Auditory Processing Disorder

Definition, symptoms, testing and treatment


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    What is Auditory Processing Disorder?

    1. Definition Of APD

    Central auditory processing disorder (CAPD) or more simply known as auditory processing disorder (APD) is a neurological condition that affects the brain's ability to interpret and make sense of sounds, especially speech.


    It is characterized by difficulties in processing auditory information, which can lead to problems with listening, learning, and communication. The formal definition of auditory processing disorder varies, but it generally refers to a set of symptoms or deficits related to auditory processing that are not the result of a hearing loss or other cognitive or language disorders.


    According to WebMD, “APD, also known as central auditory processing disorder, isn't hearing loss or a learning disorder. It means your brain doesn't "hear" sounds in the usual way. It's not a problem with understanding meaning.”

    2. APD According to Stowell Learning Center

    Auditory processing is one of the many underlying skills that support confident, comfortable learning and functioning.  Auditory processing is not your hearing, but the way the brain perceives and thinks about the information that comes in through the ears.  


    Auditory processing has a profound impact on learning, but, it can mask as other difficulties, such as attention problems, poor comprehension, trouble reading, or weak language or social skills.

    The Learning Skills Continuum

    If you think about learning like a continuum or a ladder, academics and social skills are up at the top. The rungs on the ladder are all of the supporting learning or processing skills. 


    Everyone just assumes that these skills are in place when kids go to school, but for about 30% of the population, at least some of these underlying skills are weak or inefficient - which can stress the  attention system and cause learning to be harder than it should be. 


    Auditory processing sits on the second level up on the ladder or continuum - processing skills.  Weak auditory processing skills can get in the way of fully developing or utilizing higher order skills including executive function, comprehension, reading, and social skills.

    3. Causes of APD

    The exact cause of an auditory processing disorder is not fully understood. However, research suggests that there may be a combination of genetic, developmental, and environmental factors involved.


    Some potential risk factors for an auditory processing disorder include:


    1. Prenatal or perinatal complications: Auditory processing disorders may be more common in individuals who experienced difficulties during pregnancy or birth, such as premature birth, low birth weight, or C-section delivery.
    2. Chronic ear infections: Repeated ear infections during childhood may increase the risk of developing auditory processing disorder.
    3. Head injury: Traumatic brain injury or other head injuries may disrupt the neural pathways involved in auditory processing.
    4. Genetic factors: Some studies suggest that certain genetic factors may be associated with auditory processing disorder, although more research is needed to confirm this.
    5. Environmental factors: Exposure to toxins or other environmental factors during pregnancy or early childhood may increase the risk of auditory processing disorder.
    6. Coping: Because the auditory system is dynamic and has a built-in protection mechanism,  studies indicate that very loud environments, such as living near train tracks or an airport and emotionally toxic environments (such as persistent yelling, screaming, and abuse) can cause restriction of the auditory system. 


    While these factors may increase the risk of auditory processing disorder, not all individuals with these risk factors will develop the condition, and not all individuals with auditory processing disorder will have these risk factors.

    4. What People Miss About APD

    In our experience, most students who are underachieving or struggling socially or in school have challenges with auditory, or listening skills.


    Good auditory processing skills depend upon being able to take-in and process a very broad range of sound frequencies. When the brain is not processing the full range of frequencies, the listener may get incomplete and inaccurate information to think with.


    The interesting thing about sound frequencies is that different frequencies impact us in different ways. Low frequencies are what you might think of as body sounds. They tend to be grounding and regulating. And they get us moving - like bass tones in dance music!


    Mid-range frequencies are the learning sounds. This is where most speech sounds are. High frequencies are energizing to the brain. We need to be processing high frequency sounds in order to feel alert and focused and motivated. So, if we’re not processing that full range of sound frequencies it’s going to impact our behavior.


    An interesting thing about the science of auditory processing is that the ear has neurological connections to nearly every organ and function in the body as well as to the attention, emotional, language, and learning centers in the brain.


