Auditory Processing Disorder in Adults

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When auditory processing disorder is discussed, the talk usually revolves around school-aged children. However, many adults have had auditory processing disorder their entire lives. They may have had difficulties with reading, keeping up in class and/or listening in noisy situations, but nothing so severe that they have needed to take action. Many adults with auditory processing disorder (APD) have figured out strategies or chosen career paths that allow them to function well with APD. An auditory processing disorder is a physical hearing impairment but one which does not show up as a hearing loss on routine screenings or an audiogram.

Standard Hearing Tests Don't Show Entire Picture

Many adults confuse auditory processing disorder with hearing difficulty. They are surprised when the audiogram comes back as “normal” and yet they know they are not “hearing” accurately, particularly in social situations where there is background noise. Instead, it affects the hearing system beyond the ear, whose job it is to separate a meaningful message from non-essential background sound and deliver that information with good clarity to the intellectual centers of the brain (the central nervous system). When we receive distorted or incomplete auditory messages we lose one of our most vital links with the world and other people.

As people age, minor auditory processing problems grow and can impact daily life. The auditory nervous system becomes a little less flexible with age, meaning that listening and processing language, especially with background noise, is more challenging.


Causes of APD in adults can range from genetics, head trauma, and tumors to auditory deprivation (untreated hearing loss) and periods of anoxia (that can occur with TIA or stroke). Sometimes the cause is unknown, just like with other learning disabilities.

Auditory symptoms most often associated with head injury or post-concussive syndrome (PCS) are tinnitus, peripheral hearing loss, sound tolerance issues or increased sensitivity to sound also known as hyperacusis, and difficulty processing auditory information, often in areas of timing and hearing in less-than-optimal environments.

Characteristics in Adults

A hallmark deficit often associated with APD is difficulty listening in the presence of background noise or reverberant environments. In addition to these deficits, commonly reported issues in adults with APD include:

  • Difficulty following multi-step or complex directions.
  • Difficulty multitasking in auditory situations, e.g., listening and taking notes.
  • Spelling, reading, writing issues.
  • Lack of music appreciation.
  • Problems with the ability to localize the source of a signal.
  • Difficulty following conversation on the telephone.
  • Difficulty following directions.
  • Difficulty with rapid or accented speech.
  • Difficulty following long conversations.
  • Difficulty learning a foreign language or technical information where language is novel or unfamiliar.
  • Social issues and difficulty "reading" others/pragmatic communication issues.
  • Problems organizing at home, work, and other environments. 

Treatment and Accommodations

As we learn more about auditory processing disorder for adults and children, more accommodations are becoming available. This includes environmental modifications, like using an FM listening system and/or hearing aids if hearing loss is present, and corrective treatments, brain training programs that take advantage of brain plasticity, the ability of the brain to improve processing skills at any age.

If you suspect you or a loved one has auditory processing disorder, contact an audiologist who specializes in diagnosis and treatment of APD for an evaluation.

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Article Sources
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  1. American Speech-Language-Hearing Association. Central auditory processing disorder. Updated 2019.

  2. Assi H, Moore RD, Ellemberg D, Hébert S. Sensitivity to sounds in sport-related concussed athletes: a new clinical presentation of hyperacusis. Sci Rep. 2018;8(1):9921. doi:10.1038/s41598-018-28312-1

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