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Debbie Baerlocher has her Doctorate in Audiology. She has been working at Elks Hearing and Balance, aka St. Luke's Hearing and Balance, in Idaho since she moved to the valley just about 25 years ago. Debbie has been a staff member, clinic manager, and now, the pediatric lead of the audiology program. She works with the newborn hearing screening program, Idaho Sound Beginnings.
She monitors the newborn hearing screening programs in all birthing hospitals in regions 1,2,3 in Idaho, and all the midwives that do hearing screenings. Knowing about a hearing loss early really does mean the best possible outcome for that family and child. Hearing loss is really an access issue, and if we address that appropriately, there is nothing that a child cannot do.
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If your child doesn’t seem to listen, struggles to follow directions, or constantly asks you to repeat yourself, it can be frustrating—and concerning. As a parent or therapist, it’s natural to wonder: Could this be auditory processing disorder (APD)?
The truth is, while APD is a real neurological condition, it’s also one of the most misunderstood. Let’s dive into what auditory processing disorder really is, what it isn’t, and how to support children who struggle with listening and following auditory directions.
Auditory Processing Disorder, sometimes called Central Auditory Processing Disorder (CAPD), refers to a breakdown in how the brain processes auditory information. It is not a problem with hearing itself.
In children with APD, the ears can detect sounds just fine, but the brain has difficulty interpreting and making sense of what it hears. In simple terms: APD is not about the volume of sound, but the brain's interpretation of it.
Children with true APD may:
Struggle to distinguish between similar sounds (e.g., "cat" vs. "cap").
Have difficulty understanding speech in noisy environments.
May take longer to respond to verbal instructions.
Frequently ask for repetition.
It’s important to know that APD is abottom-up neurological issue. That means the difficulty lies in how the brain receives and processes sound, not how the child pays attention or responds to it.
This is where things can get tricky. Many children display symptoms that look like APD but actually stem from other areas.
Children with ADHD, autism, language delays, anxiety, or even a bilingual background may struggle with auditory tasks. But these issues originate from attention, regulation, or cognitive challenges—not from a breakdown in auditory processing.
Common overlapping symptoms include:
Trouble following multi-step directions.
Seeming to ignore verbal instructions.
Difficulty remembering spoken information.
But remember: these symptoms are not exclusive to APD. According to pediatric audiologist Debbie, who has over 25 years of experience, true APD affects only about 2-3% of the general population and is rare, often over-attributed.
Diagnosing APD requires a series of specialized auditory tests conducted by an audiologist. These tests measure how the brain processes different types of sound, often in a distraction-free environment.
But here’s what’s crucial:
Testing must benorm-referenced and validated.
The child should beat least 7 years old, since younger brains are still rapidly developing auditory and language systems.
The audiologist must use across-check principle, meaning more than one test should confirm a deficit in the same auditory area.
If the child performs well in this quiet, controlled setting, it's a good sign that their brain can process sound appropriately—meaning the issue likely lies elsewhere (attention, language, etc.).
Here’s a helpful way to differentiate:
APD = The braincan't accurately interpret sound input.
ADHD/Anxiety/Language Delay = The braincan process sound, but attention, emotions, or cognitive load interfere with comprehension or response.
For example, a child may ignore your request in a busy classroom, not because they can’t hear you, but because they’re overwhelmed by background noise or unsure of what to prioritize.
If you suspect your child is struggling with auditory processing, here’s a step-by-step plan:
Work with a speech-language pathologist to assess receptive and expressive language skills.
Younger children often can’t perform reliably on auditory processing assessments.
Treat attention, regulation, and sensory processing issues before assuming APD.
Excessive screen exposure may limit real-life listening practice.
Read aloud, sing, and narrate daily routines. Create a quiet time for your child to focus on the sounds around them.
Even without an official APD diagnosis, many children benefit from auditory-friendly strategies. Here are a few ideas:
Use visual supports to accompany verbal instructions.
Break down directions into smaller steps.
Play auditory games like "Simon Says" or "Guess That Sound".
Encourage daily reading and audiobooks with physical books.
Seat the child closer to the teacher (first third of the classroom).
Use noise-canceling headphones for focus work.
Minimize distractions during instruction.
Use FM systems or voice amplifiers if appropriate.
Children with frequent ear infections or retained primitive reflexes may show similar symptoms to APD. For example:
Middle ear fluid can temporarily block sound input.
Retained reflexes like the Moro reflex can keep a child in fight-or-flight, making auditory input harder to process.
That’s why it’s essential to assess the whole child. APD shouldn’t be your first assumption—it should be considered only after ruling out other causes.
Here’s the good news: whether your child has APD or not, listening is a skill that can be nurtured.
Start early.
Narrate your day.
Read aloud.
Pause for responses.
Ask questions.
Make sound meaningful and fun.
Every small moment helps build your child’s auditory foundation. And remember: if your child struggles to follow directions or retain auditory information, you are not alone; the right support can make a world of difference.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.
Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.
This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.
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