Our brain receives sensory information from our bodies and interprets these messages in order to organise purposeful responses from our body. We have seven main sources of sensory information – vision, smell, taste, hearing, touch, vestibular (information provided by the inner ear about balance, movement, gravity and space as well as the position of our body in space) and proprioceptive (information received from our muscles and joints about where our body parts are and what they are doing). We need to manage and store the information we receive appropriately but sometimes, we are not able to do this efficiently and this is possibly due to a processing disorder. Let’s look at the two most common areas of difficulty in more detail: visual and auditory processing.

AUDITORY

What is auditory processing disorder?
In order to define this, we need to identify auditory processing first and this is the process by which we recognise and interpret or integrate auditory stimuli or sounds in our environment. So auditory processing disorder (APD, also called auditory perceptual disorder or central auditory processing disorder- CAPD) occurs when something negatively affects the interpretation of this information. Therefore a child with APD has perfectly intact hearing but cannot understand and interpret the sounds and words he hears.

Causes of APD
We are unsure as to what causes APD. In order for people to communicate and interpret information from the environment, there are many complex processes at play and scientists do not yet understand how all these processes work and interact, thus it is not possible to really identify how they malfunction.

However, what is known is that APD is often (though not always and not exclusively) associated with other conditions, for example, dyslexia, attention deficit disorder, autism spectrum disorder, developmental delays, pervasive developmental disorder, etc.

So what are the symptoms?
It’s important to note that these children typically have normal hearing and intelligence. But the following are common signs that may indicate difficulties with auditory processing:

• Language difficulties
• Poor listening skills
• Difficulties paying attention
• Difficulties remembering information given verbally
• Distracted in noisy environments
• Behavioural problems
• Performs and behaves better in quiet settings
• Low academic performance
• Difficulties with reading
• Spelling
• Comprehension
• Vocabulary
• Misunderstands certain sounds and syllables

There are a number of specific problems that can be identified in children with auditory processing disorder.

• Auditory memory difficulties: the inability to remember what has been heard. This affects both short-term (immediate) recall, meaning they cannot recall something right now and long-term (delayed) recall, meaning they cannot recall something later. This child is unable to recall directions and lists, names and numbers or stories and song words. Obviously, this will affect a child’s performance in the classroom and their functioning at home.

• Auditory discrimination disorder: this involves a problem with the ability to hear slight similarities and differences in sounds and words. Therefore the child is unable to notice, compare and distinguish the distinct and separate sounds in words, which is essential for reading efficiently. In addition to learning to read, they will also have difficulties understanding spoken language, spelling and writing, as well as following directions and remembering details. For example, the child may confuse similar sounds, such as; f/th, s/f, b/p, etc. A particular difficulty with auditory discrimination can be confused with inattention, as the child does not appear to have listened.

• Auditory sequential disorder: this is the ability to perceive and recall information in the correct order. Thus they will find it hard to follow instructions and to recall information, such as stories, numbers, etc. in the correct order. These children may learn the days of the week in order but be unable to use elements out of sequence, i.e. what day comes after Friday, without going over the entire list from the beginning

• Auditory analysis disorder: this is the inability to divide a whole word into it’s meaningful parts, such as breaking the word “dog” into “d-o-g”. It is essential that children can identify the individual elements and sounds in words in order to develop appropriate reading and spelling abilities.

• Auditory synthesis disorder: this is a difficulty with the child’s ability to recall the specific sounds in the correct sequence in order to form a word, such as, “t-i-p” is “tip”. Difficulties in this area lead to problems with reading and spelling, as well as inadequate comprehension of verbally presented information.

• Auditory figure-ground difficulties: these are evident when a child is unable to pay attention appropriately to individual sounds when there is background noise, which occurs in most environments but particularly in the classroom. The child is unable to filter sounds and pay attention to the correct auditory information at the right time and, once more, this can present as attention deficit disorder

• Auditory cohesion difficulties: these occur when the child has difficulties drawing inferences from conversations, understanding verbal mathematical problems or understanding riddles. Thus higher order listening tasks are a distinct difficulty and this often occurs when children have problems with any of the preceding auditory areas.

