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ADHD, Auditory Processing Disorder or Specific Language Impairment?

Posted by Devon Barnes on July 1, 2015 at 5:48 PM

auditory processing disorderMany of the children I work with in my speech pathology clinic who have dyslexia also have additional difficulties with processing information and sustaining their attention.

They often have some or many of these challenges: 

  • Difficulty following verbal instructions
  • Need instructions to be repeated
  • Slow to process information
  • Easily overloaded with auditory information
  • Difficulty sustaining attention for learning tasks
  • A tendency to daydream
  • Easily distracted
  • Academic difficulties

These symptoms could indicate that they have one or more of the conditions known as attention deficit hyperactivity disorder (ADHD), auditory processing disorder (APD), or specific language impairment (SLI).

How do we know what is causing these difficulties? Because many symptoms of ADHD, APD & SLI overlap, it could be any of them or a combination of two or even three of these conditions.

Diagnosis

It is important to make an accurate diagnosis so that the child can receive the most appropriate, correctly targeted remediation.

The best diagnostic approach is to use a specialist assessment team which will include: 

  • Audiologist: to assess hearing acuity and carry out specific assessments of auditory processing skills 
  • Speech Pathologist: to assess oral and written language skills, phonological awareness and the functional aspects of auditory processing
  • Psychologist: to assess cognitive and academic skills
  • School Counsellor: can also assess cognitive and academic skills
  • Developmental Paediatrician: to assess attention.

Key Features of ADHD, APD & SLI

ADHD – Attention Deficit Hyperactivity Disorder

It is now recognised that there are two main forms of ADHD.

Attention Deficit Hyperactivity Disorder is mainly characterised by an inability to sustain one’s attention particularly in a learning situation. It is accompanied by impulsivity, hyperactivity and distractibility.

The second form is known as Attention Deficit Hyperactivity Disorder-Predominantly Inattentive Presentation (PIP) and is characterised by poor ability to remain focussed and “daydreaming”. Paradoxically students with this form of ADHD are not hyperactive.    

Students with ADHD commonly also have difficulties with the Executive Functions such as working memory, planning and organisation.

APD - Auditory Processing Disorder

Auditory processing is different from hearing. Our hearing acuity refers to the softest sounds we can hear across a range of frequencies. Whereas auditory processing refers to “what the brain does with what it hears”.

When a student has an auditory processing disorder they may have difficulty with the following: 

  • Auditory discrimination (the ability to distinguish one speech sound from another). This can lead to difficulties with phonemic awareness, an underlying skill necessary for competent reading and spelling
  • Listening in background noise
  • Locating the source of sound
  • Perceiving the patterns in speech which can lead to not understanding a speaker’s intention such as a compliment or sarcasm
  • Understanding a speaker who has a foreign accent
  • Processing instructions in the expected time frame (they understand the information -  it just takes longer for them to respond).

Students with auditory processing difficulties may also exhibit the following signs: 

  • Say “huh” or “what” frequently when spoken to
  • Will mishear and confuse words
  • Have a lot of difficulty hearing in background noise
  • Will drift off due to “Overload” of the auditory system
  • Have a history of recurrent ear infections or glue ear.

Auditory Processing Disorders are specific to the auditory signal and can underlie language and learning difficulties.

SLI - Specific Language Impairment 

Children with SLI are delayed and disordered in the development of their understanding (Receptive Language) and use of language (Expressive Language).

SLI is not due to cognitive deficits, sensory impairments or neurological problems.

Students with SLI can present with:

  • A history of delayed language development
  • Poor comprehension
  • Limited use of vocabulary
  • Poor grammar
  • Difficulty with sentence formulation
  • Word-finding difficulties
  • Poor pragmatic skills.

Children with language impairments can have excellent decoding skills but struggle with reading comprehension and so these difficulties can be missed in the early school years because they appear to be “good readers”.

In later years language weaknesses can negatively impact the student’s ability to cope with the learning demands of the curriculum as language underpins all learning.

They will have particular difficulty understanding grade related texts and with written language tasks such as assignments and essays.

Download Helpful strategies for children with APD   

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