What is Auditory Processing Disorder?

Auditory processing disorder (APD), a neurological condition also known as central auditory processing disorder (CAPD), affects the brain’s ability to process auditory input, making it difficult to understand speech, follow oral instructions, or distinguish speech in noisy environments.  APD can affect the functions to refine, analyze, modify, organize information that our ears send to the brain.  More specifically, these functions include:

  • Discriminating Auditory Stimuli (telling different sounds apart)
  • Temporal Processing (deciphering gaps and rates of speech appropriately)
  • Binaural Processing (separating and integrating different signals from each ear at the same time)
  • Sound Localization (telling where a sound is coming from)
  • Understanding speech with background noise or when the speech signal is not clear.

The disorder can affect anyone but is estimated to appear in as many as 5 to 7 percent of school-age children, according to the Auditory Processing Disorder Foundation, with boys diagnosed twice as often as girls.

What are risk factors for Auditory Processing Disorder?

While a specific cause of Auditory Processing Disorder is unknown, research has suggested that Auditory Processing deficits have been linked to the following:

  • Frequent ear infections as an infant or child
  • Premature birth or low birth weight
  • Head injury in infancy or Traumatic Brain Injury (TBI) occurring at any age.
  • Lead poisoning
  • Seizure disorders

Girl reading with teacher

What are signs and symptoms for Auditory Processing Disorder?

In essence, APD is a learning and social-communication disability, not a hearing problem. In patients with APD, hearing thresholds are often normal, but the central nervous system has trouble processing what is being heard. Symptoms typically appear at a young age and can range from mild to severe.  Signs and symptoms can present themselves differently, depending on age.  These may include:

  • Reports of not hearing well, despite being diagnosed with normal hearing.
  • Difficulty following a series of directions (for example, when using “first”, “next”, “afterwards”, etc.)
  • Frequent requests for repetition or rephrasing of instructions.
  • Difficulty understanding intonation of speech (for example, understanding sarcasm, idioms, or jokes).
  • Difficulty learning new languages.
  • Weakness in auditory comprehension
  • Difficulty using multiple modalities at once (for example, listening to a lecture while taking notes)
  • Decreased ability to be attentive while listening vs. using visual information.
  • Increased troubles when speech is distorted, muffled, or quick.

Diagnosing APD:  A Gray Area

Though APD awareness has increased in recent years, confusion about the disorder abounds. It can appear simultaneously with conditions such as attention deficit/hyperactivity disorder, learning disabilities, or language impairment.  It is therefore important that those with APD symptoms get evaluated by a provider for proper diagnosis.

Group of children laying in grass

What can I expect during an Auditory Processing evaluation for myself or my child?

To accurately evaluate for Auditory Processing, the following must be ensured prior to the APD appointment:

  • English must be a primary language (this removes any possibility of a language barrier affecting test results).
  • Cognition must be intact to fully understand test tasks.
  • A hearing loss must be ruled out prior to APD testing to ensure this is not the underlying cause of reported difficulties. A hearing test must be completed within six months of the APD testing date.
  • Speech must be well understood, as testing requires verbal responses.

Before You Arrive….

Your appointment will be confirmed 24 hours prior to the evaluation date.  If a hearing test has not been completed within 6 months of the APD evaluation appointment, this will need to be scheduled.  An Audiologist will review any records if the test was completed at another facility to ensure it meets our standards.  Additionally, a Pre-Appointment Questionnaire will be e-mailed to complete prior to the appointment.  This may include questions about medical history, communication concerns, and symptoms that are experienced.

Evaluation Appointment:

At the evaluation appointment, the Audiologist will go over the questionnaire results and ask any other specific questions that will serve for the purpose of testing.  The ears will be examined for ear wax or abrasions.  Testing conducted for Auditory Processing will include:

  • Auditory Figure-Ground: During this test, you will be asked to listen to words and repeat them while hearing people talking in the background.  At times, the people talking will be the same level or louder than the words to repeat.  This test looks at your ability to understand speech in background noise.
  • Auditory Closure: With these tests, degraded speech through filters and at different rates of speech will be presented.  You will be asked to repeat what you hear and “fill in the gaps”. This test assesses the ability to understand words and sentences when they are not completely clear.
  • Dichotic LIstening: Dichotic tests present two different sources of speech or non-speech stimuli to the right and left ear at the same time.  At times this testing will be words, numbers, or sentences.  At times you will be asked to repeat what you hear in both ears; other times, you will be asked to focus on only one ear you are told.  These tests look at the ability to understand competing speech that occurs at the same time or to decipher what side speech is coming from, which is important for sound localization.
  • Temporal Processing: Tests for temporal processing include telling differences between pitch or gaps in stimuli that are presented.  This assesses the ability to recognize different speech sounds, pitch and intonation, as well as understanding idioms, sarcasm, or inferring indirect meaning.

A typical APD evaluation will take 1.5 to 2 hours, depending on specific needs for each patient.

Please note:  A second appointment time may be necessary to complete testing, should the allotted time not be enough for a specific patient’s needs.

Follow-Up Appointment:

The Audiologist will work with you and your family to ensure a follow-up appointment is scheduled to review results and recommendations.  Test results will not be discussed at the initial appointment, due to standardized calculations and interpretation needing to be completed prior to result discussion.  The follow-up appointment may be scheduled in person or over the phone and is usually done one week after the appointment.  This appointment will last approximately 45 minutes.

What is the treatment for an Auditory Processing Disorder?

Management and help with APD vary and are individually tailored to meet the patient’s needs.  Just as every person is different, so are the treatments for APD. What may work for one person may not be the most effective approach for another.  With management, we strive to reduce functional weaknesses and maximize ability to perform across multiple environments, such as work, home, and the classroom.

Typically, APD management or treatment involves one or more of the following approaches:

  • Changing the physical environment to assist with overcoming barriers that prevent full understanding.
  • Using amplification devices or FM systems to help improve the auditory signal
  • Strengthening language abilities, memory, concentration, differentiation between sounds, and other skills to help directly address weaknesses found in the APD evaluation
  • APD management may also require a multidisciplinary approach. Speech-Language Pathologists, Audiologists, Tutors, and other necessary professionals may work together to formulate a plan to ensure the best possible outcome.

Support and Resources for Auditory Processing Disorder

For Children

 Understanding Auditory Processing Disorders in Children– by Teri James Bellis, PhD, CCC-A

Central Auditory Processing Disorder: An Overview– By Donna Geffner, Ph.D, and Eve Kessler, Esq.

Auditory Processing Disorder: Understanding the ABCs of APD– Rebecca Lewis, AuD, CCC-A

For Adults

Obuchi C, Ogane S, Sato Y, Kaga K. Auditory symptoms and psychological characteristics in adults with auditory processing disordersJ Otol. 2017;12(3):132-137. doi:10.1016/j.joto.2017.05.001

Practice Guidance An overview of current management of auditory processing disorder (APD)- British Society of Audiology. (2011). Bathgate (United Kingdom): British Society of Audiology, 1-68.

Downloads

Pediatric APD Signs and Symptoms Checklist
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APD Tips for Parents
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APD Tips for Teacher
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Concerned your child may have APD?

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