What Is Auditory Processing Disorder? Symptoms, Comorbidities, and Exercises
Auditory processing disorder (APD) is a hearing problem characterized by deficits in how the brain processes auditory input. Children with APD struggle to make sense of what they hear — a symptom that is easily mistaken for other conditions and learning disabilities. This overview of APD clarifies common misconceptions and offers targeted strategies of support.
What Is Auditory Processing Disorder?
Auditory processing disorder (APD) throws a child’s ears and brain out of sync. This misalignment can cause a range of challenges – struggles with auditory discrimination, with listening in noisy environments, with remembering what you’ve heard, and with recalling the sequence of words spoken – that may resemble (and co-occur with) other conditions.
APD may interfere with learning, however it is not correlated with intelligence. It may cause communication difficulties, but it does not show up in traditional auditory tests for hearing loss. It is a misunderstood and largely overlooked condition that may appear in 3% to 5% of all children.1
Auditory Processing Disorder: Overview
Normal auditory processing occurs when the brain receives auditory input and processes the information into something meaningful at an acceptable speed. Auditory processing disorder may cause deficits at any point in this process. Difficulties associated with APD commonly fall into these categories:
- Auditory discrimination: noticing and differentiating similar but unique sounds
- Auditory memory: remembering what was heard
- Auditory sequencing: recalling words and directions in the correct order
- Auditory figure ground: discerning and processing a single audio input amid competing stimuli (e.g., background noise)
- Auditory cohesion difficulty, or problems processing when undertaking higher-level listening tasks (e.g., difficulty drawing inferences from conversation, picking up on tone and inflection, understanding riddles.)2
Auditory Processing Disorder: Common Signs and Challenges
The signs of auditory processing disorder often include the following daily challenges and manifestations:
- Trouble following verbal directions (“Huh? What did you say?”)
- A blank stare when spoken to; may appear distracted or unfocused
- Trouble following conversations with multiple speakers or background noise, no matter how minimal (“It’s too noise in here!”)
- Difficulty distinguishing similar-sounding words, like “coat” and “boat”
- Trouble following multi-step directions in the correct order
- Noticeable delay in responding to conversational questions
In addition to these communication difficulties, APD may trigger the following additional challenges for students:
- Behavior problems: Auditory processing issues can cause children to feel embarrassed and frustrated. They may react by becoming defensive, or cover by acting disinterested. Teachers sometimes assume that students with undiagnosed APD are ignoring instructions and displaying defiance.
- Poor social skills: Difficulty keeping up with conversations, especially in loud, active environments (like the playground, school auditorium, and classroom), can cause children to miss out on friendships and other connections. They might withdraw from social settings or compensate by acting as the class clown, or by pretending they don’t care.
- Anxiety: When children can’t trust that what they’ve heard is accurate, they may feel flustered and stressed, which could contribute to anxiety, which further impairs auditory processing.
- Academic challenges: Poor auditory processing abilities could put children at a greater risk for learning difficulties,3 and research suggests that many children with APD also have comorbid language or reading impairment.4 APD affects a child’s ability to interpret information (a problem when so much of it is delivered verbally in the classroom), which is fundamental for learning.
Auditory Processing Disorder: Diagnosis Challenges
Though APD can occur independently or alongside other conditions, it is often overlooked altogether. These missed diagnoses often happen because APD’s challenges overlap with those of other conditions.5
Though APD and attention deficit hyperactivity disorder (ADHD or ADD) share similar signs, the why behind the manifestations differ significantly. (If ADHD is also present, that only complicates the picture.) In children with APD, the following may be true:
- Inattention may be due to an overwhelming number of concurrent auditory directions, or because the child needs time to process information.
- Hyperactivity may be due to sensory overload, especially in noisy environments.
- Fidgeting may help a child focus and process information.
- Challenges with behavior, social skills, and academic achievement may all be traced back to problems processing auditory input.
When APD and anxiety co-occur, answering the question of cause and effect is critical. Is APD causing anxiety, or is anxiety worsening the child’s ability to focus and process what others are saying?
Similarly, APD is considered a “strong complicating factor” for specific learning disorders. As such, it is recommended that children suspected of having APD should undergo a complete psychometric assessment.6
A thorough and comprehensive evaluation for APD is important to tease out a child’s complex needs. The evaluation should be conducted by a multidisciplinary team, which must include an audiologist. Parents can start with the school district, or seek an independent, private evaluation.
Strategies to Help Children with APD
Remediation, Skill-Building, and Accommodations
These activities and accommodations, broken down by the auditory processing components they address, can help improve communication skills and the overall learning experience.
Auditory Discrimination: Exercises
- Ask your child to identify whether a sound is “loud” or “soft.” Give examples in advance.
- In everyday life, stop to identify the source of a sound – Is it a car? An animal? A fellow student?
- Listen to and repeat a sound pattern.
