What is Auditory Processing Disorder? 101 Health Guide

Is someone in your family behaving differently to sound? Does it seem as if they have communication disorders? Do they seem hard of hearing to you?

Yes, that might be Auditory processing disorder or APD.

Please read this article to learn about APD, its causes, symptoms, treatment, and other detailed information.

What is Auditory Processing Disorder?

APD, or Auditory Processing Disorder, is when a person does not have normal hearing. They face trouble understanding sounds. There is an inability to discriminate, recognize, attend to, or comprehend separate sounds.

The affected person often behaves as if he has a hearing impairment, especially in the presence of background noise.

The people associated with them often complain that they respond to instructions and have trouble processing sounds. It seems as if they are ignoring or avoiding the speaker.

Evaluation of APD requires professional medical treatment, special educational planning, management strategies, auditory training, and interventions like environmental modifications and FM listening devices to overcome auditory processing difficulties.

Central Auditory Processing (CAP)

When a person is diagnosed with APD, he is said to have a malfunction in his Central Auditory Processing (CAP1)- it is the neurobiological processing in the Central Auditory Nervous System (CANS2). It is due to this reason that APD is often called Central Auditory Processing Disorder (CAPD3).

Central auditory processing disorder harms the coordination of the brain and ears. Thus, the affected person cannot fully understand what he hears the same way as others do.

CAPD is recognized as a specific learning disability under the IDEA (Individuals with Disabilities Education Act).

Signs and Symptoms of Auditory Processing Disorder (APD)

Auditory Processing Disorder - Identifying Symptoms

As per the American Academy of Audiology, the common signs of APD are as mentioned below:

  • difficulty understanding speech
  • problem hearing in noisy environments
  • difficulty in understanding spoken directions
  • a problem in distinguishing different sounds
  • prolonged cases of academic challenges at school
  • trouble understanding similar sounds
  • learning disabilities, and
  • difficulty in picking up song lyrics or rhymes.

Other less frequent symptoms include difficulties in dividing attention, comprehending spoken language, following long conversations, problem-solving, following instructions, and recognizing specific sounds.

Because these symptoms overlap with other processing disorders, they cannot confirm the presence of APD.

Assessment and Diagnosis of APD

Tips for the Differential Diagnosis of Central Auditory Processing Disorder (CAPD)

The diagnosis of APD remains a challenge for speech-language pathologists because its symptoms overlap with ADHD, learning disabilities, and speech-language disorders.

The accepted tests for diagnosing APD include Staggered Spondaic Word (SSW) Test, the SCAN Screening Test for auditory processing disorders, and the Multiple Auditory Processing Assessment (MAPA).

The prerequisites for carrying out a test for APD include the following:

  • Minimum age of 7 years.
  • Normal hearing sensitivity and
  • normal cognitive functioning.

During the evaluation for APD, a set of tests is done to confirm its presence. It is designed to diagnose, evaluate and formulate accurate intervention strategies for the person suspected of APD.

The specific group of tests depends on the person’s age and the severity of symptoms reported. Since APD is no form of hearing loss, the first set (peripheral audiological and acoustic reflex testing) is to find out when the person possesses hearing sensitivity.

The next step is to record and closely observe how the person reacts to a stimulus in the surrounding, followed by witnessing how the person responds to advanced listening tests and instructions in the classroom or at home.

The test usually takes around 2 hours, depending on the client’s age and needs, followed by preparing a detailed report. The report mentions the results, interpretation of the results and recommendations.

Thus, a multidisciplinary approach is followed with the child or adult to determine whether they suffer from APD.

Tests from the following categories of behaviours are carried out:

  1. Dichotic (different important sounds presented in both ears to see how they understand speech)
  2. Low-redundancy Monaural Speech (to test the ability to fill in the missing components of sound)
  3. Temporal Processing (to observe how well the person is with auditory discrimination)

Why do Auditory Processing Disorders Occur?

Most people believe that APD is a type of hearing loss caused due to hearing impairment. But that is so not the case. Pieces of evidence have shown that APD is generally caused by the following:

  • Lead poisoning while the fetus is in the womb or later in life after birth
  • Mental trauma
  • Chronic ear infections
  • Maternal diabetes
  • Metal exposure
  • Faulty genes (genetic history)
  • Severe complications at birth (for example, extremely long labour)
  • Head injury (Traumatic Brain Injury or TBI)
  • Hyperbilirubinemia (jaundice)
  • Stroke
  • Tumours in the brain
  • Neurological diseases
  • Surgical interventions, and
  • Meningitis

Who are at an Increased Risk of APD?

What is auditory processing disorder
By Brett Jordan/Unsplash

Fewer risk factors associated with APD have been confirmed, including low birth weight or premature birth. People with severe head injuries or seizures are at risk. APD may also be caused due to family history because it runs in genes.

