OUR BLOG – Audiology & Speech

March 7, 2020

OUR BLOG

Auditory Processing Disorder

When a child has an auditory processing disorder, he has difficulty processing the information he takes in through his auditory (hearing) system. In other words, children who have auditory processing disorders have difficulty making sense of what they hear.

The term “auditory processing” can be a confusing one at first, though. It’s easy to make the assumption that children with auditory processing disorders can’t hear the sounds that are coming their way. This isn’t true. Children who are diagnosed with auditory processing disorders are actually able to hear sounds just fine- there is nothing wrong with the way that their ears work.But when the sound reaches their brain, something gets a bit fuzzy. We’re not exactly sure what goes wrong, but we do know that children who have auditory processing disorders have difficulty hearing subtle differences in sounds, accurately telling where the sound is coming from, and processing language quickly—especially in noisy and distracting environments.

Signs and Symptoms

A child who has an auditory processing disorder may demonstrate a number of behaviors. Many of these behaviors are also seen in other disorders, such as ADD, ADHD, and PDD. For that reason, it is very important to note that, upon observing any of the following signs in a child, we cannot just assume a child has an auditory processing disorder. Instead, if the following behaviors are observed in your little one, careful testing will need to be completed to arrive at an accurate diagnosis. That being said, a child with an auditory processing disorder…

May ask for repetition of what you say often–you may notice him saying “what?” or “huh?” frequently.
May not like being read to by others.
May not respond right away when spoken to by others.
May be easily distracted, especially in noisy environments, because he has a hard time blocking out background noise.
May have a hard time following more than one direction at a time, especially in noisy places such as a grocery store, a restaurant, or a daycare.
May have difficulty listening to and following directions in group settings such as school.
May be overwhelmed or even frightened in noisy environments.
May have a hard time remembering things.

May have a hard time hearing the difference between words that are very similar, such as “cat” and “cap.”
May have difficultly using spoken language.
May have difficulty with pre-literacy skills such as phonemic awareness (knowing what a certain letter sounds like) and rhyming.
May struggle with language-related school tasks, such as spelling, vocabulary, reading, and writing.
May get tired easily due to the energy and concentration required to sort through the sounds that are coming his way.
May struggle with behavior and/or self-esteem due to the frustration of not being able to meet the expectations of others.

Diagnosis

The diagnosis of an auditory processing disorder is made by an audiologist with specialized knowledge of auditory processing. Although an auditory processing disorder can be suspected at younger ages, children are most easily diagnosed after the age of seven. To make the diagnosis, an audiologist will first make sure that the child does not have a hearing loss. Then, the audiologist will have a child participate in a variety of tasks that require him to listen to sounds, words, and sentences and respond in different ways. A child’s performance on these tasks can help an audiologist determine if a child has a true auditory processing disorder. The audiologist might also use some tests that can determine just how the child’s brain responds to auditory information.

Other professionals may play a role in diagnosis as well. Speech-language therapists can administer language testing to carefully assess a child’s use and understanding of language and psychologists may be involved to rule out disorders such as autism, cognitive delays, ADHD, or ADD.

Cute little girl at speech therapist office

What To Do

There are many strategies available to help children with auditory processing disorders. Most importantly, it is essential to get an accurate diagnosis so that you can access services for your child. Speech-language pathologists and audiologists can work with children with auditory processing disorders in a variety of different ways. Some specialists may work with children to help them learn to hear sounds more accurately and follow directions of increasing length in increasingly distracted environments. Others may use specially developed and acoustically modified computer programs such as FastForWord to retrain a child’s brain to process sound more accurately.

What’s more, teachers and parents can play a role in helping a child with an auditory processing disorder cope by implementing the following strategies:
Seat the child close to the front of the class where he can better hear and attend to a teacher,
Allow the child to wear a special assisted listening device which makes the teacher’s voice just a bit louder,
Give the child time in to recharge in quiet, calm environments,
Recognize and prepare for difficulties in noisy environments such as restaurants, classrooms, gyms, and supermarkets,
Limit loud TV and music in the house, especially when a child is being asked to concentrate or participate in conversation,

Give only one direction at a time or pause between directions to give the child time to process what is being said,
Ensure that you have the child’s attention before speaking,Check to make sure a child has heard and understood something before expecting him to follow a direction, and
Use visual supports such as pictures whenever possible at home and in school.
Auditory processing disorders can be hard on children, families, and teachers alike. With the proper treatment and coping strategies in place, however, there is much hope for everyone involved.

