Auditory processing disorder (also known as central auditory processing disorder or CAPD) is a condition that makes it hard for kids to recognize subtle differences between sounds in words. It affects their ability to process what other people are saying. Here are the signs of auditory processing disorder (APD) and suggestions for how you can help your child.
What is auditory processing disorder?
Your child passes a hearing test, but is diagnosed with auditory processing disorder (APD). How is it possible to have an auditory disorder when you don’t have a hearing impairment?
Children with APD typically have normal hearing. But they struggle to process and make meaning of sounds. This is especially true when there are background noises.
Researchers don’t fully understand where things break down between what the ear hears and what the brain processes. But the result is clear: Kids with APD can have trouble making sense of what other people say.
Typically the brain processes sounds seamlessly and almost instantly. Most people can quickly interpret what they hear. But with APD, some kind of glitch delays or “scrambles” that process. To a child with APD, “Tell me how the chair and the couch are alike” might sound like “Tell me how a cow and hair are like.”
Many conditions, including ADHD and autism, can affect a child’s ability to listen and understand what they hear. What makes APD different is that the problem lies with understanding the sounds of spoken language, not the meaning of what’s being said.
Some educators and other professionals question or doubt a diagnosis of APD. Not all professionals see it as a specific disorder. The medical profession didn’t start seriously studying APD in children until 1977. Three decades later, there’s still confusion about APD.
The number of children with APD is estimated to be 2 to 7 percent.
Some experts estimate that boys are twice as likely as girls to have auditory processing disorder, but there’s no solid research to prove that
What causes auditory processing disorder?
The exact causes of APD are still unknown.
There is some research suggesting possible links to several factors. These include premature birth or low birth weight, head trauma, chronic ear infections and lead poisoning. While these may be plausible and possible, I know that I have 1 child with APD, and he fails to fall into any of these categories.
What are the symptoms of auditory processing disorder?
There are several kinds of auditory processing issues. The symptoms can range from mild to severe. Children with APD can have weaknesses in one, some or all of these areas:
The ability to notice, compare and distinguish between distinct and separate sounds. The words seventy and seventeen may sound alike, for instance.
Auditory figure-ground discrimination:
The ability to focus on the important sounds in a noisy setting. It would be like sitting at a party and not being able to hear the person next to you because there’s so much background chatter.
The ability to recall what you’ve heard, either immediately or when you need it later.
The ability to understand and recall the order of sounds and words. A child might say or write “ephelant” instead of “elephant,” or hear the number 357 but write 735.
- Find it hard to follow spoken directions, especially multi-step instructions
- Ask speakers to repeat what they’ve said, or saying, “huh?” or “what?”
- Be easily distracted, especially by background noise or loud and sudden noises
- Have trouble with reading and spelling, which require the ability to process and interpret sounds
- Struggle with oral (word) math problems
- Find it hard to follow conversations
- Have poor musical ability
- Find it hard to learn songs or nursery rhymes
- Have trouble remembering details of what was read or heard
It’s difficult to diagnose children with APD before age 7 or 8. Some of these auditory skills don’t develop until then. Getting a diagnosis requires finding a trained audiologist who can run electrophysiological tests. These tests record how the brain responds to sounds.
What skills are affected by auditory processing disorder?
Experts agree that children can learn to work around challenges they face when dealing with APD. But APD can present lifelong difficulties if it isn’t diagnosed and managed.
Here are some skills that are commonly affected:
- Children with APD may not speak clearly.
- They may drop the ends of words and syllables that aren’t emphasized.
- They might confuse similar sounds (free instead of three) long after their peers have learned to correct themselves.
- Kids with APD often have trouble developing reading, spelling and writing skills.
- Learning vowels and developing phonemic awareness—the building blocks for reading—can be especially difficult.
- Understanding spoken instructions is challenging.
- Kids with APD tend to perform better in classes that don’t rely heavily on listening.
- Kids with APD have trouble telling stories or jokes.
- They may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response.
The first step is to have a pediatrician rule out other possibilities such as hearing loss related to an ear infection. A speech-language pathologist or school psychologist may also give your child tests that measure receptive language or listening comprehension skills as well as cognitive abilities. But only a trained audiologist can conduct the tests needed to make a diagnosis of APD.
What conditions are related to auditory processing disorder?
Many children with APD also have dyslexia, ADHD and other conditions. Recent research suggests that auditory processing issues may be a contributing factor to dyslexia.
Experts also suspect that some children are misdiagnosed with ADHD when they actually have APD. Both conditions can cause attention issues, but with APD the cause is an inability to process what people are saying. With ADHD, on the other hand, there’s an underlying issue with focus.
How can professionals help with auditory processing disorder?
There’s more than one method for helping kids with APD. If your child has been diagnosed and is eligible for special education services, the school will come up with a plan of supports.
These can include:
- Accommodations (such as changes in timing, formatting, setting or presentation of assignments)
- Modifications (altering assignments to minimize the area of weakness
- Remediation (training and therapy to build skills)
Among the therapies and treatments that may help:
- Your child could have one-on-one or group instruction in reading skills, targeting any areas of weakness.
- Speech therapists can provide exercises and training to build kids’ ability to identify sounds and develop conversational and listening skills.
Modifications you and the school may want to consider include:
- Seating kids with APD in the front of the room and away distractions can help them focus.
- Closing doors and windows minimizes outside noise.
- An amplification system, such as a wireless FM system, reduces background noise and poor acoustics. The child wears a headset and the teacher wears a clip-on microphone.
- The teacher uses images and gestures to reinforce the child’s understanding and memory.
Quiet rooms for taking tests.
- Research has found that some computer programs helped improve children’s language-processing skills when the programs were used intensively.
What can be done at home for auditory processing disorder?
Even small steps can have a big impact on how your child functions at home. Here are some suggestions you may want to try:
- Provide a quiet spot for studying, with background noise kept to a minimum.
- Have your child look at you when you’re speaking.
- Use simple, one-step directions.
- Speak at a slightly slower rate and at a slightly higher volume.
- Ask your child to repeat directions back to you. If he’ll need to act on the directions later, ask him to write notes to remind himself.
What can make the journey easier?
Whether your child has been diagnosed with APD or you suspect he might have it, Understood can help you find helpful tools, strategies and support.
- Assistive technology can help kids with reading and listening challenges. You can explore Tech Finder for ideas on apps for your child.
- Connect with other parents. Other parents of kids with APD may give you more information and strategies—as well as the support you need to help your child. They know what you’re going through and can share tips to help propel you forward.
- Get behavior advice from the experts. Parenting Coach has strategies that can help with the social and emotional issues that can come along with APD.
There’s a lot you can do to help your child—and you don’t have to do it alone. Teachers, doctors and other professionals can help guide you, along with other parents who have been there.
Continue to explore information on APD, including common questions parents have. If you can, carve out some extra bonding time with your child. And remember to take care of yourself.
- APD is sometimes diagnosed as another disorder, so it’s important to have your child evaluated by qualified professionals.
- Speech therapy and special reading instruction can help with APD.
- You can take steps to help improve your child’s listening comprehension skills.