Talk to me about auditory processing disorder

[origami]

My kid’s SLP suggested I get him tested for APD. It’s not covered by our insurance and would be around $800. (We already paid for a regular hearing test and that was normal.) It also would need to take place an hour away and we’d have to go 3-4x from start to finish. When I balked at the cost the SLP said the results wouldn’t change how she treats my son. It would just affect classroom accommodations. Or something, I’m not exactly clear what would happen. Does anyone know what would change if my kid got an APD dx? Because if this would just result in his teacher wearing a microphone I’d rather skip the $800 and just get her a mic. But if it would affect multiple things then I’ll go ahead with it. I just want to make sure knowing/ruling it out is actually useful information. We are currently bleeding time and money from private therapy and I’m getting stressed out at adding yet another $$$$$ thing.

[waverly]

We definitely have been bleeding money, so I totally understand and I space out our therapies, testing and expenses.

Our school district does audiology services for free for some services. Would the school district pay for this test? DS has hearing loss not APD. He had to do a specific test at the school contracted audiologist for the FM system.

I don't know that everyone gets recommended for an FM system and the classroom strategies they may be using already. Things like sitting by the teacher etc.

I would still want to know but if now isn't the best time I think it's fine to push it off to a better time.

[auntie]

Some thoughts-

How old is your child? Most audiologists will not test/offer an APD dx until age 8 or so.

Auditory processing remains and emerging skill for all children well into puberty; even without intervention this should improve over time.

Auditory processing is more common as a go-along diagnosis to conditions like ASD, ADHD and developmental delays.

Many schools do not get terribly excited by APD; some don't even acknowledge its existence. There is no IEP classification for it under IDEA. Even if you were to pay big bucks for an evaluation and brought to your LEA they may not consider it to educationally relevant.

IME, teachers loath being mic'd. Outside of it being included in an IEP, you might not be able to force it. It puts teachers on stage in a way they'd rather not be and it prevents private prompts to individual students. DS's entire elementary school had FM sound fields and only about half the teachers used them for even part of the day.

People I know who have chased down an APD dx were given a real hard-sell around auditory training. I only know a very few people who did the training and found any permanent improvement. I know several kids who did a listening program each summer only to have the benefits fade by Thanksgiving. These programs are inconvenient, time consuming and ridiculously expensive. If you are going to consider one, Berard AIT is generally considered the best program available.

My son had some issues with APD subsumed by his ASD and complicated by ADHD. He did get some auditory training at a lab school he attended for a time. I don't know that it did much for him; he did really improve in about 9th grade- he's a late bloomer physically.

A number of people I know like this book-

www.amazon.com/When-Brain-Cant-Hear-Unraveling/dp/0743428641

and this one-

www.amazon.com/Sound-Hope-Recognizing-Treating-Processing/dp/0345512189/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=0345512189&pd_rd_r=ASGZ1NC9FEXRKXNF86VV&pd_rd_w=Z2Fuo&pd_rd_wg=02Df2&psc=1&refRID=ASGZ1NC9FEXRKXNF86VV

[akafred]

Call around to other audiologist. DD was recently tested and it was 1/2 day of testing, about 4 hours total, and much of that was because of her lack of cooperation (better for her than usual but not good by typical standards). We waited until she was 8 because of advice here and elsewhere; there is a test for younger kids that is appropriately leveled though, but not everyone does it. It was covered by DD's insurance but there isn't much Medicaid won't cover (IF you can find a provider who takes it and does the test or service).

We wanted to know because DD is complex (SPD, ADHD, anxiety, APD, and possibly more including suspected dyslexia and 2e). There are no official accommodations or treatments so much, but knowing helps us explain to new people (coaches, camp counselors) and also gives us more info for handling behaviors at home. The knowing is valuable for us moreso than it might be for other families in other environments. We don't plan to do any specific therapies around it, at least at this time.

[origami]

Jan 13, 2018 17:38:35 GMT -5 waverly said:

We definitely have been bleeding money, so I totally understand and I space out our therapies, testing and expenses.

Our school district does audiology services for free for some services. Would the school district pay for this test? DS has hearing loss not APD. He had to do a specific test at the school contracted audiologist for the FM system.

I don't know that everyone gets recommended for an FM system and the classroom strategies they may be using already. Things like sitting by the teacher etc.

I would still want to know but if now isn't the best time I think it's fine to push it off to a better time.

