Auditory Processing Disorder (APD) in Children: Guide

Campbell, N., Grant, P., Moore, D,R. and Rosen, S. | View as single page | Feedback/Impact

Intervention programmes

Neuroplasticity underpins auditory training and requires that activities are sufficiently challenging (i.e. at the ‘edge of competence’) and repeated over extended periods of time to be likely to be effective (for example, 30 minutes, 3-4 times a week for 6 weeks).

Both formal and informal methods can be used.  The distinction between these two approaches is that formal methods offer greater control over the training stimuli with material often recorded and an adaptive difficulty paradigm is used that adjusts the level to the individual’s ability.  Informal training is typically not as concerned with stimulus control.  Stimuli are presented without the use of an audiometer or software and may be presented face-to-face instead of using recorded stimuli.  As informal training is typically done at home or in school creating an adaptive difficulty paradigm is more difficult (Weihing et al et al, 2015).   It requires more preparation time and dedication from the individual clinician.  Informal methods include both commercial programmes as well as in-house developed materials, as outlined in BSA (2011), which also includes practical appendices and handouts.  There is no evidence to suggest that either formal or informal methods are better, or that more expensive methods are more effective than less expensive ones (BSA, 2011).  It is important that the method and training selected address the child’s presenting difficulties.

Computer based auditory training, not specifically developed for APD, includes Fast ForWord and Earobics, which were the first 2 software packages used in this way.  Fast ForWord is designed to improve auditory, language processing and reading abilities and claims to train the brain to process at faster rates and help to create or modify the neural pathways.  It uses both speech and non-speech stimuli that have been acoustically modified to slow down and amplify transient sounds.  Earobics is no longer available.  Loo et al (2010) reviewed the evidence for computer-based auditory training in children with language, learning and reading difficulties, and evaluated the extent to which it can benefit children with auditory processing deficits and concluded that evidence to support the remediation of auditory processing deficits is limited.  HearBuilder, a more recent training program incorporates phonological awareness, auditory memory, sequencing, and following directions.  Other software includes Memory Booster, designed to improve working memory and Cogmed, designed for improving attention by increasing working memory.

There are also computer software and apps that have been designed for APD.  Most focus on training the discrete auditory processes identified as poor on traditional APD tests.  There is limited evidence however that training discrete auditory skills, as identified by ‘traditional’ APD tests, generalises to real life improvement or benefit.  The SoundStorm app, on the other hand, offers real-world-like signal training, and has been designed to ameliorate Spatial Processing Disorder.

  • Computer software includes: the Dichotic Interaural Intensity Difference (DIID) training (administered using customized stimuli through an audiometer or as computer based training using interaural intensity differences), Constraint Induced Auditory Therapy (CIAT, based on the DIID), the Central Auditory Processing Disorder Online Training System (CAPDOTS) designed to train binaural integration and separation, and Dichotic Offset Training (DOT which trains the perception of interaural time differences (ITD)
  • Examples of apps are: SoundStorm (trains spatial processing in noise and has been designed to ameliorate Spatial Processing Disorder, Zoo Caper Skyscraper (trains dichotic listening) and Insane Earplane (trains lateralization, non-linguistic pattern training (via pitch/frequency), interaural timing/intensity differences, non-linguistic prosodic cues (via pitch/frequency).

Music training and APD

There is evidence to suggest that musicians have better auditory processing abilities than non-musicians and that children with APD can potentially derive some benefit from playing a musical instrument/s (Mandikal Vasuki et al; 2016).  However, what is less clear is the nature and duration of training necessary, the expected outcomes and whether speech-in-noise ability can be improved.  In addition, there are a number of ‘music based’ programmes, which filter and modulate music in specific ways which claim to improve auditory processing.  One example is Auditory Integration Therapy (AIT), which exposes individuals to electronically modulated sound by filtering out certain frequencies to reduce hypersensitive reactions to auditory stimuli.  Some concerns have been raised in the USA with regard to AIT by the American Academy of Audiology (2010).  Other auditory music training programs have emerged over the past several years, e.g. Johansen Individualised Auditory Stimulation, Samonas Sound Therapy and The Listening Program.  Several anecdotal reports, together with small sample size articles, pilot and case studies in support of these approaches are available on the company websites.  The evidence is thus limited.

Auditory training should be considered alongside ‘Acoustic environmental modifications’ and ‘Technology’ (sound field systems, assistive listening devices/remote microphone technology), which have a higher level of supporting evidence.

The Practical handouts section provides useful tips and practical information.


American Academy of Audiology. (2010). Auditory Integration Training: Position Statement.

British Society of Audiology APD SIG. (2011). Practical Guidance: An overview of current management of auditory processing disorder.

Loo, J.H.Y., Bamiou, D., Campbell, N., & Luxon, L.M. (2010). Is Computer-based Auditory Training (CBAT) of benefit for children with language, learning and reading difficulties and potentially children with auditory processing disorder? Developmental Medicine & Child Neurology, 52(8), 708-717.

Mandikal Vasuki, P.R., Sharma, M., Demuth, K., & Arciuli, J. (2016). Musicians' edge: A comparison of auditory processing, cognitive abilities and statistical learning. Hearing Research, 342, 112-123.

Weihing, J., Chermak, G. D., & Musiek, F. E. (2015). Auditory training for central auditory processing disorder. Seminars in Hearing, 36, 199–215.