When They Respond “What?” “Huh?” It Could Be Auditory Processing Disorder

 ADHD Weekly, February 2, 2023

Does your child seem to ignore you when you ask them to complete a task, or how their school day was? Many parents say that has been their experience with their children. How do you know if your child is purposely ignoring your requests or if they are showing signs of auditory processing disorder, ADHD, or both? What makes APD a confusing condition is that symptoms like inattention and academic struggles seem similar to those of other conditions, including ADHD, autism, and some learning disabilities. APD may go undiagnosed or be misdiagnosed because of overlapping symptoms shared with other conditions.

It is common for a child with ADHD to have another condition such as APD. Studies reveal that thirty-three percent of children with ADHD have at least one co-occurring condition. Although the rate of APD in childhood is unclear, parents need to be aware of its signs and symptoms.

A disorder of processing, not attention

Remember the childhood game of telephone? A message is whispered into one person’s ear, and then they interpret that message and pass it on to the next person. What usually happens is that by the time that message is relayed to the last person in line, it is changed or garbled. The telephone game is a bit like what happens with APD; a person hears the spoken phrase but their brain incorrectly decodes the message. For example, someone with APD may not be able to pick up on small differences between words like “pig” and “big.”

According to the American Speech-Language-Hearing Association, other symptoms of auditory processing disorder, sometimes called central auditory processing disorder, include:

  • Difficulty figuring out where a sound is coming from
  • Difficulty understanding spoken language in noisy backgrounds
  • Taking longer than typical to respond to when spoke to in conversation
  • Difficulty understanding and following rapid speech
  • Often asking “what?” or “huh?” when spoken to, or asking for the speaker to repeat themselves
  • Trouble paying attention and being easily distracted
  • Inconsistent or inappropriate responses
  • Reading, spelling, and learning problems

If your child displays many of these symptoms, you might wonder about possible hearing loss. Surprisingly, most children with APD may not have any issues with physical hearing.

Is it ADHD or APD?

How is a parent to know if a child has ADHD, APD, or both? Children with ADHD may struggle to listen to what their teacher is saying because they have difficulty paying attention. They may impulsively get out of their seat while a teacher is talking and miss what is being said. Or, they may be preoccupied with looking at a dog outside the classroom window instead of paying attention to their teacher’s directions.

A key difference between ADHD and APD is that for children who have ADHD, “it is the attention deficit that is impeding their ability to use the auditory information coming in, not the processing of it in the brain,” according to The Auditory Processing Center, an audiology clinic in Clinton, Mississippi. That is to say, children with ADHD struggle to maintain attention on what is being said, while those who have APD hear what is being said, but their brains incorrectly processes the message.

Diagnosis and treatment

Audiologist Terri James Bellis, PhD, an internationally recognized expert on APD, says that parents should be aware that not all children who have symptoms of APD actually have the condition. A diagnosis cannot be made with just a symptom checklist.

“A multidisciplinary team approach is critical to fully assess and understand the cluster of problems exhibited by children with APD,” she says.

The team approach would include teachers or an educational diagnostician who can evaluate academic difficulties, a psychologist who can test a child’s cognitive abilities, and a speech-language pathologist to assess the child’s speech, oral, and written language skills. This multidisciplinary team shares its findings with an audiologist, who can make an official APD diagnosis. Additionally, if there is any concern that symptoms could be a sign of another condition like ADHD, parents will want to consult with an ADHD specialist.

Treatment for APD may include modifying the child’s learning environment, using higher-order skills to help compensate for the disorder, and targeted services for the auditory deficit itself, says Dr. Bellis. Much like for ADHD, there is not a one-size-fits-all approach for APD, as treatment is tailored to the child’s needs.

“With appropriate intervention, all children with APD can learn to become active participants in their own listening, learning, and communication success rather than hapless (and helpless) victims of an insidious impairment,” she says.

Learn more about ADHD and co-occurring conditions:

Join the discussion: What you suggest to a parent concerned their child may have both ADHD as APD?