Understanding Auditory Processing Disorder and its Impact on Learning

Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is a condition that affects how the brain processes sounds. It is crucial to understand APD, its relation to learning disabilities, and the available accommodations and support strategies. APD is not a learning disorder, a cognition disorder, or a loss of hearing issues. APD is when the brain is having a hard time “hearing” words like it normally should.

Auditory Processing Disorder as a Learning Disability

An auditory processing disorder is a type of learning disability. Learning disabilities refer to a number of disorders that may affect the acquisition, organization, retention, understanding, or use of verbal or nonverbal information. Learning disabilities result from impairments in one or more processes related to perceiving, thinking, remembering or learning. Learning disabilities range in severity and may interfere with the acquisition and use of oral language, reading, written language, and mathematics.

APD is the term used to describe a weakness in the ability to understand and use auditory information. Individuals may have difficulties with auditory discrimination. This includes the ability to notice, compare and distinguish the distinct and separate sounds in words - a skill that is vital for reading. Auditory figure-ground discrimination includes the ability to pick out important sounds from a noisy background. Auditory memory involves the short-term and long-term abilities to recall information presented orally. Auditory sequencing incorporates the ability to understand and recall the order of sounds and words.

Symptoms of APD

Symptoms of auditory processing disorder (APD) can be subtle. APD affects both children and adults and usually manifests itself as listening or learning difficulties; the brain cannot process sounds effectively even though the individual's hearing appears to be normal.

Here is a comprehensive list detailing what a victim of Auditory Processing Disorder may be experiencing:

Difficulty understanding rapid speech.
Trouble following complex instructions.
Challenges listening in the presence of background noise.
Mishearing sounds and words.
Noisy environments being overwhelming when trying to listen.
Listening behaviors and performance improve in quieter settings.
Trouble following verbal directions, whether simple or complicated.
Trouble with spelling or phonics.
Verbal (word) math problems are hard.
Conversations are hard to follow.
Students with APD cannot differentiate between similar sounding words like crash and cash or eighteen and eighty.
The student with auditory processing delays does not always understand speech.

Who is Affected by APD?

People of any and all ages can suffer from Auditory Processing Disorder. Statistics show that 2%-7% of children suffer from APD. APD is common in someone already diagnosed with dyslexia or ADHD. It commonly occurs during childhood, but can happen at an older age. Boys are at greater risk of development than girls.

Causes of APD

While physicians aren’t completely positive about the direct cause of APD, studies have shown several links between this diagnosis and other medical factors. Researchers are still working to identify the exact cause of auditory processing disorder. Some researchers report that exposure to lead, trauma to the head, heredity, prenatal drug/alcohol exposure or chronic ear infections may be contributing factors.

APD can be linked to many conditions. In older adults, conditions might include stroke and head trauma.

The ADA and APD

The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. People with an auditory processing disorder may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with an auditory processing disorder will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Challenges Faced by Students with APD

Auditory processing difficulties can manifest in various ways-no two students face the same auditory processing challenges. Students may experience difficulties with listening, understanding what is being said and engaging in conversation. They may struggle with social skills. They may have difficulty maintaining a working memory. Executive functioning and poor organizational skills are common with auditory processing disorder in students.

