Developmental Milestones Missed: Red Flags for APD

Use these developmental milestones for indications that your child might show signs of auditory processing problems.

Lois Kam Heymann, M.A., CCC-SLP, speech pathologist specializing in auditory processing disorder

By Lois Heymann, M.A. CCC-SLP Verified Updated on June 7, 2021

Child Development Stages: Language, Learning, and Listening by Age

These typical developmental milestones common to most young children are a loose guide. They can help you to zero in on your child’s listening development.

Keep in mind that the ideas, observations, and indications that follow are not one-size-fits-all. A child’s journey to developmental maturity is a ladder of many rungs. Your son or daughter can pause on one rung longer than another child the same age, skip one, or even go back a few and still be well within the range of “normal.” Always keep in mind that variation and individual timing is the natural order of things when it comes to growing children.

Note: If your child’s listening and speaking skills don’t come anywhere near the trajectory I describe in the steps ahead, auditory processing disorder (APD) may be the problem.

Child Development Stages Guide:

Birth to Three Months

Newborns listen to sounds that are close to them.
Unexpected or loud sounds may startle them or make them cry.
New and interesting sounds may calm them or cause them to stop movement and “listen” or attend. Recognizing attention in a newborn can be tricky at first. Sometimes it’s visible only in an interruption of sucking on a pacifier or a bottle.
The baby begins to localize and turn in the direction of a sound source.
A familiar voice gets greeted with a familiar expression, sound, or gesture.
The baby responds to soft, comforting tones.

In the first ninety days of life, a newborn infant is fully occupied by the basic needs for comfort, food, rest, hygiene, and love. During these first beautiful months your baby spends most of his or her day sleeping and being kept clean, fed, and adored. At the same time that your baby begins to develop a sense of touch she also begins to respond to the trust and warmth she soaks up from the people who care for her. By the third month your baby begins to grasp and hold things such as rattles and stuffed animals, and fully expects that her comfort and contact needs will be met. Initially your baby communicates by crying. You and the other adults around her begin to read her signals and recognize that the specific cry for being hungry is different from the cry for being wet. Soon she will start making other sounds and playing with her growing ability to vocalize; she will repeat sounds that get your attention and approval.

Three to Six Months

Sounds begin to have meaning.
A child begins to respond to “no.”
The baby recognizes changes in a voice’s loudness and pitch.
He or she starts to associate word meaning with sound.
The baby listens to his or her own voice.
Rhythm and music draw their own reaction.
The baby shows an interest in toys that pair sound with movement, such as rattles, musical mobiles, or anything else designed to make noise when it moves or is moved.
The baby demonstrates increased attention to more varied environmental sounds, such as a vacuum cleaner, a fan, or a door slamming in another room.

At the ninety-day mark, your baby is now ready to play. She is awake for longer periods of time, is more physically active and clearly enjoys interacting with you. She can now grasp objects and bring them to her mouth for more sensory exploration. If your play involves language, your baby is ready to experience that, too. At this age a child can create vowel- like (“a,” “e,” “o”) and consonant-like (“p,” “b,” “m”) sounds.

Six to Twelve Months

The child begins to listen and pay attention when spoken to.
He or she responds to his or her name by turning.
He or she is able to focus on listening for longer periods of time.
The baby begins to like and play games that pair voice with movements.
Familiar words (names of daily used objects and frequently seen people) are recognized in familiar contexts.
The baby responds to familiar requests, such as waving bye-bye or being asked to give something to the parent.
The child recognizes sounds paired with objects, such as an animal sound with the appropriate animal.

Your baby is awake even more and therefore more available to play. At six to twelve months a baby loves to look at books and pictures with you and is becoming much more physically active. She’s developing a longer attention span, sitting by herself, crawling, pulling herself up to standing, and possibly even taking her first steps. She shows off her developing fine motor skills while playing with blocks and stacking rings. As the twelve-month mark approaches, she clearly understands more about the world around her.

One to Two Years

The child begins to show specific comprehension of words.
He or she can point out and identify pictures and objects by their names.
He or she can also point to simple body parts on themselves and others.
The child will now imitate words he or she hears.
The child can follow one-step commands or questions such as “Throw the ball” or “Where’s the kitty?”
He or she likes listening to simple stories.
The child loves to listen to songs and rhymes and can incorporate body and hand movements to go with some of them.

During this time your baby’s speech makes a big leap forward. Over the course of year one to two, most children go from babbling to creating nonsense words to learning and using real words and finally to using real words in two-word combinations. Increasingly your child enjoys playing with things that represent actual objects, such as using a block as a truck. She also explores her environment, learning how to walk and even how to climb stairs and using fine motor skills to manipulate simple one-piece puzzles.

