UnderstandingAuditory Processing

Auditory Processing Disorder in Children

Little girl listening to a seashell.
Marcy Willard
Marcy Willard
Last modified 22 Mar 2023
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.

Kids with impaired processing abilities may also have learning difficulties. It can be extremely difficult to read and spell when you are struggling to hear the words correctly.

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Common Symptoms of Auditory Processing Problems in Children

  • Needs words repeated: your child may ask, ‘wait, what did you say?’
  • Mishearing words: your child may have a hard time discerning or understanding words
  • Lost in conversation: your child may be paying attention but still not following the conversation
  • Reading problems: your child may struggle in reading because they have poor phonological awareness meaning that they do not ‘hear’ the letter sounds right
  • Spelling problems: your child may have trouble spelling
  • Vocabulary problems: your child may have a poor vocabulary, even with high intelligence
  • Learning problems: your child may have trouble in subjects that incorporate reading and writing. This may include: language arts, social studies, science, or other world languages
  • Academic problems: your child may have poor grades or academic performance problems due to difficulties following instructions or participating in the classroom
  • Problems following directions: your child may be trying hard to follow directions but getting confused and frustrated. They may need directions written out or repeated
  • Problems with multi-step instructions: your child may forget multiple-step directions. You may find that your child can do the first or the last step but will get lost on any other steps in your instructions

Observable Signs of Auditory Processing Challenges

Children who listen but do not hear you 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. 

Known expert in intelligence, Dawn Flanagan, describes it thusly, “Auditory processing (Ga) refers to the ability to perceive, analyze, and synthesize a variety of auditory information (e.g., sounds).”

Auditory processing includes different forms of listening skills:

  • Listening to words with missing letters and saying the correct word (e.g., hearing “olipop” and saying “lollipop”)
  • Listening to piano music and identifying the key in which the piece is being played (e.g., C sharp) [2]
  • Listening to song lyrics and identifying words and phrases within the song

Auditory processing is not the same as basic hearing. Hearing is a combination of both what the ears do and what the brain does. Auditory processing is referring to the part that the brain does. 

Auditory processing has been identified as a key factor in intelligence, as established by the trusted CHC Theory of Intelligence [2]. 

Within this model, auditory processing includes the following skills:

  • Listening and verbal comprehension
  • Temporal tracking
  • Auditory cognitive relationships
  • Discriminating sound patterns
  • Auditory span memory
  • Perception of distorted speech
  • Maintaining and judging rhythm [2]

In a child with poor auditory processing, the child’s brain is not correctly discriminating sounds. 

The progression of auditory processing complexity is as follows: 

  1. Rhymes and alliteration are the simplest forms of auditory processing 
  2. Words within sentences 
  3. Syllables within words 
  4. Beginning sounds in words 
  5. Individual phonemes 

As you can see from this list, there is a great deal of complexity required of children as they process auditory information. Challenges in any of these areas can impact memory and learning. Children with these difficulties may become frustrated in conversations, lectures, or in music class. 

They may be constantly asking people to repeat what they just said. A child with these challenges may get confused while watching a movie or reading a book due to challenges discerning speech sounds. 

Impact of Auditory Processing on Daily Life

If auditory processing is an issue, here are some additional challenges you may notice in your child.

Auditory processing impacts learning. 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.

Auditory processing impacts following directions. Auditory processing may impact a child’s ability to follow oral 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. 

Auditory processing impacts attention. Some children with auditory processing problems may be distractible. They may have a hard time filtering out background noise. In this case, their performance on tasks may suffer in a noisy environment, but they may demonstrate adequate skills when there are no distractions.

Auditory processing can impact classroom participation. Kids with auditory issues will likely have trouble in various subjects. 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. 

Auditory processing may impact musical ability. A child with these challenges may struggle with understanding the sounds in song lyrics. They may have trouble hearing pitch and tone and thus may not sing well. It could be hard for them to discern rhythm and make rhymes. They may have difficulty distinguishing between similar sounds. As such, children with auditory processing disorders may not enjoy music class and may find learning music annoying or frustrating.

Causes of Auditory Processing Challenges

Cause #1: Medical

One cause of auditory processing challenges is medical or genetic. Hearing loss or differences in the structure of the ear or the temporal lobe will impact auditory processing. The best person to talk to about these kinds of challenges is your pediatrician with a referral to a neurologist and/or audiologist.

