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Emotional Regulation: People with auditory processing disorder face challenges with emotional regulation. It can be very hard on them and take a toll on their mind because they have to work so hard to understand things that come easily to others. Lip-reading, establishing familiar routines, and doing things their own way can help them regulate their emotions and help them grow.

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Children with auditory processing problems are weak in some basic skills for decoding and remembering what they hear. They often miss, or misunderstand, information that's conveyed orally, in instruction or conversation.

Helping kids with weak auditory processing skills is a combination of building in supports in their environment, and intensive training to beef up skills they haven't developed automatically, as most kids do.

Here are some of the changes parents and teachers can make in the environment to help kids with auditory processing difficulties listen and learn more effectively:

Preferred seating. Arrange for the child to have seating that will make it as easy as possible for him to tune into what the teacher is saying. That usually means the front of the classroom, to minimize interference with the teacher's voice, and get the most access to the teacher's visual cues.

Use visual cues. Encourage your child's teacher to use visuals in instruction, and be sure your child is looking at you when you give directions or convey other important information.

Emphasize key words. Teachers and parents can help kids with auditory processing weakness by using intonation and slower speech to emphasize what is important. "One of the things we advise teachers to do with these kids is to significantly slow their rate of speech and use emphasis on key words, to bring attention to important pieces of information by the way they're talking," explains Rachel Cortese, MS, a speech-language pathologist.

Give kids a heads up when something important is coming. Cortese suggests using catchphrases to give kids a signal that you're about to say something they need to pay attention to. It could be something as simple as, say: Are you ready? or Here's the thing.

Help with sequencing. Use words that trigger or help a child to sequence events. "Using words like first, second, then, last help kids follow sequences, and teaching them to us these transition words in writing or telling a story helps them to organize their thoughts and their language," explains Cortese.

Assistive technology. For kids who need extra help following the teacher's voice in a noisy classroom, there is technology that can help. The student wears headphones that reduce background noise, and the teachers wears a microphone wirelessly connected to his headset.

Kids who have auditory processing challenges may benefit from working with a speech-language pathologist or educational therapist to strengthen skills through practice and learn effective ways to compensate for their deficits and build on other strengths.

Speech-language therapy

The most common kind of professional help for kids with these difficulties is speech-language therapy, in which kids get explicit training to improve their skills at distinguishing sounds, remembering sounds, and sequencing sounds.

"Our minds are designed to pick up automatically on these skill sets for taking in language," explains Matthew Cruger, PhD, the director of the Learning and Development Center at the Child Mind Institute. "So for kids who don't pick them up automatically, the goal is to provide instruction that's more frequent, more systematic, and more rigorous."

Dr. Cruger notes that while it's widely accepted that these interventions help, there isn't a good body of real world research to back that up. Complicating the research challenge, he notes, is the fact that when kids who get intervention show improvement, it's difficult to know whether it's the result of the therapy or the child's auditory pathways maturing over time. But he adds that waiting to see if a child's problems will go away over time can leave kids feeling frustrated and suffering from impairments. Those things can take a toll on their emotional and social development, as well as their learning.

Educational therapists help kids who are struggling with learning to develop strategies to manage frustration, build on their strengths, and compensate for their weaknesses. They look for ways to bolster a child's specific weaknesses-for instance, using multi-sensory learning for a child with an auditory processing condition who is struggling with reading. And they work on bolstering the confidence of kids who are discouraged because learning seems harder for them than other kids.

There are several "brain training" programs designed to build skills in identifying sounds and remembering auditory information, including FastForWard and Earobics.

Frequently Asked Questions

How is auditory processing disorder treated?

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Help for Kids With Auditory Processing Disorder - Child Mind Institute

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Improving the listening environment and boosting skills can help kids who have trouble taking in information, and remembering it.

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Kids with APD may be more likely to avoid social interactions with other kids. They are prone to missing the point of what others are saying, miss whole words in a conversation, and have trouble following directions in a game. They are often poorly accepted by their peers, socially alienated, not chosen to play in group activities, and more willing to conform to peer pressure. Parents should always consult the teacher so they are informed about what is going on. This would allow the teacher to set the child up for the most success. At home, taking steps towards social events is very important. Playdates, sleepovers, and birthday parties are something that all children deserve to experience. If your child is still struggling, counseling is a great resource for many kids with disabilities. It could help build communication skills, improve social cues, and become more in touch with their emotions.

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Some learning and attention issues can lead to specific social challenges.

Difficulty making friends can cause children to lose self-confidence.

There are strategies that can help your child build social skills.

Why can't my child make friends? This can be a difficult question to ask yourself. But if your child rarely gets invited on playdates and spends most of his time alone at home, it can be hard not to wonder-and worry.

For children of all ages, friendships offer the acceptance, approval and sense of belonging they crave. If your child struggles to connect with others and form friendships, it can be a blow to his self-esteem. It can leave him feeling alone and frustrated.

What Can Cause Trouble With Making Friends

If your child has a hard time making friends, it may have nothing to do with his personality. Trouble with forming friendships can be the result of learning and attention issues. Some learning and attention issues have a direct impact on social skills. Some affect communication skills or listening comprehension skills, which can make conversation difficult. And others create a variety of behaviors that can get in the way of making friends.

ADHD: Children with ADHD may lack self-control, be overactive, talk too much, talk without thinking or not pay attention to what other people are saying.

Executive functioning issues: Children with executive functioning issues may have trouble sharing, taking turns, controlling emotions and accepting other viewpoints.

Nonverbal learning disabilities (NVLD): Children with NVLD may miss social cues like body language, expression and tone of voice. They may not understand humour or sarcasm and may take what others say too literally.

Language disorders: Children with language disorders may not understand the rules of conversation or may have trouble finding the right words. They may avoid talking when around other kids.

Auditory processing disorder (APD): Children with APD may miss the point of what others are saying, miss words in conversation or have trouble following the directions in games.

Trouble Making Friends: A Common Problem

Not all children with learning and attention issues struggle to make friends. For some, social skills are their strength! But if it's a trouble spot for your child, he's not alone. Childen with learning and attention issues often face social challenges. When compared with their peers, studies have shown they're more likely to be:

Poorly accepted by their peers

Socially alienated from teachers and classmates

Viewed by teachers as lacking social skills

Not chosen to play or join in group activities

Willing to conform to peer pressure

Children can feel that they don't "fit in" at school or at outside activities. They may even feel that way at home with siblings.

It's a very real issue because many with learning and attention issues do stand out sometimes. They may require additional time and attention from teachers, parents and others. They may call negative attention to themselves by asking inappropriate questions, seeming uninterested in conversations, and interrupting or moving around a lot at the wrong times. Others may react badly or turn away.

How Friend Troubles Can Impact Your Child

Your child may be resilient and bounce back from social setbacks. Or he may enjoy spending a lot of time alone. But for many, difficulty making friends can have negative effects. It can hurt their self-esteem, wear down their confidence and keep them from trying new activities. They may feel self-conscious, sad, angry, helpless or hopeless. It can be hard for children to manage these intense feelings and find ways to cope. Encouraging your child to talk about his feelings can help him feel better about himself. Just knowing he can come to you for support and comfort can make a big difference.

Ways You Can Help

If your child feels his learning and attention issues are making him stand out, there are ways you can help. Talking to your child's teacher is a good first step. The teacher may be able to find ways to put your child in positive group experiences or match him up with classmates who are more accepting and share his interests.

At home, you can work on changing the dynamic between your child and his siblings. You can also try to change the way you respond so your child isn't singled out as much. And you can take steps to make social events like playdates, sleepovers and birthday parties more successful for your child.

If you see that your child is struggling with his emotions, you might want to consider counselling. Learn more about how to help your child build communication skills, improve social cues and become more resilient. Strengthening those skills may give him the confidence to try new ways to connect with other kids.

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ADHD affects more than just behaviour and academic performance - most children with ADHD have trouble with social skills and building friendships: Has little interest in social interactions Goes off-topic or monopolizes conversations Doesn't adapt language to different situations or people Doesn't give background information when speaking to an unfamiliar person Doesn't know how to properly ...

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Advocacy for needs: Individuals with Auditory Processing Disorder have a hard time communication and listening. It is harder for them to process what they are hearing in the moment. Transitioning from place to place can be difficult for these individuals because different environments have different noise levels. Being able to advocate for themselves and let other people know what they need to be able to understand the conversation is important. This article provides a couple ways you can help accommodate them and make life easier for them while they are trying to communicate with you.

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How to Help the Person with Auditory Processing Disorder

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Before speaking with the person with auditory processing disorder (APD), make sure you have their full attention, they are facing you and you are in good light.

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5. Problem Solving
Some problem solving tips for Auditory Processing Disorder is to get in to a routine and have their own ways of doing things. Another tip for any environment can be to try reading lips. Some more is visual cues, assistive technology, etc

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Communication: Second Website

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What Teachers Should Know

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.

Kids with APD often have trouble recognizing differences between sounds in spoken words, even when the sounds are loud and clear enough to be heard. This usually happens when there's background noise, like in a typical classroom.

Kids with APD may need to use 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.

These problem areas can affect students 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.

If the auditory deficits aren't identified and managed, many students with APD will face academic challenges.

Students with APD can benefit from working with a speech and language therapist, in addition to getting regular evaluations by audiologists.

What Teachers Can Do

APD is an auditory issue and not a cognitive, speech, or language disorder. Your student may feel embarrassed to let you know they did not understand what you said or directions you gave. Making sure that students with APD write down assignments and helping them stay organized may ease their frustration and boost their self-esteem in the classroom.

It can help to speak at a slightly slower rate with a clear voice. Louder does not always help. (Think Mr. Rogers!)

