What is Auditory Processing Disorder (APD)?

Auditory processing disorder (APD), also known as central auditory processing disorder, is a hearing condition that makes it difficult to understand what people are saying. People with APD do not struggle with hearing loss, rather, it is an issue with the ears and the brain not coordinating. In APD, the brain struggles to recognize and interpret sound, especially speech.

APD affects children and adults. APD often develops in childhood, but adults can develop APD from certain diseases, brain injuries, and aging. Many of the symptoms of APD are like symptoms of hearing loss. There is no cure for APD, but audiologists have several different treatments that can help to manage the symptoms.

There are 4 auditory skill areas that can be impacted by APD:

• Auditory discrimination. This is when there is difficulty noticing small differences between words (i.e., not distinguishing between cat, hat, or bat, or if someone says, “There are sixty dogs here” and they hear, “There are six dogs here”).
• Auditory figure-ground discrimination. This is when loud or noisy backgrounds interfere with being able to pick out specific words.
• Auditory memory. Being able to recall words or numbers that have been said (i.e., song lyrics or phone numbers)
• Auditory sequencing. Understanding and recalling the order of words.

APD in Children

Children with APD cannot understand words in the same way that other children do. When the ears and brain are unable to coordinate information, it can interfere with how sound, specifically speech, is interpreted. This can make academic settings difficult, which is why early diagnosis is crucial for children. Specifically, children usually struggle with speaking, reading, writing, and spelling. If left untreated, it can lead to social and learning difficulties. Often, children with APD experience worse symptoms in rooms that are less conducive for listening, such as gymnasiums or auditoriums where the sound reverberates off the walls, or when there are too many sounds, loud noises, or multiple people speaking at the same time.

APD in Adults

Auditory processing disorder symptoms in adults mimic symptoms of hearing loss. Often, adults get diagnosed with APD after certain diseases, brain injuries, or with aging. The earlier an adult is diagnosed, the better the treatment outcomes.

Signs and Symptoms

Symptoms for APD can vary among individuals and typically include:

• Asking people to repeat what they have said
• Difficulty understanding people if in an environment that is loud, noisy, echoing, or when several people are talking at once
• Difficulty understanding rapid speech
• Difficulty distinguishing between certain words
• Academic challenges in reading, writing, or spelling (performs below grade level)
• Taking a while to respond to others when spoken to, due to the time it takes to sort out what has been said (lag time in conversations)
• Difficulty in following verbal or auditory instructions (especially multi-step instructions)
• Difficulty with following or staying engaged with longer conversations
• Difficulty in being able to recall what people have said
• Challenges with listening to music, specifically having difficulty with recalling song lyrics
• Trouble knowing where a sound has come from
• Easily distracted by a loud or spontaneous noise

Causes

There is not a known cause for APD, but it may be connected to:

• Certain diseases (meningitis, chronic ear infections, lead poisoning, or multiple sclerosis, epilepsy, Alzheimer’s)
• Head injuries
• Genetics
• Premature birth or low birth weight

Risk Factors

Known risk factors that may contribute to the development of APD include:

• Premature birth or low birth weight
• Family history of APD
• Certain diseases
• Head injuries

Diagnosis

APD is diagnosed only by an audiologist. Typically, you will go through a physical examination and your audiologist will conduct several listening tests or assessments to determine a diagnosis of APD. Often, children may be referred to a psychologist, speech pathologist, or medical doctor first to rule out other issues before being sent to an audiologist. Children are not tested until age 7 because they are still developing and often struggle to give accurate responses when younger.

Treatment

There is no cure for APD. Treatment for APD focuses on better management of symptoms. There are several therapeutic strategies that can help symptom management. Strategies include:

• Changing your environment to reduce background noise, distracting sounds, or reverberation of sounds
• Requesting that people slow down their speaking or asking for written instructions
• Getting speech therapy, which will focus on building auditory skills
• Receiving classroom support
• Using a recording device so you can go back and listen to instructions or lectures
• Asking others for more information
• Building auditory skills that help your brain focus on auditory signals
• Developing and strengthening other skills, such as problem-solving and memory, to better manage symptoms of APD

Complications

Complications from APD vary between individuals. The most common complications include:

• Difficulties in learning, specifically in reading, writing, and spelling
• Difficulties in social connection or communicating with others
• Depression
• Anxiety