A case of auditory processing disorder or sue’s discovery of speech clarity

A Case of Auditory Processing Disorder OR Sue’s discovery of speech clarity.

Sue was caught in her own world because she could not process the sounds around her appropriately.

Auditory processing disorders are more readily acknowledged nowadays than in the past.

Only until recently, the ability to hear and the organ of the ear were the last parameters to be examined with respect to learning difficulties and speech delay. Fortunately however, now the ear has come to be appropriately viewed as a fundamental factor in the list of elements that need to be evaluated when a child presents some speech and auditory difficulties.

An Auditory Processing Disorder describes the inability to process the meaning of sounds. This condition can be present from early childhood and can lead to numerous difficulties in the development of a child confronted with oral messages and instructions that become more and more complex through his/her developmental years. An Auditory Processing Disorder is not linked to impaired hearing or hearing loss. Rather, it is more related to the inability of the child to process the sounds appropriately and the failure to process the meaning of the sounds and the oral messages. This consequently leads to a difficulty in comprehension and expressing oneself. It is a disorder linked to a dysfunction in decoding the language and can be inconsistent depending on the day, health issues, etc.

This lack of comprehension and difficulties in expressing oneself tends to isolate the child from his/her peers and his/her environment. The child “being different” may experience bullying in the school environment or even lead to being ostracized in their earlier years. The child can become so frustrated that this can result in behavioural difficulties such as aggressive outbursts, disruption in class situations, negative feelings as well as a very low self esteem. Some cases of learning difficulties, speech delay, behavioural problems and even autism can often only be appropriately labelled and treated when the main cause is linked to an early auditory processing disorder.

“Treatments designed to deal with APD have shown positive implications for these children, supporting the idea that auditory processing is central to behaviour and learning”.

In May 2004, 6 year old Sue, born in June 1998, came to me with her mother because she was suffering from Auditory Processing disorder. She needed things to be repeated to her endlessly by her mother. Consequently, her mother described her with “selective deafness” as she could spend one hour totally focused on the computer as well as on other particular activities at kindergarten, yet she could not sit still on a chair at school. She was working very hard and is very determined with a strong-will. She is the second child of two children. Her brother is 9 years old and they are like cats and dogs. Her father is a pilot and her mother works in the medical industry. Her mother is “very controlling and has a black and white type personality’ as she describes herself. Sue sleeps very well and can be a fussy eater.

Francoise Nicoloff – RCTC - Sydney – case study CAPD – IARCTC – MEXICO 07

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Her speech was very unclear; she does not say the word entirely. She said “I like “puter” better than vet” when I asked her what she wanted to do or to be when she grows up.

Here, the word computer was shortened. She can be very difficult to understand. She was assessed as suffering from Auditory Processing Disorder and word searching. She is the type of child who does not stop talking, but in fact says very little. Her speech can be very hesitant and broken. Sometimes, she uses a lot of ah ah euh euh rather than words to express herself.

Sue was born at 29 weeks by c section, showing some fetal distress after her mother started hemorrhaging. At that time, she was already at 26 weeks and Sue had stayed in hospital for more than 3 weeks. Sue was put on a ventilator for half a day and then was given oxygen for 24 hours and was diagnosed as a fine and perfect baby at a weight of 1.450 kg. She remained in hospital for 7 weeks. She then sat up at 9 months, crawled and walked at 16 months.

In regards to language, Sue was a quiet baby. She had a bad reflux and used to choke all the time. She was not chatty nor a babbler compared to other kids. Her speech developed late. Sue started preschool at 3 ½ years old and could only say 3 words together in a stream of speech. She was using a lot of one word ‘sentences’. Her speech gradually developed and a year later she could say a whole sentence.

At the age of 3 in 2001, she had a general checkup. She had a bilateral middle ear effusion; there was fluid in the middle ear but no infection. Her tympanogram was flat missing the lower sounds. No grommets were recommended. In January 2002, speech therapy was suggested and her ears were checked every three months. In July 2003, one ear was completely fine and then, the second one became fine but the tympanogram were still flat. Then Sue got a severe cold, and the hearing test showed blocked ears which took 7 weeks to clear. She has had 3 middle ear infections, followed by a cold and had ruptured her eardrums three times previously. Her last test in December 2003 showed no fluid.

Between the age of 3 and 4 ½ Sue started to show signs of frustration and a lot of anger.

This situation worsened from year to year. She would get so frustrated with her inability to express herself that she could even be aggressive towards other kids and had developed a sort of bossiness to survive.

