Auditory Processing Disorder with Gregory Chase, Part 1

In this eye-opening episode of Keys to Music Learning, hosts Krista Jadro and Hannah Mayo welcome back Gregory Chase for an in-depth discussion on Auditory Processing Disorder (APD)—what it is, how it manifests in children and adults, and the surprising ways it can impact learning in and out of the piano studio. Greg shares his personal journey of discovery through his son’s experience, the diagnostic process, and how music, especially when grounded in Music Learning Theory (MLT), plays a pivotal role in remediation.

Educators and parents alike will gain valuable insights into spotting early signs of APD, approaching families with care, and tailoring music lessons to support neurodivergent students. Whether you're a teacher, parent, or simply curious, this episode will change the way you think about sound, learning, and the transformational power of music.

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Introduction to Audiation-based Piano Instruction and Music Moves for Piano

Ready to learn more about audiation-based piano instruction and Music Moves for Piano? Visit Music Learning Academy for online courses, webinars, and resources.

Want to dive into audiation-based piano instruction? Check out Music Moves for Piano by Marilyn Lowe.

Transcript

Krista: Welcome to Keys to Music Learning. I'm Krista Jadro of Music Learning Academy. 

Hannah: And I'm Hannah Mayo of Mayo Piano.

Krista: Join us as we discuss common goals and challenges in the piano studio and offer research-based ideas and solutions to guide every one of your students to reach their full musical potential with audiation. We would like to welcome back for a third time Gregory Chase. So welcome back, Greg.

Greg: Thanks. it's great to be here as always. 

Hannah: Today we're going to be doing a bit of a deep dive into something that is near and dear to you, and that is auditory processing disorder. And we have loads of questions about auditory processing disorder.

So, if it's okay with everybody, I'm just going to jump right in with our first question. Can you remind us and the listeners what got you interested in auditory processing disorder? 

Greg: Yeah, it's actually probably through my son and even through myself, actually, because a lot of times I think that APD is that if there is genetics that's to do with that. And as my son was going through this whole process, I thought, oh, yeah, I can relate to that.

Or, yeah, I can relate to that as well. In grade three, the teachers noticed two things with him. And that was when he was reading new material, he was exhausted afterwards. So just loads and loads of yawning. So that's something for all of us to watch for. If there's loads of yawning, and I see it in my students when we're learning new material.

And the second thing that they noticed was his spelling, or do I say his atrocious spelling that was going on there. So, they really recommended that we get visual testing done, and also auditory testing done. And so, this is much deeper than what you normally would get when you go to optometrists.

So, we did ask for a comprehensive non-refractive vision examination is what you ask for, at least in Canada, that's what you have to ask for in order to get it. And they found that, yeah, he did have two processing, visual processing disorders. One was the visual sequencing processing, and the other one was the visual processing speed.

And so, we did the remedial work through that. And that's just through a computer program that's attached to the ophthalmologist. And he kind of checks it daily, and then adjusts it accordingly.

So, it's all linked to what they have. And then we had the audiologist to do the testing for an auditory processing disorder. And she did find that there was, that he was, there was some kind of disorder there.

But what you have to do then is then you have to rule out that there's any other kind of neurodivergences in play, such as ADHD, autism. So, all of that has to be determined before you can start to the remediation process, because of the way that the remediation happens. So unfortunately, since he didn't really deem eligible for it, for the psych ed testing, which is what it is, for it to be done in school, because he's marked for average.

And so, they wouldn't bother taking a look at it. So, we had to go the private way. And so that kind of cost us about $2,500 in order to get that psych testing done.

After getting the testing done, I thought, every student needs to have this done. Because it really shows, I mean, it's their aptitude, it shows their strengths, and it shows their weaknesses. And so, it really even helped to explain in raising him some of the things that we came across as well, high in logic, you know.

And so, knowing that also kind of sometimes can cause some frustration when he's dealing with his friends and go, if they only would do it this way, it would make perfect sense. You know, so there's lots of things like that. But anyways, I'm digressing here.

