Auditory Processing Disorder: Signs, Testing and Treatment
Someone can pass a basic hearing screening and still have significant difficulty following conversations, especially when there is background noise. A child may seem distracted in the classroom. An adult may hear that someone is talking but struggle to make sense of the words in a busy restaurant. These difficulties may sometimes be associated with auditory processing disorder.
Auditory processing disorder, often shortened to APD, affects how efficiently the brain interprets and organizes auditory information. It is also sometimes called central auditory processing disorder, or CAPD. People with APD often have normal peripheral hearing sensitivity, meaning they can detect the soft sounds measured during a traditional hearing test, but they may still struggle with more complex listening tasks.
At Flex Audiology, Dr. Erica Person and Dr. Taylor McCreary provide auditory processing evaluations for children and adults in Lawrenceburg, Indiana, and Harrison, Ohio. Diagnostic APD testing is typically available for patients age five and older after a comprehensive hearing evaluation confirms that hearing sensitivity is within normal limits.
What Is Auditory Processing Disorder?
Hearing involves more than the ears detecting sound. The auditory system must also organize, separate, and interpret that sound so the brain can understand what it means.
APD is associated with difficulty processing auditory information within the central auditory nervous system. This can make listening especially challenging when:
Several people are talking at once
Background noise competes with the speaker
Speech is fast, unclear, or incomplete
Instructions contain multiple steps
Different information is presented to each ear
Small timing or pitch differences carry meaning
A routine audiogram measures the softest sounds a person can hear at different pitches. That information is important, but it does not tell us everything about how the auditory system performs during complicated, real-world listening.
Signs of Auditory Processing Difficulties in Children
APD can look different from one child to another. Parents and teachers may notice that a child:
Frequently asks for repetition
Has difficulty following spoken directions
Seems to misunderstand words
Struggles to hear the teacher in a noisy classroom
Appears distracted, inattentive, or as though they are not listening
Has difficulty with reading, spelling, or written language
Becomes overwhelmed in group conversations
Withdraws from noisy social situations
Performs better when information is presented visually
Passing a school hearing screening does not necessarily rule out auditory processing difficulties. A screening is designed primarily to identify possible hearing loss. It is not a comprehensive evaluation of how the brain processes complex auditory information.
These signs are also not unique to APD. Attention-deficit/hyperactivity disorder, language disorders, learning differences, and other conditions can cause similar challenges or occur alongside APD. That is why diagnosis should not be based on a checklist of symptoms alone.
What Does APD Look Like in Adults?
Adults with auditory processing difficulties often describe hearing people but not understanding them. Common concerns include:
Difficulty following conversation in restaurants or group settings
Trouble understanding speech when several people are talking
Difficulty communicating by telephone
Needing extra time to process spoken information
Frequently mishearing similar-sounding words
Feeling unusually tired after demanding listening situations
Some adults may have experienced listening difficulties for many years. Others notice a change following a concussion, traumatic brain injury, or another neurological event. A complete case history helps the audiologist determine whether auditory processing testing or another type of evaluation is the most appropriate next step.
Can Someone Have Both APD and ADHD?
Yes. APD and ADHD are different conditions, but they can occur together and may appear similar in everyday life.
If a person cannot clearly process what was said, they may appear not to be paying attention. Likewise, difficulty sustaining attention can interfere with listening and responding accurately during conversation or testing.
An audiologist evaluates auditory function, but a complete picture may require input from other professionals. Depending on the patient's needs, this could include a speech-language pathologist, psychologist, physician, teacher, or school team. One evaluation does not automatically need to happen before the other.
What Happens During an Auditory Processing Evaluation?
The process begins with a comprehensive diagnostic hearing evaluation. This confirms hearing sensitivity and helps rule out problems involving the outer, middle, or inner ear that could explain the patient's symptoms.
At Flex Audiology, an APD screening may be available after the hearing evaluation when appropriate. The screening takes approximately 10 to 15 minutes and samples several auditory processing abilities. If the screening identifies an area of concern, a separate comprehensive diagnostic APD evaluation may be recommended.
