What is auditory processing disorder?

Auditory processing disorder (APD) is a condition where the brain doesn’t properly translate the meaning of sounds. 

“Most people think you hear with your ears, and they are certainly the input point for hearing,” says Leah Light, AuD, the founder and director of the Brainchild Institute in Hollywood, FL. “Auditory processing disorder occurs when your brain doesn’t process information correctly,” she says. 

Auditory processing disorder is a hearing impairment—not a hearing loss, notes Dr. Light. You’ll also sometimes hear the condition referred to as central auditory processing disorder.

Affects all ages

The Nemours Foundation estimates that 5 percent of school-aged children have this condition. And while it’s often associated with childhood, APD affects people of all ages. “There are many adults suffering from auditory processing disorder,” says Dr. Light.  

What are symptoms of auditory processing disorder? 

According to diagnostic guidelines from the American Academy of Audiology, some of the common symptoms of auditory processing disorder include: 

• Difficulty listening when it’s noisy and there is a lot of background noise—hearing on phone calls is also often challenging. 
• Difficulty comprehending where sounds are coming from 
• Difficulty following multi-step directions 
• Difficulty participating in conversations—that is, not responding to questions, misunderstanding what people said, not following jokes or stories, or having trouble with straightforward instructions. People with APD may frequently say “What?” after a question or ask for it to be repeated. 
• Difficulty concentrating and a lack of focus. 
• A lack of appreciation for music, as well as a lack of musical abilities. 

Many of these symptoms are also often present with other disorders, notes the American Speech-Language-Hearing Association (ASHA). “As audiologists, we say auditory processing disorder can coexist with other types of problems like ADHD or language processing [disorders],” says Dr. Light. 

What causes auditory processing disorder? 

The cause of auditory processing disorder is not always known, says Dr. Light. The disorder may be linked to some of the following factors:

• Prenatal issues or a difficult birth — Sometimes, taking a detailed case history will reveal a low birth rate or other issues that may be the root cause of this condition, says Dr. Light. 
• Other illnesses and conditions — Head trauma and chronic ear infections may be related to this condition, per the Nemours Foundation. 
• A family history — There may be a genetic component to this condition, notes ASHLA. 
• Age — Changes to the brain related to aging make it harder to process information as it’s spoken, says Dr. Light.  
• Traumatic brain injuries — Head or blast injuries can lead to APD, says Dr. Light. VA research has shown that veterans who suffered blast injuries are at risk of auditory processing disorder. 

Diagnosis 

A person with APD can perform perfectly on a hearing test that just involves listening to beeps in an otherwise silent environment. To diagnosis APD, audiologists will: 

• Take a thorough case history — Remember, some of the risk factors potentially leading to APD can occur when in utero. A detailed history can be helpful, therefore. An audiologist will ask questions about circumstances when hearing is difficult. With children, insight from other professionals (teachers, psychologists, and so on) can also be helpful, as well as details from parents.  
• Perform hearing exams — A specific battery of tests are used to assess auditory processing function, Dr. Light says. Before commencing with these tests, audiologists check for any issues with the ears (e.g., eardrum abnormalities) that need medical attention, as well as checking hearing sensitivity, she says. 

While the diagnosis is made by an audiologist, often a team of specialists—including speech-language pathologists and psychologists—also play a role in assessing symptoms and developing a treatment strategy, per the American Academy of Audiology. One of the diagnostic challenges of APD is that young children may not possess the verbal and communication skills to complete the full battery of tests that audiologists perform, says Dr. Light. 

Treatment for APD

There’s no pill or quick fix available when it comes to APD, says Dr. Light. However, there are frequently used treatment strategies, including tools: 

• Assistive listening technology: With a frequency modulation system, a speaker wears a wireless microphone that transmits to receivers in the ear of the person with APD. Often, it’s helpful in the classroom, since then “the teacher’s voice goes directly into the child’s ear, without getting polluted by other noises in the room,” says Dr. Light, who says the devices can be a helpful tactic for dealing with background noise. 
• Auditory training: Essentially, these strategies will be used to help people learn to hear. Depending on the specific type of disorder, this might be helping people distinguish between phonemes, or common sounds, like “pat” and “bat,” to recognize where sound is coming from, or focus on other hearing-related skills, per ASHA.  
• Developing compensatory strategies: As well, there are ways to learn strategies that help people work around the processing challenges, says ASHA, such as learning how to use mnemonics to recall information. 
• Environmental changes: Asking people to speak slower, using notes, and opting for written over verbal instructions may be helpful, says the Nemours Foundation. Even a new seat—in the front of the classroom, instead of the back—can be a meaningful change. 

No cure for this condition exists. Instead, treatment options will be determined by the specific form of APD occurring. 

Hidden hearing loss

Some people do not have auditory processing disorder, but have many of the same symptoms. This problem originates in a different part of the brain and is known as hidden hearing loss.

Subtypes of auditory processing disorders

There are different types of auditory processing problems, such as a decoding deficit, an auditory integration deficit, or an output organization deficit, that all sit under the umbrella of auditory processing disorder, Dr. Light explains.

“Each of these problems points to a different area of the brain that might be underdeveloped. We try to do deficit-specific interventions to target and stimulate that area,” she says.