Sometimes children and adults exhibit classic signs of hearing loss: they do not hear well, are constantly asking for clarification and may only understand a portion of what is being said in conversation. They experience learning difficulties or difficulties with work, particularly in environments with lots of background noise. When multiple people are talking, they lose focus and can’t follow the conversation.
Most patients or parents may suspect a hearing loss, but in many cases, the cause is a disorder known as an Auditory Processing Disorder (APD).
What Is APD?
Different terms are often used to describe the general observation that some individuals, despite having normal hearing sensitivity, experience significant difficulties with understanding auditory information. The most common terms include (central) auditory processing disorder (CAPD), or simply, auditory processing disorder (APD). Individuals suspected of having APD often behave as if they have hearing loss.
They may be poor listeners and have difficulty paying attention and following directions in background noise. They may respond inconsistently to speech and/or misunderstand what has been said. Children with APD may have poor auditory verbal memory, may ask for multiple repetitions and often cannot successfully follow multi-step directions. In some cases, reading and speech-language disorders may also be present (e.g., dyslexia, specific language impairment). In other cases, diagnosed difficulties in the areas of attention and memory are also present (e.g., ADHD, cognitive impairment). Several auditory and non-auditory specific factors can co-exist in each individual person but present themselves as “auditory processing” difficulties.
For these important reasons, the diagnosis, treatment and management of APD in children and adults are all challenging. At present, clinicians and researchers working in this area have different views about how to best define, diagnose and treat the problem.
Who Often Experiences APD?
An estimated 5% of school-age children suffer from APD, a condition that affects their ability to process information correctly due to a disconnect between what they are hearing and how their brain responds.
Most children with APD don’t have hearing loss. Studies have shown that the majority can hear normally in quiet environments; the problem is in the way these children process auditory information. Symptoms may range from mild to severe and include difficulty with any of the following:
- Hearing in noisy environments
- Following conversations
- Remembering spoken information
- Maintaining focus and attention
- Following directions
- Reading and spelling
- Processing nonverbal information
How Is APD Diagnosed?
Children with APD may become withdrawn, isolated and depressed. They often become disruptive and may take unnecessary risks or lash out at others. Because many of the behavioral issues closely mimic those associated with Attention Deficit Hyperactivity Disorder (ADHD) and other learning disabilities, an incorrect diagnosis is often made.
Adults with APD may have difficulty following multi-step directions, or understanding in background noise and typically resemble adults with hearing loss.
Most specialists diagnose APD through a series of tests and evaluations, which often may include a routine hearing test. A hearing test will rule out any physical hearing problems by testing their ability to hear a range of frequencies. If no hearing loss is present, behavioral and electrophysiological testing is administered.
Treating APD at Callier
At the Callier Center, our APD evaluation is aimed at documenting whether there is a deficiency in the perceptual processing of auditory information as demonstrated by poor performance in one or more of the following areas (American Speech-Language-Hearing Association, 2005): degraded acoustic signals, competing acoustic signals, temporal aspects of audition, and auditory discrimination. While there is no gold standard in APD diagnosis, we use several standardized behavioral test measures for this purpose.
Specifically, we identify whether a patient’s performance is considered typical or atypical (disordered) as compared to others without signs and symptoms of APD. If test outcomes are extremely low, the diagnosis of APD can be made based on observations and specific tests recommended (by professional bodies in the profession) to measure auditory perceptual abilities.
Consistent with the ASHA and American Academy of Audiology recommendations for APD assessment, the Callier APD team involves a multidisciplinary team, including audiologists and speech-language pathologists. While a comprehensive psychological or neuro-psychological evaluation is NOT required for APD assessment at Callier, we strongly recommend that patients and parents consider having this testing completed prior to or in conjunction with services completed at our Center.
Other Important Information Prior to Appointments:
Our recommendations prior to each appointment are as follows:
– You or your child should be generally healthy and well-rested.
– You or your child should eat breakfast the morning of scheduled visits.
– You or your child should take ALL prescribed medications as recommended.
– Please arrive to your appointment on time.
We look forward to serving you! If you have general questions about the APD evaluation process, please contact Sharon Mathews at (972) 883-3034. If she is unavailable, please leave a detailed message and an APD team member will return your call.