Auditory processing disorder (APD) in adults can lead to communication problems, poor social skills, depression, and impacts on daily function similar to those experienced by people with hearing loss. With APD, the ears hear sound but the brain doesn't properly interpret sound. APD is not a form of hearing loss identified on typical hearing tests.
Auditory processing disorder can be considered a secondary condition to a genetic or other cause, or acquired because of an accident or stroke. Symptoms are expressed in different ways, such as "word deafness" as a part of auditory discrimination problems. Much of the ADP research has focused on children but adults can also experience its challenges.
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Types of Auditory Processing Disorder
Auditory processing disorder involves one or more problems with different parts of hearing skills. These types of problems involve:
- Auditory discrimination: The ability to identify the distinct sounds in words without confusing the sounds
- Figure-ground discrimination: The ability to pick out important and meaningful sound from amid background noise, like a specific instruction in a busy classroom
- Auditory memory: The ability to recall sound, including names, songs, and steps in a series of directions
- Auditory sequencing: The ability to recall sounds and keep them in the correct order, such as numbers or directions
Various tests and assessments are used to identify the cause of APD.
Signs and Symptoms
One sign of auditory processing disorder in adults is having a hard time listening when there is background noise. Other signs and symptoms include:
- Trouble following multi-step or complex directions
- Difficulty following conversations and longer response times when talking
- Inaccurate or inappropriate answers when talking
- Asking often for repetition with speech
- Understanding or remembering spoken information
- Maintaining focus and attention
- Processing nonverbal information or assessing tone involved with jokes or sarcasm
- Organizational issues at home or work
- Difficulty localizing or pinpointing the origin of sound
- Poor voice, song, and musical skills
- Reading, spelling, and/or learning difficulties (especially with new words or languages)
If a person has APD after a head injury or post-concussive syndrome (PCS), they often have other symptoms such as:
- Tinnitus
- Peripheral hearing loss
- Sound tolerance issues or increased sensitivity to sound (hyperacusis)
- Difficulty processing auditory information (e.g. with timing, hearing in less-than-optimal environments)
APD in Childhood and as Adults
Many adults with APD have had it their entire lives. As kids, they might have had a hard time reading, keeping up in class, and listening in noisy situations. Without a diagnosis, they may have learned to adapt with strategies to manage symptoms. They also may welcome a diagnosis for symptoms that have caused fatigue and frustration all their lives.
Causes
The causes of auditory processing disorder aren't well understood. However, APD has been linked to conditions that include:
- Chronic ear infections
- Premature and/or traumatic birth history
- Seizure disorder/epilepsy
- Genetics
- Head trauma
- Lead poisoning
- Stroke (including impacts of brain anoxia, or lack of oxygen)
- Tumors
- Multiple sclerosis
- Meningitis
- Untreated hearing loss
Some studies find that auditory processing plays a key role in the development of autism and attention-deficit hyperactivity disorder (ADHD).
Sometimes the cause of someone's APD is never determined.
Diagnosis
An APD diagnosis includes an assessment of symptoms, health history, and behavioral tests and observations by a trained audiologist. Multiple tests are usually needed in order to diagnose the condition. Some of these tests may include:
- Speech in noise test: This test assesses your ability to understand speech when presented in a noisy environment.
- Dichotic listening test (DLT): This test assesses your ability to understand two different words presented at the same time, one in each ear.
- Gap detection test: This tests your ability to identify a brief pause between two identical sounds.
- Pitch pattern sequence test: This tests your ability to hear a series of three high- and low-pitched sounds and report them in the correct order.
In order to arrive at a diagnosis, the audiologist also needs to exclude conditions that may cause similar symptoms. A technology approved by the Food and Drug Administration, called Cognivue Thrive, may be used as a part of the testing process.
Why Standard Hearing Tests Miss APD
Auditory processing disorder affects other parts of the hearing system like the auditory nervous system, not just the ears. Tests for diagnosis need to evaluate other factors beyond basic hearing tests, since people often hear tones just fine but can't process them.
Treatment
Auditory processing disorder can't be cured, but treatment can help you manage your symptoms. A team approach that includes audiologists, speech therapists, and others may be needed to develop an individualized treatment plan. It can include:
- Brain training techniques that rely on the brain's own ability to improve processing skills
- Brain training computer programs designed to help people with APD learn more effective ways to process language
- Environmental modifications, such as adding visual information or written instructions on a whiteboard or moving a desk
- FM listening devices that help the wearer understand speech in an environment where background noise is present
- Coping strategies such as making lists, avoiding excessive background noise, lip reading
- Having family, friends, and teachers make an effort to speak more slowly and loudly, use simple sentences, and repeat important information to make sure it's understood
- Counseling or art and music therapy if depression, anxiety, or self-esteem issues are present
Keep in mind that hearing loss may be a part of an individual's challenges, and hearing aids or cochlear implants may offer benefits in specific cases.
Summary
Auditory processing disorder (APD) causes language and communication problems despite the fact that hearing loss isn't present. Estimates of APD in the adult population run as high as 12%, even though basic hearing tests seem fine. A number of potential causes include head injury, an underlying medical issue, or even untreated hearing loss over time.
Diagnosis of APD relies on a series of tests, with treatment tailored to the individual. Talk with your healthcare provider if you are concerned about signs and symptoms of APD.