What Is Auditory Processing Disorder?
An auditory processing disorder (APD) is a condition where a person has difficulty understanding and interpreting sounds, even though they have normal hearing. People with APD may struggle to hear and understand speech in noisy environments or when the speaker has an accent or is not speaking clearly. They may also have difficulty with verbal memory and discrimination of similar-sounding words. Symptoms of APD can include difficulty following instructions, difficulty with phonetics, and difficulty understanding conversations. APD is not a hearing loss, but a problem with the way the brain processes auditory information. It is caused by a malfunction or delay in the neural pathways that process sound, and there are different types of APD.
Many times, people who have an auditory processing disorder also have other disorders, such as attention problems. Audiologists try to differentiate between these types of disorders during testing. Sometimes the difficulties someone is experiencing start to make sense once we have taken a comprehensive history and completed the testing. Dyslexia, for example, is a type of reading disorder. Auditory processing tests often reveal a correlation between patients who have weaknesses in decoding, and those who struggle to learn to read. It is possible for auditory processing disorder to coexist with visual processing disorder as well. Overall, audiologists seek to help the person who comes to the office as best they can. Once specific weaknesses are identified, the sooner the patient, their family, and teachers can gain some insight into why this person is struggling. This, in turn, allows audiologists to suggest helpful modifications, as well as start the correct therapy to help improve those weaknesses.
Trouble Understanding Speech
An auditory processing disorder can make it difficult to understand speech.
Causes:
- Ear infections
- Chemotherapy
- Concussion
- Stroke
- Developmental delays
What are the Signs and Symptoms of Auditory Processing Disorder?
Some symptoms of APD can include:
- misunderstanding what others say
- frequently asking, “huh?” or “what?”
- delayed responses to questions, singing the wrong words to songs
- becoming disinterested or distractable in noisy situations
- unable to stay focused for long periods when someone is teaching or talking
- frequently interrupting others
- unable to follow instructions
- current or past history of ear infections
- current or past history of speech delays
- dislike for music
- difficulties learning to read,
What Causes Auditory Processing Disorder?
Causes of an auditory processing disorder can include chronic middle ear infections, familial history, traumatic brain injury, concussion, cancer treatments
How Is Auditory Processing Disorder Diagnosed?
An auditory processing disorder is diagnosed by an audiologist using a 2-channel audiometer and specific tests that are designed to task the listening system. Most of our patients are referred by a neuropsychologist or neurologist who found a possible auditory weakness during a screening test in their office. We try to communicate with the family, primary care physicians, neurologists, neuropsychologists, speech pathologists, occupational therapists, reading specialists, and teachers.
An auditory processing disorder can be diagnosed in childhood or as an adult. We see children and adults who are struggling to hear and would like help.
An auditory processing disorder (APD) in adults can manifest as difficulty understanding speech in noisy environments, difficulty following rapid or complex speech, or difficulty with language-based tasks such as reading comprehension. Individuals with APD may also have difficulty with verbal memory and discrimination of similar-sounding words. APD can have a significant impact on an individual’s ability to function in daily life and may lead to problems with communication and social interactions, as well as difficulties in school or the workplace. It is important to note that APD is not a hearing loss, but rather a problem with the way the brain processes auditory information.
Children with APD may also have difficulty with verbal memory and discrimination of similar-sounding words. They may have trouble listening and paying attention, following directions, and participating in class, and may be easily distracted. They may also have difficulty with phonetics and have a hard time learning to read. APD can have a significant impact on a child’s ability to learn and function in school and may lead to problems with communication and social interactions.
How do you test for APD?
An auditory processing disorder (APD) is typically diagnosed by an audiologist using a battery of tests that assess an individual’s ability to process auditory information. The tests typically include measures of:
- Pure-tone audiometry: This test measures an individual’s hearing threshold for different frequencies of sound.
- Speech audiometry: This test measures an individual’s ability to hear and understand speech in quiet and in background noise.
- Auditory brainstem response (ABR): This test measures the electrical activity of the auditory nerve and brainstem in response to different frequencies of sound.
- Otoacoustic emissions (OAE): This test measures the sound that is emitted by the inner ear in response to a stimulus.
- Central auditory processing tests (CAP): This group of test are designed to evaluate the ability to process auditory information, such as sound localization and lateralization, temporal processing, and speech-in-noise tests.
The audiologist will also take a case history and ask questions about the individual’s symptoms and concerns, and may also refer to other specialists, such as a speech-language pathologist or a neurologist, to help make a diagnosis.
It’s important to note that the battery of tests used for diagnosis and the interpretation of the results may vary depending on the age and abilities of the individual being tested.
Diagnosis Categories:
- Decoding
- Tolerance Fading Memory
- Type A
- Integration/separation
- Organization
How to Ease Problem Behaviors Associated with Auditory Processing Disorder
There are several strategies that can be used to ease problem behaviors associated with auditory processing disorder (APD) in children and adults:
- Create a quiet and distraction-free environment: This can be helpful for individuals with APD when they are trying to listen and understand speech.
- Repeat instructions: Children with APD may have difficulty processing and remembering spoken instructions, so repeating instructions can be helpful.
