The hearing test result is normal, yet something is off. The child seems not to hear, though they do hear. The problem is not in the ears, but in how the brain analyses the sounds reaching it. That is the essence of APD, central auditory processing disorder.
What is APD?
APD, Auditory Processing Disorder, also called CAPD, is a disorder of auditory processing. The organ of hearing works properly, sound reaches the brain, but its analysis is ineffective. As a result, a person hears, but has difficulty understanding speech, especially in difficult conditions, for example in noise or when several people are talking at once.
Where does it come from?
The causes vary. They include prematurity, oxygen deprivation, recurring infections and fluid in the ears in early childhood, injuries, and developmental factors. Increasingly, the role of stimulus overload is also mentioned, the excess of sounds and images that a young auditory system has to cope with.
Symptoms worth noticing
APD often reveals itself at school age, when demands increase. Typical signals are:
- frequent requests to repeat, saying "what?" and "huh?",
- difficulty understanding speech in noise, for example in class or in a playground,
- losing longer or complex instructions,
- confusing similar-sounding speech sounds and words,
- delayed reactions to what is said, as if with a lag,
- tiredness, distraction and withdrawal while listening,
- difficulties learning to read, write and spell.
The symptoms of APD are often confused with inattention, ADHD or a lack of motivation. That is why a reliable assessment is so important, checking whether the source of the difficulty is indeed auditory processing, and not another cause.
How do we assess APD?
We carry out the assessment with a set of tasks evaluating how the brain analyses and differentiates sounds, including speech in difficult conditions. The assessment is tailored to the child's age and usually takes up to about an hour and a half. You will find details on the APD assessment and therapy page. The result shows which auditory functions need training.
What does therapy look like?
APD therapy is a training of specific auditory functions. Depending on the profile of difficulties, we use methods that stimulate auditory processing, among others the Warnke Method® and the Tomatis® Method, as well as exercises developing auditory analysis and synthesis. We always tailor the plan individually, and part of the exercises can be continued at home.
How to support a child with APD day to day?
- Talk to the child face to face, briefly and clearly, break instructions into steps.
- Reduce background noise during conversation and learning.
- Make sure the child has understood, ask them to repeat the task in their own words.
- Support words with images, writing and gestures.
- Work with the school, because simple changes, for example a seat near the teacher, help a great deal.
Types of difficulty in APD
APD is not uniform. Different children are dominated by different difficulties, and recognising them lets us choose therapy precisely. In practice, the following are described, among others:
- Difficulty understanding speech in noise, when the sound background drowns out what matters.
- Poor differentiation of speech sounds, that is, confusing similar-sounding sounds, for example p and b, t and d.
- Difficulty localising sound and combining information from both ears.
- Poor auditory memory, losing longer instructions and sequences.
- Slow processing speed, when the brain needs more time to understand the words it hears.
How does APD affect learning and emotions?
School is the environment in which a child with APD has it hardest. Most knowledge is conveyed verbally, often in a noisy classroom. A child who cannot keep up with the stream of words starts to lose the thread, tires and withdraws. They are often perceived as inattentive, lazy or incapable, though the cause is entirely different.
The consequences reach further than grades. Repeated failures hit self-esteem, breed frustration, reluctance towards school, sometimes anxiety symptoms. That is why in APD therapy we work not only on hearing, but also on the sense that the difficulty has a name and can be addressed.
Efficient auditory processing is the foundation of learning to read and write. When a child differentiates sounds poorly, it is harder for them to link sound to letter. That is why APD is sometimes linked with the risk of dyslexia and spelling difficulties.
Assessment step by step
A reliable APD assessment has its order, which is not worth skipping:
- Assessment of peripheral hearing. First we make sure the child hears well, because APD is diagnosed with normal hearing.
- Interview and observation. We learn the developmental history, the course of ear infections, difficulties at home and at school.
- Auditory processing tests. A set of tasks assessing understanding of speech in noise, differentiation and auditory memory.
- Analysis and discussion. We create a profile of strengths and deficits and a concrete therapy plan.
What does auditory training involve?
APD therapy is the systematic training of specific auditory functions, tailored to the child's profile. Depending on needs, we use the Warnke Method®, which trains auditory and visual processing and coordination, and the Tomatis® Method, that is, auditory-attention training. We supplement them with exercises in auditory analysis and synthesis. Part of the training can be continued at home, which speeds up progress.
The role of the parent and the school
The best results come from cooperation. At home, calm face-to-face communication, breaking instructions into steps and reducing background noise all help. At school, small adjustments can change a great deal, for example a seat near the teacher, checking understanding of the instruction, supporting words with writing and images, and extra time to respond. It is worth talking to teachers, because the awareness that it is not a matter of willingness changes the approach to the child.
Do you suspect APD in your child?
Book a consultation. We will check whether the difficulties stem from auditory processing and suggest suitable training.
This article is for information only and does not replace a consultation or assessment. For an individual assessment, see our APD assessment and therapy page.