So, we had the testing done for him before we could get the remediation to happen. I mean, at this time, I was already doing my master's at Buffalo. I was teaching music, Music Moves for Piano for a couple of years.

I was studying MLT, which was really my focus of the studies at Buffalo. And so, I felt that all of a sudden, all of these things started to become married to each other, you know, just with my studies and stuff that was happening. So, when the audiologist did the initial testing to determine if there was a disorder there, just through our conversation, we got talking and she heard that I teach music.

Well, and then she was just buzzing with energy after that because she was just doing studies on that, on how music really does impact the remediation, you know, of auditory processing disorder. Then in a psych class I took at one of my master courses, I did a case study and I was fortunate enough to be able to use my son as the test subject, which normally you wouldn't allow, they wouldn't allow to do. So, I was very fortunate that way because then I was able to then delve even deeper and see other aspects of this that was happening.

And then just over time, it came about that I partnered with Eastside Audiology and Rehabilitation here in Regina. So, we'd really developed a program Music For Your Brain, retraining your brain how to hear. And it really is just for that.

It's working with clients that they really couldn't use their remediation program in order to be able to help them with APD. So again, a lot of times with APD, you can only do the retraining down to about age four or five. They are doing a little bit with three-year-olds, but even testing, you can't test it fully.

So, there's still room for them to do, to go. And so, anyone who has APD at that age, they will often refer them to come to me for music sessions, and we will work with that. And again, a lot of times if there's other things in play like ADHD or autism, things like that, then again, their remediation program won't necessarily be as effective.

So again, they end up recommending them to come to me. Yeah, so that's a really fast nutshell. 

Krista: This is all really fascinating, Greg.

And we are going to talk about how music comes into this, but let's talk a little bit more about auditory processing disorder. And can you give us an overview of what it is and how it might impact individuals? You mentioned your son was tired from reading, it showed up in his spelling, but what else might kind of give it away that maybe somebody is having challenges with this? 

Greg: Yeah. So, I mean, auditory processing, APD, where it's also known as central auditory processing because it's in the brainstem.

So APD, you're going to see both of those. And so, it's really just a neurodevelopmental disorder that affects the brain's ability to process and to interpret sound. So, some of the symptoms that you're going to hear or see, and you talk to people and they say, hey, I'm like that, you know, so difficulty understanding speech and noisy environments. That's one of the big ones. 

And you'll talk to adults and they go, yeah, I always have trouble hearing people when it's noisy or if it's echoey, if you're in a hall and it's really loud and echoey, then it becomes hard. So that's one of the, we call that SIN, speech in noisy environments.

Problems following instructions. Difficulty distinguishing between similar sounds. And that, again, that's spelling. You can't necessarily hear those blended sounds in words. And so, then the spelling, they just hear it, they spell it how they hear it. And so then that's where we get the atrocious spelling. They just aren't really hearing those blended sounds that are happening. Poor listening skills. Confusion with language pattern and grammar.

I know as a child, I would often say words backwards instead of a boxcar. And I still have to think instead of a boxcar, you know, on a train, I would go carbox, you know, and I would reverse that. And so, a lot of times, too, one of the things is that we think that dyslexia is a visual.

It's actually an auditory issue. So, if you have people that are saying, yeah, I've been diagnosed with dyslexia, you really need to get the information from them. OK, what specifically, you know, and have you been tested for auditory processing? Because that's usually is where the issue lies, is that they just aren't hearing certain things.

And so, then that reflects back into what they're doing. Delayed language development in children. That's another thing, like our son didn't start speaking until after age three, you know, and everybody said, don't worry, don't worry. I mean, it'll come, it'll come. Well, and yeah, it came and now it won't stop. Yeah, he's always talking.

But I mean, seriously, though, I'd much rather that than for him to give the very typical teenage grunt, you know, that so many boys do as they do that. 

Probably the easiest way to think of auditory processing order is when we were kids, we played the telephone game where you all sit in a circle and the teacher gives the first person a secret. And that first person ends up telling the secret to the next person.

It goes all the way around the circle. Then by the time it gets to the end, what happens is that the last person will say this is what the secret was. And it's usually very different than what was actually given.