Teachers also can help students with APD by:

using strategic (or preferential) seating so the child is closest to the teacher. This reduces sound and sight distractions and improves access to speech.

pre-teaching new or unfamiliar words

using visual aids

recording lessons for later review

Date reviewed: February 2021

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Auditory Processing Disorder Factsheet (for Schools)

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What teachers should know about APD, and teaching strategies to help students who have the disorder.

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attention deficit disorder with hyperactivity

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national center for biotechnology information

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Same or Different: The Overlap Between Children With Auditory Processing Disorders and Children With Other Developmental Disorders: A Systematic Review - PubMed

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Children diagnosed with APD perform equally to children diagnosed with SLI, dyslexia, ADHD, and LD on tests of intelligence, memory or attention, and language tests. Only small differences between groups were found for sensory and perceptual functioning tasks (auditory and visual). In addition, chil ...

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Auditory processing disorder (APD) makes it hard for students to process and make meaning of sounds. That can make it hard to learn - from focusing on what a teacher says to learning how to read.

Here are some examples of accommodations teachers can use to help with auditory processing disorder in the classroom.

Classroom seating, materials, and routines

Provide a quiet area for independent work.

Let the student sit near the teacher and away from auditory distractions, like doors and windows.

Check in frequently to make sure the student understands the work.

Provide an assistive listening device to make it easier to distinguish the teacher's voice.

Give extra time for testing.

Giving instructions and assignments

Give step-by-step instructions, and have the student repeat them.

Use attention-getting phrases like "This is important to know because...."

Decide with the student on a nonverbal signal to show that a key point is being made.

Say directions, assignments, and schedules out loud, and rephrase as needed.

Repeat key information throughout the lesson, and rephrase as needed.

Use visual tools, images, and gestures to enhance and support spoken lessons.

Break down test or classwork instructions into short, written steps.

Highlight key words and ideas on worksheets.

Give written homework instructions.

Provide a list of homework assignments for the week (or day).

Introducing new concepts/lessons

Speak clearly and slowly when presenting new information.

Give material on a new concept to the student before it's taught to the whole class (so the student can get familiar with it ahead of time).

Give a list of or highlight key vocabulary and concepts for upcoming lessons.

Give a short review or connection to a previous lesson before teaching something new.

Give the student an outline of the lesson.

Grade based on the student's completion of the lesson goal. (For instance, don't grade spelling errors if that's not what the student was supposed to learn.)

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Ginny Osewalt is a dually certified elementary and special education teacher with more than 15 years of experience in general education, inclusion, resource room, and self-contained settings.

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Classroom accommodations for auditory processing disorder

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What classroom accommodations can help students with auditory processing disorder? Here are strategies teachers can try at school.

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Communication: People with APD will have challenges at home, school, community, etc. Some of the challenges include when the child has trouble understanding speech when there is a speech or a noise in the background. Also, another challenge is when a child cannot fill in the gap in speech when it's more challenging. Lastly, the timing of the child's processing system, helps them recognize differences in speech sounds, pitches, and intonations.
Some tips and suggestions may include the following: Allow extra time for the child to exchange information, speak directly to the child, and show positivity.

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Structured Literacy | Pride Reading Program

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Use lots and lots of phonological awareness activities. What does this mean? Phonological awareness is the ability to identify and manipulate the individual speech sounds into spoken words.

Kids with auditory processing disorder often drop or add sounds when spelling or reading words so it is really important for your child to isolate each individual sound. Phonological awareness includes:

Identify rhymes - "Tell me all of the words you know that rhyme with the word " ."

Listening for sounds - "Close your eyes as I read some words to you. When you hear the " " sound, raise your hand.

Separate syllables - "How many syllables does the word have? Say each syllable."

Listening for beginning, middle and ending sounds - "What sound do you hear at the end of the word ?"( )

To learn more about this topic, including specific activities and teaching ideas that you can use with your students, you can read my previous post:
>>What is Phonological Awareness
2. Teach with Multisensory Techniques

Multisensory means having your student hear it, say it, touch it and move during every lesson. Why is this so effective for your students? Kids with auditory processing need to learn in a different way.

By using multisensory materials and activities you are giving your student an opportunity for the information you are teaching them to "stick." Using all of the child's senses, engages their entire body along with their brain. This way they make a memory that lasts and stays with them. The more senses you have your students use, the stronger this memory will be.

Here are a few multisensory strategies that you can try out:

Use trays filled with salt or sand and have your student write words or skills in these.

Build words with wooden letters, blocks, legos or puzzle pieces.

Have your student write on their palm, use arm tapping, or you can have your student spell words while at the same time doing a jumping jack or bouncing a ball.

When teaching specific skills, use letter tiles and flashcards.

Use the Right Curriculum

While there are many really great reading and phonics programs for children on the market, most of these are not geared towards children with auditory processing. This is probably the most important auditory processing disorder classroom strategy that you can provide for your student!

The best choice is an Orton-Gillingham program. Orton-Gillingham is a really structured, step-by-step, repetitive and multisensory approach. This means that when the kids are learning to read, they learn each skill individually. They see it, say it, hear it and move with it.

They also practice it over and over again until it really "sticks." For more information on Orton-Gillingham, you can read my previous posts:
What is Orton-Gillingham? Show Me an Orton-Gillingham Lesson! The Science of Reading: What All Teachers Should Know
Play Attention, Memory, Sequencing and Focus Games

You can play some really fun games in the classroom that actually help students with auditory processing disorder improve many skills. For a complete list, please check out my post: Improve Auditory Processing with These Fun Activities.

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Use lots and lots of phonological awareness activities. What does this mean? Phonological awareness is the ability to identify and manipulate the individual speech sounds into spoken words. Kids with auditory processing disorder often drop or add sounds when spelling or reading words so it is really important for your child to isolate each individual sound.

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This link provides a few different examples of assistive technology for ADP. It explains how they can help and what they are for.

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Assistive Technology for Auditory Processing Challenges

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Auditory processing challenges make it hard to understand what’s being said. Learn how assistive technology can help kids and adults who struggle with auditory processing and where to find tools.

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When my son was in first grade, his teacher complained to me that he "didn't pay attention" in class. She said he wasn't listening. To her, this was an act of defiance.

I explained that my son has auditory processing disorder (APD). He's usually a very well-behaved boy, but the classroom was too chaotic and noisy for him. With all the background sound, my son simply couldn't make out what she was saying to him, no matter how hard he tried.

For people who don't have APD, it can be a puzzling challenge. Even my husband, who tries to understand, often struggles to see the world from the perspective of my son.

I've learned a lot from parenting a child with APD. And because I have APD myself, I think I'm a good person to explain. Here are some things I wish people understood about me, my son and APD.

1. He isn't being defiant.

With APD, the brain doesn't always process spoken words smoothly. So when my son doesn't respond right away or doesn't understand what you're saying, he's not doing it to be rude or defiant. He simply didn't comprehend what you said.

My son wants to understand you - more than anything. People like my son and me sometimes give up on conversations, though, because we're afraid of seeming rude. Sadly, it's part of life for someone with APD.

2. The link between APD and hearing can be confusing.

Having APD isn't the same as being hard of hearing. My son's hearing is actually very good. In fact, that can be part of the problem.

For example, my husband's electric shaver makes a high-pitched, irritating sound when it's charging. At least it does according to my son and me. No one else in our family seems to notice the sound we complain about.

It may seem counterintuitive. He notices sounds no one else does but still can't seem to "hear" what someone else is saying. That's because APD is an information processing issue, not a hearing issue.

3. Competing sounds and noises make understanding harder.

When I'm talking to my child, my voice is competing with a thousand other noises. It could be the rush of air blowing out of the air conditioner. Or footsteps coming from down the hallway. Or the buzz of an overhead, fluorescent light. That's why I try not to start a complex conversation with my son in a loud or chaotic environment.

If you have something important to share and it's noisy, text or write down the message. Better yet, when you need to have a real conversation, talk to him in a quiet place. Speaking directly to him and making eye contact also helps.

4. Telling him to "pay closer attention" or "listen harder" doesn't help.

Yes, APD can include problems with attention. After all, it's hard to focus if you can't understand what's being said around you.

But telling my son to "pay closer attention" or "listen harder" doesn't help when his brain is scrambling the sounds coming in. That'd be like someone telling you to "listen harder" to a foreign language you barely speak.

5. Rephrasing is more helpful than repeating.

When my son responds with "What?" to something I said, it's tempting to repeat exactly what I just said and in a louder voice.

But what he really needs is for me to say what I said in a different way. That's because certain phrases and sentences can be more difficult to process. The sounds may be too similar. The word combinations may be too complex.

Rephrasing - not repeating the same words louder - can really help. When struggling with my own APD, I've learned to say, "Can you please say what you said again, but with different words?"

6. He wants to feel safe to ask you to say something as many times as he needs.

Most people don't like to say the same thing over and over. I understand that. My son does, too. That's why it's hard for him to ask.

But if he knows you're OK with repeating and rephrasing something a few times, he'll be more comfortable asking. It's wonderful when people are willing to do this for him - and for me. We appreciate it more than you can imagine.

7. It's OK to be frustrated, as long as you try to understand.

Even though I have APD, I get frustrated with my son sometimes. I lose my patience. So I know others might too.

My son's first teacher never did come around to understanding his challenges. In the end, though, we were lucky that a new teacher replaced her. This new teacher was wonderful. The only difference between her and the first teacher was the willingness to try to understand APD.

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7 Auditory Processing Disorder Parenting Tips From a Mom

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Misunderstandings can make it challenging to raise a child with auditory processing disorder. One mom, who has APD herself, shares what she wishes others knew.

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Allowing the student to sit in front of the classroom and away from audio distractions such as, windows, AC units, doors, etc. Having the educator wear a microphone or AT that allows the student to hear better. Checking often to ensure the student is on track and can comprehend the class material. Adjustments to instructional opportunities could be seen in the example above, as well as overall making sure the environment is free from audio distractions.
-Kate Kilcoyne

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2. Three different strategies in the home setting that can help is talking very slow and putting an emphasis on the important words, try communicating in a quiet setting, and make sure you have your child's full attention before communicating.

