Connecting APD services to tamariki in South Auckland

Audiologist Joanna Wallace was awarded a TSB GoodStuff! grant to trial a tele-audiology service to children in South Auckland suspected of having APD but unable to access specialist APD services. Resource Teachers for Learning and Behaviour (RTLBs) referred children, and acted as case coordinators and tele-audiology facilitators. Children were able to be assessed in school by an audiologist working remotely, and were connected to Ministry of Education Assistive Technology services for a remote microphone hearing aid system trial if eligible. The trial was successful and well-received.

Joanna Wallace is a specialist APD audiologist at SoundSkills APD Clinic. Karen Blackall, Education Adviser at SoundSkills, helped design the project. Thanks to Cluster 11 RTLBs Karen Eaton, David Livermore and Kieren Brand for making this project possible.

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Listen to a simulation of auditory processing disorder

Auditory processing disorder (APD) is a general term for hearing disorders in which the ears process sound normally but the hearing centres and circuits of the brain don’t always process incoming information sufficiently quickly or accurately. APD is not detected by standard hearing tests. People with APD can hear but they sometimes have trouble understanding what they hear. APD is a prevalent and under-recognised hearing problem that is a major underlying cause of learning difficulties.

To listen to an audio simulation of APD click here, or go to, and navigate to About APD/CAPD; APD in Children; How does it sound to have APD?

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Auditory processing definition disorder

Auditory processing disorder (APD) is an “umbrella” term covering a variety of central auditory processing deficits. APD is listed as a disorder in the WHO International Classification of Diseases, editions ICD10 and ICD11. However some academics promote an alternative terminology, “listening difficulties”. While less emphasis on a “disorder” label might be a good thing, “listening difficulties” unfairly suggests a lack of attention on the part of the person with APD.

In a recent international conference presentation SoundSkills audiologist Dr Bill Keith addressed controversies surrounding APD including the terminology debate. At SoundSkills we like the educational psychology and inclusive education approach of discussing strengths and weaknesses rather than “disorders” and favour a range of terminology options. We are accordingly reducing emphasis on the “disorder” term and making more use of auditory processing “weaknesses” or “difficulties”. Obviously at times the officially recognised term “APD” is necessary. As part of the conference presentation participants were polled on preferences. The majority favoured having a range of terms, but definitely not “listening difficulties”.

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Personal experiences of two adults with autism with low-gain hearing aids for auditory processing problems

Many people with autism experience auditory processing difficulties and research confirms that they benefit from the same treatments which help other people with auditory processing disorders. This personal testimony provides an illuminating insight into the experiences and benefits of hearing aid use to alleviate auditory processing difficulties.

Note: SoundSkills adheres to international protocols which require hearing aids to be fitted by an audiologist using “real ear” acoustic measurement methods to determine the actual sound levels in the user’s ears (that is, not remote hearing aid fitting by estimation and postal delivery). SoundSkills also follows research evidence in recommending accessory remote microphones with low-gain hearing aid fittings to provide enhanced audibility in situations where the background noise level or distance from the speaker are such that it is difficult for hearing aids alone to provide sufficient assistance.

Read article here

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APD features in Māori TV News item

Follow the story of seven year old Poi, whose learning difficulties were attributed by her school to her being bilingual in Te Reo and English, before she was found to have auditory processing disorder (APD). The news item discusses the prevalence of APD in Māori and Pasifika children and the lack of financial support for most children with APD. Following diagnosis, auditory and phonics training has resulted in a dramatic jump in Poi’s reading skills.

The news item can be viewed on Māori Television On Demand at the link below. It is the first item in the programme – Te Ao with Moana, Series 3, Episode 19.

A captioned version of this video is available on Facebook at this link. Go to the Settings wheel at bottom right to turn the captions on.

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Another Award for APD expert Professor Suzanne Purdy

Professor Suzanne Purdy was awarded the honour of Companion of the New Zealand Order of Merit (CNZM) in the 2021 Queen’s Birthday Honours List. The award was for “services to audiology and communication science”. This comes shortly after receiving the International Award for Hearing from the American Academy of Audiology. Dr Purdy is an internationally recognised expert on auditory processing disorder (APD) and collaborates with SoundSkills on APD research. The press release accompanying the award read as follows.

Professor Suzanne Purdy, current Head of the School of Psychology at the University of Auckland, has had a distinguished career in the field of Audiology and Communication Science.

