I’m going to tell you a story.

It’s about a recent presentation I gave on Auditory Processing Disorder.

Afterwards one of the attendees had some specific questions,

and I had some ideas to offer. Here’s how it goes:

One of the things that I had mentioned that APD wasn’t really “curable”, but that one could improve some skills to cope with it. She was concerned because the school had released her son from therapy some years ago, and yet her son was demonstrating obvious difficulties again … she was concerned and puzzled.

As I’ve mentioned before, a person can “lose their label” by having achieved the proscribed psycho-educational goals. This means that the particular skills have been met so that the problem is no longer severe enough to warrant the diagnostic label. The therapists, the school district that may have employed them, the family, and the child have all succeeded in the neatly-documented IEP goals. Whoopee!

But in cases like this, although the child’s enunciation may be much improved, and his phonemic awareness sharpened (meaning he is better at discriminating between different spoken sounds), that does not mean the APD has necessarily gone away.

So why was the boy having so many of the familiar, discouraging, “Huh?” moments again?

Well, I asked, how old is the boy now? Thirteen, she explained. Ah, yes … well, things have changed in the school environment. Think about it: he was doing well in grade school, where one has relatively small classes with the same teacher all day long. It’s easier to know what’s going on because there is a lot of consistency.

But when you get to junior high / middle school, suddenly there are class changes all the time, with different teachers who have different speaking and teaching styles. There’s also a lot heavier cognitive demand going on academically as well, as the material is more abstract and is being assessed at higher taxonomic levels. Students have to start taking more notes as part of their instruction and learning processes. Things are much more complex and demanding now. Plus, the social world in junior high is a really rough place, which adds to the stresses. There are a lot of changes to get used to and learn to deal with.

She went on to explain that before the APD diagnosis, they were concerned because the boy was speech-delayed, and not very social; he just “sat in the corner and played with his Legos”. They’d even wondered if he was autistic or something.

I was nodding energetically again at this familiar tale (as are, I’m sure, a lot of you readers). It’s quite possible that the boy could have something else in addition to the APD, as a lot of these things are co-occurring (“comorbid”). A lot of the symptoms tend to overlap, especially with AD/HD, Asperger’s, or Non-Verbal Learning Disorder.

There seems to be this phenomenon of what I call “diagnostic stoppage” where if a person gets one diagnosis, it is usually deemed sufficient to describe most all issues they are having. It’s as though a person is only “allowed” one disability, possibly because that’s more one-dimensional and therefore much easier to deal with.

As tutors, such problems with our own children are particularly frustrating for both of us, because one of the problems is that no matter how much either of us knows about teaching or tutoring, our offspring are quick to tune out any advice or suggestions we may have, because at home, we’re just Mom (or Dad, as the case may be for some of the other tutors).

On the more immediate end of things, she asked, what about all those “Huh?” moments? Of course, the kid never seems to misunderstand when asked, “Do you want to get a new video game?” But if you ask, “Did you remember your materials to study for the history test?” then there’s that “Huh?” response again. She explained that years ago the therapist said he had a “15-second delay” in processing. Fifteen seconds is a l-o-n-g time. (Seriously, watch fifteen seconds on your clock.) What was going on, and what could be done? Did it really take him 15 seconds to process the test-studying question but not the game-purchasing question? Parental skepticism and frustration and confusion and obvious love for her child oozed from her questions.

Well … probably not, I suggested. Of course, I don’t really know what’s going on in someone else’s brain, but I could describe the sort of thing that might be going on.

Being asked if you want to get a new game is easy — you already know what new games you want.

But being asked about the test studying is more likely about all the accessory answer-processing, than it is about decoding of the sounds into words and the words into a meaningful sentence. Think about it — you’re a teenage kid, and you come home from school. Your mind is already miles away from scholastic subjects, thinking about snackage and relaxing from the work day, when suddenly your mom asks you, “Did you remember your materials to study for the history test?”

So when he says, “Huh?” it’s not so much about not understanding what was being said, as it’s really more of a conversational habit and a place-holder, while he’s thinking. Meanwhile, his mind is churning with thoughts about Test? What materials was I s’posed to bring home? History? What do I need for studying? Did I bring it home? How grumpy is Mom? Do I have to do this right now? Am I in trouble?

Well, that made more sense as a possibility. But how could it be handled?

Well, at our home I’ve a kid of my own with APD, and a hubby who’s hard of hearing. I have APD too, so you can imagine the potential for conversational confusion at times. When I’m being sufficiently self-aware I try to “headline” queries. (Parents aren’t perfect, especially those who are tired and/or pre-occupied, which is oh … 99.9% of us.)

You know how someone at work will stop you in the hallway and ask you a question, and it takes you a few seconds to figure out what they’re talking about? That’s the kind of thing that can be going on. Headlining is about alerting someone to the subject you’re introducing, and giving them time to pull up the necessary information. It could go something like this:

“Say, in your history class,”

(pause a couple seconds for auditory processing and recollection about history class)

“… you have a test coming up …”


“… did you bring home the stuff you need for studying?”

