Auditory Processing Disorder Therapies For Children | A Comprehensive Free Guide

Introduction 

Can your child hear sounds clearly but struggle with understanding, remembering, or following what they hear? This problem could show up as trouble figuring out where a sound is coming from or telling apart words that sound alike,  such as “bat” and “cat.” If these symptoms resonate with your observations of your child, they may have auditory processing disorder (APD).

This article takes a deep dive into APD, its symptoms, causes, and how it affects daily life. We also examine available auditory processing disorder therapies for children, including assistive devices, auditory training, and supportive accommodations designed to help them cope with the condition. Lastly, we discuss how Soundsory® can complement these existing auditory treatments, providing a way to manage the condition from the comfort of your home.

Key Take-Away Messages

What are auditory processing activities for children?
Auditory processing activities aim to target a particular auditory processing skill problem like auditory discrimination (differentiating similar sounds), auditory figure-ground (distinguishing a sound from competing noise), and auditory memory (recalling what was heard). 

Here are some auditory processing activities for children that you can try doing at home:   
listen to a story and narrate what they remember    – read rhyming books
repeat or rephrase an instruction
auditory games like Musical Chairs and Simon Says 
recalling words and directions in their proper order
memorizing a poem or a song
listen for sounds with eyes closed and identify them
telephone game  

Try Soundsory®, a unique blend of music and movement therapy, to enhance your child’s neurodevelopment.

What is Auditory Processing Disorder?

Hearing is a complex process where vibrations by soundwaves in the environment are converted into electrical signals. These travel to the brain through the auditory nerve [1]. The brain analyzes, organizes, and interprets this information [2] — a process called auditory processing – and turns it into something meaningful you can recognize and understand.

Auditory processing disorder, also called APD and central auditory processing disorder (CAPD), is a disorder of the auditory (hearing) system that impacts the brain’s ability to filter, process, and interpret sounds. The disorder happens at the level of the brain called the central auditory nervous system (CANS). People with APD have normal hearing structures and hearing abilities [3]. However, even though the ears can hear just fine, the brain has trouble making sense of the sounds it hears. 

APD is estimated to be present in 2 to 3% [4] of the general population. It primarily affects children and is commonly present in those diagnosed with autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and dyslexia [3].

Signs and Symptoms

According to the American Academy of Audiology [5], some of the common signs and symptoms of APD include:

  • difficulty understanding speech when there is background noise or when in echoey places
  • problem identifying the source of the sound
  • difficulty hearing on the phone
  • problems following rapid speech
  • difficulty picking up prosody changes that help interpret humor and sarcasm
  • inappropriate or inconsistent responses when asked for information
  • frequent requests for repetitions or rephrasing of what was said
  • difficulty following directions
  • difficulty paying attention
  • easily distracted
  • poor singing and musical skills
  • problems with reading, learning, and spelling

Many of the behavioral characteristics seen in children with APD are not unique to the condition and may overlap with the other conditions that commonly co-exist with APD, such as ADHD and ASD.

Causes

APD (or CAPD) can have many different causes. It can be directly linked to a particular lesion or disorder, or its cause may be unknown [3]. Below are the leading causes and risk factors of APD:

  • genetics
  • neurological diseases and disorders (e.g., epilepsy, head trauma, and meningitis)
  • ear disorders or diseases (e.g., chronic otitis media)
  • developmental delay
  • prenatal/neonatal risk factors (e.g., prematurity, drug exposure, hyperbilirubinemia, and hypoxia)

It can also affect adults of all ages due to causes like cardiovascular diseases, neurotoxicity, and malignancy. 

Impact on Daily Life

Because of how deeply interrelated auditory perceptual abilities and skills are with language development, having APD can make communication and learning difficult. They may find reading and writing a challenge, putting them at a higher risk of developing learning disabilities, according to a 2020 study [6]. They may also have trouble learning in class, particularly those delivered verbally in the classroom.

A child’s auditory processing difficulties can negatively affect their ability to socialize and have meaningful conversations.This difficulty can result in them withdrawing from social interactions. Additionally, they might feel embarrassed or frustrated, potentially leading to behavioral problems. Moreover, the struggles associated with APD can contribute to the development of anxiety and depression [7] in these children.