March 7, 2020

OUR BLOG

Red flags for autism in toddlers

One of my passions as a pediatric speech-language therapist is helping parents understand the early signs and symptoms of autism. Autism is a complex disorder that requires systematic and often intense treatment, but there is much hope for children who receive this diagnosis, especially if they are diagnosed a young age and receive treatment early. Early diagnosis, though, depends on a keen understanding of the early signs and symptoms of autism in toddlers.

Parents are often told to talk to their pediatrician about autism if their child has not spoken a single word by 15 months, or is not using 50 words and short phrases by 24 months. This is good advice, because delays in verbal communication are part of the diagnosis of an autism spectrum disorder (except in the case of Asperger’s Syndrome, but I’ll chat about that in another post). However, (note the italics because this is a *really important* however), just because a child is a late talker, one can notassume that the child has autism. Not by a long shot. Many, many children have language delays without having a diagnosis of autism. A delay in language is one indicator of autism, but it is a very broad one. Luckily, we do have other, much more specific signs and symptoms to look for in toddlers to help us differentiate children with “simple” language delays from children who we may suspect have autism. A significant loss of language, for example, is one red flag. Here are the others.

Even if they are not yet talking, typically developing toddlers constantly attempt to communicate their needs and interests to the adults in their world. They do so through gestures, facial expressions, and eye contact. Watch as Baby Girl manages to communicate surprise, joy, and love all without saying a word.

By 12 months, children are really starting to use gestures to communicate with their world. They wave bye-bye, shake their head no, reach toward things and people they want, give objects to people to get help, show objects to people to share their interest in them, and point out things of interest to those around them.

Importantly, typically developing toddlers use their gestures to both indicate what they want and to show others what they find interesting. They point–not only to things they want to wrap their little hands around, but also to things that they simply want to show their parents.

This pointing to get their parents to look at things (technically called proto-declarative pointing) is an important skill that we really want to see children develop. It tells us that toddlers want to share their world with the grown-ups in it, something we call joint attention. Joint attention simply means that two people are looking at and sharing an interest in the same thing at the same time. Imagine a child pointing out the window at a dog to get his mom to look at it. His mom looks at the dog and then smiles at the child to share his joy. This child has just used a proto-declarative point as a way of establishing joint attention with his mom (in other words, he used a gesture to get his mom to look at the same thing he was looking at). Typically developing toddlers do this all the time– they are constantly trying to get the attention of their parents for a wide variety of reasons.

Decreased Eye Contact

We expect children to look at their parents often. They start doing this very early on, and continue to develop their use of eye contact as they grow. By 6-12 months, we want toddlers to use what we call gaze shifts. Gaze shifts occur when children look from an object to the face of an adult (often their parent or caregiver) and then back to the object. Children use gaze shifts to share emotion with others– for example, a child might be playing with a pop-up toy, find it delightful, look at his parent and smile broadly to share his joy, and go back to playing with that toy. He’s just completed a gaze shift.

Watch the video of Baby Girl again. This time, check out how she uses gaze shifts to share her joy (and surprise) with us. She alternates between looking up at the TV where the music is coming from, looking at me sitting next to her, and peeking around me to see her brother laughing at her. In doing so, she involves each of us in her joy.

Toddlers also look at their parents’ faces for what is called social referencing. This occurs when young children are unsure of themselves and look to their parents’ faces to figure out what to do. If a child was scared of a pop-up toy, for example, he might look to his mother to see her reaction. If she was smiling, he might go back to playing, but if she looked scared, he might crawl over to her for comfort. Amazingly, even very young children use their parents’ faces to help them decide what to do. A classic and fascinating study of social-referencing involved presenting babies with a “virtual cliff” and watching how the babies’ reactions to the cliff depended on their mothers’ facial expressions. Watch the video here.

Red Flag: Young toddlers with autism are less likely to look at their parents’ faces to share emotions such as joy and less likely to check out their parents’ faces to observe the parent’s reaction in ambiguous or scary situations.

