Auditory Processing Disorder

What is Auditory Processing Disorder?

Also known as APD, this disorder affects how you process sounds and can affect how you process speech, but it is largely misunderstood. So, what is APD and how can you manage the symptoms? Jordon Thompson, Clinical Lead and audiologist at Harley Street Hearing & Musicians’ Hearing Services, London, explains.

Have you noticed increased difficulty understanding speech in background noise or lyrics in a song?  Are you finding it more difficult to hear your friends or family when in the pub or out at a recent social event? Are you finding that you are more tired from the effort of listening in noisy places?  If so, then you may be one of the estimated 0.5 to 1% of the general population experiencing a condition known as Auditory Processing Disorder, or APD for short [1].

What are the symptoms of APD?

APD is a disorder that affects the way you process and understand sounds, including speech. It may cause you to mishear words that are spoken or to have a difficult time making sense of words when there is competing background noise. This might cause you to take longer to understand what was said and therefore take longer to respond. So, APD is not really hearing loss but people with APD might report some of the same difficulties especially when in noisier spaces. Similarly, APD is not a learning difficulty either, but it can be linked with neurological conditions such as ADHD (attention deficit hyperactivity disorder) or dyslexia: these conditions may mask or amplify the symptoms of APD.

A good analogy is to think of the human hearing system and the brain like a keyboard and a computer, respectively. The keyboard is used to input information into the computer – just like your ears are used to input sound information into your brain. The computer must process the information input from the keyboard to display it on the computer screen, just like your brain has to process the sound information from your ears so that you can understand it. If something is wrong with the computer processor the information from the keyboard isn’t displayed correctly no matter how well the keyboard is working; similarly, for someone with APD the sound information from the ear has not been processed correctly by the brain and is unable to be correctly interpreted.

Why does APD develop in some people and not others?

Researchers are not entirely sure how APD comes about. We do know that it can affect anyone of any age, although it often occurs in childhood but can in some people develop later into adulthood. Research has shown links between repetitive chronic ear infections or other conditions to the ear that cause sound deprivation (i.e. lack of stimulation of the ear) that could make one more susceptible to developing APD. Other conditions such as traumatic head injuries, or complications at birth could also cause APD [1].

What steps can you take to speak to someone and get help?

If the above describes symptoms that you have been experiencing, you can use the following support services to get help.

1. A good starting point is to visit your GP or audiologist for a complete hearing test. This is to check for hearing loss or other conditions that could be present and causing your symptoms.
2. Afterwards, you will need a referral to a specialist centre to test your hearing processing. In the UK there is very limited provision by the NHS for APD testing and screening. According to a study by Agrawal et al (2021) about APD services provided in the UK, there were only two NHS centres in England and Wales that offered complete testing for adults with APD. Furthermore, a report by APD Support UK states that there is no provision for APD testing for adults in either Scotland or Northern Ireland. Similarly, the support and management of APD that is offered by the NHS and local authorities differs widely. A survey conducted by the APD Support UK suggests that 30% of UK local authorities provide no devices for management of APD. [1,2]
3. There are private specialist clinics that can offer complete APD testing and management for adults; they help to fill the gaps in the service that exists for both adults and children. Harley Street Hearing in London provides complete specialist APD testing, and a variety of management options and can tailor recommendations specific to you.

If you have been diagnosed with APD, what are the next steps? What can audiologists, GPs and other specialists do to help?

Although there is no “cure” for APD, treatment is offered in the form of management strategies to help you perform better in the listening environments where you struggle. APD management might include:

• Specialised hearing devices or remote microphones that enhance the sound signal and reduce background noise
• Listening exercises that help rework neural connections in the brain and listening and communication strategies that might help you and your communication-partner (the person with whom you are speaking) optimise listening cues.

Is there anything you can do before seeing a professional to help improve communication?

The short answer is yes; but ultimately you will still want to have an assessment just to have everything checked and identify the cause of your struggles. Communication is 50/50, and your communication partner can do things to help make comprehension easier. Here are some tips to help improve your communication and speech reception (understanding what others are saying):

• Where possible avoid having a conversation in a noisy environment.
• If in a noisy environment, try to have your back to the source of the noise.
• Where possible, converse in areas with good lighting – it helps to make the other person’s face more visible so that you can use lip-reading cues or other visible cues to help understand what they are saying.
• Always face the person who is speaking to you; it is best to have them avoid covering or blocking their mouth or eating food and talking at the same time.
• Be in close proximity (about 1 metre) with the person you are conversing with and avoid having a conversation around a corner or from another room.
• Ask for the person to rephrase what they have said instead of just repeating it. Ask them to use different words if there are words you cannot hear or do not understand.

Ultimately, auditory processing disorder affects how you process sounds and can affect how you process speech. It is not hearing loss, but the symptoms can appear similar to hearing loss, and for this reason it is important to have your hearing checked if you are experiencing difficulties.

Generally, APD is misunderstood by the public and even some healthcare professionals, which is why it is important to speak with a healthcare provider who is knowledgeable in APD. APD would certainly benefit from more public awareness, this would help people who are struggling with APD to receive support and guidance more quickly and effectively. Additionally, it would help the public be more aware of this invisible disorder and be more compassionate and supportive of those who experience it.

Despite this, it does not mean that you need to suffer in silence with your APD; there are resources and professionals that can help and there are tools available for APD management. Speak with your GP or audiologist if you have further questions and they can help to point you in the right direction.

References:

1. Agrawal D, Dritsakis G, Mahon M, Mountjoy A, Bamiou DE. Experiences of Patients With Auditory Processing Disorder in Getting Support in Health, Education, and Work Settings: Findings From an Online Survey. Front Neurol. 2021 Feb 18;12:607907. doi: 10.3389/fneur.2021.607907. PMID: 33679580; PMCID: PMC7930331.
2. Local authority APD support statistics for England and Wales 2021-22 - yola. APD Support UK. (n.d.).