Auditory Processing Disorders

What is Auditory Processing?

It is how well the ear talks to the brain and how well the brain understands what the ear tells it (Musiek) or what we do with what we hear (Katz).

What is an Auditory Processing Disorder?

There are many different clinical definitions for APD, but in essence, it is the auditory system mechanisms and processes responsible for the following behavioural phenomena (as per ASHA 1996, 2005; AAA 2010):

· Sound localization and lateralisation (identify the detected sound in direction and distance)

· Auditory discrimination (the ability to identify and distinguish between different sounds)

· Temporal aspects of audition (ability to process auditory stimuli over time, to sequence sounds, ability to integrate a sequence of sounds into words, ability to perceive sound as separate)

· Auditory performance with degraded or competing acoustic signals (background noise/competing speech/ filtered speech/ rapid speech/ distorted speech).

However, to make it simple:

An Auditory Processing Disorder (APD) is when the brain can’t hear (Bellis).

Every listening skill we have uses auditory processing. This includes determining where a sound is coming from, following a teacher in a noisy classroom, recognizing your favourite song, picking up on sarcasm, etc. Auditory processing is a building block for language, and although the involvement is complex, we see significant relationships with auditory processing and phonemic awareness and we know that it affects reading abilities. There are also significant correlations to spelling abilities, language understanding and following verbal instructions in the classroom. Auditory Processing should therefore be measured on every child with a language, reading, or classroom learning difficulty.

How does it Present?

· Difficulty hearing in noisy situations and reverberant environments (e.g. swimming pool).

· Difficulty following long conversations.

· Difficulty learning a foreign language or challenging vocabulary words.

· Difficulty remembering spoken information (auditory memory deficits).

· Difficulty taking notes.

· Difficulty maintaining focus on an activity if other sounds are present (easily distracted).

· Difficulty with organizational skills.

· Difficulty following multi-step directions.

· Difficulty in directing, sustaining, or dividing attention.

· Difficulty with reading and/or spelling.

· Difficulty with nonverbal information (lack of music appreciation, inflection/tone of voice).

The Clinical Picture of APD is Changing

From my experience working at Beacon Audiology and setting up the APD clinic, I have learned that the clinical picture of the child presenting with APD is very different from the operational definition of ‘what is an auditory processing disorder’. We are holistic beings with various sensor-motor pathways in our brain. We have thoughts, feelings and emotions. We are not just “ears” and our auditory-brain pathway is not domain-specific; there are numerous variables affecting our auditory skills and listening behaviours in the classroom environment:

Just take sitting quietly and listening to the teacher in the classroom:

· An upright sitting posture

· Good static balance for sitting

· Physical endurance

· Working against any possible retained reflexes

· Sustained auditory attention

· Separating the teacher’s voice from the background noise

· Visually tracking the teacher as she walks and talks throughout the classroom.

· Processing of rapid speech

· Auditory memory of the information

· Auditory sequential memory of speech sounds into unfamiliar words

· Comprehension / understanding of the information

· Employing auditory closure (drawing from your linguistic knowledge to fill in the blanks that the ear couldn’t hear) in acoustically challenging classrooms.

· Managing feelings and emotions

It is very hard to separate auditory processing from movement (balance, eye movements, gross and fine motor skills) in the classroom environment. That is why we are advocating for exercises or interventions that target the auditory-motor system because we Move to Learn & Learn to Move in a multisensory way.

APD is not a condition in isolation and requires a multidisciplinary team approach:

• Step 1: Hearing Test - to rule out hearing loss, middle ear fluid.

• Step 2: Educational Psychology - to identify possible attention, memory, IQ-related disorders.

• Step 3: Speech-Language Therapist - to assess receptive and expressive language skills.

• Step 4: Diagnostic Audiology - auditory processing assessment.

• Step 5: Behavioral Optometrist – to assess visual processing.

• Step 6: Neuromotor assessment - assess possible retained reflexes, soft neurological signs and other neuromotor immaturities.

What can parents do:

- Slow down your speech rate when talking to your child.

- Pause between sentences or instructions.

- Switch off or reduce any competing noise when talking to your child or when your child is doing homework.

- Develop memory skills by playing ‘Simon Says’-games or ‘I see’-games when driving in the car. Increase the number of items or instructions each time to challenge your child’s memory.

- Read a short story and encourage your child to retell the story. If your child struggles, ask specific questions, such as ‘Who was in the story? Where did it happen? What happened? When? Why? How did it end?

- Movement and memory: give your child 3 single numbers to remember (e.g. 7,5,3). Tell your child to run upstairs and recall the numbers when they get to the top. Ask them to run downstairs and recall the numbers but backwards (e.g. 3,5,7).

- Clap, jump or step out the syllables of tricky multisyllabic words: ca-ter-pi-lar. This is a fun way to learn the names of the dinosaurs or the elements of the periodic table.

For ideas on how to develop 'Movement and Listening Skills' at home, please go to our YouTube channel:


To listen to Aled and Marinet on 'Move to Learn - Learn to Move' click on the Apple / iTunes Podcast link below. You can also find us on Spotify.