Auditory Processing Disorder: Symptoms, Diagnosis & Treatment
Individuals with auditory processing disorder have normal hearing capacity, but the mechanisms in the brain that process audio input are impaired. Learn more about this condition, including symptoms, diagnosis guidelines, and treatment options.
What is Auditory Processing Disorder?
Auditory processing disorder (APD), also known as Central Auditory Processing Disorder (CAPD), refers to a condition that impacts the brain’s ability to filter and interpret sounds.
People with APD have normal hearing abilities, but their brains have a hard time receiving, organizing, and making sense of sound. Auditory processing disorder is typically diagnosed in school-aged children.
APD is somewhat controversial – much debate continues among scientists today about diagnostic criteria for APD, and whether it should be considered a distinct disorder at all.1
Given these issues, estimates of APD’s prevalence rates vary considerably, from 0.5 to 7 percent of the population and even more.2 APD’s symptoms (see more below) also overlap with that of other conditions and disorders, including attention deficit hyperactivity disorder (ADHD or ADD) and learning disabilities.
Auditory Processing Disorder Symptoms
- auditory discrimination: the ability to distinguish distinct, separate sounds in words (a necessary skill for reading)
- auditory figure-ground discrimination: the ability to focus on specific sounds in noisy/competing backgrounds
- auditory memory: the ability to recall, in the short-term and long-term, information that is presented orally
- auditory sequencing: the ability to understand and remember the order of sounds and words
- difficulty hearing speech in noisy environments
- difficulty maintaining attention
- problems locating the source of a sound
- difficulty following directions
- commonly asking for information to be repeated
- inability to detect subtle changes in tone
- distracted and inattentive behavior
- difficulty learning to read
- academic difficulties, including poor reading and spelling
The symptoms of APD can impact listening and communication skills, and they may make academic success difficult to achieve. The same applies to adults with APD, who may show difficulties with telephone conversations, following directions, and other issues in the workplace 5.
Auditory Processing Disorder and ADHD
- poor listening skills
- academic difficulties
- difficulty following directions
One dated study even suggests that 50 percent of individuals diagnosed with APD also meet criteria for ADHD 7. Some experts also believe that APD is simply part of the sensory processing deficits typically experienced by individuals with ADHD (one study that may contribute to this belief, for example, found that children with ADHD who take stimulant medications for treatment do better in hearing and listening tests compared to children with ADHD who took no medication 8). Still, most contend that APD and ADHD are separate disorders, especially given key differences in executive functioning (EF) skills (APD is not strongly tied to EF deficits, while ADHD is) and the parts of the brain associated with each condition 6.
Auditory Processing Disorder Causes
APD’s causes are unclear, but the condition is thought to be either:
- developmental – having to do with delays in the maturation of the central auditory pathway) or
- acquired (through brain injury, for example). Factors including low birth weight, maternal diabetes, heavy metal exposure, and ear infections may be risk factors for symptoms that present as APD.9
Auditory Processing Disorder Diagnosis
Auditory processing disorder is not listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The symptoms commonly associated with APD, however, tend to fall under the DSM-5’s language disorder diagnosis category.
Audiologists, psychologists, and speech-language pathologists screen for APD using a battery of tests that examine the patient’s auditory discrimination, processing, attention, memory and more4. These tests, for example, may ask patients to listen to tones and identify whether they are high or low, and listen to audio input and repeat back what they heard10. Clinicians also make sure to rule out hearing loss and other conditions that may be causing the symptoms.
Patients should be at least 7 years old by the time of evaluation, according to guidelines from the American Academy of Audiology, as the cognitive functions that are involved in testing are usually still developing in younger children4.
Auditory Processing Disorder Treatment
Auditory processing disorder is considered a lifelong condition. Treatment for APD consists of skills training to reorganize and improve the way the brain processes sound, as well as interventions and accommodations in the classroom, in the workplace, and at home. Under the Individuals with Disabilities Education Act (IDEA), APD is considered a specific learning disability, characterized by a disorder “that may manifest itself in the imperfect ability to listen.”
