Auditory Processing Disorder (APD) is a diagnosis used to describe difficulties experienced with the
processing of sound despite the ear being able to detect sounds at normal levels. Humans hear
when energy that we recognize as sound travels through the ear and is changed into electrical
information that can be interpreted by the brain. APD is the inability to notice, compare and
distinguish the distinct and separate sounds in words. Auditory processing disorder (APD) is not a
hearing impairment but the inability to process what is heard.

The term auditory processing disorder (APD) means that something is adversely affecting the
processing or interpretation of the information. Hearing starts with a complex set of actions within
the outer, middle and inner ear. These actions send the sounds to the brain that interprets them so
the individual can understand. This set of actions may be defined as listening and carries the
medical term auditory processing. APD can negatively affect various skills such as academics,
communication and social success. The child may have problems paying attention to auditory
input, distinguishing sounds and remembering auditory information. All theses can affect a child’s
ability to learn and cope well in academics.

APD goes by many other names. Sometimes it is referred to as central auditory processing
disorder (CAPD). Other common names are auditory perception problem, auditory comprehension
deficit, central auditory dysfunction, central deafness, and so-called "word deafness”. Human
communication relies on taking in perplexing and continuous information from the outside world
through the senses, such as hearing and interpreting that information in a meaningful way.
Communication also requires certain mental abilities, such as attention and memory. Even though
your child seems to hear normally, he or she may have difficulty using the sounds of speech and

Possible Causes

If an individual's auditory processing is functioning well but there is no understanding of the sounds
that are heard, the individual may have an APD. In some children with APD there may be tiny
differences in the way that neurons (brain cells) are joined together, or send messages to each
other. This may make it hard for sounds to be passed on to the areas of the brain that aid the
understanding of language. It is possible such brain cell differences may cause APD. Scientists still
do not understand exactly how all of these processes work to interact or how they malfunction in
cases of communication disorders.
APD is an auditory deficit that is not related with cognitive and language skills. In some children,
auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit
disorder, autism, autism spectrum disorder, specific language impairment, pervasive development
disorder or developmental delay. Sometimes this term has been misinterpreted in children who
have no hearing or language disorder but have challenges learning. A diagnosis of all these
disorders may be helpful in understanding the cause to behavioral problems.

Signs and Symptoms

•        Have difficulty processing and remembering language-related tasks but may have no trouble
interpreting or recalling non-verbal environmental sounds, music, etc.

•        Difficulty understanding spoken messages and/or remembering instructions

•        Struggles with expressing themselves clearly and using speech

•        May process thoughts and ideas slowly and have difficulty explaining them

•        Have trouble paying attention to and remembering information

•        Often is distracted by background sounds/noises

•        Have behavior problems

•        May misinterpret or find it hard remembering oral directions

•        Has difficulty comprehending complex sentence structure or rapid speech

•        Ignores the speaker especially if preoccupied by something

•        Have difficulty with reading, comprehension, spelling, and vocabulary

•        Need more time to process information

•        History of multiple ear infections

Children with auditory processing difficulty overall have normal hearing and intelligence. It is
thought that up to 10% of children may have some level of APD. There are a number of tests to
diagnose APD. APD cannot be diagnosed from a symptoms checklist. No matter how many
symptoms of APD a child may have, only careful and accurate diagnostics can determine the
underlying cause.

Diagnosing APD

A multidisciplinary team is crucial to fully assess and understand the group of problems exhibited
by children with APD. Thus, a teacher or educational diagnostician may shed light on academic
difficulties; a psychologist may evaluate cognitive functioning in a variety of different areas; a
speech-language pathologist may evaluate written and oral language, speech, and other related
capabilities. Some of these professionals may use test tools that include the terms “auditory
processing” or “auditory perception” in their evaluation, and may even suggest that a child exhibits
an “auditory processing disorder.”

It is important for parents to know that, however beneficial the information from the multidisciplinary
team is in understanding the child’s overall areas of strength and weakness, none of the test tools

used by these professionals are diagnostic tools for APD, and the actual diagnosis of APD must be
made by an audiologist.

To diagnose APD, the audiologist will administer a series of tests in a sound-treated room. These
tests require listeners to attend to a variety of signals and to respond to them via repetition. Other
tests that measure the auditory system’s physiologic responses to sound may also be
administered. Most of the tests of APD require that a child be at least 7 or 8 years of age because
the variability in brain function is limited in younger children that test interpretation may not be

Once a diagnosis of APD is made, the nature of the disorder is determined. There are many types
of auditory processing deficits and, because each child is an individual, APD may manifest itself in
a variety of ways. It is necessary to determine the type of auditory deficit a given child exhibits so
that individualized management and treatment activities may be recommended that address his or
her specific areas of difficulty.

Treatment of APD

Treatment of APD focuses on three fundamental areas: changing the learning or communication
environment, encouraging higher skills to help compensate for the disorder, and intervention of the
auditory deficit itself. The primary purpose of environmental modifications is to improve access to
auditory presented information. Suggestions may include use of electronic devices that assist
listening, teacher-oriented suggestions to improve delivery of information, and other methods of
altering the learning environment so that the child with APD can focus his or her attention on the

Compensatory strategies usually consist of suggestions for assisting listeners in strengthening
central resources (language, problem-solving, memory, attention, and other cognitive skills) so that
they can be used to help overcome the auditory disorder. In addition, many compensatory strategy
approaches teach children with APD to take responsibility for their own listening success or failure
and to be an active participant in daily listening activities through a variety of active listening and
problem-solving techniques.

Finally, direct treatment of APD seeks to resolve the disorder, itself. There exist a wide variety of
treatment activities to address specific auditory deficits. Some may be computer-assisted; others
may include one-on-one training with a therapist. Sometimes home-based programs are
appropriate whereas others may require children to attend therapy sessions in school or at a local
clinic. The type, frequency, and intensity of therapy, like all aspects of APD intervention, should be
highly individualized and programmed for the specific type of auditory disorder that is present.

With appropriate intervention, all children with APD can learn to become active participants in their
own listening, learning, and communication success rather than being helpless to the disorder.
Auditory Processing Disorder          Developmental Disorders          Autism          Parenting Issues