In One Ear & Out the Other

What to know about auditory processing disorder vs. ADHD

WORDS ERIN HAYES BURT

KIDS WITH ADHD OFTEN HAVE TROUBLE with focus, impulse control, managing emotions, memory, and finishing tasks. But what happens when the problem is not that they can’t focus on the information they receive? For some kids, that information never makes it through to their brain in the first place.

That’s what’s happening in children with auditory processing disorder. They don’t have a problem hearing, and they may not even have an issue with focus. They have a problem processing the information that comes to their ears. So how can you tell if your child isn’t paying attention because they can’t hear, can’t focus, or both?

WHAT IS AUDITORY PROCESSING DISORDER?

An auditory processing disorder affects auditory areas of the brain and its interpretation of sounds, according to the American Academy of Audiology. This can be more pronounced in noisy environments, like a classroom or lunchroom. “Symptoms for auditory processing disorder are having trouble understanding what’s being said in noisy places, following directions, telling the difference between words and noises that may sound the same,” explains Dr. Dean Beckloff of the Beckloff Behavioral Health Center in Dallas. Not being able to understand what people are saying can cause kids to check out and quit paying attention, which is where these symptoms can get confused as attention deficit hyperactivity disorder (ADHD).

Auditory processing disorder hasn’t gotten the same kind of attention as other processing disorders because it’s not a separately recognized condition, says Dr. David Atkinson, associate professor of psychiatry at UT Southwestern in Dallas. “Central Auditory Processing Disorder has been noted in the literature for well over 20 years. But because it’s not a DSM-5 recognized psychopathology distinct disorder, sometimes this is something that doesn’t get the research attention that the DSM-recognized disorders get.” DSM-5 refers to the Diagnostic Statistical Manual of Mental Disorders, fifth edition, put out by the American Psychology Association, which identifies known psychological disorders. That doesn’t mean auditory processing disorder isn’t real, but it does impact how much research attention it gets and how it’s treated.

How Adhd And Auditory Processing Disorder Are Similar

While often behavior in the classroom can be the tipoff that a child needs additional help, that help doesn’t end with a diagnosis and prescription. Doctors already know that stimulants can help the most bothersome symptoms of ADHD, but if an auditory processing disorder is present, they may still need additional help, says Atkinson. The inability to process speech can result in missing information. “I can see this sometimes in the ADHD kids where if a teacher’s angry, they pick up, ‘Oh, teacher irritated,’ but they don’t pick up the actual instruction that the teacher told you, ‘I want you to put your name on the paper and the date on the top right-hand corner.’” Until they get the needed help understanding what’s being said, they are still likely to exhibit behaviors that appear to be ADHD, like not following directions, says Beckloff. “So that’s where it gets very hard to distinguish between the two.”

These two conditions are also similar in that they can be genetic, environmental, and/or a combination of the two. Jane Shook, a Dallas speech pathologist, says one trigger for auditory processing disorder can be ear infections while speech is developing. “The inner ear is a nerve bundle that is turning sound energy into electrical energy to send it to the brain. If that is inflamed, it is going to send distorted messages into the brain. If you are having those issues at a time of your life when you are just learning the foundational pieces of language, you’re going to send those to your brain [with] missing pieces.” 

According to the American Auditory Society, other associations include premature or traumatic birth, lead poisoning and head trauma, but often the cause of an auditory processing disorder is unknown.

At the core, both disorders impact how the brain handles information. But kids with ADHD are having processing issues in several areas—not just with sound, says Atkinson. “A lot of people with ADHD have deficits in motor planning and emotional regulations. So it’s not just physical impulsivity, it’s also emotional impulsivity.”

Diagnosing And Treating Auditory Processing Disorder

Testing for auditory processing disorder is done by an audiologist and requires children to be at least 7 or 8 years old because of the demands of the test. It takes two hours and requires the child to respond to signals in a sound-treated room. A diagnosis also requires a multidisciplinary approach to determine the extent of any other processing deficits. An educator is needed to determine the problem areas at school, you may need a psychologist to evaluate cognitive function, and a speech pathologist can help determine if there are difficulties in other areas of written or oral language.

The good news is, there’s no age beyond which you can’t be treated or can’t see improvement, says Shook. “Certainly, the younger you are, you’re going to have faster results. The brain is much more plastic than we ever thought it was,” she says.

Treatment of an auditory processing disorder, with or without ADHD, will also involve a multidisciplinary team. Due to the nature of language processing and how the child has learned to cope with it, it will take an individualized approach. Some kids need speech therapy with a professional or at school, while others can work with a computer program at home or with a parent.

Common treatment for auditory processing disorder is a combination of therapies for long-term success and strategies for short-term success. This includes things like using visual aids to help kids keep track of schedules or instructions, using closed captions when watching TV, establishing eye contact with your child before speaking to them, and minimizing background noises like the TV or radio.

Once you have figured out a course of action, you may notice new self-confidence in your child, both academically and socially, says Dr. Beckloff. He often says to parents, “Let’s test, understand where the strengths are and play to those, and the weaker areas we work on beefing them up, what we all have to do.”

SYMPTOMS OF ADHD VS. AUDITORY PROCESSING DISORDER

ADHD

Trouble focusing

Lack of impulse control

Trouble managing emotions

Memory challenges

Trouble finishing tasks

Unable to concentrate on tasks

AUDITORY PROCESSING DISORDER

Trouble following directions (when spoken)

Easily distracted by background noises

Trouble following conversations

Trouble remembering things that were heard or spoken

Trouble with reading or spelling

Asking people to repeat themselves