Infrequent Social Games and Bids for Attention

Typically developing young children love to play little social games such as “peek-a-boo” and “hide and seek.” They’ll also often repeat their behaviors to get their parents to laugh. Again, I’ll use the video of Baby Girl as an example–she is clearly enjoying the attention she is receiving as she responds to her brother’s laughter. As she dances some more, she peeks around to make sure he is still watching. Although she is enjoying the music, it is the reaction from her brother that is really making her smile. Her actions are, in part, attempts to get her brother to continue laughing at her.

Red flag: Children with autism are less likely to engage in social people games such as peek-a-boo and are less likely to perform for attention and laughter.

Lack of Pretend Play

By 12-18 months old, typically developing children are using objects in functional ways. This means that a child this age will use the object for its intended purpose– he might put a brush to his hair or a toothbrush to his teeth, or he might pretend to drink from a cup or feed his parent with fork. You’ll see him start to imitate housework as he uses a washcloth to wipe the table or grabs the broom to sweep the floor. Then, by 18-24 months, children engage in true pretend play. The toddler will now talk on the phone, fly airplanes, drive cars, give a drink to a baby, put the baby to sleep, and push that baby in a stroller. These pretend play episodes might be very short, but they are still important. Around 12-18 months, toddlers will also start taking an interest in other young children. Although they won’t always play with other young children, they will enjoy playing next to them.

Red Flag: Children with autism are less likely to use objects in pretend play and often do not take as much of an interest in other young children. They are also more likely to use the same type of repetitive action with a object or toy over and over (for example, opening a door and shutting it repeatedly) and to get upset if someone interrupts their repetitive play.

Decreased Response to Adults

Babies start to recognize and respond to their name as early as six months; by 12 months, they respond to their name being called consistently. They also follow an adult’s eye gaze when that adult points out something interesting across the room.

Red flag: Toddlers with autism are less likely to respond to their names when called. They’re also less likely to be able to follow an adult’s point at something across the room.

woman-holding-hand-to-head-looking-distressed

Each of the above categories lists a red flag for autism. However, (here’s another really big however), just because a young toddler has one or more of these risk factors, this does not mean he has autism. Autism is a complex diagnosis that can only be diagnosed through careful evaluation by trained professionals. What’s more, many of the above categories are very subjective– it can be really hard to know how often, for example, your child should be looking at your face to share joy. It can be easy to read into something that is really not there. It can be just as easy, though, to ignore the signs that are right in front of you. If you have any concerns, it is really worth a conversation with your pediatrician. And if you see your child in a number of the above categories, don’t hesitate to push for an evaluation by an early intervention professional. As scary as it might be (and I can only begin to imagine how scary it might feel), you will never do your child wrong by seeking help early.

Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist in Wisconsin. Her areas of specialty include child language, early intervention, autism, and developmental apraxia of speech. In her spare time, she can be found chasing her two children around, reading, and blogging about speech and language at http://www.talkingkids.org.

March 7, 2020

OUR BLOG

The link between a woman’s diet and hearing loss

As people age, many lose some of their hearing. Experts say that, of those over the age of 75, about half have hearing loss. Not being able to hear well can make it hard to communicate. That can affect relationships with loved ones, friends, and coworkers. A new study shows that there is a link between a woman’s diet and hearing loss. Specifically, women who have a pattern of healthy eating have a lower risk of hearing loss than women who don’t eat well. A healthy eating pattern includes lots of vegetables, fruits, and whole grains. It limits sugar, salt, and animal fat.

The Study Linking a Woman’s Diet and Hearing Loss

The study took place between 1991 and 2013. The women who took part in the study were all professional nurses. Every four years, the researchers asked the women to recall what they had eaten over the past year. About 71,000 women responded to the questionnaires.

The research team also asked the women whether they had noticed a hearing problem. During the study, more than 2,000 women said they had developed moderate or worse hearing loss.

The team used the reports of food intake to group the women by diet patterns. They compared women with the healthiest patterns to those with the least healthy patterns. The women with the healthiest diets were less likely to have a hearing problem.

“Interestingly, we observed that those following an overall healthy diet had a lower risk of moderate or worse hearing loss,” says researcher Dr. Sharon G. Curhan at Brigham and Women’s Hospital. “Eating well contributes to overall good health, and it may also help to reduce the risk of hearing loss.”

Source NIH: News in Health
July 2018