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
What Causes Auditory Processing Disorder?
Often, the cause of a child's APD isn't known. Evidence suggests that children
with head trauma, lead
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
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
help from other professionals to manage non-listening symptoms. For example, a
child may benefit from:
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
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
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
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
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.