Auditory Processing Disorder
Auditory Processing Disorder is actually an umbrella term that describes various issues that affect how the brain perceives and processes what the ears hear. APD is a hearing disorder in which your brain has trouble processing sounds. It is often mistaken for other disorders, can present kids with learning challenges and warrant an IEP.
It is now referred to as APD or Auditory Processing Disorder. The old term, not often used anymore, is Central Auditory Processing Disorder or CAPD. I’m going to explain symptoms of APD, who diagnoses and a few IEP goal ideas for Auditory Processing Disorder. Plus I have a list of a few dozen IEP Accommodations for APD.
APD is still controversial to some, as many new terms for diagnoses can be. Not all experts agree that it’s a disorder on its own, however there is an insurance billing code for it. The term APD or Auditory Processing Disorder is used to describe a variety of listening challenges and is growing in commonality and acceptance.
Since there are different types of APD, symptoms will vary from child to child. While no two people with APD are alike, these individuals may have similar challenges in processing information.
Autism vs. APD vs. SPD
Autism is a processing disorder. APD is a processing disorder but specific to hearing and processing sounds. SPD refers to Sensory Processing Disorder. Yes, hearing is one of our 8 senses. Yes, there are 8! But APD refers to only the hearing issues.
SPD is less widely accepted than APD as a separate diagnosis. I don’t want to get into the weeds with it, but SPD does not have an insurance code for billing. And, there are many who believe that autism and SPD are the same thing. While others feel they should be two separate diagnoses. However that’s another discussion for another day.
A person can have both autism and APD. Or, they can just have one. Having one does not automatically mean you have the other. Some autistics can process sounds just fine.
Diagnosing APD can be complex and require multiple professionals. It usually starts with a teacher or parent recognizing learning difficulties, but it may take several steps to get you to the Auditory Processing Disorder diagnosis. It can be particularly difficult if the student cannot speak.
If your child is exhibiting several of the symptoms below, here is a list of professionals to reach out to.
- The first step in identifying APD is to rule out hearing loss.
- Request a Comprehensive Evaluation for Special Education Services.
- Your child should first see a pediatric audiologist who will perform a variety of hearing tests and auditory processing tests.
- You should also consider psychologist can assess cognitive functioning and learning disabilities.
- A speech-language therapist can evaluate your oral and written communication skills. An SLP can also do a treatment plan if the audiologist feels your child has APD.
- Teachers can offer feedback on any learning challenges.
APD is not something that is treated with medication. Compensatory strategies and learning to work with accommodations, using a multi-disciplinary approach, is what is recommended.
It’s also important to note that many of the conditions that our kids have, have comorbidities. That is, it is common for a child to have ADHD and APD, or autism and APD, or Dyslexia and APD. Children and adults who have Auditory Processing Disorder can exhibit the same symptoms as ADHD, Autism, Poor Working Memory, or Receptive Language Disorder, to name a few.
It’s important to note that while these are symptoms of Auditory Processing Disorder, there is much overlap with other disorders. I have put some closely related disorders or other things that this could also be a symptom of.
Symptoms of APD
- Parents often report that their kids did not enjoy (or seek out) being read to as a toddler or preschooler.
- Difficulty remembering spoken information
- Frequently requesting others to repeat themselves (ADHD, poor working memory, hearing loss)
- saying “what” or “huh” often (poor hearing, working memory)
- Difficulty understanding speech with competing talkers or background noise
- Difficulty following multiple-step or lengthy oral instructions (ADHD, autism, EF disorders or difficulties)
- Slowness in processing and responding to auditory information
- Distracted by background noise, often sensitive to soft sounds in the environment most people do not notice
- Easily overwhelmed by complex or noisy auditory environments (i.e. classrooms, parties, shopping malls)
- Difficulty maintaining attention when listening to information
- Inconsistent or inappropriate responses to verbal requests for information
- Misinterpretation of questions (struggles interpreting body language, pragmatics, autism)
- Difficulty following classroom discussions, or making off-topic contributions
- Trouble hearing the differences between sounds in words (actual hearing loss)
- Poor spelling skills, with better performance when quizzed one-on-one
- Child struggles to understand or interpret tone of voice cues that makeup emotion, humor, and sarcasm (and may be likely to interpret messages literally or get feelings hurt easily)
- Articulation errors that persist past the age they should (see a speech therapist for this).
