What is Auditory Processing Disorder?

Auditory Processing Disorder

Have you ever been in a situation where you said something to someone, and they completely misunderstood what you said? You might be thinking, "oh they just didn’t hear me", but in reality, they most likely did not process what you said. If this happens for someone pretty often, they most likely have auditory processing disorder.

At a Glance:

  • Auditory processing disorder (APD) makes it hard to know what people are saying.
  • It isn’t related to hearing problems or intelligence.
  • APD can impact people of all ages, and in different ways.

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 catthat, 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. Auditory processing disorder is different than sensory hearing loss.

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.

How do I know if we need to practice this cognitive skill?

Some signs of auditory attention or auditory processing problems might include:

  • Difficulty remembering. This could be anything from difficulty remembering a few simple directions to forgetting math facts to an inability to remember the characters of a story that’s just been read aloud.
  • Consistent difficulty understanding letter sounds or how sounds go together to form words. In other words, trouble reading.
  • Difficulty identifying rhyming words.
  • Trouble with spelling.
  • Consistently omitting sounds when speaking or saying common words incorrectly.
  • Difficulty concentrating if there are too many distracting sounds in the background.
  • Difficulty distinguishing sounds in general.
  • Asking often for information or directions to be repeated. You might hear “Huh?” or “What?” a lot.
  • Difficulty organizing or expressing thoughts.

Auditory Attention, Processing and Memory Activities

Choose one to three of the activities to do each day. Lean in hard on the fun activities so the less fun activities don’t seem so monotonous.

Following Auditory Directions I need you to…You begin with telling your child to do one thing. Before he’s allowed to do it, he must picture that activity in his mind and repeat the direction back to you. Make sure you hold up one finger when telling the direction and your child holds up one finger when he repeats it back to you. Then, they need to go do the one thing they were told to do.

The next day, go through the same process with two directions. You give the directions, holding up one finger for the first direction and two fingers for the second direction. Your child pictures the two directions and repeats them while holding up one finger for the first direction and two fingers for the second. He/she then does both things he was asked.

The third day, give three directions. The fourth day, four. And, so on.

Find the ___ and put it on the ____.  You can use any objects you like for this activity. Quite simply, you give oral directions that your child must follow correctly. Start with easy directions and increase the difficulty as you see fit. The directions should only be given once.

Easy Example: “Find three red cubes and snap them on top of a blue cube.”

More Difficult Example: “Find the following magnetic letters – l, s, a and w. Place them from left to right alphabetically.”

Simon Says. Yes, this is the same old-fashioned game you remember as a child.

Start easy: “Simon says touch your nose.”

Add more directions as your child improves: “Simon says touch your nose, tap your foot, and whistle.”

Battleship. This is a great listening game (as well as coordinate graphing practice!)

Listening and Responding Quickly

Red Light/Green Light. Here’s another old-fashioned game that’s perfect to practice listening skills, with the added bonus of your child needing to respond quickly. In case you don’t remember how to play, your child stands far away from you and races as fast as they can toward you when you say “green light”, but stops as quickly as possible when you say “red light.” If you have several players, the person who reaches you first is the winner. If someone doesn’t stop when you say “red light,” they must return to the start.

Musical chairs. You don’t have to have a large group to play musical chairs, but it certainly helps to have at least a few people. Provide one less chair than you have players. While you play music, players walk around the chairs. When the music stops, players try to sit in the empty chairs. The person left without a chair is out. This is a great activity for responding quickly to auditory changes.

Simon. Simon is a solitary electronic game where colored buttons light up and make sounds in various patterns. Once the game goes through a pattern, you must remember which buttons to press in order to complete the same pattern. Listening for sound patterns is a great cognitive exercise.

Twister. The very premise of Twister is listening carefully to the referee as they tell you to put a certain body part on a certain color on the playing board. It can be played with one child as well as many. Anytime you can combine full-body action with the cognitive skill you’re working on, it’s a good thing.

Listening and Remembering

I Went Shopping. This game requires at least two players.  Each person takes a turn repeating the current grocery list and adding a new item in alphabetical order. “I went shopping and bought an apple.” “I went shopping and bought an apple and a banana.” “I went shopping and bought an apple, a banana, and a cookie.” “I went shopping and bought an apple, a banana, a cookie and a d_____.” This game is great for both listening and remembering!

 Who Comes Next? The Pictureka deck of cards is so silly, but very useful for brain training. In this game, the parent calls out two of the card’s characters and the child must find the characters and place them in the order mentioned. Next time, list three characters. The next time, four characters. And, so on to increase the listening skills and short-term memory.

Circle This. I love this activity. Download the Circle This activity sheet (below) and place it in a page protector so you can use the same page over and over again.

Here’s what you do… Give your child a dry erase marker.  On the first day say, “Circle all the B’s.” That’s it. Your child should go from left to right through the letter rows and circle all the B’s. On the second day say, “Circle all the B’s and put a square around all the E’s.” On each subsequent day, you add a new letter with a new direction. So…besides listening, this activity also practices visual cognitive skills and memory. It’s a blockbuster! You could easily create other pages with different letters or numbers or images to keep this activity fresh.

Telephone. I bet you’ll remember playing this game, too! You need at least two players, but more players mean more fun. The first person whispers something in the ear of another player. That player must listen carefully and repeat the message to another player (or repeat it aloud if there are no other players.) The goal is to listen carefully so that the message is relayed correctly from one person to another.

Hand Clapping Rhythms. This is quick and easy. One person claps (or taps, stomps, snaps, etc.) a rhythm. The other person must repeat the pattern successfully. Start with short patterns and build as your child is able.

Clue. When you think of the game of Clue, you don’t necessarily think of auditory skills. However, listening and processing other players’ guesses is a very important part of winning the game! As a bonus, logical thinking is practiced, too.

With consistency you can definitely make an improvement in your child’s auditory processing skills!  

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