That's a really good example of how auditory processing order happens, that the first person is the ear and they hear it. The last person is the brain. And that's the information that they got. So, it's quite a process. It's divert and it's a longer way around. It's not a direct connection with that.

Other examples of this. Okay, so true confession. I watch a daily British soap opera from the UK. And so, I usually watch it as I'm having lunch. It's just a 30-minute show and it's just mindless. And maybe that's why I like it so much.

But in the UK, they actually have commercials about auditory processing disorders. And so, an example of one of the commercials is that one police officer is saying to another, I told you to go and look at the back of the house. And as the camera flips to the other policeman, it's the officer is looking under the tail of a horse.

You know, so that again, that just kind of gives you an example. The other commercial, there's three that I really like. The commercial is a paramedic is on the phone running and said, there's a lady with rabies.

And as he turns the corners, it's a lady holding babies with a couple of babies. So again, that's a really good example of auditory processing disorder. You just don't hear all those little subtle things.

And then the third commercial, there's this poor lady standing outside of the back of her house in tears and she's yelling on the phone, I said I wanted a divorce. And the camera pans back and you have this beautiful horse with a ribbon and bow on its neck. So those are just examples that can occur in everyday life with people who have APD.

Krista: And is there an overlap or do they find kids that might have ADHD or autism more prone to have auditory processing disorder? 

Greg: Yeah, there is. There is a lot, I think, of overlap.

And I think that's why, you know, with my son, she really wanted to rule out all of those things. I mean, because she just said, we have to rule them out before we can do any type of remediation so that we know what we're dealing with. So, it's not uncommon.

The fact that you have to have that done before any remediation takes place, I think shows that, yeah, there is a lot of overlap. 

Hannah: And we recently learned from you that APD affects one in five people, which I had no idea. And so, we're wondering, how does this prevalence influence the way educators approach their students? 

Greg: Yeah, probably the biggest thing would just be an awareness on the part of the teacher.

So, for an example, a teacher will stand in front of the classroom, you know, and tells the students that there's going to be show-and-tell on Friday and that they can bring something to share with the class. So, then the teacher goes ahead and tells them what is appropriate to bring, what is not, because you never know. I won't even tell you some of the things I took for show-and-tell at school.

But each child must first really, their auditory processing to acknowledge that they know what show-and-tell is and how it works. Then each child must use their auditory processing to remember that the teacher said show-and-tell was this Friday, and they have to remember what is appropriate and what is not appropriate to share with the class. And then finally, they must use their auditory process to store that information and recall or repeat the details to their parents when they come home from school.

Surprisingly, many children struggle with auditory processing on a daily basis, and they often can't recall what they need to do for homework. They can't recall the facts of the details when they get ready to do a test or an exam. So, a lot of times, you know, these are usually the students who ask the teacher, what am I supposed to do again? And you just gave them the instructions, right? They said the retention just isn't there.

Krista: Greg, I feel like that's my husband. 

Greg: I think probably a lot of wives feel that way. It's not just you.

Krista: And he has actually said, I think he read about APD somewhere, and he's like, well, I really actually wonder if I have this. You know, this is one of my challenges. 

Greg: Very well could be. I know I was never tested as a child, but I mean, I just see a lot of the symptoms, yeah. 

Krista: Yeah, so what are some of the key auditory tests that are used to diagnose this? You had mentioned in a previous email, there's auditory continuous performance tests, dichotic digits. Could you briefly kind of explain how these tests work? 

Greg: Yeah, and I think it's really important to realize that with APD, it's not just one thing, that there's multiple aspects, you know, of the hearing that are tested.

And so, there's basically four tests that they use to determine if there's an auditory processing disorder. So, the Auditory Continuous Performance Test, which you just said, the ACPT, it really tests auditory vigilance. So, what the test composes of is listening to a list of words, and then the student or the client will respond every time that targeted word was heard.

And so usually it's just a hand device that they have, and they just use their thumb. And every time they hear that, they will actually press it every time they hear that word. So, the results of this test indicated that my son was in the normal range.

