Why Do Parents Often Overlook Auditory Processing Disorder?

November 11, 2022 The Ed Psych Practice No Comments Referrals ADHD, Auditory Comprehension, Auditory Processing Disorder (APD), Dyslexia, Executive Functioning, Language Delays, Listening Skills, Noisy Environment, Working Memory

Takeaway: Children with auditory processing disorder (APD) have brain differences that give them specific characteristics. But these characteristics sometimes overlap with those of children with hearing issues, language disorders, dyslexia, anxiety disorders, and ADHD. So, you’ll need a specialist to help diagnose your child’s APD and design the right support plan.

Auditory processing disorder (APD) affects the way we process sound.

Auditory processing disorder (APD) is a condition in which a child’s brain can’t recognise and interpret sounds (especially speech sounds) correctly. So, she might have trouble following spoken instructions or remembering those instructions. She might be easily overwhelmed in noisy environments like loud classrooms and malls. And she might struggle to recognise speech nuances like tone of voice. Learn more about auditory processing disorder.

But diagnosing APD is tricky as some of its characteristics overlap with other conditions.

The trouble with APD is that other conditions can similarly affect your child’s life. For instance, brain injuries and neurological disorders could also affect sound processing. And some types of hearing problems (from middle-ear illnesses, for example) might appear to be linked to sound processing. So, it’s worth exploring the differences between APD and other overlapping conditions.

First, although APD makes it harder to follow conversations, it’s not a hearing issue.

Children with APD have trouble following conversations, so it’s natural to think they might have hearing issues. The ear is a complex organ with multiple, highly-sensitive parts that need to coordinate precisely. So, many mechanical problems can affect a child’s hearing. For example, too much fluid can build up behind the eardrum, or hair cells of the inner ear could get damaged. And even if the sound makes it through to the inner ear, the auditory nerve might malfunction and not transmit the sound impulse to the brain. But APD is different because it’s a sound processing problem, not a hearing problem. I.e., sound signals get to an APD brain just fine. It’s the brain that has trouble making sense of the signals.

Second, APD affects sound processing, but not in the way dyslexia does.

Dyslexia is a learning difference that makes it harder for children to read, write, and spell. Sound-processing issues do show up in dyslexia, but they’re not the main problem. Rather, dyslexia is more of a language processing issue – specifically, a difficulty converting speech sounds into writing, and vice-versa. It’s this sound-to-text mapping that children with dyslexia primarily struggle with, rather than sound-processing alone. So, children with APD and dyslexia may have similar difficulties – e.g., trouble following a conversation in a noisy room. But these are caused by different brain mechanisms, so we deal with them differently.

This language-vs-sound difference is what separates APD from language disorders.

Language disorders also affect how well a child listens, speaks, and learns. And again, mixing up speech sounds is part of the problem. But the main challenge here is attaching meaning to speech sounds rather than struggling to process those sounds. So, unlike children with APD, those with language disorders have difficulty finding the right word to use or constructing a grammatically correct sentence.

Also, APD struggles don’t come from being distracted or emotionally overwhelmed.

Children with anxiety disorders have many of the same learning difficulties as children with APD. But when an anxious child has problems following a conversation, it’s because she’s emotionally overwhelmed. It’s not because – as in APD – the background noise is intruding, or her brain is mixing up phonemes (i.e., units of speech). So, children with APD struggle with a sound-processing overload, while those with anxiety struggle with an emotion-processing overload.

One of the features of APD is that it can weaken a brain’s executive functions.

Our brains have a core set of processes called executive functions that guide our behaviour. Think of them as a little manager in the brain, helping us stay organised and active. For instance, your child’s executive functions help her make decisions, pay attention, prioritise activities, regulate emotions, and more. And they do this via core mechanisms like impulse control, working memory, mental focus, and perspective-taking. (Learn more about executive functions.) This is relevant because children with APD often also have weakened executive functions. So there’s likely a link between the two.

But APD isn’t connected to executive functions the way ADHD is.

And this brings us to the next overlapping-but-different condition: Attention-deficit/hyperactivity disorder (ADHD). Children with ADHD have problems paying attention, staying focused, and controlling impulses – all of which stem from executive function issues. And these executive function issues might also make it harder for them to interpret sounds or separate speech sounds from background noise – similar to the challenges of children with APD. The difference is that ADHD’s executive function issues affect more than just sound processing. For example, if we took two groups of children – one with ADHD and one with APD – and gave them an audio-based memory test, both groups would likely struggle. But if we made it a written test instead, the APD group’s scores would improve while the ADHD group’s wouldn’t. The APD group only struggled with the audio aspect of the test, while the ADHD group struggled with much more. (Learn more about ADHD.)

Finally, things get really complicated when APD co-occurs with other conditions.

Diagnosing APD gets much tougher when it co-occurs with another condition. For instance, you can tell APD and ADHD apart by conducting verbal and written versions of a test (as outlined above). But what if your child has APD and dyslexia? Now, she’ll struggle with both versions of the test – the same as children with ADHD would – making it harder to diagnose her. And that’s why we need specialists to assist with the diagnosis.

The right specialist can help your child adapt to APD by creating a nurturing learning environment.

Your child’s brain can transform itself based on input from her environment. (It’s a phenomenon called brain plasticity.) So, specialists can help you set up a nurturing home and school environment. For instance, adding carpets or soft furnishings will absorb stray sounds. And teachers could wear a small mic attached to a speaker on your child’s desk – allowing her to follow along in a noisy classroom. Further, a speech and language therapist could design listening drills to strengthen the auditory aspects of your child’s working memory, mental processing, and attention. And she could teach coping skills to deal with frustration and disappointment along the way.

If you’d like to consult with a specialist, feel free to reach out to us via phone or email.

The Ed Psych Practice offers face-to-face and online assessments, consultation, advice, and problem-solving strategies for parents, nurseries, schools, and universities in London. We have psychologists, paediatricians, and therapists who can help assess your child and offer guidance and support. To consult with us or set up an appointment:

Phone: +44 (0) 78 3344 7356
Email: Office@TheEdPsych.com

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