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UnderstandingAuditory Processing

Auditory Processing Disorder In Children

Little girl listening to a seashell.
Marcy Willard
Marcy Willard
Ph.D., NCSP
Last modified 09 Aug 2022
Published 17 Jan 2022

What is Auditory Processing in Childhood?

Auditory processing is the brain’s ability to hear and understand information that comes in through the ears. 

Simply put, there is a part of hearing that the ears do and a part of hearing that the brain does. Auditory processing is the part that the brain does.

Your child may say ‘what did you say’ a lot. It may seem like they didn’t hear you. Your child may have unexplained reading challenges or poor listening skills.

When asked to repeat words that sound slightly different, they may pronounce them the same. For example, they may read ‘where’ instead of ‘were’ or ‘mack’ for ‘make’ or ‘shock’ for ‘shop’ or ‘sack’ for ‘snack.’ A child with these challenges has trouble processing the different sounds within words.

Many of these mistakes are common for early readers. Children with problems hearing these sounds may continue to make errors, though, while their peers “grow out of it.”

Kids with these issues may struggle to see the difference between two similar words. Their spelling is likely to be affected. It is tough to spell words correctly when the sounds were not correctly deciphered in the first place.

Common Symptoms of Auditory Processing Problems in Children

  • Doesn’t hear people: Asking, ‘Wait, what did you say?’
  • Mishearing words: Having a hard time discerning or understanding words
  • Gets lost in conversation: Listening and paying attention but still not following the conversation
  • Reading problems: Struggling with reading because he does not ‘hear’ the letter sounds right
  • Spelling problems: Having trouble spelling
  • Vocabulary problems: Demonstrating poor vocabulary, even with high intelligence
  • Trouble learning: Having difficulty in subjects that incorporate reading and writing
  • Academic issues: Getting lost in class
  • Needs directions repeated: Asking people to repeat a lot
  • Challenges with following multi-step directions: Seeming lost on multi-step instructions
  • Trouble understanding teacher: Getting lost during class lectures or seeming unsure how to follow classroom routines

Observable Signs of Auditory Processing Challenges

Kids who listen but do not hear you right may have problems with auditory processing. ‘Auditory processing’ refers to the brain’s ability to hear and understand information that comes in through the ears. 

Normal hearing: Auditory processing is not the same as hearing. Children with normal hearing can still have auditory processing problems. Auditory processing is listening carefully to sounds and hearing the subtle differences between words. It includes telling the difference between letter sounds and letter combinations.

In the classroom: Kids with auditory issues will likely have trouble in various subjects. Auditory processing is required for several skills used in the classroom. Kids use auditory processing to understand what they hear, to pick out sound patterns while they are reading or writing, and to remember what they have heard. 

Following classroom routines: Auditory processing may impact your child’s ability to follow directions. For example, if the teacher says, “put a line through the yellow circle before you cross out the blue square,” your child may get confused. 

Learning or academic performance issues: Generally, problems with auditory processing impact learning. Recognizing the difference between similar phonemes is necessary for reading. In turn, reading is a building block for most other subjects. As such, children with auditory processing problems will likely have trouble in several subjects. They may have learning disabilities.

What to Do about Auditory Processing Disorder

Now we are going to get into resources and next steps for auditory processing problems. First, though, we need to understand what auditory processing is NOT.

Auditory processing is NOT:

  • Distractibility
  • Impulsivity
  • Attention problems or attention deficits
  • Hyperactivity

The above list is all signs of attention deficit hyperactivity disorder (ADHD). They have nothing to do with auditory processing. If your child cannot focus long enough to hear the directions, but they hear just fine, this is more likely ADHD, not Auditory Processing Disorder. 

Yes, a noisy environment or a setting with a lot of background noise isn’t great for kids with ADHD or auditory processing issues. However, remember that the children with auditory issues are paying attention and trying to follow instructions. They simply aren’t quite sure what the person said. Children with ADHD might care very much about following directions; they simply cannot focus long enough to get through the instructions. 

Children with other behavior problems may simply refuse to follow directions. Again, these issues are separate and apart from auditory processing problems. Unfortunately, many parents have been sold on the idea that their child’s behavior is simply due to “auditory filtering.”

Professionals have told parents that better hearing leads to better behavior. That is, they say that a child who can filter auditory information correctly will behave better. They claim that a hearing device or auditory therapy is the solution. This claim is a myth. If the child cannot hear the sounds correctly, they can feel very frustrated. However, auditory issues are NOT a likely cause of other significant behavioral problems and refusals.

Now that we have discussed what auditory processing is not… it is time to discuss what to do if your child has an actual deficit in this area. If your child is struggling with auditory processing, various professionals can provide support.

What To Do For Your Child’s Auditory Processing Issues:

First, have your child’s hearing checked.

  • Talk to your pediatrician about having your child’s hearing checked. If your child has normal hearing but is still incorrectly interpreting the sounds within words, this is a sign of auditory processing issues
  • If any concerns arise, request a referral to a pediatric audiologist
  • If there are additional concerns, your child may need a hearing aid

Second, talk to the school about formal or diagnostic reading tests.

