The Brain Understanding Itself

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) if six or more symptoms of inattention or hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level, a child or adult may be diagnosed with ADHD. Depending on the symptom combination, this could be further classified as inattentive, hyperactive, combined type, or not otherwise specified (NOS).     

This diagnosis often leads to a treatment regime including medication such as Adderall, Concerta, Dexedrine, Ritalin, Strattera, among others.  If medication doesn’t work parents may turn to behavioral management techniques, dietary changes, nutritional supplements, neurofeedback, and school accommodations. An integrated treatment approach is generally best. ADHD symptom management can be an exasperating experience for both parent and child.   

What many parents and professionals may not recognize is that something else may be going on. Many of the symptoms of ADHD are shared with an Auditory Processing Disorder (APD).  There is parallel situation with Autism Spectrum Disorders and Sensory Processing Disorder (SPD).  If it looks like, talks like, and quacks like a duck, it must be a duck. Right? Not necessarily…

Staying with the ADHD/APD link children with APD may struggle to block out background noise, follow conversations, are often fidgety and distractible. They may have difficulty following directions, keeping themselves organized, experience auditory working memory deficits, and have challenges understanding instructions or conversations. Problems with language, reading, academic performance, peer relationships, and self-confidence are also part of the APD profile. Sound familiar? Simply put, auditory processing is what the brain does with what it hears. This is something I understand quite well having spent a good deal of my childhood and teen years with some of these challenges.  

Children with APD are frequently lost in the cracks, in large part because auditory processing disorders are not yet well known and are not included in the DSM.  How many children have an auditory processing disorder? Estimates range from as low as 3% to as high as 20%. An accurate number is difficult to determine due to lack of professional understanding, co-morbidity, and the plain fact that it looks a lot like ADHD and can co-exist with it. 

The APD brain has difficulty taking in, storing, processing, and understanding sounds and words. Imagine listening to a radio station that is not quite tuned to the channel frequency. You can hear part of a song through the noise, but miss a lot of it, perhaps without even realizing. The brain has a tough time filling in the missing pieces, so the song may not make sense.  We have all experienced this at one time or another.

Ever listen to and even sing a song thinking the lyrics are one thing, later to find they are different? I love Johnny Cash, Ring Of  Fire is one of my favorite songs. Here is a great example of a misheard lyric, “I fell in like a child on fire”. Real lyric,”I fell into a burning ring of fire”. See, it’s easy to do! Trouble is, with APD this happens in conversations, when listening to instructions in the classroom, or trying to follow directions at home. This is just one illustration.

What looks a lot like ADHD can be APD. Diagnosis is made by an audiologist using a specific assessment battery, rather than relying on symptoms alone. An accurate diagnosis can be made starting at age 7.  Parents often ask if APD is a hearing problem, in most cases hearing is fine, the brain just doesn’t understand what it hears. Often the difficulty includes filtering out background sounds and even experiencing pain or discomfort with exposure to certain sounds, which can lead to distractibility. Auditory distractions have a major impact on attention, taking a student’s attention away from what they are trying to or should be focusing on in the classroom.     

Is it ADHD or auditory processing disorder in disguise? If APD, what are the causes, and most effective strategies and treatments?

This is what will be explored in my teleconference with psychologist and ADHD expert Dr. Rory Stern, this Monday, June 1st at 9:00 PM EDT.

Please sign up for your FREE VIP Seat for The Ear-Brain Connection: The Role of Auditory Processing in Attention, one of 12 interviews in the online ADHD Family Summit by clicking here http://www.adhdfamilyonline.com/public/244.cfm?affID=ABT2009 .