Two to Three Years

The child’s understanding broadens to include following two-step commands such as “Pick up your crayons and put them in the box.”
He or she attaches meanings and activities to environmental sounds, such as attempting to answer a ringing phone or running to the door at the sound of a doorbell.
The child begins to understand concepts and their opposites, including hot/cold, up/down, and stop/go.

During this year your child starts using sentences and conversation begins. She’s walking, maybe riding a tricycle, and using increasingly complicated toys, such as interlocking blocks, to build and play.

Three to Four Years

The child can hear and understand at increasing distances from the source of a sound.
He or she understands questions such as “who,” “what,” and “where.”
Social interactions with other children become more important.
The child listens to longer stories.
Attention span increases at this age.
The child can now link two separate pieces of information into one.

A three- to- four-year-old is a very busy little person. Children of this age get involved with other children more as play becomes increasingly interactive, especially outside at the playground. They also like “helping” around the house. Because she is around other children more, your child will hear and say things she’s never heard or said before and begin to tell stories. Her fine motor skill development has progressed, so she can play games with smaller pieces. Simple board games and drawing and coloring become favorite activities.

Next Childhood Development Stage: Four to Five Years

Four to Five Years

Enjoyment and understanding of stories deepen. The child is now able to answer questions about the stories and shows increasing comprehension.
He or she is able to take turns in a conversation by understanding and listening for the cues that indicate turn taking.
The child understands longer and more complex sentences.
He or she retells longer stories with more details.

By this age a child’s language and narrative skills have progressed and she’s able to grasp a pencil and begin to write. She’s also becoming more independent and dressing herself. Four- and five-year-olds love ball games and start learning and playing games that have rules.

The Causes of APD

The root cause of a condition that plagues so many perfectly intelligent children with normal hearing in the United States alone is still under study and discussion. Clinical observation hasn’t offered up a single genetic, environmental, physical, or developmental smoking gun behind APD. But as doctors, scientists, and therapists work to unlock its secrets and treat its symptoms, several general factors associated with auditory processing disorder have drawn increasing scrutiny.

Children Are More at Risk for APD…

After complicated births. Newborns who endure physically traumatic arrivals appear more likely to develop an auditory processing disorder.
After premature births. Preemies are sometimes born with an immature or weakened sensory system, affecting their ability to effectively process sound.
In the aftermath of chronic middle ear infections (otitis media).
In boys more than girls. In my practice I see boys and girls with APD or APD symptoms in about equal numbers, but some sources observe that two- thirds of children with APD are male.
In children that have been neglected or isolated after birth.

From day one a healthy child with undamaged hearing needs to hear sounds that will encourage his or her brain to install and streamline the pathways and connections that make speech and language possible. A household or living situation where a newborn is exposed to manageable amounts of quality language and sound is simply vital to developing the skill of listening. If a child arrives in the world and is placed in an environment that doesn’t address this need, his auditory processing skills may not develop the way they should. APD is often seen in children who have been neglected at birth. While many adopted children receive the necessary auditory developmental boost from attentive caregivers and foster parents, some children are born into situations where they had to subsist on the bare minimum necessary to survive, let alone develop, learn, and grow. The good news is that with interventions, parents and caregivers can begin to make up for these early deficits and foster the neural connections that were not nurtured early in a child’s life.

What It’s Like to Have APD

At the simplest level, a child with APD struggles with using sound to listen. This primary difficulty becomes the root cause of a wide variety of developmental, educational, and behavioral symptoms. Over time APD-related symptoms can worsen, combine, and increase in number as the condition goes undiagnosed and the child goes untreated.

The child may not respond appropriately or consistently to what’s been said or heard — even calling his name can cause different reactions at different times.
The child can’t pinpoint where a sound is coming from.
When spoken to or expected to interact or play in a situation that relies on talk and sound without anything visual to back it up, the child gets easily distracted or quickly bored.
Loud noises and noisy environments may upset, anger, or frighten the child, while quiet rooms, places, and activities may calm and reassure him.
The beginning of a poor memory for words and numbers shows up. Simple vocabulary such as the ABCs, days of the week, names of everyday objects, and names of familiar people goes unlearned. Similar-sounding words become difficult to distinguish from each other and comprehend separately.

Successfully processing sounds and words is a constantly growing skill set the child takes to his first school experience. A child with APD faces increasing struggles in school, at home, and in the world outside.