Why Auditory Processing Disorders (APD) are Hard to Spot

by Martha Burns, Ph.D

Does this ever happen to you? You ask your child to do something simple, and he or she says, ?huh??? For example, you might say something like, ?Chris, time to get ready for school: go upstairs, get your shoes, grab your homework (we worked really hard on that last night) and shut your window because it looks like rain.? And your child acts as though he didn?t hear a word.

Often teachers describe a child like this as having?poor listening skills?because the same thing will happen in class?except that in school the child misses important assignments, fails to follow instructions on tests, or is unable to learn information when it is presented orally. What is going on here?

Parents or teachers may assume that a child is deliberately ignoring them when they ask to have instructions repeated or miss important information in school. But audiologists, who are specialists in hearing, have identified a specific reason for these listening problems. They refer to them as auditory processing disorders, or APD for short.

APD is not a hearing loss and not an attentional problem, although it can often seem as though the child is not paying attention. Rather, with APD a child has trouble figuring out what was said, although it sounds loud enough. All of us suffer from this problem when we are trying to listen to someone talk in a very noisy room, like at a party where a band is playing very loudly. We know the person is speaking?we can hear their voice?but we can?t easily discern what they are saying. Sometimes we try to read the person?s lips to figure out what they are talking about. But after a while it gets so hard to listen we just tune out or leave the situation. Now, imagine you are a child and speech always sounds muddled like that. The child?s natural instinct, just like yours, is just to stop listening. As a result, children with APD often achieve way under their potential despite being very bright. And in some cases, the children may have speech and/or language problems as well.

Audiologists have been able to diagnose auditory processing problems for many years. The recommendations for school intervention with children with this disorder have been largely compensatory, such as ?seat the child at the front of the class, right in front of the teacher? or ?amplify the teacher?s voice with a microphone and provide the child with a listening device to hear the teacher?s amplified voice more clearly than other noises in the room.? Specific, targeted interventions like?Fast ForWord?are a more recent development.

Although Fast ForWord Language and later Fast ForWord Language v2 were specifically developed to treat temporal sequencing problems associated with specific language impairment, and the programs have been successfully used as a clinical intervention for auditory processing problems for fifteen years, specific peer-reviewed case studies on auditory processing benefit from these programs has been lacking. That changed in April of this year (2013) when researchers at Auburn University, a leader in the study of APD, published controlled research in?International Journal of Pediatric Otorhinolaryngologyon the benefits of intervention with children diagnosed with APD. The researchers not only found that Fast ForWord Language v2 improved auditory processing skills, and in one child language and cognitive skills as well, but they found evidence of what scientists call ?neuroplastic? brain changes in the children with APD after the program as well. This means that the children?s brains were rewiring themselves and getting better at auditory processing at the same time.

I will discuss the study in detail in next week?s blog post. If you?re not already a subscriber, you can?sign up here?to have the next blog post delivered to your inbox.


Abrams, D.A., Nicol, T., Zecker, S.G., &Kraus, N. (2006).?Auditory brainstem timing predicts cerebral dominance for speech sounds.?Journal of Neuroscience, 26(43), 11131-11137.

King, C., Warrier, C.M., Hayes, E., &Kraus, N. (2002).?Deficits in auditory brainstem encoding of speech sounds in children with learning problems.Neuroscience Letters?319, 111-115.

Krishnamurti, S., Forrester, J., Rutledge, C., & Holmes, G. (2013). A case study of the changes in the speech-evoked auditory brainstem response associated with auditory training in children with auditory processing disorders.?International Journal of Pediatric Otorhinolaryngology, 77(4), 594-604.?doi: 10.1016/j.ijporl.2012.12.032

Wible, B., Nicol, T., Kraus, N. (2005).?Correlation between brainstem and cortical auditory processes in normal and language-impaired children.Brain,?128, 417-423.