Last month, we took a look at some of the most common co-occurring conditions that might occur in somebody who has dyslexia and literacy differences, and spent a little time exploring how they might interact with the effects that dyslexia can have on somebody’s lived experience. One topic we didn’t cover, however, was Auditory Processing Disorder (APD) – and that’s because as a lesser-known co-occurring condition of dyslexia’s, it requires a bit of a deeper dive than usual. It’s one of the topics that’s talked about in academia and dyslexia research a great deal, but relatively little of this focus makes it in to the mainstream discourse and media of the global dyslexia community… which isn’t amazing when we consider that there are studies out there that suggest that up to 70% of individuals with dyslexia could have an underlying auditory processing disorder.
What is Auditory Processing Disorder?
APD is, in the simplest terms, a difference in how the brain processes the sounds and language that surround it every day. Some people call it an ‘abnormality’ in this kind of processing, but many people in the global neurodiversity community are moving away from this kind of language, and simply call it a ‘difference’. This ‘difference’ in processing causes a breakdown in the ways that your brain deals with what you hear, and it can make it difficult to distinguish things like small sound differences within words, remember what was heard, and keep up with ongoing speech.
Many people find it’s worse when there’s ongoing noise in the background too, or they’re competing with other sources of stimuli – somebody might not struggle so much if they’re having a conversation in their kitchen with their friend, but things could look different if they’re having a conversation with a sales assistant in a crowded grocery store. It can also lead to doubt and a need for repetition in conversations even when an individual has heard things correctly, as they become either consciously or subconsciously aware that there’s a difficulty in working with what they’ve heard – so asking people to repeat things or relying on non-verbal gestures like “huh?” become second nature.
One thing to remember is that it’s not just being ‘hard of hearing’ – it’s actually a more complex issue that goes on inside the brain.
What’s the relationship between APD and Dyslexia?
The two conditions are quite different in their effects: APD is a difference in how the brain processes sounds and heard language, whereas dyslexia is widely agreed to be a language-based learning disability often associated with weaker reading skills, poor spelling, slower reading processing and character confusion when unsupported.
There are a number of different types of APD, but not all seem to occur with the same frequency in people who have dyslexia: most people with dyslexia and APD will demonstrate weaknesses in temporal sequencing of information, auditory figure ground problems, and interautal asymmetry in competition. So that’s ‘remembering what order you heard a list or some instructions in’, ‘the ability to pick out sounds from a noisy or disruptive audio backdrop’ and ‘differences in assessed listening performance between each ear’ – although it is very possible for different forms of APD to exist in people with dyslexia too.
The combined effect of APD and dyslexia can mean that it’s difficult for somebody to take in information in both of these forms, and when in education, it can be particularly isolating and have a powerful impact on academic progress when unsupported. In the workplace, too, it can mean that an individual struggles with tasks that their co-workers feel able to complete with ease as they simply struggle to access and process the information that they need to know. It can also have an impact on worker safety, as it means that extra time and care needs to be taken to ensure that somebody is up to date and confident in the measures that they need to understand to keep themselves and co-workers safe, or even keep important data or materials confidential. That’s why supporting dyslexia is of particular importance in people who do exhibit symptoms of APD, however it does mean that traditional text-to-speech dyslexia supports may be less effective in some cases.
What do the symptoms look like in children?
APD can look like…
👂 Struggling to pick up names or object names
👂 Struggling to pick up nursery rhymes or song lyrics
👂 Unable to follow a tune or sing a simple tune back accurately
👂 Problems following ability-appropriate directions
👂 Doesn’t remember details of instructions or conversations
👂 Struggling to ‘place’ sounds and the directions they’ve come from
👂 Overuse of “huh?” or “what?” in conversations, asking for repetition
👂 Sound confusion; hearing ‘bat’ as ‘bap’, ‘but’, ‘vat’, ‘dat’ etc;
👂 Saying ‘ne’ or ‘ny’ instead of ‘me’ or ‘my’
👂 Leaning in close during conversation
👂 Actively turning to face an ear toward the speaker
👂 Thinking different musical notes ‘sound the same’
👂 Better listening and conversational skills in quiet environments
👂 Struggling to listen and converse in loud environments
👂 Appears ‘irritated’ by loud spaces such as football crowds or busy stores
👂 Trouble learning to read and spell
👂 Difficulties in expressing themselves clearly
…And in adults?
As with many sense-based conditions and neurodiversities, things become a little more difficult to detect in adulthood due to what we call ‘masking’. ‘Masking’ is where somebody actively conceals their symptoms or finds different ways to work around them, in many cases subconsciously – and this leads to many people not realising until much later that they have conditions like dyslexia, ADHD/ADD, APD, dysgraphia and dyscalculia. But some common and indeed, some ‘masked’ symptoms may look like…
👂 Listening to the TV on full volume as standard
👂 Using headphones for calls as speakers sound ‘unclear’ or ‘fuzzy’
👂 Struggling to understand differences in tone or detecting sarcasm
👂 Struggling to understand people with speech accented differently to your own
👂 Sound feels distracting; having to turn sound sources off to concentrate
👂 Turning on transcription during meetings and reading it back because ‘you miss things sometimes’
👂 Needing noise-cancelling headphones for a comfortable listening experience
👂 Difficulty in multitasking in complex auditory situations; like writing whilst listening to music
👂 Some people might struggle with learning a foreign language, or have good reading comprehension in a foreign language that doesn’t extend to aural
How do we go about diagnosing APD?
Testing for APD often goes via a speech and language pathologist in the US and Canada, and in the UK via a hearing specialist, either privately or on the NHS. Both can be accessed and referred to via your regular healthcare services provider, however many of these specialists have long waiting lists due to them often being the same healthcare professionals who deal with hearing impairment or hearing loss in the elderly, and many are still ‘catching up’ after the effects of national lockdowns in the wake of Covid-19. There’s a much more in-depth review of the kinds of testing that an audiologist could use as a means of diagnosing APD over at Reading Rockets.
