Sensorineural Hearing Loss and APD

CSign

CSign

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My son had his annual hearing test yesterday and his levels have remained stable in the last year. The audiologist wrote in the notes that he has very good speech and language skills. I made a point of asking her to clarify in the notes that expressively he has great speech and language, but that receptive language is another story.

I told her that one on one, ideal listening situations he does fine- but anytime there is background noise it is extremely difficult for him relying on audition alone.

When she did the speech perception in noise, his scores were not very high. After the testing was done, she asked if anyone had talked to us about an Auditory Processing Disorder because she suspected that he may have one.

I have always attributed his challenge hearing in noisy environments to his hearing loss. It never even occurred to me that he might have an APD. Doing a bit of research it seems like it is a very good possibility that is what's going on. We will get him assessed to be sure one way or the other, and to know how to best proceed. Interestingly, most accommodations for an APD are essentially the same as for students who are DHH.

Is there anyone on this forum who has an APD and sensorineural hearing loss? It is hard for me to differentiate between what he doesn't hear due to his hearing loss, and what may be due to an APD.

I guess I don't have any specific questions, but I'm interested in others thoughts and experiences about hearing loss and an APD.
 
CSign said:
Is there anyone on this forum who has an APD and sensorineural hearing loss? It is hard for me to differentiate between what he doesn't hear due to his hearing loss, and what may be due to an APD.

I guess I don't have any specific questions, but I'm interested in others thoughts and experiences about hearing loss and an APD.
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I have both, and actually to be more specific, APD and Visual Processing Disorder as well. My opinion only, but I believe it's fairly common. At work I have to turn off my hearing aids so I can concentrate. I just can't work with noise and it's impossible to weed out conversation unless it's directed to me. I think you can guess my feelings on group activity at school and work. I can't hear in group settings and never could. In school I had to have a room to myself during exams because I used to be so distracted by the others sharing the class.

Laura
 
I have both.

For me the biggest thing is that while I do well as a Hoh person in quiet, I'm functionally deaf in noise. By "functionally deaf" I mean I am unable to understand any speech at all, and in many situations my brain registers all the noise just as a "blur" so I can't distinguish other non-speech sounds either (meaning fans, phones, honking cars, fire alarms etc). My brain sort of gets overwhelmed.

I also find that if I'm getting a lot of auditory information (school, lectures, etc) that I have a fairly significant "sound to comprehension" delay ... sometimes almost a sentence behind.

For me, when I went to university ASL interpreters were a must - I tried a class without them, and there was no way I could follow without interpreters or CART.

The most important thing I can stress as someone who has APD is for people to realize is that APD in additional to SNHL causes major differences in how we function in quiet vs noise (something that teachers, caregivers, parents, etc all need to be very very aware of).

APD+SNHL also means that all the things that happen with SNHL can be amplified - meaning I get VERY tired if I have to process a lot of auditory information, espeically if there's any background noise at all (even a fan). From the time I was in school, I'd come home at lunch and take a 15min nap ... working full time I did the same thing (I lived across from work at that time).

I'm not sure if any of this helps, but feel free to ask any more questions :)
 
I don't have APD, I would not jump right on that!! Background noise will make it hard to understand speech!!! Hearing aids are not the same as hearing. I don't know how to explain it. I think audi's have maybe a little too much confidence in hearing aids capabilities, but maybe that's just me.

I lost my hearing in my 20's, I never had a problem understanding speech in noisy situations, well not any harder than your average bear. I now have profound loss and if you stick me in a noisy situation I am going to be relying almost 100% on speech reading.

I'm not saying dismiss the idea of him having APD as well, but just being deaf/HOH and having low speech understanding in noise is perfectly understandable in itself.
 
I would look into it if you can. I have perfect hearing and apd. The reson i think you should look into a diagnosis if you can is that although there are some things that are the same as being hoh like difficulty in noise there are other thing he might need help with that he might not get without a diagnosis. My problems are sequencing, auditory memory and processing speed, spelling as well as background noise problems but there are others.
 
