It is a conversation we have often, usually in September or October. A teacher has raised a concern; the child does not seem to be listening, misses instructions, or falls behind when the classroom gets noisy. A hearing test is arranged, the results come back normal, and the family is left with the same question they started with: if the hearing is fine, what is going on?
For some of these children, the answer may be auditory processing disorder (APD).
Photo by CDC
What Is Auditory Processing Disorder?
Auditory processing disorder (APD), also called central auditory processing disorder, affects how the brain makes sense of sounds even when hearing sensitivity is normal.
A child with APD hears sounds at a normal level. The challenge is not with the ears; instead, the difficulty lies in what happens afterwards as the brain organizes, sequences, and interprets that sound. In quiet, one-to-one conversation a child may cope perfectly well. Put them in a classroom with scraping chairs, a humming fan, and twenty or more other children, and the same instructions can become much harder to follow.
APD is different from hearing loss, which is what a standard hearing test measures and what programs like Ontario’s Infant Hearing Program are designed to identify. A child can have normal hearing thresholds and still find listening genuinely difficult.
Contributing factors can include developmental or genetic factors, a history of frequent ear infections in early childhood, head injury, and, in adults, neurological illness or age-related change.
What APD Looks Like Day to Day
The signs families and teachers most often describe include:
- Difficulty following spoken instructions unless they are short and simple
- Frequently asking for things to be repeated, or responding with “what?”
- Struggling to understand speech in noisy environments
- Trouble remembering spoken information, either immediately or later
- Confusing similar-sounding words, such as coat and boat
- Difficulty with phonics, spelling, or reading comprehension
Adults with APD often describe similar experiences. Following a conversation in a restaurant or during a meeting can feel disproportionately exhausting, even though their hearing test results are normal.
How Is APD Different from ADHD or a Learning Disability?
This is one of the most important questions families ask.
The symptoms of APD can overlap significantly with ADHD, language disorders, learning disabilities, and other developmental concerns. A child who misses instructions or struggles in a noisy classroom does not automatically have an auditory processing disorder.
Because these conditions can look very similar, it is important to understand the whole picture before testing for APD.
For this reason, our clinic generally recommends a psychoeducational assessment before an auditory processing assessment whenever appropriate.
A psychoeducational assessment helps identify whether attention, learning, memory, or language factors may be contributing to the child’s difficulties. This information allows any auditory processing findings to be interpreted within the broader context of the child’s strengths and challenges.
At What Age Can a Child Be Tested?
At Ear & Hearing Clinic, full auditory processing assessment is offered beginning at age seven.
The tests used to evaluate auditory processing require a certain level of auditory, language, and cognitive development in order to provide reliable results. For this reason, formal APD testing is generally not completed in younger children. This is consistent with the Canadian Guidelines on Auditory Processing Disorder, which note that behavioural tests of auditory processing show reduced reliability and validity for children under the developmental age of seven.
We offer auditory processing screening for children aged five and six when appropriate. Screening helps identify children who may benefit from a full assessment, but it is not used to make a diagnosis. If your child is younger than seven and you have concerns about listening and communication, a standard hearing test, a speech-language assessment, or a developmental assessment may be a more appropriate first step. Speak with your family physician or your child’s teacher about where to begin.
What Happens During an Assessment
The assessment begins with a standard hearing test, because hearing sensitivity has to be confirmed as normal before auditory processing can be examined meaningfully. If hearing loss is identified, that becomes the priority.
From there, a series of listening tasks assesses specific skills, including:
- Understanding speech in background noise
- Processing different information presented to each ear at the same time
- Following the timing and pattern of sounds
An auditory processing assessment identifies whether auditory processing is contributing to your child’s listening difficulty. It does not rule out other conditions, and it is not a substitute for assessments conducted by other professionals.
An auditory processing assessment is typically completed over two appointments. The first is an hour long and the second is an hour and a half including electrophysiology.
The assessment is divided into two sessions because the testing requires a great deal of listening, attention, and concentration. Splitting the assessment helps reduce fatigue and allows children to perform at their best.
The first appointment begins with a comprehensive hearing test to confirm that hearing sensitivity is within normal limits.
Following the hearing test, a series of specialized auditory processing tests are completed that are selected depending on the child’s age and listening concerns. These tests are designed to challenge different aspects of the auditory system and assess how the brain processes sound. In general, children are asked to repeat words, numbers, sounds, or sentences that they hear.
The second appointment continues with these sorts of listening tasks, followed by electrophysiological testing. During the electrophysiological portion of the assessment, small sticker electrodes are placed on the child’s head to measure the brain’s response to sound. The child sits quietly while sounds are presented through earphones, and specialized equipment records how auditory information is travelling through the hearing system.
This testing is safe, painless, and non-invasive.
Your child’s test results are not reviewed immediately following testing. The assessment generates a significant amount of information that must be carefully scored, analyzed, and interpreted by your audiologist. Following both appointments, your audiologist prepares a comprehensive report outlining the findings, conclusions, and recommendations.
Auditory processing assessment is available for children aged seven and older at our Elmira, Kitchener, and Palmerston locations, with screening offered for children aged five and six. While APD is most common in children, we also offer auditory processing assessments for adults with normal hearing.
Frequently Asked Questions
What is auditory processing disorder?
Auditory processing disorder, sometimes called central auditory processing disorder, affects how the brain makes sense of sounds even when hearing sensitivity is normal. The ears detect sound normally, but the brain has difficulty interpreting it, particularly in noisy or complex listening environments. It is assessed and diagnosed by an audiologist.
How is APD different from ADHD or a learning disability?
The everyday signs overlap considerably, which is why the distinction cannot be made from behaviour alone. Difficulty following instructions, trouble concentrating in noisy environments, and needing things repeated can all arise from attention difficulties, language disorders, reading difficulties, or auditory processing disorder, and these can occur together. For this reason, a psychoeducational assessment is generally recommended first, so that learning, memory, and attention factors can be considered.
At what age can a child be tested for auditory processing disorder?
At Ear & Hearing Clinic, a full auditory processing assessment is offered from age seven, with screening available for children aged five and six. A full assessment requires a certain level of auditory, language, and cognitive development to provide reliable results.
Can adults have auditory processing disorder?
Yes. Auditory processing difficulties can persist from childhood or develop later following head injury, neurological illness, or as part of age-related changes to the auditory system. Adults often describe struggling to follow conversation in restaurants or meetings despite a normal hearing test. We assess adults as well as children.
What happens during an auditory processing assessment?
The assessment begins with a standard hearing test to confirm hearing sensitivity is within normal limits. A series of listening tasks then examines specific auditory processing skills. Electrophysiological testing assesses the integrity of the auditory pathway.
About Ear & Hearing Clinic
Ear & Hearing Clinic has been providing audiology services to families in Waterloo Region and Wellington County for more than 25 years. Our audiologists assess and manage hearing loss, tinnitus, auditory processing disorder, and other hearing-related concerns.
