By Dr. Leah Light Au.D.

Amblyaudia, also called an auditory Integration Deficit, relates to weak connections between the hearing reception center in the brain and other related sensory areas (most notably, vision). Deficits are often due to weak interhemispheric integration (between the two hemispheres). Children with auditory integration deficits may have trouble processing rapid, connected speech discourse because it takes longer for them to “digest” what has been said due to the inefficient ability to use both sides of the brain together or to connect hearing to other input-output modalities.

Receptive and expressive language skills may be deficient, including symbolic, syntactic, and semantic skills.  Pragmatic skills and ability to communicate effectively with peers may be affected by difficulty associating verbal (words) and non-verbal (tone of voice, facial expressions) speech cues, often resulting in behavioral outbursts or withdrawal. Most significant is their difficulty understanding parts-to-whole concepts, recognizing patterns, or organizing pieces of information into a gestalt. In other words, children with auditory integration deficits have trouble “seeing the larger picture.” Instead, they may get stuck focusing on irrelevant details.

Reading and spelling deficiencies are commonly experienced due to difficulties with sensory integration and sequential thought processes. In the classroom, the child with an auditory integration deficit may take a “wait and see” approach, watching what other students are doing before beginning tasks. They have difficulty knowing “how to do” what is required and often need additional time for completing assignments. In many cases, they must be shown a task repeatedly until “it sticks,” or they will need to be taught an alternative way to get the job done.

As task demands increase, children with Amblyaudia become less able to tolerate distractions, especially if they must expend more effort trying the “figure out” what comes next. Although their processing skills are considerably slower than most, children with auditory integration issues may be able to come up with the correct answer if given extra time to respond.Reading and listening comprehension may be difficult for these kids, especially when asked to recall specific details mentioned such as “who,” “what,” “where,” “when,” and “why.” Children with Amblyaudia are sometimes described as being lazy or inattentive and characteristically respond to questions by saying “I don’t get it” or “I don’t know how.” They are often overly concerned with time and amount, asking “what time is it?” or“how much longer?” or “How many more?”. Despite this preoccupation, they frequently have difficulty learning math concepts relating to time, space, money, and amount. In addition, they may have been diagnosed as ADHD – Primarily Inattentive Type.

Intervention strategies for auditory integration deficiencies should include giving simple, well-paced messages that do not “overload” the child in terms of linguistic length or complexity. In the classroom, these children can benefit from an experiential, well-structured, “hands-on” learning environment. A highly animated, creative teacher with a melodic voice, and one who uses ample demonstration and examples, is a good choice for this type of child. This allows the child to maximize their access to prosodic features of speech (which may need to be learned) and provides the “how-to” instruction and practice that these children need. A multi-sensory environment replete with visual, tactile, or other sensory enhancements will be effective but only if concrete examples and repeated modeling of the desired response are provided. Simply adding extra cues will be of little value to the child with an integration problem unless he is shown “how to” use those cues. If presented simultaneously, auditory-visual cues must “match” or confusion will result in conflicting sensory messages. An alternative is to present information in a sequential manner, one modality at a time (e.g. tell the child the instructions, then show the child what to do; listen then look as opposed to listen and look). These children must know the task demands “up front” so that they will not be “overwhelmed” by the demands later on.

Remediation techniques to improve the interhemispheric transfer of functions include musical instrument training, singing, dancing, and linguistic labeling of tactile stimuli (e.g. “reach into this bag and describe what you feel inside”). “Simon Says” and “Mother May I” strengthen both integration and the ability to listen for and extract key information from a complex message.  Another task that teaches extraction of keywords or information from a complex message would be to have the child identify the “who,” “what,” “when,” or “where” from a story, newspaper, or magazine article. Other direction following games or activities that require action in a specified pattern can be useful (e.g. “Simon” toy, “Bopit,” “Brain Warp,” karate, gymnastics, cheerleading, baton) for improvement of both transfer of function and pattern recognition skills.  Even cooking according to a recipe or doing common household chores that have a specific order, can serve to enhance pattern recognition and temporal ordering skills. Activities that start with a “whole” and then teach “parts-to-whole” may also be useful for these children (e.g. working a jigsaw puzzle, building a model airplane, re-telling a story).  The use of visualization techniques to teach the child how to create mental images of stories, facts, or other spoken information is essential.

Direct intervention for Amblyaudiais provided through programs such as DIID (Dichotic Interaural Intensity Differences), ARIA (Auditory Rehabilitation for Interaural Asymmetry), and CAPDOTS, all of which are provided at Brainchild Institute. For more information, please contact us at 954-987-8887.