Central auditory processing

Central auditory processing is about the way the brain uses the information which enters each ear and will determine how well people can listen. The doctor should always be consulted if there is any possibility that a child is not hearing adequately. Problems here are relatively unusual, although many children have a history of hearing loss and grommets may have been inserted when they were younger.

Most people with central auditory processing difficulties hear perfectly well. However, people who were periodically deaf in early childhood as a result of blocked ears and ear infections are very likely to have listening difficulties, because the deafness may have prevented early auditory processing development from proceeding normally.

Central auditory processing problems are almost never picked up because there is no mainstream testing available. If a child is often in trouble for not listening at school and a conventional hearing test shows no problem, the conclusion may well be that the child is being naughty and choosing not to listen. This is seldom the case.

Problems in this area include hyperacute or hypersensitive (painful) hearing, a slow speed of auditory processing, poor sound discrimination, poor sound localization, poor pitch discrimination and disruption to auditory reflexes.

Hyperacute hearing makes it very hard for people to concentrate. Their hearing is so acute that they are easily distracted by background sounds. Children with hypersensitive hearing are easily upset by loud noises and will often react by putting their hands over their ears.

A slow speed of processing is another common problem. In this case a new piece of information will be presented before there has been time to fully process the previous one. To listen accurately under these circumstances is mentally tiring and concentration can only be held for a short time. A child with these difficulties will muddle similar speech sounds such as b/d and k/t. This can also lead to ‘cocktail party effect’, where it is very difficult to concentrate on the voice of the person you want to listen to when there is any significant background noise. People who suffer from this problem will generally be easily distracted.

Auditory integration is the ability of the brain to take the sounds received from each ear and combine them. This requires brain integration and if someone has problems with auditory integration they are likely to have a slow speed of processing and difficulties with comprehension. They may also be forced to listen with just one ear, which may make them excessively literal if they rely on the right ear, or over-emotional if they rely on the left ear.

Some people have difficulty locating the source of a sound accurately. This can make it hard for them to focus on a speaker when they are listening in a group situation, particularly if they are not sitting where they can see the speaker all the time. Sound localisation requires good auditory integration.

Problems with pitch discrimination can lead to difficulties in recognizing the intonation in speech, which is one of the ways in which meaning is conveyed. This in turn may lead to poor or delayed comprehension. It can also affect the inflexion in someone’s speech.

The functioning of the auditory system is easily disrupted by stress. This can affect the normal functioning of auditory reflexes, such as the middle ear reflex. This is our “pneumatic drill” reflex and turns down the volume automatically to protect our ears if we are exposed to a loud noise. If this is triggered by stress a child may become quite deaf in certain circumstances, which will make it hard for them to listen effectively.

A very high proportion of children diagnosed with behaviour problems in the classroom have undiagnosed central auditory processing difficulties. It’s not that they won’t listen but they can’t listen in classroom conditions.

Central auditory processing difficulties are dependent on mature functioning in the olfactory, vestibular and reflex systems, good muscle tone and maturity in differentiation, lateralisation and brain integration.

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