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2. Three different strategies in the home setting that can help is talking very slow and putting an emphasis on the important words, try communicating in a quiet setting, and make sure you have your child's full attention before communicating.

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An example of a no/low technology device could be closed captioning. This can help the individual read what is being said and help them stay on task. Another example could be a poster with class rules/ expectations so they can read what they are rather than listening to them and potentially missing something. An example of a mid technology device could be something like noise canceling head phones. ADP makes it harder for individuals to focus in noise areas, so canceling the noise could help them focus on their independent work. Another example of mid technology could be a text to speech software to help them better understand what people are saying. An example of a high technology device could be a personal FM system to help the student and teach communicate better. Another example could be a sound field system that helps amplify the teachers voice throughout the classroom.

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The most common way to assess APD is with a group of hearing tests by an audiologist. Doctors look for a multitude of specific hearing issues. Auditory closure is when a child has trouble "filling in the gaps" of speech. This makes it hard for a child to understand when the speaker is talking very fast or mumbles. Dichotic Listening is when a child has trouble understanding two meaningful speeches happening at the same time, neither will be processed. Temporal processing is when the timing of a child's processing is delayed, which helps them figure out the difference between short sounds.
Some accommodations for APD is allowing students to test in a separate and quiet location to limit distractions. Another is to let the student know ahead of time that a question will be coming his or her way, or give it in written form.
https://study.com/special-needs-education/auditory-processing-disorder.html

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What Is Auditory Processing Disorder?

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 these conditions.

What Causes Auditory Processing Disorder?

Often, the cause of a child's APD isn't known. Evidence suggests that children with head trauma, lead poisoning, seizure 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 system matures.

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

individual therapies

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 box.

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 APD.

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 toward success.

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

visual aids

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.

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how can i help my child with academic progress

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Kids with APD can't understand what they hear in the same way other kids do. That's because their ears and brain don't fully coordinate. But early diagnosis and a variety of strategies can help them.

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1. There are many different ways that family can show their support for their child with Auditory Processing Disorder. Some ways they can help is talking slower, putting an emphasis on the important words, have child face you when talking, try to communicate in quieter places where this is not much background noises. The most important is to be compassionate and understanding of the child's disorder and to help in the best way possible. Challenges can include child misunderstanding things, missing important info you tell them, however the suggestions above should help these barriers.

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Independence: People with auditory processing disorder can face challenges like difficulty understanding speech and following multi-step directions without visual cues. Providing a quiet area can help with independent work, they can sit near the teacher and away from auditory distractions like doors or windows. An assistive listening device can also be provided so that they can distinguish the teacher's voice and are able to do their work and understand without someone assisting them.

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Auditory processing disorder (APD) makes it hard for students to process and make meaning of sounds. That can make it hard to learn - from focusing on what a teacher says to learning how to read.

Here are some examples of accommodations teachers can use to help with auditory processing disorder in the classroom.

Classroom seating, materials, and routines

Provide a quiet area for independent work.

Let the student sit near the teacher and away from auditory distractions, like doors and windows.

Check in frequently to make sure the student understands the work.

Provide an assistive listening device to make it easier to distinguish the teacher's voice.

Give extra time for testing.

Giving instructions and assignments

Give step-by-step instructions, and have the student repeat them.

Use attention-getting phrases like "This is important to know because...."

Decide with the student on a nonverbal signal to show that a key point is being made.

Say directions, assignments, and schedules out loud, and rephrase as needed.

Repeat key information throughout the lesson, and rephrase as needed.

Use visual tools, images, and gestures to enhance and support spoken lessons.

Break down test or classwork instructions into short, written steps.

Highlight key words and ideas on worksheets.

Give written homework instructions.

Provide a list of homework assignments for the week (or day).

Introducing new concepts/lessons

Speak clearly and slowly when presenting new information.

Give material on a new concept to the student before it's taught to the whole class (so the student can get familiar with it ahead of time).

Give a list of or highlight key vocabulary and concepts for upcoming lessons.

Give a short review or connection to a previous lesson before teaching something new.

Give the student an outline of the lesson.

Grade based on the student's completion of the lesson goal. (For instance, don't grade spelling errors if that's not what the student was supposed to learn.)

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Ginny Osewalt is a dually certified elementary and special education teacher with more than 15 years of experience in general education, inclusion, resource room, and self-contained settings.

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Classroom accommodations for auditory processing disorder

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What classroom accommodations can help students with auditory processing disorder? Here are strategies teachers can try at school.

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Families can help students with auditory processing disorder at school by giving them preferred seating, visual cues, emphasizing keywords, and assistive technology. They can help at home by using brain-training computer programs to help build skills and taking them to emotional and speech-language therapy.

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Children with auditory processing problems are weak in some basic skills for decoding and remembering what they hear. They often miss, or misunderstand, information that's conveyed orally, in instruction or conversation.

Helping kids with weak auditory processing skills is a combination of building in supports in their environment, and intensive training to beef up skills they haven't developed automatically, as most kids do.

Here are some of the changes parents and teachers can make in the environment to help kids with auditory processing difficulties listen and learn more effectively:

Preferred seating. Arrange for the child to have seating that will make it as easy as possible for him to tune into what the teacher is saying. That usually means the front of the classroom, to minimize interference with the teacher's voice, and get the most access to the teacher's visual cues.

Use visual cues. Encourage your child's teacher to use visuals in instruction, and be sure your child is looking at you when you give directions or convey other important information.

Emphasize key words. Teachers and parents can help kids with auditory processing weakness by using intonation and slower speech to emphasize what is important. "One of the things we advise teachers to do with these kids is to significantly slow their rate of speech and use emphasis on key words, to bring attention to important pieces of information by the way they're talking," explains Rachel Cortese, MS, a speech-language pathologist.

Give kids a heads up when something important is coming. Cortese suggests using catchphrases to give kids a signal that you're about to say something they need to pay attention to. It could be something as simple as, say: Are you ready? or Here's the thing.

Help with sequencing. Use words that trigger or help a child to sequence events. "Using words like first, second, then, last help kids follow sequences, and teaching them to us these transition words in writing or telling a story helps them to organize their thoughts and their language," explains Cortese.

Assistive technology. For kids who need extra help following the teacher's voice in a noisy classroom, there is technology that can help. The student wears headphones that reduce background noise, and the teachers wears a microphone wirelessly connected to his headset.

Kids who have auditory processing challenges may benefit from working with a speech-language pathologist or educational therapist to strengthen skills through practice and learn effective ways to compensate for their deficits and build on other strengths.

Speech-language therapy

The most common kind of professional help for kids with these difficulties is speech-language therapy, in which kids get explicit training to improve their skills at distinguishing sounds, remembering sounds, and sequencing sounds.

"Our minds are designed to pick up automatically on these skill sets for taking in language," explains Matthew Cruger, PhD, the director of the Learning and Development Center at the Child Mind Institute. "So for kids who don't pick them up automatically, the goal is to provide instruction that's more frequent, more systematic, and more rigorous."

Dr. Cruger notes that while it's widely accepted that these interventions help, there isn't a good body of real world research to back that up. Complicating the research challenge, he notes, is the fact that when kids who get intervention show improvement, it's difficult to know whether it's the result of the therapy or the child's auditory pathways maturing over time. But he adds that waiting to see if a child's problems will go away over time can leave kids feeling frustrated and suffering from impairments. Those things can take a toll on their emotional and social development, as well as their learning.

Educational therapists help kids who are struggling with learning to develop strategies to manage frustration, build on their strengths, and compensate for their weaknesses. They look for ways to bolster a child's specific weaknesses-for instance, using multi-sensory learning for a child with an auditory processing condition who is struggling with reading. And they work on bolstering the confidence of kids who are discouraged because learning seems harder for them than other kids.

There are several "brain training" programs designed to build skills in identifying sounds and remembering auditory information, including FastForWard and Earobics.

Frequently Asked Questions

How is auditory processing disorder treated?

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Help for Kids With Auditory Processing Disorder - Child Mind Institute

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Improving the listening environment and boosting skills can help kids who have trouble taking in information, and remembering it.

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This resource explains what the disorder means and how it can be treated. It also has many questions that have been answered on the website, so people can have answers. Lastly, it promotes audiologists just in case anyone needs to schedule an appointment to see if they have the disorder.

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Auditory processing disorders (APDs) are referred to by many names: central auditory processing disorders, auditory perceptual disorders, and central auditory disorders. APDs affect the auditory areas of the brain.

An auditory processing disorder is a broad term used to describe a variety of different auditory challenges rather than a single event. Broadly, auditory processing disorders negatively impact the brain's interpretation of sounds. Individuals with auditory processing disorders may not perceive subtle differences in sounds of words even though the sounds are loud enough. This difficulty becomes more noticeable in noisy or challenging listening environments or when listening to complex information.

What Are the Signs and Symptoms of an Auditory Processing Disorder?

Children and adults with APD often report difficulty hearing in background noise, in rooms that reverberate (echo) and/or other less-than-ideal listening situations.

Individuals often need more time to process auditory instructions, they "mishear" information and look for visual cues to help fill in the missing auditory information.

Who Is Affected by APDs?

APD is often associated with various learning disabilities. Children with APD experience difficulties in less-than-ideal (noisy) listening situations and may have difficulties with reading, spelling, attention, and language problems.

APD is common in older adults, particularly when hearing loss is present. It is likely that many processes and problems contribute to APD in children.

In adults, neurological disorders such as stroke, tumors, degenerative disease (such as multiple sclerosis), and head trauma can contribute to APD. (Musiek, 2009)

How Common Is an Auditory Processing Disorder?

The exact prevalence of auditory processing disorder is variable given the wide definitions of auditory processing and how it is measured in different areas.