Assistance for APD

So, having looked at all the potential problem areas, what do we do to help the child? Initially, it is essential that a full audiological evaluation with an audiologist occur to identify the specific area of difficulty and to rule out (or in) any other auditory or physical hearing problem. Auditory training and speech and hearing therapy are usually indicated for these children and it is important that the parents follow the therapist’s advice in this regard. If you are unhappy with the process or progress, you can always seek a second opinion but don’t simply stop the therapy.

However, help does not end here. There are a number of suggestions for classrooms and home that will be beneficial. Please discuss the following tips with your child’s therapist to ensure you are doing the most appropriate activities and your actions at home are supporting the therapy.

At home:

• Have your child look at you when you are speaking
• Use simple, expressive sentences
• Provide your child with a quiet place to study and do homework in
• Ask your child to repeat instructions back to you
• Encourage your child to repeat instructions to himself until the task is completed (when this is relevant)
• Maintain a routine for your child to follow and to provide stability and predictability
• Play games where he closes his eyes and identifies the sounds he can hear
• Help him to develop organisational and scheduling skills
• Encourage good eating and sleeping habits
• Keep in close contact with his teacher
• Limit TV time
• Read to your child daily
• Provide him with books that have accompanying CD’s telling the story
• Encourage the learning of songs and rhymes

At school

• Make use of earphones to reduce auditory distractions – this does not refer to earphones plugged into an iPod or other music provider, but simply headphones to muffle sounds
• Provide written information for aurally presented work
• When teaching spelling, say each word distinctly at first so each syllable can be heard and provide a visual image of the word as well
• Keep learning periods short before you review work
• Try to personalise information for the children to make it more meaningful
• Don’t overload the child with too long or too many instructions
• Provide a clear view of the board
• Be precise with your instructions
• Present instructions in small easy steps
• Allow time for the child to process questions before prompting for an answer
• Provide encouragement and praise often
• Have a book that travels between home and school to keep in touch with the parents and to make suggestions on what parents can do to help with particular sections of work
• Involve the child in a discussion of the material

VISUAL

What is visual processing disorder?

As we take information in primarily through the visual sense, it is essential to consider the visual processing disorders. VPD’s are the inability to understand and put meaning to what you see. The problem is that we do not know what someone else sees and children have no standard of vision to compare to, so as the child is not actually blind, it is difficult to identify if they are missing visual details or visual cues. Clues such as untidy handwriting and poor hand-eye coordination may be attributed to other factors.

Signs of VPD

So what should we be looking for?

• Clumsy – tends to bump into things or trip up
• Repeated spelling errors – same words with different spellings
• Left and right confusion
• Writes in mirror image
• Poor eye contact
• Visual distractibility
• Poor handwriting
• Reading avoidance
• Quickly distracted visually
• Misses visual social cues
• Skips lines or words when reading
• Recognises a word today but not tomorrow
• Letter or number reversals
• Problems with sequencing and place order in maths
• Can’t work with graphs, tables and diagrams
• Careless errors
• Works with eyes close to the page or looks away frequently

It is important to note that these indicators could be due to a number of different reasons but they need to be recognised and further evaluated.

So what are the specific problems of VPD then?

• Visual discrimination difficulty: this is the inability to recognise similarities and differences between letters, objects and symbols, thus the child cannot differentiate between things based on their individual characteristics. This would interfere with the ability to gain information from pictures, graphs, tables, etc. as well as prevent accurate identification of symbols and make it difficult to see visually presented information. They may struggle to identify differences between ‘n’ and ‘m’ or write these letters with more or fewer ‘humps’.

• Visual memory disorder: this involves the inability to recall visual stimuli including the specific details and characteristics. Children may find it hard to describe something they have seen, will struggle to recall the spelling of irregular, though familiar words, they may need to look carefully at a phone to dial a number and they will have difficulties with calculators and computer keyboards.

• Visual sequencing difficulties: involve the inability to recall the correct order of something that was seen. This would obviously lead to distinct problems with spelling words, as well as reading words previously seen.

