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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When It's Not Just Hearing Loss

By Morgan Leppla & Laura Friedman

This year Autism Sunday, an international day to raise awareness of autism spectrum disorder (ASD), is on Feb. 12.

Did you know that one third or more of pediatric hearing loss cases overlap with another condition? This may sometimes be ASD, making treatment and management of co-occurring conditions a challenge.

In a 2007 report in the Journal of Deaf Studies and Deaf Education, British researcher Lindsay Edwards, Ph.D., cites an estimate that 30 to 40 percent of children with hearing loss have co-occurring conditions that could prohibit them from forming language, speech, and sociocognitive skills. But despite this large percentage, there is little research on hearing loss that occurs with other disorders. What research there is has shown the benefit of cochlear implantation for children with additional needs (such as physical or learning disabilities), and the difficulties of language acquisition and development for 3-year-olds with developmentally related conditions such as ASD, cerebral palsy, or Down syndrome.

One silver lining is that the fact that 30 to 40 percent of pediatric hearing loss may occur with other conditions may prove helpful in predicting future disorders. A July 2016 Autism Research paper suggests that a noninvasive measure of otoacoustic emissions in the inner ear—a common hearing test for infants, who are preverbal—may help identify the risk of ASD at an early age, accelerating treatment. Study author Anne Luebke, Ph.D., of University of Rochester Medical School, found that children with ASD often have trouble hearing a frequency range (1–2 kHz) that is important for understanding speech. The range includes sounds for the meaning-conveying consonants S-, H-, and F-.

Scientific conclusions can help shape future research, but cannot illustrate daily life for families with children with co-occurring conditions. Dual diagnoses make unlocking any child’s learning style challenging, but reviving research and upgrading professional training are essential tools in order to advocate for and successfully educate children with co-occurring conditions.

If you’re interested in funding research related to diagnosing and treating co-occuring disorders, such as hearing loss and autism, please consider donating today: or contact us at

This blog was adapted from an article original appearing in Hearing Health magazine’s Fall 2016 issue. For references in this story, see

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Educating Children with Hearing Loss and Autism Spectrum Disorder

By Eric Sherman

Older Brother, Zach, Cole, and Eric (dad)

Older Brother, Zach, Cole, and Eric (dad)

Gallaudet Research Institute’s 2009-2010 Annual Survey estimates that about 40 percent of children with hearing loss exhibit another disability and notes the prevalence of autism spectrum disorder (ASD) to be 1 in 59. Early intervention is critical for the development of speech, language, communication skills, and learning. Some families are fortunate to discover their child’s hearing loss at a young age so an early intervention program can be implemented to help their child stay on track with their hearing peers.

What happens when your child is diagnosed with profound to severe hearing loss at 6 months of age, receives his first cochlear implant at age 1½ (second at before his 5th birthday) and spends a couple of years in auditory-verbal therapy (AVT) or speech therapy, but is showing little to no progress?

This was the case with my youngest son. After receiving a second cochlear implant at 1½ and then two years of AVT, my son was nowhere near his hearing peers in communication and language skills. My wife and I knew language development could be a long process, but our gut was telling us that something else was wrong. Our auditory-verbal therapist advised us to seek additional medical evaluations to see if there was something else prohibiting our son’s language development. After having evaluations done, our son at almost 3 years of age was diagnosed on the autism spectrum.

Having a child with hearing loss takes lot of work. Add autism to the mix and it is like trying to solve a puzzle without knowing which pieces are in play.

With intensive behavioral and speech therapy over the years, our son, age 11, has done well. He has become more verbal and can certainly communicate his needs and wants. What is difficult is unlocking the doors into his learning style. There is this blurred line between his autism and hearing disability. When our son has difficulty doing schoolwork, we always question whether he is hearing the information, whether he has a problem processing the information, or whether he is just not interested in the material because it has no real meaning to his everyday life.

Our son has been lucky over the past three years having a teacher who is very creative and skillful in engaging her students. But this has not always been the case. My family’s experiences have taught us that the school district needs more information and training on how to educate a child with both hearing loss and ASD. Service providers need to know how to address each disability individually and collectively understand how they impact a child’s overall education. We have a school audiologist who wanted to create a goal for our son where he tells his aide or teacher when his CI processors are not working. This is a reasonable expectation for a child with hearing loss, but when ASD is added to the mix this may be difficult to achieve.

A child with ASD may have to be taught what it means for their processor not to be working, as well as what to do after they determine they are not working. Furthermore, generalization of whether the processor is “working or not working,” “broken,” or “on or off” may be confusing and difficult to understand. Our son believes his processor is “on” if his headpiece was attached to his head. Also, a child with autism may prefer the silence and not notify anyone their processors are off.

The dual diagnosis of hearing loss and ASD has been documented for the past 20 years; however, research and clinical guidelines on how to find and teach young children with this dual diagnosis are sparse. School professionals and educators need more tools and training to better equip the growing number of children afflicted with ASD and hearing loss. Both Advanced Bionics, which makes cochlear implants, and Illinois State University have done work on this issue, calling attention to the need for better diagnostic tools, early intervention, and training of education professionals. Still, significantly more needs to be done.

Eric Sherman is a father of two boys. In addition to advocating for his son and others, he serves as a parent representative on advisory boards on how special education and family support services are implemented in his local school district. To learn more about Eric Sherman visit

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