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Kids on the Autism Spectrum and Auditory Processing Disorder

Do loud noises annoy and disturb your high-functioning autistic child? If so, she or he may have APD.

Auditory Processing Disorder (APD) is an umbrella term for a variety of disorders that affect the way the brain processes auditory information. It is not a sensory or inner ear hearing impairment.

Kids with APD usually have normal peripheral hearing ability. However, they cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech.

APD can affect both kids and grown-ups. Approximately 2-3% of kids and 17-20% of grown-ups have this disorder. Males are two times more likely to be affected by the disorder than females.

APD can be genetic or acquired. It may result from ear infections, head injuries or developmental delays that cause central nervous system difficulties that affect processing of auditory information. This can include problems with:
  • auditory discrimination
  • auditory pattern recognition
  • auditory performance in competing acoustic signals (including dichotic listening)
  • auditory performance with degraded acoustic signals
  • sound localization and lateralization
  • temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking

APD results from impaired neural function and is characterized by poor recognition, discrimination, separation, grouping, localization, or ordering of speech sounds. It does not solely result from a deficit in general attention, language or other cognitive processes.

As APD is one of the more difficult information processing disorders to detect and diagnose, it may sometimes be misdiagnosed as ADD/ADHD, Asperger Syndrome and other forms of Autism, but it may also be a comorbid aspect of those conditions if it is considered a significant part of the overall diagnostic picture. APD shares common symptoms in areas of overlap such that professionals unfamiliar with APD may misdiagnose it as a condition they are aware of.

Children with APD intermittently experience an inability to process verbal information. When children with APD have a processing failure; they do not process what is being said to them.

There are also many other hidden implications, which are not always apparent even to the child with the disability. For example, because children with APD are used to guessing to fill in the processing gaps, they may not even be aware that they have misunderstood something.

Characteristics—

HFA kids with Auditory Processing Disorder often:
  • have a preference for written communication (e.g. text chat)
  • dislike locations with background noise (e.g., a school lunch room)
  • have behavior problems
  • have sensitivities to loud noises
  • have difficulty with reading, comprehension, spelling, and vocabulary
  • have language difficulties (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
  • have low academic performance
  • have poor listening skills
  • have problems carrying out multi-step directions given orally
  • need to hear only one direction at a time
  • have trouble paying attention to and remembering information presented orally
  • may cope better with visually acquired information
  • having trouble paying attention and remembering information when information is simultaneously presented in multiple modalities (i.e., problems with multi-tasking)
  • need more time to process information
  • needing others to speak slowly

APD can manifest as problems determining the direction of sounds, difficulty perceiving differences between speech sounds and the sequencing of these sounds into meaningful words, confusing similar sounds such as "hat" with "bat", "there" with "where", etc. Fewer words may be perceived than were actually said, as there can be problems detecting the gaps between words, creating the sense that someone is speaking unfamiliar or nonsense words.

Those suffering from APD may have problems relating what has been said with its meaning, despite obvious recognition that a word has been said, as well as repetition of the word. Background noise, such as the sound of a radio, television or a noisy classroom can make it difficult to impossible to understand speech, depending on the severity of the auditory processing disorder. Using a cell phone can be problematic for a child with auditory processing disorder, in comparison with someone with normal auditory processing, due to low quality audio, poor signal, intermittent sounds and the chopping of words.

Many HFA kids who have auditory processing disorder subconsciously develop visual coping strategies (e.g., lip reading, reading body language and eye contact) to compensate for their auditory deficit, and these coping strategies are not available when using a cell phone

Those children who have APD tend to be quiet or shy – and even withdrawn from mainstream society due to their communication problems, and the lack of understanding of these problems by their peers.

One who fails to process any part of the communication of others may be unable to comprehend what is being communicated. This has some obvious social and educational implication, which can cause a lack of understanding from others. In grown-ups, this can lead to persistent interpersonal relationship problems.

