Auditory processing disorder (APD): symptoms, diagnosis and what helps

The NHS says that if you or your child have APD, you may find it difficult to understand people speaking in noisy places, people with strong accents or fast talkers, similar sounding words and spoken instructions. It stresses that APD is not a hearing problem and people with the condition usually have normal hearing.

The Dudley Group NHS Foundation Trust says children with APD are most likely to have difficulty understanding speech, especially in noisy environments such as a classroom or crowded shopping centre. They may also have trouble concentrating and reading when there is background noise. These problems may lead to difficulty understanding and remembering instructions, speaking clearly and developing reading skills.

Parents may suspect that their child is not hearing or listening properly at quite a young age, but the leaflet says it is often at school that the difficulties become more obvious, and that teachers may be concerned when a child does not start reading at the usual age or is slow to pick up reading skills. It notes that these difficulties may be caused by other problems that affect communication.

• Struggling to follow speech with background noise, such as in a classroom.

• Mishearing similar sounding words.

• Difficulty following or remembering spoken instructions.

• Trouble concentrating and reading when it is noisy.

• Difficulty with strong accents or fast talkers.

The Dudley Group leaflet explains that APD affects how the brain interprets sound, rather than how sound is carried through the ear to the brain. Sound enters the ear canal and passes through the middle and inner ear as usual and then travels to the brain through the auditory nerve. Once it has arrived in the brain there are problems processing the sound, which can make it hard to make sense of what is heard.

It says each person is affected in a different way and to a different degree, so APD may be called a spectrum disorder, and some children have a greater range of difficulties than others.

The NHS says to see a GP if you or your child find it hard to hear or understand speech, and the GP may refer you to a hearing specialist. To test for APD you or your child may be asked to listen to speech with background noise, spot small changes in sounds, and fill in missing parts of words.

Other tests may include having electrodes on your head to measure how the brain reacts to sound, speech and language tests, and memory, problem-solving and concentration tests. The NHS says testing for APD is not usually done on children under 7 years old.

The Dudley Group leaflet explains why a routine hearing test often looks normal: a common hearing test is carried out in a quiet room with minimal distractions, so children with APD do not usually show any hearing impairment. It says complex tests are needed, including hearing speech in different levels of background noise, pitch discrimination, sound pattern recognition and detecting subtle changes in sound, with results compared with children of a similar age. Testing is usually offered to children with a developmental age of 7 years or more.

The NHS says there is no cure for APD but there are things that can help. Treatment usually involves activities to improve listening and concentration, called auditory training, which you can do with a hearing specialist or in your own time online.

To reduce background noise, the NHS says schoolchildren with APD may be advised to wear a wireless earpiece that connects to a tiny microphone worn by their teacher. The Dudley Group leaflet adds that training programmes to address specific issues can be very effective if practised regularly, and that adjustments at school such as sitting near the front of the classroom, asking the teacher to check that your child is listening and backing up verbal instructions with written ones can make things easier.

The leaflet says there is no medicine or procedure that can cure APD, but there are strategies that can reduce the effects on everyday life.

The Dudley Group leaflet says it is not known exactly how many children are affected, but estimates from around the world suggest between three and five per cent of children have APD to some degree. It says other conditions can affect children alongside APD, including dyslexia, attention deficit with or without hyperactivity disorder, poor attention, poor short-term memory and speech or language problems.

The NHS likewise says APD is often found in people with attention, language and learning difficulties, such as dyslexia and ADHD. For many children, the Dudley leaflet says APD improves as they grow older, usually because they incorporate coping strategies into their everyday life, and with reasonable adjustments most children and young people have a successful school and work life.

Help at home suggested by the leaflet includes getting your child's attention before speaking, speaking clearly at a normal pace, reducing background noise by turning down the television or radio, emphasising key points, breaking information into smaller chunks, asking your child to repeat back what you have said, and avoiding covering your mouth when you speak.

The NHS says it is not always clear what causes APD. Possible causes include regular ear infections, genetics, head injury and complications at birth. The Dudley Group leaflet says doctors do not really know what causes it, but that there may be a genetic component, because parents sometimes report similar problems when they were young.

The leaflet also says it may be caused by the brain being wired slightly differently in some children who had lots of ear infections in childhood, so that message signals are passed from cell to cell less effectively than usual.

The NHS lists things that you and other people can do. Do talk face to face, use pictures and text, repeat or rephrase things if necessary, and use carpet and soft furnishings to reduce room noise. Do not cover your mouth when talking, do not talk in long complicated sentences, do not speak too fast or too slow, and do not have background noise like TV and radio.

It points to APD Support UK for information and online support groups for parents and adults with APD. The NHS says APD often starts in childhood but some people develop it later, so these tips apply to adults as well as children.

The NHS says to see a GP if you or your child find it hard to hear or understand speech. The GP may refer you to a hearing specialist. The NHS hearing loss page adds that you should ask for an urgent GP appointment or get help from NHS 111 if you have sudden hearing loss in 1 or both ears, or your hearing has been getting worse over the last few days or weeks.

Because APD is not a hearing problem, a hearing test may come back normal even though listening is hard. The Dudley Group leaflet says complex tests are needed to diagnose it, so tell the GP or audiologist what situations are difficult.

The NHS route starts with a GP and referral to a hearing specialist. The Dudley Group leaflet says APD testing is usually offered to children who have a developmental age of 7 years or more, and the NHS says testing is not usually done on children under 7. Services differ between areas, so ask the audiology service what is offered locally.

Private audiology services may also offer listening assessments. Whichever route you use, ask what the tests will show, who will interpret them, and how the school will be informed so that classroom adjustments can be agreed.