Hearing comprises more than our ears picking up sound. Hearing requires complex and fast precision throughout our auditory nervous system to allow our brain to interpret signals from the ears effectively. This happens within our auditory nervous system You can think of it like complex electrical wiring from the ears to the brain with several complicated circuit boards along the way.

Through this unique wiring system, our auditory nervous system is responsible for enhancing important information, which is usually speech, as well as suppressing nonimportant information, which is usually background noise. This needs to be done extremely fast. Our hearing sense is much more sensitive to speed of processing than any other sense. In fact, our auditory system needs to process more than 1000 times faster than our visual system.

All of this circuitry within our auditory nervous system has to work right, any problems within it will cause auditory processing problems, like difficulty:

1. Locating Sounds – Knowing where a sound is coming from.

2. Telling Sounds Apart – Recognizing differences between similar sounds, like "pat" and "bat."

3. Recognizing Sound Patterns – Identifying rhythms, melodies, or repeated sounds in speech and music.

4. Processing Timing in Sound – Understanding the speed and order of sounds, which allows coding of speech and language.

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1. Understanding APD

What is Auditory Processing Disorder?

Auditory Processing Disorder (APD) is a condition that affects the way sound is processed by the brain. While people with APD have “normal hearing”, they may struggle to understand or interpret what they hear, especially in noisy environments.

Auditory processing disorder is a breakdown of neural synchrony, which is how groups of neurons in the brain’s auditory system fire together in a coordinated way to process and interpret sound. Auditory processing is fundamental to listening, which is a key process underlying communication, learning, and reading. APD can affect children and adults and can have a significant impact on everyday life.

How does APD differ from hearing loss?

We don’t just hear with our ears. Our auditory system is ear-to-brain. Hearing loss is a physical issue with the ear itself that will results in a reduced ability to detect sounds, making sounds quieter or muffled.

APD is a problem with how the auditory nervous system encodes essential sound attributes like pitch, loudness, and timing, transforming them into neural signals that the brain can understand. Auditory processing involves complex neural mechanisms that refine, analyze, and organize sound information. When these processes are disrupted, individuals may struggle with understanding speech, especially in noisy environments.

Does peripheral hearing (sound detection) need to be normal to have processing deficits?

No, in fact if you have peripheral hearing loss the way sound is processed is altered as well. Hearing loss results in changes in the acoustic representation of sound, which will alter how sound can be processed by the auditory nervous system and brain.

However, to have a diagnosis of APD peripheral hearing must be normal. If you have a hearing loss, that would be your diagnosis, and we would anticipate problems with processing as a result. Auditory processing deficits will vary by severity of hearing loss, type of hearing loss, age and there may have been auditory processing deficits before peripheral hearing loss, which will be exacerbated by the peripheral hearing loss.

2. Signs & Symptoms

Common Characteristics of APD

• Poor listening skills

• Behavior typical of peripheral hearing loss, but normal audiogram/hearing test

• Difficulty understanding speech in background noise, competing speech or reverberation

• Misunderstanding what is spoken

• Inconsistent or inappropriate responses

• Delayed responses

• Frequent need for repetition, saying ‘what’ or ‘huh’ often

• catter in results on psychological and language tests, with weakness in auditory domains

• Verbal IQ lower than performance IQ score

• Difficulty paying attention

• Easily distracted by sound or visual stimuli

• Difficulty following multistep spoken directions

• Difficulty localizing sound

• Difficulty learning songs

• Poor musical and singing skills

• History of ear infections/tubes

• Associated reading, spelling, and learning problems

• Has memory deficits (short- and long-term)

• Difficulty understanding muffled speech

• Poor auditory attention

• Delayed response in answering

• Reduced tolerance for loud sounds or hypersensitiy to noise

• Difficulty understanding sarcasm/emotions

• Difficulty taking notes and listening at the same time

 How APD affects communication, learning, and daily life.

Difficulty hearing, whether peripheral (ear) hearing loss or APD, leads to increased listening effort, fatigue, frustration, misunderstandings, social withdrawl, and depression.

Auditory processing is the foundation of language and literacy skills. APD affects how the brain processes speech sounds (phonemes), so APD can contribute to difficulties with language development, phonological awareness, spelling, and reading - including dyslexia.

Can someone have APD and other conditions?

APD is not typically a stand-alone condition. Common conditions which can simultaneously be present with auditory processing disorders:

• Dyslexia

• Learning disabilities

• Peripheral hearing loss

• Sensory Processing disorder

• Autism spectrum disorder

• Social-pragmatic disorder

• Specific language impairment (SLI)

• Non-verbal learning disabilities

• ADHD

Differences between APD and other conditions like ADHD or dyslexia.

