Hearing—With Difficulty Understanding: Life With Auditory Processing Disorder

By Lauren McGrath

This April, Hearing Health Foundation (HHF) draws your attention to Auditory Processing Disorder (APD), a condition that causes impairments in sound localization—the ability to identify sound sources—and has been closely linked to autism. April 4 is recognized as APD Awareness Day in some regions of the U.S. and April is Autism Awareness Month nationwide.

APD occurs when the central nervous system has difficulty processing verbal or auditory information, specifically in noisy, social environments. Individuals with APD do not necessarily have a diagnosed hearing loss; in fact, many have normal audiogram results. With APD and typical hearing, the inner ear properly sends signals to the brain, but, once received, the brain fails to interpret and analyze these sounds accurately, resulting in jumbled messages.


In the U.S., it is estimated five percent of school-age children, or 2.5 million children, have APD. Individuals with APD are often unable to hear sounds as words and have learning problems, including difficulty in reading, spelling, and language comprehension. It is vital to review the symptoms, demographics, and treatments of APD, should you suspect it in yourself or a loved one.

Individuals with APD have trouble distinguishing between words or syllables that sound alike (auditory discrimination) and recalling what they heard (poor auditory memory). They show delayed responses to verbal requests and instructions and will often ask someone to repeat what has been said. APD is commonly misdiagnosed as ADD/ADHD, dyslexia, or hearing loss.

Demographically, APD is a common secondary diagnosis for children with autism; most children diagnosed with autism have auditory processing disorders or auditory difficulties. HHF Emerging Research Grants (ERG) recipient Elizabeth McCullagh, Ph.D.’s 2017 published work in The Journal of Comparative Neurology examines the strong connection between Fragile X Syndrome (FXS), the most common genetic form of autism, and difficulties with sound localization.

Additionally, APD is prevalent in individuals with neurological problems, including those who have experienced head injuries or strokes. Older adults, who are more susceptible to some cognitive decline, are also at greater risk for APD.

Military veterans who have been repeatedly exposed to blasts are another community disproportionately affected by APD. An estimated 15% of all returning military personnel live with APD. HHF’s ERG recipient Edward Bartlett, Ph.D., explains that the changes to the central auditory system may account for the behavioral issues that veterans experience, such as problems with memory, learning, communication, and emotional regulation.

Retired U.S. Army Colonel John Dillard of HHF’s Board of Directors remarks, “It is truly unfortunate that our veterans, after making such honorable sacrifices, are forced to live with APD, often alongside tinnitus and/or hearing loss. I am hopeful that future scientific advancements will better the lives of veterans and all Americans.”

There are no cures for APD, but there are many treatments that aim to improve the effectiveness of everyday communication. These include environmental modifications, addressing functional deficits, and improving listening and spoken language comprehension. Pursuing treatment for APD as early as possible is imperative, McCullagh explains, because hearing is vital to social and educational interactions. “Those with APD often develop issues with language development, hearing in noise, and sound localization. Risks associated include not being able to participate in noisy environments which can often result in depression and anxiety.”

Much more research of APD is needed to improve the accuracy of methodologies for diagnosis and to determine the best interventions for each child or adult. Even though there are available strategies to treat APD, researchers, including those funded by HHF, largely through the generosity of the Royal Arch Masons Research Assistance, are hard at work finding alternative treatments that will improve the lives of those with APD.

We need your help supporting innovative hearing and balance science through our Emerging Research Grants program. Please make a contribution today.

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Understanding Auditory Processing Disorder

 By Frankie Huang

April 4 is Auditory Processing Disorder Awareness Day and the Hearing Health Foundation is highlighting the effects and challenges associated with living with APD.

Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is an auditory deficit affecting how the central nervous system interprets verbal information. Those living with APD show impairments in sound localization, specifically their ability to isolate a sound source in social environments.

Approximately 5% of school-age children have APD. Children with APD often are uncertain about what they hear and have difficulty listening in loud background noises as well as understanding rapid speech. Often distracted, they can struggle to keep up with conversations which impedes their ability to read, spell, and follow oral directions.

Researchers found a correlation between working memory capacity, which is the ability to retain and manipulate information, and speech development. They found that working memory capacity was significantly lower in children with APD and may be the cause of their inability to separate and group incoming information and, in turn, lead to poor speech perception in noisy environments.

Other researchers found that peripheral hearing loss may affect performance in certain APD tests in older adults. Older adults with mild to moderate hearing loss did significantly poorer on tests that require recalling words, identifying high and low tone patterns, and repeating short sentences.

Although APD can be difficult to diagnose, there are telltale signs: poor auditory memory, difficulty identifying sounds, and a delayed response to verbal requests and instructions. APD is sometimes misdiagnosed as ADD/ADHD or dyslexia, so if you suspect you or a loved one may have APD, it is advised that they go through an individual comprehensive assessment with an audiologist for a more accurate diagnosis.

It is important to understand that research is still needed to understand auditory processing disorders, accurate methodologies for diagnosis, and the best interventions for each child or adult. Even though there are available strategies to treat children with APD, researchers are hard at work finding alternative treatments that will improve the lives of those suffering from APD.

Learn about Hearing Health Foundation’s 2016 Emerging Research Grants recipients who are conducting research to improve the lives of those affected by APD. These grantees are General Grand Chapter Royal Arch Masons International award recipients and we are grateful to the Masons for their ongoing support.

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