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Understanding Auditory Processing Disorder
Explaining APD and How It Affects Learning
If your child is bright and hard-working but struggles to keep up in class, follow verbal directions, or master reading, you may be looking at an auditory processing challenge.
Auditory processing describes how the brain interprets sounds after the ears hear them. Analyzing sound includes:
- distinguishing one sound from another (/ma/ versus /na/), called auditory discrimination,
- holding words in auditory memory, and
- dichotic listening – being able to separate out one stream of sound, e.g., a teacher’s voice, from background noise, e.g., a noisy classroom.
Auditory Processing Disorder (APD) is a difficulty in making sense of sounds that can reach the severity level of a disorder. Many children don’t fully develop their auditory processing skills until 7 or 8 years of age, or later, but the delay falls short of the audiologist-defined standard for APD.
APD is 100% a neurological issue. It is not hearing loss, nor is it a biological problem or medical condition; rather, it refers to symptoms. It has been described as like listening through water.
Delays in auditory processing cause delays in language processing, which undermines reading and learning – we listen and think using language – by muddying the inputs and by requiring extra effort by the brain to make sense of the sounds the ears hear, creating exhaustion and a negative connection to learning.
APD: One Issue Often Seen As Many
When parents review a psychoeducational or school evaluation for their child, they might panic. They receive a list of deficits, often including reading delays, weak working memory, distractibility, and struggles with listening comprehension.
However, in most cases, there are not separate disorders.
It is like evaluating a broken ankle. A doctor could list a dozen separate “deficits” – can’t run, can’t jump, can’t climb stairs, etc. But really, it’s one issue—a broken ankle—causing those downstream symptoms.
Similarly, an auditory processing deficit affects processing speed and processing efficiency (effort required to process), which causes a range of diverse difficulties:
- Reading & Phonics Delays: If language processing is muddy and imprecise, phonics and then reading become an uphill battle.
- Working Memory: When the brain takes in garbled sounds that don’t match words in auditory memory, it doesn’t retain them, so working memory skills don’t develop naturally.
- ADHD: Inefficient listening is physically exhausting, causing mental strain that leads to tuning out and ADHD symptoms. Similarly, slow processing speed makes it hard to keep up with the teacher, leading to confusion, getting lost, and then tuning out.
Most Reading Delays Are Processing-Related
We tend to think of reading as a visual activity because our eyes scan the pages. However, the human brain processes language through auditory word memory, not print. Reading is oral language in a visual format.
Reading is easy when the words in auditory memory match the text, letter by letter. Deciphering distinct phonemes, particularly consonant blends like /sp/ or /cl/, requires the brain to process up to 25 distinct sounds per second.
This is a massive cognitive demand. For a child with an auditory processing delay, natural speech moves too fast to map accurately. If /ba/ and /da/ sound the same, reading becomes guessing, and nearly identical sounds are flipped. They aren’t seeing the letters incorrectly; they are hearing them incorrectly.
If you suspect processing is holding your child back, check out our APD symptoms checklist here.
APD Is Underdiagnosed
The APD diagnosis is only applied to children who cannot meet certain thresholds in skill, which is why 2-7% of the population has an official APD diagnosis.
Many APD children are diagnosed with something else, either ADHD, developmental dyslexia, or another learning disability. Others have processing difficulties that fall just below testing thresholds or are not tested.
Take our 5-minute free APD screening tool that reviews risk factors and symptoms associated with APD.
ASHA on APD
American Speech‑Language‑Hearing Association (ASHA) describes APD and its impacts.
“Some children have difficulty processing linguistic information, resulting in an inability to integrate sound and meaning to comprehend language.”
“Auditory processing disorders are deficits in the processing of audible signals not attributed to impaired peripheral hearing sensitivity or intellectual impairment. This information processing involves perceptual, cognitive, and linguistic functions.”
APD is not about hearing loss, but rather about how the brain processes auditory information.
Auditory Processing Disorder, Dyslexia, and Reading:
The Sequential Connection
There is a material overlap between APD and reading disorders. Many parents wonder: Can you have APD and dyslexia at the same time? Assuming they are separate issues requiring different treatments.
In reality, these difficulties are not separate; they are sequential. One causes the other. APD causes dyslexia and reading delays. Educators call it Phonological Processing Disorder (PPD)—APD through a reading lens.
The Four Pillars of Phonological Processing
Mapping letters on a page to auditory word memory requires four auditory sub-skills:
- Auditory Discrimination: The ability to recognize tiny differences between speech sounds.
