Auditory Processing Disorders - A Guide to Understanding APD

Central auditory processing disorders (CAPD), also referred to as APD, is when someone has difficulty processing or interpreting sounds by the brain, despite having normal hearing. In short, it can be simply defined as a problem with "what the brain does" with "what it hears".

People with auditory processing disorder difficulties often have normal hearing sensitivity but their brain struggles to interpret, organize, and remember what is said, especially in background noise. Children with auditory processing problems are weak in some basic skills for decoding and remembering what they hear. They often miss, or misunderstand, information that is conveyed orally, in instruction or conversation.

On this page, you can find information about a variety of topics related to auditory processing, commonly observed symptoms, screening and assessment, and benefits of therapy. Click on the links below to view information on different aspects of APD.

Information about Auditory Processing Disorders

You will find information about various aspects of auditory processing such as identifying, screening, assessment and therapy for APD. Click on a link to read the content for a specific topic or continue reading all topics below.

Auditory Processing Skills How Does APD Affect Learning Common Signs and Behaviour Screening for APD and Getting Assessed The Need for APD Testing How is APD Identified and Diagnosed? How Does APD Testing Help? Intervention for APD Benefits of APD Therapy - Procedural Aspects and Improvement Areas How Can We Help Children with APD? TedX Talk about APD (YouTube)

Auditory Processing Skills

The human brain possesses a variety of auditory processing skills that allow it to interpret sounds. These skills are most often dependent on each other. The brain uses these skills in different combinations to help a person hear what is happening around them and understand what it means.

Localization

• Identifying where sounds are coming from
• Important for knowing where we are
• Critical skill for sorting background noise
• The role of brainstem is critical in this skill

Decoding

• Identifying different types of sounds and patterns
• Critical skill for language learning

Temporal Processing

Identifying timing and pitches

Integration

Taking sounds coming from two ears and putting it together

Tolerance-Fading Memory

Sorting through competing sounds/noise and remembering what is heard

Relation between Auditory Skills and Effective Communication

As a speaker arranges thoughts in the brain and starts speaking to a listener there are 2 processes happening - the listener hears the spoken message which is conveyed to their brain. The speaker then hears their own articulation of speech though a feedback link, where the speaker’s ear picks up their own voice and send it to the brain to process it. As the role of the speaker is finished, the listener would then take up the role of the speaker and the whole process is repeated.

How Does APD Affect Learning

Children receive a lot of instruction both at home and at school – whether it is for obeying their parents, learning a new task, reading, math or other educational activity, interacting with or playing other kids, and many others. If the child is suffering from auditory processing disorder, you begin to see many occasions when the child fails to understand simple or mildly complex instructions.

Even in situations when the child is provided with visual aids like pictures, text, or video, they can still have trouble understanding the audio content. This can make it difficult for them to understand what they are hearing especially in noise, have difficulty communicating with their friends or classmates and awkwardness in social situations (for example, classrooms or family gatherings).

Children with APD have difficulty performing tasks when they are instructed orally. They appear disconnected and confused and may respond inappropriately in several situations. In fact, it is quite possible that a child with APD may fare worse than a child with hearing impairment because inability to process a full range of audio is more problematic than hearing nothing at all.

Common Signs and Behaviour

A person or child with APD may exhibit difficulty with auditory processing in the following ways.

• Poor listening skills
• Difficulty following oral instructions or classroom discussions
• Frequently say “huh?” or “what?”
• Difficulty with phonics or letter-sound correspondences, sound blending or segmentation
• Difficulty decoding unfamiliar words
• Poor spelling
• Slow fluency of reading
• Poor reading comprehension
• Difficulty understanding in the presence of background noise
• Poor attention, daydreaming, high distractibility (may seem like an attention disorder)
• Give slow or delayed responses to oral questions
• May be prone to behavior problems due to frustration or boredom (inability to follow the class)
• Avoidance of reading or other difficult tasks

Screening for APD and Getting Assessed

If you or your child exhibit any of the signs and symptoms, it would be helpful to screen for APD in order to rule out the need for a comprehensive diagnostic assessment. Screening would help in identifying those for whom a comprehensive auditory processing evaluation is warranted, while, at the same time reduces the number of inappropriate referrals.