APD here too

I can eventually understand speech in noise, but it depends on the type of noise. If many people are speaking, I can't hear and understand all of them at once. If I sort of focus on one person, and then listen to him/her for a while, then it starts making sense, but he/she has to be talking for about a minute. If everyone were to suddenly speak at once, they sort of all mix up and I can't tell one from the other :P
 
Lau2046 said:
I have both, and actually to be more specific, APD and Visual Processing Disorder as well. My opinion only, but I believe it's fairly common. At work I have to turn off my hearing aids so I can concentrate. I just can't work with noise and it's impossible to weed out conversation unless it's directed to me. I think you can guess my feelings on group activity at school and work. I can't hear in group settings and never could. In school I had to have a room to myself during exams because I used to be so distracted by the others sharing the class.

Laura
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I'm kind of the same way in terms of taking tests essentially in isolation, especially with math.

When he does the math portion of the Star Test (statewide test), he goes in a distraction free room. I'm almost thinking to have him start taking majority of his tests that way and see if it helps him.

There have been times when he has wanted to turn his HA's off at school, particularly when he's reading. His teacher and the IEP "team" tried to say he needed to leave them on, and I wanted to knock them out. I made it clear to them that it is not their place to say he couldn't do that, and ensured that it was written in his IEP that if he chose to do that then they needed to respect that.

I can only imagine how difficult it must be to have both an auditory processing disorder and a visual processing disorder. I know we all learn to compensate, but I can imagine what a hurdle that must have been for you in school.
 
Anij said:
I have both.

For me the biggest thing is that while I do well as a Hoh person in quiet, I'm functionally deaf in noise. By "functionally deaf" I mean I am unable to understand any speech at all, and in many situations my brain registers all the noise just as a "blur" so I can't distinguish other non-speech sounds either (meaning fans, phones, honking cars, fire alarms etc). My brain sort of gets overwhelmed.

I also find that if I'm getting a lot of auditory information (school, lectures, etc) that I have a fairly significant "sound to comprehension" delay ... sometimes almost a sentence behind.

For me, when I went to university ASL interpreters were a must - I tried a class without them, and there was no way I could follow without interpreters or CART.

The most important thing I can stress as someone who has APD is for people to realize is that APD in additional to SNHL causes major differences in how we function in quiet vs noise (something that teachers, caregivers, parents, etc all need to be very very aware of).

APD+SNHL also means that all the things that happen with SNHL can be amplified - meaning I get VERY tired if I have to process a lot of auditory information, espeically if there's any background noise at all (even a fan). From the time I was in school, I'd come home at lunch and take a 15min nap ... working full time I did the same thing (I lived across from work at that time).

I'm not sure if any of this helps, but feel free to ask any more questions :)
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Thank you for the post... My son is much the same as you... He gets tired at the end of the day, and even gets headaches from it sometimes.

He has an interpreter at school which I know helps him, but I know there are situations where it's difficult for him.

We have a new audiologist, and I almost got into it with her at the appointment. She asked about how school was going, and I told her he was doing well but that it was frustrating because the district/teachers/administrators don't have a good understanding of what it really means to be deaf.

When I say they don't have a good understanding of what it means to be deaf I mean that they really don't understand his unique communication needs. They look at me sideways whenever I have the nerve to request something as if he doesn't need it-when in reality he does. They also don't show him respect as a deaf student. There have been too many situations to even recount.

She told me, "oh- well we would never classify him as deaf."

I looked her dead in the eyes and said, "he is deaf"...

She said, "no- he has a severe hearing loss. We wouldn't say he's deaf."

I felt like banging my head against a brick wall.

I told her, "perhaps from the medical/audiological perspective he's not deaf, but from the cultural perspective he is. We don't differentiate between degrees of hearing loss."

At that point she backtracked and apologized because she could tell I was really pissed off.

Like you, my son is functionally deaf. Sure, in ideal 1:1 listening situations he is fine. However, you add any type of background noise he has an extremely difficult time discerning spoken language surrounding him.

Thinking back to when he was younger, there were times when he needed to just go to a corner where it was quiet to sort of rejuvenate.