Treatment Options

Every child with APD has different needs. Therefore, they need a unique treatment plan consisting of a combination of auditory processing disorder therapies prepared by a multidisciplinary team. [2] The team can include audiologists, speech-language therapists/pathologists, teachers, counselors, parents, and interpreters, depending on the child’s needs and goals. 

The major goal of treatment is to improve the child’s ability to communicate effectively in everyday situations, including at school and home. It should include both:

  • Bottom-up approach: remediation of auditory processing deficits through various auditory training techniques, which typically involve computer-based training
  • Top-down approach: intervention that focuses on higher-order resources like language, memory, and attention to minimize the impact of APD on cognition, learning, and academics.

Auditory Training (Direct skills remediation)

The central idea behind remedial treatment for APD is brain plasticity – the brain’s ability to adapt and change. It is believed that children under 13 who are diagnosed with APD or CAPD can still “grow out” of the disorder because auditory processing can be processed in other areas of the brain that can still develop until this age [3]. 

Studies suggest that APD may be reversed by active learning [8]. Auditory training targets different auditory processing skills through targeted auditory training techniques. It aims to change how the brain processes sounds and improve a child’s auditory function by maximizing brain plasticity. 

Auditory training helps the brain distinguish between sounds. Some skills that can be targeted include:

  • distinguishing the intensity, duration, and frequency of one sound from another
  • identifying the origin, direction, and distance of sounds
  • distinguishing between different speech sounds
  • perceiving signals received over time, including those presented to both ears and sounds presented simultaneously
  • recognizing sounds presented with background noise

Auditory training can be formal or informal:

  • Formal Auditory Training: Sounds are recorded and played through an audio device. An audiometer can be used to adjust the sounds. Someone scores the child’s responses and changes the difficulty level until the child’s score gets closer to the target score.
  • Informal Auditory Training: Someone provides auditory signals face-to-face and does not use an audiometer to control them

Soundsory® is a 40-day program based on the Tomatis® method that can complement traditional auditory training for children with APD. It combines exercises recommended by occupational therapists with rhythmical music processed with a dynamic filter and listened through specially designed headphones. The program aims to help children with auditory processing disorders and other sensory processing disorders (SPD) build and strengthen new neural connections.

Forbrain® is another brain training device that uses a dynamic filter to modulate the sound of your child’s voice and transmits the sound back to your child via bone conduction, helping retrain their auditory system’s feedback loop. The device can help with the auditory process particularly with auditory discrimination, phonological awareness, and rhythm integration – skills that are challenging for children with APD.

Computer-Based Training Programs

Auditory processing disorder therapies also utilize computer-based training programs to address auditory and language skills. These programs capitalize on the brain’s plasticity. These programs may provide multisensory stimulation and engaging formats, boosting the child’s motivation [2]. These programs can also facilitate intensive training and provide feedback and reinforcement [2].

Environmental Modifications

Aside from providing auditory processing disorder therapies, changing the environment can improve a child’s access to auditory information. Environmental modifications include the enhancement of the auditory signal and modifications to the listening environment.

Hearing Aids and Assistive Devices

Environmental modifications include changes made to help make sounds clearer and easier to hear. This includes the use of hearing aids and hearing assistive technology, like the use of a sound-field amplification system, so that the child can hear the speaker better and take in less background noise.

Classroom Accommodations

Changes to the listening environment include making modifications to the child’s classroom to improve acoustics [3]. Examples of this are:

  • removing things that cause background noise, like fluorescent lights that hum
  • covering reflective surfaces to decrease echoing sound (reverberation)
  • using absorption materials in open spaces
  • using acoustic dividers

Other accommodations [2] that can increase a child’s access to auditory information include:

  • strategic seating choices
  • recording verbal lectures and presentations
  • preparing lessons with visuals
  • teacher to speak more slowly, emphasize keywords, have frequent pauses, and give lessons in chunks
  • using written supports
  • providing support so the child can focus on attentive listening (e.g., organizers, note-takers, providing access to information before the actual lesson)

Compensatory Strategies

Compensatory strategies target a child’s higher-order skills like attention, memory, and language to help improve their listening, communication, social skills, and learning. These include metalinguistic and metacognitive strategies.