- Auditory Blending: The mental process of pulling individual phonemes together to form a word (e.g., blending /c/ – /a/ – /t/ into cat).
- Auditory Sequencing: The ability to understand and recall sounds in words, numbers, and words in order.
- Auditory Memory: The capacity to receive and hold verbal information in mind. It includes sensory memory (a few seconds), working memory, and long-term memory.
Indications that your child is struggling to process language appear early on with final consonant deletion (saying “ca” instead of “cat”) or cluster reduction, where the child omits a letter sound in a syllable blend (saying “poon” for “spoon”).
These kinds of errors as a toddler can indicate a difficulty wth phonemic awareness, the ability to pick out every separate sound – every phoneme – in a word.
Auditory Processing Deficits Undermine Reading Comprehension
When auditory processing hinders the development of phonological and phonemic awareness, reading is impacted:
- Decoding Not Automatic: Young readers need not only to learn to decode every word, but also to do so with automaticity so that mental bandwidth can be fully devoted to comprehension.
- Comprehension: Reading comprehension requires language knowledge – vocabulary and syntax – which is learned early on solely through listening. Inefficiencies in auditory processing slow down this process.
What are the 5 Types of Auditory Processing Disorders?
The 5 Profiles of APD & How They Present in Daily Life
Because auditory processing involves a complex network of neural pathways, APD does not look the same in every individual. It rarely presents as a single, neat category; most children and adults experience a blend of these five functional processing profiles:
1. Auditory Hypersensitivity (Tolerance-Fading Memory)
This profile centers on an inability to block out background noise while simultaneously holding spoken words in short-term memory.
- What parents notice: “My child can’t hear me when the TV is on.” The child appears to ignore people or tune them out because they have to use 100% of their concentration just to decipher a single voice in a crowded room, called dichotic listening.
2. Phonetic Decoding Delays
This is a baseline neurological speed issue in which the brain struggles to break down and map linguistic data at natural speech rates.
- What parents notice: A child who had no evidence of speech and language delays runs into an unexpected difficulty with phonics and spelling. They may mix up similar-sounding words, drop syllables, or make random spelling errors, including on phonetically simple words like /band/.
3. Auditory Integration Gaps (The Left-Brain / Right-Brain Disconnect)
A communication lag across the corpus callosum—the neural bridge connecting the left and right hemispheres of the brain. It prevents the brain from efficiently integrating visual and auditory information.
- Following the Coach: An auditory integration delay makes it difficult for a child to hear a coach’s instructions and translate them into physical action. They get into the habit of waiting to see what the other players do rather than relying on what they hear.
- Writing and Note-Taking: Listening to the teacher (auditory) and then taking notes is challenging.
One of the reasons children cannot start our Fast ForWord exercises until they are at least 5 years of age is that this is when auditory integration skills develop. Until then, children have difficulty hearing the up-and-down sound sequences (auditory) in Fast ForWord and translating them into clicking up-and-down (visual) arrows to match.
4. Prosodic Deficits
Prosodic deficits refer mainly to speech – an inability to change tone or emphasis to match meaning. Reading with prosody means reading with emphasis and expression. It’s a right-brain ability to pick up the nonverbal nuances and meaning of language.
- What parents notice: A monotone speaking style. In reading, being able to read with prosody is a signal of reading fluency, as it means the child has the capacity to recognize what they are reading and add prosody as they go.
5. Output or Organizational Deficits
This refers to a difficulty recalling information in the correct sequence.
- What parents notice: Mixing up the order of numbers or instructions. Organizational deficits are more common when the child has to contend with noisy backgrounds.
“Prior to the program, we were at our wits’ end trying to figure out the best way to help her. Since the program, for the first time in 13 years, it’s as if a switch in her brain went on,”
“She received her first trimester 1st grade report yesterday. Her subject grades were as follows: Language Arts 97%, Reading 96%, Math 99%, Science 100%, Social Studies 100%. Plus her Diebels reading scores were OFF THE CHARTS! Based on this report card Rachel no longer needs any special intervention for her auditory processing issues as she continues to advance at a higher level than her peer group… So it was wonderful to use your service but I do not anticipate we will need Gemm Learning in the future. Thanks for all your help.”
What Causes Auditory Processing Disorder?
Auditory processing develops and matures through practice, through listening. For many children, the cause of APD is neurological. Their neurological makeup is such that mastering language processing skills (lightning fast) requires more time and targeted stimulation than their daily oral language surroundings provide.