I am fairly certain he does have an APD... He will be getting assessed in the next month or so.
 
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ambrosia said:
I don't have APD, I would not jump right on that!! Background noise will make it hard to understand speech!!! Hearing aids are not the same as hearing. I don't know how to explain it. I think audi's have maybe a little too much confidence in hearing aids capabilities, but maybe that's just me.

I lost my hearing in my 20's, I never had a problem understanding speech in noisy situations, well not any harder than your average bear. I now have profound loss and if you stick me in a noisy situation I am going to be relying almost 100% on speech reading.

I'm not saying dismiss the idea of him having APD as well, but just being deaf/HOH and having low speech understanding in noise is perfectly understandable in itself.
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I get what you are saying... That's why it never even occurred to me that he might have an APD. But, with the test in noise the levels are theoretically loud enough for the patient to be able to discern the word being said.

I'm definitely not hoping for another diagnosis, but I do want to make sure we are meeting his needs and knowing what's going on. I should know in
The next few months.
 
ambrosia said:
I don't have APD, I would not jump right on that!! Background noise will make it hard to understand speech!!! Hearing aids are not the same as hearing. I don't know how to explain it. I think audi's have maybe a little too much confidence in hearing aids capabilities, but maybe that's just me.

I lost my hearing in my 20's, I never had a problem understanding speech in noisy situations, well not any harder than your average bear. I now have profound loss and if you stick me in a noisy situation I am going to be relying almost 100% on speech reading.

I'm not saying dismiss the idea of him having APD as well, but just being deaf/HOH and having low speech understanding in noise is perfectly understandable in itself.
Click to expand...

I concur. It is extremely rare that anyone with an at least a moderate or higher loss will function well in noise, even with HAs. That's why HA manufacturers are working on programming that help to eliminate background noise in speech in reception. The newer Naida's, if I understand correctly, are going a long ways towards that. There have been some other threads here about that. Anyway, I think it's the level of loss/noise in speech issue that is the concern here.
 
Two things......first of all, the audi, someone who actually has a lot of interaction with dhh children stated that he has very good speech and hearing.....I think that should make you feel a lot better.....it's one less thing to worry about.
Second of all, I wonder if the audi actually KNOWS what she is even talking about. It's possible to be HOH AND APD at the same time, but even unilateral dhh people can and do have significent difficulty in noise...that's all part and parcel of being HOH!
 
deafdyke said:
Two things......first of all, the audi, someone who actually has a lot of interaction with dhh children stated that he has very good speech and hearing.....I think that should make you feel a lot better.....it's one less thing to worry about.
Second of all, I wonder if the audi actually KNOWS what she is even talking about. It's possible to be HOH AND APD at the same time, but even unilateral dhh people can and do have significent difficulty in noise...that's all part and parcel of being HOH![/]
Audiologists have a college degree and usually four years of graduate school to earn their doctorate degree.
I'm not saying to agree with everything your audiologist says, but maybe don't place the advice of people on the Internet above people with advanced degrees.
Some of the people on AllDeaf don't have hearing loss but are militant against cochlear implants. Some have mild conductive hearing loss but are militant against using spoken language for children with mild hearing loss (where it would likely be most useful), some people have moderate hearing loss but say they are audiologically and culturally Deaf because thAt is how they roll.

The thing is that almost nobody here has EVER taken a graduate course about audiology or the auditory system.
I'm not saying you should trust me because I have had 4 graduate courses about audiology or the auditory system.
I'm saying in should trust your audiologist and if you think turning to the Internet is a good choice, you should find a different audiologist.
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I told her that one on one, ideal listening situations he does fine- but anytime there is background noise it is extremely difficult for him relying on audition alone
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And indeed CSign that tends to be the norm for virtually anyone who is dhh. The world is not a soundbooth, and technology can only do so much!
 
