Auditory Processing Disorder (APD)

What is auditory processing disorder?

Auditory processing disorder (APD), also known as central auditory processing disorder, is a hearing issue that makes it hard for you to understand what people are saying. The condition often starts in childhood, but adults may develop it from having certain diseases, getting a head injury or growing older.

People with APD have difficulty understanding speech even though they don’t have hearing issues. Many APD symptoms are similar to hearing loss symptoms. Although there’s no cure for ADP, audiologists have treatments that help people with APD manage hearing issues.

Is it common?

That’s hard to say. Research shows healthcare providers use different standards when they diagnose APD, which leads to a wide range of estimates. One recent study concluded that between 1 and 2 children in 1,000 have APD. Another study estimated between 23% and 76% of adults age 55 and older have APD.

Are there different kinds of APD?

No, but people with APD may have different areas of weakness. These four areas are:

• Auditory discrimination: Noticing small differences between words. For example, if you said, “There are (40) cats here,” someone with APD may hear “There are (four words) cats here.”
• Auditory figure-ground discrimination: Being able to pick out specific words in a loud or noisy background.
• Auditory memory: Being able to recall what was said, like remembering phone numbers or song lyrics.
• Auditory sequencing: Understanding and recalling the order of words.

What are auditory processing disorder symptoms and signs?

Auditory processing disorder symptoms and signs vary, but typically include:

• Asking people to repeat what they’ve said.
• Having difficulty understanding what other people are saying, especially in places where there’s a lot of noise or echoing noise or when more than one person is speaking.
• Having trouble telling the difference between words.
• Having trouble understanding rapid speech.
• Having difficulty reading, spelling and writing below grade level.
• Not responding when people talk. This happens because people with APD need time to sort out what they’ve heard.
• Taking longer to respond in conversations.
• Having trouble following verbal directions.
• Having trouble following long conversations.
• Not being able to remember what people said.

What causes auditory processing disorder?

If you have auditory processing disorder, it means your brain is having trouble interpreting what your ears are hearing. To understand APD, it may help to understand the chain of events that lets you hear sounds, including words:

• Sound waves enter your outer ear, hitting your eardrum, which starts to vibrate.
• This sets up vibration in very small bones in your middle ear.
• That vibration triggers ripples in your inner ear fluid. That ripple effect eventually hits tiny hair cells in your inner ear.
• The hair cells react by sending electrical signals to your auditory nerve. Your auditory nerve forwards the signals to your brain.
• Your brain processes the signals and makes sense of sounds, including speech.

In APD, something keeps your brain from processing or interpreting the signals that your auditory nerve sent. When that happens, your brain misinterprets signals and you have trouble understanding what’s being said.

Auditory processing disorder happens for many different reasons. In general, experts link the condition to the following issues:

• Central nervous system disorders like stroke, epilepsy, multiple sclerosis or Alzheimer’s disease.
• Genetics. APD runs in families.
• Frequent ear infections.
• Head injuries.
• Low birth weight or premature birth.

What are APD complications?

People with APD may have trouble learning, including learning how to read and write. They may also have trouble communicating with others. Learning and communication issues may cause people with APD to develop anxiety and depression.

How is auditory processing disorder diagnosed?

In the beginning, many people may be involved in evaluating symptoms and signs of auditory processing disorder. For example, a psychologist may do tests to evaluate cognitive function and a speech-language pathologist may evaluate verbal and written language skills. However, audiologists make the actual diagnosis. Audiologists may use different listening tests to diagnose auditory processing disorder.

What are auditory processing disorder therapies?

Treatment varies, but may involve one or all of the following:

• Changing your environment, like changing where you sit in meetings, in a classroom or your workplace. If you have APD, you may benefit by asking people to speak more slowly or provide written instructions.
• Getting specialized speech therapy that focuses on building auditory skills.
• Using coping strategies, like a recording device to capture communication or asking for more information.
• Using other management strategies to help your brain focus on the auditory signal.

Can auditory processing disorder be prevented?

Most issues that cause APD are issues you can’t control, like certain central nervous system disorders. This makes it difficult to prevent auditory processing disorder.

What can I expect if I have auditory processing disorder?

Healthcare providers can’t cure APD, but there are therapies that help people manage it.

How do I take care of myself?

Self-care with auditory processing disorder starts with understanding all the ways that APD may affect you. Certainly, APD affects your ability to understand what you hear. It may also affect your self-confidence and self-esteem. That said, taking steps to make it easier for you to understand what you hear can help you feel more confident.

What questions should I ask my healthcare provider?

If you have APD, you may want to ask the following questions:

• How does APD affect me?
• What treatments will help me manage APD?

Do people with auditory processing disorder also have autism spectrum disorder (ASD) or attention-deficit/hyperactivity (ADHD) disorder?

Some people with auditory processing disorder also have ASD or ADHD, but having APD isn’t always a sign of either.

A note from Cleveland Clinic

Auditory processing disorder (APD) is a hearing issue that affects how your brain processes sound and how you understand speech. If you have auditory processing disorder, you may struggle to make sense of what you hear. APD can’t be cured, but there are steps you can take to reduce APD’s impact on your daily life. Talk to an audiologist or healthcare provider if you’re having trouble understanding what people say.