Tag Archive for: speech and hearing


Turtle Twins (Part 2) – Treating Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In my previous post I explained that auditory processing disorder (APD) is like a game of “Operator” where a message is misinterpreted when travelling between the ears and brain.  This causes problems with communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.    The good news is that APD can be improved organically and through modifications to the functional environment.

Personally, my daughter was diagnosed in Grade 3 (age 8).  To understand her problems, I read several books on APD and copied some chapters for family.  I disclosed fully to my daughter the results of her testing and explained that sometimes her ears and her brain are hearing different things.  I wanted her to understand that at times, when things people say might seem funny, confusing or strange to her, she might have heard them wrong.  She was encouraged to ask questions about her ADP, and to never be shy about asking people to repeat themselves if needed.

At school, the teacher started wearing an FM unit to help best deliver instructions and teachings to my daughter who wore corresponding headphones.  The teacher and I put tennis balls on the classroom chairs to reduce noise.  My daughter was relocated near the teacher’s desk and away from the busy hall.  The door was closed (reducing background noise) during lectures.  She was allowed to write tests in the quiet resource room.  The teacher was provided a list of other classroom modifications to implement, including ways to breakdown instructions into smaller chunks to improve her retention and follow-through.  I talked to the teacher about the fact that when my daughter was reading in class (when she was supposed to do other things) to tune out classroom noise and / or because she missed the directions.

In sports, we noticed an issue with her playing basketball.  The sound of the balls bouncing on the floor made it difficult for her to hear her coach and the background noise in the gym during practice was a struggle for her.  At Karate, she would look around to see what the other kids were doing as she would miss instructions.  All of her coaches and Sensei’s were advised of her APD and started speaking more directly to her, asked her to repeat instructions, and tried to reduce background noise when possible.

We also made changes at home.  We took extra time to reduce background noise (difficult in a family with four kids), would reduce the number of instructions we gave her at one time, had her repeat these back to us, and developed a “roger that” mantra that she would say to indicate she got her instructions.  Our audiologist recommended Fast Forward, an online game designed to help improve APD.  While research does not conclusively confirm that this is helpful for APD, we decided to give it a try and she found it very helpful.  Ultimately, and for reasons other than just her APD, we moved her to a small school with very low class sizes and she is now thriving.  We still notice her APD at times, but she is very aware of this and is mature enough to understand that if something sounds wrong (i.e. turtle twins) she should politely ask for clarification.



Turtle Twins (Part 1) – Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In recognition of Speech and Hearing Month, I wanted to tell the story of my personal experience as a mom of a child diagnosed with auditory processing disorder (APD).

APD is best explained using the example of the game “Operator”.  If the first person is the ears, and the last the brain, everyone in between is the channel by which the message travels.  And remember what happens?  By the time the message reaches the “brain” it has been altered.  So, really APD is just that – when a message or sound changes as it travels from the ears to the brain resulting in the brain getting the wrong message.

Signs of APD can include difficulty with: communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.  As an overlap exists between the signs of APD and other disorders, and this may coexist with other problems, it can be difficult to diagnose.

Being a clinician, I recognized early that my daughter struggled with “hearing”.  Yet at 18 months her hearing test was “fine”.  When she was three I remember telling her that her “ears and brain were not talking”.  In school she would become easily distracted, would struggle with multi-step instructions, and did much better in classes that were smaller, less chaotic, or when she sat closer to the teacher.  At home the presence of her APD was apparent when my instruction “change your shirt” would be met with the response “I am not wearing shorts”.   Or, when the instructions “brush your hair, grab your lunch and put your coat on” might result in one, maybe two, but rarely three of those instructions being followed.  But my favorite remains when my daughter told her sisters they were “turtle twins” as she had misheard the word “fraternal”.

The diagnosis of APD is made by an audiologist when the child is at least 7 or 8 years old.  However, psycho-educational tests can also be helpful to rule out other or comorbid problems.  In adults, APD also exists, and can be the result of many factors, including acquired brain injury.  Also, some research suggests that men start to struggle with APD after age 35 and women after menopause.  My next blog will focus on ways we managed our daughter’s APD at home, in sports and school, and these same strategies could also be used by others who have, treat, or know someone with APD.