ecp said:
deafdyke said:
Two things......first of all, the audi, someone who actually has a lot of interaction with dhh children stated that he has very good speech and hearing.....I think that should make you feel a lot better.....it's one less thing to worry about.
Second of all, I wonder if the audi actually KNOWS what she is even talking about. It's possible to be HOH AND APD at the same time, but even unilateral dhh people can and do have significent difficulty in noise...that's all part and parcel of being HOH![/]
Audiologists have a college degree and usually four years of graduate school to earn their doctorate degree.
I'm not saying to agree with everything your audiologist says, but maybe don't place the advice of people on the Internet above people with advanced degrees.
Some of the people on AllDeaf don't have hearing loss but are militant against cochlear implants. Some have mild conductive hearing loss but are militant against using spoken language for children with mild hearing loss (where it would likely be most useful), some people have moderate hearing loss but say they are audiologically and culturally Deaf because thAt is how they roll.

The thing is that almost nobody here has EVER taken a graduate course about audiology or the auditory system.
I'm not saying you should trust me because I have had 4 graduate courses about audiology or the auditory system.
I'm saying in should trust your audiologist and if you think turning to the Internet is a good choice, you should find a different audiologist.
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ecp, sorry but you're acting like I'm a militant. First of all, I do distinctly recall a parent whose kid was having issues orally. I had suggested that she look into stuff like APD, and she stated that the audis she saw (these were top of the line audis, like affliated with CID) stated that you cannot seperate HOH from APD. second of all, it's a fact that hearing aids/CIs cannot and do not minmic normal hearing. The world is not a soundbooth.......That's all I'm saying....
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deafdyke
I, for one, am still puzzled about where your knowledge of current conditions comes from. Your profile still says "college student". If that is not current, what degree did your studies lead to? Are you working in a field that deals with hearing? It appears that so much of what you post is from "I have heard".
 
deafdyke said:
ecp said:
ecp, sorry but you're acting like I'm a militant. First of all, I do distinctly recall a parent whose kid was having issues orally. I had suggested that she look into stuff like APD, and she stated that the audis she saw (these were top of the line audis, like affliated with CID) stated that you cannot seperate HOH from APD. second of all, it's a fact that hearing aids/CIs cannot and do not minmic normal hearing. The world is not a soundbooth.......That's all I'm saying....
Click to expand...

No, the world is not a sound booth but children should be encouraged to use whatever works best for them. (It should be noted that when dealing with young children (or even teens and some adults) "encouragement" isn't merely saying "yay, you tried your hearing aids for 2 days, you didn't like them...so we will abandon them".

Of course someone can have hearing loss and auditory processing disorder. But difficulty with hearing in noise is generally part of having hearing loss.

I sometimes wonder if all people who have moderate and above hearing loss also have APD. it isn't the same but with a certain amount of hearing loss there just aren't enough hair cells to make sense of complex sounds.

Of course, APD refers to an inability of the auditory cortex in the brain to be able to process speech not a defect in the ear or auditory nerve. Different locations and vastly different treatments.
Click to expand...
 
It's common for people that have apd to have problems other than just speech processing. There's often problems with auditory memory and cohesion as well. So remembering and organizing auditory info is difficult.
 
ecp said:
deafdyke said:
No, the world is not a sound booth but children should be encouraged to use whatever works best for them. (It should be noted that when dealing with young children (or even teens and some adults) "encouragement" isn't merely saying "yay, you tried your hearing aids for 2 days, you didn't like them...so we will abandon them".

Of course someone can have hearing loss and auditory processing disorder. But difficulty with hearing in noise is generally part of having hearing loss.

I sometimes wonder if all people who have moderate and above hearing loss also have APD. it isn't the same but with a certain amount of hearing loss there just aren't enough hair cells to make sense of complex sounds.

Of course, APD refers to an inability of the auditory cortex in the brain to be able to process speech not a defect in the ear or auditory nerve. Different locations and vastly different treatments.
Click to expand...

Which is basicly why we're pushing the full toolbox. Yes, many dhh kids can develop spoken language skills, and be able to hear with hearing aids/CIs....but the fact of the matter is that they don't hear like a hearing person. Even I don't (conductive loss, born with it)
I just wonder if the APD is an unnessary additional label, since it goes without saying that even late deafened people still may have issues with processing speech in noise.
Click to expand...
 
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