    Weak auditory processing skills not only impact learning and reading, but can also affect clarity of speech, energy, attention, mood, and sense of well-being.

    Download: Learning Skills Continuum

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    Signs and Symptoms of an Auditory Processing Disorder

    1. General Symptoms of APD

    Auditory Processing Disorder can affect individuals of all ages, but it is most commonly diagnosed in children, particularly those with learning difficulties or language disorders. Some common symptoms of auditory processing disorder include:

    • Difficulty understanding speech in noisy environments
    • Trouble following spoken instructions, and
    • Problems with auditory memory and sequencing

    2. How Can Educators Help Spot APD in Children?

    Parents and educators can help spot auditory processing disorders by paying close attention to these common educational challenges that may indicate an issue with auditory processing:

    • Say, “Huh?”  “What?” frequently?  Often ask for things to be repeated
    • Miss details or parts of what was said
    • Mishear and therefore misunderstand or misinterpret information
    • Give responses that don’t match the question or conversation
    • Difficulty following oral directions
    •  Fatigue easily during auditory (listening) tasks
    • Have poor long and short-term memory
    • Look at you when you’re speaking, but don't appear to be listening
    • Look like they are not paying attention 
    • Have trouble listening when there is background noise
    • Have difficulty knowing where a sound is coming from
    • Have difficulty with phonics, reading, or spelling
    • Confuse similar sounding words
    • Have trouble sounding out or pronouncing words
    • Have speech or articulation problems
    • Have disruptive behaviors (distracted, impulsive, frustrated)
    • Often feel anxious or lost
    • Withdraw or talk incessantly so that they don’t have to listen
    • Yawn often when listening
    • Have a history of ear infections?
    • Have normal hearing acuity but inconsistent response to auditory stimuli?


    Reading and spelling have a direct correlation to phonological awareness – the auditory processing skill that allows the person to think about the number, order, and identity of sounds inside of words and the sound groupings that make up common patterns in the language. 


    When students are struggling to speak clearly and accurately, use appropriate intonation, express themselves verbally, read, spell, or comprehend, the first place to explore is the auditory processing. 

    Overlapping symptoms of auditory processing and other learning challenges

    Diagnosing auditory processing disorder can be challenging because there are other learning difficulties and attention issues that have similar symptoms.


    Attention Deficit Hyperactivity Disorder (ADHD)
    Children and adults with auditory processing challenges may find listening exhausting and simply cannot keep it up for long, causing attention drifts in conversation and when listening to lectures. They may become agitated and occupy themselves with other things.


    Because they tend to miss or mishear pieces of information, those with poor auditory processing may “connect the dots” incorrectly, causing them to say something that seems “off the wall” in conversation, or ask questions about things that were just explained. Comprehension will be compromised, making it very difficult to maintain attention.


    Many of the symptoms of attention deficit hyperactivity disorder and auditory processing disorder look the same, and because loss of attention is the most obvious symptom in the classroom, often the first (but possibly incorrect) conclusion about these students is that they have attention deficit hyperactivity disorder.


    Autism Spectrum Disorder
    Individuals on the autism spectrum experience differences in sensory processing that can dramatically impact how they perceive and respond in the world. In our experience, auditory processing is typically an area of challenge for our students on the autism spectrum.


    An oversensitivity to sound, weak ability to locate where sound is coming from, or inability to quickly identify what the sound is can trigger a stress response, causing the person to operate in a high alert state. It is much harder to regulate emotions when fearful or over aroused. Anxiety, hiding, covering ears, and rigidity or strict adherence to familiar routines in order to feel secure may result.


    Weak auditory processing impacts speech clarity both for receiving and expressing language, including tuning-in to intonation. Our students with autism almost always experience challenges with comprehension. Improving auditory processing is a key component to our overall approach to developing comprehension.


    Dyslexia almost always has an auditory processing component. Dyslexic students may be very verbal and well-spoken, but struggle when it comes to processing the sounds in words for reading and spelling.


