When Auditory Processing Disorder Keeps You Isolated

There is help available if you have trouble understanding what others are saying

For the second time, my 86-year-old father decided to forego a monthly stand-up lunch with a group of friends. He no longer enjoys these gatherings because, even with hearing aids, he cannot understand a word someone says – he may have central auditory processing disorder (APD).

Extensive research is being conducted at Ohio State University to determine the impact of auditory processing on aging. Studies have shown that constant wearing of hearing aids for those who use them can delay decline or even improve cognitive function. | Credit: Getty

The American Speech, Language and Hearing Association refers to central auditory processing disorders as deficits in the way auditory information is processed – what the brain does with what the ears hear. APD is commonly thought to be a neurological problem due to damage to the central auditory nervous system.

Other causes include long-term noise exposure, such as being in noisy work environments or delayed access to hearing aids.

However, Dr. Jay Luckerprofessor emeritus at Howard University with an audiology practice in Reston, Va., notes that there are many types of APD, and they often involve other systems, such as executive functioning, attention, decision making and language processing.

Additionally, APD can result from an accident, such as a traumatic brain injury, a disease process such as multiple sclerosis, or an unresolved childhood developmental issue. Other causes include long-term noise exposure, such as being in noisy work environments or delayed access to hearing aids.

Symptoms of this disorder may involve:

  • Difficulty understanding spoken language in noisy environments
  • Incomprehensible messages such as sarcasm or jokes
  • Frequently asking people to slow down or repeat themselves

Additionally, decoding issues are common, such as switching between sounds (bag for Thumbtack) or omitting sounds (star instead of beginning). Cohen says problems with APD (think hearing words in the wrong order or having trouble understanding a person when there are a lot of speakers in the room) often leave people with mental and auditory fatigue and anxiety, which reduces the desire to socialize.

While many consider APD to be more evident in noisy atmospheres, architecture can also have an impact. For example, rooms with high ceilings and large windows resonate sound. For Dr. Sandra Gordon-Salantprofessor of hearing and speech sciences at the University of Maryland, “places of worship can be challenging auditory environments.”

In the lyrics of Gail Whitelaw, Ph.D.clinical associate professor and clinical director of the Department of Speech and Hearing Sciences at The Ohio State University, “many people with APD have significant communication impairments that impact their work lives, social life and their quality of life.

What to do if you have symptoms

Rather than turning down social engagements, people with hearing and listening problems should seek formal diagnosis and treatment. Whitelaw acknowledges that “APD is considered underdiagnosed because listeners with these types of problems are told they have normal hearing and their concerns are dismissed.”

The best place to start is with a standard audiological evaluation. Be sure to find an audiologist knowledgeable in APD who can perform a thorough exam.

Still, Whitelaw estimates that up to 26 million American adults may have APD or a similar disorder. The best place to start is with a standard audiological evaluation. Be sure to find an audiologist knowledgeable in APD who can perform a thorough exam.

While the standard hearing test focuses on the peripheral auditory system (outer, middle and inner ear), APD is related to the “ear to brain” connection. The standard test serves as a fundamental test for hearing, but it will not challenge the auditory system enough to assess APD.

“There is little correlation between hearing well in quiet and being able to hear effectively in the presence of background noise,” says Whitelaw. Instead, she encourages the use of self-assessment, such as the Adult hearing performance scale (AAPS), with a battery of tests that verify real listening skills.

Dr. Samira Anderson, an associate professor at the University of Maryland, has done extensive research on APD testing. In addition to behavioral tests, she uses electrophysiology to assess how the brain processes speech signals. She acknowledges the challenge of assessing APD in adults, “is it hearing loss, cognitive decline, or both?”

How to improve comprehension

Given the multiple types of APD, individuals should work closely with their audiologist to ensure treatment is appropriate for their condition. For example, says Lucker, “a listening enhancement program can improve the ability to focus on important spoken messages and filter out background noise. Yet it won’t help with sound hypersensitivity.”

Plus, pursuing options that specifically address your issues will help ensure convenient treatment. An alternative can be hearing aids as they can help filter out noise. Remote microphone technology can also be advantageous.

Being socially active is key to feeling engaged and maintaining your health.

Similarly, auditory training programs, such as Amplify, CAPDOTSPioneer of acoustics, and word success, can help train the brain to be better listeners. Treatment can also focus on individual therapy training. Cohen typically works with patients for 12 to 14 weeks, depending on the protocol (such as Buffalo Model Therapy or ARIA) used to address specific issues.

Environmental changes also make a difference. As an illustration, Whitelaw suggests fostering useful two-way communication by reducing the distance between speaker and listener, positioning oneself with their back to the wall and away from noise (like in a restaurant), being able to see the speaker and asking the speaker to speak clearly and rephrase, if necessary.

Long-term impact of ODA

Extensive research is being conducted at Ohio State University to determine the impact of auditory processing on aging. Studies have shown that the constant wearing of hearing aids for those who use them can delay decline or even improve cognitive function.

Likewise, being socially active is key to feeling engaged and maintaining health. If you have trouble following conversations, understanding the dropping line of a joke, or following directions, consider an assessment for APD.

Finally, my dad decided he would only eat lunch with groups of four and at a restaurant that allows them to eat in a booth to keep the noise down – it allows for more meaningful conversations and deeper connections.

Judy Harju Galliher
Judy Harju Galliher recently retired from a 37-year career in corporate communications during which she wrote about issues related to health and well-being, data center management and security of schools and colleges. She continues to immerse herself in stories that fascinate her and has been published in The Mindful Word and The New York Times. Read more