If your child seems to hear you fine but struggles to follow what is said, or says "what?" a lot even though a hearing test was normal, this post is for you.
Auditory processing disorder, usually shortened to APD, is one possible explanation for why some children struggle to make sense of what they hear, even when their ears pick up sound normally. It is not the only explanation, and it is not a label to reach for quickly. This guide explains what APD is, what parents commonly notice, how an assessment works and who to speak to first.
What is auditory processing disorder?
According to Raising Children Network, an Australian parenting information website, APD means the brain has difficulty making sense of the sounds it hears. A child can have typical hearing, in the sense that sounds reach the brain, yet still have trouble recognising and interpreting them.
That is why a standard hearing test can come back normal. APD is not about how quietly or loudly a child hears. It is about what happens to sound after it has been detected.
Raising Children Network estimates that APD affects around 2 to 5 per cent of school-age children. Figures vary between sources, so treat that as a rough guide rather than an exact number.
What parents often notice
Raising Children Network lists some things a child with APD might have difficulty with:
- listening and hearing, especially when there is background noise and distraction
- following instructions
- staying focused, for example being easily distracted
- remembering spoken instructions
- telling the difference between letters that sound similar, like "k" and "g" or "t" and "d"
Notice how ordinary that list is. Plenty of children do these things now and then, especially in a noisy classroom or at the end of a long day.
That is the important point. Raising Children Network notes that the difficulties APD causes can look like the signs of other conditions, including attention difficulties, hearing loss, learning difficulties and speech and language problems. A list of signs cannot tell you what is going on. Only an assessment can.
Start by checking the basics
Before thinking about APD, it makes sense to rule out the simpler possibilities.
Have your child's hearing tested. A hearing test checks how well sound is detected. At Hearing Help we test the hearing of children as well as adults.
Talk to your GP. Raising Children Network says that if you think your child might have signs of APD, it is best to see your GP. If you are worried about your child's listening, attention, learning or development, your GP can look at the wider picture and discuss whether a referral to an audiologist or another professional would help.
See your GP for ear problems. If your child has a suspected ear infection or fluid in the ear, that is a medical question. Please see your GP.
Some symptoms need a doctor the same day. If your child has ear pain, discharge, dizziness or bleeding from the ear, or their hearing seems to change suddenly, see your GP or go to an emergency department the same day.
Talk to the school. Teachers see your child in a different setting. What they notice in the classroom can add useful information, and you can ask what support the school may be able to offer.
How APD is assessed
According to Raising Children Network, APD can usually be diagnosed once children start school. If an audiologist thinks the problem might be APD, they will do an auditory processing assessment, which includes diagnostic hearing tests and auditory processing tests.
Hearing Help carries out auditory processing assessments for children and teens. We do not assess adults for APD. What an appointment involves, and how to prepare, are things we are happy to explain when you book, because they depend on your child.
Because the signs of APD overlap with other conditions, an assessment is one piece of information. Your audiologist will talk you through the results and, where it would help, suggest that you speak with your GP, paediatrician or another professional about anything outside audiology.
What if the result is "not APD"?
This is a perfectly good outcome. A result that shows no auditory processing disorder still tells you something useful: it narrows down the list of possible explanations, so you and your child's doctor or school can look at other avenues.
Everyday communication habits
These are ordinary conversation habits, not treatments, and they will not suit every family. If your child seems to find listening tiring, you could try:
- turning off the TV or radio before you give instructions
- getting your child's attention, and a bit of eye contact, before you speak
- giving one or two instructions at a time rather than a long string
- speaking clearly at a natural pace
- allowing a few extra seconds for your child to respond
None of this replaces an assessment. If you are concerned, the next step is to ask the question.
Talking with your child
Children who find listening hard often know it, even if they cannot explain why. Some feel frustrated or embarrassed. Try to keep conversations calm and curious: "It seems like loud rooms are tricky. Do you want to try some things that might make it easier?"
Avoid framing it as a fault. Needing a quieter space or a repeated instruction is simply a way of working that deserves some patience.
A word about teens
Auditory processing difficulties are not only a primary school matter. Hearing Help assesses teens as well as younger children. A teenager can often describe what they find difficult in their own words, which is useful information for an assessment.
When to book
If you have been wondering about your child's listening and you are not sure where to start, a good first conversation is with your GP, paediatrician or your child's school. A hearing test and, where appropriate, an auditory processing assessment can follow.
If you'd like to talk it through, book a hearing assessment with Erin at Hearing Help (Newport Marketplace). Bring along any notes from home and school, and we will explain what the next steps could look like for your child.