Some research has suggested a prevalence of 2-3 percent in the pediatric population (Chermak and Musiek, 1997), with other estimates at 3-5 percent (Santucci cited in Matson, 2005). Up to 5 percent in school-aged children according to the National Institutes of Health.

A 2:1 ratio of boys to girls has also been cited.

What Causes an Auditory Processing Disorder?

There is no single cause of auditory processing disorder; however, it is linked to risk factors such as (Musiek and Chermak, 2009):

Chronic ear infections

Premature and/or traumatic birth history

Seizure disorder/epilepsy

Head trauma

Lead poisoning

Stroke

Meningitis

How Does an Auditory Processing Disorder Affect an Individual's Life?

Auditory processing disorders make communication more challenging overall. For children, this often leads to learning difficulties in school and perceived behavioral challenges due to miscommunication. For adults, auditory processing disorders may lead to decreased communication due to frustration. The social isolation of hearing loss is a tragic outcome of this untreated disorder.

Who Can Diagnose an Auditory Processing Disorder?

APD is an audiological diagnosis, and therefore, the audiologist is the professional who generally makes the diagnosis.

How Is an Auditory Processing Disorder Diagnosed?

To properly diagnose APD, special tests need to be administered by an audiologist. Individuals with APD usually pass standard hearing tests because standard hearing tests are designed to test the quietest sounds one can hear. APD may be present with or without hearing loss.

Can an APD Be Treated or Cured?

APD in children and adults often is best managed by a multidisciplinary team of professionals that may include audiologists, speech-language pathologists, psychologists, and teachers, to evaluate and treat hearing, language, cognition, and academic issues.

Although APD treatment is usually determined based on the likely cause of APD, a variety of treatment approaches may be recommended. These approaches can include medical treatment, hearing aid amplification, assistive listening devices, auditory training, and special listening strategies. Treatment strategies are usually provided by audiologists, although physicians, speech-language pathologists, psychologists, teachers, and other professionals may be involved.

How Can Educators Help Spot an Auditory Processing Disorder in Children?

Whenever a concern for hearing is present, educators should refer for a comprehensive hearing assessment first. If hearing sensitivity is normal an auditory processing screening should then be performed. Children with medical histories that include frequent middle-ear infections, lead poisoning, seizure disorder, extreme prematurity all present with greater risk factors associated with auditory processing disorders.

Think Your Family Member Has an Auditory Processing Disorder? Find an Audiologist.

If you or a family member needs to be tested for an auditory processing disorder, use the Academy's Find an Audiologist Directory to find an audiologist near you.

References

Chermak G, Musiek F. (1997) Central Auditory Processing Disorders: New Perspectives. Sand Diego, CA: Singular Publishing

Musiek F, Chermak G. (2009) Diagnosis of (Central) Auditory Processing Disorder in Traumatic Brain Injury. The ASHA Leader.

Maston A. (2005) Central auditory processing: a current literature review and view and summary of interviews with researchers on controversial issues related processing disorders. Washington University School of Medicine.

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Auditory Processing Disorders - American Academy of Audiology

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Auditory processing disorders (APDs) are referred to by many names and can affect the auditory areas of the brain. Learn more.

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This journal describes the evaluation, treatment, diagnosis/prognosis and characteristics of APD. It reviews studies that have been done on the disorder and how it presented.

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Continuing Education Activity

Central auditory processing disorder is a rare, poorly understood condition that affects the central auditory nervous system. Patients are classically young children presenting with hearing difficulties but may have other learning disorders, such as attention deficit hyperactivity disorder. The condition requires a multidisciplinary team to diagnose and manage the disorder, with further research in these areas. This article reviews the basic principles of the condition as well as identification and management and explains the role of the interprofessional team in the delivery of patient care.

Objectives:

Understand how the central auditory nervous system works and how its dysfunction relates to central auditory processing disorder.

Describe the common signs and symptoms of central auditory processing disorder.

Summarize the types of tests used to diagnose central auditory processing disorder.

Outline the management strategies for central auditory processing disorder.

Access free multiple choice questions on this topic.
Introduction

Central auditory processing (CAP) is the ability to perceptually receive stimuli within the central auditory nervous system (CANS) and conduct the subsequent neurobiological activities that give rise to the electrophysiological auditory action potentials.[1] Disruption of this process will result in deficits in speech perception, sound localization, auditory discrimination, and temporal characterization of sounds.[2]

Central auditory processing disorder (CAPD) is a condition that primarily affects the CANS. Patients with CAPD tend to have normal outer, middle, and inner ear anatomy with preserved function; however, they have deficits in the neural processing of auditory stimuli that are not due to cognitive or higher-order language pathology.[3]

The CANS extends from the cochlear nucleus in the brainstem to the auditory cortex. Auditory information reaches the cochlear nucleus from the peripheral auditory system via the auditory nerve. A series of nuclei transmit the information to the cortex for the perception of sound to occur: the cochlear nucleus, the superior olivary nuclei, the lateral meniscus, the inferior colliculus, and the medial geniculate nuclei.[4]

There are several levels of crossing fibers throughout the brainstem, allowing both ipsilateral and contralateral signals to contribute to the many aspects of auditory processing.[5] There is also a series of descending neuronal circuits within the auditory system, which allows for the modulation of auditory processing at multiple levels.[6]

The auditory system is highly interconnected with ascending, descending, and crossing fibers that enable higher-order functions from the prefrontal cortex, hippocampus, limbic circuits, etc., to connect directly or indirectly with the auditory system, giving rise to our perception and understanding of auditory information.[7]

CAPD is primarily a condition that affects children and is highly prevalent in patients with diagnoses of learning difficulties such as dyslexia, attention deficit disorder (ADHD), and autism spectrum disorder (ASD).[8] However, CAPD can affect adults of all ages, as there are multiple etiologies, including cerebrovascular disease, malignancy, and neurotoxicity. Clinically, CAPD presents in young children as behavioral characteristics.[9] These include:

Difficulty in localizing sound

Difficulty in understanding language in noisy backgrounds or when words are presented rapidly

Longer response times in oral communication

Inappropriate or inconsistent responding

Poor attention span and easy distraction

Reading, spelling, and learning difficulties

Inability to follow complex commands or directions

This list is not exhaustive, and there is significant symptomatic overlap with the aforementioned learning disorders, e.g., ADHD.

To diagnose CAPD, a battery of auditory diagnostic tests examines the integrity of the CANS. Problems with the CANS may be isolated or associated with conditions that interact with other sensorimotor modalities and/or higher-level cognitive functions. Therefore, to diagnose CAPD effectively, a multidisciplinary team approach that considers other parameters such as cognition, memory, and linguistics should be employed.[9]

The information must be collected from a thorough review of the patient's medical, educational, and developmental background, as behavioral and electrophysiological tests in conjunction with relevant imaging and assessment of speech, language, and cognition.[9]

Intervention should be undertaken immediately once evidence from behavioral and/or electrophysiological tests demonstrate deficits in the CANS sufficient to diagnose CAPD. When CAPD is identified early, there is an opportunity to utilize the brain's plasticity to induce cortical and brainstem reorganization.[10] Intensive interventions and auditory training that exploits this plasticity are most likely to produce successful outcomes.[11]

Etiology

CAPD can be a difficult condition to diagnose, given that its etiology is so broad. Generally, CAPD is linked to a specific lesion or disorder, or the cause may be unknown.

There are several leading causes and risk factors for CAPD.[12] They are as listed below.

Neurological disease or damage

Cerebrovascular disorder - e.g., stroke

Brain injury or damage - e.g., meningitis or head trauma

Neurodegenerative disorders - e.g., multiple sclerosis

Lesions or tumors of the central nervous system (CNS)

Neurotoxins - e.g., heavy metals

Otological disease - e.g., auditory deprivation as a result of chronic otitis media

Prenatal/neonatal risk factors

Epidemiology

Unfortunately, it is difficult to calculate the incidence and prevalence of CAPD due to the lack of standardized diagnostic criteria and guidance from different academic organizations varies. However, some studies have given estimates on prevalence.

In patients over the age of 55 years, the prevalence of CAPD has been estimated to be between 27% and 75%; however, it is as high as 95% in the population over 80.[13][14]

This extreme range of estimates in prevalence is also reflected in the pediatric population. Using different diagnostic criteria causes significant variability in the estimated prevalence of CAPD within the same population group. A 2013 study demonstrated that using nine different sets of diagnostic criteria on a population of children that completed CAPD assessment ranged from a prevalence of 7.3% with the strictest criteria to 96.0% with the most lenient.[15]

CAPD tends to affect males more than females, with a male: female ratio of 2 to 1.[16] Further studies on the epidemiology of CAPD are clearly needed, and standardized criteria that can give a more accurate representation of the actual prevalence of the condition should be developed and universally adopted.

Pathophysiology

The pathophysiology of CAPD is classified into two categories based on coexisting conditions:

1) Neurological conditions

Very few cases of CAPD in children will have an underlying neurological pathology; nonetheless, CAPD may be the only presenting manifestation of a space-occupying lesion. For this reason, when patients present with CAPD, there must be a high level of clinical suspicion for underlying CNS pathology, and performing a thorough neurological and developmental examination is critical.

2) Delayed central nervous system maturation or other developmental disorders

Despite the fact that the human auditory system is already fully developed at birth, myelination in the higher auditory pathways is still occurring up until the ages of 10 to 12 years.[12] Therefore any form of auditory deprivation, even in diseases such as chronic glue ear, can have disastrous effects on the organization and maturation of the central auditory pathway, a fact that may explain the correlation of CAPD with other developmental and behavioral disorders, such as ADHD.[17]

History and Physical

A thorough history must be taken to determine the nature and type of disorder, along with its impact and functional ramifications. This will also help to delineate the diagnosis and the subsequent treatment plan.

