When it comes to hearing, two main elements are involved: our ears, of course, and our brain. Within both structures, there are complex systems, and they must work together to help us hear the sounds around us and interpret and understand them.
For some, though their ears are processing sound normally, their brain has difficulty with interpretation – meaning sounds become distorted, and hearing seems impaired. When the ears are functioning correctly, but the brain cannot process the information received from sound, this is called auditory processing disorder.¹
Though it’s often diagnosed in school-aged children², auditory processing disorder can affect people of any age and may be diagnosed in adulthood as the result of brain injury and stroke. Here, we dive deeper into auditory processing disorder in adults.
Many early signs and symptoms of an auditory processing disorder in adults are similar to symptoms of hearing loss due to other causes. Difficulty understanding speech in noisy environments, for example, being overwhelmed by a lot of background noise, not knowing where a sound is coming from or frequently having to ask people to repeat themselves, are common auditory processing disorder symptoms.³
Other symptoms may include having trouble following spoken directions unless they are brief and simple, and attending to and remembering spoken information; difficulty processing spoken information; sensitivity to loud sounds; poor listening skills; an inability to differentiate tone of voice or other nuances of speech.
At home, this might look like turning the TV volume up very loud but still not being able to understand what’s happening on the screen or being accused of ‘not paying attention’ to a family member or housemate’s requests. Out and about, you may have trouble hearing what friends are talking about when you go to a café or bar or struggle to hear speech in a crowded supermarket. At work, you may not notice your phone ringing, have trouble following complex directions or recognising how someone is feeling by their tone.
When living with an auditory processing disorder, adults often say they can hear but can’t understand what they’re hearing. Sounds may be garbled or fragmented, like listening to someone on a phone whose reception is dropping in and out.
The cause of auditory processing disorder in adults isn’t often clear.⁴ As mentioned, it can develop after brain injury or stroke, as well as a neurological disease, and tumours – even following surgical intervention to treat brain disorders. Some adults may also have untreated APD since childhood.⁵
Other potential causes of risk factors for APD include developmental delays in the areas of the brain that process sounds, age-related neurological changes, neurological damage caused by degenerative diseases (e.g. multiple sclerosis, infection, head injury), recurring ear infections and even genetics.
Auditory processing disorder can be difficult to diagnose, as the symptoms are often non-specific and can be caused by other conditions. For example, autism spectrum disorder or attention deficit hyperactivity disorder can present similarly to APD. For this reason, a multidisciplinary approach is needed to rule out other conditions.⁶
There is no standard testing process for auditory processing disorder, but the process often involves an audiologist performing a variety of hearing tests (if hearing tests show that the ears are functioning as they should be, this could indicate APD), a psychologist assessing cognitive function and a speech-language therapist evaluating communication skills.
Auditory processing disorder can only be diagnosed by a qualified audiologist, like the ones you’ll find at Bay Audiology.
Although APD is considered a lifelong condition, it can be managed with various tools and techniques that ease auditory processing disorder symptoms.⁷ While every person with APD needs a personalised management plan, a combination of auditory training, environmental changes and assistive hearing technology is a commonly used approach to help people with APD to better understand the sounds around them.⁸
Auditory training involves a person with APD practicing exercises that target the specific issues they’re facing. These might be done using computer programs, or it can be in-person or online training, and involves tasks that help people with things like learning to distinguish between similar speech sounds (like b and p in rhyming words, such as buy and pie), identifying the direction sounds are coming from and more.⁹
People with APD can also learn certain ‘workaround’ strategies that compensate for the areas that are a cause for concern – for example, strengthening memory, attention and problem-solving skills. Learning to predict potential elements of a conversation, using visual aids, incorporating memory techniques like mnemonic devices, and practicing active listening techniques can also help people get around their ADP, leading to better understanding and communication.
Assistive listening devices may also provide relief for auditory processing disorder symptoms, although specific advanced technology is needed. For example, assistive remote microphone devices can help improve the clarity of sounds (rather than increasing volume, as a standard hearing aid might). Frequency-modulated (FM) listening devices can also help the wearer better understand speech in noisy environments – these use a microphone and receiver to help deliver sounds directly to the wearer’s ears.
Making adjustments to your everyday surroundings can also be incredibly useful in supporting someone with APD – for example, choosing room furnishings that reduce noise (such as using carpet instead of hard floors) and removing objects that generate a significant amount of background noise, such as fans, radios, or TVs. Sitting closer to sound sources can also help (for example, positioning yourself close to the speaker during meetings) and requesting the use of visual aids where possible can also help improve communication for APD sufferers.