    Speech or Language Delay
    Auditory processing provides a foundation for speech, articulation, and language. Children with speech or language delays will typically have auditory processing delays or inefficiencies. Early speech and language delays, even if the child has had intervention, will often become reading challenges if the underlying auditory foundation is not addressed.


    Key Takeaway

    The key takeaway is that if you have the slightest suspicion that you or your child have an auditory processing disorder, we highly recommend that you get testing done right away.


    When getting tested at Stowell Learning Centers, we’ll also be able to detect other learning and attention challenges that often overlap or get confused with auditory processing disorder.

    Download: Auditory Processing Screener

    This screener contains the most common functional indicators of an auditory processing disorder for both children and adults.

    We based this list on our extensive experience with evaluation and treatment of learning and attention challenges related to auditory processing disorders.

    Subscribe to our weekly newsletter to download this guide and gain access to APD resources and more.

    Testing For Auditory Processing Disorder

    1. Where To Get Tested

    Testing at an Audiologist

    Diagnosis typically involves a comprehensive evaluation by an audiologist or other trained professional, using a combination of behavioral and electrophysiological tests to assess auditory processing abilities.


    Auditory processing disorder testing typically includes a series of tests that assess various aspects of auditory function beyond just hearing sensitivity, such as the ability to process and understand speech in noisy environments, the ability to distinguish between similar sounds, and the ability to localize sounds.


    The evaluation usually begins with a comprehensive hearing evaluation to rule out any underlying hearing loss that may be contributing to the individual's auditory difficulties. 


    The evaluation may include questionnaires and interviews with the individual and their family members to gather information about their history, symptoms, and everyday communication challenges.


    The length of the evaluation will vary depending on the specific tests included and the student's needs, but generally takes several hours to complete and may be done in multiple visits.


    Many Auditory Processing tests require children to be at least 7-years old. Since the child's brain is still developing, testing results may be inconclusive.

    Testing at Stowell Learning Centers

    Stowell Learning Center's Functional Academic and Learning Skills Evaluation is a comprehensive assessment designed to identify the root causes of learning difficulties.  Because auditory processing has such a profound impact on learning, functional evaluation of auditory processing skills is always a part of our assessment process. 


    We assess multiple cognitive skills at every level of the Learning Skills Continuum in addition to auditory processing to ensure the student has a strong learning foundation to support higher level cognitive skills such as Executive Functioning and academic learning.

    2. How Does Stowell Learning Center Test For APD

    Assessments are tailored to each individual student; however, they will typically include evaluation of some or all of the following:

    • Visual processing
    • Visualization and visual reasoning
    • Processing speed
    • Working Memory
    • Auditory processing including auditory attention, ear dominance, auditory analysis of sounds/phonemic awareness, auditory memory, reasoning and comprehension, and discrimination
    • Reflex testing
    • Reading, writing, spelling, and math
    • Expressive and receptive language
    • Comprehension
    • Attention
    • Executive function 

    3. Can I Use This Diagnosis From Stowell to Get Special Accommodations?

    Our goal is not to diagnose or qualify students, but rather to determine the root cause of the struggles with learning or attention in order to create a Cognitive Learning Plan to resolve the learning difficulties.


    We do not officially provide a diagnosis of auditory processing disorders, but can determine the types and extent of auditory challenges that are impacting the student’s learning and functioning.


    The information provided by the Functional Academic and Learning Skills Evaluation will be an outstanding tool for helping parents, teachers, and therapists better understand the child’s needs, and learning or attention challenges.


    It may be helpful in working with teachers to provide accommodation in the classroom but will not generally be able to be used for official diagnoses, services, or accommodations at school.

    A Word About Accommodations

    Accommodations are a good thing on a temporary basis, but the belief that students with auditory processing disorder will just need to manage forever using accommodations is unfair and untrue.


    While alternate ways of teaching and testing help students be more comfortable in school, they don’t address the underlying issues that are causing the problem. 


    If the school is offering accommodations and support, by all means make use of them while the real problem is being corrected, but don’t think of them as a permanent solution.