So, he had 18 errors, which narrowly is within the cutoff score of 25 for a child of his age. And so, he was at age eight when this test took place. So that part was okay.

Another test that they do, the BKB Speech and Noise, or what they call SIN. And I often end up calling it sound and noise instead of speech and noise, but it is speech and noise. And so, it's really a test of figure ground in which my son is required to repeat sentences with increasing levels of background noise.

So, with this, his performance on the task was at five decibels, which was mildly in the impaired range. So, if there was background noise more than five decibels, he had a challenge to hear what those sentences are. The normal range is over 15 decibels, is the normal range of how the background noise and you would still be able to hear the conversation or what the person is saying to you.

So, the average classroom will range about six decibels. Yeah. So, he's just on, he's really on that verge, just on the edge.

And that's why she said, you know, just mildly, you know, really challenged with that. Then the Dichotic Digits is the third one. And so, it's a bimanual integration.

So really what this is, is they're kind of saying, how is the sound going in both ears? So, both ears are stimulated at the exact same time. So, the clinician will present single syllable numbers in each ear at the same time, but they're different numbers. And so, then the patient repeats as many of those numbers as they can.

So, in addition, yeah, it also tests the temporal ordering and the linguistic labeling. So, my son's performance was abnormal for this age, in both ears, but particularly in the right ear. So again, knowing that is really important.

So, in order for me to teach him, for me to sit on the right side of him is not the best, you know. So that's why having, if you know of anyone who has, who has been tested and that they are diagnosed with APD, to get these reports is huge because then you get the specifics of how you can actually work with them. Yeah.

And I did, I did say to my son, are you okay with me sharing all of this stuff? And he said, oh yeah, go ahead. And I thought, yeah, because you just don't know what's all in here. But he was good about it.

So, with a dichotic digit, that would explain some of the problems with the spelling as well. Okay. And then the scan with a Three Gap Detection Screen.

So, this is really testing the temporal resolution where my son was required to indicate whether one or two tones were heard. So, when two tones are present, there's an increased gap interval that happens. So, the sounds get closer and closer and closer together.

So, the upper limit of detection for two tones for a normal listener is 20 milliseconds. So, if they're as long as they're 20 milliseconds apart, we would hear two tones. But with my son, he required 30 millisecond gaps before detection.

So again, this would really help explain with the spelling as well, because he wouldn't necessarily hear some of those blended sounds because they almost happen on top of each other. They were just too close together. So those are really the four main tests that they do that really helps them in determining if there's an auditory processing disorder.

Hannah: So how did the results of these tests help identify APD challenges and how can that information guide educational or therapeutic approaches? 

Greg: I think probably the best thing a teacher can do, which I think I already have mentioned, is really get to know the report. Know the report. Know the specific details.

And just don't throw a big blanket over APD and just say, my student has APD. Rather, if you can get your hands on those results of the tests, that really helps you to know where to pinpoint things and what you're doing and again, what areas are below average, what areas are above average. And I think that this really will help you in knowing how to work with your student.

Krista: So, let's talk about music then. How does APD, how does it show up in a piano lesson or in a studio environment? And what specific challenges might students with APD face in the studio? 

Greg: I'll probably give more later, but I thought I'll give you three for right now, three challenges that come to my mind right away. Frustration level, lack of retention, delayed responses due to the long route or the processing that is occurring in the brain before they can actually perform the activity.

And I mean, since APD really affects the auditory decoding of language and sound, it often leads to the deterioration of behavior due to poor expressiveness and the receptive communication. So, a child who has experienced this discouragement of being misunderstood and the frustration of misunderstanding others, they can become quite disconnected from their environment. We will see them act out in frustration or we'll see behavior issues that maybe we normally wouldn't see in other students.

And it really is, it's just the high level of frustration that's happening. Another one is participation level that is being observed. You know, maybe why aren't they singing in the classroom, you know, in the music classroom or even in the Watch Please game that we do in the small group lessons? Why aren't they participating? You know, at other times that can lead to frustrations, you know, or feelings of incompetence, you know, which then again may present itself as aggression, disruptive behavior, you know, and just a cynicism about learning. I just hate piano, that sort of thing, you know, and so those will come out in that way. 

