Auditory processing disorder (APD)

Auditory processing disorder, also called APD, is a type of hearing loss caused by something affecting the part of the brain that processes how you hear. Ear damage causes other types of hearing loss.

APD is also sometimes called central auditory processing disorder (CAPD). It can happen in anyone. But it most often happens in children and older adults.

Many conditions can affect how well a person understands what they hear, such as attention-deficit/hyperactivity disorder (ADHD) or autism. But these conditions are different from auditory processing disorder, although they can appear with APD. APD also can happen with other types of hearing loss.

Auditory processing disorder has no cure. But treatments can help you hear better.

Symptoms of auditory processing disorder (APD) can be subtle. Symptoms can include having trouble with:

• Telling where sound is coming from.
• Understanding words that are spoken quickly or in a noisy room.
• Paying attention.
• Reading and spelling.
• Following directions unless they are short and simple.
• Learning a new language.
• Singing or enjoying music.
• Understanding and remembering spoken information.

If you have APD, you also might:

• Take longer to reply to someone who is talking to you.
• Often need others to repeat themselves.
• Not understand sarcasm or jokes.

APD is often seen with attention, language and learning issues like those seen in attention-deficit/hyperactivity disorder, or ADHD.

When to see a doctor

If you have trouble hearing or understanding what you hear, talk to a health care professional.

The cause of auditory processing disorder (APD) is sometimes unknown. APD can be linked to many conditions. In older adults, conditions might include stroke and head trauma. In children, APD can be linked to issues at birth, such as low birth weight or early birth, or repeated ear infections.

In typical hearing, the brain's auditory center takes the sound waves sent from the ears and turns them into sounds you know. But with auditory processing disorder (APD), the auditory part of the brain can't do this.

Factors that increase your risk of auditory processing disorder (APD) include:

• Aging.
• Stroke.
• Head trauma.
• Lead poisoning.
• Seizure disorders.
• Issues linked to birth, such as an early birth, low birth weight or a pregnant person using alcohol, drugs or tobacco.
• Repeated ear infections, especially at a young age.

Auditory processing disorder (APD) complications include:

• Trouble understanding what people are saying.
• Trouble taking part in activities.
• Feeling isolated and lonely.
• Trouble reading and writing, in children.
• Trouble doing well in school.
• Feeling depressed.

To diagnose auditory processing disorder (APD), your health care team may ask questions about your symptoms and how long you have had them, as well as order tests.

Several specialists on your health care team might help diagnose you or your child with auditory processing disorder (APD). For children, the team might include teachers, who look at learning and attention issues. For children and adults, the team might include mental health professionals, called psychologists, who look at how the mind works. And speech-language pathologists can look at the use of language.

A hearing specialist called an audiologist may do tests to see what is happening when you or your child hear sounds. These tests might include:

• Tympanometry. This test can tell if the eardrum isn't moving well. The eardrum needs to move for good hearing. For this test, the audiologist places a soft probe in the ear canal. Then they send small bits of air pressure toward the ear. The probe measures how much the eardrum moves in response to the air.
• Acoustic reflex test. This test shows what happens in the ear when it hears a loud sound.

• Auditory brainstem response. This test shows how well the inner ear, called the cochlea, and the brain pathways for hearing are working. An audiologist places sensors around the ear and on the head. The sensors connect to a computer.

  Short clicking sounds come through headphones worn during the test. The computer records how the nerves between the ears and the brain respond to the sounds.

• Evoked potential test. This test shows how well sound travels along the nerves that connect the ears to the brain. For this test, an audiologist places sensors on the head. The sensors connect to a computer. Short clicking sounds come through headphones worn during the test.

  This lets an audiologist see how well sound gets to different parts of the brain. It also shows if anything is blocking the nerves that link the ears to the brain.

Not everyone with auditory processing disorder (APD) needs treatment. If you or your child need treatment, there are many approaches. Every person with APD has different needs. Your health care team can work with you to help you. Your or your child's treatment might include:

• Hearing aids and listening devices. Your health care team may suggest that you use hearing aids with wireless listening devices. Listening devices help direct sound to you. They get sound from the source to your hearing aid.

  Frequency modulated, or FM, systems send sounds to you so you can hear them better. They work with a hearing aid and direct sounds to it. These systems help make it easier to hear sounds in noisy environments.

• Auditory training. Auditory training, also called hearing rehabilitation, helps you adjust to hearing loss. You may train with an audiologist, a speech-language pathologist or both. You may train one-on-one with a therapist or as part of a group.

  During auditory training, you learn to tell one type of sound from another. You do this by listening to sounds that are louder and softer, given quickly and slowly. Sounds come from different directions. You also learn to tell the difference between speech sounds, which affects the meaning of the words you hear.

  Auditory training helps the brain tell the difference between the many sounds you hear every day. The goal is to help you feel like you're able to talk with others more.

• Computer-based training. Computer-based programs can help train the brain to recognize and understand sounds. These programs are like auditory training, but you do them online or with a computer program.

There are simple steps you can take to manage auditory processing disorder (APD). For instance:

• Try using a remote microphone to improve how well you can hear in a noisy room.
• Move closer to the person who is speaking.
• Think about covering surfaces that make sounds echo, such as open or empty spaces.
• Move away from other sources of noise, such as a fan.
• In a class or at a meeting, ask someone to take notes for you or get a written copy of what was said.
• Ask for anything important to be in writing.
• Use subtitles when watching TV.

Having auditory processing disorder (APD) can make you feel left out of everyday events. It can make you feel lonely. Auditory training as part of your treatment may help you or your child learn how to cope with hearing loss and adjust to it.

Auditory training might help you or your child learn to talk to others better and help them talk to you. This can help you feel less alone and more connected to others.

You or your child might start by seeing your family health care professional. For testing, you or your child might be referred to a specialist in hearing, called an audiologist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your or your child's symptoms, including any that don't seem linked to the reason for your appointment, and when they began.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins, or other supplements you or your child take, including the doses.
• Questions to ask your health care professional.

Take a family member or friend along, if possible, to help you hear or remember the information you get.

For auditory processing disorder, some basic questions to ask include:

• What's likely causing my or my child's symptoms?
• Other than the most likely cause, what are other possible causes for these symptoms?
• What tests are needed?
• Is this condition likely to go away or be long-lasting?
• What's the best course of action?
• Are there brochures or other printed material I can have? What websites do you suggest?

Be sure to ask all the questions you have about this condition.

What to expect from your doctor

Your health care team is likely to ask you questions, such as:

• Are the symptoms constant or do they come and go?
• How bad are your symptoms?
• What, if anything, helps you hear better?
• What, if anything, makes it harder for you to hear?