Treatment—

Recent research has shown that practice with basic auditory processing tasks (i.e., auditory training) may improve performance on auditory processing measures and phonemic awareness measures. These auditory training benefits have also been recorded at the physiological level. Many of these tasks are incorporated into computer-based auditory training programs such as Earobics and Fast ForWord, which is adaptive software available at home and in clinics worldwide.

APD treatments include:
  • Auditory Integration Training typically involves a youngster attending two 30-minute sessions per day for ten days
  • Lindamood-Bell Learning Processes (particularly, the Visualizing and Verbalizing program)
  • Neuro-Sensory Educational Therapy
  • Physical activities (e.g., occupational therapy)
  • Sound Field Amplification

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

Kids on the Autism Spectrum & Lack of Demonstrated Empathy

“My son with high function autism is almost completely heartless when it comes to dealings with his younger sister. He’s rude and mean and sometimes aggressive with her. Is it common for a child with this disorder to have no empathy? Will this aggression become more violent over time?”

The lack of “demonstrated empathy” is possibly the most dysfunctional aspect of High-Functioning Autism (HFA). But I do use the term “demonstrated empathy” for a very important reason, and I want to be very clear about this: It’s not that these children have no empathy – they do. Rather, they often “give the impression” that they do not care about others. 
 
However, this is due to their “mind-blindness” and “sensory sensitivity” issues, and has little to do with their ability or willingness to have feelings for others.

Kids with an autism spectrum disorder experience difficulties in basic elements of social interaction, which may include the following:
  • lack of social or emotional reciprocity
  • impaired nonverbal behaviors (e.g., eye contact, facial expression, posture, gesture)
  • failure to seek shared enjoyments or achievements with others (e.g., showing others objects of interest)
  • failure to develop friendships

Unlike those with Autism level 3, youngsters with Autism level 1 (HFA) are not usually withdrawn around others. Instead, they approach others – even if awkwardly. For example, a child on the spectrum may engage in a one-sided, long-winded speech about a favorite topic, while misunderstanding or not recognizing the listener's feelings or reactions (e.g., the need for privacy or haste to leave). 
 
This social awkwardness has been called "active but odd." This failure to react appropriately to social interaction may appear as disregard for other’s feelings, and may come across as insensitive.

The cognitive ability of kids with HFA often allows them to articulate social norms in a laboratory context, where they may be able to show a theoretical understanding of other’s emotions; however, they typically have difficulty acting on this knowledge in fluid, real-life situations. 
 
Youngsters with the disorder may analyze and distill their observation of social interaction into rigid behavioral guidelines, and apply these rules in awkward ways (e.g., forced eye contact), resulting in a demeanor that appears rigid or socially naive. Also, childhood desire for companionship can become numbed through a history of failed social encounters.

RE: aggression. The hypothesis that children on the autism spectrum are predisposed to violent or criminal behavior has been investigated, but is not supported by data. More evidence suggests that kids with HFA are victims rather than victimizers. One review found that an overwhelming number of reported violent criminals with Aspergers ALSO had coexisting psychiatric disorders (e.g., schizoaffective disorder).

In a nutshell, what you’re dealing with may have more to do with good old fashion sibling rivalry than it does your son’s inability to empathize with others. But, having mind-blindness and sensory sensitivities does not give him a license to be aggressive with his sister. Aggressive behavior should be disciplined regardless of any autism-related deficits.
 
 
Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Teenagers on the Autism Spectrum and Learning to Drive

"My daughter is 18 and has ASD [level 1]. Hers is particularly with anti-social behavior and thoughts. My entire family is ridiculing me for not forcing her to get her drivers license, but she is scared and doesn't want to. Should I force her to? Am I wrong?"