Information gathering should focus on the patient's family and genetic history; the pre-, peri-, and post-natal course; current health, including medications; developmental history, especially communication and listening behavior; psychosocial factors; education; social behavior; and any other hearing concerns.

The history can be obtained directly from the patient, although this may be difficult in a younger patient; therefore, collateral history from the parent or family members is extremely beneficial.

A thorough neurological examination should also be conducted, as other signs may be elicited that could reveal the cause of the presenting symptoms; focal neuropathy, for example, may present if there is a space-occupying lesion.

Patients presenting with CAPD will frequently present with one or several of a set of specific behavioral characteristics. They will be uncertain about what they hear or misunderstand what has been said and have difficulty understanding or listening in loud or noisy environments with frequent requests for repetition.[9] Patients may also have difficulty paying attention, are easily distracted, have difficulty localizing sounds, and have associated learning difficulties.

CAPD symptoms will become apparent in the early school years or later during the more academic stage of patients' lives as their environments change and there is increased demand for focus and concentration. In rare cases, this presentation can manifest a neurological disorder rather than isolated CAPD.[12]

Because individuals with CAPD have primary auditory difficulties, young patients are liable to develop associated language, reading, writing, and spelling disorders. Therefore, it is crucial to recognize that the behavioral characteristics associated with CAPD are not exclusive to this condition and that other diagnoses present similarly, such as ASD, ADHD, learning disorder, and language impairment; these characteristics are not pathognomonic of CAPD.[12]

Evaluation

There are two primary diagnostic modalities: behavioral and electrophysiological. To diagnose CAPD, tests have to evaluate the integrity of the CANS. Combining these modalities allows clinicians to assess the CANS via a bottom-up sensory approach and top-down cognitive evaluation.[9] A sizeable battery of tests can be utilized by an interprofessional team that includes physicians, audiologists, speech and language therapists, and psychologists. An accurate diagnosis requires careful consideration of the following parameters:[9]

Cognitive, memory, and linguistic assessments

Medical, education, and developmental histories

Electrophysiological tests

Speech and language assessment

Some electrophysiological tests will require specialist audiometry equipment and must be carried out in an acoustically controlled environment under the guidance of trained audiologists. These test results will be interpreted by audiologists, who are responsible for accurately assessing hearing and balance.

Although there is no universally accepted screening program for CAPD, there is still a need to identify patients likely to benefit from further central auditory testing. Screening is performed in children who have shown delays in speech and language development, following which abbreviated test protocols can then be followed. Questionnaires and checklists are available for clinicians to determine a patient's auditory and social behaviors and then ascertain whether a more systematic approach to evaluation needs to be taken.

Initially, a peripheral cause for any hearing loss or behavioral characteristics should be sought, as peripheral auditory disorders, e.g., conductive or sensorineural hearing loss, can similarly affect an individual. However, if there is an identified cause of peripheral hearing loss, it does not preclude further assessment for CAPD. It may, nevertheless, alter the results of further testing - in patients with profound hearing loss, testing cannot be completed. Therefore, tests that utilize stimuli minimally affected by peripheral hearing loss should ideally be used.[18]

To effectively evaluate the CANS, an audiologist must select an appropriate CAPD test battery. Findings from the patient's history, language assessments, cognitive assessments, and peripheral hearing tests will inform the decision of which tests to administer to diagnose or exclude dysfunction of the CANS.[19]

Appropriate test selection may pinpoint impairments in the neurophysiological processes that occur within the CANS, which will lead to more precisely targeted treatment plans. Tests of auditory discrimination are used to determine the ability to differentiate between similar acoustic stimuli that have different frequencies, intensities, and temporal characteristics. Tests that assess the auditory temporal processing ability monitor how the CANS analyzes acoustic events over time. Additional tests should assess the CANS' ability to separate or integrate (binaural separation or binaural integration) different sounds presented at each ear simultaneously.

The ability to recognize speech in noise, speech in competition, low pass filtered speech, and rapid speech are assessed using monaural low redundancy speech tests. Binaural interaction tests are used to evaluate the CANS' ability to combine inputs that complement each other when simultaneous and otherwise identical stimuli are distributed between the ears with different intensities, timing, or spectral differences.[20]

Essentially, behavioral tests fall into three main categories.

1) Monaural low redundancy

This type of test presents speech stimuli to one ear, which will either be accompanied by competing signals, e.g., background noise, or degraded in terms of their frequency context. The patient is then asked to identify the correct speech stimulus.[12]

2) Dichotic or binaural interaction tests

The stimuli are presented to one or both ears, and the patient is asked to identify the side of the stimulus.[12]

3) Temporal tasks

The patient is asked to identify auditory stimuli in sequencing tasks.

Electrophysiological tests asses the neural processing and functioning of the auditory structures of the CANS from the vestibulocochlear nerve to the auditory cortex.[21] These tests include:

Electrophysiological tests tend to be preferable in the following circumstances:

When behavioral tests are not feasible, e.g., in infants and young children or non-English speakers

Suspicion of a neurological disorder

To confirm behavioral test findings

If behavioral tests are inconclusive

Treatment / Management

Each patient will have specific needs and, therefore, a unique treatment plan devised by a multidisciplinary team. The overall aim of any treatment plan is to allow the patient to communicate effectively in everyday situations, such as school and work environments.

There are currently three main treatment approaches for patients with CAPD that are recognized by the American Speech Language Hearing Association:

These three methods complement one another to provide auditory training in a bottom-up fashion along with the recruitment of higher-order brain functions, i.e., the top-down approach that helps patients compensate for the disorder. Changing the patients' environment further maximizes their opportunities to process auditory stimuli effectively.

Direct skills remediation targets the individual tasks of auditory processing. These skills may help with difficulties in the following:[22]

Auditory pattern recognition

Sound localization and lateralization

Inability to recognize auditory stimuli in the presence of background noise

Recognition of different auditory information when it is presented into each ear simultaneously

Computer-based training methods are used for direct skills remediation and can address both auditory system and language deficits. These programs are designed to utilize the brain's plasticity within the auditory system.[23] Another category of direct skills remediation is exercises that train interhemispheric transfer, the process responsible for binaural hearing and processing.[24]

Compensatory strategies are referred to as the top-down approach, and they effectively reduce the impact of CAPD on patients' language, cognition, and learning. These strategies target higher-order abilities such as memory and attention and strengthen them to develop communication, improve social and listening skills, and optimize learning outcomes. Compensatory strategies can be split into two different categories: metalinguistic and metacognitive.

Metalinguistic strategies focus on predicting elements in a message (schema induction) and using grammar to identify links and relationships between sentences. Patients can use a better understanding of context and active listening to create a broader vocabulary. Metacognitive strategies, in contrast, are more internally focused, looking at self-instruction, metamemory skills, organization skills, problem-solving, and assertiveness training.[25]

Environmental modifications allow the patient to improve access to any auditory information with which they are presented. This approach can be split into two categories:

Enhancement of the listening environment and the auditory signal (bottom-up)

Management approaches (top-down)

These two methods aim to improve the overall clarity and the audibility of the signal that is received and to improve access to the signal's information. Enhancement of the listening environment involves making physical modifications to the patient's physical surroundings to improve the acoustics, such as covering reflective surfaces, removing any objects that generate background noise, placing absorption materials in open spaces, and using acoustic dividers.

Management approaches try to develop the compensatory ability of the higher-order neural processing centers and support the areas of the CANS that are deficient. Examples of management approaches include: advising speakers to slow their speech, emphasizing keywords, checking to understand, and using visual aids and written support.

Differential Diagnosis

Other clinically distinct disorders present similar to CAPD and can cause similar behavioral auditory function test results, producing comparable functional listening difficulties. For example, patients diagnosed with ADHD often present with deficits in tasks designed to challenge the CANS.[26]

Patients with any learning disability, developmental delay, or psychological disorders, e.g., ADHD or ASD, should be screened for CAPD. Therefore, a multidisciplinary assessment is required to distinguish diagnoses from one another. Children, in particular, with any of these conditions not only present similarly but also tend to have similar scores on cognitive, communication, and auditory evaluations.[27]

Prognosis

The management of CAPD does have a certain degree of controversy surrounding it, as many of the proposed interventions are based on assumptions. One such assumption is that the brain's ability to process incoming auditory signals follows a bottom-up pathway, i.e., sensory-to-cognitive, and therefore deficits in the auditory process result in language impairments. It would then follow that attempting to rectify auditory deficits would lead to an improvement in language abilities.[28]

While this may not necessarily be true, there is sufficient evidence to indicate that current management strategies for CAPD benefit patients; future research is required to determine how and why these methods work.[12]

Prognostically, children diagnosed with CAPD before their teenage years can "grow out" of the disorder because auditory information is processed in areas of the brain that can still develop until around the age of 13. Auditory processing can still improve in other patients receiving therapy for CAPD; however, in older patients, the treatment should be orientated towards developing new coping mechanisms instead of relying on neural plasticity. It is recommended that patients diagnosed with CAPD be retested every 1 to 2 years to ascertain whether or not there have been any improvements.

Complications

CAPD predominantly affects children's speech and language development, resulting in difficulty in communication. These difficulties may also affect the ability to read and write, resulting in dyslexia or other conditions associated with talking and understanding, e.g., ASD. In adults, CAPD may cause similar complications, but difficulties may manifest in a more limited fashion, such as in processing sound localization.

Deterrence and Patient Education

Studies indicate that patients and their families lack awareness of CAPD, not just in the work and education sectors but also in healthcare, and this leads to difficulty accessing support for CAPD.[29] CAPD's social media presence is growing. However, providing a resource that audiologists can use to promote awareness of CAPD and provide reliable information about the condition.

There are screening tests to identify CAPD; however, there is currently no standardized methodology. Questionnaires and checklists are used to measure and record auditory behaviors and deficits, but they are not yet universally accepted. More widespread use of standardized screening would likely identify more patients with CAPD and do so earlier, thereby potentially improving access to care and functional outcomes.

