Auditory Processing Disorder
Testing, Evaluation, and treatment for auditory processing disorder in Coastal Georgia
General Symptoms of Auditory Processing Disorder (APD)
Frequently Says "huh?" or "what"
The individual may frequently say "huh?" or "what?" or they "cannot hear you."
Difficulty hearing in background noise
Individuals with APD often will remark they cannot hearing or understand what is said in even minimal background noise.
Difficulty following multiple-step or lengthy oral instructions
Someone with APD may struggle with multi-step directions. At home you may say something like, "wash your hands, set the table, then tell your brother it's time for dinner." If you're lucky, they may wash their hands. They won't recall or understand the other two items in that list.
Slowness in processing and responding to auditory information
Because they may struggle with auditory memory, someone with APD may take much longer than expected to respond to auditory information.
Trouble hearing the differences between sounds in words
Someone with APD may know their letters but will have trouble distinguishing between sounds that sound similar, such as /m/ and /n/ as in the words 'beam' and 'bean'.
Trouble focusing when conversations or activities do not include visuals
As in the example above, the person with APD may not be able to discern the conversation is about a bean (as in green bean, butter bean, baked bean...) or a support beam, balance beam--unless there are cards or symbols with the pictures of the objects.
Symptoms of APD in Pre-school & Kindergarten-aged children
- Delayed speech and language abilities
- Confusion of similar sounding words (cap/cat)
- Articulation errors that are not consistent or that suggest acoustic confusions (such as substituting d for g)
- Difficulty following directions that other children the same age can follow easily (e.g. “Put your notebook away, and line up for recess.”)
- Highly distractible, especially in noisy situations
- Need to have directions repeated
- Need tactile or visual cues to attend when spoken to.
- Prefer puzzles or watching videos and television to listening to books.
- Seems to “tune out” others “daydream” or be “in a world of his/her own.”
- Difficulty staying focused on a person’s voice
- Difficulty sitting for story time
- Over sensitivity to sounds
- Difficulty learning new verbally presented concepts, instructions, or activities (may stare back with a blank face, wait and watch other children, or refuse to participate)
- Learns better through hands on activities when shown what to do, rather than being told what to do
- Has an easier time with “nonverbal” concepts such as matching colors and shapes
- Difficulty learning nursery rhymes
- May sing way off-tune or have a monotone voice
- May appear shy or keep to himself/herself to avoid talking with other children
- Poor phonological awareness skills such as sound discrimination, sound-symbol relationships, and identifying the beginning, middle, and ending sounds of words
- May avoid noisy situations such as loud parties and group play activities
- May like music but have difficulty learning the words to children’s songs. (i.e.. “The ABC’s, “Happy Birthday” or “Old MacDonald”)
- Prefer action games to listening to stories
Symptoms of APD in Elementary-aged Children
- Act as if a hearing loss is present, despite passing hearing screenings
- Frequently ask ”huh?” or “what?” and often need information repeated
- Seem easily distracted or bored when conversations or activities do not include visuals
- Difficulty understanding spoken information presented in class
- Difficulty listening and following directions, especially multi-step directions in noisy environments
- Greater difficulty with verbal than nonverbal tasks
- Exhibit a language delay (weak vocabulary and poor sentence structure)
- Misinterpretation of questions
- Difficulty understanding announcements over loudspeakers
- Have articulation errors that persist longer than they should
- Tend to be distractible, especially when background noise is present
- Difficulty following classroom discussions, or making off-topic contributions
- Difficulty carrying on telephone conversations
- Have poor social communication skills or difficulty making and/or keeping friends
- Inability to sing in tune and poor musical ability
- Difficulty understanding riddles and jokes
- Misinterpret sarcasm or tone of voices and get feelings hurt easily
- Become frustrated with certain tasks. (i.e. saying “I don’t understand,” I can’t do this,” or “I don’t know what you mean” )
- Poor reading comprehension
- Trouble sounding out new words and poor fluency when reading aloud
- Poor spelling skills
- Confusion or reversal of letters
- Difficulty remembering people’s names
- Display poor memory for words and numbers
- Difficulty with complex language such as word problems
- Seeming to ignore others when engrossed in a non-speaking activity
- Difficulty understanding people who speak quickly
- Difficulty finding the right words to use when talking
- Slow or delayed responses to verbal instructions
Symptoms of APD in Middle & High Schoolers
- Difficulty following sequential instructions
- Trouble paying attention for appropriate periods, such as during a class lecture
- Difficulty in classes in which they had excelled previously
- Lack of motivation to learn as academic demands increase
- Problems understanding concepts presented in lecture-based classes because of difficulty with note-taking
- Difficulty comprehending reading assignments
- Poor grades in foreign-language classes because of the new speech sounds and vocabulary that must be learned
- Difficulty with timed tests presented in multiple-choice or short-answer format, including college entrance exams
- Difficulty with certain teacher styles or accents
- Talking louder than necessary
- Difficulty remembering a list or sequence
- Often needing words or sentences repeated
- Poor ability to memorize information learned by listening
- Interpreting words too literally
- Becoming mentally fatigued more easily than peers
- Difficulty hearing clearly in noisy environments
Symptoms of APD in College-aged & young adults
- Complaining of difficulty hearing or understanding lectures
- Greater difficulty listening and learning in large classrooms with poor acoustics or when sitting far from professors
- Performing better in classes that are less lecture oriented such as math or science labs
- Having significant difficulty taking notes during class
- Reporting that homework takes them much longer than other classmates
- History of mild difficulties in reading, spelling, or comprehension that becomes much more apparent after entering college
- Extreme difficulty learning in foreign language classes or other classes where vocabulary is unfamiliar
- Performing better on un-timed tests than on timed tests
- Poor grades on tests despite knowledge of the material and demonstrated understanding of the topic when allowed to respond orally
Symptoms of APD in Adults
- Difficulty understanding conversation with background noise (i.e. restaurants)
- Difficulty dividing attention (i.e. talking on phone while tuning out or listening to other sounds)
- Difficulty understanding unfamiliar speakers
- Difficulty following long conversations
- Difficulty with teleconferences
- Misinterpreting the intent of a person’s comments (i.e. sarcasm, tone of voice)
- Feeling exhausted at the end of the day due to straining to follow conversations
- Struggling to understand music lyrics or to hear differences between melodies or instrument types
If an individual with a normal or near-normal audiogram reports difficulty understanding speech when there is background noise, it is imperative to go beyond the basic audiological evaluation to determine the source of this “hidden” hearing problem. An APD evaluation uses a battery of tests to assess the integrity of the central auditory nervous system. If weaknesses are identified, it is not too late to get help. Adults can benefit from deficit-specific auditory processing therapy and assistive hearing technology. There are also online therapy programs that can be beneficial.