Auditory processing

Also called Auditory processing disorder, APD, Central auditory processing, Listening difficulties

Hearing fine on the test and still struggling to make sense of what is heard, especially in noise. What it is, what it is often confused with, and what helps.

What it is

Auditory processing is what the brain does with sound after the ear has delivered it: separating speech from background noise, telling similar sounds apart, holding a sequence of words long enough to use it, and filling in what was missed. A person with an auditory processing difficulty passes a hearing test and still mishears, needs things repeated, and fades in a noisy classroom.

Auditory processing disorder is the diagnosis when this is the main problem. It's contested territory: the same difficulties can be produced by attention, language and memory problems, and specialists disagree about where the line is. What isn't contested is that the difficulties are real for the person having them.

Who it can help

Children who seem not to listen, especially in noise, and adults who struggle in restaurants and meetings despite normal hearing. It often overlaps with ADHD, developmental language disorder, dyslexia and autism, and a history of glue ear in early childhood is common.

It's worth being sceptical of the label and generous with the help. The classroom adjustments work whether the underlying cause is processing, attention or language, so they're the place to start.

How it works

Assessment starts with a full hearing test to rule out the ear, and then, in a specialist audiology clinic, tests of listening in noise, telling sounds apart, hearing different things in each ear and processing fast speech. In the UK it's usually assessed from about seven, because younger children's results are too variable. A speech and language therapist and sometimes a psychologist assess language, attention and memory alongside, because those are the alternatives that need ruling in or out.

The difficulty is worst when the signal is poor: background noise, echo, distance, a speaker facing away, fast or unfamiliar speech. It's least when the listener can see the face, knows the topic and has the words written down. That points straight at what helps: improve the signal and add a second channel.

Getting started

Reduce the noise and the distance. Seat the child near the front and away from the corridor, the fan and the fish tank. Get their attention with their name before the instruction. Face them.

Add a visual channel. Write instructions down, use a visual timetable, and put key words on the board. Pair speech with sign or symbol where you can. For an adult, ask for written summaries after meetings; it's a reasonable adjustment.

Check understanding by asking them to tell you the plan, not by asking "okay?". And ask the GP for a hearing test first if there hasn't been one recently; a treatable ear problem is the one thing you don't want to miss.

Where to get help

The NHS page on auditory processing disorder explains the referral route, which is GP to audiology. The National Deaf Children's Society supports families of children with listening difficulties whether or not they have a hearing loss, and RNID covers adults.