Auditory Processing and Perception Disorders: Causes, Symptoms & Treatment

The term auditory processing and perception disorders is used to describe certain hearing impairments that are localized exclusively in the area of processor processing of auditory nerve impulses. Sound conduction and sound perception are not affected. For example, the processor-related deficits affect sound localization, auditory selection ability, or auditory short-term memory.

What are auditory processing and perception disorders?

The term auditory processing and perception disorders (AVWS) was introduced and defined by the German Society of Phoniatrics and Pediatric Audiology (DGPP) in 2000. Sound processing or processing in specific brain areas is enormously complex. Sound processing involves unconscious as well as conscious processes. For example, travel time differences of sound between the right and left ear and certain sound refraction processes at the pinna are used to localize a sound source. Another important perceptual ability is the ability to differentiate different sounds that hit the left and right ear at the same time in the auditory pathway and to assign them to the right or left ear. Important for speech recognition is the ability to recognize words within a “sound-break” and to store them for a short time for unconscious further processing. In the case of AVWS, at least one of the complex further processing processes is impaired. Sound conduction in the outer ear and middle ear and the conversion of mechanical auditory impulses into nerve impulses in the cochlea are not affected by AVSD.

Causes

The exact causes to which AVSD could be attributed are not (yet) adequately understood. There are various explanatory approaches that are discussed among experts. AVSD is often first noticed in everyday language use. Difficulties in differentiating between different consonants such as “b” and “p” or “d” and “t” then become apparent. Differentiation between the syllables “da” and “ta” or “da” and “ba” also causes difficulties. Since the diagnosis of AVWS is usually associated with a sound conduction disorder or sound perception disorder, frequent and prolonged middle ear infections in childhood and environmental influences are discussed as one of the causative complexes. Furthermore, brain developmental disorders due to inadequate oxygen supply during birth and similar factors are also considered. In some cases, the child is under- or overchallenged during speech development, which causes the child’s ability to differentiate between different sounds to atrophy. Because of observed familial clustering, genetic reasons are occasionally cited, but have not yet been corroborated with specific genetic mutations except by statistical figures.

Symptoms, complaints, and signs

Complaints and signs of Auditory Processing and Perceptual Disorders show up either in early childhood during the phase of language development or at an advanced age. In an early phase of AVWS, it makes it difficult to follow a conversation if loud background noise is heard at the same time. It is difficult to filter out the speech information from the entire noise complex and to process it further. Typical for this phase are frequent questions and misunderstandings or word confusions. Affected children find it difficult to follow lessons with concentration. The children tend to cover their ears when there is a lot of noise, as is often the case in kindergartens, or they even refuse to go to kindergarten. A limited auditory memory may also make a conspicuous appearance, making it difficult to remember speech content heard.

Diagnosis and course

In children, peripheral hearing impairment, which is based on problems in the outer, middle, or inner ear and produces symptoms similar to those of AVSD, is much more common than auditory processing and perception disorder. This implies that sound conduction and sound perception disorders must be carefully excluded before diagnosis to avoid misdiagnosis.Clear diagnostic procedures in the form of speech audiometry should be performed exclusively in phoniatric-pediatric centers or by appropriately trained ENT physicians. The possible disorders that can underlie AVWS are checked in various audiometric procedures. The course of the disease depends on the underlying disorder, which is not known in most cases. If AVSD is detected in children during the speech development phase, further problems in the psycho-social development may occur if left untreated, because the perception and processing disorders may lead to learning difficulties and social isolation. Frequently, reading and spelling disorders, language development disorders, and attention deficit hyperactivity disorder are associated with AVSD.

Complications

Auditory processing and perception disorder involves acoustic processing problems in the auditory nerve. These problems can prove to be very disruptive and troublesome in the long run, especially since therapy is difficult in some cases. Specifically for students, the disorder has various consequences. These include poor understanding of oral tasks and dictation, a tendency to dyslexia and lack of concentration, impaired learning of foreign languages or permanent discomfort in a noisy environment. If behavioral abnormalities indicate this form of disorder, an accurate diagnosis should be made, as delayed or incomplete language development may occur. The disorder can be assessed in time by kindergarten educators and teachers and verified by speech therapists or occupational therapists with tests. The exact diagnosis is made by school, child and adolescent psychologists, as well as psychiatrists. However, ENT physicians can also specifically diagnose the disorders and assess the severity, as can pediatric audiologists and clinics for phoniatrics. People with auditory processing and perception disorders specifically have difficulty in selecting, localizing, and discriminating sounds, as well as in binaural hearing. Causes include both medical factors (middle ear, brain damage) and environmental influences. There are a number of audiometric tests (hearing tests) that can provide information about the presence of this disorder. Multiple audiometric procedures must always be used to rule out other disorders of the auditory-cognitive apparatus with certainty.