Auditory Localization: The student cannot locate the source of sound and may lack a skill called auditory localization. The student has trouble identifying precisely where a sound is coming from. Auditory localization is essential in most daily activities.
Auditory Sequencing: The student cannot understand the order of sounds. Students with auditory processing disorder may lack a skill called auditory sequencing and may be confused about the order of sounds. Their brain cannot store and recall auditory stimuli, such as the exact order in which sounds arrive. Not being able to store and recall makes it difficult for students to learn anything by repetition, recite a poem or remember music.
Auditory Discrimination: Students with auditory processing disorder cannot differentiate between similar sounding words like crash and cash or eighteen and eighty. The student with auditory processing delays does not always understand speech. They are lacking in the skill of auditory discrimination, having difficulty understanding speech when more than one person is talking, there’s noise in the background or the quality of sound is bad. This is because the student cannot differentiate between sounds of different frequency, duration, and intensity and cannot distinguish speech from background noise.
Temporal Processing: The student may not understand when someone speaks fast. The rate at which we process sound is known as temporal processing. For a student with APD, temporal processing is slow.
Auditory Memory: APD affects auditory memory or the ability to store sound information and recall them, as necessary. When the speed of processing sound is low, students take more time to understand spoken instruction, directions or commands.
Auditory Attention Problems: The student with APD gets distracted easily by noises, self-distractions and/or environmental distractions. They find it difficult to listen in a noisy place, classroom, hallway, school bus, etc. The student may not be able to identify the primary sound from background noise, a necessary auditory skill known as auditory figure-ground.
Fatigue: Students with APD become tired easily and may be observed with their head down on their arm, pretending to be involved in the lesson, eyes closed or staring. A noisy place can be tiring due to the increased need to put in more effort to listen above the noise or not be distracted. In fact, the daily effort of listening may become so strenuous that the student may just stop trying to adjust.
Academic Performance: Students with auditory processing disorder may not perform well at school.
Auditory Closure: Sometimes, when a part of a sentence is missing or garbled, we make sense of the context and fill the gap using common sense. For example, in the sentence, “The __ rises in the east,” we can easily fill in the missing word, sun, from what we know. This is known as auditory closure. We all use auditory closure to understand what is being said. Students with APD might constantly have to rely on auditory memory and auditory closure.
Skills Deficits: Students with APD have poor spelling, reading, recall and singing skills. While instructing a student with APD to spell or read, make sure to speak in a clear, distinct way with pauses and repetitions. Students with APD mispronounce words and leave out syllables. While singing, they might change both the lyrics and the tune. Learning to read, spell or sing depends on auditory skills as identifying and joining syllables, attaching meaning to sounds, and remembering the sequence of sounds and words.
Social Skills: Students with APD struggle with holding conversations and may speak in ways inappropriate to the moment or their age. Students with auditory processing delays will need help from a speech-language pathologist to stay at the same speech and language level as their peers.

Unfortunately, students with auditory processing disorder are often thought to be easily distracted, not focused, not paying attention, not caring about what is happening, lazy, disrespectful or in need of medication.

Diagnosis of APD

If you think you or your child may have APD, speak to your family doctor or pediatrician about your concerns. Only audiologists can diagnose auditory processing disorder. The most common way to diagnose APD is to use a specific group of listening tests. If you suspect you might be suffering you want to set up an appointment with an Ear (hearing loss), Nose, Throat (ENT) doctor’s office to seek answers from a physician trained in the Ear/Auditory function. If you suspect that you or your child has Auditory Processing Disorder, attention deficit you can request testing done by an audiologist, given in a sound-treated space. Proper screening can be conducted by a learning disabilities teacher-consultant (LDT-C), school psychologist, and/or a speech-language pathologist knowledgeable in APD or from an audiologist who specializes in the diagnosis of central auditory processing disorders (CAPD).

Because of the similarities of APD with other disorders, determining if a child is eligible for testing requires a very comprehensive review of the child’s past medical, educational, and developmental history. Testing for APD requires a child to participate in several listening tests that assess different areas of the auditory system. This testing can last for up to two hours, and requires a significant amount of attention and effort from the child.

Common Listening Tests

Auditory figure-ground: This is when a child has trouble understanding speech when there is speech babble or ambient noise in the background. Noisy, loosely structured or open-air classrooms can be very frustrating for a child with APD.
Auditory closure: This is when a child can't "fill in the gaps" of speech when it is more challenging. This can happen in a quieter situation but is more common when the speaker's voice is too fast or is muffled, making it hard for the child to make sense of the sounds and words.
Dichotic listening: This is when a child has trouble understanding competing, meaningful speech that happens at the same time. For example, if a teacher is talking on one side of the child and another student is talking on the other side, the child with APD cannot understand the speech of one or both of the speakers.
Temporal processing: This is the timing of a child's processing system, which helps them recognize differences in speech sounds (such as mat versus pat). It also helps them understand pitch and intonation (for example, asking a question instead of giving a command), understand riddles and humor, and make inferences.
Binaural interaction: This is the ability to know which side speech or sounds are coming from, and to localize sound in a room. Although less common, this problem happens in children with a history of brain trauma or seizure disorders.

