ADHD or Auditory Processing Disorder in Disguise?

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 .

  

13 thoughts on “ADHD or Auditory Processing Disorder in Disguise?

  1. Rachel Gee says:

    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.

    • Alex Doman says:

      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

  2. Colleen Spivey says:

    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?

    • Alex Doman says:

      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

  3. Umm Yum Yum says:

    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.

    • Alex Doman says:

      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.

  4. Umm Yum Yum says:

    Thanks for such a specific reply. I will definately get onto contacted the above. I will let you know how things go.

  5. ADHD says:

    Interesting article, thank you. There are a lot of sites out there that don’t make as much sense about ADHD. I’ve made a note of your site details and will visit again.

  6. Tamara says:

    Dear Alex,

    I have read your article and find it very interesting. My son is 8 years old and had been diagnosed with having ADHD, but I do not think that is the root of his problems. From birth until the age of 4, he suffered many chronic ear infections until his doctors decided to insert tubes into his ears. Since starting school, he is now in 3rd grade, his teachers have always told me that he has problems with focusing and paying attention. I had done extensive research into the possibility of ADHD or dyslexia, but not CAPD. This disorder seems like it may be what he suffers from after all. He is always complaining that loud noises bother his ears. He has trouble with memorizing simple math facts and any verbal directions his teacher gives to him. He is not a very hyperactive boy, although sometimes he does have difficulty with sitting still while in the classroom setting. Before being diagnosed as having ADHD, his hearing was tested and found to be normal. His IQ was also tested for possible learning disablities. His scores were as followed: perceptual reasoning was 119, verbal comprehension was 110, working memory was 88 and processing memory was 86. Being that his verbal comprehension was much higher than that of his working memory and processing memory, would in fact this disorder possibly be what is the issue at hand? I would like to find some answers as I just found out yesterday that he does not qualify for an IEP in school and therefore, will continue to struggle with his academic progress. Any feedback would be greatly appreciated. Thanks.

    • Alex Doman says:

      Thank you for writing about you son. I apologize for the lengthy delay in responding to your comment, I have not posted in awhile. Working memory could be the underlying issue based on the information you shared and does not necessarily mean your son has an auditory processing disorder. However, with an auditory working memory issue this will have a significant impact on auditory processing, attention, memorizing math facts and following verbal directions. This can be addressed through specific working memory training. You may want to take a look at the BrainBuilder(R) software program to assess and train your son’s working memory. The hypersensitivity may be helped with The Listening Program(R) which is a method of music listening therapy, which can also help the working memory. More information on both programs is available at http://www.advancedbrain.com. Take a look there, then you can contact the office at 801.622.5676 and a program consultant can give you further guidance.

  7. Anthea Wendt says:

    I have twins with CAPD disorder and have endured 5 years in the education system in Australia, but they don’t recognise this disorder and therefore provide very little assistance at school.

    I am trying to get backing from academics, professionsal and groups that can assist to prove to this government that there are a number/ percentage of children who are being jeopardised by the lack of assistance. And that a lot more assistance, recognition and funding is providing to these children. Can you provide any reliable sources to help me. kind regards anthea

    • Alex Doman says:

      Unfortunately we still have a long way to go before CAPD is recognized at the level it needs to be. However, there is much you can do as a parent to help your twins. I encourage you to contact Links 2 Learning based in Adelaide.
      http://links2learning.com.au The Director is Tracey Butler. Best of luck to you. Alex

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