I never even thought about the district paying for this. I’ll have to check. I know they do the regular hearing tests but I have no idea about this test. Thanks for the idea!

[origami]

Jan 13, 2018 18:19:48 GMT -5 auntie said:

Some thoughts-

How old is your child? Most audiologists will not test/offer an APD dx until age 8 or so.

Auditory processing remains and emerging skill for all children well into puberty; even without intervention this should improve over time.

Auditory processing is more common as a go-along diagnosis to conditions like ASD, ADHD and developmental delays.

Many schools do not get terribly excited by APD; some don't even acknowledge its existence. There is no IEP classification for it under IDEA. Even if you were to pay big bucks for an evaluation and brought to your LEA they may not consider it to educationally relevant.

IME, teachers loath being mic'd. Outside of it being included in an IEP, you might not be able to force it. It puts teachers on stage in a way they'd rather not be and it prevents private prompts to individual students. DS's entire elementary school had FM sound fields and only about half the teachers used them for even part of the day.

People I know who have chased down an APD dx were given a real hard-sell around auditory training. I only know a very few people who did the training and found any permanent improvement. I know several kids who did a listening program each summer only to have the benefits fade by Thanksgiving. These programs are inconvenient, time consuming and ridiculously expensive. If you are going to consider one, Berard AIT is generally considered the best program available.

My son had some issues with APD subsumed by his ASD and complicated by ADHD. He did get some auditory training at a lab school he attended for a time. I don't know that it did much for him; he did really improve in about 9th grade- he's a late bloomer physically.

A number of people I know like this book-

www.amazon.com/When-Brain-Cant-Hear-Unraveling/dp/0743428641

and this one-

www.amazon.com/Sound-Hope-Recognizing-Treating-Processing/dp/0345512189/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=0345512189&pd_rd_r=ASGZ1NC9FEXRKXNF86VV&pd_rd_w=Z2Fuo&pd_rd_wg=02Df2&psc=1&refRID=ASGZ1NC9FEXRKXNF86VV

Thanks auntie. My son is 7. We’re looking at Inattentive ADHD too but wanted to wait a bit to make sure a dx was accurate. Glad to know post-dx training are mostly ineffective. Time-consuming + expensive is exactly what I don’t need right now.

[waverly]

DS meets with a hearing teacher 2 times a month for 30 minutes. This is provided by the school district. She talks about his hearing aids and FM system. She also does some very basic listening skills with him. I don't even know if I would call it a program. More like strategies. Not sure if it's that helpful, but it just puts him on the outlook and makes him aware of strategies.

[auntie]

origami,

I would focus on sorting out the potential ADHD. Scales for student 6+ are pretty reliable. I would encourage the school to use Conners' Scales in addition to BASC with Student Reporting and the full scale Vineland.

APD often travels with ADHD and can be exacerbated by it. A big part of auditory processing is auditory attention; ADHD can impact that. Another piece to consider is your child's learning style. Despite having ASD, DS is something of an auditory learner for many subjects and actually has a remarkable auditory memory, so supporting that was a path to success for him.

Like waverly, said, compensating strategies are useful- being seated near the teacher, being given instruction sheets and rubrics for assignments, being given a set of classroom notes so that he doesn't have to multitask listening/note-taking, etc.

[origami]

That sounds good, auntie. I had the misconception that it was an either/or type of thing with ADHD. I could have sworn my SLP said she wanted to sparse out whether his "not listening" was due to adhd OR apd, but I must have misunderstood.

[origami]

Well auntie you nailed it about the hard sell for those time-consuming, expensive programs. I had a meeting with the audiologist (DS wasn’t there) today and she went through what the test is like and what possible treatments would look like. The answer was $1500 on Fast ForWord. I think she said that was per year too, which WTF. Do you know where I can read more about the long term efficacy of this or similar programs? I died inside at the cost and frankly I don’t want to go through with it. But I can’t help feeling guilty after hearing her say it helps make ST so much more effective, blah blah blah. I need to either convince myself it will help ST or that putting $1500 toward extra ST would be far more beneficial.

[origami]

This?
www.ncbi.nlm.nih.gov/pmc/articles/PMC3061204/#!po=38.7324

[auntie]

origami,



Fast ForWord meets my criteria for borderline woo. Splashy website. Parent testimonials. Clever name. Ability to treat symptoms of multiple issues- ASHD, APD, ASD, Specific Learning Disability, Dyslexia. Financial incentive for the person evaluating and recommending the program.

