Processing Disorder in Children
National Institute on Deafness and Other Communication Disorders
Processing Disorder (APD) is a complex problem. The term is used
by many people, in very different ways. There is research underway
to help understand this disorder. There also is research to investigate
therapies that will help individuals who may have an auditory processing
disorder. As you will read, it will take a team of experienced professionals
to diagnose and treat a true APD. Two organizations certify many
of the professionals qualified to diagnose and treat ADP: the American
Speech-Hearing-Language Association (ASHA) and the American Academy
of Audiology (AAA).
is auditory processing?
Auditory processing is a term used to describe what happens when
your brain recognizes and interprets the sounds around you. Humans
hear when energy that we recognize as sound travels through the
ear and is changed into electrical information that can be interpreted
by the brain. The "disorder" part of auditory processing
disorder means that something is adversely affecting the processing
or interpretation of the information.
with APD often do not recognize subtle differences between sounds
in words, even though the sounds themselves are loud and clear.
For example, the request "Tell me how a chair and a couch are
alike" may sound to a child with APD like "Tell me how
a couch and a chair are alike." It can even be understood by
the child as "Tell me how a cow and a hair are alike."
These kinds of problems are more likely to occur when a person with
APD is in a noisy environment or when he or she is listening to
goes by many other names. Sometimes it is referred to as central
auditory processing disorder (CAPD). Other common names are auditory
perception problem, auditory comprehension deficit, central auditory
dysfunction, central deafness, and so-called "word deafness."
causes auditory processing difficulty?
We are not sure. Human communication relies on taking in complicated
perceptual information from the outside world through the senses,
such as hearing, and interpreting that information in a meaningful
way. Human communication also requires certain mental abilities,
such as attention and memory. Scientists still do not understand
exactly how all of these processes work and interact or how they
malfunction in cases of communication disorders. Even though your
child seems to "hear normally," he or she may have difficulty
using those sounds for speech and language.
cause of APD is often unknown. In children, auditory processing
difficulty may be associated with conditions such as dyslexia, attention
deficit disorder, autism, autism spectrum disorder, specific language
impairment, pervasive developmental disorder, or developmental delay.
Sometimes this term has been misapplied to children who have no
hearing or language disorder but have challenges in learning.
are the symptoms of possible auditory processing difficulty?
Children with auditory processing difficulty typically have normal
hearing and intelligence. However, they have also been observed
trouble paying attention to and remembering information presented
Have problems carrying out multistep directions
Have poor listening skills
Need more time to process information
Have low academic performance
Have behavior problems
Have language difficulty (e.g., they confuse syllable sequences
and have problems developing vocabulary and understanding language)
Have difficulty with reading, comprehension, spelling, and vocabulary
is suspected auditory processing difficulty diagnosed in children?
You, a teacher, or a day care provider may be the first person to
notice symptoms of auditory processing difficulty in your child.
So talking to your child's teacher about school or preschool performance
is a good idea. Many health professionals can also diagnose APD
in your child. There may need to be ongoing observation with the
of what will be done by these professionals will be to rule out
other problems. A pediatrician or a family doctor can help rule
out possible diseases that can cause some of these same symptoms.
He or she will also measure growth and development. If there is
a disease or disorder related to hearing, you may be referred to
an otolaryngologist--a physician who specializes in diseases and
disorders of the head and neck.
determine whether your child has a hearing function problem, an
audiologic evaluation is necessary. An audiologist will give tests
that can determine the softest sounds and words a person can hear
and other tests to see how well people can recognize sounds in words
and sentences. For example, for one task, the audiologist might
have your child listen to different numbers or words in the right
and the left ear at the same time. Another common audiologic task
involves giving the child two sentences, one louder than the other,
at the same time. The audiologist is trying to identify the processing
speech-language pathologist can find out how well a person understands
and uses language. A mental health professional can give you information
about cognitive and behavioral challenges that may contribute to
problems in some cases, or he or she may have suggestions that will
be helpful. Because the audiologist can help with the functional
problems of hearing and processing, and the speech-language pathologist
is focused on language, they may work as a team with your child.
All of these professionals seek to provide the best outcome for
current research is being conducted?
In recent years, scientists have developed new ways to study the
human brain through imaging. Imaging is a powerful tool that allows
the monitoring of brain activity without any surgery. Imaging studies
are already giving scientists new insights into auditory processing.
Some of these studies are directed at understanding auditory processing
disorders. One of the values of imaging is that it provides an objective,
measurable view of a process. Many of the symptoms described as
related to APD are described differently by different people.
will help identify the source of these symptoms. Other scientists
are studying the central auditory nervous system. Cognitive neuroscientists
are helping to describe how the processes that mediate sound recognition
and comprehension work in both normal and disordered systems.
into the rehabilitation of child language disorders continues. It
is important to know that much research is still needed to understand
auditory processing problems, related disorders, and the best interventions
for each child or adult. All the strategies undertaken will need
to be suited to the needs of the individual child, and their effectiveness
will need to be continuously evaluated. The standard for determining
if a treatment is effective is that a patient can reasonably expect
to benefit from it.
treatments are available for auditory processing difficulty?
Much research is still needed to understand APD problems, related
disorders, and the best intervention for each child or adult. Several
strategies are available to help children with auditory processing
difficulties. Some of these are commercially available, but have
not been fully studied. Any strategy selected should be used under
the guidance of a team of professionals, and the effectiveness of
the strategy needs to be evaluated. Researchers are currently studying
a variety of approaches to treatment.
strategies you may hear about include:
trainers are electronic devices that allow a person to focus attention
on a speaker and reduce the interference of background noise. They
are often used in classrooms, where the teacher wears a microphone
to transmit sound and the child wears a headset to receive the sound.
Children who wear hearing aids can use them in addition to the auditory
Environmental modifications such as classroom acoustics, placement,
and seating may help. An audiologist may suggest ways to improve
the listening environment, and he or she will be able to monitor
any changes in hearing status.
Exercises to improve language-building skills can increase the ability
to learn new words and increase a child's language base.
Auditory memory enhancement, a procedure that reduces detailed information
to a more basic representation, may help. Also, informal auditory
training techniques can be used by teachers and therapists to address
Auditory integration training may be promoted by practitioners as
a way to retrain the auditory system and decrease hearing distortion.
However, current research has not proven the benefits of this treatment.
can I learn more about auditory processing?
For information related to audiology and audiology professionals
and services, contact:
Academy of Audiology (AAA)
11730 Plaza America Drive, Suite 300
Reston, VA, 20190
Voice: (703) 790-8466, 8:00 a.m. - 5:30 p.m., Eastern time
Toll-free Voice: (800) 222-2336
TTY: (703) 790-8466, 8:00 a.m. - 5:30 p.m., Eastern time
Fax: (703) 790-8631
American Speech-Language-Hearing Association (ASHA)
10801 Rockville Pike
Rockville, MD, 20852
Voice: (301) 897-5700
Toll-free Voice: (800) 638-8255, 8:30 a.m. - 5 p.m., Eastern time
TTY: (301) 897-0157
Fax: (301) 571-0457
more information, contact the NIDCD Information Clearinghouse.
NIH Pub. No. 01-4949
Updated February 2004