RE: "Should I force her to?" No. I'm pretty sure that would backfire. When teens get their driver’s license, parents get worried. And this worry is justified! Here are the alarming national teen driving statistics:
  • 16- and 17-year-old driver death rates increase with each additional passenger.
  • 16-year-olds are 3 times more likely to die in a motor vehicle crash than the average of all drivers.
  • 16-year-olds have higher crash rates than drivers of any other age.
  • About 2 out of every 3 teenagers killed in motor vehicle crashes are males.
  • About 2,014 occupants of passenger vehicles ages 16-20 who are killed in crashes are not buckled up.
  • About 2,500 drivers between the ages of 15 and 20 die in motor vehicle crashes every year.
  • About 31% of drivers ages 15-20 who are killed in motor vehicle crashes are drinking some amount of alcohol and 25% are alcohol-impaired (i.e., have a blood alcohol content of 0.08 grams per deciliter or higher).
  • About 37% of male drivers ages 15-20 who are involved in fatal crashes are speeding at the time.
  • About 63% of teenage passenger deaths occur in vehicles driven by another teenager.
  • About 81% of teenage motor vehicle crash deaths are passenger vehicle occupants.
  • Among deaths of passengers of all ages, 19% occur when a teenager is driving.
  • Crashes involving 15- to 17-year-olds cost more than $34 billion nationwide in medical treatment, property damage and other costs.
  • Drivers age 15-20 account for 12% of all drivers involved in fatal crashes and 14% of all drivers involved in police-reported crashes.
  • Hand-held cell phone use while driving is highest among 16- to 24-year-olds.
  • Motor vehicle crashes are the leading cause of death among 15- to 20-year-olds.

Now, throw Aspergers (AS) or High-Functioning Autism (HFA) into the mix – and parents really do have something to worry about. For a teenager on the autism spectrum, it often takes quite a bit longer to learn all the implications of driving. What may be a problem for the young driver is the ability to judge what other road users, pedestrians, animals, etc. might do and how this should affect his driving. Understanding that not all drivers and other road users obey all of the rules all of the time is a real challenge for young drivers on the autism spectrum.

==> Discipline for Defiant Aspergers & High-Functioning Autistic Teens

Neurotypical (i.e., non-autistic) teens effortlessly talk on their cell phones when driving. They smoke cigarettes, eat a sandwich, sing to the radio, and nonchalantly discuss all sorts of topics with their passenger-friends. While they are doing all this multi-tasking, they also have to watch out for other cars in front of and behind them, shift gears, reverse, use the windshield wipers, brake, and so on.

However, for teens with AS and HFA to perform all the above tasks simultaneously is very difficult due their input system. When performing a task which requires concentration, most teens on the spectrum prefer total silence (or at least very little noise). They may not mind listening to a bit of music, but usually don't like someone talking to them because they have to (a) listen to what the other person is saying, (b) think of an answer, and (c) reply.

So how can parents ensure that their "special needs" teenager will not end up killing himself while on the road? Below are some critical tips to consider.

Driving Tips Specifically Related to AS and HFA—

1. Long before driving comes into the picture, be sure to help your child learn how to ride a bike. Learning to ride a bike as a youngster is a very good foundation for anyone with an autism spectrum disorder. Bike-riding skills will help the child become more aware of the possible actions of other drivers and pedestrians. Also having an instructor who is aware of the anxieties and other issues that AS and HFA teens will have goes a long way toward positive lessons where what is taught and being learned is remembered and recalled.

2. Have your teen take driving lessons with a driver education instructor, but double the amount of physical driving practice to help him really get used to reacting to normal driving situations.

3. Ask the instructor to allow your teen to take frequent breaks during driving instruction sessions.

4. Ask the instructor to use physical cues to help with estimating speed and distance. Also ask that the driving instructions be broken down into small sections.

5. Bring information that can help the driving instructor adapt strategies to help your AS or HFA teen understand better.

==> Discipline for Defiant Aspergers & High-Functioning Autistic Teens

6. Don't let your teen use computer simulation when practicing to drive. The teenager on the autism spectrum may not generalize the information well enough from computer to real life situations, plus it could confuse him.

