If you feel your general hearing is good but you suffer from understanding communication in noisy environment or understanding people with different accents, you may be suffering from auditory processing disorders (APD). It happens in children and adults alike. APD can also affect the way brain remembers complex information so, the sufferers may have an issue in interpreting and remembering complex instructions. The condition may co-exist or in some cases, even be misdiagnosed as dyslexia or language comprehension issues; and may result in unexplained slow academic progress.

Standard hearing tests do not pick up APD. Standard tests (called pure tone audiometry and tympanometry) will only assess how well your ear is hearing whereas APD test battery assesses how well your brain is breaking up the information received from the ears and analysing it to make a sense from it. Therefore, specialised assessment is required by a highly qualified audiologist to diagnosed APD.

At Audiology Planet, we offer a comprehensive service for APD assessment and management. Also, we provide hearing aid, and balance/dizziness care for children and adults.  Click here for more information and queries.

How do we hear

Most of us can hear well so, we do not give much thought to how complex the process of hearing and understanding is. It starts with a series of mechanical actions inside the ear when a sound strikes the ear drum. The ear converts the mechanical sounds into electrical waves that are taken to the brain via hearing nerve. The brain helps us understand the meaning of the sound, based on the information stored in the memory.

What is auditory processing

Our hearing (auditory system) allows us to listen to sounds, words and sentences and our brain works together with our ears to process and work out the meaning of these sounds. It is vital that our ears and brain work together and co-ordinate fully to achieve the effective processing of these sounds. For example, after hearing a series of sounds /t/, /e/, /b/, /l/, brain knows that it refers to an object called ‘table’. Although, it happens without any special effort in a normal hearing person, the brain works very hard to ‘process’ the sounds in order to make sense out of it. It has to correlate the sounds with memory and emotional systems, for example, to make sense of the sounds. This is what we call ‘listening’ and the medical term for this is ‘auditory processing’. Auditory processing essentially refers to what happens when the brain ‘recognises’ and ‘interprets’ the sounds around us. Simply put- it is ‘what we do with what we hear’.

What is auditory processing disorder

When ears are working well and hearing is within normal limits, we can easily make sense of what is being said. However, some children and adults have something that adversely affects the processing or interpretation of the information they hear, even when their hearing is within normal range. Difficulty in listening even when the hearing is normal, is called ‘auditory processing disorder’ (APD).

 Standard hearing test, known as pure tone audiometry, will only test the ears ability to pick up very basic auditory information (single pitches) and transmit it to the brain. This test will not have any information how the brain breaks this information down in smaller elements and uses other mental processing to understand the meaning of the sound. For example, the word ‘Beatles’ may mean different things to different people around the world. Some will think of a legendary music band and others will think of an insect. People who do not understand English, will think of it as gibberish. However, when the word is pronounced- ear will send the same information to everybody’s brain. Brain has to analyse this information from memory, emotional system  (same words can produce different emotions in men and women for example)  and its inherent ability to understand the speech in noisy areas (if there is some noise around). So, auditory processing skills are higher than hearing skills as they require the brain to do very complicated tasks in fractions of seconds. If the chain of those tasks is broken- it will not affect your hearing (so the ear will still be working normally) but it will affect the way you perceive that information and make use of it.
No two APD sufferers are same and have APD 100% of times. Some people suffer more and others suffer less. Some people have it only in certain environments (particularly in noisy environment) and some people have it in more than one environments.  There are some conditions that can either co-exist with APD or may be misdiagnosed as something else when it really is APD (Dyslexia, Attention deficit etc.)

Symptoms of APD

The ability to make sense of what we hear at home, school, work or in our everyday environment is crucial if we are to carry out a wide variety of tasks effectively. If the brain appears to be having difficulty working out the meaning of sounds properly (especially the sounds composing speech) –then the ears and the brain are not coordinating fully. This results in one or more of the following symptoms:

1. Difficulty distinguishing one sound from another (phonemes)
2. Difficulty identifying similarities and differences in sound patterns (rhyming)
3. Difficulty blending, isolating, or separating sounds in words (decoding words).
4. Poor auditory memory

These difficulties with auditory processing may manifest in the following ways:

• Poor listening skills.
• Difficulty following oral instructions or classroom discussions.
• Frequently say, “huh?” or “what?”
• Difficulty with phonics or letters, sound blending or segmentation.
• Difficulty decoding unfamiliar words.
• Poor spelling.
• Slow fluency of reading.
• Poor reading comprehension.
• Difficulty understanding in the presence of background noise.
• Poor attention, day dreaming, high distractibility (like an attention disorder).
• Give slow or delayed responses to oral questions.
• May be prone to behavior problems due to frustration or boredom
• Avoidance of reading or other difficult tasks.

How can we recognise the need for specialist APD testing?

Questions which teachers/parents should ask in class or at home are:

-Is the child easily distracted or unusually bothered by loud/sudden noises?
-Are distracting environments upsetting to the child? (background noise)
-Does the child find it easier to cope in quieter settings?
-Does the child have difficulty following multi-step oral instructions/directions, whether simple or complicated? (needing to hear only one direction at a time)
-Does the child have reading, spelling, writing or other speech-language difficulties?
-Is abstract information difficult for the child to comprehend? Are verbal maths problems difficult? -Is the child disorganised and forgetful?
-Are conversations hard for the child to follow? Does the child take longer time to process information?

How can we help children (and adults) with APD?

There are many strategies which can be applied at school and at home to ease some of the difficulties associated with APD. Apart from special instructions for school and parents, there are specialised software based therapy and communication devices that can help.

Management of APD generally focuses on three primary areas:

  1. Changing the learning or communication environment,
  2. Recruiting higher-order skills to help compensate for the disorder, and
  3. Remediation of the auditory deficit itself.

Some implications of information that we have on APD:

-APD is for life, as with other invisible disabilities.
-APD cannot be cured but with the correct diagnosis, remediation and strategies
-APDs find following social interaction difficult especially with new people, and those with good adversarial debating skills.
-Those who have APD may have problems filling in textual forms e,g, problems in processing what the meaning of the questions mean will in turn, cause problems when trying to process an answer.
-Those who have APD who have a high IQ are more difficult to diagnose, as they are very good at developing their own coping strategies.
-APDs really find life difficult to cope with when leaving the relative safe confines of the education system if they have not come to terms with their disability and how best to cope with it. They can become very isolated.

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1. 2015. Central auditory processing disorder (CAPD) tests in a school-age hearing screening programme – analysis of 76,429 children. Skarzynski PH, Wlodarczyk AW et al. Annals of Agricultural and Environmental Medicine 2015, Vol 22, No 1, 90–95. Full text article of available at: retrieved in Mar 2015

2. 2015. Children and auditory processing disorder (APD) – information and research update. Retrieved August 2015. ocessingdisorder(apd)%E2%80%93informationandresearchupdate.pdf

3. 2012. Children’s Hospital Medical Center Language. Health Topics. Language/auditory processing disorder. Retrieved August 2015.

4. 2011. British Society of Audiologists (2011). Position statement on Auditory Processing Disorders March 2011. Retrieved in July 2015

5. 2010. American Academy of Audiology (2010). Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. Accesses in Jan 2015 9.73897613.pdf

6. 2001. Florida Department of Education. Technical Assistance Paper 10967: Appendix C. Suggestions for successful management of students with central auditory processing disorder (CAPD): Tips for the teacher. Retrieved September 2012. Cincinnati