What this does is to not only alert the person to the upcoming subject of query and slows down the rate, but it also does something else that’s important. The normal question (in English) would actually have those three parts in reverse order: “Did you bring home the stuff you need for study for the test in history class?”

So someone with APD is not only decoding a long sentence, but also trying to put the parts into order (sequencing is a common issue in APD), and also trying to figure out what they need to know to answer the question plus recalling the necessary information.

The headlining puts things into the right processing order, and gives enough time to retrieve the necessary bits of information, review them, and assemble an answer.

Additionally, it might be time for someone (else) to review her son’s situation. New demands upon his abilities can mean new difficulties.


  1. RH said,

    11 August 2011 at 17:47

    Doe anyone know who the best audiologist is for adults with CAPD? I haven’t been diagnosed, so I need to be tested as well. I live in Atlanta, but am willing to travel anywhere to get help.

  2. Susan G. said,

    29 January 2011 at 22:16

    My 40-year-old daughter has been struggling with APD all her life. We learned that she had it 15 years ago but really didn’t take any steps to address it. We are now trying to get all the information we can and give her some coping mechanisms. This blog has been very helpful. Just seeing that other people have this problem and that it has a name makes us feel better. Thank you for making this possible.

  3. Donna R. said,

    14 January 2010 at 19:32

    My daughter is 18. Has APD and basically fell apart entering the high school scene. As a result she also struggles with mild depression & anxiety/panic disorder. She is a very young (somewhat immature) 18 year old. She is discovering her limitations in the workplace & I think it is really scaring her. I don’t believe she has actually told an employer (or prospective employer) of her APD. I think they need to know so she presents herself honestly. That she is a hard worker, but may need their help periodically for redirection. Am I wrong?

  4. jean s said,

    6 September 2009 at 14:47

    My grandson was recently diagnosed with APD and I had never heard of it. Thank you for all of the first hand tips and ideas to help him. He is a wonderful 9 year old that was treated unfairly in previous school years. I hope with the diagnosis and with the teacher training, he will finally enjoy school instead of dreading it.

  5. Lisa G. said,

    9 March 2009 at 14:59

    Today I stumbled upon your blog desperately seeking migraine info. While your migraine description was no surprise here, being sidetracked to this APD installment really opened my eyes. I already communicate in the way you describe as ‘headlining’ and did not realize I was doing so. What I do realize is how difficult simple instructions and processing of incoming communications have been, and how limiting. Wondering if APD can come and go since when I am not in that mode I experience the exact opposite – but only under pressured situations with high accountability expectations. Can it be turned off? It all seems too extreme, just like entering and exiting migraine.

  6. Melissa Wagner said,

    23 September 2008 at 5:00

    Your blog is such a wealth of info for a mom with a child with SID and auditory processing issues. I had so many of these issues as a child (including difficulty recognizing people out of context) and its wonderful to know some of the underlying problems that made me feel stupid or just weird at times.

    Thanks for the practical suggestions

  7. Amanda said,

    30 August 2008 at 2:45

    HI! I just wanted to let you know how helpful your blogposts are on APD. My 9 year old daughter was recently diagnosed with CAPD last year, and I am struggling to get her school to do the proper testing so that she can receive the proper services. I am a school teacher, so you think that it would be a little easier, but nope, I have met the same brick wall that every other parent must meet. Is it normal to have to constantly remind yourself that not your child is not always disobeying you, the directions that you have given them have been misunderstood, or forgotten completely? I would like to find some literature or a “support” forum (for lack of better term), but there is just not a lot of information out there that is readily accessible. Sorry to ramble, once again, thanks for your insights that help me to better understand my precious daughter!

  8. Jamie said,

    18 August 2008 at 0:57

    Thank you for the suggestions. I am glad that I found your blog.

    I will try this method on my seven year old with ADHD and of course many of

    what I call side-kick dissorders. Again thank you very much.

  9. shiva said,

    15 March 2008 at 17:34

    Interesting. In the UK, APD isn’t (generally, as far as i know) regarded as a “diagnosis” in itself, but as a symptom that can be diagnostic for several conditions. This is a much more sensible way of looking at it for me – while it’s possible to have APD without having any broader condition that it’s a part of, i doubt it’s common – and it seems like pretty much everyone with autism, AD(H)D, dyslexia or dyspraxia has some degree of difficulty with auditory processing.

    There are also several physical impairments which can cause auditory processing difficulties, and they can also result from, for example, temporary deafness during periods of childhood in which “normal” learning of how to process sound usually occurs (I know a couple of people who have it for this reason).

    The concept of APD, when i discovered it, was immensely useful to me, because it explained perfectly why i could hear sounds that the majority of people had difficulty hearing, but still found it difficult to understand what people were saying if there was any noise in the background, for example. But it doesn’t really make sense to me as a “condition” in itself, but as one aspect of the sensory integration difficulties associated with Aspergers/autism.