People with ADHD (Attention deficit hyperactivity disorder) or dyslexia are more likely to develop APD.

People of all ages can be diagnosed with APD. It often sets in childhood, but some people show its signs and symptoms later. Studies and research have shown that boys are more likely to suffer from APD than girls.

How to treat Auditory Processing Disorder?

Currently, there is no cure for APD, but there are things that can help. Auditory training, which involves activities to improve listening and concentration, is undertaken to help children with this distinct disorder. Often, people appoint hearing specialists to help the affected people.

The treatment for central auditory processing disorder incorporates modifying the environment to eliminate background noise while talking, teaching skills as compensatory strategies for a better life, and using an electronic device to aid in listening.

APD usually starts developing in childhood or adolescence. Early detection and prolonged training can help the person improve his condition. The perfect combination of school, professional, and home therapies with a vocal pathologist is the most effective method.

Dos and Donts to support people with APD

It is extremely important to behave politely with people with special needs. We must be empathetic and try our best to cater to their needs. Following are some Dos and Donts that each of us must keep in mind:

DO’S
  • Use visual instructions to give directions or to convey any other important information.
  • Encourage assistive technology to help people with an auditory processing disorder.
  • Using speech therapy to improve reading comprehension. People with auditory processing disorder have problems differentiating sounds; working with a trained therapist can help improve their ability to make and understand sounds.
  • Gain the full attention of people with an auditory processing disorder and ensure they face you in good light.
  • Necessary repeat phrases.
  • Modify communication skills to make it easy for people with APD to understand your conversation.
  • Use shorter sentences and let them take their time to understand and process what has been said.
DON’TS
  • Avoid overlapping the speech of others during conversations, including more than one person.
  • Avoid using large sentences.
  • Avoid talking at a fast speed.
  • Avoid talking in complex sentences.
  • One should not treat people with APD disrespectfully because they are not being defiant or rude.

What can Parents do for Children with APD?

Parents of children with APD face many challenges. They must undertake a few special measures to raise their children the best way. Some are mentioned below:

  • Study and learn about auditory processing disorder APD as much as you can. Be knowledgeable about what your child goes through so that you can assist in the best way possible.
  • Be patient with your child. Repeat your sentences if they need to hear them again to understand.
  • Ensure that you encourage your child to overcome his language disorder by giving him the time to speak clearly.
  • Provide visual aids if he has a problem processing sounds presented verbally.
  • Read aloud to your child in a firm voice.
  • Ask the concerned audiologist how to enhance your child’s language skills with simple methods that can be undertaken at home.
  • Do not scold or shout at your child. It might shake his confidence. Understand that your child needs extra attention and help. Do not compare him with other children.
  • Lastly, shower him with love and make him feel you are there for him.

How can Teachers help APD-Diagnosed Children?

As per the Disabilities Education Act (formerly the Education for All Handicapped Children Act from 1975), every student with a disability has the right to be provided with a Free Appropriate Public Education, considering his special needs.

Since children spend a large part of their day in school, teachers can be of great help in helping children process auditory information better by following these tips:

  • Speak at eye level, and gain full attention.
  • Assign peer partners to students with APD. Provide preferential seating distance so the student with APD can be seated near the sound source.
  • Avoid seating near a noise source; the student must be seated away from distracting noise sources. Providing a quiet study area helps to minimize the student’s problems with background sound differentiation.
  • Speak in a clear and well-modulated voice. Speak at a loud level and at a rate the students can follow easily.
  • Use gestures to enhance the message you want to convey
  • Use modelling to provide a clear demonstration of student performance expectations.
  • Repeat the phrases you want to emphasize.
  • Ask for verbal accounts rather than a yes or a no.
  • Help in boosting the self-confidence of children with APD.
  • Avoid dividing the attention of the children with APD between listening and taking notes at the same time.
  • Allow extended time for the students to understand and process the sounds they hear.
  • Keep the windows and doors closed to reduce external noise
  • Prefer a closed classroom for students with APD to help them focus on the main speech and not get confused with the background noises. Learn more about the 7 types of learning disabilities 

Therapy for Auditory Processing Disorder

Strategies as simple as repeating the instruction and asking for clarification after speaking are the to-go for APD. Since APD-affected people tend wrongly hear words such as ‘that’ for ‘cat’ or ‘dead’ for ‘bed,’ vocal therapy can help them improve their language and reading comprehension.

Since therapists spend considerable time understanding auditory processing disorders, regular appointments with a therapist can enhance the person’s ability to make, understand, and differentiate between similar words.

Audiologists

They adopt various techniques to train the child’s brain in a quiet environment, followed by increasingly louder background noise. This helps the child overcome sound discrimination problems.

They encourage the child to develop a personal note-taking system to manage language processing issues to capture the information taught in the classrooms. They encourage the children to ask for repetitions of sounds when their peers, adults, or teachers are talking.