Her gross motor skills were mixed. She has had an extraordinary sense of balance on “healeys” (American shoes with wheels) and can ride a bicycle with training wheels. She is improving in catching balls. She has some problem with coordination, but her fine motor skills have improved a lot since last year. She also does a lot of drawings and is very neat with her hand motor control.

Her mother brought her to the Tomatis Method expecting that Sue’s speech will improve and that her words will begin to flow.

Francoise Nicoloff – RCTC - Sydney – case study CAPD – IARCTC – MEXICO 07

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Her first listening test showed difficulties in processing sounds as a response of the air conduction on both ears and was very low with lots of variation within the peaks and dips. Her bone conduction on both ears was much higher than the Air conduction (AC).

For us, as Tomatis Consultants, this could indicate that there is some fluid in the ear or it may signify an immature way of processing sounds. Rather than through air conduction, she was using more of the bone conduction. Therefore, it suggests that there is either too much acidity in the body leading to fluid in the ears and to a weak hammer muscle not being able to work on the eardrum or there is too much wax in the ear canal. Moreover, Sue’s testing showed that she was strongly left ear dominant, adding to her difficulty in processing oral information.

She completed the first 30 hours of the Tomatis Program at a rhythm of 2 hours per day, for 5 days over a period of 3 weeks. She had another ear infection, which resulted in a ruptured eardrum again and was under the care of antibiotics.

However, her stages of progress stated both at home and at school were both reassessed at the end of June 2004.

Her teacher said that Sue started to hear sounds and letters better. Her writing had improved and she now finishes what she has started, which is a totally new behaviour. In class, she is putting her hand up to answer questions.

Her speech has improved in clarity, less hesitations and even her concentration has improved. She is definitively less cranky and frustrated. At her grandfather’s place, she was able to explain to her friends how to play “musical chairs”.

She came back end at the end of July 2004 for an 8-day program. Her mother commented that after the first program, Sue continued to evolve positively. Now she is not as fidgety and is more in control of herself. Her posture has improved.

After reassessing her at the end of the second program, her progress continued to increase. She went skiing during the weekend and her instructor commented on how she showed so much confidence and joy. Her speech “was so impeccable”. Sue started to be compliant, which was a big surprise to her mother. On the day of the consultation, she was even able to say to her Mum: “Britney is sick today, I am not going to have any friends” which demonstrated that she had started to be in touch with her feelings and emotions.

The teacher is seeing a big improvement in Sue’s attitude, speech, posture and work. Her speech is very articulate now.

When Sue came back to start the third program, Sue’s mum reported that the speech therapist was even impressed and said “she had not seen such a huge improvement in a child after four weeks of a break”!

Sue’s mum recognized that there was a tremendous change in Sue’s behaviour and that she was much more cooperative.

Francoise Nicoloff – RCTC - Sydney – case study CAPD – IARCTC – MEXICO 07

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However, Sue’s speech had gone off recently and I suggested doing an ear candle treatment to get the wax out. Immediately after doing it, Sue said to her mother, “Mum you speak too loudly!” The mother was so surprised. She also realized that Sue was speaking less loudly and was less noisy. Her speech immediately returned with the same clarity as before. We retested Sue the following day and her listening test was better. Sue finished her third Tomatis program in October 2004. She did 62 hours all together.

I called her Mother in January 2007 to find out how Sue was progressing. Mum said that Sue was doing very well and is starting year 3 in February 2007. Her abilities to concentrate and pay attention are very good; she reads well and is applying herself to write very neatly. She is a happy child who does not stop talking and she even loves singing in French. She saw an ENT in 2006 for an ear check up who said that Sue’s ears are totally normal with no signs of hearing loss or middle ear effusion. Mum acknowledged that the Tomatis Method made “the difference” in her daughter’s development and learning skills.

The Tomatis Method, through sound stimulation and using the appropriate technology such as the electronic ear and Tomatis earphones, is able to stimulate both air conduction and bone conduction. It involves exposing the ear to carefully monitored sound to strengthen neurological pathways and train the ear to listen more accurately. This has a direct strengthening effect on the middle ear, the inner ear, the auditory system as a whole and the Central Nervous System. This alleviates the troubles experienced through Auditory Processing Difficulties.

Françoise Nicoloff.

Director Australian Tomatis Method Psychologist Registered Certified Tomatis Consultant International Tomatis Trainer President IARCTC fnicoloff@tomatis.com.au

Francoise Nicoloff – RCTC - Sydney – case study CAPD – IARCTC – MEXICO 07

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