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>Auditory Processing in FASD

May 2, 2011

>Since I made this post introducing Terri Bellis’s book When the Brain Can’t Hear, I’ve been ruminating on the relationship between attention deficits and APD, or Auditory Processing Disorder. As a layman it seems like a chicken-and-egg question. In a child who has both, which comes first? Are the auditory processing deficits one way that inattention manifests itself? Or are attention losses triggered by auditory processing gaps?

Let’s say, I say. “It’s time for dinner. Please go wash you hands.” Hope stops playing and washes her hands, so I expect next she will show up at the dinner table. Instead, Hope washed and went back to playing. Was her attention elsewhere when the words, “It’s time for dinner,” passed through the air? Or did her brain only decode, “Please go wash your hands”?

Oviously, the two deficits don’t always come together. Mercy has auditory processing differences, but no attention deficits. Hope has both.

Despite the seeming overlap between attention and auditory processing disorders, this study indicates they are neurologically distinct phenomena. Researchers identified children who had been diagnosed with both ADHD and APD, then ran blind trials testing the children’s auditory processing performance and attention on and off Ritalin (a stimulant medication). The study found that while Ritalin improved attention, it did not improve auditory processing skills.

This 2001 research study on audtiory processing in children with FASD defines an auditory processing disorder as “the inability or the imapired ability to attend to, discriminate, remember, recognize, or comprehend information presented auditorily.” The study matched children with an FASD diagnosis by age and demographic background with children without any neurodevelopmental diagnosis. The report summarized: “that children with FAS scored significantly lower than their age-matched peers” on all but two sub-measures on standard tests for central auditory processing disorder. The children with FASD also showed more variabilty in their performance than children who were not prenatally exposed to alcohol.

A few conclusions. Like everything else in FASD, no two people seem to experience auditory processing deficits the same way. Hope’s probable auditory deficits compared to her peers showed up on a sensory survey during intake for Occupational Therapy. Given that we were pretty sure Hope had ADHD, I don’t think it would have occurred to me to ask to have her tested for APD as well. Would her ADHD have masked her APD?

I wonder if with time, APD may be moved off the list of intractable deficits often associated with FASD. I’m reviewing a stack of FASD lit. right now and all of it places APD chacteristics like processing speed on the list of permanent neorological changes caused by exposure. But if in kids with APD who do not  have FASD, the APD can be remedied (to varying degrees) with auditory processing therapy, might auditory processing therapy also help at least some children who have FASD? In the future, might testing for auditory processing disorder, and where indicated, treatment, become a norm in kids with FASD?

I mean Executive Function deficts are currently in the permanent column for FASD, too, but appear, in trials, to improve (not be “healed”) with guided therapy. So why not APD?

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