We highly recommended that you or your child take a screening test for APD if you exhibit difficulty with auditory processing because it:

• is helpful in identifying conditions that may require medical attention
• increases awareness among parents, teachers, and special educators about APD
• minimizes psychological factors on the part of the child arising from anxiety and stress
• allows for insightful educational planning based upon the child’s individual auditory strengths and weaknesses
• is helpful to get screened early rather than lose valuable time that is crucial for child’s development, as prevalence of APD among different age groups is not widely documented
• requires minimal amount of time and resources that can help identify or rule out potential problem areas for an under-performing child
• can be used as a basis to recommend other psychological and behavioral tests and suitable remedies

You can use our APD screening questionnaire to verify if existing issues may be attributed to auditory processing deficits.

The Need for APD Testing

• APD could be a factor for your child’s academic struggles.
• This could probably be one of the components causing delays and/or failure to progress in other therapies targeted at remediating language and/ or learning disorders.
• Once APD is identified and treated there would be better progress in other therapies.
• A complete diagnosis of APD would be helpful in knowing where the breakdown is happening along the central auditory pathway in order to target our therapy effectively.
• It would be essential to remediate APD based on the type of APD even if there is difficulty hearing in noise as one of the core issues.
• A deficit specific diagnosis would be helpful in targeting our intervention strategies by allowing us to understand what type of difficulties a person is facing and what would be the most useful intervention strategy.
• Assessment could help in preparing a much easier approach to remediate reading and other communicative and learning deficits.
• It would also be helpful in planning intervention to improve memory related issues.
• It would give a complete insight into how a person is combining information together along with sequencing them to form one set.

How is APD Identified and Diagnosed?

APD diagnosis, testing and therapy have seen significant advances in the last 60 years with the development of research-based testing protocols. However, prior to testing for APD, it is mandatory to rule out hearing loss as any degree of hearing loss, however small it may be, raises auditory processing concerns.

APD testing is typically conducted on children or adult who have normal hearing, or already wear hearing assistive devices (e.g. hearing aids) to compensate for hearing loss. APD testing can be conducted on children as young as 3 and a half years old. It is advisable for children suspected of having APD to get tested as early as possible, as it can greatly improve their academic and social success.

There are different testing protocols currently in use for APD testing – Buffalo model, Terri Bellis model, to name a few. The purpose of these tests is to assess APD using a series of tests that target decoding, integration, tolerance fading memory and organization difficulties. Apart from testing for APD, the Buffalo model testing procedure also includes separate modules for therapy which improve a person’s auditory processing skills.

During an APD test, the client or child is presented with a series of tests to determine how their brain identifies and uses sounds and words in both quiet and noise. The stimulus (sounds) used in these tests target specific centers in the brain for language, speech, memory, and comprehension. In addition to regular APD testing, both children and adults can also be assessed using an interactive test called Acoustic Pioneer, which is available as an iOS application on Apple-related devices such as an iPhone or iPad. The application was designed and validated by an audiologist named Matthew Barker, and is a great tool to use for diagnostics and also for measuring progress with therapy.

How Does APD Testing Help?

APD assessment using a formalized testing procedure is highly beneficial in the following aspects.

• It provides information about comprehension and expression of spoken language
• It helps in understanding cognitive and psychoeducational abilities
• It can be used as an aid to address issues associated with articulation, spelling, oral language, speech understanding in noise, distractions, sequencing, short term memory, and other auditory based tasks
• It helps to identify academic and communication difficulties
• The test would help in understanding how a word is read
• It helps in diagnosing APD from other disorders, such as ADD, ADHD, learning disabilities and depression
• It prevents misdiagnosis and provides possible prognosis of therapy
• Psychological effects of APD can be minimized
• Appropriate identification of children with APD will allow insightful educational planning
• It provides additional information that helps in understanding benefit from other therapies

Intervention for APD

Although there are several strategies to APD intervention, none of them are aimed directly at therapy. The therapy program is targeted to improve decoding, integration, organization and tolerance fading memory deficits by training to blend sounds together, improving the degree to which they are remembered effectively, how such sounds are synthesized into words, improving hearing abilities in noise, improving sequencing abilities, dichotic listening training (hearing different sounds in both ears simultaneously) and some non-auditory approaches.

