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We don't hear with our ears alone. Hearing also involves the brain.
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What is Auditory Processing Disorder (APD)?
Auditory processing disorder (APD), sometimes referred to as central auditory processing disorder (CAPD), is a general term for hearing disorders in which the ears process sound normally but the hearing centres and circuits of the brain don’t always process incoming information sufficiently quickly or accurately.
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APD in Adults
Children with untreated APD often grow up to be adults with APD. APD can also arise in adulthood as a consequence of disease, injury or ageing. APD is a common consequence of brain injury and stroke. Adults with APD often report that they can hear but they sometimes have trouble understanding what they hear. APD can especially affect understanding in challenging listening situations such as in the presence of other distracting sound or when listening to complex information. Often adults who have had APD since childhood have learnt to compensate for or mask their hearing difficulties. Sometimes adults who receive an APD diagnosis conclude that APD may explain past difficulty at school with academic progress, social and behavioural difficulties.
In a Government report on APD services in New Zealand one adult with APD described his experience as follows.
- “Throughout school I thought I was “stupid” Why? Because that’s what “school” told me, my academic achievements at school were very poor but not through lack of trying (just like my daughter) I’m sorry to say even some of my teachers told me I’d never succeed. I now realise this was in part because I could not understand what was being said to me in the classroom. Let me explain further - I can only focus on the first piece of information someone tells me, I can’t listen and write things down at the same time – still to this day I can’t…”
(Auditory processing disorder: New Zealand review. Esplin and Wright, 2014).
APD in adults can impact quality of life significantly. Communication difficulties can negatively affect socialisation, relationships, and career.
If the APD is a consequence of an injury, it may affect ability to return to work. APD often makes understanding difficult when listening in noise and groups, leading to reduced communication and social confidence. The additional effort required to listen and understand everyday conversations can also result in listening-related fatigue. Sometimes the hearing difficulties are highlighted when the person moves into a new listening environment such as moving into a new open plan office or, in the case of a student, embarking on university learning for the first time.
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APD Symptoms
If one or more of the following hearing or listening problems are present, and standard hearing test results are normal, APD may be the cause.
- difficulty following spoken directions unless they are brief and simple
- difficulty attending to and remembering spoken information
- slowness in processing spoken information
- difficulty understanding in the presence of other sounds
- being overwhelmed by complex or “busy” auditory environments e.g. social situations, shopping malls
- undue sensitivity to loud sounds or noise
- poor listening skills
- preference for loud television volume
- insensitivity to tone of voice or other nuances of speech
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How does it sound to have APD?
Adults with APD, particularly if it arose in adulthood so they have prior experience of good hearing, can provide insight into the experience of hearing with APD.
Dr Louise Carroll QSO, JP, GDPPA , MPM, previously Chief Executive Officer of the National Foundation for Deaf and Hard of Hearing, has Auditory Processing Disorder and uses hearing aids and a remote microphone (RM) system. She describes her hearing experience as follows.
“Without my hearing aids or RM system, speech seems fast, fragmented and confusing. Voices lack tonality. My directional hearing is poor and voices from behind are particularly difficult to hear. It’s very difficult to distinguish a voice from any other sound that is present. For example, if the refrigerator switches on (a sound barely noticeable to most people) it seems to me to swamp anyone speaking. With my hearing aids I hear much better, losing only perhaps 25% of speech. With both my hearing aids and RM system I can usually hear 100%. But I am still exhausted from listening at the end of the work day and want to take my hearing aids off as soon as I get home.”
Listen to an Audio Simulation of APD:
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Diagnosis
Many hearing clinics and audiology services provide general audiological diagnostic assessments and fit hearing aids for age-related or noise-related hearing loss problems. At SoundSkills APD Clinic we provide an audiology service that specialises in APD diagnosis and APD treatment. To diagnose APD we use specialised hearing tests (APD tests) that examine ability to hear in noise, to effectively use both ears together, to detect subtle changes in the pitch and duration of sounds, and auditory memory. A diagnostic assessment can be very helpful in explaining the cause of past and current hearing problems. SoundSkills’ multidisciplinary approach will also ensure that, if other co-occurring difficulties are suspected, advice on any necessary further referral will be provided.
Auditory processing disorder can only be diagnosed by a qualified Audiologist.
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Treatment
As with children, adults with APD benefit from auditory training and assistive hearing technology.
Adults with APD often experience immediate benefit from using hearing instruments to help compensate for the hearing difficulties caused by APD such as difficulty understanding speech, difficulty listening in groups, and listening-related fatigue.
Hearing assistance for APD includes use of advanced technology hearing aids and assistive remote microphone devices to provide increased clarity (not necessarily volume) of voices. Research supports use of mild amplification to treat auditory processing difficulties despite having normal hearing thresholds on a standard hearing test. For hearing aid fittings SoundSkills provides a 30-day trial, the results of which are evaluated together with the audiologist, using agreed goals set out at the beginning of the trial. If the trial is unsuccessful the equipment portion of the costs is refunded.
At SoundSkills APD Clinic our goal is to provide an individualised service focused on improving quality of life. Our audiologists use the most current auditory training programmes and hearing technologies to treat hearing difficulties.
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Funding
For hearing issues caused by an accident such as a head injury, ACC may pay for an assessment and hearing technology if appropriate. For students under the age of 21 and in full time education, funding from the Ministry of Education for a remote microphone hearing aid system may be available. If hearing aid funding is an issue for you please discuss this with our clinical staff who may have other suggestions as to where you may obtain funding assistance.