Auditory Processing Disorder

Auditory Processing Disorder

At 15 years old, Laura had been studying English for 7 years.  She could read the words out loud, compose sentences, spell words correctly, present projects in front of the class from her notes, when called upon she could read text with inflection and punctuation.  Nevertheless, she was always scared that someone would find out:  Laura was in 9th grade, and just didn’t know what the words meant. 

With 20/20 hindsight, I looked back, imagining what Laura heard in the early years.  The sounds and symbols were incredibly confusing to an 8 year old child: 

Candy hair mei?(Can’t he hear me?) mei mei is the Mandarin for little sister 

Erhu hungry?(Are you hungry?) Erhu is a Chinese musical instrument 

You shirare?  (You sure are) shir er = 11 in Mandarin 

These look like mixed up words in a puzzle to me.  To my daughter it was Mandarin-ized English. Laura never did speak her first language very well; it never occurred to her that Iwasn’tspeaking a version of the language she’d heard around the orphanage.   I don’t suppose my speaking some mangled Mandarin helped matters any. 

We arrived home in June, 1994 and spent the next 3 months immersed in a typical crash course on American culture.  Laura learned about grocery stores, playgrounds, how to swim and a hundred other fun things.  She was a girl with joy in her heart and a smile on her face.  Gradually we fell in love with each other. 

I never dreamed that learning English would be a huge problem for my new daughter.   Teachers advised me to just keep on speaking English – read the signs, point out the sights, listen to the radio and read books out loud.  We used a little Chinese sign language and made up more signs on our own.  To get ready for school in the fall I taught Laura the English alphabet.  Every night I read books to her – Laura loved the one on one time and learned to name objects I’d point to.  

When she started American school in the fall, her ESL teacher told me that she’d be taught to read and write in English and the meaning of words would follow.  Well, she learned to read and write and spell – but other than the basic words for objects, movement and descriptions, the meanings never really followed.   Laura could handle only one definition for each word and was easily confused after that. 

For example, Laura knew the definition of white, clouds and sky.  She got confused with the phrase: white clouds in the sky.  And was totally lost with: the fluffy white clouds looked like cotton candy.  At first, we all blamed it on too many concepts – such as cotton candy and fluffy – that she’d never heard of before. 

I knew we were in trouble when I saw her first writing attempts: nouns and verbs were used forwards and backwards:How is big rocket bottom hot is.  I knew we had plenty of work ahead. 

For some time the term auditory processing delay entered my mind as the problem I saw with Laura.  She didn’t really comprehend things until the third or fourth time through.  I asked myself if it was because I’d said it repeatedly? Or was it because I’d eliminated the extraneous word and just used the really important ones?  

Laura used a lot of pat-answers and body postures that made it seem like she understood what people said.  After studying it a while I realized she was listening with her eyes more than her ears.  Clearly Laura was very smart; she fooled all of us for years. 

One day at the end of 9th grade Laura announced she could hear out of one ear better than she could the other.  The dutiful mom, I made an appointment with the audiologist.  He determined Laura does have a high frequency loss in one ear, but not enough to affect her much.  Finally, I screwed up my courage asked if he had any tests for auditory processing.  He performed the SCAN-A, a test for auditory processing disorders in adolescents and adults.   

The SCAN-A test consists of 4 parts, administered through well-fitted earphones in a soundproof booth.  Laura listened to the test words on a pre-recorded CD.   

First Laura was asked to repeat 20 one-syllable words played separately in each ear.   Her results showed an inability to understand distorted speech of various kinds – especially rapid speakers and those who do not articulate clearly.  

Next was an auditory figure-ground test to evaluate her ability to understand words in the presence of background noise. Laura was asked to identify single syllable words over competing speech or background noise.   

In the next test, Laura heard two different words spoken at the same time, one word in each ear. She was instructed to repeat both words in the order she hear them.  

Finally, Laura heard pairs of completely unrelated sentences, of exactly the same length, one in each ear, spoken at the same time. 

The audiologist was perplexed.  I was baffled.  Laura failed completely.  Her individual scores fell below the 5%.  The literature from the testing company suggested that a person with that score was probably not verbal.  At best, the two sides of Laura’s brain were not communicating with each other. Clearly, we needed more answers than the screening test was capable of providing.  I turned to the Internet and typed in: Auditory Processing findingwww.ncapd.organd one of its founders: Dr. Jay Lucker. 

National statistics estimate 1 in 8 children has some type of speech and language difficulty. Auditory Processing Delays (APD) are found in all kinds of children - lots of whom are not adopted.  However, there does seem to be a special variety of APD found in adopted children that may be caused by combination of things - not the least of which is an immature auditory system. 

I’ve only met Dr. J once and found him kind, compassionate and very skilled in what he does.   He and other professionals have a clinic in Alexandria, Virginia where a large part of their practices are adopted children.  We flew across the country in August, 2002 to get a complete assessment of Laura’s situation. 