While interventions are available for individuals of all ages with APD, experts agree that early diagnosis and treatment are better for symptom outlook, given the brain’s increased plasticity at young age4.
Auditory training includes a variety of exercises that target specific deficits directly, or via “compensatory” strategies. Therapy can range from computer-assisted software programs, like Fast ForWord and Earobics, to one-on-one training with a speech and language therapist. Some therapy techniques include3:
- listening to a variety of auditory inputs within a sound booth, with interference introduced and controlled to train the auditory pathways on differentiating sound
- training to distinguish between similar speech sounds (like the b and p in buy and pie)
- learning to identify the location and direction of a distant sound
- playing auditory games (like musical chairs and Simon Says)
- attempting to predict elements in a message by using context
Treatment schedules vary, but many clinicians meet patients for therapy about four times a week for up to half an hour11.
- improving the acoustics: closing a window, shutting a door, adding a rug to help absorb sound
- sitting closer to the source of sound and away from others (i.e. in the front of the classroom)
- installing a stereo system in the classroom or lecture hall
- eliminating other sources of sound from the immediate area
- emphasizing clear speech; asking others to repeat themselves
- being provided with written instructions (on paper, a whiteboard, via e-mail, etc.)
- using assistive technologies (like headphones)
- being provided with note takers or written summaries of classroom discussions/work presentations
- for teachers: making frequent checks of comprehension
- asking for information to be rephrased in simpler terms
- being provided important information only in the absence of noise or other distractors (like the TV)
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.
2 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
3 Cortelia, C., Horowitz, S. (2014). The State of Learning Disabilities: Facts, Trends and Emerging Issues. National Center for Learning Disabilities. Retrieved from https://www.ncld.org/wp-content/uploads/2014/11/2014-State-of-LD.pdf
4 American Academy of Audiology. (2010). Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. http://audiology-web.s3.amazonaws.com/migrated/CAPD%20Guidelines%208-2010.pdf_539952af956c79.73897613.pdf
5 Obuchi, C., Ogane, S., Sato, Y., & Kaga, K. (2017). Auditory symptoms and psychological characteristics in adults with auditory processing disorders. Journal of otology, 12(3), 132–137. https://doi.org/10.1016/j.joto.2017.05.001
6 Lovett, B., Lewandowski, L., et. al. (2010). Auditory processing Disorder and ADHD: What’s the Relationship? The ADHD Report. Guildford Press. https://guilfordjournals.com/doi/pdf/10.1521/adhd.2010.18.3.7
7 Riccio, C. A., Hynd, G. W., Cohen, M. J., Hall, J., & Molt, L. (1994). Comorbidity of Central Auditory Processing Disorder and attention-deficit/hyperactivity disorder. Journal of the American Academy of Child Psychiatry, 33, 849-857.https://doi.org/10.1097/00004583-199407000-00011
8 Lanzetta-Valdo, B. P., Oliveira, G. A., Ferreira, J. T., & Palacios, E. M. (2017). Auditory Processing Assessment in Children with Attention Deficit Hyperactivity Disorder: An Open Study Examining Methylphenidate Effects. International archives of otorhinolaryngology, 21(1), 72–78. https://doi.org/10.1055/s-0036-1572526
9 Shechter J.A., Caplan B., Leinen S.J. (2018) Central Auditory Processing Disorder. In: Kreutzer J., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-56782-2_1527-3
10 Miller, C. A., & Wagstaff, D. A. (2011). Behavioral profiles associated with auditory processing disorder and specific language impairment. Journal of communication disorders, 44(6), 745–763. https://doi.org/10.1016/j.jcomdis.2011.04.001
12 Bellis, T., Anzalone, A. (2008). Intervention Approaches for Individuals With (Central) Auditory Processing Disorder. Contemporary Issues in Communication Science and Disorders. 35, 143-153. https://pdfs.semanticscholar.org/77b0/a07c18de2cc1614193e4cbc1d78722e26561.pdf