Working Memory and Auditory Processing

When attention deficit disorder or attention deficit hyperactivity disorder has been identified, concomitant problems with phonologic or auditory processing when hearing tests are normal can lead to serious deficiencies in learning that will persist into adulthood.

In my experience, these often are comorbid and can both mask and magnify each other. Attention deficits can mimic phonologic or auditory processing impairments because deconstructing words for meaning and developing meaning out of the context of the usage of the word both require attention and working memory. Conversely, the inability to perceive phonemic or auditory information produces functional limitations with learning that occur in the context of increasing levels of anxiety in the child, causing frustration that appears to the casual observer to be hyperactivity or distraction that is a strategy the child employs to minimize his or her frustration.

Fortunately, once appropriately identified both of these types of impairment can be relatively easily improved through integrated treatment. Optimally, this can be done at home over summer vacation under the direction of a team involving the parent, speech/language therapist, reading resource teacher, and pediatrician. Before summer vacation starts, the pediatrician can work with the parent to provide to the child a brief introduction to ADD/ADHD medications, identifying the optimal medication, dosage, and timing.

Baseline testing using sophisticated measures by the reading resource teacher and speech language therapist should be obtained under the optimal medication regimen. During summer vacation, the medication regimen can be used with daily computer-based drills at the child’s home using software such as that provided by Posit Science and Lumosity, under the direction of the speech language therapist, no more than one hour each day. As the child moves towards competence with auditory processing, recreational reading is introduced with a meaningful reinforcement schedule involving another hour each day.

Near the end of summer vacation, the speech/language therapist and reading resource teacher should retest the child under the medication regimen and one week later without the medication. Using this information, an appropriate strategy for the new school year can be determined for the child.