Laura was very eager for the testing to begin.  She wanted to find the problem and get rid of it before any of her peers figured out her secret.  Testing is normally done over several days but since we had traveled such a great distance and needed to get a plan together before school started it was compressed into an afternoon.  We all agreed to this based on Laura’s age (15 years, 10 months) and determination to proceed.  

Dr. J started out with a repeat audiogram (hearing test) then moving to the earphones and pre-recorded testing.  This time I got a list of answers so I could follow along.   

The first exam was to repeat unrelated pairs of words, one spoken into each ear.  The speaker said: chair, cup.  Laura said: cup, chair. At the conclusion of the test Dr. J pointed out that the normal mistake rate would be one or two order reversals.  Laura has reversed 25 out of 40 word pairs.  

As she went from one test to another, Laura’s performance declined. The more she struggled, I revisited Laura’s education experiences wondering how I’d missed the obvious.   Little by little, I moved closer, leaving the sofa to sit in a chair at the testing table.  At first I held her hand.  By the end of the session, I was standing with my arms around my daughter, my eyes filled with tears.  Her performance confirmed the SCAN-A screening test. At 15 years old, Laura could not decode words properly.  If she could not correctly identify the words, she could not possibly know what they meant, or manipulate them into sentences of her own. Laura could not write or speak any better than she could hear. 

The tests confirmed what I had suspected all along, but it was still a tough pill to swallow. Dr. J gave us three specific recommendations.

He gave us some proven techniques and programs to work with. But before we did anything else, I had to clear the air with Laura about her elaborate cover up.  “When were you planning to tell me about all this?” I asked later in the hotel room. 

“In the beginning, I didn’t know.  I thought I heard just like everyone else. I didn’t know Iwasn’thearing things correctly until I saw people shrug their shoulders and walk away. When I finally figured out that I was lost, I didn’t know how to tell you,” said my sweet daughter who only wants to please others. 

I am glossing over here, a long painful discussion about trust, and being honest with the ones we love.  After tears on both sides, we promised to be more honest with each other and I vowed to be a better listener.  

Then I wondered all the way home on the plane about what to do next. 

Dr. J’s analysis began with this: Laura needed to go back to the beginning and learn the phonemes of English words.  Laura’s ears were not picking up the minute differences between the sounds in English and could not recognize whole words, similar sounding words.  This is why she had performed so poorly when trying to recognize words over background chatter, fast speakers, and those who did not enunciate well.   

Dr. J’s first prescription was a program titled: Earobics (  This is a very basic computer guided learning program available for about $60 that we used on our home computer.  Immediately I noticed the difference between Earobics and other children’s computer programs we had used: this time there were no graphics.  

Graphics are very important attention grabbers in children’s TV and computer programs.  They give many clues as to what is going on.  In Laura’s case, she read the clues so successfully with her eyes she never depended on spoken directions.  In other computer games, she learned through trial and error how to win the prizes. With Earobics she had to learn to listen.  It is possible to outsmart Earobics games and I cautioned Laura repeatedly not to do this.   

In the teacher portion of Earobics I could see the her progress. Laura went through several of the games quite rapidly.  Nevertheless, there were a couple that she struggled with. At the conclusion of the program (which Laura completed in about 3 weeks), Laura listened to spoken words much more carefully.  It was helpful to have someone other than her mother highlight her listening problems. 

Dr. J’s next prescription was for a Linda Moodbell program:Visualizing and Verbalizingby Nanci Bell.  (  She has a wonderful program for those living near one of her learning centers.  We were nowhere near one, so I ordered the materials (   

When the materials arrived, and I started by reading“Visualizing and Verbalizing for Language comprehension and thinking.” As read the first page I called to Laura and Dr. Bell’s description of a student that prompted her to write this book: 

“Here was a 17 year old girl who could read adult level material, could spell adequately, had a sufficient oral vocabulary, who was failing nearly all her classes….. She could read at a 12th grade level but her comprehension was unstable after the 3rd grade paragraph. Her reading rate was good, with few decoding errors, but she had little idea of content.  She could not recall nor interpret information from short paragraphs.  Her oral reading comprehension was at the 9% and silent reading comprehension was at the 10%.” 

Laura was excited, “That’s me she’s writing about! What do we do now? What’s the first lesson?” 

I stayed a couple of chapters ahead of Laura as we implemented Bell’s techniques – which is a straightforward method to teach the two sides of Laura’s brain to speak to each other.  In a nutshell, Laura did not use pictures to store information in her brain.  Laura stored lists of words not images. 

If asked to describe a dog, Laura retrieved a list consisting of: wet nose, tongue, fur and a tail that moves.  Her working memory problems were partly caused by the confusion of keeping all the lists straight. Laura’s brain was overloaded with lists – spelling lists, states and capitals, word identification and pronunciation guides – when it got to be too much, her eyes glazed over and she zoned out. 

Nanci Bell’s system was deceptively simple and straightforward, but requires diligent repetition and follow up.  I photocopied drawings from her book, colored them in by hand, and made specific descriptive structure word flash cards. While holding up the picture and prompting her with the flashcards,  Laura learned how to describe the drawings.   

