Kids who have auditory processing disorder may present with many symptoms like having trouble concentrating when it's noisy. Here are the signs parents can look out for and what they should do next.
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Kelly Novotny will never forget the day the administrator of her 3-year-old's Mommy's Day Out program called her in for a meeting to discuss her son's behavior. "My kid was having frequent outbursts," she says. "He was frustrated all the time, and he didn't understand what they were telling him to do. They thought he had speech or behavioral issues."

Novotny, who lives in Cypress, Texas, says she started obsessing over what could be wrong with her child. In preschool, he qualified for speech services, and three years later, he'd met all his goals. But Novotny noticed he still wasn't conversing at the same level with kids his age, and he barely communicated with her. At the start of second grade, he was a year behind his peers in reading comprehension.

Nothing made sense until Novotny googled his symptoms and read about a condition called auditory processing disorder (APD). According to the Hearing Health Foundation, 5 percent of school-age children in the U.S., or 2.5 million, have APD. But the true number may be greater due to undiagnosed or misdiagnosed cases.

What is Auditory Processing Disorder?

Auditory processing refers to how the brain understands speech. Our ears transmit sound, but our brain interprets and makes sense of what we hear.

"Most of the time, children with auditory processing issues have had several 'normal' hearing tests," says Leah Light, Au.D., audiologist and founder and director of the Brainchild Institute. "But those tests are tests of hearing sensitivity. They don't look at how functional your hearing is."

Diane Tracey, Ed.D., literacy specialist and author of Helping Your Child Overcome Reading Challenges, explains, "Think about listening to a song when you can't understand the lyrics; you can hear the song perfectly, but you can't decipher what the singer is saying. That's what kids with APD deal with all the time."

Auditory Processing Disorder Symptoms

Warning signs for auditory processing issues can show up as early as a few months old and progress as children age, according to Dr. Light.

Dr. Light tells parents to look for red flags like babies who are unusually quiet and not babbling by 6 months, not turning their heads in the direction of sound by 6 months, and not responding to their name by 12 months old. They may also suffer from frequent ear infections or fluid behind the eardrum.

"As they get older, they may have articulation problems and referral to a speech therapist," says Dr. Light.

Children with APD can also struggle to hear in noisy situations or understand meaningful speech that happens at the same time, like when a teacher and a friend are talking simultaneously, according to KidsHealth.org.

Another sign is being "easily distracted when it's noisy but able to concentrate when it's quiet," explains Dr. Light.

Auditory Processing Disorder Test and Diagnosis

APD can only be diagnosed by an audiologist who specializes in testing for auditory processing weaknesses. You can find a list at the International Guild of Auditory Processing Specialists (IGAPS) or search your local area for a specialist.

The testing is complex and spans several hours, so most evaluators require the child to be at least 7 years old. The test can help detect which auditory skills your child is having trouble with and specialists can recommend what to do next. KidsHealth.org says newer electrophysiology tests using noninvasive electrodes to check the body's response to speech can offer some early information about the central auditory system in younger kids.

Auditory Processing Disorder and ADHD

Because children with APD are easily distracted or show behavioral problems in the classroom, they're often misdiagnosed as having ADHD.

Rich Hogan, an audiologist based in St. Louis, Missouri, who screens for APD in his clinic, missed diagnosing his own child for years because teachers immediately concluded he had ADHD. "He had trouble following instructions, learning to read, and paying attention. But when we treated him for ADHD, the medication didn't help. It finally dawned on me to test him for APD, and we found he was missing half of what was said in noisy environments."

Novotny's son was also almost diagnosed with ADHD, but she trusted her gut and insisted on testing him for an auditory processing issue instead.

Children can have both ADHD and APD though. "But kids with ADHD tend to show symptoms no matter the environment they are in, while kids with APD can focus when there is little background noise," says Dr. Light. Understood.org offers a helpful chart to help parents differentiate ADHD and APD.

Auditory Processing Disorder Treatment

The cause of a APD is often unknown, although research indicates kids who have head trauma, lead poisoning, seizure disorder, or chronic ear infections may be more at risk. The good news is a child's auditory system doesn't fully develop until about 14 years old, so children's listening skills can improve as they get older. Although there is no cure, auditory processing weaknesses can be strengthened through training with a speech-language therapist or computer software programs, like Fast ForWord and assistive technology.

In most cases, your child can qualify for special education services in school through an IEP or accommodations with a 504 plan. Some common classroom accommodations include preferential seating closest to the source of instruction and decreased background noise, like sitting away from air-conditioning units, fish tanks, or windows that amplify noise from the playground.

Children can also receive assistive listening devices. These include frequency modulation (FM) systems and special hearing aids—the teacher wears a microphone and transmitter with an FM system, while the student wears a receiving device over the ear. Other hearing aids specialize in filtering background noise. Novotny's son uses the FM system and a low gain hearing aid.

Ways Parents Can Help Strengthen Their Child's Auditory Processing Skills

There are online games and programs for training auditory discrimination, like Super Duper and Capdots, but parents can also play a role in enhancing their child's skills. Dr. Tracey recommends parents engage in exercises with their kids in the car or when there are few distractions.

For example, they can play a game of how many words in a sentence? Start with three-word sentences, like "I like sports." Ask your child to tell you how many words they hear. Once they've mastered this game, move on to four-, five-, and six-word sentences.

Or try the going on an imaginary picnic game. This game highlights individual words within sentences. Start with "I'm going on a picnic, and I'm bringing apples." The second player then says, "I'm going on a picnic, and I'm bringing apples and bananas." Keep going until a person forgets an item.

Other games include having your child pick out the first, middle, and last sound in a word and tell you if it's the same or different than the sound of another word, like the first sound in butterfly and basketball. And rhyming games help children pick up on subtle sound differences.

Providing comfort

"I tell parents to keep an open mind and not feel sorry for their kids. The best thing you can do is educate them about the condition, so they can take power and control over it," says Dr. Light. "Using accommodations is nothing to be ashamed of, it's just like wearing glasses to correct vision."

Novotny's son is now a bubbly, happy third grader, and Hogan's son is off to college next year. They're grateful they figured out what was wrong and advise other parents to trust their gut and seek answers. APD may sound scary but understanding and treating it has changed all their lives for the better.