A guide on auditory processing disorders

The 3 key takeaways

• Auditory processing disorders do not always accompany hearing loss — APDs occur when the brain struggles to process sound accurately.

• There are different kinds of auditory processing disorders — Developmental APDs are present in childhood and may improve with early intervention, while acquired APDs may improve with time.
• Audiologists can diagnose and properly treat APDs  — If you suspect you have an APD, request an appointment with an audiologist either on audiologists.org or through your primary care physician.

We’ve all heard the question at least once in our lives: “are you even listening to me?”

It’s a fair question when you’re actively ignoring someone, but if you’re constantly struggling to comprehend what someone is saying or find that you often mishear conversations, it might be a symptom of an auditory processing disorder (APD).

An auditory processing disorder can also be known as a central auditory processing disorder. Symptoms of APDs can often be incorrectly attributed to other disorders, such as attention-deficit hyperactivity disorder (or ADHD) or speech-language delays.

Let’s explore the signs and symptoms of the most common auditory processing disorders, who is most affected by APDs, and how best to treat these disorders once you’ve received a diagnosis.

What is an auditory processing disorder?

An auditory processing disorder, also known as a central auditory processing disorder (or CAPD), has more to do with how the brain and the ears work together than it does the parts of the ear alone.

Hearing loss is often caused often occurs when a part of the inner ear is damaged or deteriorating. APDs occur when a person with normal hearing struggles to differentiate, recognize, or understand sounds in the same way someone without an APD understands them.

For example, individuals with an APD may have difficulty understanding similar-sounding words, spoken instructions, or people speaking in loud or crowded places.

What are the different types of auditory processing disorders?

There is more than one type of auditory processing disorder. It can exist on its own or as a symptom of other disorders, such as ADHD.

Explore the different types of APDs and what causes them.

• Developmental APD. This type of auditory processing disorder presents in children. If untreated, APD could continue for the child into adulthood. Often, the earlier a child receives an intervention, the better the outcome. Developmental APDs can also coexist with other developmental or learning disabilities.

• Acquired APD. This type of APD usually occurs after a traumatic brain injury, the development of a brain lesion, a stroke, or as a result of aging. It may improve with time or may be permanent, depending on the extent of the damage.

• Secondary APD. This type of APD usually accompanies hearing loss or another kind of hearing impairment. It’s often secondary to the hearing impairment itself and should be treated alongside the hearing impairment.

What are the symptoms of an Auditory Processing Disorder?

While auditory processing disorders affect both children and adults, it’s most noticeable in children. Many parents might believe their child is simply a poor listener or purposefully ignoring instructions.

However, persistent misunderstanding may indicate a deeper problem.

Pair that with teachers or other staff members reporting behavioral problems or struggles keeping up in class, and it might be time to get your child tested.

Additional signs and symptoms include:

• Mishearing sounds and words. Both children and adults with an APD will often mishear sounds or words completely, which leads to misunderstanding.

• Difficulty concentrating or increased anxiety in loud environments. People with an APD often get overwhelmed by all the sounds in noisy environments such as classrooms, restaurants, or ball games.
• Improved listening in quieter settings. If you or your child’s ability to listen and comprehend what’s going on improves in quieter settings, it may be a sign of an APD.

• Trouble following both simple and complex instructions. If there are issues following any type of instruction, the listener may be misunderstanding the instructions or their brain may be mixing up the instructions after they initially hear them.
• Struggling to follow conversations. If it’s difficult for you or your child to follow conversations or understand what someone is saying, it may be a sign of an APD.

Adults and auditory processing disorder

Adults who have either struggled with an auditory processing disorder throughout their life or who may be experiencing acquired APD as a result of aging or a health condition often struggle with additional symptoms.

• Difficulty following phone conversations. While they may be able to process in-person conversations because of their ability to read lips or body language, phone conversations may be difficult for adults with APD to follow.

• Learning a new language. Learning a new language is often difficult, but shuffling sounds or mishearing accents or sounds can make it nearly impossible to learn or understand a foreign language.

• Depression. APDs can make everyday life and tasks at work more difficult, which can lead to mental health issues, most notably, depression.  

How do audiologists diagnose an APD?

While outside observers such as teachers, colleagues, therapists, and family members can help in identifying a possible APD, only an audiologist can actually provide a diagnosis.

There are a few key steps in diagnosing APD.

1. Complete a comprehensive audiologic evaluation (CAE) – Before they can diagnose an APD, the audiologist must determine if the patient qualifies. This means the audiologist needs to rule out other factors, like a blockage or physical hearing loss.
2. Provide your medical history – After you take the CAE and rule out hearing loss or another kind of blockage, your audiologist will review your medical history to make sure you qualify for the next test. If your child is under 7 years of age, they cannot undergo the full auditory processing evaluation. However, there are other auditory processing assessments available for younger children. The audiologist will determine what type of testing is most appropriate.
3. Schedule an auditory processing evaluation (APE) – Much like a hearing test, an APE is completed in a soundproof test booth and administered by an audiologist. This test specifically evaluates how a person processes auditory stimuli and sound.

What is an auditory processing evaluation?

An APE is typically a 3-hour evaluation with multiple parts, though your audiologist may choose to break it up into multiple sessions to reduce fatigue, frustration, and distraction.

First, an audiologist will meet with you to go over your medical history. Next, you will begin testing, with time built in for breaks.

Finally, at the end of the APE, you will meet with the audiologist to discuss the preliminary results.

The evaluation consists of a variety of tests that assess multiple auditory processes. Throughout the evaluation, patients listen to different sounds, words, numbers, or sentences, also known as testing stimuli.

Stimuli may be presented to one ear or both ears and with or without background noise.

