Auditory Processing Disorder

What is an Auditory Processing Disorder?

Auditory Processing Disorder (APD) is a disorder of the auditory (hearing) system that causes a disruption in the way that an individual’s brain understands what they are hearing. It is not a form of hearing loss, despite showing difficulty with hearing-related tasks.

Auditory Processing Disorder is a disorder of the auditory system at the level of the brain, in an area called the auditory cortex.

Auditory Processing Disorder, also referred to as Central Auditory Processing Disorder (CAPD), can occur in both children and adults. It can only be tested for and diagnosed by an audiologist.

What are the Signs and Symptoms?

Signs and symptoms of Auditory Processing Disorder vary from person to person.  Many of these symptoms can often be associated with other commonly known disorders, such as ADD/ADHD, Autism Spectrum Disorder and speech and/or language disorders.   A child with APD often appears to have a combination of many symptoms.

Some of the most frequently reported symptoms of APD include:

  • Significant difficulty understanding speech, especially in the presence of background noise
  • Difficulty following multi-step directions that are presented verbally, without visual cues
  • Easily distracted by loud or spontaneous (sudden) sounds
  • Difficulty attending to long lectures or other long periods of listening
  • Difficulty remembering and/or effectively summarizing information presented verbally
  • Difficulty reading, spelling, and/or writing when compared to their peers (performs consistently below grade level)
  • Trouble following abstract thoughts or ideas
  • Delayed or misunderstanding of jokes, idioms, and figurative language

How is it Treated?

Auditory Processing Disorder is relatively rare – with only about 3-4 percent of the population truly having APD – and is not always fully understood.

Currently, APD is recognized as a “specific learning disability” under the Individuals with Disabilities Education Act (IDEA).  This qualifies a student for reasonable services and accommodations at school if they have been diagnosed with APD by an audiologist.

Following a diagnosis of APD, a customized list of recommendations to best help the child succeed is created by the audiologist and provided to the child’s family and school for consideration.  Each child and diagnosis is different, so careful attention is taken to ensure that the child’s individual needs are met appropriately. 

Some examples of recommendations include:

  • Specific and strategic seating arrangements in class
  • A device to help raise the level of the teachers voice above the classroom noise, called an FM system
  • Written or picture-based instructions to accompany verbally presented instructions
  • Specific focus on auditory processing skills in a therapy setting

Can it be Cured?

The areas of the brain responsible for auditory processing abilities continue to grow and develop throughout childhood until around age 13, when the auditory system is considered to be more mature and adult-like.

Due to this gradual maturation, it is possible that a child who was diagnosed with APD before age 13 could essentially “grow out” of APD.  Additionally, a child’s auditory processing skills may also improve if he or she is receiving therapy for APD.

For these reasons, it is recommended that children diagnosed with APD before age 13 be re-tested every 1-2 years until after their 13th birthday to monitor for any changes or improvements with their auditory processing skills.

How is it Tested?

Often times a child is identified by their parent or school teacher with concerns for auditory processing difficulties, and a referral to audiology can be placed by the child’s pediatrician to begin the evaluation process.  Once the referral is received, a team of audiologists carefully collect and review information about the child to determine if the child meets the requirements for testing.

Due to the complexity of APD, there are several factors that are REQUIRED for a child to be eligible for testing.

A child must:

  • Be at least 7 years old
  • Have normal hearing, normal speech and language skills
  • Have normal (or at least near-normal) intelligence

In addition, there are some co-occurring conditions that prevent a child from qualifying for testing. 

Common reasons that a child may not be eligible for APD testing include:

  • Autism Spectrum Disorder
  • Down Syndrome
  • Developmental delay/disorder
  • Intellectual disability or below average IQ
  • Significant speech/language disorders, such as apraxia of speech, stuttering, etc.
  • Hearing loss of any degree or type

Because of the similarities of APD with other disorders, determining if a child is eligible for testing requires a very comprehensive review of the child’s past medical, educational, and developmental history.  Testing for APD requires a child to participate in several listening tests that assess different areas of the auditory system.  This testing can last for up to two hours, and requires a significant amount of attention and effort from the child.  The results of each test are compiled and reviewed to determine if a diagnosis of APD is appropriate.