Should kids with central auditory processing disorder play video games?

• December 23, 2010

Q: We believe that we need to have our child tested for central auditory processing disorder. We homeschool, and even though the signs were there, we misread them (as do many other parents). We would like to make any adjustments in our home that we can or need to make to help our son. Is there any correlation between this condition and video games that I should be aware of? Should we limit our child’s time spent playing video games?
– Concerned in Norwalk, CT

A: Dear Concerned,

A central auditory processing disorder (APD) is a problem with understanding or decoding what is heard. It can occur in children with normal hearing and cognitive abilities or in kids with a variety of learning disabilities or developmental delays. Because it can vary in severity and look different in different kids, APD can easily be missed or mistaken for other issues, ranging from attention deficit disorder to behavioral problems to hearing impairment. APD is often only noticed when the child faces educational demands and has academic or behavioral difficulties. It is wonderful that you have noticed your son’s issues and are seeking professional help in sorting them out.

The cause of APD is unknown, but our best understanding at present is that it is something a child is born with rather than something that they develop. In other words, video games or other environmental influences are not to blame for causing APD. Auditory processing is a complex task: Out of the noise of a typical classroom, for example, a child must distinguish the teacher’s voice, comprehend the words that teacher is saying, and synthesize the message in those words in order to respond appropriately. However, a child with APD has difficulty isolating the critical communication from the whole of what he hears.

To understand how this feels, imagine taking a tape recorder into a lunchroom, picking out a conversation, and listening to it while recording from where you stand. You might be able to hear and understand the conversation clearly in person, but when you played back the recording later you would likely find that you couldn’t distinguish the conversation from the crowd noise. Like the microphone, the child with APD hears everything fine, but cannot resolve and respond to the important sounds of communication. Understandably, many treatments for APD try to focus on communicating critical information by simplifying a child’s audio environment, either by reducing background noise or by using electronic devices that transmit the teacher’s words to the child wearing headphones, much like a football coach communicates to his quarterback’s headset.

Since extraneous noise is distracting to a child with APD, one might think that a video game could be problematic. However, because everything in the game, including the audio, is designed to propel the game’s action forward, even the loud, seemingly chaotic sounds of some video games are actually easier for kids with APD to process than the confusing mix of ambient noises that they hear every day. Many children with APD and other learning or developmental disabilities are attracted to, and very successful in, video game environments because they are limited in scope, they focus on specific repetitive tasks, and they allow players to progress at their own speed.

However, this comfort with video games (coupled with a lesser ability to process the chaotic outer world) may result in children with APD spending more time gaming than other children—and they may be more susceptible to learning the content of the game, whether it be building a better city, racing a car, or killing zombies. That said video games can be a powerful teaching technology, even with kids who are less vulnerable than those with APD. The sort of auditory training and language-building skills that speech pathologists use to help those with APD improve their function can be adapted to an interactive electronic environment. Although I cannot speak to their quality, there are several software packages that seek to help children with APD by leveraging their engagement with media and using the capabilities of electronic environments to create a set of conditions and challenges, reward success, allow “redos” of failures, and rehearse behaviors of any kind again and again. (Discuss potential brands and uses with your child’s doctor.)

Indeed, your son may not be hurt by video game play and may, in fact, experience real accomplishment and mastery through them, a valuable gift to a child who may be struggling and feel inadequate in other realms. Consider these usage tips:

• Choose games that depict content and behaviors you wish your son to learn, because learn them he will. (See this prior Q&A about APD and violent video games.)
• Opt for games whose audio does not over-stimulate or confuse him.
• Limit his game-playing to no more than an hour at most throughout the day, so that he has the time and energy for the more challenging negotiation of the outside world.
• Observe him while he plays. If he gets upset or anxious, it is time to stop. But odds are that he might appear calmer and more in control of a video games than he is in the “offline” or real world.

Enjoy your media and use them wisely,
The Mediatrician®