear training may be employed by the audiologist for the treatment of APD.
There are also a group of "sound based" treatment approaches that are used by a few isolated audiologists and speech language pathologists as well as a few other professions. The most popular of these programs are Auditory Integration Training (AIT), the Tomatis Listening Program, and the Somatis Listening Program. The latter are often referred to simply as "The Listening Program". I do not recommend or approve the use of these programs. They have been developed out of conjecture and presumption without regard to hypothesis testing or controlled research. The American Speech, Language, and Hearing Association published a statement, several years ago, indicating that it was unprofessional to use AIT training as there was not evidence to support its effectiveness. Dawson and Watling (Journal of Autism and Developmental Disabilities) stated, "Results of these studies provided no, or at best equivocal, support for the use of auditory integration training in autism." As well, there are no controlled experimental studies that support the use of AIT or the Listening Program for the treatment of auditory processing disorders. ASHA has stated that AIT is an "experimental treatment". I cannot in good conscience consider having a parent spend money and time putting a child through a program that does not have proven benefit. The only positive comments ever heard about AIT or the Listening Program are anecdotal. Proponents report that after participating in these programs children appear to pay more attention, or seem to better follow directions, or look like they have improved listening or speech. There is, however, no proof or research data that supports these claims.