Diagnostic testing is completed in a sound-treated booth. Although the exact test battery is individualized for the patient's age, history, and abilities, it may examine areas such as:
Temporal Processing
Temporal processing involves recognizing very small differences in the timing, sequence, duration, or pitch of sounds. These cues help the brain distinguish speech sounds and follow changes in spoken language.
Auditory Closure
Auditory closure is the ability to fill in missing or unclear parts of a message. This skill becomes important when someone mumbles, speech is distorted, or background noise covers part of what was said.
Binaural Integration
Binaural integration describes how the brain combines different information presented to the two ears. This ability supports listening when multiple streams of auditory information are present.
Binaural Separation
Binaural separation involves focusing on information presented to one ear while ignoring competing information presented to the other. This skill is particularly useful when trying to concentrate on one speaker in a noisy environment.
No single test diagnoses every auditory processing difficulty. The audiologist interprets the pattern of results alongside the person's hearing evaluation, symptoms, developmental or medical history, and information from other professionals when appropriate.
Can Auditory Processing Disorder Be Treated?
Management is individualized according to the specific auditory skills affected and the patient's everyday needs. Recommendations may include a combination of:
Targeted auditory training
Communication strategies
Classroom or workplace accommodations
Visual supports and written instructions
Changes to the listening environment
Remote microphone technology
Collaboration with a speech-language pathologist or school team
At Flex Audiology, in-office auditory training may be recommended for approximately one hour per week over 12 weeks. Certain patients may also receive structured activities to complete at home for approximately 15 to 30 minutes, four or five days per week. The frequency and length of treatment depend on the evaluation findings and individual goals.
Remote microphone systems may also improve access to speech in background noise by transmitting a speaker's voice more directly to the listener. These systems can be useful in classrooms, meetings, lectures, and group settings.
For patients who have traditional hearing loss, Flex Audiology does not perform diagnostic APD testing because reduced hearing sensitivity can affect auditory processing test results. However, these patients may still benefit from appropriately fit hearing aids, remote microphone technology, communication strategies, and selected auditory training activities.
When Should You Consider APD Testing?
An auditory processing evaluation may be worth discussing when a child or adult has ongoing listening difficulties that are not explained by a routine hearing test. It may be particularly helpful when someone repeatedly struggles with speech in noise, spoken directions, telephone conversations, or group communication despite having hearing sensitivity within normal limits.
The goal is not simply to assign a label. A thorough evaluation can identify patterns of auditory strengths and weaknesses and guide practical recommendations for home, school, work, and social situations.
Schedule an Auditory Processing Evaluation
Flex Audiology provides auditory processing evaluations for children and adults at our Lawrenceburg, Indiana, and Harrison, Ohio locations. Diagnostic testing is generally available beginning at age five and starts with a comprehensive hearing evaluation.
If you or your child seems to hear normally but continues to struggle with understanding spoken information, contact Flex Audiology to discuss the appropriate first step.
Frequently Asked Questions About APD
Can a child pass a hearing screening and still have APD?
Yes. A basic hearing screening primarily checks whether a child can detect certain sounds. Auditory processing testing examines more complex abilities involved in organizing and interpreting auditory information.
Is APD the same as hearing loss?
No. A person with APD often has hearing sensitivity within normal limits but experiences difficulty processing complex auditory information. A comprehensive hearing evaluation is completed first to determine whether hearing loss is present.
Is APD the same as ADHD?
No. They are separate conditions, although their symptoms may overlap and a person can have both. Evaluation by the appropriate professionals helps distinguish auditory, attention, language, and learning concerns.
Can adults be tested for auditory processing disorder?
Yes. APD evaluations are not limited to children. Adults who struggle significantly with speech in noise or other complex listening situations may also be candidates for testing.
How old does a child need to be for APD testing?
At Flex Audiology, diagnostic APD testing is typically available for children age five and older. The audiologist will consider the child's development, attention, language, and ability to participate reliably in the test battery.
Sources
American Academy of Audiology: Clinical Practice Guidelines for the Diagnosis, Treatment, and Management of Children and Adults with Central Auditory Processing Disorder
American Speech-Language-Hearing Association: Understanding Auditory Processing Disorders in Children