For younger children, we are able to provide access to two different therapy apps from the same developer of Acoustic Pioneer. These apps are a great way to practice dichotic listening and temporal processing, and report back weekly progress.

Benefits of APD Therapy - Procedural Aspects and Improvement Areas

The results and outcomes of therapy are long lasting and are achievable in a short period of time. APD therapy is most helpful in improving:

• Outcomes of other therapies children who are hyperactive, distractible or have short attention spans
• Focus in a task
• Sequencing abilities
• Ability to extract signal from noise without getting distracted
• Calmness in noisy situations
• Academic performance at school
• Social communication and helps to ease frustration

The weaknesses in auditory processing are treated from a multi-system coordination of skills perspective. This includes:

• Whole body focus
• Attention
• Ability to endure sustained attention for repetitive tasks
• Ability to stay seated for longer periods of time
• Decreased need for verbal reminders
• Improved eye contact
• Ability to wait for the information to be presented in full
• Ability to self-monitor and self-correct responses
• Ability to self-regulate body posture for active listening
• Ability to self-regulate emotional reactivity to simple tasks hat were perceived as difficult or aversive
• Improved stamina and energy
• Ability to connect meaningfully to the task rather than mechanically completing task from rote memory
• Ability to connect to the task at a linguistic level to meaningfully process the information in connected speech
• Ability to self-advocate when the task is too difficult or to ask for clarification

The Buffalo Model for Auditory Processing Therapy

Therapy is based on Jack Katz’s Buffalo Model of Auditory Processing Therapy (Katz, 2007, 2009; Katz & Fletcher, 2004) which includes:

• Phonemic synthesis training
• Phonemic awareness and recognition training
• Auditory attention, whole body active participation and listening training
• Endurance for auditory listening
• Short-term memory (repeating words, numbers, phrases, and sentences)
• Working memory/organization training (ability to repeat longer units of numbers forwards and backwards)
• Dichotic and monaural listening training
• Selective ear listening training
• Speech in noise training for each individual ear
• Ear separation listening
• Auditory ear lateralization
• Auditory processing integration training

How Can We Help Children with APD?

To help children who have APD, it is important to understand the problems associated with APD and how they affect daily activity, response to situations and performance of the child. The following strategies can be used either at home or at school to ease some of the difficulties associated with APD. These strategies can prove greatly beneficial when used together with APD therapy.

• Identify and acknowledge that the child is facing auditory difficulties - it must be explained to the child as early as possible that their trouble with understanding words is not their fault and encourage them through positive feedback.
• Provide the child with a quiet environment with reduced background noise at home and at school to prevent distraction from listening tasks. In the classroom, the child should be seated away from doors and windows, and closer to the teacher who can observe and help with confusion or distraction.
• Allow the child to do reading and independent work in a quiet room and provide studying aids like assignment pad or recording/replaying device.
• Maintain constant eye contact with the child while speaking to keep them engaged in conversation. Try to provide visual aids to help them understand the spoken part, e.g. written text or pictures that represent the spoken instructions.
• Repeat the first few steps of a series of instructions to ensure that the child understands them properly. Watch for signs of the child being lost or inattentive and keep asking questions to keep the child focused.
• Provide reading assignments and non-auditory material (e.g. presentations, slideshows) before introducing new material during classroom instruction. Inform parents and other support staff in the school about upcoming topics and lessons.
• Allow students with APD to get additional time to complete tasks where spoken instructions are provided.

TedX Talk about APD (YouTube)

Watch the TedX talk about auditory processing disorders by Dr. Angela Alexander, an audiologist with over fifteen years of experience specialising in diagnosing and treating Auditory Processing Disorder (APD).

Schedule an appointment for CAPD services

If you would like to make an appointment for in-clinic or online APD assessment and/or therapy, please contact us directly through email or phone. You can also complete our APD screening questionnaire and provide us with your contact information, and we will reach out to you as soon as we review your responses.