Speech-Language Pathologists

They target specific auditory deficits using appropriate computer-assisted software like FastForWord and Earobics4. To overcome auditory memory, the pathologist 5uses sequencing routines= making the child repeat a series of numbers to exercise the listening muscles.

The therapy’s type, intensity, and frequency are tailored according to the intensity of the auditory processing power present in the child. Thus, simple lifestyle changes can help the child hear and work better.

History of the Disorder

Helmer Myklebust pioneered APD assessment in the early stages when the disorder was diagnosed for the first time in 1954.

He and one of his students at Northwestern University, Jim Jerger, first realized that there were cases when parents would describe instances of their children as not doing good with background noise. Even then, the ways to identify this disorder were limited. But, the recognition of auditory processing disorder is traced back to the early 1950s.

Jim Jerger spent a long time studying and closely observing the children with weak auditory processing skills. The first test for APD was developed in 1970 and is continued to date.

How Common is this Disorder?

As compared to other disorders, Auditory Processing Disorder is relatively rarer. Only 3 to 4 percent of people are diagnosed with APD. This processing disorder affects 3 to 5 percent of school-aged children. They cannot hear in the same way as other kids.

Why APD is confused with ADHD

ADHD (Attention deficit hyperactivity disorder) and APD (auditory processing disorder) have a lot of similar symptoms. Thus, APD cannot be confirmed with the list of symptoms alone. Things like memorizing information and remembering it for longer times, and understanding spoken instructions often confuse APD with ADHD6.

But both are very different from one another. Children with ADHD tend to portray hyperactivity, distractibility, and inattention in any environment. While in APD, these issues are seen only in a noisy environment.

How to Prevent APD?

Auditory processing disorder can be prevented by subtle changes in how younger children are raised. Some easy yet effective ways include:

  • Covering hard floors with soft mats or rugs so that child does not hurt his head by falling
  • Limiting the use of radio, and television with infants
  • Not exposing infants to loud sounds

Frequently Asked Questions about APD (FAQs)

  1. What is an example of APD?

    Usually, the person has a hard time hearing small sound differences. For example, if someone says, “Please raise your hand,” the person might listen, “Please haze your plan.” You might say, “Look at the cows over there,” and the person might hear ‘Look at the clown on the chair.”

  2. How badly does APD affect learning?

    It negatively affects learning since it is hard for students to identify isolated sounds in the classroom. They also face difficulty in reading and spelling. However, the extent to which studies would be affected depends on APD and its treatment.

  3. How is APD similar to autism spectrum disorder?

    People with ASD usually experience various sensory processing difficulties. Auditory processing disorder is one such. People experience difficulties understanding speech with a lot of noise in the background. They find it difficult to listen to many people talking simultaneously and face problems focusing on verbal instructions.

People with APD 7also face social and communication difficulties, and these problems with an autism spectrum disorder. APDs might also be linked to other autistic characteristics, such as anxiety, inattentiveness and confusion in social and communication situations.

The Bottom Line

Often confused with a hearing disorder and other developmental disorders, APD possesses subtle differences from both. From sounds not making sense to the brain to difficulty in comprehending written instructions, APD affects the person adversely.

It stops them from leading a normal life. But, with early diagnosis, regular help, and the right compensatory strategies, one can make life easier for the person with Auditory Processing Disorder.

  1. Lillemets, Jüri, Imre Fertő, and Ants-Hannes Viira. “The socioeconomic impacts of the CAP: Systematic literature review.” Land Use Policy 114 (2022): 105968. ↩︎
  2. Podgórski, Maciej, et al. “Toward stimuli‐responsive dynamic thermosets through continuous development and improvements in covalent adaptable networks (CANs).” Advanced Materials 32.20 (2020): 1906876. ↩︎
  3. Kapela, Tomasz, et al. “CAPD:: DynSys: a flexible C++ toolbox for rigorous numerical analysis of dynamical systems.” Communications in nonlinear science and numerical simulation 101 (2021): 105578. ↩︎
  4. Rice, Marianne, et al. “Phonemic awareness: A meta‐analysis for planning effective instruction.” Reading Research Quarterly 57.4 (2022): 1259-1289. ↩︎
  5. Reisenbichler, Emily S., et al. “Prospective multi-institutional evaluation of pathologist assessment of PD-L1 assays for patient selection in triple negative breast cancer.” Modern pathology 33.9 (2020): 1746-1752. ↩︎
  6. Faraone, Stephen V., et al. “The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder.” Neuroscience & Biobehavioral Reviews 128 (2021): 789-818. ↩︎
  7. Hao, Qun, et al. “Development of pulsed‐laser three‐dimensional imaging flash lidar using APD arrays.” Microwave and Optical Technology Letters 63.10 (2021): 2492-2509. ↩︎

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