7. Have a driving instructor assess your teen’s visual/motor skills. You want to know how easily he gets distracted.

8. Have you teen drive along familiar routes as often as possible. New routes and not knowing where they are going can easily distract and upset teens on the spectrum.

9. Have your teen continue to practice his driving skills even after he has already passed his driving test.

10. Help your teen apply for a driving license at the normal legal age, but be sure to put down Aspergers or High-Functioning Autism on the application at the DMV. It's against the law not to declare this on the application, but it won't disqualify your teen for getting a license.

11. Simulate situations in an empty parking lot that require avoidance steering, emergency breaking and distractions like loud music, water on the windshield and pedestrians until the teen driver is comfortable.

12. Teach your teen to remain calm when other drivers break the rules of the road. AS and HFA teens follow the rules of the road and the signs concretely, sometimes to a fault. Help your teen anticipate the actions of other cars by observing their behavior.

With the above information in mind, parents should be able to have some peace-of-mind knowing that their young driver with special needs will make it home safely with nothing more than an occasional fender-bender.

==> Discipline for Defiant Aspergers & High-Functioning Autistic Teens

How to Discuss Puberty with Your Preteen on the Autism Spectrum

"Our son with high-functioning autism (age 12) has never really had the 'official' discussion about what to expect in puberty. We may have waited too long at this point, but in any case, how can we approach this topic in a way that a person with his challenges can understand (he takes most things very literally by the way - and is a bit immature for his age)?"

The teenage years can be trying for kids and their moms and dads. An autism diagnosis compounds the journey and makes it more complex. Thinking about a future of surging hormones can be very scary for moms and dads. We, as parents, feel a part of ourselves back in that intense and sometimes scary world of our own adolescence. Try not to let your own fears about your youngster’s changing hormones scare him or make him feel that the change he is going through is scary or bad.

A youngster with ASD level 1 or High-Functioning Autism (HFA) can learn to cope with the trials and tribulations of puberty and the teenage years. Your son or daughter may have many questions, and it is important for parents to be tuned-in to what the teenager might be asking for. There are plenty of teachable moments in everyday life. For the conscious and aware mother or father, more often than not, kids teach us as much or more than we teach them. There is no shame in educating (or re-educating) ourselves to be equal to the task. 
 

Many changes happen around puberty, and these changes can certainly affect behavior, including in areas where your teen has already made so many strides. As with all teens, your adolescent may regress in some areas even while he continues to move forward in others. Furthermore, these changes can be unexpected and unpredictable.

HFA teens need information that matches their level of understanding. Your child needs to learn about puberty and the physical and emotional changes he may go through so that he can take some responsibility to piece together what will be happening to him.

Don't wait for your youngster to come to you with questions about his or her changing body — that day may never arrive, especially if your youngster doesn't know it is acceptable to talk to you about this sensitive topic. Ideally, as a mother or father, you've already started talking to your youngster about the changes our bodies go through as we grow.

It's important to answer questions about puberty honestly and openly — but don't always wait for your youngster to initiate a discussion. By the time children are 8 years old, they should know what physical and emotional changes are associated with puberty. That may seem young, but consider this: some females are wearing training bras by then and some males' voices begin to change just a few years later.

With females, it's vital that moms and dads talk about menstruation before they actually get their periods. If they are unaware of what's happening, females can be frightened by the sight and location of blood. Most females get their first period when they're 12 or 13 years old, which is about two or two and a half years after they begin puberty. But some get their periods as early as age 9 -- and others get it as late as age 16.
 

On average, males begin going through puberty a little later than females, usually around age 11 or 12. But they may begin to develop sexually or have their first ejaculation without looking older or developing facial hair first.

Just as it helps adults to know what to expect with changes such as moving to a new home or working for a new company, children should know about puberty beforehand.

