According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) if six or more symptoms of inattention or hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level, a child or adult may be diagnosed with ADHD. Depending on the symptom combination, this could be further classified as inattentive, hyperactive, combined type, or not otherwise specified (NOS).
This diagnosis often leads to a treatment regime including medication such as Adderall, Concerta, Dexedrine, Ritalin, Strattera, among others. If medication doesn’t work parents may turn to behavioral management techniques, dietary changes, nutritional supplements, neurofeedback, and school accommodations. An integrated treatment approach is generally best. ADHD symptom management can be an exasperating experience for both parent and child.
What many parents and professionals may not recognize is that something else may be going on. Many of the symptoms of ADHD are shared with an Auditory Processing Disorder (APD). There is parallel situation with Autism Spectrum Disorders and Sensory Processing Disorder (SPD). If it looks like, talks like, and quacks like a duck, it must be a duck. Right? Not necessarily…
Staying with the ADHD/APD link children with APD may struggle to block out background noise, follow conversations, are often fidgety and distractible. They may have difficulty following directions, keeping themselves organized, experience auditory working memory deficits, and have challenges understanding instructions or conversations. Problems with language, reading, academic performance, peer relationships, and self-confidence are also part of the APD profile. Sound familiar? Simply put, auditory processing is what the brain does with what it hears. This is something I understand quite well having spent a good deal of my childhood and teen years with some of these challenges.
Children with APD are frequently lost in the cracks, in large part because auditory processing disorders are not yet well known and are not included in the DSM. How many children have an auditory processing disorder? Estimates range from as low as 3% to as high as 20%. An accurate number is difficult to determine due to lack of professional understanding, co-morbidity, and the plain fact that it looks a lot like ADHD and can co-exist with it.
The APD brain has difficulty taking in, storing, processing, and understanding sounds and words. Imagine listening to a radio station that is not quite tuned to the channel frequency. You can hear part of a song through the noise, but miss a lot of it, perhaps without even realizing. The brain has a tough time filling in the missing pieces, so the song may not make sense. We have all experienced this at one time or another.
Ever listen to and even sing a song thinking the lyrics are one thing, later to find they are different? I love Johnny Cash, Ring Of Fire is one of my favorite songs. Here is a great example of a misheard lyric, “I fell in like a child on fire”. Real lyric,”I fell into a burning ring of fire”. See, it’s easy to do! Trouble is, with APD this happens in conversations, when listening to instructions in the classroom, or trying to follow directions at home. This is just one illustration.
What looks a lot like ADHD can be APD. Diagnosis is made by an audiologist using a specific assessment battery, rather than relying on symptoms alone. An accurate diagnosis can be made starting at age 7. Parents often ask if APD is a hearing problem, in most cases hearing is fine, the brain just doesn’t understand what it hears. Often the difficulty includes filtering out background sounds and even experiencing pain or discomfort with exposure to certain sounds, which can lead to distractibility. Auditory distractions have a major impact on attention, taking a student’s attention away from what they are trying to or should be focusing on in the classroom.
Is it ADHD or auditory processing disorder in disguise? If APD, what are the causes, and most effective strategies and treatments?
This is what will be explored in my teleconference with psychologist and ADHD expert Dr. Rory Stern, this Monday, June 1st at 9:00 PM EDT.
Please sign up for your FREE VIP Seat for The Ear-Brain Connection: The Role of Auditory Processing in Attention, one of 12 interviews in the online ADHD Family Summit by clicking here http://www.adhdfamilyonline.com/public/244.cfm?affID=ABT2009 .
June 3, 2009 at 6:30 pm
Dear Alex, thanks for posting this information. I found your comments to be exactly our situation. Many teachers and psychologists tried to pin my daughter into the ADHD box by just examining her symptoms alone. It wasn’t until she was screened by an Audiologist did the right diagnosis emerge as APD. I wonder how many other children are being pinned into the ADHD box when they really have APD. I agree that a lack of professional understanding contributes to misdiagnosis. I hope that as APD is researched and understood an appropriate diagnosis will be the end result.
June 5, 2009 at 9:05 am
Hi Rachel,
Good to hear from you and thank you for sharing your experience with your daughter. The lack of professional understanding of APD will take time to overcome. It is not the fault of our educators and psychologists, they simply need education to understand what APD is and how to recognize the symptoms. A multidisciplinary team approach is important in fully understanding the varied problems associated with APD, with diagnosis being made by an audiologist.
Parents such as yourself can play a big part in raising awareness of APD. I encourage you to share your experience with others as you are comfortable. The new community at http://www.advancedbrain.com and groups on facebook, etc. are a great place to begin. A grass roots effort on behalf of our kids and adults happens one person at a time.
Please let me know how your daughter’s progress has been with The Listening Program since you attended your training course at Advanced Brain Technologies.
Kind regards,
Alex
June 5, 2009 at 7:06 am
Alex: I listened to you with Dr. Rory Stern. I am very interested in learning more about APD. I’m the opposite of most people b/c I have always been convinced my son is ADHD, and if it is not that then there is some kind of learning disability that I can’t pinpoint. Now I am thinking it may be APD. My husband is the same way, and you did mention that it could be hereditary. How would I find an Audiologist in my area?
June 5, 2009 at 8:56 am
Hi Colleen,
Thank you for listening to my teleseminar with Dr. Rory Stern.
As long as your son is at least 7 years old he can be tested for APD. Not all audiologists do APD testing, so you will need to specifically ask if they do. If you email me privately at alex@advancedbrain.com and let me know where you live I may be able to make a referral for you. Otherwise there is a professional directory of audiologists and speech and language pathologists available through the American Speech Language and Hearing Association at http://www.asha.org/findpro.
Treatment for APD varies based on the specific issues and the experience of the audiologist you work with. Often compensatory strategies are recommended, and computer-based training with programs such as Earobics and FastForword, as well as listening therapies such as The Listening Program from my company.
Please let me know if we can help your family any further.
Kind regards,
Alex
June 18, 2009 at 6:04 am
Hi, my son was first diagnosed ADHD but then after an Occupeational therapist ran the battery of tests, it turned out to be APD. the school my son attends do not know how to help APD alone. They only know how to help when attached to another difficulty eg poor spelling, reading etc. My son is top of his class due to help at home to keep him ahead. Do you have any suggestions as to how to deal with /support APD in itself? I am writing a blog to share my own experiences.
June 18, 2009 at 9:14 am
Judging from your email address it appears you are in the UK. If so, you definitely want to visit the website for Auditory Processing Disorder in the UK. http://www.apduk.org. This group is leading the charge for APD awareness in the United Kingdom. Further, if you contact Alan Heath the Director of Learning Solutions in Bradford he can help you access programs to help you son. His email is alan@learning-solutions.co.uk. Dilys Treharne a lecturer in the Department of Communication Sciences at the University of Sheffield is one of the foremost experts on Auditory Processing in the UK and would be another good resource for you. She is involved in the APDUK group. Please let me know if I can help you further.
June 20, 2009 at 4:06 pm
Thanks for such a specific reply. I will definately get onto contacted the above. I will let you know how things go.
August 9, 2009 at 12:29 pm
I enjoyed reading your article! You write with great insight and we share many similar ideas. Amazing! You can read what I wrote about APD: Attention Deficit Disorder Verses Auditory Processing Disorder – A Big Difference
at http://www.learningsolutionsathome.com. Thanks and take care, Lucy Barlow