Auditory Processing Disorder in Adults

Auditory processing disorder (APD) is trouble understanding spoken communication due to the way the brain interprets sound. While it's a hearing issue, it's not a form of hearing loss. In other words, the ears themselves are not affected.

In fact, people with APD often have normal hearing as assessed by routine hearing screenings and a hearing test (audiogram), neither of which can catch this disorder.

Conversations about APD usually focus on school-aged children. However, adults can also have auditory processing disorder.

This article goes over the signs and causes of auditory processing disorder in adults. It also reviews how it is diagnosed and treated.

Causes of Auditory Processing Disorder

The causes of auditory processing disorder aren't well understood. It does, however, tend to be associated with other conditions, such as multiple sclerosis or conditions that affect attention, learning, and languages such as ADHD and dyslexia.

Other possible causes of APD may include:

• Genetics: The specific genes responsible for APD have not been identified, but many researchers suspect some types of APD may be inherited.
• Head trauma: It is common for auditory processing problems to develop after a brain injury, though researchers are still unsure why this happens.
• Tumors: Rarely, an auditory processing disorder may be caused by a brain tumor.
• Untreated hearing loss: Although people with APD often have normal hearing, untreated hearing loss and the auditory deprivation it causes may also lead to problems with auditory processing in the brain.
• Anoxia: Periods of oxygen not getting to the brain, which can happen during a transient ischemic attack or stroke, may be responsible for some cases of auditory processing disorder.

Sometimes the cause of someone's APD is never determined.

Signs of Auditory Processing Disorder in Adults

A major sign of auditory processing disorder in adults is having a hard time listening when there is background noise or in reverberant environments.

Adults with APD can also have other signs and symptoms, including:

• Trouble following multi-step or complex directions
• Difficulty multitasking in auditory situations (e.g., listening and taking notes at the same time)
• Trouble spelling, reading, and writing
• Inability to appreciate music
• Difficulty figuring out where a signal is coming from
• Trouble having a conversation on the telephone
• Difficulty following directions
• Challenges with rapid or accented speech
• Struggles keeping up with long conversations
• Difficulty learning a foreign language or making sense of technical information with many new words
• Social challenges, difficulty "reading" others, communication issues
• Problems organizing at home, work, and in other environments

Many adults with APD have had it their entire lives. As kids, they might have had a hard time reading, keeping up in class, and listening in noisy situations. However, these challenges may not have been enough of a problem to be recognized and addressed during their childhoods.

As a result, many adults with APD figured out strategies to cope with the disorder as they grew up. Many choose jobs that allow them to function well with APD.

If a person has APD after a head injury or post-concussive syndrome (PCS), they often have other symptoms such as:

• Tinnitus
• Peripheral hearing loss
• Sound tolerance issues or increased sensitivity to sound (hyperacusis)
• Difficulty processing auditory information (e.g. with timing, hearing in less-than-optimal environments)
  

Auditory Processing Disorder Tests

APD is typically diagnosed by an audiologist. Multiple tests are usually needed in order to diagnose the condition. Some of these tests may include:

• Speech in noise test: This test assesses your ability to understand speech when presented in a noisy environment.
• Dichotic listening test (DLT): This test assesses your ability to understand two different words presented at the same time, one in each ear.
• Gap detection test: This tests your ability to identify a brief pause between two identical sounds.
• Pitch pattern sequence test: This tests your ability to hear a series of three high and low pitched sounds and report them in the correct order.
  

In order to arrive at a diagnosis, the audiologist also needs to exclude conditions that may cause similar symptoms.

Why Standard Hearing Tests Miss APD in Adults

Many adults confuse APD with hearing difficulty. They're surprised when their hearing test comes back normal. They know they are not hearing right, especially when there is a lot of background noise.

APD affects the whole hearing system, not just the ears. The system has to separate meaningful messages from background sounds. It then has to deliver that information clearly to the brain. If a person gets auditory messages that are not complete or are wrong, they lose connection with the world around them.

The part of the body that helps us process what we hear is called the auditory nervous system. This system doesn't change as well as we get older. That's why listening and processing language, especially with background noise, gets harder as we age.

How Is Auditory Processing Disorder in Adults Treated?

Auditory processing disorder can't be cured, but treatment can help you manage your symptoms. Typically, each person with APD needs a customized treatment plan based on their specific symptoms and situation.

As experts learn more about auditory processing disorder in adults and children, more recommendations are coming to light.

Here are a few examples of some of the things that may be suggested for people with auditory processing disorder:

• Speech-language therapy with a focus on auditory training
• Brain training techniques that rely on the brain's own ability to improve processing skills
• Brain training computer programs designed to help people with APD learn more effective ways to process language
  
• Environmental modifications, such as adding visual information or written instructions as a complement to verbal classroom instruction, placing a child's desk closer to the front of the classroom, etc. 
• FM listening devices that help the wearer understand speech in an environment where background noise is present
  
• Coping strategies such as making lists, avoiding learning or working environments with excessive background noise, lip reading, etc.
• Having family, friends, and teachers make an effort to speak more slowly and loudly, use simple sentences, and repeat important information to make sure it's understood
• Counseling or art/music therapy if depression, anxiety, or self-esteem issues are present
• Hearing aids if hearing loss is present

If you or a loved one might have auditory processing disorder, you'll want to work with an audiologist. This doctor specializes in the diagnosis and treatment of hearing problems like APD.