When should one go to the doctor?

Ideally, processing and perceptual disorders should be treated right when they are first identified in a patient. This can prevent various further complaints in adulthood. Especially in children, immediate treatment is necessary to avoid bullying or teasing. The processing and perception disorders can manifest themselves in a severely delayed development of speech. The affected persons can no longer follow simple conversations and thus cannot actively participate in everyday life. Furthermore, the patients may feel strongly disturbed by background noises. A doctor should also be consulted if the patient becomes irritable or inexplicably aggressive. It is not uncommon for patients to be unable to remember simple content and thus suffer from significant developmental disorders. The quality of life of the affected person is significantly limited by the processing and perception disorders. As a rule, a pediatrician or a general practitioner is consulted first in the case of processing and perception disorders. Furthermore, treatment of the disorders themselves and the underlying disease takes place at a specialist. However, a positive course of the disease cannot be predicted in every case.

Treatment and therapy

Therapeutic options for the treatment of AVSD in children are essentially limited to exercises that enable the child to compensate for some of the deficits. Psychological support for the child and those in the immediate environment, such as parents, siblings, teachers, and educators, is the primary focus. According to the current state of scientific knowledge, a variety of other offered therapies, which mainly aim at training various auditory functions, such as high tone training or order threshold training, are not recommended. Computer-assisted speech therapy programs, on the other hand, which can be used to accompany personal support, can be assessed as helpful and goal-oriented.In principle, any therapy should be checked for effectiveness from time to time so that it can be readjusted if necessary. Passive measures in the form of noise-absorbing wall coverings in the home environment or even in the classroom can also be helpful, if this can be arranged.

Outlook and prognosis

The prognosis of an auditory processing and perception disorder depends on the individual causes, the patient’s cooperation, and the therapeutic steps offered. A possible cure is certainly possible under optimal conditions. Mostly children suffer from the disorder. Relatives or educators notice the impairments and should consult a doctor as early as possible. The sooner medical care is initiated, the better the chance of cure. The processing of sound in the brain does not take place comprehensively and can be trained with the child. In many cases, there are psychological or emotional causes that must be considered to improve the prospect of recovery. Separations, deaths or a change of friends can trigger traumas in a child that have not been processed. The parenting methods of the relatives or the way the parents treat each other as well as the child are quite crucial and strongly influencing a positive development and healing. In case of abuse or shock, the child needs psychotherapeutic help. This can take several months or years. In many cases the auditory processing and perception disorders disappear within a therapy that takes place. Supportive techniques for stress reduction and understanding the situation help the child immensely. In addition, targeted training and exercise sessions are important to avoid permanent impairments.

Prevention

There are some possible complexes of causes under discussion that may be responsible for triggering AVSD. However, the possible processes that cause the onset of the disorder are not yet adequately understood. Direct preventive measures that could effectively protect against AVSD are therefore non-existent. This is especially true if the disease is caused by gene mutations. Indirect preventive measures include a healthy lifestyle, in which both stress and rest phases are planned. This also applies to the diet, if it is enriched with naturally left foods and contributes to the strengthening of the immune system.

Aftercare

In most cases, no special measures and options for aftercare are available to the affected person for the processing and perceptual disorders. In this regard, these disorders should be detected and treated at a very early stage to avoid further symptoms or complications in adulthood. In general, early detection has a very positive effect on the further course of the disease and is therefore a priority. As a rule, processing and perception disorders cannot heal themselves, so that the affected person is dependent on treatment in any case. In the case of processing and perception disorders, the affected children are dependent on comprehensive and intensive therapy so that these complaints can be alleviated. Above all, the parents must support the children in this therapy and also initiate it. Psychological support is also very important, so that the children do not develop depression or other psychological upsets. Furthermore, contact with other people affected by processing and perception disorders can be useful, as this often leads to an exchange of information. The life expectancy of the children is not reduced by the processing and perception disorders.

Here’s what you can do yourself

In children with auditory perception disorders (AVWS), the problems are particularly apparent at school. Here, the following tips should be followed to help the child learn. A seat close to the teacher is important. The child should sit so that he or she can see the teacher’s mouth clearly. A quiet, even-tempered bench neighbor provides few distractions. In the classroom, visual aids, such as a volume light, and pedagogical skill can be used to create a quiet learning environment. It is important that the child can signal to the teacher when he or she has not understood.Conversations at home should take place without additional acoustic distractors such as TV, radio or telephone. Eye contact between parents and child is an important signal of whether the child has perceived information. You can tell by the child’s reaction. It is not helpful to shout something after the child. These statements often miss the recipient. Children with AVWS are often very exhausted after school. They need a break before starting homework. It is important to agree on fixed study times and stick to them consistently. Otherwise, there is a great risk that the child will not start the homework voluntarily. If the homework takes too long every day, this should be discussed with the teacher.