- Use visual aids: Children with APD may have difficulty processing auditory information, so using visual aids such as pictures or diagrams can be helpful.
- Break down instructions: Break instructions down into smaller, more manageable steps to make them easier for the individual to understand and follow.
- Use repetition: Repetition can help to reinforce the information that the individual has heard and to improve their memory for that information.
- Use a FM system: A FM system is a wireless communication system that can be used to amplify the teacher’s voice and transmit it directly to the child’s ear via a special receiver worn in the ear.
- Auditory training: Auditory training programs can help to improve the individual’s ability to process auditory information and to improve their listening skills.
- Speech-language therapy: Speech-language therapy can help to improve the individual’s language skills, including vocabulary, grammar, and comprehension.
It’s important to work with a qualified professional, such as an audiologist, speech-language pathologist, or a special education teacher, to develop an individualized plan that addresses the specific needs of the individual with APD.
Treating Auditory Processing Disorder
Auditory Training:
- Auditory Memory Tasks
- Dichotic Listening Games
- Hearing Aids -low gain
- FM Systems
- Music lessons
Treatment for auditory processing disorder (APD) typically involves a combination of interventions that can help to improve the individual’s ability to process auditory information and to improve their listening skills. Some of the most common treatment options include:
- Environmental modification: It’s important to realize that in some environments a person with an auditory processing disorder may struggle more than other environments. Reducing background noise can make a big difference, such as reducing the level of the background music at a cafe or restaurant. Adding rugs, acoustical tiles, and adding chair leg noise reducers for a large classroom or restaurant dining room can help reduce echoes and amplification of ambient distracting sounds.
- Auditory training: Auditory training programs can help to improve the individual’s ability to process auditory information and to improve their listening skills. These programs often include exercises that focus on discriminating between different sounds, improving the individual’s ability to understand speech in background noise and competing signals, as well as short term auditory memory training.
- Speech-language therapy: Speech-language therapy can help to improve the individual’s language skills, including vocabulary, grammar, and comprehension. This may include activities such as listening to stories and answering questions about them, or practicing following directions.
- Assistive technology: Assistive technology such as FM systems and low-gain hearing aids can help improve the clarity of speech. An FM system can amplify a teacher’s voice and transmit it directly to the student’’s ear via a special receiver that can either be worn in the ear or listened to via a speaker that is close to the student’s seat. This can help to reduce the amount of listening effort needed to process a teacher above the ambient noise level of the typical classroom.
- Educational accommodations: Accommodations, such as taking tests in a quiet room, or providing written copies of verbal instructions in class can help individuals with APD to access education.
- Enrollment in music lessons.
APD Stories
Example A
Peter’s mom was worried about him. He is a sweet kid and he’s struggling in school. He’s in the second grade, having a lot of difficulties learning to read, and although he’s not a hyper child, his teacher wondered if he should be evaluated for attention issues. He always seemed to drift in class and had a hard time following directions. Sometimes he got into trouble for talking when he should have been doing his work.” Peter reports he was only asking the child next to him what they were supposed to do because he’d forgotten all the steps. This is a typical scenario we hear in our office when a child is referred for an APD evaluation. The typical classroom has background noise can be louder than the teacher’s voice and if a child has difficulties understanding what the teacher is teaching, it can lead to a domino effect of struggles.
Example B
Sarah came to us as a healthy woman in her 50’s. She decided that it was finally time to get hearing aids. She was always struggling to hear and understand what others were saying, especially in groups when there was background noise and people talked fast in their lively conversations. She was also an ESL teacher and was struggling more than ever with a new colleague who had a foreign accent and spoke rapidly. Sarah’s evaluation started with a complete hearing evaluation, which indicated normal hearing. That came as quite a surprise to Sarah. A more extensive history was taken and it revealed that she had a history of chronic ear infections since childhood as well as frequent sinus infections. She needed speech therapy as a child as well, but she does not know all of the details.
Example C
Stephanie was referred to us by another audiologist because she reported extreme difficulties hearing in restaurants, but her hearing was normal. Her new job required that she attend business dinners, but she was failing to be able to keep up with the conversations. When asked, she admitted that she never liked going to noisy restaurants and simply avoided them in the past. She reports that she has always been a strong reader and it’s one of her strengths.
Insight:
Understanding the speech of another can be difficult for individuals with an auditory processing disorder. To compensate, they must use more effort and concentration to read between the lines by relying on other clues. It causes them to take longer amounts of time and more listening effort to process the information and this can make it difficult to keep their attention for longer periods of time.
Sometimes, when they hear that same person, but at a faster rate of speech and/or with the addition of competing talkers, there can be a point where the listener begins to fatigue, no longer can hear as clear of a message, only interprets only parts of what is being said, and stops adequately understanding what they are hearing.
It is important to work with a qualified professional, such as an audiologist, speech-language pathologist, or a special education teacher, to develop an individualized plan that addresses the specific needs of the individual with APD. Additionally, family support and home programs are important to support the progress made during therapy sessions.
It’s important to note that the specific treatment plan will depend on the individual’s needs and abilities, and that some people may benefit more from one type of treatment over another. It’s also important to note that treatment of APD is typically ongoing, as the brain is constantly adapting and changing, and therapy should be adjusted accordingly.