However, there are other root causes of APD:
Chronic Childhood Ear Infections Or Early Hearing Loss
It surprises many parents to learn that many language-based learning difficulties can be traced back to a few weeks of accumulated ear infections during the first three years of life.
An ear infection (otitis media or glue ear) occurs when fluid builds up behind the eardrum. Because young children’s Eustachian tubes are shorter and more horizontal than those of adults, fluid and bacteria can easily become trapped. 5 out of 6 children will experience at least one ear infection by the age of 3.
Ear infections affect the quality of language a child hears, making it muddy and often meaningless. And so an extended period of ear infections, sometimes called “glue ear,” interrupts language stimulation in the all-important first three years of life.
The Impact of Lost Processing Practice
Ear infections or early hearing loss difficulties slow down language development in several ways:
- Early Speech Gaps: Toddlers may begin leaving off the beginnings or ends of words (such as saying “ca” for cat) because they have not heard the “t” on the end of cat. That issue can persist long after the fluid clears.
- Selective Listening: Auditory processing deficits make it difficult for children to isolate a teacher’s voice in a noisy classroom.
- Reading Issues: Because the processing needed for conversation deals in whole words, children with ear infections typically have no ongoing speech issues. But picking out each sound inside words – phonemic awareness – is a much more demanding auditory processing skill. This is why dyslexia is often traced back to ear infections.
If your child has a history of ear infections, and is now struggling with reading, you have likely found the root cause. Their brain missed thousands of hours of language stimulation during ia formative time of life for language development.
Identifying the source also identifies the best course of action – an intervention to add the missing stimulation. Gemm Learning provides these interventions at home with overight. More on our auditory processing software here.
Other Contributing Factors
- Not Hearing English at Birth: Children who are not exposed to the distinct phonetic sounds of English during early childhood—such as internationally adopted children or those for whom English is not spoken at home—face unique hurdles. Even the slightest glitch in processing can be problematic for these children.
- The Word Gap: Early childhood environments with limited conversational stimulation can affect how quickly a child maps receptive language. (Hart & Risley) Rich language experience early on translates into a faster start in reading.
- Head Injuries or Illnesses (Acquired APD): An auditory processing deficit caused by an outside event, such as head trauma, chemotherapy, or an illness like viral meningitis, which impacts general cognitive skill functioning.
- Genetics: About 40% of learning disabilities are hereditary, and auditory processing disorder fits into this pattern, frequently running in families.
- None of the Above – Neurological: Language is lightning-fast, so language processing is a challenging skill for the brain to master. Many children require more stimulation than their surroundings provide.
The Diagnostic Journey: How is APD Tested?
A school or pediatrician hearing screening will not catch APD. Those screenings only test peripheral hearing sensitivity (volume). To measure how the brain actually handles that sound, a specialized evaluation by an audiologist is required.
Does a standard hearing test detect auditory processing disorder?
Physical hearing tests and auditory processing tests are separate, but can be conducted by the same licensed audiologist (hearing specialist) who possesses the specialized clinical equipment and training required to perform a formal auditory processing evaluation and render a diagnosis.
A comprehensive evaluation combines behavioral questionnaires, medical history, and listening tests:
- Dichotic Listening Tests: Stereo headphones play different sounds simultaneously to test how well the brain can focus on and process separate sound streams, a vital skill, particularly in noisy environments. More on dichotic listening here.
- Speech-in-Noise (Auditory Figure-Ground) Tests: Test a child’s ability to pick out words and sounds with background noise.
- Temporal Processing & Gap Detection: Temporal processing measures how well the brain can detect rapid changes in sounds, such as /b/ changing to /r/ in the syllable /br/. Gap detection tests how well the brain can pick a silent gap in a stream of sound.
What age can a child be tested for APD?
Language processing skills typically mature around 7 years of age. And so, even if your child has a history of speech and language delays, there is limited value in testing for auditory processing disorder before that age.
Audiologists will generally also follow the 7-year-old age guideline for electrode-based tests such as an Auditory Brainstem Response (ABR) test, which measures electrical activity in the nerve pathways of the inner ear in response to sounds.
Until that age, you can still be observant, taking note of symptoms on our APD symptoms checklist and how they might be changing over time.
Blaise went to a good school, but he was falling further and further behind, and now it was affecting his confidence. His mother could see a downward spiral starting. She found Gemm Learning and Blaise worked over the summer.