Then I painted a verbal picture using Laura’s descriptive words.  We clarified any parts that were not clear. Laura was surprised that the lessons were so simple.  I was surprised to see that she had never connected her memories to pictures.  This was evident by her amazement that other people got so much more out of pictures than she did.   Clearly, Laura did not see a picture worth more than 5-10 words. 

Next, we worked on creating word images.  That is, describing an image that was only in Laura’s head.  Using the flash cards and a memory holding activity, Laura described something simple such as a chair, or dog, or cat.  When she was finished, I described the picture she had created for me. 

This activity leads into creating images with whole sentences; gradually increases to include three line stories, four line stories and short paragraphs.  This is very similar to the routine used in ESL training – with the exception here of concentrating on creating a mental image of the words.  Instead of remembering the new word for “red pencil” Laura could now see a red pencil in her mind. 

Eventually, Laura progressed far enough to utilize the learning scenarios on the CD Rom “Visualizing and Verbalizing CD: Adventures with Ivan and his Cousins.” This 2 CD set has short stories told by a very entertaining cat named Ivan, who knew the structure word prompts. Laura can do them on her own. 

For the first week, we did Nanci Bell exercises every night for about 30 minutes.  It was about all either of us could stand. Laura wanted to go really fast – and I continually reminded her she needed to learn the process.  It was hard for her to give up the memorization techniques she’d practiced for so long.  We had many discussions over where Laura how she wanted to understand the words she knew before her friends found out, the doors increased reading skills could open, and she was mentally exhausted from learning the same material over and over.   

As Laura’s increased her time on the exercises she became better at visualizing; As she visualized things in her mind instead of storing word lists, she could retain more of the information.  Within a few weeks, learning became it’s own reward. 

A couple of weeks into the program, I explained to Laura that this is how most of us store our memories.  It is much simpler and faster this way, and this is how she needed to start approaching books, conversations and lessons. 

Laura nodded in agreement and went into her bedroom with a 4th grade reading level book.  She emerged about 30 minutes later having read the first two chapters.  For the first time in her life, Laura related the plot, main characters, location of the story and predicted where the story might be going.  We were both shocked and thrilled. 

We began the Visualizing an Verbalizing Program (as taught my mom) about 6 months ago.  In the hands of a trained professional, Laura might be a lot further along, but we are pleased with her progress.   

Laura’s reading and listening comprehension are so much better than they were.  She is able to follow spoken conversations in the classroom and with friends.  She is not as isolated socially.   

In addition to the comprehension program, Dr. J had other suggestions that have helped.  Laura has never had an Individualized Education Program (IEP), nor a “504” and I decided not to ask for either, now.  Instead, I went to each teacher and explained Laura’s learning style, and left a copy of Dr. J’s report.  Each agreed to give me access to written materials before they were introduced in class.  So we have been able to prepare Laura BEFORE class.  This allows her to participate in the classroom discussion and increase her knowledge of the subject on her own.  

In addition, I asked the teachers not to ask Laura questions in class discussions unless Laura indicated she wanted to answer them by raising her hand or joining in discussion. 

Tests were another story, but I prevailed and each agreed to allow Laura additional time to complete them.  Laura, however, did not want anyone to know she might need more time and arranged to stay at lunch or after school if necessary.  

Laura is in her sophomore of high school.  She had been scheduled for World English, World History, Geometry, Biology, PE and Art.  While she had looked forward to taking biology we agreed to put it off for a year, leaving Laura with fewer classes while she learned to read.  In addition, I really wanted her to learn and retain the subject matter because her career goal is to do something in medicine.  Her history class was tailored for students at risk for failing to graduate – so there was little reading. She loves PE and math.  Word problems in Geometry occasionally trip her up, but Laura considers it her favorite subject.  

My requests were easy for teachers to go along with.  None of the other students caught on to her struggle.  Staying after school until I get off work, Laura now assists other students in high school math, and that boosts her spirits, too. 

Next year, Laura will tackle biology.  Her math teacher has advised a straight Algebra II class to fill in the gaps in her math background.  We are crossing our fingers for English and History.  Laura must pass a high school exit exam, too.  She took it for the first time last month and feels she may have passed the math portion, but anticipates she may need the additional four offerings to pass reading and writing. 

This is to say, we are not out of the woods, yet.  Laura was hoping she’d get a magic pill that would give her instant comprehension.  I point out she is learning the skills to read and comprehend; only practice will give mastery over words.   

When I asked Laura what the impact of all this has been on her reading and comprehension, this is what she said: 

I can relate to the characters in what I read.  I can feel their emotions and experiences and learn things to apply to my life.  I don’t really think about making pictures in my head but I guess that must be what I am doing, the pictures give me more confidence. 

The other night we arrived home in the middle of a feature story on National Public Radio.  We both stayed in the car to hear it to the end.  As we got out of the car Laura said, “Can you believe that really happened to someone?” 

I was shocked to realize that in only 6 months, Laura had listened to a long story with no visuals, understood the concepts, and personalized the situation to her own life.  “No,” I replied, and I said to myself, “I never thought I’d hear Laura say those words, either.”


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