If a patient scores below average in two or more of the tests, then they could be diagnosed with an APD.

How do audiologists treat an APD?

How an auditory processing disorder is treated is highly dependent on the individual patient. While treatment can come from your audiologist, more commonly, it will be implemented by a speech-language pathologist.

Factors such as the type of deficit, the age of the patient, the patient’s abilities, and access to speech-language pathologists, audiologists, and even occupational therapists all determine what the treatment plan will look like.

However, these are the few of the typical changes an audiologist or speech therapist might suggest.

Environmental Changes

There are several ways to change your environment at home – and even at school – to help accommodate for an APD. For a greater chance of success, the family needs to be supportive of the person with the APD.

It’s important to understand that the person with the APD does not choose to misunderstand or ignore instructions, they simply struggle to process the information.

There are a few lifestyle and environment changes that can help people with APD be more successful.

• Assistive listening devices (ALDs). These can be used in the classroom or the workplace to help separate sounds, particularly people speaking, from surrounding background noise. A commonly used ALD in the classroom is an FM system.
• Establish eye contact. It’s important to establish a connection to ensure active listening. It’s also important to pause while you’re speaking to someone with an APD to ensure they have time to sort information.
• Visual aids. While these can be particularly helpful in the classroom with children, they can also work with adults. Written instructions help reinforce what needs to be done in order to achieve success.
• Sit closer to the speaker and away from other noises. For example, in a classroom, it’s best that students with an APD sit closer to the front of the class and away from auditory distractions like the door or a shared classroom wall.
• Limit distracting background noise. When it’s time to perform a task or have a conversation, eliminate background noise like television, music, or laundry machines.
• Ask questions to test comprehension. Teachers can make sure a student understood instructions by asking comprehension questions. Use the same strategy at home to double-check understanding.

Strengthening skills

While a speech-language pathologist cannot diagnose an APD, they can help strengthen some of the skills that are lacking because of the disorder.

Because there is no cure for an APD, it’s important to acknowledge the patient’s disorder and help them advocate for themselves. A speech therapist may help the patient learn how to request more information from a teacher or an employer.

They may also work with the patient to identify a note-taking system that helps them capture necessary information.

If the patient struggles with discriminating between background noise and speech, the speech therapist will work with the patient to help differentiate those sounds.

They often start in a quiet environment, then gradually increase the background noise in order to strengthen sound discrimination skills.

Sometimes, people with an APD may struggle with auditory memory. In order to treat this particular difficulty, the speech therapist may have the patient repeat a series of numbers or instructions, exercising the “listening muscles.”

Treating the deficit

Audiologists can work with patients to identify and treat hearing-specific deficits. They can also recommend medical treatment that may help with the APD and can provide prescription devices like hearing aids and other services that might help overcome some of the hearing-related issues.

These include:

• Hearing aids
• Assistive listening devices
• Auditory training

Your primary care provider can help you find an audiologist in your area, or you can use our Audiologist Explorer to schedule an appointment.

How can I help someone with an auditory processing disorder?

To comply with the Americans with Disabilities Act, a person with an auditory processing disorder does not have to disclose their disability, either at school or at work.

However, if you suspect someone may have an APD – or if you’re looking for ways to be more accommodating to neurodivergent students or colleagues – there are a few practical ways to help someone succeed.

How to help kids at home

If your child has been diagnosed with an auditory processing disorder, or if they’re exhibiting symptoms, a few lifestyle changes can make a big difference.

• Always make eye contact. Make sure your child is looking at you whenever you give them instructions.

• Eliminate background noise. When it comes time to do homework or when you’re having a conversation, make sure there’s no background noise that could interfere with auditory processing.
• Use closed captioning when watching TV. It makes it easier for your kid to follow storylines and conversations.

• Speak slowly and concisely. This helps to ensure they understand and have time to sort the information. Encourage them to ask questions.
• For more complex tasks, write down instructions. Checklists and steps can help a child keep track of what they need to do, setting them up for success.
• Request a 504 meeting at school. If your child has received an official diagnosis of an APD, it might be helpful to request a meeting with their school counselor and create a 504 plan, a legal document that requires teachers to accommodate their needs in the classroom.

How to help adults with an APD

Obviously, helping adults with an auditory processing disorder is a bit more complicated than helping kids. Many adults don’t like to disclose they have a disorder, and some may not even know.

If they were not diagnosed until later in life, they also probably haven’t had the opportunity to develop proper coping mechanisms.

However, if you suspect a family member has an APD – or if you have an APD – there are a few practical ways to make life easier.

• Make consistent eye contact
• Create checklists
• Use closed captions on TV
• Speak clearly and concisely
• Invest in an assistive listening device
• Ask questions to ensure comprehension

How to help colleagues at work

Some of your colleagues at work may silently struggle with APD.

They don’t have to disclose their disability, but there are a few common sense ways to help make sure that everyone in the workplace has equal opportunity to perform at their best.

• Always make eye contact when speaking. You will also want to speak clearly and concisely, and use hand gestures and body language to make sure everyone has the opportunity to understand. Leave room for questions.
• Send follow-up emails. After a meeting where tasks have been discussed and assigned, it’s best to send a follow-up email clarifying the needs and clearly spelling out everyone’s responsibilities.
• Ask your colleagues how they work best. Some may tell you they prefer instructions in writing, while others may reveal they enjoy visual aids in meetings.

Auditory processing disorders can be a barrier for understanding friends, family, teachers, and work colleagues.

However, with the help of an audiologist and support from the school or work environment, people diagnosed with an APD can accommodate for their disorder and find renewed success.

If you or your loved one suspect that an auditory processing disorder is disrupting your life, make an appointment with an audiologist today.