Auditory processing disorder: What you need to know

If you know someone who has trouble understanding what people say, you may have heard the term auditory processing disorder (APD). It’s one name for problems recognizing the sounds in speech.

The challenges aren’t related to hearing. People hear the sounds others make when speaking. But they have trouble processing and making sense of those sounds in the brain.

APD also isn’t related to intelligence. People who have it are as smart as anyone else. They just struggle with a specific group of skills.

Learn more about APD, and the effect it has on understanding sounds and words.

What is auditory processing disorder?

APD refers to challenges in how the brain understands speech. The sounds may be loud and clear. But people with APD don’t pick up on the subtle differences between them.

For example, people with APD may not recognize the difference between cat, that, and bat. The words seventy and seventeen may sound the same. Words can also get scrambled, so the question “how are the chair and couch alike” might sound like “how a cow and hair are like.”

There are four auditory processing skills that people with APD may struggle with:

• Auditory discrimination: noticing, comparing, and distinguishing between separate sounds

• Auditory figure-ground discrimination: focusing on the important sounds in a noisy setting

• Auditory memory: recalling what you’ve heard, either immediately or in the future

• Auditory sequencing: understanding and recalling the order of sounds and words

It’s not clear what causes APD. But the difficulties impact people of all ages, and in different ways. Here are some common signs of auditory processing disorder:

• Trouble following spoken directions, especially multi-step ones

• Often asking people to repeat themselves or saying “Huh?” or “What?”

• Trouble following a conversation, especially if there are multiple speakers or lots of background noise

• Being easily distracted by background noise or sudden, loud noises

• Trouble remembering details of things that are read or spoken

• Trouble with reading or spelling, which require processing sounds

• Taking longer to respond when someone speaks

• Trouble knowing where sounds/speech is coming from

Conversations can be difficult in general for people with APD. They’re often slow to respond to what others say. And if they don’t understand, they may respond in ways that don’t make sense.

How auditory processing disorder is diagnosed 

APD is controversial. Experts don’t agree that it’s a disorder on its own, and there are multiple definitions of it. But the term is still used to describe these challenges.

The first step in identifying APD is to rule out hearing loss. Health care professionals can usually do that. But testing for APD is done by audiologists. These specialists do a series of advanced listening tests where patients listen and respond to different sounds.

APD often shows up in childhood. But kids aren’t usually tested until the age of 7 because their auditory skills are still developing. Adults can also be tested and identified with these difficulties.

APD isn’t the only thing that makes it hard to follow what people are saying. Problems with working memory can cause similar challenges. And the difficulties with focus that come with ADHD can make it hard to pay attention when others talk.

APD and ADHD can look so similar that they’re often mistaken for each other and misdiagnosed. Plus, people often have both conditions, which makes it even more complicated.

Another condition that makes it difficult to understand what people say is receptive language disorder. But the problem there is with understanding the meaning of language, not sounds.

What can help with auditory processing disorder

There are many ways to support people with APD and make it easier for them to manage the challenges. These include:

• Using simple, one-step directions

• Speaking at a slower rate or slightly higher volume

• Providing a quiet spot for doing work

• Being patient and repeating things people miss

Schools may give students extra support in class under a special education plan called an IEP . For example, kids might be seated at the front of the room, away from distractions. Or they might get written instructions instead of spoken ones. These types of supports can also be helpful at work. Learn more about accommodations for APD, and technology that can help.

The main treatment for APD is speech therapy. Schools might provide therapy for free under an IEP, if the child has a language disorder. But there are also speech-language pathologists who work in clinics or in private practice. The earlier treatment starts, the better.

APD can create challenges at school, at work, and in everyday life. But with the right help and support, people who have it can thrive.