Central Auditory Processing Disorder (CAPD), or more plainly, Auditory Processing Disorder (APD), are terms growing in prevalence and recognition over recent years. This is especially true in their relation to children and learning. But with that rise in popularity has come a lot of confusion and circulation of conflicting information. Before explaining what it is, let’s start by stating what it’s not. Auditory Processing Disorder is not a hearing loss. Someone with APD may have a completely intact hearing mechanism, able to hear the entire span of frequency and sound we need to survive. APD is not indicative of a cognitive deficit. It is not resulting from issues in memory, attention, or intellectual functioning. APD is not a language deficit. A language deficit may exist in understanding, expression, and use of language in visual and written forms, as well as verbal.
So… what is it?
Auditory Processing Disorder is the difficulty distinguishing and treating auditory or sound information. Auditory information may include speech, music, or loud noises in the environment, to name a few examples. This difficulty in information processing occurs at the level of the Central Nervous System (CNS), which contains the brain and the spinal cord. It could mean difficulty deciphering lyrics to a playing song, trouble hearing an adult over background noise, or, more discretely, it could mean difficulty distinguishing closely related sounds (e.g., discriminating between “bus” versus “buzz”). In a common day-to-day experience, someone with APD may hear, “Look at the bunny there” as “Look in the bunny’s hair.” APD can vary in type and severity, but you can imagine the frustration in trying to integrate what is heard with what is seen in the environment. And then afterward, trying to fill- in gaps.
So… where did the confusion come from?
One of the main ways information is delivered and received as people grow and develop is through auditory means. People are expected to learn from their surroundings as parents warn their children of environmental dangers or add imagination during playtime. Teachers read stories, speak lessons, and converse with students in school. With APD, these instances of learning become compromised. With repeated erroneous intake of auditory information, individuals are at a disadvantage, as time that would be spent using auditory information is spent decoding and determining what is right instead. But it also means that it presents much like a deficit in language or cognition. Someone with APD will still have difficulty following lengthy auditory instructions, may still rely on the repetition of auditory information before showing understanding, or may highly benefit from visual support from their environment.
How is APD related to speech and language, and why is it important to explore further?
APD may impact speech development since children rely on the sounds they hear to imitate and formulate speech sounds. Erroneous speech patterns, or phonological processes, may persist past what is considered age-appropriate for someone with APD because they may not be getting the correct information all the time. APD may impact the development of early literacy skills, including rhyming, sound-to-letter recognition, and syllable segmentation. APD may impact language development as the auditory information load increases with age. This makes it harder to follow lengthy verbal instructions since difficulty does not lie in the understanding of what is expected but in accurately interpreting parts of lengthy instructions, storing them, and then continuing to interpret the next set of instructions. This entire process may look like difficulties with memory or language comprehension. Since an APD may look like a speech and language deficit, it is important to explore the possibility of an APD as soon as it is age- appropriate (most children are not able to tolerate the diagnostic process until they are about age 5). This is because, over time, difficulties resulting from an APD can lead to true speech and language deficits and challenges in an academic setting overall.
Ultimately, speech and language deficits or trouble with cognitive skills may manifest in early childhood years before the possibility of Auditory Processing Disorder can be explored. This leaves room for variability in the role APD could have in some of those challenging areas. Persisting speech and language deficits may be explained by the presence of an APD. APD may or may not exist in conjunction with other, more global disorders, including Autism or general intellectual disability. The mechanics of APD and what sets it apart from other disorders related to speech and language add nuance to other therapies, including speech and language. Knowing the mechanics of APD empowers families and caregivers to seek the appropriate support for their children in school and at home! If Auditory Processing Disorder is now a topic of discussion related to your child’s needs, your child’s healthcare team will be more than happy to explain further what next steps are, and to guide you in the direction of an audiologist, the professionals who diagnose APD, ready to lead the way.
https://www.asha.org/public/hearing/understanding-auditory-processing-disorders-in-children/ https://kidshealth.org/en/parents/central-auditory.html https://www.gemmlearning.com/can-help/central-auditory-processing-disorder/info/types-of-apd/