Many children receive some sex education at school. Often, though, the lessons are segregated, and the females hear primarily about menstruation and training bras while the males hear about erections and changing voices. It's important that females learn about the changes males go through and males learn about those affecting females, so check with teachers about their lesson plans so you know what gaps need to be filled. It's a good idea to review the lessons with your youngster, because children often still have questions about certain topics.

When talking to children about puberty, it's important to offer reassurance that these changes are normal. Puberty brings about so many changes. It's easy for a youngster to feel insecure, and as if he or she is the only one experiencing these changes.

Many times, adolescents will express insecurity about their appearance as they go through puberty, but it can help them to know that everyone goes through the same things and that there's a huge amount of normal variation in their timing. Acne, mood changes, growth spurts, and hormonal changes — it's all part of growing up and everyone goes through it, but not always at the same pace.

Females may begin puberty as early as second or third grade, and it can be upsetting if your daughter is the first one to get a training bra, for example. She may feel alone and awkward or like all eyes are on her in the school locker room.

With males, observable changes include the cracking and then deepening of the voice, and the growth of facial hair. And just as with females, if your son is an early bloomer, he may feel awkward or like he's the subject of stares from his classmates.
 

Children should know the following about puberty:
  • A girl's period may last 3 days to a week, and she can use sanitary napkins (pads) or tampons to absorb the blood.
  • Both females and males have a growth spurt.
  • Both females and males often get acne and start to sweat more.
  • Males grow facial hair and their muscles get bigger.
  • Males' penises and testicles grow larger.
  • Males sometimes have wet dreams (i.e., they ejaculate in their sleep).
  • Males' voices change and become deeper.
  • Females and males get pubic hair and underarm hair, and their leg hair becomes thicker and darker.
  • Females become more rounded, especially in the hips and legs.
  • Females' breasts begin to swell and then grow, sometimes one faster than the other.
  • When a girl begins menstruating, once a month, her uterine lining fills with blood in preparation for a fertilized egg. If the egg isn't fertilized, she will have a period. If it is fertilized, she will become pregnant.

Not surprisingly, children usually have lots of questions as they learn about puberty. For you, it's important to make sure you give your youngster the time and opportunity to ask questions — and answer them as honestly and thoroughly as possible.

Let your youngster know that you're available any time to talk, but it's also important that you make time to talk. As embarrassing or difficult it may be for you to talk about these sensitive topics, your youngster will likely feel even more uncomfortable. As a parent, it's your job to try to discuss puberty — and the feelings associated with those changes — as openly as possible.

It can be made easier if you're confident that you know the subject matter. First, before you answer your youngster's questions, make sure your own questions have been answered. If you're not entirely comfortable having a conversation about puberty, practice what you want to say first or ask your youngster's doctor for advice. Let your youngster know that it may be a little uncomfortable to discuss, but it's an important talk to have.

If there are questions or concerns about pubertal development that you can't answer, a visit to your youngster's doctor may help provide reassurance.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Best Comment:

They should also be educated on the social changes. Aspies are socially and emotionally delayed producing an 9yr in an 11 or 12 yr old's body. My son became very confused when girls stopped playing with him and why boys his age didn't want to play with toys.

This is when girls and boys break into groups and say that boys/girls have 'cooties'. Some girls will have monthly mood swings, so explain to boys what's happening to the girl. (My Aspie nephew watches the calendar and stays out of his mother's way one week a month.)

It's also a time when boy have increased testosterone causing some to act as if they were in a primitive society that requires competition between males for their standing in the 'clan' (increase bullying, rule enforcers or 'tattle tales', female protectiveness, and so on.) If your son already has frequent melt downs, he'll have even more during puberty. 

Teach them early to control their anger and frustration. Explain what the bullies will do and act out situations so that your son will know what to do. If not, some Aspies, as a defense mechanism, will, after repeated bullying, become the bully. An example: my son has had to lean to ignore the bullies instead of hitting them; however, if he sees a girl or disabled kid being bullied, he becomes the protector - by hitting the bully. We are currently trying to teach him to either get a teacher or escort the victim away from the situation.

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