Listening difficulties in children: Bottom-up and top-down contributions

The brain mechanisms of hearing include large regions of the anterior temporal, prefrontal, and inferior parietal cortex, and an extensive network of descending connections between the cortex and sub-cortical components of what is presently known as the auditory system. One important function of these additional (‘top-down’) mechanisms for hearing is to modulate the ascending, sensory (‘bottom-up’) auditory information from the ear. In children, normal, immature hearing during the first decade of life is more strongly influenced by top-down mechanisms than in adulthood. In some children, impaired top-down function presents a significant challenge to their auditory perception, often associated with a range of language and learning difficulties and sometimes called auditory processing disorder.Learning outcomes: Readers will be able to (a) discuss the difference between and integration of auditory information in the ascending, descending, and cortical auditory centres, (b) state alternate interpretations of normal maturation of human hearing in typical children, (c) explain how sensory and cognitive contributions to auditory temporal and spectral processing may be teased apart, (d) discuss how listening difficulties may be assessed in children, and (e) critically assess whether APD is really an auditory problem or may be symptomatic of a broader neurodevelopmental disorder.