APD often occurs alongside other conditions, making diagnosis and treatment more complex. It is particularly common in individuals with dyslexia, attention deficit disorder (ADHD), autism spectrum disorder (ASD), and developmental language disorder (DLD).

The main difference between Auditory Processing Disorder (APD) and other conditions like Attention Deficit Hyperactivity Disorder (ADHD) and dyslexia lies in how the brain processes information:

Auditory Processing Disorder (APD):

The brain has difficulty interpreting sounds, even though hearing is normal.

APD is a hearing-related issue-the brain struggles to process sounds correctly

Attention Deficit Hyperactivity Disorder (ADHD):

The brain has difficulty maintaining attention, controlling impulses, and managing focus.

ADHD is an attention-related issue—the brain struggles with focus and impulse control.

A person with ADHD may not listen because they're distracted, while a person with APD may listen but not clearly understand what was said.

Dyslexia:

The brain has difficulty recognizing and processing written language.

Developmental Language Disorder (DLD):

The brain has difficulty understanding and using language correctly.

Autism Spectrum Disorder (ASD):

Differences in communication, social interaction, and sensory processing.

3. Diagnosis & Testing

Diagnosing Auditory Processing Disorder (APD) requires a comprehensive evaluation to identify specific auditory processing challenges. APD is an umbrella term that includes various types of auditory processing deficits, such as difficulty understanding speech in noisy environments, distinguishing similar sounds, integrating and separating information from both ears, or processing the timing of sounds.

At our clinic, we use specialized audiological assessments to pinpoint the exact nature of an individual’s auditory processing difficulties so we can optimize treatment recommendations. We are trained in the Bellis-Ferre Model, Buffalo Model, Amblyaudia, and Frequency Following Response. We conduct both objective and behavioral measures that assess:

• Decoding

• Binaural (two ear) integration/separation

• Temporal resolution

• Temporal patterning

• Speech-in-Noise

• Spatial Processing

• Auditory Closure

When to see an audiologist for evaluation

• Children 5 and up who have

  • hearing difficulties with normal hearing test results

  • difficulties with learning, reading, language, speech with common characteristics of APD

• Adults who have

  • Hearing difficulties with normal hearing test results

  • Head injuries with resulting hearing difficulties

  • Hearing aid benefits are less than expected

4. Causes & Risk Factors

Possible causes of APD

• Prenatal/neonatal factors such as anoxia/hypoxia, CMV, hyperbilirubinemia, low birth weight, prematurity, prenatal drug exposure

• Recurrent ear infections, PE tubes

• Neurological disorder, disease or damage, such as brain injury, stroke, MS, exposure to heavy metals/organic solvents, lesions to the central nervous system, seizure disorder

• Genetic Factors

• Age-related changes in the central nervous system

• long-standing auditory deprivation due to peripheral hearing loss

5. Treatment & Management

Amplification

• Amplification overcomes dis-synchrony and likely engenders synaptogenesis resulting in improved hearing skills

• Amplification with remote microphones are a proven and recommended treatment for APD

• Therapy options; targeted auditory training, speech-language therapy

• Assistive listening devices and technology.

• Strategies for school, work, and home life.

Advanced APD Testing with Frequency Following Response (FFR) – Exclusively at Our Clinic!

We are proud to be one of the only clinics nationally offering Auditory Processing Disorder (APD) testing using Frequency Following Response (FFR), a cutting-edge technique that provides deeper insights into how the brain processes sound.

Why is FFR Important?

Traditional APD tests assess how well someone hears and understands sounds, but FFR goes a step further—it measures the brain’s electrical responses to speech and sound patterns. This allows us to:

✅ Detect subtle auditory processing deficits that standard tests may miss.
✅ Assess neural timing and sound encoding to pinpoint specific auditory challenges.
✅ Provide a more accurate diagnosis for personalized treatment plans.

By combining FFR with comprehensive APD evaluations, we offer the most advanced and precise approach to diagnosing auditory processing difficulties.

Frequency Following Response (FFR) testing is a valuable tool for assessing auditory processing deficits (APD) because it provides an objective measure of how the brain processes complex sounds, particularly speech and music. Here’s how it helps:

1. Measures Neural Encoding of Sound

• Allows us to see how sound is encoded within the auditory nervous system.

• Individuals with APD often show abnormal FFR responses, indicating difficulties in encoding speech sounds accurately.

• FFR can detect timing-related deficits, which are common in APD and may affect reading, language development, and listening comprehension.

• FFR indicates concussion occurrence and severity

2. Differentiates APD from Other Disorders

• APD symptoms overlap with other conditions like ADHD or dyslexia.

• FFR provides a biological marker to distinguish APD from other learning or attention-related issues.

3. Tracks Intervention Effectiveness

• FFR testing can be used to monitor how well treatments, such as auditory training or speech therapy, are improving neural processing over time.