Enhancing Healthcare Team Outcomes

CAPD is a disorder that still requires a lot of research; it is a very complex and under-recognized condition. The lack of an effective screening program further compounds the challenge of diagnosing the condition promptly. Furthermore, there is increasing evidence to suggest that CAPD overlaps symptomatically with many other more prevalent and better-recognized disorders, such as ADHD, dyslexia, and ASD. For this reason, it is important to have a high index of suspicion for CAPD when evaluating children with learning disorders if they are to be managed effectively.

Effective screening programs still need to be developed so that implementation as part of routine health maintenance could help to identify children with CAPD at a younger age, thereby allowing clinicians to capitalize on available neural plasticity to remedy the condition.

CAPD has features of not just neurological disorders but also developmental disorders. CAPD has been linked definitively to certain conditions and syndromes, but with other disorders, the relationship to CAPD is poorly understood. Through additional research, a clearer insight into exactly how CAPD alters auditory processing may lead to the development of more effective management strategies for use by the interprofessional healthcare team. [Level 5]

References

Disclosure: Isaac Aristidou declares no relevant financial relationships with ineligible companies.

Disclosure: Marc Hohman declares no relevant financial relationships with ineligible companies.

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Central auditory processing (CAP) is the ability to perceptually receive stimuli within the central auditory nervous system (CANS) and conduct the subsequent neurobiological activities that give rise to the electrophysiological auditory action potentials.[1] Disruption of this process will result in deficits in speech perception, sound localization, auditory discrimination, and temporal characterization of sounds.[2]

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This article discusses the list of symptoms for Auditory Processing Disorder. It also states that because these symptoms overlap with other disabilities, we cannot use this list alone to diagnose an Auditory Processing Disorder.

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Signs and Symptoms of Auditory Processing Disorders

There are many behaviors that may point to APD. Individuals with APD demonstrate a poor ability to:

Direct or divide attention

Discriminate subtle differences in sounds and words

Read, spell, write, understand vocabulary, or learn a foreign language

Understand rapid speech

Hear in noisy, social environments

Recognize and integrate a sequence of sounds into words or other combinations

Remember and/or comprehend spoken information

Understand instructions

Follow long conversations

Follow multi-step directions

Maintain focus on an activity if other sounds are present

Take written notes from speech

Complete verbal math problems

Learn songs or rhymes

Because these symptoms overlap with other disorders, auditory processing disorder cannot be diagnosed from this list of symptoms alone. The condition can only be diagnosed by audiologists, who use tests that measure specific auditory processing functions.

Symptoms like difficulty listening, remembering information, or understanding spoken language, make APD commonly confused with Attention Deficit Hyperactivity Disorder (ADHD) or dyslexia, but it is distinct from both.

With ADHD and dyslexia, there is no impairment of the processing of auditory input in the central nervous system.

Children with ADHD tend to exhibit inattention, distractibility, and hyperactivity in any environment, while children with APD usually don't have difficulty focusing and paying attention in quiet environments.

While those with dyslexia also have difficulty memorizing, spelling, thinking and/or understanding, these difficulties do not exist because of an inability to hear clearly. Unlike APD, dyslexia is a language-based learning disability.

See more information at American Speech-Language-Hearing Association.

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Signs & Symptoms | Auditory Processing Disorder - Hearing Health Foundation

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There are many behaviors that may point to APD.

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This article gives an entire overview of Auditory Processing Disorders. It discusses the symptoms and signs of ADP and what kind of complications it can come with.

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Auditory Processing Disorder (APD): Symptoms & Treatment

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Auditory processing disorder (APD) is a condition where your brain can’t understand and interpret certain sounds the way it should.

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This website explains the factsheets of APD and the statistics. It also explains what teachers should know about the disorder and what they can do about it to help that child out.

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What Teachers Should Know

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.

Kids with APD often have trouble recognizing differences between sounds in spoken words, even when the sounds are loud and clear enough to be heard. This usually happens when there's background noise, like in a typical classroom.

Kids with APD may need to use 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.

These problem areas can affect students 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.

If the auditory deficits aren't identified and managed, many students with APD will face academic challenges.

Students with APD can benefit from working with a speech and language therapist, in addition to getting regular evaluations by audiologists.

What Teachers Can Do

APD is an auditory issue and not a cognitive, speech, or language disorder. Your student may feel embarrassed to let you know they did not understand what you said or directions you gave. Making sure that students with APD write down assignments and helping them stay organized may ease their frustration and boost their self-esteem in the classroom.

It can help to speak at a slightly slower rate with a clear voice. Louder does not always help. (Think Mr. Rogers!)

Teachers also can help students with APD by:

using strategic (or preferential) seating so the child is closest to the teacher. This reduces sound and sight distractions and improves access to speech.

pre-teaching new or unfamiliar words

using visual aids

recording lessons for later review

Date reviewed: February 2021

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Auditory Processing Disorder Factsheet (for Schools)

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What teachers should know about APD, and teaching strategies to help students who have the disorder.

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APD is a disorder in which audio processing of an individual is developmentally delayed, resulting in loss of hearing and attention when being spoken to/listening to material.-kate kilcoyne

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APD is a disorder in which audio processing of an individual is developmentally delayed, resulting in loss of hearing and attention when being spoken to/listening to material.-kate kilcoyne

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This article discusses how some comorbidities can predict an Auditory Processing Disorder. There is not as much research done for ADP, but when other disabilities are present it can help to diagnose them.

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They may have difficulties processing information, misunderstanding, or mishearing words. They might also have a hard time paying attention and being easily distracted.

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How is it Treated?

Auditory Processing Disorder is relatively rare - with only about 3-4 percent of the population truly having APD - and is not always fully understood.

Currently, APD is recognized as a "specific learning disability" under the Individuals with Disabilities Education Act (IDEA). This qualifies a student for reasonable services and accommodations at school if they have been diagnosed with APD by an audiologist.

Following a diagnosis of APD, a customized list of recommendations to best help the child succeed is created by the audiologist and provided to the child's family and school for consideration. Each child and diagnosis is different, so careful attention is taken to ensure that the child's individual needs are met appropriately.

Some examples of recommendations include:

Specific and strategic seating arrangements in class

A device to help raise the level of the teachers voice above the classroom noise, called an FM system

Written or picture-based instructions to accompany verbally presented instructions

Specific focus on auditory processing skills in a therapy setting

Can it be Cured?

The areas of the brain responsible for auditory processing abilities continue to grow and develop throughout childhood until around age 13, when the auditory system is considered to be more mature and adult-like.

Due to this gradual maturation, it is possible that a child who was diagnosed with APD before age 13 could essentially "grow out" of APD. Additionally, a child's auditory processing skills may also improve if he or she is receiving therapy for APD.

For these reasons, it is recommended that children diagnosed with APD before age 13 be re-tested every 1-2 years until after their 13 th birthday to monitor for any changes or improvements with their auditory processing skills.

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Auditory Processing Disorder (APD), also referred to as Central Auditory Processing Disorder (CAPD), is a disorder of the auditory (hearing) system that causes a disruption in the way that an individual's brain understands what they are hearing. It is not a form of hearing loss.

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This article explains what Auditory Processing Disorder is and gives some examples of things these individuals may mishear. It also includes some causes, testing, treatment and suggestions on what can be helpful to do.

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People with auditory processing disorder (APD) have a hard time hearing small sound differences in words. Someone says, "Please raise your hand," and you hear something like "Please haze your plan." You tell your child, "Look at the cows over there," and they may hear, "Look at the clown on the chair."

APD, also known as central auditory processing disorder, isn't hearing loss or a learning disorder. It means your brain doesn't "hear" sounds in the usual way. It's not a problem with understanding meaning.

People of all ages can have APD. It often starts in childhood, but some people develop it later. Between 2% and 7% of kids have it, and boys are more likely to have it than girls. The disorder can lead to learning delays, so kids who have it may need a little extra help in school.

APD may be linked to other things that cause similar symptoms. In fact, it may be part of the reason some people have dyslexia. And some experts think children are sometimes diagnosed with ADHD when they actually have APD.

APD can affect the way your child speaks as well as their ability to read, write, and spell. They may drop the ends of words or mix up similar sounds.

It also can be hard for them to talk with other people. They may not be able to process what others are saying and come up with a response quickly.

Your child also may find it hard to:

Follow conversations

Know where a sound came from

Listen to music

Remember spoken instructions, particularly if there are multiple steps

Understand what people say, especially in a loud place or if more than one person is talking

Doctors don't know exactly what causes APD, but it may be linked to:

Illness. APD can happen after chronic ear infections, meningitis, or lead poisoning. Some people who have nervous system diseases, such as multiple sclerosis, also develop APD.

Premature birth or low weight.

Head injury.

Genes (APD may run in families).

Your doctor can use a hearing test to see if your child's issues are caused by hearing loss, but only a hearing specialist, called an audiologist, can diagnose APD.

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Could you or your child have an auditory processing disorder? WebMD explains the basics, including what to do.

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Social: Individuals with APD are not deaf, they can pass a standard hearing test, stop and turn when someone is trying to get their attention, and appear to be digesting all the information during a conversation. However, the message that reaches them is unclear. Because of this, individuals with APD may participate less in conversation in order to avoid ridicule or frustration.
Academic: APD can inhibit phonemic awareness, making it hard for students to identify the isolated sounds in language. When students are unable to tell the difference between similar sounds, sounding out words can be particularly challenging. This affects reading fluency and comprehension

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What is Auditory Processing Disorder (APD)?

The social and academic impact of APD can sometimes go unnoticed. Individuals with APD often have difficulty understanding and interpreting what they hear. They can listen attentively to speech that is clear and loud, yet still receive a muddled, confusing message. This can lead to a number of social and academic challenges.