Cause #2: Language processing

Another cause of auditory processing challenges relates to language processing. If a child has a language disorder, it may impact the way information is processed through the ears. The best person to talk to about these kinds of challenges is a speech and language pathologist.

Cause #3: Attention challenges 

A third cause of auditory processing challenges relates to significant attention deficits and would be associated with ADHD. While this is not the same thing as auditory processing, attention, and auditory processing are often mistaken for one another, so ADHD is something you would want to rule out if your child does not have medical or language processing challenges. 

Children with ADHD often have challenges with auditory working memory, listening skills, shifting attention and multitasking which can all impact the way they process language and information. The best person to talk to about these kinds of challenges is a clinical psychologist or child psychiatrist.

Auditory Processing Disorder vs. ADHD

If you have the sense that your child may have an auditory processing issue, we will provide some solutions and next steps in this article. Before we get into that, though, it is important for parents to know the difference between auditory processing and attention. Kids who are ‘not listening’ may be having trouble either hearing the sounds or paying attention. 

Auditory processing is NOT the following:

  • 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. 

Keep in mind that regardless of the reason for the difficulty, it is still helpful and supportive to address any distractions in the learning and listening environment. Teachers can give your child a private place to do certain assignments, headphones to block out background noise, and a work area that is reasonably free from distractions.

Yes, a noisy environment or a lot of classroom 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.

Although many children with auditory processing problems may appear distractible and inattentive, it is important to differentiate these challenges from attention and behavior problems. 

Auditory processing is not an attention problem. Children with attention problems are more likely to be distracted in various environments, whether the environments are noisy or not. Of course, we all work better in a quieter setting. However, children with true attention problems have persistent, pervasive problems with attention in multiple settings and environments. 

With auditory processing, the difficulty is specifically related to spoken information. With ADHD, the attention problems can be related to all different forms of sensory distractions that may include auditory, visual, or physical sensations.

Auditory processing is not a behavior problem.  It is critical that parents are aware that problems with auditory processing do not explain or excuse poor behavior at school or at home. Although it may be frustrating to have some problems with auditory processing or sensory sensitivities, many children with these challenges are able to be compliant, social, and well-adjusted. It is a good idea to have the school consider any issues in the learning and listening environment that can be resolved to support your child. However, if there are problems with defiance, aggression, and rule-breaking, auditory processing and other sensory needs do not provide the explanation.

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. Standard hearing tests at school may not be as sensitive to some voice sounds or auditory processing issues. Your pediatrician likely has a highly specialized hearing screening available
  • If your child has normal hearing but is still incorrectly interpreting the separate 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
  • Learning tests: If there are issues identified regarding your child’s processing skills, it is a good idea to have the school or private practice psychologist test for a specific learning disability. Issues with auditory processing are commonly related to learning disorders such as Specific Learning Disability in Reading (also known medically as Dyslexia), or Specific Learning Disability in Writing (also known medically as Dysgraphia). There may also be speech-language issues that impact learning that can be identified during a school evaluation for special education

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

The following professionals can help you understand and diagnose your child’s difficulties.

  • Multi-disciplinary 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 which may include auditory processing
  • Pediatrician: most pediatricians test hearing, do an APD evaluation, and provide any necessary referrals to an audiologist 
  • 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 issues
  • Speech-language pathologist (SLP): most speech therapists assess auditory discrimination and speech articulation problems and 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 for their individual child. They can request an evaluation by the special education team which may include an IQ test
  • Classroom accommodations: to help your child access classroom instructions. Written instructions can help a child with academic difficulties related to auditory processing. 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. These accommodations can be provided through a 504 Plan or a special education plan
  • FastForward intervention: to help your child with reading. FastForward is a recognized intervention for reading problems that can be associated with auditory processing issues
  • Speech therapy: to 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 to get information on auditory processing, the ASHA website is an excellent resource for people with auditory processing issues

Similar Conditions to Auditory Processing Issues

  • Non-compliance: it may be that your child cannot hear your instructions and thus has trouble following directions
  • 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

[1] Sattler, Jerome (2014). Foundations of behavioral, social, and clinical assessment of children. P.140.

[2] 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. 

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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