Auditory processing disorder (APD)

Auditory processing disorder (APD) is a hearing problem where the brain is unable to process sounds in the normal way.

It can affect people of all ages, but often starts in childhood.

Symptoms of auditory processing disorder

APD can affect people in many different ways. A child with APD may appear to have a hearing impairment, but this isn't usually the case and testing often shows their hearing is normal.

It can affect your ability to:

• understand speech  – particularly if there's background noise, more than one person speaking, the person is speaking quickly, or the sound quality is poor
• distinguish similar sounds from one another  – such as "shoulder versus soldier" or "cold versus called"
• concentrate when there's background noise – this can lead to difficulty understanding and remembering instructions, as well as difficulty speaking clearly and problems with reading and spelling
• enjoy music

Many people with APD find it becomes less of an issue over time as they develop the skills to deal with it.

Although children may need extra help and support at school, they can be as successful as their classmates.

When to see your GP

See your GP if you or your child has difficulties with hearing or understanding speech. This may not be caused by APD – it could be the result of language difficulties.

Your GP may refer you or your child to a hearing specialist called an audiologist for a range of tests.

Testing for auditory processing disorder

Normal hearing tests aren't very effective at diagnosing APD because they're usually carried out in a quiet room without distractions and don't test the ability to hear in a normal day-to-day listening environment.

More complex tests are needed to test the ability to hear with different levels of background noise, poor quality speech, people talking with different accents, and people talking quickly.

Specific tests that may be used to help diagnose APD include:

• tests to check your ability to hear speech with different levels of background noise
• sound pattern recognition tests
• tests to detect  subtle changes in sound  – the results will be compared with those of similar-aged children
• electrode tests – you wear headphones to listen to sounds and electrodes placed on your head measure your brain's response
• speech and language assessments
• cognitive assessments that test your thinking

Treatments for auditory processing disorder

There are a number of strategies that can help people with APD.

Auditory training

Auditory training involves using special activities to help train your brain to analyse sound better. You can do this on your own, with the help of an audiologist, or by using a computer programme or CD.

It involves a range of tasks, such as identifying sounds and guessing where they're coming from, or trying to focus on specific sounds when there's some slight background noise.

The tasks can be adapted for people of different ages, with children often learning through games or by reading with their parents.

Changes at home or school

Be aware of room acoustics and how it can affect your ability to hear. Rooms with hard surfaces will cause echoes, so rooms with carpets and soft furnishings are best.

Switch off any radios or televisions and move away from any noisy devices, such as fans.

If your child has problems hearing, talk to school staff about changes that may help them, such as sitting near the teacher, using visual aids and reducing background noise.

Your child may also benefit from wearing a radio receiver or having a speaker on their desk at school, which is connected wirelessly to a small microphone worn by their teacher.

Alternatively, a speaker system in the class that's connected to the teacher's microphone may help your child hear their teacher over any background noise.

Help from others

It may be useful to tell other people about your hearing problems and let them know what they can do to help you hear more clearly.

Ask them to:

• get your attention and face you before they talk
• speak clearly and at a normal pace (not too fast or too slow)
• emphasise their speech to highlight the key points of the message
• repeat or rephrase the message if necessary

Other strategies that might be particularly useful when talking to children with APD include:

• not covering your mouth when talking to them
• not using long sentences when you talk
• using pictures to help them understand what you mean 

Further help and support

Independent Parental Special Education Advice (IPSEA) provides information to help parents of children with special educational needs.

What causes auditory processing disorder?

The causes of APD aren't fully understood. Some cases in children may be related to having glue ear when they were younger. It may also be caused by a faulty gene, as some cases seem to run in families.

In both adults and children, APD is sometimes linked with brain damage from a head injury, stroke, brain tumour or meningitis.

It can also be caused by a traumatic birth where there's a significant lack of oxygen to the brain, severe jaundice and brain haemorrhages.

Some cases in adults have also been linked to age-related changes in the brain's ability to process sounds and progressive conditions that affect the nervous system, such as multiple sclerosis.