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Through many years of work in the field of communication disorders, I have spent time with children with learning problems, autism and a variety of speech and language disorders. I have been very interested to follow some common threads that weave through these seemingly dissimilar problems.

One such common field is that of poor pragmatic skills, the "social skills" aspect of communication. These children almost without fail seem to have difficulty with everyday social tasks that some so easily to other; skills such as turn-taking, give-and-take, topic control or not switching topics at the wrong moment, how to repair a misunderstanding or miscommunication.... and many more. As children develop, these skills are employed with increasing ease. But these are tasks that often never reach a competence level in the child with SLD, Autism, or a language deficit.

This lack is what causes these children to be labelled "immature" in reports. A "normal" child will make rapid progress in this area, and learn socially acceptable ways. But the learning and language-challenged child commonly does not acquire these skills as expected, so he seems to lag behind socially - hence the label "immature". As far as the child with autism, a serious deficiency in social skills of the most basic kind is one of the distinctive characteristics of this disorder, so severely that the observer may conclude that this person lacks interest in social interaction. This conclusion may in fact be false since people with autism who have been able to tell of their experience say that they do want to be part of society as much as anyone, but seem not to be able to make the "moves" or to "crack the code".

Another common thread is that of hearing problems: an informal survey reveals that around 90% of children with specific learning disabilities (SLD) have a history of repeated otitis media, or of constant upper respiratory tract problems (asthma, allergies, constant colds, etc.). It is interesting that the same percentage of children with autism have the same kind of ear-history. Medical opinion is somewhat divided about the significance of hearing problems in the histories of these children. This is largely due to the definition of the terms used in research projects on this topic, especially "hearing within normal limits".

Audiologists test hearing to determine the presence of hearing loss, or deafness. Degree of hearing loss is expressed in percentages, or as decibels (dB). Normal hearing is around 0dB, but audiologists allow for a loss of acuity of up to 25dB as being "hearing within normal limits". A number greater than that would signify a mild hearing loss, then a moderate loss. A profound loss means being almost totally unresponsive to sound.

But it must be point out that "hearing within normal limits" does not necessarily mean hearing at all: when you put your fingers into your ears to block our sound, you may be losing as little as 15dB. But this is still regarded as being within normal limits!!! It is well recognised that the implication for an adult to have this kind of hearing loss is not the same as for a young child: the young child is still learning about his auditory environment. He must still make connections, learn to listen, acquire skills that are best done through the ears, and for this he needs an intact hearing mechanism that will deliver all the auditory information for processing: ....... clearly, and without distortions.

It is standard practice to test the hearing of speech, language, and learning disordered children to see whether their is some hearing loss (that is greater that 25 dB). In most cases, none is found. So it is assumed that hearing is normal. Not so!! What is present is called an Auditory Processing Disorder, the child has difficulty following directions, forgets what he was told, has a poor auditory memory span, has trouble with spelling, struggles with his phonics, learns poorly though the auditory channel and may show evidence of slow auditory processing.

It is as if the ear receives the auditory information, but some interference disturbs the proper harmonious, decoding process that should lead to understanding, and so comprehension of the message is poor. If the hearing system does not perform its task efficiently, if the message is received with distortions in it, the meaning will be lost in places, and the child has to work very hard to fill in the gaps. After a short while such effect becomes tiring, and he may give up and let his thoughts wander. From time to time a call from the teacher may re-engage him, but the same difficulty is repeated and he will again lose concentration. In the classroom situation this child will be accused of day dreaming, or of having a problem with concentration. The child has not idea that everyone else hears differently from himself - all he sees is that they are coping better that he is and discouragement grows, with frustration leading to bad behaviour and he becomes disruptive in class or on the playground.

A problem with auditory processing may occur at any point along the pathway to the brain, even in the way the ear prepares itself to receive the sound, i.e. attention to the signal, or in the way the nerve cells respond to the stimulation by sound waves. The system may be so dysfunctional that an ordinary signal elicits an extraordinary response: - an ordinary sound that doesn't bother anyone may cause this person acute discomfort. This condition is called hyper-acusis. Research has revealed that about 40% of autistic people suffer from hyper-acusis and that many learning disable children suffer from the same problem.

Up to now, professional in the field of hearing, speech, and learning have known of the existence of this disorder in auditory processing/listening skills, but there hasn't been very much we could do about them. Open any textbook on learning problems, and there will be many chapters on how to remediate visual problems, but there's not much for auditory problems other than to speak more loudly and clearly, and also tips on classroom management. Various activities to remediate are usually based on using the stronger visual channel to support the weak auditory one.

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