    It seems like the US in particular likes to give people multiple, very specific labels (even down to a label for each individual “symptom”), when one, broader diagnosis could make large numbers of the more specific diagnoses redundant (and avoid the regarding of “labels” as somehow mutually exclusive to each other which you descibe so often)…

  10. andrea said,

    15 March 2008 at 15:54

    Mike and David,

    Glad to hear that you think it’ll be helpful! It’s really useful for any sort of class, especially on Mondays or after long breaks, when the subject material is mentally buried under everything that’s happened since then. This first example is much easier for everyone to mentally re-group and pull up the relevant information, than the second, more typical phrasing.

    “Last day we met and we were talking about cells … How mitosis is when one cell divides into two, for growth (show diagram) … There were four steps: Prophase, Metaphase, Anaphase, and Telophase (show next diagram and point to each step, with a slight pause between naming each for the students to recall information) … Today we’re going to review meiosis, which has some things in common, and some things that are very different.”

    “Today we’re going over meiosis, which is like mitosis with the same steps but is a different cell process.”

    Frankly, this is not a completely new concept — in serial shows, they always did a recap, “In our last episode…” The difference however, is the sequence of concepts used in the Headlining, where we go from most general to most specific, rather than the usual grammatic structure that is bass-ackwards.

    I also like to use the terms “last day” and “next day” rather than trying to remember the specific weekday. It removes the conversational sideline of trying to remember which day it was we last met. Anything that helps me and the students stay on track is a good thing! (-:


    You’re quite right — sorting all the sensory stimuli, deciphering it, “patterning” it, and then creating sensible meaning to the patterns does take a while.

    This is especially true for the whole patterning part, because you have to perceive which elements are significant, determine if they belong together in the same pattern, and then figure out what the pattern is related to or what it means. Then we have to be able to identify when something is different or additional to the pattern, and the resulting significance to that. (This is part of why so many autistics don’t like changes in routine. There’s an additional pattern-decoding demand, as well as having our numerous coping-strategy subroutines messed up.)

    And yes, attention-shifting is problematic for lots of people, including myself. I’ve finally written myself a little “script” to pull out when I’m interrupted, so I can be respectful to the other person and advocate for what I need, “Just a moment — let me finish this one thing so I can give you my FULL attention.”

    After all, if they’re bugging me, naturally they want my full attention. Most people are willing to wait a moment to let someone else finish.

    And as you might expect, I have to do a bit of switching just to go from focusing to being able to recognise this interruption, and then pull up that script. For that intermediate step, I’ll point one index finger in the air, a cultural sort of, “Hold on a second” sign, which gives me the few seconds necessary to retrieve the phrase and engage the speech processor.

    Having that phrase not only lets the other person know I’m not ignoring them and will attend to them, but it also helps remove stresses from me, because I don’t have to invent a whole new sentence on the spot (with the required polite social noise framing it), and also because I know that I will be able to finish the thought or activity step I’m on. I’m allowed to continue my focus and reach a natural breaking point, which is satisfying.

    Come to think of it, this is sort of the first-person variation on the parent’s “five-minute warning” (“We need to leave in five minutes, finish up what you’re doing.”)


    • Dorothy said,

      15 October 2010 at 5:47

      That variation on the “five-minute warning” works fine with adults–I’ve naturally used it most of my life. However, it does not work well with children who expect your full attention immediately and can’t wait for me to finish the thought that was already in my brain before I can even process that they need to tell me something. I find myself becoming very overwhelmed when I have one interruption let alone 2 or more coming at me at the same time along with background noise, etc.

      I have never been diagnosed with APD but as I am learning about it I am seeing the symptoms I’ve had all my life. I have had multiple hearing tests and been told consistently that my hearing is fine. Yet, subjectively, I knew differently. I knew that in crowds it was impossible to hold a meaningful conversation, that I could only pick out the clearest words in most music. I am intelligent and done well academically all my life but I now see how I have been compensating. With age and children I am now so overwhelmed that I don’t have the ability to “cope” as I have in the past.

      Now, my son seems to be having similar problems and I am learning about APD. With us both having difficulties it is going to take a lot of patience and tolerance not to butt heads often due to misunderstanding or impatience.

  11. alyric said,

    15 March 2008 at 14:16

    Going to add my ten cents worth here – What about the newness factor – for completely new, never before experienced environments? That’s a very big issue for my lot and seems to be simply a matter of absorbing enough detail over at least a year – possibly more. Only time and familiarity fixes this one.

    And shifting tracks is another. If the brain is pleasantly occupied thinking of topic x – it’s going to take time to track whatever it was someone said.

  12. 15 March 2008 at 11:35

    I could incorprate this idea in the professional training courses that I devise and occasionally get to run…

  13. mike stanton said,

    15 March 2008 at 10:09

    I have not been around in a while. I am glad I dropped by. Headlining will definitely become part of my teaching style from now on. Thanks.

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