“He got a standing ovation back at school when he read out loud to class for the first time. The teacher was amazed. And now he made first honors. He had a 95.6 average. I can’t even tell you how thankful I am. Blaise is diligent and hard-working, and your Fast ForWord program was the perfect fit. THANK YOU!!!!!!”
“He has made a remarkable transformation in just a few months. First, he noticed he was following instructions at a summer sports camp far more easily. He said that he wished he had done the program years ago. Now at school he is much happier and has more confidence. His school day is so much more productive as now he catches everything the teacher says.”
The APD Controversy: Is It “Real?”
There is some confusion about auditory processing disorder as a diagnosis because, unlike ADHD, dyslexia, and other educational diagnoses, APD is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the primary reference manual for clinicians and psychiatrists managing learning and mental disorders.
This can create hesitancy over insurance coverage for evaluations and treatments, although this is generally resolved by using one of the many downstream difficulties caused by APD, such as ADHD, which are listed in the DSM-5.
This is not, however, because APD is not real. Processing delays are very real. Rather, the hesitation to define it stems from how fundamental it is to learning and the breadth of symptoms it causes. The preference for clinicians is to identify a cluster of symptoms that fit into much narrower diagnostic categories.
This so-called ‘Is APD real?” controversy has no practical significance in most cases. Many children seek help for difficulties caused by APD – speech, working memory, dyslexia, attention, and others- and start with a clinician who will start with auditory testing as a possible cause of the reported difficulty, and that leads to an auditory processing-based solution like Fast ForWord.
Worried It’s APD?
Find out if you or your child is at risk for auditory processing difficulties.
This 5-minute free ASHA category-aligned APD screening tool reviews APD risk factors and symptoms. We will send an estimate of APD risk and recommendations.
Auditory Processing Disorder FAQ
What is an example of an auditory processing disorder?
At what age can APD be diagnosed?
APD is typically diagnosed around age 7 or older when children have developed language skills.
Does APD get worse with age?
For children, auditory processing tends to improve with age through the age of seven, and then more slowly into the teens. However, APD symptoms can resurface again in older individuals, particularly those over 55, who frequently experience accelerated difficulty processing speech in noisy environments.
How is APD different from ADHD?
APD often causes inattentiveness and/or reading delays that lead to a dyslexia diagnosis. More on the impact of processing delays on ADHD here.
Is APD ADHD or autism?
While ADHD and autism are distinct and separate conditions, there is a high rate of overlap. APD causes a number of ADHD symptoms because it makes it challenging and exhausting for a child to follow a teacher. Furthermore, there is research investigating the use of auditory processing delays as an early biomarker of Autism Spectrum Disorder (ASD), such as the level of comorbidity.
Is APD hard-wired or can it be improved?
Just like physical muscles, all cognitive skills can be strengthened if exercised appropriately. Auditory processing skill growth heavily influences cognitive development stages. Auditory processing may be the easiest to improve, since it is the easiest to interact with, using sound.
What are the red flags for auditory processing disorder?
The most common signs of APD include: difficulty listening in the presence of background noise, difficulty following multi-step verbal directions, and, in younger children, unexpected difficulty with phonics. More on APD symptoms here
Disclaimer: The information on this page is for educational purposes only and does not replace a formal diagnosis from an audiologist or SLP.
Research Sources
| Study / Source | Key Finding | Why It Matters |
|---|---|---|
| Alanazi, A. (2023). Auditory Processing Disorder: A Narrative Review. | Defines APD as “difficulty in listening despite normal-hearing thresholds” showing the issue lies in brain processing, not hearing sensitivity. | Provides a concise, research-based definition. |
| Musiek, F. & Chermak, G. (2017). 20Q: CAPD Diagnosis and Intervention. | Reviews evidence-based diagnostic protocols and outlines interventions for CAPD. | Supports Gemm Learning’s targeted training, aligning with audiology practices. |
| Bellis, T. (2020). Auditory Processing: What You Need to Know. | Explains how APD affects language, literacy, and classroom performance, with guidance for SLPs and educators. | Reinforces the connection between auditory processing and learning challenges. |
Defines APD as “difficulty in listening despite normal-hearing thresholds,” highlighting that the issue is brain processing.
Provides a concise, research-based definition.
Reviews diagnostic protocols and outlines interventions for CAPD.
Supports Gemm Learning’s targeted training.
Explains how APD affects language, literacy, and classroom performance.
Reinforces the connection between auditory processing and learning challenges.