People with auditory processing disorder (APD) have a hard time hearing small sound differences in words. Someone says, “Please raise your hand,” and you hear something like “Please haze your plan.” You tell your child, “Look at the cows over there,” and they may hear, “Look at the clown on the chair.”
APD, also known as central auditory processing disorder, isn’t hearing loss or a learning disorder. It means your brain doesn’t “hear” sounds in the usual way. It’s not a problem with understanding meaning.
People of all ages can have APD. It often starts in childhood, but some children develop it later. Between 2% and 7% of children will have it, and boys are more likely to have it than girls. The disorder can lead to learning delays, so children who have it may need a little extra help in school.
APD may be linked to other things that cause similar symptoms. In fact, it may be part of the reason some people have dyslexia. And some experts think children are sometimes diagnosed with ADHD when they actually have APD.
APD can affect the way your child speaks as well as their ability to read, write, and spell. They may drop the ends of words or mix up similar sounds.
It also can be hard for them to talk with other people. They may not be able to process what others are saying and come up with a response quickly.
Your child also may find it hard to:
- Follow conversations
- Know where a sound came from
- Listen to music
- Remember spoken instructions, particularly if there are multiple steps
- Understand what people say, especially in a loud place or if more than one person is talking
Doctors don’t know exactly what causes APD, but it may be linked to:
- Illness. APD can happen after chronic ear infections, meningitis, or lead poisoning. Some people who have nervous system diseases, such as multiple sclerosis, also develop APD.
- Premature birth or low weight.
- Head injury.
- Genes (APD may run in families).
Your specialists can use a hearing test to see if your child’s issues are caused by hearing loss, but only a hearing specialist, called an audiologist, can diagnose APD.
The audiologist will do a series of advanced listening tests in which your child will listen to different sounds and respond when they hear them. For instance, they might repeat them or push a button. The doctor also may attach painless electrodes to your child’s ears and head to measure how their brain reacts to sound.
Children usually aren’t tested for APD until age 7 because their responses to the listening test may not be accurate when they’re younger.
There’s no cure for APD, and the treatment is specific to each person. But it usually focuses on the following areas:
Classroom support: Electronic devices, like an FM (frequency modulation) system, can help your child hear the teacher more clearly. And their teachers can suggest ways to help them focus their attention, like sitting toward the front of the class and limiting background noise.
Making other skills stronger: Things like memory, problem solving, and other learning skills can help your child deal with APD.
Therapy: Speech therapy can help your child recognize sounds and improve conversational skills. And reading support that focuses on specific areas where your child has trouble can be helpful as well.
You can make a few changes at home, too. Cover hard floors with rugs to reduce echoes, and limit use of the TV, radio, and other noisy electronics
Understanding Auditory Processing Disorders in Children
In recent years, there has been a dramatic upsurge in professional and public awareness of Auditory Processing Disorders (APD), also referred to as Central Auditory Processing Disorders (CAPD). Unfortunately, this increase in awareness has resulted in a plethora of misconceptions and misinformation, as well as confusion regarding just what is (and isn’t) an APD, how APD is diagnosed, and methods of managing and treating the disorder.
The term auditory processing often is used loosely by individuals in many different settings to mean many different things, and the label APD has been applied (often incorrectly) to a wide variety of difficulties and disorders.
As a result, there are some who question the existence of APD as a distinct diagnostic entity and others who assume that the term APD is applicable to any child or adult who has difficulty listening or understanding spoken language.
Terminology and Definitions
In its very broadest sense, APD refers to how the central nervous system (CNS) uses auditory information. However, the CNS is vast and also is responsible for functions such as memory, attention, and language, among others. To avoid confusing APD with other disorders that can affect a person’s ability to attend, understand, and remember, it is important to emphasize that APD is an auditory deficit that is not the result of other higher-order cognitive, language, or related disorder.
There are many disorders that can affect a person’s ability to understand auditory information. For example, individuals with Attention Deficit/Hyperactivity Disorder (ADHD) may well be poor listeners and have difficulty understanding or remembering verbal information; however, their actual neural processing of auditory input in the CNS is intact. Instead, it is the attention deficit that is impeding their ability to access or use the auditory information that is coming in. Similarly, children with autism may have great difficulty with spoken language comprehension. However, it is the higher-order, global deficit known as autism that is the cause of their difficulties, not a specific auditory dysfunction. Finally, although the terms language processing and auditory processing sometimes are used interchangeably, it is critical to understand that they are not the same thing at all.
For many children and adults with these disorders and others—including intellectual disabilities and sensory integration dysfunction—the listening and comprehension difficulties we often see are due to the higher-order, more global or all-encompassing disorder and not to any specific deficit in the neural processing of auditory stimuli per se. As such, it is not correct to apply the label APD to these individuals, even if many of their behaviours appear very similar to those associated with APD. In some cases, however, APD may co-exist with ADHD or other disorders. In those cases, only careful and accurate diagnosis can assist in disentangling the relative effects of each
APD is an auditory disorder that is not the result of higher-order, more global deficit such as autism, intellectual disabilities, attention deficits, or similar impairments.
Not all learning, language, and communication deficits are due to APD.
No matter how many symptoms of APD a child has, only careful and accurate diagnosis can determine if APD is, indeed, present.
Although a multidisciplinary team approach is important in fully understanding the cluster of problems associated with APD, the diagnosis of APD can only be made by an audiologist.
Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD.
Shelley A. Borgia, CCCA https://www.webmd.com/brain/auditory-processing-disorder
Teri James Bellis, PhD, CCC-A https://www.asha.org/