What is Auditory Processing Disorder (APD)?

by listen2up

Auditory Processing Disorder (APD), also called Central Auditory Processing Disorder (CAPD), is a collection of brain-based impairments in the processing of auditory information despite normal hearing levels.

Due to hereditary factors, illnesses such as ear infections as a small child, or other factors (or a combination), someone with APD may lack the ability to rapidly discriminate and process sounds. For instance, tracking conversation in the presence of background noise can be much less successful for an APD’er than a normal person – an occurrence known as the “cocktail party effect”.

Only recently coming into popular awareness, the condition is recognized by audiologists although diagnosis can sometimes be confused with other (possibly co-existing) conditions such as attention deficit.

What Can be Done?

There is no known cure or remedy other than environmental support, such as facing a speaker and sitting close to a lecturer in order to catch more of what is being said (and possibly unconsciously read lips), helping to fill in gaps in perception of what is being expressed. Depending on the degree and exact nature of the problematic neural connections, some APD’ers may opt to try an amplification system as an aid, although others may be hypersensitive to sound and need – to a far greater degree than the average person – quiet settings to be comfortable and able to think calmly.

Like the case with other neural difficulties based in the brain, it may be possible to intensively retrain and strengthen existing neural structures to take over some of the missing function (known as “plasticity”) but audiologists have not endorsed listening-training programs due to insufficient quality and extent of evidence supporting these measures. Little work is being done at academic centers to address coping with this lifelong condition, estimated to affect at least 1 percent of the population. In fact, some listening-program equipment cannot be imported into the United States due to a lack of strong evidence to support its use.

Patterns of Difficulty

People with the condition may have a number of traits in common. For instance, they may receive feedback or determine that they:

• Appear to not connect
• Are forgetful due to running compensation strategies through their working memory (that has short-term, limited-capacity storage)
• Are inattentive to detail and may miss the full meaning of what is being conveyed; sometimes the language impact spills over to writing and reading shortfalls
• Rely (sometimes seemingly to a fault) on routine and structure, so may not transition well or cope with change as well as unaffected people do
• Have communication that seems brusque and without preamble, like a telegraph message, or when the speaker tries to open up, is not distilled to a few key points and can be hard to follow
• Can be somewhat poor spellers or make careless errors, underperforming compared with what would be expected for their intelligence level, although APD’ers are tenacious and can obtain advanced degrees
• Are able to present information in a prepared talk far better than they can respond to questions in the moment – producing answers on the spot can be difficult
• Find keeping up with and participating in dynamic group conversations – such as at a dinner party – hard
• Be likely to miss many social cues in general, being slightly tone-deaf to them
• May be easily distracted when concentrating and lose the thread when interrupted – affecting ability to focus or multitask
• Notice that noise and conflicting sensory input or distractions can be unbearable at times – but the APD’er is likely to hide this out of respect for others or an attempt to fit in

In fact, the overwhelming conflicting incoming sensory input to process can cause a feeling of panic or momentary disorientation and lead to the individual “snapping” or feeling somewhat traumatized. Sometimes any conflicting demand for attention can be unduly challenging to a greater or lesser degree, partly because working memory is more taxed than in a normal person.

Impact of the Condition and Feelings it Elicits

Along with limitations of the impairment are reactions it evokes in the affected person and those around them. APD’ers will tend to try to avoid making errors, choosing actions that can still engender resentment. These effects include:

Treatment by others:

• Socially or within families, the APD’er may tend to feel belittled, criticized, pressured, and/or avoided – there is a sense something is subtly off that might make the APD’er’s motivations, competence, or sense of etiquette distrusted; acquaintances feel let down, burdened, or miffed

Feelings:

• APD’ers can feel frustrated, despair of overcoming issues, and have some self-contempt or sorrow about innate limitations to managing the condition
• APD’ers generally try as best they can, so can sometimes be accused of appearing defensive when confronted with perceived shortcomings