- Difficulty finding the right words to use (also seen language disorders such as dyslexia)
- Difficulty singing in tune and poor musical ability
- Preference for loud television volume, has unusual listening habits for recreational activities
- Fatigues easily when listening is required, such as in school, church or even recreational activities like a concert or play
- Trouble focusing when conversations or activities do not include visuals
- Difficulty with complex language such as word problems (dyslexia)
- Poor phonological awareness skills such as sound-symbol relationships, blending a sequence of sounds into words, and identifying the beginning, middle, and ending sounds of words
- Become frustrated with certain tasks (autism, ADHD)
- Cannot discern sounds in unusual environments (loudspeaker, phone, etc.)
- Poor memory for lists of words and numbers (ADHD, dyslexia, working memory)
- cannot tell the difference between sounds
- cannot determine where a sound is coming from
- Poor reading fluency and/or reading comprehension
APD and Learning Challenges
I verbally prompt my husband at least 100 times a day. We all do this at home to our partners and kids. Right?
As humans, we lean heavily on verbal and auditory communication. So just imagine what it’s like for a student who cannot adequately process this information. Imagine if, just for a day, you were not able to hear, as a student. For one day, the only information you could adequately process was visual.
Yet that is just one example of how much information an APD student may miss out on. Furthermore, it’s not just a matter of not hearing the information. Because the ears hear it.
However, the child’s brain cannot adequately or efficiently process the information, and expends a tremendous amount of energy trying to do so. This can be exhausting for a child and lead to meltdowns.
Teachers spend so much of their time providing auditory information to students. It’s essential that you get to the root of the issue and provide what the child needs.
The most common treatment for APD is speech therapy. Schools might provide therapy for free under an IEP, if the child qualifies under one of the 14 IEP eligibility categories. However, many parents choose private therapies either instead of an IEP, or as a supplement to the services the child receives at school.
APD IEP Goals
As always, you want to put the task or skill in the formula to make it measurable. You also should work with your audiologist or other professional for accommodations and goals.
And, you can specify the environment, level of practice and whether this is done hot/cold to make it more or less difficult. Here are a few examples of IEP goals for Auditory Processing Disorder that I grabbed from students’ IEPs.
- After presentation and practice, student will repeat a list of 2/3/4 words presented orally to them in (specific) setting.
- Student will discriminate between minimal pairs presented orally after practice in (specific) setting.
- With/without visual prompts, student will follow 1/2/3 step directions that are presented orally (add in novel/rehearsed for degree of difficulty)
- Student will summarize 3 key points from classroom lesson (with/without rehearsal, prompting)
Auditory Processing Disorder Apps
As always, speak with your child’s SLP or audiologist before purchasing and using an app for this.
- ABC PocketPhonics: letter sounds & writing + first words – Apps in My Pocket Ltd(phonological processing)
- Tap Drums FREE – Victor Ren (pattern recognition/sequencing)
- Simon- – Horizon Business, Inc. (temporal processing)
- SONUS (ONE) – Matthew Applegate (temporal processing)
- Kids Can Match – Animals, a vocal memory game for children: full version HD! – Kids Place – Auditory Memory
- Tap Tap Voices
- White Noise – TMSOFT
Treating Auditory Processing Disorder
Currently there is no cure for APD, only treatments and therapies. Be careful, as there are a lot of scams and unproven treatments out for APD and some of them are quite expensive.
Accommodations for APD
- sound canceling headphones
- Assistive Technology Evaluation
- Noise Cancelling Headphones with FM system for teacher
- Home-adjusting the furnishings of a room to help make it less noisy, such as using carpet instead of hard floors
- Provide classroom information (videos, worksheets) ahead of time for student to pre and post watch or read.
- Record classes with smart phone to review later
- Quiet location with minimal distractions for doing work or tests
- If dividing the class into small groups for work, make sure this student’s group has a quiet place to work
- Patience, particularly when it comes to repeating yourself
- breaks or shorter classes for listening fatigue
- college students should not choose 3-hour classes (listening fatigue)
- Home-remove items from student’s space that generate background noise, such as fans, radios, or TVs
- Asynchronous assignments and classes, if the student can manage this appropriately (or give them supports)
- School- Preferred seating; sitting close to the sound source in situations where communication is necessary
- Speak at a slower rate and/or slightly higher volume than usual
- visual aids in a classroom
- visual schedules
- using visual aids to help organize information, graphic organizers
- provide lecture/class notes or outline prior to class
- pre and post teaching/review
- Simple, one-step directions; ask them to repeat back before completing
- incorporating memory techniques like mnemonic devices
- learning active listening techniques
I hope that this has been helpful and gets your child on the path to learning success!
This post was written by an Audiologist, who preferred not to be named because she works for a school district. She has 8 years experience and is a CCC-A.