    Student and clinician in an auditory training session
    SLC student and clinician in an auditory training session

    Treating Auditory Processing Disorders

    1. Can You Treat APD?

    It is commonly believed that learning disabilities, or learning and attention challenges like auditory processing disorders, are a life-long struggle can never be corrected.


    Neuroscience research proves that through targeted and intensive cognitive training, the brain can rewire itself to learn to process information more effectively.


    Most diagnosed and undiagnosed learning disabilities including auditory processing disorders can be permanently corrected by identifying and developing the weak underlying learning/processing skills that are at the root of the problem.


    2. What If APD Isn't Treated

    If left untreated, auditory processing disorders can have a significant long-term impact on academics, professional work and well-being.


    Some real life examples from our students prior to getting treatment:

    • Lacks confidence and independence - always missing info and feeling  lost or behind
    • Poor social relationships - hard to listen and communicate adequately with background noise (Ex. classroom, party, restaurant, gathering of friends, attending live sports games) 
    • Easily exhausted and overwhelmed -  avoids social or group interactions, leaves early, isolates self and withdraws
    • Struggles academically - memory, attention, comprehension, participation in discussions all affected by the energy it takes to listen and piece together the information.
    • Frequent misunderstandings -  mishear or miss information at school, work, home, and with friends 
    • Emotionally misunderstood - misinterpreted as unmotivated or irresponsible because work is missing or incomplete due to mental exhaustion and getting incomplete and inaccurate information

    3. What Does Auditory Processing Skills Training Look Like?

    Auditory Stimulation and Training is a scientifically-based auditory training programming that uses a combination of sound therapy (passive auditory training) and specific evidence-based reading, language, or comprehension lessons to improve underlying skills critical to listening and reading success. 


    Auditory processing skills are improved through sound therapy and audio-vocal training lessons that help the learner get clearer and more accurate information when listening.  This impacts speech clarity, intonation, comprehension, verbal expression, and attention.  


    Lessons are structured to stimulate and improve visualization of information that is read or heard; working memory; grammar and word usage; phonological awareness, decoding, and spelling skills; reading accuracy, fluency and comprehension; and reasoning skills for test-taking and analyzing questions.


    There are four unique and comprehensive Auditory Stimulation and Training (AST) Programs developed by Jill Stowell, founder of Stowell Learning Centers:

    • AST-Reading and Spelling
    • AST-Comprehension
    •  AST-Comprehension and Study Skills
    •  AST-Language


    Each program has a strong auditory training base and addresses critical processing skills in combination with targeted one-on-one training in listening, speaking, reading, comprehension, and/or spelling.


    The AST programs stimulate:

    • Auditory discrimination, awareness and processing of a full range of sound frequencies
    • Auditory attention to higher frequencies in sound
    • The voice to become an ongoing stimulus for the auditory system (auditory feedback loop)
    • Improved self-monitoring of voice and content
    • Right ear/left brain dominance for language and reading


    Passive auditory training programs:

    • The Listening Program (TLP) and inTime developed by Advanced Brain Technologies
    • iLs (integrated Listening Systems) 


    To view a sample treatment plan, view the case study below.

    Case Study: APD Summer Intensive

    Learn about a high school student's dramatic academic and social improvement after completing a Summer Intensive Program at Stowell Learning Centers.

    Results of Auditory Processing Skills Training

    1. How Soon Can I See Results?

    Each student is different, but we typically begin seeing changes within the first few weeks or month of auditory processing skills training.

    • The AST programs typically take 5 to 6 months to complete.
    • A Cognitive Learning Plan which includes overall processing skills training (often needed to help fill-in the gaps once the auditory system is stronger), could take approximately 9 months to complete at the pace of our Signature Program
    • In the accelerated Intensive Program, a Cognitive Learning Plan could take approximately 4 - 5 months to complete.
    SLC Student wearing headphones for an auditory training session
    SLC Student wearing headphones for an auditory training session

    Additional Resources


    Speak to a Learning Specialist to ask questions and learn how Auditory Processing Skills training can help.

    The call is free and without obligation.