Auditory Processing Disorder: The Coordination of Hearing and The Brain


Child Hearing Test
You may notice that someone you know has difficulty understanding speech in noisy environments, following directions, or distinguishing between similar sounds. They may have Auditory Processing Disorder. Below is some more information on what that is, what to look for and when to seek professional help from an audiologist.

What Is Auditory Processing Disorder

(Central) Auditory Processing is the term to describe how the brain processes auditory information; that is “what we do with what we hear”. Our ears are just the first step in processing – it encodes and sends the signals to our brains to interpret so that we can respond accordingly. Our brains are processing multiple types of information associated with sound – pitch, loudness, timing, and more – all simultaneously! This type of processing allows us to determine where sounds are located, focus on particular sounds, even when there are other noises and distractions present, and to obtain other information from speech, such as emotion from intonation.

A (Central) Auditory Processing Disorder ((C)APD) results from a weakness in the brain’s ability to accurately recognize and process more complex auditory information for interpretation. These weaknesses can be in different areas, and a person may experience different things depending on their particular weakness. For example, someone with a weakness in recognizing tonal differences may have difficulties understanding intonation and emotion in speech, but can still hear speech in background noise. Another person may be unable to understand and pick out a speaker when there is background noise, but can have an excellent ability to understand auditory tonal and pattern information. However, in our day-to-day life, it is rare that we are only using one type of processing at a time, so a weakness in one area can (and often will) impact the effectiveness of other auditory processing skills.

Signs and Symptoms of Auditory Processing Disorder

People with (C)APD are thought to hear normally because they can usually detect pure tones that are delivered one by one in a very quiet environment, such as the usual hearing test or hearing screening. Furthermore, all of the organs and structures required for hearing, such as the eardrum and cochlea, are healthy and intact. People with (C)APD do not have a loss of hearing sensitivity, but have a hearing problem in the sense that they do not process sound information effectively.

Some most common signs and behaviors associated with (C)APD are:

  1. Difficulty hearing in noisy situations
  2. Difficulty following long conversations
  3. Difficulty hearing conversations on the telephone
  4. Difficulty learning a foreign language or challenging vocabulary words
  5. Difficulty accurately remembering spoken information
  6. Difficulty taking notes in a classroom or meeting environment
  7. Difficulty maintaining focus on an activity if other sounds are present; individual is easily distracted by other sounds in the environment
  8. Difficulty with organizational skills
  9. Difficulty following multi-step directions
  10. Difficulty in directing, sustaining, or dividing attention
  11. Difficulty with reading fluency, reading comprehension, and spelling
  12. Difficulty processing nonverbal information (for example, lack of music appreciation or tone deafness).
  13. Difficulty in understanding intent in speech, such as sarcasm

Learning Disabilities, Child Development and Auditory Processing Disorder

The above signs and symptoms are not unique to those with auditory processing difficulties. Many learning disabilities and attention difficulties share many of these behaviors. Before beginning the process of evaluating for an Auditory Processing Disorder, it is highly recommended that the individual be evaluated for other learning disabilities and that those are addressed before and in addition to the auditory processing component. There is often overlap between an Auditory Processing Disorder and other learning disabilities as well, and a full evaluation will better address the nature of someone’s difficulties.

Often a (C)APD is discovered in school age children, and is generally due to developmental “lag”, meaning that area of a child’s brain may be slower to develop than that of their peers. The Auditory Processing areas of the brain do not fully develop until we are in our teens, and so certain areas and auditory skills may be slower to develop in individuals. If another learning difficulty is present, this can compound the difficulties! In some cases, a (C)APD may carry over into adulthood. In adults, an auditory processing difficulty may result from illness or trauma that has affected the auditory areas of the brain.

What To Expect In An Evaluation

A (Central) Auditory Processing evaluation is a much longer evaluation than your standard hearing test. A standard hearing test is performed to ensure normal hearing, and then the individual is put through a series of listening “tasks”, such as repeating back words and sentences in background noise, identifying tonal patterns, and identifying gaps between sounds. In more complex cases, electrophysiological tests may be performed to see how the nerves are transmitting sound signals to the auditory areas of the brain. An average test session is about two hours.

(Central) Auditory Processing is a complex part of how our brains work with sound. If you have questions regarding auditory processing or wish to be considered for evaluation, please give our audiology specialists a call! We work with people of all ages focusing on hearing and balance disorders through identification, evaluation and rehabilitation. Our offices are located in the Fairfield County, CT towns of Danbury, New Milford, Norwalk and Ridgefield.

– Melissa Lev, Au.D.


Topics: Audiology, Blog, Ear, Nose & Throat, Melissa Lev, Au.D.