There is very little research around the effectiveness of such programs. Most of it focuses on developmental dyslexia which can also be repaired using a multisensory program like Orton Gillingham or Lindamood Bell programming.

I do know kids who have done this program and others like it. TBH, $1500 is a friggin' steal compared to the money I have seen some people pay for programs like these. One of DS's classmates spent about $4000 (and 5 days a week) every summer in the intermediate grades. Her mom, a special educator by trade, reports that it did help her daughter (dx APD, expressive language delay, maybe ADHD- girl graduated from Bryn Mawr so no dummie) during the time she was actively doing therapy but that the benefit seemed to fade by Thanksgiving or so. Plus it comes with a draconian schudule to be followed (bye-bye summer vacation) and some have restrictions around headphone and earbud use.

My thought is that if this stuff was as awesome as they claim, public schools everywhere would have Fast ForWord for all their students. My former district did bring it in to pilot for a reading remediation setting. According to one of DS's former Orton teachers who used it there, it just did not work and they ended the program at the end of the first year.

Listening programs can be a good choice for sound sensitivity but I really question them as a one-size-fits-all approach.

Good luck. I would encourage you to work on accommodations to help him work around this.

[auntie]

Jan 18, 2018 13:20:35 GMT -5 origami said:

This?
www.ncbi.nlm.nih.gov/pmc/articles/PMC3061204/#!po=38.7324

That's a review of multiple papers published that says-

There is no evidence from the analysis carried out that Fast ForWord is effective as a treatment for children's oral language or reading difficulties.

[origami]

Fast ForWord also has a draconian 5d/week schedule and uses headphones. 30min/day minimum and an adult has to monitor the kid. Sounds very similar to what your friend did. I’m going to discuss this with our SLP on Monday but I’ve almost decided not to do it. And probably not the test either, although I’d consider it next year. DS2 has been evaluated 3x this year for speech (due to moving) and I feel like we have a good grasp on what his needs are, for this year at least.

I’m pretty sure I would throw up if someone told me my kid needed a $4k software program. I still think $1500 is absurd. I’m going to ask if the district does anything with that program though. If it’s free via them then that changes things a bit since it wouldn’t hurt. (I’d never replace ST with FFW).

[akafred]

IDK about Fast ForWord, and I am not advocating The Listening Program, but just for anecdote's sake, I know that one of the districts in my area (wealthier district) does provide TLP as a no cost rental for its students with APD.

[origami]

Jan 19, 2018 9:58:58 GMT -5 akafred said:

IDK about Fast ForWord, and I am not advocating The Listening Program, but just for anecdote's sake, I know that one of the districts in my area (wealthier district) does provide TLP as a no cost rental for its students with APD.

thanks! I just emailed the district to ask. I don’t have my hopes up because theyve done nothing but disappoint thus far, but you never know!

[auntie]

The Listening Program is more or less equivalent to Fast Forword, Interactive Metronome or Earobics. Yeah, I get that it's "free" but pull outs for special education services have to be weighed to determine if the benefit of something that doesn't have a whole lot of research backing it up being implemented by someone who may not be trained in it is worth the time away from the instructional portion of the day. Should a kid miss RELA or gym for this?

[akafred]

Jan 19, 2018 12:41:16 GMT -5 auntie said:

The Listening Program is more or less equivalent to Fast Forword, Interactive Metronome or Earobics. Yeah, I get that it's "free" but pull outs for special education services have to be weighed to determine if the benefit of something that doesn't have a whole lot of research backing it up being implemented by someone who may not be trained in it is worth the time away from the instructional portion of the day. Should a kid miss RELA or gym for this?

It's a valid question, and one that would vary by school, district, and kid. I'm not advocating the program or any other, just saying that some districts do provide some of them and it may be worth checking into. IIRC on TLP in the wealthy district, it was not administered during school hours but rather at home. But my kid was too young for an APD dx at the time and I don't live in that district. It was more of a general statement by the OT evaluating DD for SPD, who commented that from what she was seeing, APD might be something we look into some day, and there are some listening programs that can help with that, etc. So I may not have all the facts straight. Worth a phone call or a question at an IEP meeting though, IMO.