  • Most public schools have reading tests available to test your child’s ‘phonemic awareness’ (meaning the ability to identify sounds within words). Phonemic awareness is required for basic reading, so most schools know about it. Diagnostic reading assessments can consider whether your child’s brain recognizes the subtle differences between speech sounds and words.
  • Academic and diagnostic assessments should provide an age and grade equivalent of your child’s abilities. The scores are given for reading, writing, spelling, and phonemic awareness. A score of two grade levels behind in any of these areas is a sign that your child may have learning disabilities or auditory processing deficits.
    • Poor performance in basic reading and spelling skills can result from an auditory processing deficit. Your child may understand the material but have trouble discriminating the sounds within words. Kids who are not hearing sounds the right way will likely have a hard time reading them in words or spelling them on paper. 
    • The good news is that your child can learn these phonemic skills, which can result in much improved academic performance.

Third, talk to the school about formal speech/language tests.

  • Speech / Language pathologists can test your child’s ability to discern and articulate sounds. Speech therapists can test for often mistaken sounds in everyday communication and academic language. They can see if there are difficulties understanding spoken or written language in the classroom or other settings
  • If concerns arise, your school may have speech services to help address both the hearing and speaking of sounds

If you have additional concerns, talk to a licensed psychologist or multi-disciplinary team about testing.

  • Intelligence tests: An IQ test can provide information about your child’s vocabulary and comprehension
    • Many IQ tests provide a scale or an ‘index’ for auditory processing. As a parent, you can request that testing include a measure of auditory processing. For example, some tests measure your child’s ability to repeat back numbers, words, or sentences. Those skills are all summarized in a composite score or an ‘Auditory Processing Index’
  • Phonemic awareness assessment: Other cognitive ability and achievement tests can measure phonemic awareness. Some tests assess your child’s ability to hear the sounds within words. Examples include asking your child to say ‘popcorn’ without the ‘pop’ or say ‘backstop’ without the ‘back’ 
  • Standard Scores: The psychologist can provide you with a percentile rank and standard score. Standard Scores below 79 on Auditory Processing scales would be cause for concern in this area

When To Seek Help for Auditory Processing Issues

Testing can uncover possible significant concerns.

It is time to seek help when your child is scoring 2-grade levels behind in reading, writing, or spelling. Seek support if your child’s auditory issues are getting in the way of their speech or communication skills. If your child’s words are hard to understand, please know that this issue of speech articulation is readily amenable to treatment. Finally, it is time to get help if your child receives a standard score of 79 or below on the auditory processing part of an IQ test or a test of phonemic awareness. 

Further Resources on Auditory Processing Disorder

  • Multi-disciplinary Team: Ideally, to have your child’s cognitive skills evaluated, you would work with a multidisciplinary team. Most hospitals and some private clinics provide these ‘arena evaluations.’ This type of evaluation includes multiple professionals, including a psychologist, pediatrician, occupational therapist, and speech therapist. 
  • Psychologist: most psychologists can provide a general cognitive functioning evaluation and an auditory processing deficit (APD) assessment
  • Pediatrician: to test hearing, do an APD evaluation, and provide any necessary referrals
  • Occupational Therapist (OT): some Occupational Therapists can do Auditory Processing Disorder assessments to help with participation in music and P.E., where sounds may be overwhelming; they can also address sensory needs and assist with auditory filtering
  • Speech Language Pathologist (SLP): to assess auditory discrimination and speech articulation problems and to recommend specific treatment for such problems

In addition to getting a diagnosis, there is more support available here for everyday life:

  • School Psychologist: to potentially test IQ or to consider academic issues (generally, only in the context of an IEP evaluation – parents cannot necessarily request an IQ test from the school psychologist)
  • Classroom Accommodations: Written instructions can help a child with auditory processing difficulties. Also, visual checklists and graphic organizers are great visual aids. They can help with the learning problems that can be associated with auditory processing issues
  • FastForward Intervention: FastForward is a recognized intervention for reading problems that can be associated with auditory processing issues
  • Speech Therapy: many speech therapists can help children work on auditory processing issues such as reading, writing, understanding speech sounds, speech articulation, and therapy for other language disorders
  • American Speech-Language-Hearing Association website is an excellent resource for people with auditory processing issues

Similar Conditions to Auditory Processing Issues

  • Non-compliance: if your child simply does not want to follow your directions, there could be a behavior problem. This problem is entirely different than auditory processing
  • Intelligence: it may be that a cognitive problem is restricting your child’s processing of verbal information
  • Verbal Comprehension: it may be that your child is not understanding the information, rather than an issue of auditory processing. This difficulty would be evident in poor reading comprehension and oral comprehension.
  • Articulation: it may be that your child is not able to hear or say sounds correctly
  • Attention: it may be that your child is struggling to pay attention to verbal information
  • Learning Problems: it is likely that problems with auditory processing impact learning, particularly with reading and spelling

Resources On Auditory Processing Disorder

Dawn P. Flanagan, Ph.D. (Nov 5, 2014). Cross-Battery Assessment: A Pattern of Strengths and Weaknesses Approach to SLD Identification St. John’s University, New York Yale Child Study Center, School of Medicine

Sattler, Jerome (2014). Foundations of behavioral, social, and clinical assessment of children. P.140.For information on the Auditory Working Memory index and the cognitive processes involved in reading and math: Gloria Maccow, Ph.D. (2016). Advanced Interpretation of the WISC-V, (2016). Download: http://downloads.pearsonclinical.com/videos/WISC-V-020515/WISC-V-Advanced-Webinar-Handout-020515.pdf

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