Auditory Processing Disorder (APD) in Children

Practical handouts relating to APD and co-existing disorders

Acoustic environment

Architectural interventions to reduce reverberation and improve the signal-to-noise ratio should be considered for both new build schools and refurbishments.  Signal-to-noise ratio refers to the level of a desired signal (usually the teacher’s voice) in relation to background noise.  Architectural interventions are primarily about blocking out sounds from outside the classroom and absorbing noise within the classroom.  There are specific acoustic performance standards which UK schools are required to meet. 

Case history

A detailed case history is important to obtain a 360° view of a child’s development and functioning in real life as well as the support that is already in place.  It facilitates decisions around the assessment and support that a child may need (including onward referral to another professional), offers a backdrop against which test results can be interpreted, helps differentiate between primary and secondary concerns and finally facilitates decisions around intervention.

Presenting difficulties

Children referred for APD assessment typically have a normal audiogram but present with characteristics that may include:

Types of APD

There are three types or categories of APD (BSA, 2018)

1  Developmental APD

Cases presenting in childhood with listening difficulties, but with normal audiograms and no other known aetiology (causes) or potential risk factors other than a family history of developmental communication and related disorders.  These individuals may retain APD into adulthood.

2  Acquired APD

Cases associated with a known medical or environmental event (e.g. brain lesion, trauma, illness, noise or ageing).

International guidance

A number of countries around the world have APD position statements and guidance documents.

Online links to these documents are provided, where available.

American Academy of Audiology. (2010). Diagnosis, treatment and management of children and adults with central auditory processing disorder [Clinical Practice Guidelines]. CLICK HERE

Evidence-based management

Linking an individual’s test results and needs to specific management strategies can be done in 3 ways (BSA, 2011).

Evidence-based assessment

An evidence-based multi- or interdisciplinary approach is needed, given the overlap between APD and other developmental disorders/delays.

Audiological assessment for APD should not be done in isolation given that aspects such as language, attention and memory can affect test results.

Multi- or interdisciplinary approach

There is general agreement that auditory processing abilities may influence language development, particularly pre-literacy skills including phonological awareness, and that it can be difficult to separate the influence of auditory and language skills with regard to academic demands (Richard, 2012, 2013; Watson & Kidd, 2008).

What is APD?

Auditory Processing Disorder (APD) was first described more than 60 years ago as the inability ‘to structure the auditory world’ (Mykelbust, 1954:158).  It is said to affect 2-3% of children (Chermak and Musiek, 1997; Palfery & Duff, 2007) but prevalence is difficult to know with certainty, given that there is no universal ‘gold standard’ for defining APD.

The British Society of Audiology (2018) define APD as follows:


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