Auditory Processing Difficulty Toolkit

There is equipment that can help make speech a lot more accessible and therefore easier to hear. 

If you are in education, contact the Disability support and inclusion department where you are studying or look on the Government website for a Disabled Students assessment provider:
Find a Disabled Students' Allowance assessment provider - GOV.UK (www.gov.uk) 

If you are in work, self-employed or looking for work contact Access to Work who help fund equipment for the workplace: 
Access to Work: get support if you have a disability or health condition: What Access to Work is - GOV.UK (www.gov.uk) 

The Phonak Roger On is a wireless hearing system that uses ear level receivers (or hearing aids if you use them) that enable better understanding of speech in noisy situations. It is often used in educational settings and work settings for people who have APD.

You can also purchase it privately: 
Phonak Roger On Microphone Transmitter | Connevans 
Phonak Roger ON The Ultimate Guide | Hearingloop

Some people with APD may benefit from hearing aids if they have a hearing loss as well as APD. The Phonak Roger On can connect to hearing aids. This is easiest if your hearing aids are also made by Phonak. If not, ‘shoes’ can be purchased and added to your hearing aids to enable connection to the Roger On.

There are a huge range of speech to text apps you can download from your app store onto your mobile phone to help you understand conversation when there is noise or poor acoustics. Some are free and some have a charge. Two good ones to try that have some free features are: Otter Ai and Live Transcribe. Things change rapidly in this area of so you may need to experiment with a few and see which ones work best.
Speech-to-text smartphone apps for deaf people and those with hearing loss and tinnitus - RNID

Visual information contributes a surprising amount to what we understand. Body language represents a very significant proportion of meaning that is conveyed and interpreted between people. In fact, about 50-80% of all human communications are non-verbal.

So, non-verbal communication is very important in how we understand or misunderstand each other, especially in face-to-face and one-to-one communications, and most definitely when the communication involves an emotional or attitudinal element.

Some key points

Body language is not just about how we hold and move our bodies. Body language encompasses:

• How we position our bodies
• Our closeness to and the space between us and other people (proxemics), and how these changes
• Our facial expressions.
• Our eyes especially and how our eyes move and focus.
• How we touch ourselves and others.
• How our bodies connect with other non-bodily things, for instance, pens, cigarettes, spectacles and clothing.
• Our breathing, and other less noticeable physical effects, for example our heartbeat and perspiration.
• The pace, pitch, and intonation, volume, variation, pauses, etc., of our voice.

Paying more attention to the above when listening to someone can sometimes help supplement what you are hearing. This does mean listening is more effortful for you and you may get tired much more easily.

Lip-reading classes can also help you understand speech better by teaching you how to visually interpret the movements of the lips, face and tongue. Lip-reading is not always easy but understanding visual cues can make quite a difference. For information on lip-reading and where to find classes see ATLA – Lipreading.

There are also free online lip-reading classes available at Lipreading Practice. In addition, Stories for Lipreading – YouTube has various jokes and stories you can use to practise using your visual skills.

Another important part of managing communication effectively is explaining the difficulties you experience and crucially how people can help.

Finding a way to explain to people that you have APD and, as a result, find some situations difficult lessens the chances of people assuming you are not interested or ignoring them.

Some possible phrases to use

• I can’t hear well in this noise due to a hearing problem. Can we go outside/ /somewhere else away from the air conditioning/TV/traffic?
• I’m having trouble hearing you, please can you speak up?
• I can hear you are speaking but it’s just not very clear, can you say it again and face me?

Find a phrase that you feel comfortable with and practise saying it in situations where the outcome is not vitally important (i.e., with good friends who are aware of your difficulty or in a shop you don't often go to). It will then come more naturally in situations where you don’t know the speaker well or feel uncomfortable or under pressure.

Other communication strategies that may make a difference

• Arrive early to social occasions/meetings so you can position yourself near to the person who is likely to do the most talking.
• If possible, try to arrange meetings and social occasions in places with good acoustics (this usually means minimum background noise/echo and the presence of soft furnishings such as carpet and curtains).
• Give whoever is speaking your full attention and position yourself close to them. Watch lip patterns and observe body language.
• Disclose any difficulty as soon as it occurs. Try not to wait until you are in a lengthy conversation, or the conversation is almost finished as this is frustrating for you and the speaker.
• Ask individuals to write down very important information such as directions, telephone numbers and names.

There are also various communication tips you can discuss and/or hand out to friends, family and colleagues (see hand out at the end of the page).