Behaviors that may be typical for coping:

• Withdraw
• Rely on written expression
• Seem tense, vigilant, anxious
• Possibly bottle things up and be indirect to avoid creating confusion due to difficulty talking things through in the moment; “people-please” and have difficulty self-advocating or receiving credence for unseen problems
• Transitions can be extremely difficult, so the APD’er may appear resistant

Physical:

• Have a tendency to get emotionally exhausted more easily than most. Coping can be draining by the end of the day

Recognition of the Problem

Some aspects of the condition can be frustrating for everyone due to its subtle but pervasive symptoms that may escape immediate notice, but emerge as patterns or an unusual “style” or approach to things.

An APD’er personality may be unusual with quiet and sweet surface traits and strong-minded convictions under the surface, a combination that may have developed as a way of coping with the deficit.

With a bright individual, it may be hard for others to accept that he or she is challenged, with the challenges masked by development of complex coping mechanisms – but he or she does suffer all the same, and generally over time the nature of the difficulties will emerge and be more apparent, which can lead to harsh treatment in the workplace or ruptured relationships and a lack of sorely-needed support and acceptance without an intent on fixing the impediment.

However, rest assured that due to their limitations and vulnerability, APD’ers are among the least likely to intend to slight anyone and are managing the best they can, doing better when not stressed by ill-will or hostility.

The communication difficulty and invisibility of the condition make it hard for them to be good self-advocates. It may be helpful to compare it to a mental limp and treat them with the same consideration as someone trying to keep up while on crutches, to not take their challenges as an affront.

Aids for Interacting with an APD’er

Supplement spoken instructions with written ones.

Allow someone with APD to take notes – even in personal discussions this can aid memory, the ability to capture the essence of what is being said, and clarity.

Wait to say something until in the same room and facing each other, and be mindful of trying to talk over nearby background noise, such as a running dishwasher.

Realize the APD’er cannot control the consistency in which they are functioning – the degree of success may be spotty.

Be willing to entertain more follow-up questions than with a normal person. The APD’er may have trained him- or herself to not ask clarifying questions in order to be accommodating, but does appreciate the opportunity for understanding.

If APD’ers suspect they are socially tone-deaf they may enlist the opinions of support persons when assessing how to handle a situation. This does not mean overall they are naïve or immature, just that they are compensating for anticipated blind spots.

As with all unrecognized invisible disabilities, try to avoid blame and shame. This condition is one the APD’er lives with everyday without hope of improvement, and they have encountered their fair share of mistreatment as a result, so may harbor a store of hurt feelings as a result. Simple, nonjudgmental human kindness and plenty of forgiveness for frailties can go a long way to making the burden a little easier to bear and the individual feel a little more comfortable with human contact.

Recognize the APD’er may feel overtaxed at times and unable to keep up with the schedules of someone without the condition. With breaks to rest and recharge, an APD’er can still be fairly productive and competent in their own way.

Accept that structure and predictableness help the APD’er feel more relaxed, secure, and able to perform. Encouragement to get out of a rut, have a change of scenery, or to plan toward goals or contingencies may also help if the APD’er is overcautious or preoccupied with daily functioning.

Realize that despite their limitations they are generally well-meaning and sympathetic to others’ struggles, stemming from their own personal experience.

References

1. APDUK. http://www.apduk.org.uk/ (experiences of people with the condition)
2. Wikipedia. “Auditory Processing Disorder” http://en.wikipedia.org/wiki/Auditory_processing_disorder (intervention)
3. National Institute on Deafness and Other Communication Disorders. “Auditory Processing Disorder in Children” http://www.nidcd.nih.gov/health/hearing/Pages/auditory.aspx

CAPD chart – Audiologists who specialize in this screening describe in a one-page table impairments along the auditory pathway, the associated symptoms, and advice for each of the four main subtypes  (most cases are mixed, with one subtype dominant).