Sometime ago a delightful nine year old boy, I shall call Sam, came to see me with his mother, with a very specific set of issues that Sam was very aware of and concerned about.
Sam could not work out why he found it so hard to remember multiple verbal instructions and why he could not pronounce certain single speech sounds and blends very well. He found being around noise really stressful to the point that he had left the music room and sat in the corridor at school, because the noise to him was overwhelming. In the classroom he had moved to another table for the same reason on many occasions. He also felt he could not hear certain sounds either close to or from a distance. My initial thought was that this sort of hypersensitivity to sound can be associated with sensory neural deafness, which would also account for his hearing difficulty related to certain sounds. But Sam had passed a hearing test when he was four years old and he did not have a family history of progressive hearing loss and he had not had a bout of ear infections or illnesses over the following years that would trigger, this response.
The assessment results showed that Sam had above average numeracy skills and conversely below average phonological processing skills results, echoing Sam’s description of his difficulties. Sam’s spelling skill and untimed word reading skill were almost inevitably at the low average level. He had an above average expressive and receptive vocabulary, and this supported his reading in context which was at the mid-average level. Sam had secure attention
and concentration skill overall, but he had real difficulty reversing a list of letters dictated to him, he simply could not recall the letters well enough to re-order them. The ‘Object Recall’ sub test in the ‘Test of Memory and Learning 2’ Verbal Memory Index, also produced a below average result. The test required Sam to recall in sequential order the names of a set of objects. Images of the objects were displayed to Sam as they were named. This task disturbs the ease of recall of individuals with learning difficulty as the mixed visual to verbal cue, interferes with their recall as opposed to supporting it.
Sam had a history of speech and language difficulty, he found it hard to pronounce certain speech sounds and he wrote at a slow rate and he achieved a low average result for the ‘Beery Visual Motor Integration Test V1’, which is a test which assesses the individual’s ability to draw shapes. All this pointed towards Sam having fine motor dyspraxia, which also affects formation of speech, as it is in part a muscular process and Sam had said, ‘I know what I want
to say I just can’t get it out of my mouth.’
So what to do?
My recommendations included: Sam having support directed at developing his discrimination of letter sounds, using multi-sensory learning techniques, which would simultaneously develop his spelling, reading and continuous writing skill. To experiment with using ergonomic pencils and pens. To visit the local speech and language team for re-assessment and to have his hearing re-assessed across all the frequencies required to hear speech sounds both with and without background noise.
I was pleased to see an email in my inbox from Sam’s mother recently. She told me that Sam’s hearing assessment had due to her persistence, led to him being referred to a specialist audio-neurologist in London. Sam has as a result been diagnosed as having ‘auditory processing disorder’. This explains Sam’s hyper sensitivity to noise. Sam is not deaf as such, his difficulty is that his neural processing of sounds he has heard, is underdeveloped. Fortunately, our
auditory processing skills gradually develop until we are around fifteen years old. With the right support Sam can gradually develop his discrimination of speech sounds and his ability to distinguish general sounds and this will help him to cope with noisy situations and to feel less assaulted by sound. One relatively simple but useful intervention which can help students at school is the teacher’s voice can be amplified through a microphone connected to a headset worn by the student, this cuts out any extraneous distracting noise. Each child has their own pattern of need and so must be assessed by a specialist at an auditory processing clinic such as the one at Great Ormond Street Hospital in London. They take NHS referrals and will also see children privately.