Children with Auditory processing disorder (APD) have difficulties processing the meaning of sounds.

"Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), refers to the reduced ability to process auditory information. Simply put, it is a difficulty in processing and decoding sounds," ​say speech therapists ​from the ​Speech Therapy Department​ from Singapore General Hospital (SGH), a member of the SingHealth group.​

People with APD often have normal hearing abilities but exhibit difficulty in tasks that require them to decipher and process the meaning of sounds. People with APD are a heterogeneous group, with individuals presenting with different profiles of difficulty. These difficulties may manifest as problems in identifying the locations of sounds, differentiating between similar sounds and differentiating speech from background noise, to name a few.

APD is estimated to affect between 2 to 5 per cent of children in Western countries. The figures for Singaporean children, unfortunately, are not known.

8 Common signs of auditory processing disorder (APD)

Common characteristics of auditory processing disorder (APD) are:

  1. Poor comprehension especially in noisy environments

  2. Frequent use of “huh?” or “what?”

  3. Difficulty following directions

  4. Poor phonics skills

  5. ​Inattentiveness

  6. High distractibility

  7. Difficulty following conversations

  8. Academic difficulties

Causes of APD

Unfortunately, the cause of APD is still unknown. It is suspected that APD may stem from an abnormal representation of auditory information in the brain. This could be a result of varying factors, such a delay of the development of the central auditory nervous system. Children with neurological disorder or trauma to the brain may also present with APD.

There is no relationship between intelligence and APD as many children with intelligence levels in the normal range have APD. APD is also a characteristic of other disorders, including, but not limited to, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), dyslexia and language impairments.

How APD is diagnosed

APD is diagnosed by an audiologist and requires the use of standardised tests and calibrated equipment. It cannot be diagnosed from general observation. Although other professionals may be involved in the identification and treatment of APD, it is the audiologists who conduct the assessment and determine the diagnosis of APD. The assessment of APD involves a series of specially controlled hearing tasks that look at the following processing abilities:

  • Locating the source of a sound

  • Differentiating between similar sounds (e.g. /p/ and /b/)

  • Recognising patterns of speech

  • Stringing sounds together and perceiving them as meaningful speech

  • Distinguishing speech sounds from other competing sounds

  • Processing and understanding incomplete auditory information

As certain aspects of auditory processing only fully develops as the brain matures, a true assessment and diagnosis of APD can only take place after the child enters primary school, around the age of 7 or 8.

APD: How to treat

"Auditory processing disorder (APD) cannot be cured, but treatment is effective in improving the individual’s listening skills. Treatment is often conducted by the speech therapist and involves individual speech therapy sessions that focus on stimulating and training the different processing pathways," ​say SGH speech therapists.

The specific focus of therapy depends on the severity of the disorder and the auditory processing profile of the individual. Individuals with APD may also be taught compensatory strategies to help them in different environments.

Intervention also often involves the manipulation of the child’s academic or learning environment. Examples of modifications implemented include the reduction of noise (where possible), the allocation of seating close to teachers and away from distractions (e.g. windows) and the use of visual cues such as documentation or handouts to help children with APD follow the lessons better. Assistive list​ening devices may also be recommended to ensure that speech signals are amplified and fed directly to the child’s ear.

9 Tips to manage APD

  1. Make sure they can see the face of the person speaking to them

  2. When giving important instructions, encourage them to stop what they are doing, look at the speaker and listen

  3. Keep information and instructions short and simple

  4. Don’t rush your instructions

  5. Give instructions in a time-ordered sequence using words such as “first”, “next”, and “last”.

  6. Check that they have understood the instructions by asking them to repeat them

  7. Use visual cues to facilitate their understanding. This can be in the form of words, pictures or gestures

  8. Emphasise the important words in the sentence

  9. Reduce the background noise in their learning environments

Ref: O17​