Hidden Disabilities: Auditory Processing Disorder (APD/CAPD)

When speaking of “disabilities,” mental images of missing limbs, muteness, deafness, and blindness, would pop up- and it is understandable because they are hard not to notice. These are very visible- and familiar- disabilities which would force an individual to be accommodated by society through infrastructural inclusivity, mainstreaming their vernacular language for living feasibility, like braille for the blind and sign language for the deaf and mute, and educating the general average populace about them through sensitization. There is a conscious effort to empower them so they can succeed in life in any sector of society, and likewise, society works to meet them halfway and make things a norm, by combating stigma and exposing the rest of society to them early, and continuously, so no one looks at a blind or lame person and feels surprised, acts demeaning, or lacks social skills on how to relate with the person.

Hidden Disabilities

Interestingly, an article written by World Health Organization last year noted that an estimate of a billion people live with some form of disability- that’s about 15% of the world’s population. To make it worse, about 80% of these people have other hidden disabilities. Hidden disabilities are defined as a “spectrum of hidden disabilities or challenges that are primarily neurological in nature”. They are not immediately visible and span from mild deafness, sight impairments of varying strengths, chronic pains, and mental illness.

Auditory Processing Disorder (APD)

One of the many hidden disabilities is the Auditory Processing Disorder (APD) or Central Auditory Processing Disorder (CAPD), also rarely termed as the King-Kopetzky Syndrome, or the Auditory Disability with Normal Hearing (AND). This disability covers a wide range of disabilities which interfere with the brain’s processing of auditory information. Persons with APD typically have normal structure and operation of outer, middle, and inner ear, however, they struggle to receive sounds the same way others do. This results in difficulties recognizing and interpreting sounds and words, finding the source of sounds, differentiating the subtle differences in words, making sense of the order of sounds, and/or blocking out background noise. For instance, when a person says “that” the child or adult could hear “hat,” though the word had been said clearly and loudly enough, with no impeded pick-up or strong external interference. Therefore, APD is not a learning disability or form of hearing loss, but rather a neurological, brain comprehension-related, problem. The person understands what is being talked about, but has challenges in processing the data into retained auditory information. 


According to the American Academy of Audiology, APD is diagnosed by difficulties in one or more auditory process which reflect the function of the central auditory nervous system. Therefore, APD is thought to result from a dysfunction in the central nervous system. It hasn’t been affirmed what causes CAPD, but doctors presume that it could be a result of:

  • Illnesses such as chronic ear infections, meningitis, or lead poisoning
  • Nervous system diseases, such as multiple sclerosis, or damage to the nervous system
  • Premature birth, low weight, pre-natal complications
  • Ageing
  • Head injury
  • Genes since APD may run in families.

Anyone can have APD, from children to adults, and research shows that males seem more likely to have it than females. APD often starts in childhood, often causing delays in learning, and may continue into adulthood. Studies show that its prevalence increases with natural ageing with about 2-7% of children diagnosed.

APD may also be linked to other disabilities with similar symptoms. In fact, it may be part of the reason some people have dyslexia, a learning disability in reading. Some experts think children are sometimes diagnosed with ADHD (Attention Deficit Hyperactivity Disorder) when they actually have APD.

Signs and Symptoms to Look Out For

Considering the consequences of such an unseen handicap, one can imagine the nightmare school is for kids with this condition. So it is advised that parents and guardians take note of complaints by their children, or teachers, about struggles in understanding lessons in class and instructions. Should you think you, or your child, has CAPD, schedule professional assessment by an audiologist. The following list has some signs and symptoms from various sources which can help in identifying CAPD as a possibility. It is not exhaustive, and varies from person to person, but it can give you an idea of what to look out for.

  • Has difficulty remembering language-related tasks or presentations, but may have no trouble interpreting or recalling non-verbal environmental sounds, music, etc.
  • Problems related to reading, spelling, and overall learning; difficulties learning a new language
  • May process thoughts and ideas slowly and have difficulty explaining them
  • Misspells and mispronounces similar-sounding words or omits syllables
  • Has trouble locating sounds and confuses similar-sounding words
  • May be confused by figurative language (metaphor, similes) or misunderstand puns/jokes; interprets words too literally
  • Often distracted by background sounds/noises and frequently responds inconsistently or incorrectly
  • Finds it difficult to stay focused on a verbal presentation or lecture
  • May misinterpret/have difficulty remembering oral directions; following directions in a series
  • Poor performance on speech-language, or psycho-educational, tests (auditory-related skills)
  • Has difficulty comprehending complex sentence structure or rapid speech
  • “Ignores” people, especially if engrossed, and says “What?” a lot, even when has heard much of what was said.

What Next?

If you, or your child, have been diagnosed with CAPD, there are tips on how to live with the disability and accomplish day-to-day activities. However, treatment plans for CAPD depend on each person’s diagnosis- and the disorder is not curable. Early diagnosis along with lifestyle and learning adjustments would be made to accommodate the neurological hiccup and improve hearing skills. Some of them include:  

  • Showing instructions or ideas rather than explaining them
  • Installing “classroom support” such as with the use of electronic devices, like an FM (frequency modulation) System so the student can hear the teacher better; by placing the student in a better position to hear, like the front of the classroom, and by limiting noise
  • Supplementing with more intact senses (use visual cues, signals, handouts)
  • Strengthening other skills like memory, critical thinking, problem solving skills, and other learning skills to help the student deal with APD
  • Reducing or spacing directions; give cues such as “ready?”
  • Encouraging reading to clarify word pronunciation and comprehension; speech therapy focusing on student’s weak points
  • Reducing use of noisy electronics like the radio and television at home
  • Rewording or helping decipher confusing oral and/or written directions
  • Teaching abstract vocabulary, word roots, synonyms/antonyms
  • Varying pitch and tone of voice, slowing speech pace, stressing key words
  • Undergoing speech therapy which can help in recognition of sounds and improvement of conversation skills
  • Asking specific questions as you teach to find out if they do understand
  • Adding rugs at home to reduce echoes
  • Allowing for “think time” to respond (5-6 seconds) and
  • Having the student constantly verbalize concepts, vocabulary words, rules, etc.

Sadly, despite the prevalence of invisible disabilities, not a lot of attention is given to it. The causes of this originate from both the challenged persons themselves and society. Amplifying individual concerns about stigma, employment discrimination, and challenges in keeping the job, there is society’s lack of awareness about the long

(long) list of hidden disabilities among challenged and normal persons. Consequently, it ties closely with the effects being visible in the workplace, health, social life, and individual future expectations. This noticeable gap in knowledge and reform for persons with hidden disabilities is an innovation and educational opportunity as well as a welfare need.

By: Ann Yebei

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