And so, when you hear comments like that, it's like, okay, but why? What's going on there? There's something undercurrent that's happening. And whether it's APD or some kind of other learning challenge that they have, yeah, it's something that we want to kind of take a look at.

I think with auditory processing, it really is the ability to hold, to sequence, and to process the auditory information. And so, it really forms the wiring between hearing and understanding. So, the ear and the brain communicate with one another.

But when this communication is cut, or when there's a small delay, or there may be background noise that interrupts or interferes with this communication, you know, the frustration, that misunderstanding, or the confusion can arise with what's happening in there. 

And so, this delayed communication between the ear, brain, and the fingers can be a source of frustration in students in regards to which notes do they play and when. 

Hannah: Could you point to any real-life examples or experiences of working with students who have APD and how this revealed itself in the lesson? You talked briefly about knowing which notes to play because of the delay between the brain and the fingers, but I'm sure there are more.

Greg: So, with children with APD deficits, it can occur by means of uncertainty in what is heard, particularly when there's that background noise, the difficulty in understanding the spoken word. So, this may help explain why students do not hear, you know, when instructions were given to them as part of the activity. So, I mean, it's not uncommon with a student with APD is that I may give them an instruction and then they'll say, what? Or play what? After I just did it.

And part of that is the delay as well, is that they need that time in order for the processing to happen. Or I've even seen it when we're doing movement activities and we switch the movement activity that we're doing. For the first half, I want you to, whether it is, you know, moving in honey.

The second half, I want you to float on clouds. Well, they'll move in honey. They'll pretend that they're moving in through honey for the entire thing.

They didn't necessarily hear that actually the instructions changed partway through. Or even if you go through it one time, do it one way, go through a song another way and get them to move in a particular way. They still go back to the first way because they didn't hear the changed instructions with it.

So, again, we will see, I've seen APD reveal itself. You know, when we talk about APD, we include deficits in sound location. So that is where the sound is coming from.

And it's rather interesting in the summer when all my family, when we're outside and we'll hear a noise. And we might say, oh, where did that come from? And I'll say, oh, well, it came from this direction. My son says it came from that direction. And my wife said, no, it came from this direction. And she's usually the one that's right. So, I mean, that sound localization is important.

Like where did the sound actually come from? You know, and so then that's all part of it. You know, that temporal process and the auditory performance and, you know, competing acoustic signals, you know. So, if your studio has lots of reverb, and I have a live studio, but I've got a carpet now, which kind of has dampened the sound, that makes a huge difference for them so that you don't get that echo that's happening.

But in a concert hall, you're going to get it. And so that will have an effect. But even this temporal processing that we talk about, I mean, I've seen it revealed in playing the tonic and dominant notes, you know, or in playing the tonic-dominant-tonic, melodic cadence.

And I had a student who played that, and he said, you know, I know it's wrong, but this is how I think of it, you know, or this is how I hear it, which just really confirms that abnormality in the temporal ordering that is happening. And again, this will be reflected in the singing of the I and V, even sometimes in the tonal patterns, you know, they'll see it in a different order. And not to say, because I mean, this is a common thing where students will get the syllables and the pitches mixed up, different things like that.

So, I'm not going to say as soon as they do that, that it means they have APD. But if it is consistent, consistently happening, there may be something that you might want to look into, you know, with that. I've also seen APD reveal itself in the mirroring and the pulsating activities that students do, that they might be behind each other in the activity, or they might be moving to a different macrobeat than everybody else, that everybody else is doing.

Again, it's that delayed activity, that delayed process that is happening with them. Playing wrong notes, you know, in the order, different things like that. So those are just some of the major ones that I often will see. 

Krista: I have questions and comments, Greg.

This is all making me think of my own family. We have some neurodivergence in my family. And I'm thinking specifically of my little guy, Nico, who you have taught in the past virtually some Music Play classes. And I just recently started piano classes with him as well. And you said about the echo in the room. My piano room right now has, we took the curtains down.