Symptoms of Auditory Processing Disorder include:

Difficulty following directions

Difficulty following along in conversation

Frequently misinterpreting what's said or asking for things to be repeated

Difficulty with reading and/or spelling

Difficulty tuning out background noise

Having slow or delayed responses when spoken to

Difficulty with expressive and/or receptive language (organizing and expressing thoughts, understanding figurative language, words with multiple meanings, and tone)

Sensitivity to noise

Speech or language delays at young age

Difficulty with phonemic awareness

Social Impact of APD

Individuals with APD can hear. They can pass a standard hearing test, stop and turn when you call out to them, and appear to focus intently when spoken to. But the message that reaches them is unclear. Responses like huh or what after seemingly simple statements and directions are common. The absence of a laugh, when presented with a pun or sarcasm, is sometimes misinterpreted negatively by others.

Because of this, individuals with Auditory Processing Disorder may participate less in conversation in order to avoid ridicule or frustration. Their behavior can also be mistaken for a lack of intelligence, defiance, or inadequate social skills. Sensitivity to noise can turn places others often look forward to, like crowded cafeterias, gyms, and auditoriums into dreaded sources of anxiety.

Following directions and knowing what to do during sports, group activities, or even a friendly board game can be uncomfortable and challenging. Consequently, students with Auditory Processing Disorder can find themselves isolated from peers.

Academic Impact of APD

Auditory Processing Disorder can inhibit phonemic awareness, making it hard for students to identify the isolated sounds in language. Recognizing and creating rhymes can be challenging as a result. This can lead to reading and spelling difficulty.

When students are unable to discriminate between similar sounds, blending letters to decode or sound out words can be particularly challenging. This affects reading fluency and comprehension. The longer it takes to decode and read through text, the less likely a student is to recall or understand what was read afterwards. The learner becomes so focused on the process of reading that the story or passage content is lost. This can also prevent the student from recognizing when a word is used repeatedly, causing him or her to sound it out again each time, as if it were the first.

Mental Fatigue

Following along in class can be difficult for students with Auditory Processing Disorder. Because the message is muddled, they often need additional time to try and decipher what the teacher has said. The end result may be a child who's on step two when the teacher is on step five, or one who only understands part of the homework, test, or assignment directions.

As with social situations, students may respond by choosing to withdraw or tune out the speaker. This is a way of reducing frustration and avoiding drawing unwanted attention. This is especially true when previous attempts to have information repeated haven't improved understanding. The constant extra effort needed to try and interpret information can cause mental fatigue. This makes school and other tasks exhausting for an already frustrated learner. For some individuals, the choice to no longer put in this effort may soon follow.

What To Do If You Suspect APD

If you suspect your child has an Auditory Processing Disorder, an audiologist can perform an evaluation that specifically looks for and diagnoses these challenges. In order to help students be successful, a number of things can be done at home or school. Individuals with auditory processing challenges should sit close to the teacher or speaker during class instruction. Using short steps, frequent repetition of concepts and instructions, and visual aids can also be helpful.

This could mean listing simplified assignment details on the board, in a notebook, or on a Post-It note on the child's desk allowing him or her to revisit and check these reminders when unsure. Asking the child to repeat steps back to check for understanding can also be helpful when done in a way that doesn't cause the individual to feel singled out or embarrassed.

Interventions for APD

There is hope. There are a number of recognized interventions including speech therapy and research driven programs, like cognitive exercises, that can substantially improve skills. Because Auditory Processing Disorder impacts so much more than a child's ability to hear, identifying and addressing challenges early can make a world of difference.

In addition to improving a child's ability to participate in conversation and communicate orally, it can lead to progress in phonemic awareness, decoding, fluency, comprehension, and spelling. It may also enhance the student's ability to follow along in class, respond to and recall information, and complete assignments in a timely manner. These changes can have a significant impact on a child's self-esteem as well, potentially turning a frustrated, withdrawn learner into a confident and enthusiastic one.

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The Social and Academic Impact of APD - Gemm Learning

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The social and academic impact of APD can sometimes go unnoticed. Individuals with APD often have difficulty understanding and interpreting what they hear. They can listen attentively, yet still receive a muddled, confusing message. This can lead to a number of social and academic challenges.

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APD challenges include struggling to pay attention in class, following directions, needing to repeat themselves over and over again, and difficulty learning from auditions. When someone with APD gets frustrated, it can cause a decrease in communication which can become a problem in the work environment. Another challenge is when an adult struggles to process conversations while background music is being played or when multiple people talk at once. It can be difficult for them to participate in social activities.

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What Teachers Should Know

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.

Kids with APD often have trouble recognizing differences between sounds in spoken words, even when the sounds are loud and clear enough to be heard. This usually happens when there's background noise, like in a typical classroom.

Kids with APD may need to use 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.

These problem areas can affect students 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.

If the auditory deficits aren't identified and managed, many students with APD will face academic challenges.

Students with APD can benefit from working with a speech and language therapist, in addition to getting regular evaluations by audiologists.

What Teachers Can Do

APD is an auditory issue and not a cognitive, speech, or language disorder. Your student may feel embarrassed to let you know they did not understand what you said or directions you gave. Making sure that students with APD write down assignments and helping them stay organized may ease their frustration and boost their self-esteem in the classroom.

It can help to speak at a slightly slower rate with a clear voice. Louder does not always help. (Think Mr. Rogers!)

Teachers also can help students with APD by:

using strategic (or preferential) seating so the child is closest to the teacher. This reduces sound and sight distractions and improves access to speech.

pre-teaching new or unfamiliar words

using visual aids

recording lessons for later review

Date reviewed: February 2021

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Auditory Processing Disorder Factsheet (for Schools)

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What teachers should know about APD, and teaching strategies to help students who have the disorder.

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This article explains what an Auditory Processing disorder is. It also talks about how studies show that about 50% of individuals with an auditory processing disorder also have ADD or other disabilities.

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Henry is fidgety and distractible during classroom activities, according to his second grade teacher. During gym class, he's hypersensitive. He gets cranky and lashes out at classmates who "are yelling at me and telling me what to do." His mother has noticed similar behaviors at home. When he's doing homework, she says, "He uses every little sound as an excuse to delay getting down to work." Even the dishwasher distracts him, despite the fact that the kitchen is on the other side of the house. "He just can't sit still."

This sounds like a classic profile of attention deficit disorder ( ADHD or ADD), right? Well, yes and no. Henry does have ADHD, but an audiologist has also diagnosed him with something called auditory processing disorder (APD).

Do You Hear What They Hear?

While APD isn't as well known as ADHD, it is becoming increasingly common. Roughly 7 percent of children have some type of auditory hypersensitivity or processing difficulty.

But what is it exactly? At its most general, APD is a glitch in the brain's ability to filter and process sounds and words. An APD child doesn't have difficulty hearing or selective hearing - in fact, in most cases, her hearing is good. Rather, her brain perceives the sounds incorrectly, affecting the child's ability to distinguish between similar sounds (da and ga, for example).

Some children with APD also have trouble screening out background noise, so they pick up bits of surrounding sounds. The echo in a gymnasium or the hum of the air conditioner in the classroom interferes with the conversation at hand. It's like listening to the radio with interference from other stations garbling the reception.

A child with the disorder typically tries so hard to understand what's being said that she forgets parts of the conversation or doesn't pick up on the nuances or subtleties of the words. Combine APD with ADHD, and a child's abilities to listen and remember are severely compromised.
[Self-Test: Could Your Child Have Sensory Processing Disorder?]
Sorting Out Symptoms of ADD & APD

Just as APD can affect a child's ability to focus, so an attention deficit can affect auditory processing. Symptoms of the two disorders often overlap. Studies suggest that 50 percent of those diagnosed with ADHD may also have APD. Experts continue to disagree whether APD is a manifestation of ADHD, or if they are separate disorders.

How can a parent tell if his or her child has APD? In general, children with ADHD exhibit inattention, distractibility, and hyperactivity in any environment. Children with APD, on the other hand, usually don't have difficulty focusing and paying attention in a quiet space. But many children with APD are exquisitely sensitive to sound. In fact, some sounds can "hurt" - a blender, a train engine, police sirens. My daughter, who has APD, plugs her ears before the movie previews, in case the sound gets loud.

"Children with ADHD may be poor listeners and have difficulty understanding or remembering verbal information," explains Teri James Bellis, author of When the Brain Can't Hear , but "it is the attention deficit that is impeding their ability to access or to use the auditory information that is coming in," not the processing of it in the brain.

A study conducted at the State University of New York in Fredonia looked at the effects of Ritalin on auditory processing in children with both ADHD and APD. The drug didn't improve auditory processing, despite improving children's performances on a standard test that measured attention and impulsivity.

Do you think your child's poor performance in school and his social awkwardness may be caused or exacerbated by APD? Here are the facts to help you determine whether this is the case and which treatments may help.
[Free Expert Resource: Are Your Senses in Overdrive?]
The Cause

The underlying cause of APD isn't known. Experts debate whether heredity or environment - or both - are responsible for the condition. While the human auditory system is fully developed at birth, auditory pathways don't mature until the age of 10 to 12. Because of this, early influences - such as poor prenatal nutrition, a mother's exposure to cigarettes or alcohol, childhood malnutrition, and chronic ear infections - may negatively affect auditory processing. Premature birth, Lyme disease or other brain infections, closed head injury, and exposure to low levels of heavy metals (lead or mercury) may also play a role. The good news is that, because the auditory pathways continue to develop up until adolescence, APD is responsive to early intervention.

Three Disorders in One

Jack Katz, M.D., a pioneer in the field of auditory processing disorder, says that APD comprises three distinct conditions that often overlap but may occur in isolation.

Sound discrimination problems. When children learn to talk, they mimic the sounds they hear to produce speech. A child with APD may not speak clearly, using similar ("dat" instead of "that"; "free" instead of "three") rather than exact sounds long after peers have corrected themselves. Typically, children with faulty sound discrimination will run words together and drop word endings and unemphasized syllables when speaking. Reading and spelling may also be affected.

