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

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

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

Possible Causes

If an individual's auditory processing is functioning well but there is no understanding of the sounds that are heard, the
individual may have an APD. In some children with APD there may be tiny differences in the way that neurons (brain cells)
are joined together, or send messages to each other. This may make it hard for sounds to be passed on to the areas of the
brain that aid the understanding of language. It is possible such brain cell differences may cause APD. Scientists still do not
understand exactly how all of these processes work to interact or how they malfunction in cases of communication disorders.

APD is an auditory deficit that is not related with cognitive and language skills. In some children, auditory processing
difficulty may be associated with conditions such as
dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive development
disorder or developmental delay. Sometimes this term has been misinterpreted in children who have no hearing or language
disorder but have challenges learning. A diagnosis of all these disorders may be helpful in understanding the cause to
behavioral problems.

Signs and Symptoms

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

• Difficulty understanding spoken messages and/or remembering instructions

• Struggles with expressing themselves clearly and using speech

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

• Have trouble paying attention to and remembering information

• Often is distracted by background sounds/noises

• Have behavior problems

• May misinterpret or find it hard remembering oral directions

• Has difficulty comprehending complex sentence structure or rapid speech

• Ignores the speaker especially if preoccupied by something

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

• Need more time to process information

• History of multiple ear infections

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

Diagnosing APD

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

It is important for parents to know that, however beneficial the information from the multidisciplinary team is in understanding
the child’s overall areas of strength and weakness, none of the test tools used by these professionals are diagnostic tools for
APD, and the actual diagnosis of APD must be made by an audiologist.

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

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

Treatment of APD

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

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

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

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