[auntie]

Jan 19, 2018 16:34:25 GMT -5 akafred said:

Jan 19, 2018 12:41:16 GMT -5 auntie said:

It's a valid question, and one that would vary by school, district, and kid. I'm not advocating the program or any other, just saying that some districts do provide some of them and it may be worth checking into. IIRC on TLP in the wealthy district, it was not administered during school hours but rather at home. But my kid was too young for an APD dx at the time and I don't live in that district. It was more of a general statement by the OT evaluating DD for SPD, who commented that from what she was seeing, APD might be something we look into some day, and there are some listening programs that can help with that, etc. So I may not have all the facts straight. Worth a phone call or a question at an IEP meeting though, IMO.

How does Wealthy SD deliver THP programming? These programs usually have a 5 day/week schedule of 30-120 minutes with an audiologist. Do they send an audiologist to the homes 5 nights a week? Or do they just assign the software and have the parents oversee it?

[origami]

Jan 19, 2018 17:53:29 GMT -5 auntie said:

Jan 19, 2018 16:34:25 GMT -5 akafred said:

It's a valid question, and one that would vary by school, district, and kid. I'm not advocating the program or any other, just saying that some districts do provide some of them and it may be worth checking into. IIRC on TLP in the wealthy district, it was not administered during school hours but rather at home. But my kid was too young for an APD dx at the time and I don't live in that district. It was more of a general statement by the OT evaluating DD for SPD, who commented that from what she was seeing, APD might be something we look into some day, and there are some listening programs that can help with that, etc. So I may not have all the facts straight. Worth a phone call or a question at an IEP meeting though, IMO.

How does Wealthy SD deliver THP programming? These programs usually have a 5 day/week schedule of 30-120 minutes with an audiologist. Do they send an audiologist to the homes 5 nights a week? Or do they just assign the software and have the parents oversee it?

it’s my understanding that any adult can oversee the kid using the program. I’m sure there’s some coordination with an audiologist but not daily. At least, that’s how FFW was described to me.

[akafred]

Jan 19, 2018 20:19:50 GMT -5 origami said:

Jan 19, 2018 17:53:29 GMT -5 auntie said:

How does Wealthy SD deliver THP programming? These programs usually have a 5 day/week schedule of 30-120 minutes with an audiologist. Do they send an audiologist to the homes 5 nights a week? Or do they just assign the software and have the parents oversee it?

it’s my understanding that any adult can oversee the kid using the program. I’m sure there’s some coordination with an audiologist but not daily. At least, that’s how FFW was described to me.

That's the gist as I recall it. The audiologist or I think she said SLP even oversees it on a weekly basis (or so) and the child does the actual listening at home while the parent supervises/oversees it. But again it was 4 years ago that she explained it (and "she" wasn't even the one who would do the program) and didn't relate to me so I could be mistaken.

[auntie]

Odd.

The people I know who have done this went to the audiologist's office 5 days a week and the sessions were done in an acoustically "sound proof" space.

Maybe with the universality of computers, they've redone the programs to be more parent-friendly. But I could see where that would impact the effectiveness of the programs. IME, parents aren't always perfect about making sure kids do this sort of therapy-homework, especially if they aren't paying for it.. I wonder if they still have all the restrictions about headphone and earbud use.

[origami]

You do have to wear headphones. Not sure if they’re special or normal ones.

I got a preliminary “nope” from my school district but they’re supposed to check further before they give me the official “no way”. Sigh.

[auntie]

Jan 21, 2018 10:47:01 GMT -5 origami said:

You do have to wear headphones. Not sure if they’re special or normal ones.

I got a preliminary “nope” from my school district but they’re supposed to check further before they give me the official “no way”. Sigh.

Many listening programmed designed to improve auditory attention and discrimination restrict the use of headphones for other activities- so if your child is doing one, they can't use headphones with their iPad, to listen to music or play games. They are also not supposed to use noise canceling headphones which can be a problem if they have sensory defensiveness or are very easily distracted.

[origami]

Jan 21, 2018 12:25:11 GMT -5 auntie said:

Jan 21, 2018 10:47:01 GMT -5 origami said:

You do have to wear headphones. Not sure if they’re special or normal ones.

I got a preliminary “nope” from my school district but they’re supposed to check further before they give me the official “no way”. Sigh.

Many listening programmed designed to improve auditory attention and discrimination restrict the use of headphones for other activities- so if your child is doing one, they can't use headphones with their iPad, to listen to music or play games. They are also not supposed to use noise canceling headphones which can be a problem if they have sensory defensiveness or are very easily distracted.

oooooooooh. Yah I have no idea about that.