Auditory Processing Disorder (APD): Symptoms, Diagnosis & Treatment Options
People with Auditory Processing Disorder (APD) have normal hearing but experience difficulties in understanding speech and other sounds they hear.
The hearing condition often starts in childhood, affecting between 3-5% of children, although it can be developed later in life. If you notice your child finds it difficult to understand, early diagnosis can help them receive the proper support. To learn more about APD, its symptoms, diagnosis and treatment options, the Attune Hearing team have created this guide to help all those who might be experiencing APD.
What is Auditory Processing Disorder (APD)?
Before we go into what ADP is, we need to discuss auditory processing. Auditory processing is a term used to describe how our brain recognises and understands sound. APD, also known as central auditory processing disorder (CAPD), is an umbrella term for various disorders that produce a failure in the hearing and listening process.
- 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
What is The Cause of APD?
The exact cause of APD is unknown, but it is known to involve the neural pathways of the central auditory nervous system. There is currently growing evidence that it is probably a developmental delay for many children.
APD may also be linked to:
- Premature birth, or low weight
- Head injury
APD in Children
In children, APD can contribute to learning delays where additional help in school may be required. It is even thought to be why some people may have dyslexia or some children are misdiagnosed with ADHD when they have APD. One of the most frequent difficulties reported by children with APD is difficulty listening in noisy or academic environments, which usually encourages a referral for APD assessment.
How do I know my child has APD?
Four auditory processing skills that people with APD report struggling with include:
- 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 in Children
If you are a parent and are wondering whether your child might be experiencing APD, there are common signs and symptoms you or your child may notice, including:
- 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
Remember, APD is not hearing loss. Still, some children with hearing loss can also experience any of these symptoms.
APD and Other Conditions
APD is also often 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)
- 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.
How is APD Diagnosed?
An audiologist can help diagnose APD. As a university-trained health professional, an audiologist is a specialist with skills and knowledge of hearing, hearing-related conditions, illnesses, and treatment options.
Step 1: Hearing test
Your first step in being diagnosed with APD is to visit an audiologist where they can conduct a hearing, tympanometry and acoustic reflex test. The hearing test can rule out any medical causes or temporary hearing loss in children, such as middle ear problems. Children will often 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 abnormalities are found, your GP will receive the final report, and a recommendation to refer to an ENT will be made.
Step 2: APD assessment
After your hearing test, your audiologist will perform the APD assessment. It can be performed both on adults and children over seven years of age who do not have hearing loss but cannot process sound information accurately.
Step 3: Auditory processing and memory testing
Auditory processing and memory testing is 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.
What is included in an auditory processing and memory test?
- The LiSN-S Test (listening in spatialised noise): Assesses the child’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
Step 4: Diagnosis and recommendations
In the final steps of your assessment, your 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 for APD
If your child has confirmed APD, multiple support and treatment options can help them improve their ability to understand and learn in the classroom. In some cases, the intervention can improve the listening ability to almost normal.
Your child’s audiologist might suggest strategies or learning programs that can improve listening in background noise. A personal remote microphone or sound field amplification system may also be recommended to help the child hear their teacher’s voice more clearly in a noisy environment.
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. It’s important to remember that treatment and intervention for APD are personalised to each child, so there isn’t one standard form of treatment.
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.