Metalinguistic strategies involve teaching the child to analyze and understand the underlying rules of language. It includes teaching the child to use grammar to see the links and relationships between sentences (discourse cohesion devices), use context to understand, and predict elements in a message (schema induction).

Metacognitive strategies are internal methods designed to enhance a child’s awareness and management of their thought processes. These strategies can involve self-instruction, problem-solving, and the use of metamemory techniques like mind mapping and mnemonics. It also includes assertiveness training, where the child is taught to ask others to repeat what they said or to request clarifications.

Alternative Therapies

Speech Therapy

Speech-language pathologists (SLPs) are equipped to teach children various auditory skills, such as identifying different speech sounds (sound discrimination) and recognizing individual sounds within words (phonological awareness). These skills are crucial for understanding words, processing spoken information, and enhancing reading abilities. Additionally, SLPs focus on improving children’s social and communication skills, which can boost their confidence in engaging in conversations with others.

Cognitive Behavioral Therapy

Children experiencing emotional and mental health challenges from APD, including anxiety and depression, may benefit from cognitive behavioral therapy (CBT). CBT can help children identify wrong mindsets and unhelpful thoughts and provide tools and strategies to help them cope and manage their problems.

Lifestyle Changes

Modifications and accommodations are not limited to classrooms. Below are some tips children with APD can do to help manage their condition:

  • learn lip reading
  • move closer to the person who is speaking
  • cover reflective surfaces that make sounds echo, like untreated ceilings and linoleum and wood floors
  • move away from sources of noise, like aquariums and fans
  • use subtitles when watching TV
  • request for visuals and written copies when possible, like handouts
  • record when necessary
  • develop a routine that the child can follow
  • go over lessons ahead
  • improve acoustics by closing doors and windows
  • play games and activities that boost auditory attention, like Simon Says

Support Resources

APD can make a child feel isolated and alone. Seeking support groups and resources can help children and their parents understand their condition better, gain ideas for proper management, and learn effective ways to cope with and adapt to it.

National Organizations

Below are national organizations that can provide valuable resources about CAPD, including its signs and symptoms, causes, diagnosis, and management. They may also help you find specialists who can diagnose and offer APD therapies:

–       American Academy of Audiology

–       American Speech-Language-Hearing Association

–       The National Coalition on Auditory Processing Disorders

Support Groups

Here are some private Facebook groups created to give people with APD a place to come together, share their experiences and coping strategies, and better understand APD. Note that these groups are private, so you may need to answer some questions and wait for an administrator or member to approve your request to join.

–       Auditory Processing Disorder (APD / CAPD) & Auditory Sensitivities Support Private group

–       Adults with APD (International) Facebook group

–       (Central) Auditory Processing Disorder (C)APD Facebook group

–       Auditory Processing Disorder (APD) Facebook group

Conclusion

Auditory Processing Disorder (APD) is when the brain struggles to process and interpret sounds effectively. Children with APD often face challenges in distinguishing between different sounds, comprehending spoken language, and maintaining focus. These difficulties can significantly affect their everyday activities, including communication and learning, and thus can have a negative impact on their daily life.

Children with Auditory Processing Disorder (APD) often see improvements with a combined treatment approach. Auditory training leverages the brain’s natural plasticity to improve auditory skills, helping to mitigate the deficits typically associated with APD.

Compensatory strategies employ the child’s higher-order skills, such as memory and attention, to help them navigate the challenges posed by APD. Meanwhile, environmental modification and accommodations help create an optimal listening environment, enhancing the child’s ability to access and process sounds more effectively.

Soundsory® greatly complements other auditory processing disorder therapies, particularly auditory training programs. It is a 40-day multisensory home-based program that combines specially designed music and movement-based exercises based on the principle of neuroplasticity. Another brain training device that can benefit children with APD is Forbrain®, a tool that processes your voice and modulates it clearer to stimulate and retrain your brain’s auditory feedback loop.

