Auditory Processing Disorder: What is it and How Do We Test for it?
Have you ever met a child who can hear perfectly well, but still seems to “miss” what’s being said in the classroom? Or an adult who struggles to follow conversations in noisy places, even though their hearing test came back normal? This could be more than distraction — it might be Auditory Processing Disorder (APD).
In this article, we’ll explore what APD is, how it presents in both children and adults, and how we assess for it. Whether you’re a parent, teacher, or someone who suspects they might be affected, understanding the signs and testing process is the first step toward support and clarity.
What is Auditory Processing Disorder?
APD describes how the brain processes the sounds it hears. It’s not just about the ears — it’s about what happens after the sound is detected. Although many people with APD have normal hearing, those with hearing loss (either congenital or acquired) can also experience auditory processing difficulties.
Historically, APD was misunderstood or overlooked, with signs often dismissed as “poor behaviour” or “lack of intelligence.” As a result, many individuals who struggled to learn or communicate in conventional ways were left unsupported. In the 1950s, research from both audiology and speech pathology fields led to the recognition of auditory processing as a distinct area of study. Over time, and through decades of clinical work, APD became a recognised diagnosis used by clinicians to categorise a particular set of listening-related difficulties.
Today, studies estimate that around 5% of school-aged children are affected by APD, though this number may be even higher due to underdiagnosis. Adults can be affected too — either as an extension of childhood APD or as a result of head injury, neurological conditions, or age-related processing changes.
How Does APD Present?
Common signs or symptoms vary between age groups:
- Children under 5 may show signs like delayed speech and language development, difficulty following simple instructions, or seeming “tuned out” in noisy environments. For instance, a child might respond only to part of a request like “get your shoes and put on your hat,” or seem to ignore their name when called from another room.
- School-aged children might struggle with understanding instructions, listening in noisy classrooms, or processing spoken information quickly. They may frequently ask “what?” or “huh?”, show inconsistent academic performance, or have difficulties in reading, spelling, or writing. Think of it like trying to understand someone speaking through a muffled radio — the message is there, but it’s hard to decode.
- Adults with APD may find it hard to follow group conversations, particularly in noisy spaces, or feel mentally drained after long listening tasks. They might mishear words that sound similar or avoid phone calls altogether. Despite often normal hearing, their brain has to work much harder to make sense of sound, which can lead to fatigue, anxiety, or reduced confidence.
Understanding the Assessment Process
At Knox Audiology, our APD assessments aim to help clients and their families understand the cause behind certain behaviours and listening challenges — whether in the classroom, at work, or in everyday interactions. We offer assessments for both children and adults, with tools tailored by age and need. All assessments begin with a comprehensive hearing test, as APD cannot be diagnosed without first ruling out hearing loss.
We then proceed with one or more of the following:
1. Central Test Battery (CTB)
Developed by Dr. Jack Katz, the CTB is grounded in the Buffalo Model, which breaks auditory processing into four key domains:
• Decoding – Difficulty making sense of speech sounds. Signs may include poor spelling, unclear speech, or frequent mishearing of words.
• Tolerance-Fading Memory – Difficulty remembering auditory information and understanding speech in background noise. This may show up as distractibility or failure to follow multi-step instructions.
• Organisation – Trouble sequencing information or structuring thoughts logically. Common in both oral and written expression.
• Integration – The most complex domain. It refers to combining what we hear with other inputs, such as visual cues. Difficulties may affect reading comprehension, writing, and processing abstract concepts.
This test suite includes the W-22, SSW (Staggered Spondaic Word) test, and Phonemic Synthesis test. Results from the CTB provide a clear diagnostic breakdown that can guide intervention and school support.
2. Feather Squadron by Acoustic Pioneer
This iPad-based assessment is engaging and more accessible for a range of clients, including children, neurodiverse individuals, and those who are non-verbal. It evaluates multiple auditory processing skills, such as:
• Dichotic listening – how both ears coordinate information
• Auditory memory – remembering spoken words or sounds
• Spatial listening – understanding speech in noisy settings
• Auditory closure – filling in the blanks when speech is unclear
• Lateralisation and discrimination – identifying where a sound is coming from and what it is
Feather Squadron offers a user-friendly and visual interface, but still provides clinically reliable data, especially when combined with other assessments. Results are collected using calibrated headphones in a soundproof booth.
3. Auditory Skills Assessment (ASA)
Ideal for younger children (typically under 7), the ASA screens:
• Speech Discrimination: Identifying words in noisy settings and repeating nonsense words.
• Phonological Awareness: Blending syllables/sounds and recognising rhymes.
• Non-Speech Processing: Differentiating tones and identifying tonal patterns.
Each of these tools allows us to build a detailed picture of a person’s auditory strengths and
weaknesses.
What Happens After Diagnosis?
After the assessment, our audiologists provide a detailed report explaining the results in easy-to-understand terms. Where applicable, we also provide:
• Recommendations for auditory training (in clinic or at home)
• Communication strategies for families, teachers, or workplaces
• Guidance on classroom or environmental modifications
• Recommendations for additional support if needed (e.g., speech pathology, psychology, or occupational therapy)
It’s important to know that a diagnosis is not the end — it’s a hopeful beginning. With the right tools and support, people with APD can learn to navigate the world more confidently and comfortably.
You’re Not Alone
If you or someone you care about relates to the information in this article, please know you’re not alone — and help is available. At Knox Audiology, we’re here to support you through the journey of understanding and managing Auditory Processing Disorder.