Auditory Processing Disorder (APD) has been in the middle of many heated debates. It’s been elusive to diagnose, difficult to treat, and often looks like something else. How do you know if it’s really APD?

Symptoms of APD
Some of the most frequently reported symptoms of APD include:

  • Significant difficulty understanding speech, especially in the presence of background noise;
  • Difficulty following multi-step directions that are presented verbally, without visual cues;
  • Easily distracted by loud or spontaneous (sudden) sounds;
  • Difficulty attending long lectures or other long periods of listening;
  • Difficulty remembering and/or effectively summarizing the information presented verbally;
  • Difficulty reading, spelling, and/or writing when compared to their peers (performs consistently below grade level);
  • Trouble following abstract thoughts or ideas;
  • Delayed or misunderstanding of jokes, idioms, and figurative language

The auditory system has a peripheral and central mechanism, but most audiologists have focused on the peripheral system. This system consists of the outer, middle, and inner ear — but the auditory system doesn’t stop there. The peripheral system is just a part of the lengthy pathway along the auditory nerve that travels to the auditory cortex (brain) where sound is interpreted. Things that happen beyond the peripheral system are considered to be “central” or part of the “processing” of sound.

Problems in the peripheral system are fixed by “repairing” the mechanism. These types of “repairs” are managed by surgery or amplification — or both. This system can be habilitated to almost normal conditions with the proper parts (e.g., Hearing aids, cochlear implants, pressure equalization tubes, etc.), but these repairs do not include the neural plasticity of the system. Neural plasticity is the nervous system’s ability to reorganize its structure, functions, or connection to brain morphology and physiology. In other words, old dogs can still learn new tricks new to the plasticity of the brain. Therapy accompanying a “repair”’ to the peripheral system utilizes the plasticity of the auditory nerve and auditory cortex — making new sense and meaning of sounds.

On the other hand, a problem that arises beyond the peripheral system does not necessarily have a mechanical “repair.” There’s no device that is used to remediate these problems and because of where they are, neural plasticity is the best source of therapy.

Practice, practice, practice is the mantra for APD.

Causes of APD

Although research is ongoing to understand all the causes of APD, we know there are some reasons why people are predisposed to an auditory pathway problem. These include:

  • Illness — chronic ear infections, meningitis, or lead poisoning
  • Nervous system diseases such as multiple sclerosis
  • Premature birth or low weight
  • Head Injury or stroke
  • Genes (APD can run in families
  • High fevers (105 degrees +) as a very young child
  • Traumatic birth
  • Hyperbilirubinemia (jaundice)

APD is often mistaken for or coexists with other disorders. Since it is an auditory deficit in the higher auditory pathways in the central nervous system, global deficits such as intellectual disabilities, autism spectrum disorders, or attention deficits are generally not involved. In order to correctly and appropriately diagnose APD, a multidisciplinary approach is necessary.

Psychoeducational evaluations and speech-language evaluations do not test for APD. Tests may incorporate the terms “auditory processing” or “auditory perception” but they are actually assessing higher-level language processing, memory, or phonological awareness. These are different skills than those assessed during an APD evaluation.

To properly diagnose APD, special tests need to be administered by an audiologist, and a multidisciplinary team of professionals and caregivers should meet for a holistic diagnosis.

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