Wednesday, April 14, 2021

Beyond the hearing: Auditory processing disorders impact what we do with what we hear

By Dr. Sarah Wakefield

When we think about how we hear, the first part of the body that comes to mind is the ear. And while the ear plays an important role in hearing, it is the brain that filters and interprets sounds into something meaningful, such as speech or music. This process is called auditory processing. Simply put, auditory processing is what we do with what we hear.

For most individuals, auditory processing skills develop normally without direct training. However, for 2 to 7 percent of the population, auditory processing may be delayed or disordered. The cause of an auditory processing disorder (APD), also known as a central auditory processing disorder (CAPD), is not clear. It is thought to be due to delayed development of the brain’s auditory pathways, or acquired due to premature/low birth weight, chronic ear infections, lead poisoning, or a head injury. APD also has a genetic component and may run in families.

APD may co-exist with other conditions, including ADHD (attention deficit hyperactivity disorder), dyslexia, sensory processing disorders, or autism. While these conditions can occur together, it is important to note that a diagnosis of APD does not replace these diagnoses. It is strongly recommended that a speech and language assessment or neuropsychological evaluation is completed before being evaluated for auditory processing disorder. These evaluations will guide the audiologist in determining if an auditory processing disorder exists independently, or if it is part of a larger diagnosis.

Additionally, these assessments will help select the most appropriate intervention, allowing for a more multi-disciplinary approach. It is important to point out that auditory processing testing cannot be completed on an individual with hearing impairment. The audiologist should complete a hearing evaluation prior to completing an auditory processing evaluation.

Early preschool warning signs of an auditory processing delay are:

  • Disinterest or difficulty singing along to age-appropriate songs
  • Not responding to their name
  • Poor social skills
  • Sensitivity to loud sounds
  • Poor ability to rhyme words
  • Trouble learning letter sounds

For school-age children, signs of an auditory processing delay are:

  • Difficulty knowing where sound is coming from
  • Weak auditory attention
  • Trouble hearing in noise
  • Frequently saying “huh?” or “what?”
  • Mishearing spoken language
  • Does not get sarcasm or humor
  • Trouble following multi-step directions
  • Delayed early reading skills
  • Poor reading comprehension

If a child presents with difficulties in any of these areas, an auditory processing evaluation may be warranted.

An auditory processing evaluation can be completed on children as young as 5 years of age. However, due to the wide range of what is considered typical, a firm diagnosis of auditory processing cannot be made until 7 years of age. Auditory processing testing can also be completed on older adults who may be experiencing hearing difficulties in the absence of hearing loss. The evaluation will include a battery of tests that assess both non-verbal and verbal auditory processing abilities.

This information is then used to determine weaknesses in the way the brain encodes auditory information and what type of auditory processing difficulties are present. Specific recommendations and therapies to manage and treat the auditory processing disorder are provided in a report format. Current therapists or the child’s school can use the report to guide therapy and educational instruction for the child.

What can you do to improve your child’s auditory processing abilities?

  • Aim to enrich your child’s sound environment from an early age. You can do this by engaging in auditory based play such as freeze dance, red light, green light, Simon says, etc.
  • Monitor and manage chronic ear infections. This is important to prevent delayed auditory development due to conductive hearing loss.
  • Encourage your child to play a musical instrument or learn a second language. Research has shown that playing a musical instrument or learning a second language may also boost auditory processing abilities over our life span.


Sarah Wakefield, AuD, is a provider with Mount Nittany Physician Group Audiology. She earned her bachelor’s degree in communication disorders from Penn State University and her doctorate in audiology from Nova Southeastern University in Fort Lauderdale, Florida. She is a member of the American Academy of Audiology and the American Auditory Society.