What is Auditory Processing Disorder (APD)?
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What is Auditory Processing Disorder (APD)?

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Children and adults with APD, short for Auditory Processing Disorder, have normal hearing but difficulties recognising and understanding speech and other sounds they hear. Early diagnosis can help get the right support. Learn more about APD, it’s symptoms, diagnosis and treatment options!

Auditory Processing Disorder (APD) At a Glance

Auditory Processing is a term used to describe how the brain recognises and understands sound.  APD, also known as central auditory processing disorder (CAPD), is an umbrella term for a variety of disorders that produce a failure in the hearing and listening process. It is a complicated problem thought to affect more than 5 per cent of school-aged children.

  • Auditory processing disorder (APD) makes it hard to know what people are saying
  • APD is not related to intelligence or hearing loss
  • APD affects people of all ages, and in various ways
  • APD is diagnosed by an audiologist

Consequences of APD in Children and Adults 

The affected children and adults do not correctly process auditory information which results in difficulty detecting subtle differences between sounds in words. One of the biggest problems reported by individuals with APD is difficulty listening in noisy environments, however, it is frequently the presence of academic deficits that will trigger a referral for APD assessment.

There are four auditory processing skills that people with APD may struggle with:

  • Auditory discrimination: Noticing, comparing, and distinguishing between separate sounds
  • Auditory figure-ground discrimination: Focusing on the important sounds in background noise
  • Auditory memory: Recalling what you’ve heard, either immediately or in the future
  • Auditory sequencing: Understanding and recalling the order of sounds and words


Signs and Symptoms of APD

As a parent or teacher, common signs of APD in children to look out for are: 

  • Difficulty following instructions
  • Difficulty understanding speech in background noise
  • A short attention span, the child is easily distracted
  • A lower reading or spelling ability
  • Difficulty in understanding information when presented verbally
  • Difficulty learning in background noise or in group environments
  • Low self-esteem
  • Acts as if there is a hearing loss present by often asking for repetition or clarification
  • Literacy, or general academic development concerns
  • Language and speech delays
  • Poor memory skills

These symptoms are often present without hearing loss.

APD is found to co-exist with other conditions

APD can often be confused with other conditions such as language disorders or higher-order cognitive disorders such as:

  • Autism Spectrum Disorder
  • Communication Disorders
  • Speech and Language Delay
  • Specific Learning Disorders (e.g. Dyslexia)
  • Dyspraxia
  • Developmental Delay

This is because the symptoms and behaviours displayed by the child can be similar. In some people, APD can co-occur with these disorders and therefore a careful and accurate assessment is required for correct diagnosis. 

Click here to learn more about the signs of hearing loss in children that parents should look out for.

What Causes APD?

The exact cause of APD is unknown, but it involves the neural pathways of the central auditory nervous system. There is growing evidence that for many children it is probably a developmental delay. Children still need to improve and strengthen the neural connections and pathways required for auditory processing.

APD may also be linked to:

  • Illness
  • Premature birth or low weight
  • Head injury
  • Genes (APD may run in families)

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.

develop APD

Diagnosis of APD

Diagnosis of APD will be made by an audiologist.  An audiologist is a university-trained health professional with specialist skills and knowledge about the ears and hearing.  The first step in diagnosing APD is to rule out hearing loss. The audiologist will perform a hearing test, tympanometry and acoustic reflex testing.  

Comprehensive hearing test

In children, the hearing test can rule out any medical causes or temporary hearing loss such as middle ear problems.  Often children will also be tested by bone conduction, which allows the audiologist to distinguish between the middle ear and inner ear problems (conductive hearing loss or sensorineural hearing loss).  If a hearing loss or other abnormality is found by the audiologist, a report will be supplied to the GP and a recommendation to refer to an ENT will be made.

APD assessment

Then the audiologist will perform the APD assessment.  It can be performed on adults and on children over 7 years of age who do not have a hearing loss but cannot process sound information accurately. It is more common to assess children, many (but not all) of these children experience significant learning difficulties because they are unable to make sense of what they are hearing. 

Auditory processing and memory testing

Auditory processing and memory testing consist of a series of tests designed to test specific auditory skills.  Tests for children may vary depending on individual difficulties.  An audiologist will do the testing and interpret the pattern of results.  

This provides the audiologist with a profile of strengths and weaknesses for the individual. This is vital because the degree and type of auditory processing deficit, combined with individual experiences will determine the best therapy for each person. 

The tests include:

  • The LiSN-S test (listening in spatialised noise): Assesses children’s ability to hear in a noisy environment
  • Auditory working memory tests: The children’s ability to recall numbers and sentence material is tested
  • Dichotic digits test: Assesses children’s ability to listen to information presented simultaneously to both ears
  • Random gap Detection test: Assesses the children’s ability to detect two tones presented at different time intervals
  • Frequency pitch pattern test: Assesses the children’s ability to detect subtle differences in sound
  • Continuous performance test: Tests the children’s visual and auditory attention
  • Non-verbal IQ: Children are compared to age-specific tables to give a scaled IQ score

Diagnosis and recommendations

At the end of the assessment, the audiologist will be able to explain the test results, discuss recommendations and answer any questions.  They will supply a formal written report (at a later date) and include any recommendations for further investigations and management or intervention as appropriate. The audiologist will be available to call you should you have any questions about the report.

The nature and degree of the disorder are determined during the assessment process. This allows the audiologist to recommend a management and treatment plan to address the specific needs of children individually. 

Support and treatment for auditory processing disorder

Children with APD can improve their ability to listen in the classroom and other noisy environments with the right intervention and support. In some people, the intervention can improve the listening ability to almost normal.

The audiologist might suggest strategies or training programs which can be used to improve listening in background noise. The audiologist may also recommend using a personal remote microphone or sound field amplification system. This will help children hear the teacher’s voice more clearly, even when it’s noisy.

Children might be referred to a speech pathologist to work on their language skills. A referral to see a special education teacher for extra help at school, especially with reading and writing may also be warranted. Sometimes an educational psychologist might also be able to help.

Treatment and intervention for APD are personalised to each individual child. It’s a good idea to ask your audiologist or speech pathologist about the treatment options that might work best for your child.

If you have concerns that your child may have APD, do not delay booking a children’s hearing test with your trusted, local Audiologist at Attune Hearing.

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