Auditory processing disorder (APD) is a difficulty in how the brain makes sense of sound, even when the ears detect it normally. It is different from hearing loss. In children and teens it often shows up as trouble following speech in noise. An audiologist can assess it, and diagnostic hearing tests are part of that assessment.
If your child hears fine on a hearing test but still struggles to follow what is said in a noisy classroom, you are probably wondering what is going on. This guide explains auditory processing disorder in everyday language, how it differs from hearing loss, and what the path to an assessment can look like.
Hearing Help assesses auditory processing in children and teens. We do not assess adults for auditory processing disorder.
What is auditory processing disorder?
Hearing happens in two stages. First, the ears pick up sound and send signals along the hearing nerve. Second, the brain sorts those signals into something meaningful: words, tone, direction, rhythm.
Auditory processing disorder is an umbrella term for difficulties in that second stage. A review of a national Australian auditory processing service (Cameron and colleagues, in the journal Seminars in Hearing, 2015) describes it as an umbrella term for difficulties that originate in the central auditory nervous system and make it harder to perceive sound accurately, especially in noisy places such as classrooms.
Two points are worth holding onto:
- APD is about how sound is processed, not whether sound is detected.
- "Disorder" is a clinical label. It is about how sound is processed, not about how hard a child is trying.
How is APD different from hearing loss?
Hearing loss means the ear and hearing pathway are not letting enough sound through. A standard hearing test measures this by finding the quietest sounds a person can detect at different pitches.
With APD, a child can respond to those quiet sounds normally. The difficulty appears when the listening task is more demanding, such as:
- picking one voice out of background chatter
- following a fast or multi-step instruction
- telling apart words that sound alike
- remembering a string of spoken information
That is why a hearing test comes first. An audiologist needs to know whether the ears are detecting sound normally before looking at how the brain handles it. In the Australian clinical service described in that review, children whose hearing tests showed a significant hearing loss were referred on for further evaluation rather than going ahead with auditory processing testing.
What might parents and teachers notice?
Raising Children Network, an Australian parenting information website, says a child with APD might have difficulty with:
- listening and hearing, especially when there is a lot of 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"
No single sign points to APD, and each of these has other possible explanations. They are best taken as a reason to ask questions, not as a conclusion. Only an assessment can tell you what is behind them.
Why can other conditions look like APD?
Raising Children Network notes that the difficulties APD causes can look like the signs of other conditions, including attention difficulties, hearing loss, learning and literacy difficulties and speech and language problems. The Australian service review mentioned above makes a similar point: telling APD apart from learning and attention difficulties that look like it is complex, which is why working out the cause takes care.
This is also why an assessment is not just one test. The service described in that review used a series of tests in sequence. A child's language, attention and learning picture may sit with other professionals, such as a speech pathologist or paediatrician, and your GP can help you work out who to see.
What does an auditory processing assessment involve?
According to Raising Children Network, if an audiologist thinks a child's difficulties might be APD, they will do an auditory processing assessment, and this includes diagnostic hearing tests for hearing loss as well as auditory processing tests. Raising Children Network also says APD can usually be diagnosed once children start school.
Your audiologist will explain what your child's assessment involves and what the results do and do not tell us. Ask Hearing Help when you book whether your child's age suits the assessment, and how to prepare. How long the appointment takes is also something to ask us when you book.
What does the referral pathway look like?
Concerns can start at school, with a teacher, or at home. A common route looks like this:
- 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. Describe what you and the school have noticed. Your GP can look at the whole picture and discuss whether other health professionals, such as a paediatrician or a speech pathologist, should be involved.
- Have your child's hearing tested. This rules in or out hearing loss as part of the picture.
- Book an auditory processing assessment with an audiologist who assesses children and teens, if your audiologist or GP thinks it is worth doing.
- Share the findings with your GP and, with your permission, your child's school.
Hearing Help can see children for hearing tests and for auditory processing assessments. Some clinics ask for a referral first and some do not, so ask us when you book.
What if the hearing test shows hearing loss or an ear problem?
If your child has ear pain, discharge from the ear, dizziness or bleeding, or their hearing changes suddenly, see your GP or go to an emergency department the same day.
If you suspect an ear infection, fluid in the ear, or a fever alongside ear symptoms, see your GP. These are medical matters, and an audiology appointment does not replace that visit.
Hearing Help does not fit hearing aids for children. If a hearing test shows something that needs medical review or other support, your audiologist will explain the next step and who to see.
How can parents and teachers support a child with listening difficulties?
An assessment is one way to understand what your child needs. In the meantime, these are ordinary communication habits that suit most children:
- Get your child's attention and make eye contact before speaking.
- Reduce background noise where you can, such as turning off the TV when giving instructions.
- Keep instructions short and check that your child has understood.
- Tell teachers what you have noticed so they can seat your child away from noise sources.
These are ordinary communication habits, not treatments. Your audiologist can talk through what is relevant to your child after an assessment.
Does a child grow out of APD?
This is a common question, but we cannot promise outcomes, and results differ between children. What an assessment can do is describe your child's listening profile. From there, your audiologist can explain what the results mean and what support options exist, and which other professionals might be involved. If you would like to know more about how outcomes are discussed after an assessment, ask when you book.
When to book
You might consider an assessment if:
- your child's hearing test is normal, but listening difficulties continue
- a teacher or health professional has raised concerns about listening in class
- your child struggles to follow speech in noise much more than other children their age
If you would like to talk it through, book a hearing assessment with Erin at Hearing Help (Newport Marketplace). Erin has over 25 years as an audiologist, 17 of them serving the Redcliffe area. You can book online at www.hearinghelpredcliffe.com.au/booking-form/ or call 07 3214 3641.
Frequently asked questions
Can adults be assessed for auditory processing disorder at Hearing Help?
No. Hearing Help assesses auditory processing in children and teens only. If you are an adult with listening concerns, a hearing test is the place to start, and your GP can talk through other options.
Is auditory processing disorder the same as hearing loss?
No. Hearing loss is about how much sound reaches the brain. APD is about how the brain makes sense of the sound that arrives. A child can have normal hearing test results and still find listening hard in noise.
Does my child need to see a GP first?
A GP visit is a sensible first step because your GP can look at the whole picture, including attention, language and learning, and can talk about referrals to other professionals. Ask Hearing Help when you book whether a referral is needed.
How is APD diagnosed?
By an audiologist, using a series of tests rather than one test, including diagnostic hearing tests and auditory processing tests.
Does Hearing Help fit hearing aids for children?
No. Hearing aid fittings at Hearing Help are for adults. Hearing Help tests children's hearing and assesses auditory processing in children and teens.
My child had an ear infection recently. Should I still book?
For ear pain or discharge, see your GP or go to an emergency department the same day. For a suspected infection, fluid or fever, see your GP. Once your GP is happy with your child's ears, an audiologist can assess hearing and listening.