Auditory Discrimination: Accommodations
- Speak clearly, but at a normal volume, so that students can discern individual words; consider a sound amplification system.
- Repeat instructions often, especially if they contain similar-sounding words.
- If you’re wearing a facemask, use a clear film so students can lip-read.
- Allow the student additional time to process verbal information and offer a response.
- Allow students to use response cards to convey information (instead of verbal answers).
Auditory Figure Ground: Exercises
- Ask students to close their eyes and point to the physical source of a sound.
- Record a conversation and ask students to listen and reflect on what they learned.
- Experiment with music; have your child or student repeat lyrics from different songs. (Take note of what type of music is most challenging in this exercise.)
Auditory Figure Ground: Accommodations
- Sit students with APD close to the board and to your voice.
- Minimize distracting noises in the classroom.
- Allow students to wear headphones to block out background sounds while working.
- Consider providing environmental accommodations by improving the classroom carpeting and acoustics.
- Important: Teach students to be alert to safety issues and instructions (like fire alarms and protocols).
Auditory Memory: Exercises
- Give simple auditory directions and gradually add on to them (e.g. play the “I went to the market” game).
- Rehearse poems.
- Teach word associations (word webs) and mnemonics.
- Use visuals (like graphic organizers) and multi-sensory approaches to support auditory information. Redundancy builds fluency.
Auditory Memory: Accommodations
- Use cues like “this is important” and “be sure to write this down” when delivering information verbally. Look out for “Swiss cheese notes,” which are incomplete due to hurried writing to keep up with the teacher’s key points, and trying to record what the teacher says while the teacher continues to talk.
- Repeat instructions and important information.
- Provide written class notes prior to the lesson (to allow students to review prior to and after class) or use a note taker.
- Allow students to use voice-to-text software and other assistive technologies.
Auditory Sequencing Exercise
- Dictate simple directions, out of order, and have the student write them down. Make sure to use vocabulary the student understands.
- Ask the student to arrange the directions in order. Provide them with clues as needed. Optional: Have them draw a picture of each direction and rearrange the visuals in order.
- Have the student dictate the directions they arranged and complete each direction.
If a student struggles with written expression, skip the written portion of this activity. Have the student use visuals and other methods to convey sequence.
Auditory Sequencing: Accommodations
- Delivery simple instructions one at a time, and repeat as necessary.
- Provide visual cues showing procedure.
- Provide written instructions or cue cards.
Auditory Cohesion: Exercises
- Dictate a statement and ask the student what they can infer from it (e.g., reading between the lines, picking up on emotion, mood). Reword your statements if necessary. You can also use scenes and snippets from movies, TV shows, and audiobooks for this exercise.
- Explain your emotion when addressing a student. (“I’m happy you applied lots of effort in class.”)
- Rehearse challenging social situations.
It’s important to teach children with APD (and any other learning difficulty) compensatory skills to help boost their self-esteem and motivation.
- Talk to your child or student about their strengths, and about their challenges. Always lead with their gifts and assets, especially when they are learning a new skill.
- Always point out a student’s successes with affirming statements: “I noticed you were really paying attention in class today. Well done.” Attribute their successes to their purposeful effort.
- Teach children and students how to speak up and advocate for themselves – a useful skill for later in life, too. They should know to clearly state their needs (“Multi-step directions are difficult for me to follow due to auditory processing disorder. Can you repeat them or write them down?”
- Remind your child or student that you will always support them, and that they should use supports without shame or embarrassment.
Auditory Processing Disorder: Next Steps
- Free Download: 20 Learning Strategies Designed for Students with ADHD
- Read: Learning Disabilities Overview — Reading, Writing & Math Disorders
- Read: Sounds Like Auditory Processing Disorder
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled “What Did You Say? Differentiating Auditory Processing Disorder from ADHD in Children” [Video Replay & Podcast #378] with Beverley Holden Johns, which was broadcast live on November 2, 2021
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3 Choi, S., Kei, J., & Wilson, W. J. (2020). Learning difficulties and auditory processing deficits in a clinical sample of primary school-aged children. International journal of audiology, 59(11), 874–880. https://doi.org/10.1080/14992027.2020.1771782
4 de Wit, E., van Dijk, P., Hanekamp, S., Visser-Bochane, M. I., Steenbergen, B., van der Schans, C. P., & Luinge, M. R. (2018). Same or Different: The Overlap Between Children With Auditory Processing Disorders and Children With Other Developmental Disorders: A Systematic Review. Ear and hearing, 39(1), 1–19. https://doi.org/10.1097/AUD.0000000000000479
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6 Cunha, P., Silva, I., Neiva, E. R., & Tristão, R. M. (2019). Auditory processing disorder evaluations and cognitive profiles of children with specific learning disorder. Clinical neurophysiology practice, 4, 119–127. https://doi.org/10.1016/j.cnp.2019.05.001