Auditory Processing Disorder

The other day, my younger son and I were on my tablet. We were choosing team gear to purchase for his new AAU basketball team. I was looking at the website and he was on his phone, and he was describing things to me and asking me questions (what size do I wear? should I get red or black?). Kevin was nearby playing with one of his toys that makes noise.

The Sixers game was on the TV. Then, my husband entered the room and started talking about doing and getting his COVID booster.

“STOP!” I yelled. “I can’t even hear myself think!”

We’ve all done this as parents, right? Guess what? You’ve just had an Auditory Process Disorder experience. So many acoustic and sensory signals were being thrown at you, you had a negative behavior (yelling).

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.

APD and Behaviors

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.

But, both involve how the brain and body process sounds. Sometimes a person’s ability to process sounds (or lack thereof) is so distressing to them, it can cause behaviors. This is why I always preach to get at the real root cause of behavior, rather than try to reward and punish it.

There’s this one episode of Young Sheldon, and he finds a refrigerator noise so disturbing that he gets up in the middle of the night and dismantles the refrigerator. Meanwhile, the rest of his family could not even hear the noise that was bothering him.

Recently at a 76ers game, my son found the noise and sounds there to be so distressing that he hit me and then began gagging. By treating his hitting as a behavior flaw rather than as a signal of distress would have been nothing short of abusive–if I forced him to sit there and endure the noise.

My point being–noise and sound is often a cause of elopement in a classroom. Many teams treat eloping as a behavior when the child may be trying to escape sounds they cannot tolerate.

In interacting with and supporting our kids, it is essential for us to recognize and acknowledge that not everyone has the same sensory experiences. One person may enjoy the noise and hoopla that accompanies an NBA game. Another person may literally be nauseated by it.

Processing sounds differently and having different auditory experiences should not be considered an impairment. That creates negative stigmas, stereotypes and infers “won’t” instead of “can’t.” Processing sounds differently is just that–different.

Diagnosing APD

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.

You should also speak with your IEP team about adding a speech-language pathologist to the team, a school audiologist to the team, or both. Both audiologists and SLPs (speech language pathologist) often assist with this issue. An audiologist can diagnose APD.

The audiologist will do a series of tests in which your child will listen to different sounds and respond when they hear them. For instance, they might repeat them or push a button. The doctor also may attach electrodes to your child’s ears and head to measure how their brain reacts to sound.

Children usually aren’t tested for APD until age 7 because their responses to the listening test may not be accurate when they’re younger.

When K was an newborn, he failed his hearing screening in the nursery. He eventually passed it (2nd or 3rd time, I don’t remember). And, we now know that he has many sensory processing issues and motor planning issues. These issues can often present themselves as something like a hearing impairment. He is not hearing impaired. At all.

It’s also important to note that some kids (mine!) have poor processing issues and motor planning issues.

So, if you are ‘grading’ his performance based upon his ability to push a button when hearing a sound, you may not get accurate results. It may have nothing to do with his hearing or APD, and everything to do with his motor planning.

Symptoms of APD

Children with APD often have normal hearing. It is just how they process it that differs from other children.

Children who have a disorder such as APD or auditory processing disorder, may have co-existing conditions such as ADHD (attention deficit hyperactivity disorder) or autism.

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. Imagine you could not separate sounds out, or sort them out in your brain. If you were doing group work in class, you experienced confusion with all the separate sounds happening at once.

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)

Interventions for APD Auditory Processing Disorder

Again, work with your child’s team to come up with the supports and interventions that will meet your child’s needs.