Auditory Processing Disorder

What Is Auditory Processing Disorder?

Auditory processing disorder (APD) is a hearing problem that affects about 3%–5% of school-aged children.

Kids with this condition, also known as central auditory processing disorder (CAPD), can't understand what they hear in the same way other kids do. This is because their ears and brain don't fully coordinate. Something interferes with the way the brain recognizes and interprets sounds, especially speech.

With the right strategies, kids with APD can be successful in school and life. Early diagnosis is important. If the condition is not identified and managed early, a child is at risk for listening and learning problems at home and school.

Trouble Understanding Speech

Kids with APD are thought to sense sound normally because they usually can hear sounds that are delivered one at a time in a very quiet environment (such as a sound-treated room). The problem is that they usually don't easily recognize slight differences between sounds in words, even when the sounds are loud enough to be heard.

These kinds of problems usually happen in a poor listening situation — such as when there's background noise or in a reverberant room like an auditorium — which often is the case in social situations. Kids with APD can have trouble understanding what is being said to them when they're in noisier places like a classroom, playground, sports event, school cafeteria, or party.

What Are the Signs & Symptoms of Auditory Processing Disorder?

Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, ask yourself:

• Does my child often mishear sounds and words?
• Are noisy environments overwhelming when my child is trying to listen?
• Does my child's listening behaviors and performance improve in quieter settings?
• Does my child have trouble following verbal directions, whether simple or complicated?
• Does my child have trouble with spelling or phonics?
• Are verbal (word) math problems hard for my child?
• Are conversations hard for my child to follow?

APD is often misunderstood because many of its symptoms are similar to those found in other disorders. Also, APD symptoms can be hidden by other problems, like speech-language delays, learning disabilities, attention deficit hyperactivity disorder (ADHD), and depression. Auditory memory deficits, auditory attention problems, and sound sensitivity are not symptoms of APD, but also may involve trouble with using sound information correctly. Seeing an audiologist, and other related specialists, can help parents understand these conditions.

What Causes Auditory Processing Disorder?

Often, the cause of a child's APD isn't known. Evidence suggests that children with head trauma, lead poisoning, seizure disorder, or chronic ear infections are more at risk. Sometimes, there can be more than one cause.

How Is Auditory Processing Disorder Diagnosed?

If you think your child is having trouble hearing or understanding when people talk, have an audiologist (hearing specialist) examine your child. Only audiologists can diagnose auditory processing disorder.

The most common way to diagnose APD is to use a specific group of listening tests. Audiologists often look for these main problem areas in kids with APD:

• Auditory figure-ground: This is when a child has trouble understanding speech when there is speech babble or ambient noise in the background. Noisy, loosely structured or open-air classrooms can be very frustrating for a child with APD.
• Auditory closure: This is when a child can't "fill in the gaps" of speech when it is more challenging. This can happen in a quieter situation but is more common when the speaker's voice is too fast or is muffled, making it hard for the child to make sense of the sounds and words.
• Dichotic listening: This is when a child has trouble understanding competing, meaningful speech that happens at the same time. For example, if a teacher is talking on one side of the child and another student is talking on the other side, the child with APD cannot understand the speech of one or both of the speakers.
• Temporal processing: This is the timing of a child's processing system, which helps them recognize differences in speech sounds (such as mat versus pat). It also helps them understand pitch and intonation (for example, asking a question instead of giving a command), understand riddles and humor, and make inferences.
• Binaural interaction: This is the ability to know which side speech or sounds are coming from, and to localize sound in a room. Although less common, this problem happens in children with a history of brain trauma or seizure disorders.

Most traditional APD tests require a child to be at least 7 years old. So, many kids aren't diagnosed until first grade or later. Newer electrophysiology tests (which use noninvasive electrodes to check the body's response to speech) can give some early information about the central auditory system in kids younger than 7.

How Can Parents and Teachers Help?

The auditory system isn't fully developed until kids are about 14 years old. Many kids diagnosed with APD can develop better listening skills over time as their auditory system matures.

There's no known cure, but different strategies may help with listening and also improve the development of the auditory pathway over time, especially when started at younger ages. These include:

• physical accommodations to improve the listening environment
• individual therapies
• help from other professionals to manage non-listening symptoms. For example, a child may benefit from:
  • speech-language therapy for language deficits
  • counseling to help with depression or anxiety
  • art therapy or music therapy to build self-esteem
  • occupational therapy to help with sensory issues or auditory timing concerns

One common physical accommodation is a remote microphone system, previously known as a frequency modulation (FM) system. This assistive listening device emphasizes a speaker's voice over background noise, making the voice clearer so a child can understand it. The person talking wears a tiny microphone transmitter, which sends a signal to a wireless receiver that the child wears on the ear or to a speaker box.

Other physical accommodations often focus on optimizing a kid's access to speech. Optimizing speech means reducing the interference of other things, like background babble, sound and sight distractions, and poor classroom acoustics. In a classroom, for example, the teacher might slow down their speech, speak clearly and deliberately (Think Mr. Rogers!), and seat the child where they can see and hear them better.

Some individualized therapies also may help kids improve the growth of their auditory pathway. These usually are recommended by the audiologist based on the results of a child's tests and concerns. Several computer-assisted programs are geared toward children with APD. They mainly help the brain do a better job of processing sounds in a noisy setting. Some schools offer these programs. If your child has APD, ask school officials about what's available.

Strategies used at home and school can ease some of the issues associated with APD.

At Home

At home, these strategies that can help your child:

• Reduce background noise whenever possible.
• Have your child look at you when you speak. This helps give your child visual clues to "fill in the gaps" of missing speech information.
• Use strategies like "chunking," which means giving your child simple verbal directions with less words, a key word to remember, and fewer steps. 
• Speak at a slightly slower rate with a clear voice. Louder does not always help. (Again, think Mr. Rogers!)
• Ask your child to repeat the directions back to you to ensure they understand.
• For directions to be completed later, writing notes, keeping a chore chart or list, using calendars with visual symbols, and maintaining routines can help.
• Many kids with APD find using close captions on TV and computer programs helpful.

Encourage kids to advocate for themselves. Telling adults when listening is hard for them can help. But shy kids might need to use agreed-upon visual cards or signals for coaches, parents, and teachers.

Most important, remind your child that there's nothing to be ashamed of. We all learn in different ways. Be patient. This is hard for your child and takes time. Your child wants to do well, and needs patience, love, and understanding while they work toward success.

At School

Teachers and other school staff may not know a lot about APD and how it can affect learning. Sharing this information and talking about it can help build understanding about the disorder.

APD is not technically considered a learning disability, and kids with APD usually aren't put in special education programs. Depending a child's degree of difficulty in school, they may be eligible for an accommodation plan such as an individualized education program (IEP) or a 504 plan that would outline any special needs for the classroom. Accommodations for APD often fall under the disability category of "Other Health Impairment."

Other helpful adjustments are:

• strategic (or preferential) seating so the child is closest to the main person speaking. This reduces sound and sight distractions and improves access to speech.
• pre-teaching new or unfamiliar words
• visual aids
• recorded lessons for later review
• computer-assisted programs designed for kids with APD

Stay in touch with the school team about your child's progress. One of the most important things that parents and teachers can do is acknowledge that the APD symptoms your child has are real. APD symptoms and behaviors are not something that a child can control. What your child can do, with the help of caring adults, is recognize the problems from APD and use the strategies recommended for home and school.

A positive, realistic attitude and healthy self-esteem in a child with APD can work wonders. Kids with APD can be as successful as their classmates. With patience, love, and support, they can do anything they work toward.