Auditory training is a way to train and practise using the pathways in your brain responsible for processing sound. There are various websites and APPS that offer free auditory training exercises.

Your hearing therapist may suggest which sort of auditory training could be most helpful for you and how often to do it. Research suggests that auditory training which also includes exercises that help with memory and attention are most likely to result in real life benefits. More research into the benefits of auditory training is needed to accurately assess how to get the best from it.

Free online auditory training resources and APPS to try <H3>

• The StiNT app is free to use and involves practising hearing stories in noise.
• BrainHQ has a free section and paid section. There are auditory exercises on there and ones for attention, memory and concentration.
• Hear Beyond is an app that helps you practise hearing in noise.

Some key points

• The training is best done consistently, (e.g., doing the training every day for 4 days and then nothing at all for a month will not give as good results as 2–3 times per week for a month).
• The brain likes to learn in a graded manner – so the tasks you will be performing should be of graded difficulty, with simpler tasks to begin with and more complex tasks as you make progress.
• Try working “at the edge of competence”. If a task level is too easy, move on to the next (more difficult) level, but not to a level that you find impossible to do. As a rough guide, you should be able to get 50-70% of what you are listening to, once you are at 70% or better you should change level.

Hearing and communication are at the heart of all human life. APD can therefore have a profound impact on all areas of people’s lives. It is common to experience stress, anxiety and frustration because of the difficulties encountered.

Stress has a direct impact on how we process sound making it more difficult for us to filter out background noise.

Finding a method of stress reduction that works for you and doing it regularly can help both the impact and symptoms of APD.

Mindful Meditation

Mindful meditation is a way of being in the present moment as non-judgementally as possible. There is lots of evidence to suggest it is very helpful for reducing stress, anxiety and improving memory, attention and concentration (which may be particularly helpful for people with APD).

Below are some free resources:

New to Meditation - Tara Brach

Resources - Mindfulness: Finding Peace in a Frantic World

Insight Timer — #1 Free Meditation App

Medito Foundation - Building a more mindful world

For a book and CD with meditations from the standard 8-week meditation course try ‘Mindfulness: A Practical Guide to Finding Peace in a Frantic World’ William and Penman (British voice)

Relaxation

Relaxation exercises are a good way to practice relaxation and this doesn’t mean simply watching TV.

• Calm App. This is a great app with a variety of exercises. Costs may apply.
• MIND. Relaxation exercises – Mind. Lots of different suggestions for ways to relax.

Hearing Therapy

Common-sense suggestions for relatives/friends/colleagues of those with central auditory processing disorders (APD) can be found below. May be laminated for posting on the refrigerator and other handy places.

People often report that simply knowing what the person’s problem is, and the increased appreciation of the difficulties has made a big difference.

People with auditory processing problems suggestions for relatives, friends or colleagues

1. People with auditory processing problems seem to hear inconsistently. If they seem to hear some things and not others do not assume they are purposely ignoring you.
2. You will have greater success in communicating if there are not other activities (other people talking or laughing, television or radio playing, dishwasher or vacuum cleaner running etc.) competing with you.
3. During communication provide a quiet setting. Go into a quiet room, turn off the TV, ask others to be quiet for a moment etc.
4. Delay important conversation until a quiet time can be found
5. Make a point of finding “quiet conversation periods” on a regular basis during the course of each day.
6. Simplify your language level if the person you are talking to does not seem to understand
7. Try slowing down your rate of speech if they continue to have trouble understanding. One way to accomplish this is to pause between utterances, especially after they have finished talking and before you respond.
8. If you need to repeat something, try saying it in a different way (different words, different type sentence etc.)
9. Do not try to have discussions when you are both in separate rooms.
10. When conversing, allow adequate time for a response.
11. Young people may need time to recover after school or college. Allow time for relaxation before asking them to do chores/study.
12. Get attention first by addressing the listener by name or touching them. If giving instructions to a child get them to repeat the instructions back, thus allowing you to monitor where a message may have broken down and then repeat the parts missed. Do not ask “did you hear me?” but ask specific questions about the instructions.
13. Multiple part instructions should be given one part at a time with a slight pause (long enough to repeat mentally each part of the instruction back to yourself) in between the parts to allow the listener time to receive the message and comprehend each part.
14. Some people with auditory processing disorder have a “strong ear” if so, try to speak on the side of the “strong ear”.
15. It may be difficult for people with auditory processing disorder to follow conversations at the dinner table but try to involve them.
16. Visual cues should be used as often as possible to supplement verbal communication.