FAQ

How do you fix auditory processing issues?
There is no cure for auditory processing issues. However, children under 13 may still “grow out” of the condition using brain plasticity [3]. Treatment for APD includes a combination of auditory training techniques, compensatory strategies, and lifestyle changes and accommodations.
What therapy is used for auditory processing disorder?
Typically, speech-language pathologists (SLPs) provide auditory training or auditory rehabilitation to children with auditory processing disorders. They also help with their social skills and other auditory skills like sound discrimination and phonetic awareness, to help them communicate and listen better.
What are the coping skills for auditory processing disorder?
Many children with auditory processing disorder develop coping skills and strategies to help them manage their condition. This includes learning how to lip read, removing background noise and reflective surfaces that can make places more echoey, use note-takers and recorders, and come closer to the person speaking.
Can auditory processing be improved?
Yes! By utilizing brain plasticity, children with auditory processing deficits can still learn auditory skills as their brain matures and use other brain areas. At the same time, they can learn compensatory strategies and use accommodations to create an optimal listening environment.
Is APD a form of autism?
APD is not a form of autism. However, APD and autism can co-occur and their symptoms overlap. Many children with autism have difficulties processing sounds.
Is ADHD an auditory processing disorder?
ADHD and auditory processing disorder are two separate conditions, but they may co-occur and have overlapping symptoms. A 2017 study shows that many children with ADHD have auditory processing issues [9].
How do you test for APD?
There is no gold standard for testing APD. It typically involves specialists called audiologists running a series of tests that assess the integrity of the central auditory nervous system (CANS). At the same time, other specialists, like psychologists and speech-language pathologists (SLPs) also assess their speech, language, and cognition, along with relevant imaging.

References 

1.    National Institute on Deafness and Other Communication Disorders. (2022, March). How do we hear? U.S. Department of Health and Human Services, National Institutes of Health. https://www.nidcd.nih.gov/health/how-do-we-hear

2.     American Speech-Language-Hearing Association. (n.d.). Central auditory processing disorder.  https://www.asha.org/practice-portal/clinical-topics/central-auditory-processing-disorder/

3.     Aristidou, I. &, Hohman, M. (2023) Central Auditory Processing Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK587357/

4.     Alanazi A. A. (2023). Understanding Auditory Processing Disorder: A Narrative Review. Saudi journal of medicine & medical sciences, 11(4), 275–282. https://doi.org/10.4103/sjmms.sjmms_218_23

5.     American Academy of Audiology. (2010).  American Academy of Audiology clinical practice guidelines diagnosis, treatment and management of children and adults with central auditory processing disorder.  Retrieved from: http://audiology-web.s3.amazonaws.com/migrated/CAPD%20Guidelines%208-2010.pdf_539952af956c79.73897613.pdf

6.     Choi, S., Kei, J., & Wilson, W. (2020). Learning difficulties and auditory processing deficits in a clinical sample of primary school-aged children. International journal of audiology. 59:11, 874-880, DOI: 10.1080/14992027.2020.1771782

7.   Kähkönen, S., Yamashita, H., Rytsälä, H., Suominen, K., Ahveninen, J., & Isometsä, E. (2007). Dysfunction in early auditory processing in major depressive disorder revealed by combined MEG and EEG. Journal of psychiatry & neuroscience, 32(5), 316–322. 

8.     Moore D. R. (2007). Auditory processing disorders: acquisition and treatment. Journal of communication disorders, 40(4), 295–304. https://doi.org/10.1016/j.jcomdis.2007.03.0059. Lanzetta-Valdo, B.P., de Oliveira, G. A., Ferreira, J. T. C., & Palacios, E. M. N. (2017). Auditory processing assessment in children with attention deficit hyperactivity disorder: an open study examining methylphenidate effects. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5205523/

Rachel Ann Melegrito

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I’m a licensed occupational therapist turned content writer with over a decade of clinical experience as a pediatric OT. I also used to teach basic sciences and OT courses in a university before I shifted to content writing.