Most traditional APD tests require a child to be at least 7 years old. So, many kids aren't diagnosed until first grade or later. Newer electrophysiology tests (which use noninvasive electrodes to check the body's response to speech) can give some early information about the central auditory system in kids younger than 7.

Solutions and Accommodations for APD

Here are some ideas for helping to reduce some of the issues a sufferer of APD struggles with. These solutions will make communications between you and this person much more fluid and easier to understand. There's no known cure, but different strategies may help with listening and also improve the development of the auditory pathway over time, especially when started at younger ages.

Communication Strategies

Rather than using oral language to get a concept across, try focusing instead on communication through sensory means (hand gestures, visual means, paper handouts, manipulatives).
Reduce verbal directions by instead giving slow, simple ones that incorporate spacing between from one to the next direction. Use transition words or phrases such as “ready?” or “here we go.”
Change the tone of voice throughout a direction, making sure you stress keywords or direction. Slow the pace of your speech and change the pitch of your voice over different words.
Work on understanding synonyms and antonyms of words
Teach them word roots
Work on vocabulary words that are abstract
When teaching them, ask the questions that are specific in order to find out if they are cognitively grasping what you are saying
Allow them some extra time to think before they respond
Work on having them verbally practice their vocabulary words

Classroom Accommodations

Adjust quantity of homework.
Grade based on the student’s completion of the lesson goal.
One common physical accommodation is a remote microphone system, previously known as a frequency modulation (FM) system. This assistive listening device emphasizes a speaker's voice over background noise, making the voice clearer so a child can understand it. The person talking wears a tiny microphone transmitter, which sends a signal to a wireless receiver that the child wears on the ear or to a speaker box.
Other physical accommodations often focus on optimizing a kid's access to speech. Optimizing speech means reducing the interference of other things, like background babble, sound and sight distractions, and poor classroom acoustics.
In a classroom, for example, the teacher might slow down their speech, speak clearly and deliberately (Think Mr. Rogers!), and seat the child where they can see and hear them better.
Some individualized therapies also may help kids improve the growth of their auditory pathway. These usually are recommended by the audiologist based on the results of a child's tests and concerns. Several computer-assisted programs are geared toward children with APD. They mainly help the brain do a better job of processing sounds in a noisy setting. Some schools offer these programs. If your child has APD, ask school officials about what's available.
Strategic (or preferential) seating so the child is closest to the main person speaking. This reduces sound and sight distractions and improves access to speech.

Home Strategies

Reduce background noise whenever possible.
Have your child look at you when you speak. This helps give your child visual clues to "fill in the gaps" of missing speech information.
Speak at a slightly slower rate with a clear voice. Louder does not always help. (Again, think Mr. Rogers!).
Ask your child to repeat the directions back to you to ensure they understand.
For directions to be completed later, writing notes, keeping a chore chart or list, using calendars with visual symbols, and maintaining routines can help.
Many kids with APD find using close captions on TV and computer programs helpful.
Encourage kids to advocate for themselves. Telling adults when listening is hard for them can help. But shy kids might need to use agreed-upon visual cards or signals for coaches, parents, and teachers.

General Support

Stay in touch with the school team about your child's progress.
One of the most important things that parents and teachers can do is acknowledge that the APD symptoms your child has are real. APD symptoms and behaviors are not something that a child can control. What your child can do, with the help of caring adults, is recognize the problems from APD and use the strategies recommended for home and school.
A positive, realistic attitude and healthy self-esteem in a child with APD can work wonders.
Most important, remind your child that there's nothing to be ashamed of. We all learn in different ways. Be patient. This is hard for your child and takes time. Your child wants to do well, and needs patience, love, and understanding while they work toward success.
Teachers and other school staff may not know a lot about APD and how it can affect learning. Sharing this information and talking about it can help build understanding about the disorder.

APD is not technically considered a learning disability, and kids with APD usually aren't put in special education programs. Depending a child's degree of difficulty in school, they may be eligible for an accommodation plan such as an individualized education program (IEP) or a 504 plan that would outline any special needs for the classroom.

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