Auditory memory problems. This part of the disorder makes it difficult for a child to memorize numbers and facts, and also affects his reading and language skills. Children with auditory memory problems typically take longer to learn their telephone numbers and addresses, and have difficulty remembering basic math facts. Verbal instructions and lists are similarly tough to retain.

Language processing problems. This component of APD is the most troublesome. It affects a child's abilities to understand what's being asked of him and to socialize with peers. A child with this cognitive glitch has trouble taking oral tests and becomes confused when reading and telling stories with lots of characters and events. He will often pass up a chance to hold a conversation because of the time it takes to process words being spoken and to formulate responses.

Christina suffered from all three elements of APD. She never sang as a small child, even though she clearly enjoyed listening to music and to others' singing. "Christina could never put everything together - the words, the rhythms, the tunes," says her mother, Tricia. "Her hearing was fine - exceptional. But put her into a circle of kids singing nursery rhymes and playing spoons and tambourines, and all she wanted was to get away!" When Christina was finally diagnosed with APD, Tricia was relieved.

Diagnosing APD

"Not all language problems are due to APD, and not all cases of APD lead to language and learning problems," cautions Bellis. APD isn't diagnosed by checking off a laundry list of symptoms.

The only way to diagnose the condition is with a battery of tests, performed by an audiologist who monitors the child's hearing. A child listens to words and sentences as background noise is slowly increased and to instructions spoken at faster speeds, to determine if the ability to listen decreases.

A child should be at least 6 or 7 years old before undergoing testing. "The symptoms you commonly see in a 3- or 4-year-old are sound sensitivities and difficulties discriminating between sounds, which you'll hear in their speech," explains Wendy Tepfer, a speech and language pathologist in New York City. "They need to work with an expert in APD."

When a child reaches school age, however, Tepfer advises that APD may begin to compromise academic success. "At that age, I would recommend evaluation for APD," she says, "because now, it's not only the language but also his performance in the classroom. To manage the disorder, the student may need remediations other than speech and language therapy. A full evaluation will help you know what those are."

The Treatments

APD can be treated from childhood through adolescence - when the auditory pathways stop developing - and even later, although experts agree that the earlier the diagnosis and treatment, the better. As with ADHD, a combination of professional, school, and home therapies is most effective.

Working With a Professional

Treatment includes a wide variety of exercises that target specific auditory deficits. Therapy can range from computer-assisted software programs like Fast ForWord and Earobics to one-on-one training with a speech and language therapist. Here are some common approaches:

To overcome sound discrimination problem, a professional trains the child's brain to differentiate sounds - first in a quiet environment, then with increasingly louder background noise.

To sharpen auditory memory, an audiologist uses sequencing routines - having the child repeat a series of numbers and directions - to exercise the listening "muscles."

To manage language-processing problems, a therapist will train and encourage a child to ask a teacher, adult, or peer to repeat or rephrase an instruction or comment. The therapist and child might also work on developing a customized note-taking system that enables him to capture the information being taught in the classroom.

At School

Classroom accommodations can often include:

Improving the acoustics - closing a window, shutting a door, adding a rug - can help an APD child "hear" the teacher.

Seating a child in the front of the classroom, away from students who might be disruptive, will also enhance a child's ability to listen.

Asking a teacher to face a child, speak slowly, and use simple sentences when giving assignments can help an APD student retain the information. Writing instructions on a blackboard or a piece of paper can reinforce what was said.

At Home

The following tips will increase your child's ability to listen when he or she is at home:

Don't try to have a significant conversation when your child is in another room, watching television, or listening to music - or when an appliance is running.

Before you start a conversation, be sure your child is ready to listen (finished with what she was doing). Also, face her directly and make sure she's looking at you.

Speak slowly and use simple, short sentences; pause between ideas.

Encourage your child to ask you to repeat something that he doesn't understand.

Christina, now 11, has learned to use the latter strategy - asking questions until she grasps what's being said - with friends, parents, and teachers. "It's been successful for her," says Tricia. Eight years of speech and language therapy have helped her daughter accomplish many of her social and academic goals.

But Christina did something that her mother thought she'd never achieve - joining the chorus. "There she was, on stage, at the parents' day assembly, singing her heart out, and playing drums!" says her mother. "She was so proud of herself, and I was the only fourth-grade mom with tears streaming down her cheeks."
[Read This Next: What's the Difference Between ADD and ADHD, Anyway?]

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Could Your Child Have Auditory Processing Disorder?

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Does your child struggle to block out background noise, follow conversations or pronounce words correctly? Is she hypersensitive to sound? She may have an auditory processing disorder in addition to (or mistaken for) ADHD.

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This article talks about what Auditory Processing Disorder is and the signs/symptoms, how it is treated if there is a cure, and if it can be tested.

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How is it Treated?

Auditory Processing Disorder is relatively rare - with only about 3-4 percent of the population truly having APD - and is not always fully understood.

Currently, APD is recognized as a "specific learning disability" under the Individuals with Disabilities Education Act (IDEA). This qualifies a student for reasonable services and accommodations at school if they have been diagnosed with APD by an audiologist.

Following a diagnosis of APD, a customized list of recommendations to best help the child succeed is created by the audiologist and provided to the child's family and school for consideration. Each child and diagnosis is different, so careful attention is taken to ensure that the child's individual needs are met appropriately.

Some examples of recommendations include:

Specific and strategic seating arrangements in class

A device to help raise the level of the teachers voice above the classroom noise, called an FM system

Written or picture-based instructions to accompany verbally presented instructions

Specific focus on auditory processing skills in a therapy setting

Can it be Cured?

The areas of the brain responsible for auditory processing abilities continue to grow and develop throughout childhood until around age 13, when the auditory system is considered to be more mature and adult-like.

Due to this gradual maturation, it is possible that a child who was diagnosed with APD before age 13 could essentially "grow out" of APD. Additionally, a child's auditory processing skills may also improve if he or she is receiving therapy for APD.

For these reasons, it is recommended that children diagnosed with APD before age 13 be re-tested every 1-2 years until after their 13 th birthday to monitor for any changes or improvements with their auditory processing skills.

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Auditory Processing Disorder (APD), also referred to as Central Auditory Processing Disorder (CAPD), is a disorder of the auditory (hearing) system that causes a disruption in the way that an individual's brain understands what they are hearing. It is not a form of hearing loss.

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home:
Difficulty in understanding certain tasks such as chores, commands, help ,etc

school:

-difficulty understanding speech by teacher or peers
-difficulty in reading and spelling
Community:
-easily distracted by loud noises
-hard to focus on a certain task

Employment:
It can be really difficult when talking to customers if they are impatient and unaware of disability, so may need to ask to repeat a few times.
Social and Emotional:
Can be hard as you can misinterpret lots of different things both social and emotionally.
relationships:
Difficult to hear what the other person in saying and misinterpret it for something else

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Auditory Processing Disorder can be present alongside other disabilities. Individuals may also experience learning disabilities, language impairments, ADHD, and autism spectrum disorder.

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This disorder is relatively rare among the population, with only 3-4 percent prevalence.  APD was found in 5% of US children and 1% of US adults who referred to an audiology clinic
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930331/#:~:text=(13)%20estimated%20a%20prevalence%20of,general%20audiology%20clinic%20(13).
Both of these resources give the same estimation of overall prevalence of APD in the US. One gives extra information regarding its prevalence in children and adults

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Some potential causes can be head trauma, seizure disorder, chronic ear infections, premature birth, genes (could run in the family). https://kidshealth.org/en/parents/central-auditory.html#:~:text=What%20Causes%20Auditory%20Processing%20Disorder,be%20more%20than%20one%20cause.

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What Is Auditory Processing Disorder?

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 these conditions.

What Causes Auditory Processing Disorder?

Often, the cause of a child's APD isn't known. Evidence suggests that children with head trauma, lead poisoning, seizure 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 system matures.

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

individual therapies

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 box.

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 APD.

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 toward success.

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

visual aids

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.

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how can i help my child with academic progress

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Kids with APD can't understand what they hear in the same way other kids do. That's because their ears and brain don't fully coordinate. But early diagnosis and a variety of strategies can help them.

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Examples of characteristics that fall under Auditory Processing Disorder could be things like having a hard time following multi step directions if there are no visual cues present. It can also be hard to understand what someone is talking about if the individuals is in a noisy environment. Something else they may struggle with is being able to decipher between sounds that are similar.

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 Emma Grogan:Auditory Processing Disorder is a disorder that makes it difficult to understand speech. It does not allow your brain to understand auditory signals as it should.

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 Emma Grogan:Auditory Processing Disorder is a disorder that makes it difficult to understand speech. It does not allow your brain to understand auditory signals as it should.

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Do/Can any other disabilities exist in addition to this primary diagnosis?

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What are the academic, behavioral, or functional areas of struggle based on this disability?

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Identify challenges in the following areas:
- School
- Home
- Community
- Employment (for adults)
- Relationships
- Social and Emotional

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This week, you will be working in groups based upon your chosen disability. During each class, you will be given a set of criterion to follow to construct your own research and find resources to create a disability padlet. On Friday of this week, you will be teaching another group about your disability using the padlet you have created, which will lead into our second edition of the Who Am I? Demystification poster regarding Specific Learning Disabilities.

Tasks: Conduct your own research (I have given you a head start with the resource hub) on each of the subtopics for each day. As always, based on course policy, do not copy and paste. Quote, summarize, and paraphrase. For each subtopic, you will also be required to find two resources (videos, links, websites, pdfs, etc.) to assist and teach others. Provide a brief description for each of your resources as well.

Subtopics: In each subtopic, you will need the following:
- Defining, summarizing, quoting, or paraphrasing to give an understanding of each one.
- Two resources + an explanation of each one.