And sometimes it's a lot for him to even be in the room. And he'll go into the next room while I'm still teaching his piano partner. And it didn't really occur to me until right now that maybe that echo is just too much for him.

So, I have to, I think curtains are in my very near future to see if that helps, helps with the sound. I'm also thinking, and I know we're going to talk about this, but listening and how in our Music Moves classes from the very beginning, listening is just such an important part of our time together. Either when I'm just singing songs and they're moving and listening, or performing chants and they're listening, or I'm playing their keyboard piece and they're listening, or we're doing same and different activities, or I'm playing a piece and we're listening for whether it moves in two or whether it moves in three, and also just that informality of Keyboard Games where they're not expected to know those answers yet, but we're listening and I'm giving them the answers, or I'm saying the answers with them, just giving them so many opportunities to listen and to respond in their way.

I can only imagine that that's at least helpful for the student to start it at such a young age. I know we're going to talk about that, but I also want to ask, as a teacher, if we start to notice this in lessons, how can we approach the parents or the caregivers, or what kind of questions can we ask so that we're not being one to diagnose something, but just that we may notice something and would like to know more? 

Greg: That is always such a touchy subject, you know, how do you approach a parent? I think the biggest thing that you can do is you just tell them what you observe. I have students that I think that have APD because I see all these things happening, but they have not said anything to me, and we often will get that, and so I haven't necessarily talked to them about it.

I just know what to do, and so then I just go through the process, and even the process that I do with my APD students is often the process that I do with my other students as well, and so I think what you can do is that you just say, these are the things that I'm observing. I'm wondering if the teachers at school have mentioned anything or, you know, anything like that. I mean, you have to, and it really depends on what kind of a relationship you have, whether you can actually come right out with the parents and say that or not.

Some are very open about it, some are not. So yeah, I don't have any real solid answers for you except all you can do, go with what you know, teach with what you know, and teach the child that's before you, and then just say to the parents, you know, I've just noticed a few things, and I was just wondering if you noticed them or if teachers have said anything, so that the door is open, and hopefully it's received well, yeah. 

Krista: Yeah, and then how does the remediation process for APD align with the principles of Music Learning Theory? 

Greg: I can answer that with one word, beautifully, just absolutely beautifully. I guess that's two words. But seriously, to me, they fit like a glove, and I really want to be careful here, and I really have refrained from saying this until now, but I don't want it to come across that MLT is a form of remediation for neurodivergent children, or that it is remedial or rehabilitation approach to music, and that it should be taught only to students who have neurodivergences.

So, I want to put that disclaimer in there, because it's not true, it's for everyone, and really when we take a look at it, whether we like it or not, no matter what our critics say, MLT is really pedagogically sound, no pun intended on that, but the principles and the foundation of MLT make perfect sense in learning music, and really when you think of it, what is music? It's sound. What does auditory processing deal with? Sound. We're dealing with sound, whether it's through music or through language, and okay, I'll stop there, because I'm getting on my soapbox, but I mean, training can minimize, and in some cases can eliminate the effects of APD.

APD can't be cured. There's no cure for it, but it can be lessened, yeah, through the treatments, and I think that that's really important to remember. Neuroscientists, even though they don't fully understand the many ways that music helps the auditory processing and the other cognitive skills, they just know that it does, that music lays down this neural scaffold that happens, and it challenges the brain to look for patterns, to differentiate tones, to process multiple sounds simultaneously, while picking out the main melody.

So, I mean, children with APD, they need to distinguish the relevant sound of speech in the classroom or at home from background noise, and so based on neuroscience research, they're really engaging in music training can prime the brain for all of this. 

There's actually a longitudinal study that is done, and they found that the outcomes indicate that two years of group music training are sufficient to confer the significant benefits for speech perception and noise. It's huge, it's huge what we do and what music does, you know. 

Hannah: And was that specifically group, or could it also be individual? 

Greg: It could be individual. Two years, yeah, two years of music, yeah, totally reshapes the brain, yeah. 

Hannah: Powerful. 

Greg: It is, yeah. We don't realize, we don't realize the tool that we have and that we work with every day and the impact that it has.