Professor Purdy’s four decades of research have impacted diagnostic and treatment practices in the areas of cochlear implants; hearing, auditory processing and language disorders in children and adults; and communication disorders in autism. She has helped instigate novel approaches to stroke and aphasia rehabilitation including Māori-led community initiatives, choral and public speaking therapies for neurological conditions, and sensory training for mild cognitive impairment. Her electrophysiology research at the National Acoustic Laboratories in Australia resulted in the development and routine adoption of a new objective hearing test for infants with hearing loss throughout Australia and New Zealand. She has contributed substantially to the development of the Audiology and Speech-language professions nationally through two professional degree programmes at the University of Auckland. She has been involved with the governance and management of numerous community organisations relating to speech and hearing disorders, including the National Foundation for Deaf and Hard of Hearing, the Gavel Club, and the Stuttering Treatment and Research Trust. She is Deputy Co-director of the Eisdell Moore Centre for Hearing and Balance Research. Professor Purdy has chaired the International Evoked Response Audiometry Study Group since 2015.

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Congratulations Professor Suzanne Purdy

The team at SoundSkills congratulates our friend, colleague and APD research collaborator, Dr Suzanne Purdy from the University of Auckland, who has been awarded the American Academy of Audiology International Award for Hearing for 2021 to acknowledge her significant contribution to audiology internationally.

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Conferences and seminars in 2020

2020 was a promising year for participation at conferences with sessions on auditory processing disorder (APD), until a world pandemic resulted in the cancellation of most conferences internationally. Dr Bill Keith, Director of SoundSkills, was planning to report APD research findings at the Hearing Across the Lifespan (HeAL) conference in northern Italy, and the American Academy of Audiology annual conference in New Orleans, both at venues that were early Covid 19 hotspots. Both conferences were cancelled. The HeAL conference has been rescheduled for mid 2021 and the AAA 2021 Convention will be held as an online conference. An Australia-New Zealand online audiology conference was hastily arranged and Prof Suzanne Purdy and Dr Keith made a joint presentation on New Zealand APD research. Dr Keith also presented on APD at New Zealand conferences of paediatricians (live), educational psychologists (online), and Ear Nose and Throat Surgeons (live). APD teaching for audiology and speech-language students at the University of Auckland was all conducted online. SoundSkills staff conducted seminars for various groups including resource teachers for learning and behaviour (RTLBs), the Raukatauri Music Therapy Centre, and parent seminars.

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Treating auditory processing difficulties in children with autism spectrum disorder (ASD)

Children with autism spectrum disorder (ASD) frequently also have auditory processing difficulties which affect their ability to hear and communicate especially in difficult listening situations such as when there is other conversation or noise going on. The auditory processing difficulties may also affect ability to hear prosody in speech, that is the changes in tone and emphasis that add meaning to spoken language and help us distinguish the emotion associated with a statement and whether or not it is a question or is spoken with humour. Complex auditory environments are stressful for children with ASD as they are also for many children with APD. SoundSkills is participating in a project with APD and ASD experts at the University of North Texas and the University of Melbourne to diagnose and treat auditory processing deficits in children with ASD. The project is supported by hearing instrument company Sonova.

Research at the University of Melbourne has shown that wearing remote microphone hearing aid systems in class reduces listening stress for children with ASD. Research at the University of North Texas has shown that children with ASD benefit from auditory training and the use of remote microphone hearing aid systems. Research by Dr Joan Leung at the University of Auckland has shown that children with ASD can improve their understanding of prosody with training, and that this training progresses faster if they wear remote microphone hearing aid systems. All this research shows that many children with ASD can be helped to hear and communicate better.

Dr Leung is also the ASD Adviser on the staff of SoundSkills and has been working with SoundSkills clinicians to develop their skills and protocols for working with children with ASD, and diagnosing and treating their auditory processing difficulties.

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Current APD research at SoundSkills and the University of Auckland

Data analysis for five research projects funded by the William Demant (previously Oticon) Foundation and carried out by SoundSkills and the University of Auckland has been completed and writing up the results for publication in scientific journals has begun. The projects investigated:

  • actual and optimal duration of use of remote microphone hearing aid systems by children with APD
  • actual and preferred listening levels of remote microphone hearing aid systems by children with APD
  • the effects of different levels of loudness on auditory memory, the auditory brainstem response and speech perception in quiet by children with APD
  • quantification of degree of disability for APD
  • phonological perception training for children with APD both with and without remote microphone hearing aid systems

A project currently in progress is examining whether it is possible to correct amblyaudia, suppression of input from one ear by the brain in difficult listening situations (the auditory equivalent of ‘lazy’ eye), by gradually varying the loudness difference between the weak ear and strong ear over a matter of weeks in children with APD wearing remote microphone hearing aid systems. Professor Suzanne Purdy at the University of Auckland has a number of APD research projects underway including measuring brain function in children with APD using functional magnetic resonance imaging (fMRI), and benefits of auditory training for older adults with mild cognitive impairment. Auditory neuroscience colleagues in the Eisdell Moore Hearing and Balance Research Centre are measuring electrical brain responses to sounds in mice with autism traits to better understand the effects of autism on the central auditory nervous system of the brain.

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SoundSkills will soon be merging with Family Hearing Clinic on the 15th of July, located on 371 Manukau Road, Epsom. Visit our website here.