• Visual closure: is the ability to identify or recognise an object when the entire object is not visible. This is often considered to be a function of visual discrimination. Difficulties in this area would mean that a child would not recognise a word when a letter is missing, making crossword puzzles and other word games a distinct problem. They may also neglect to identify and draw missing elements of a picture, as the picture is unrecognisable to the child and they are thus unable to complete it.

• Visual figure ground: these difficulties occur when the child is unable to focus on the significant figure when there are other visual inputs in the background. They would be unable to see one specific toy on the toy shelf for example. Reading problems would occur, as these children would skip out lines or words as they read and would not be able to consistently isolate the words.

• Visual analysis: this involves the ability to divide the whole word that is seen into its component parts. It may be possible to recognise complicated words but a child with this difficulty would experience difficulties in identifying the individual letters in the word. They are able to describe pictures and places broadly but without any of the specific details.

• Visual synthesis: involves joining the individual parts together to make a whole. A child with this difficulty would be able to recognise the individual letters but could not put them together to make a word. They are able to focus well on details while missing the whole picture.

• Visual motor processing disorder - visual motor processing is also known as visual perception and hand-eye coordination skills. Essentially, this involves the thinking necessary for feedback from the eyes to coordinate movements from other parts of the body. These children will struggle with ball games, as well as with skipping ropes, puzzles and using scissors to cut neatly on a line. They tend to be clumsy, bumping into things and they may have difficulties placing objects on surfaces without them falling off. Writing neatly and staying within the lines is near impossible for these children and they cannot copy properly, whether from the board or something placed on the table in front of them.

• Spatial relationship difficulties: are slightly different to problems with visual motor processing, and considers the ability to determine how objects are positioned in the space around us. This affects our ability to perceive how close objects are and children with difficulties in this area often knock things over as they misjudge depth and distance. This is a critical skill for reading, counting, writing and thinking about numbers.

Assistance for VPD

So that’s the list of possible problems, now we need to consider how to help these children. Obviously the first step is a comprehensive visual test but this needs to be done by a specialist optometrist, as it is not sufficient for a child to just be tested by reading an eye chart. Occupational therapy is available to assist many of these difficulties, such therapy would involve purposeful activities to exercise and develop certain areas and skills in the child’s developing visual area.

Please discuss the following tips with your child’s therapist to ensure you are doing the most appropriate activities and your actions at home are supporting the therapy.

At home:

• Provide large print books and numbers to work with
• Cut a window in a piece of card that can be moved down over the sentences so only a few words/lines are visible at a time
• Highlight alternating lines in books to provide a visual reminder of where the child needs to write and to help them stay within the lines and space their work appropriately
• Make lines on the page darker
• Reduce clutter
• Organise their working environment
• Label areas for your child
• Colour code books and files
• Have a place for everything and put it back once used
• Make ‘to do’ lists
• Give step by step notes and instructions for tasks
• Use a watch to identify left and right
• Play sorting games
• Play “I spy”
• Look for specific objects in pictures

At school:

• Avoid teaching with only visual information; talk about and explain information
• Simplify visual materials
• Highlight the symbols in maths problems
• Provide maths (grid) paper for maths problems or even for writing initially
• Don’t expect the child to copy accurately form the board
• Provide enlarged print
• Worksheets should have less information on – rather three pages of 5 sums than one page of 15 sums
• Praise and mark work content rather than focus on their handwriting and spelling
• Allow work to be completed on computer
• Encourage the use of a ruler to follow the lines being read
• Use a hands on approach for experiments and practical work; this child will likely struggle to copy a task if they have only seen it being performed
• Test the child orally sometimes, not always on written tasks.

Remember that the best assistance will be that which changes with the needs and development of the child so keep in touch with the therapists and teachers and help where you can.

Author:
Melanie Hartgill
Educational Psychologist
Pr. no. 0860000115134
Click here to email Melanie
082 678 4300

Specialising in: Assessments (educational, psychological, school readiness, emotional and career), Learning Disabilities, Parenting Issues and Training and Child Development
Visit Melanie's Q&A page

Published: 04 February 2009

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