Hearing But Not Listening: The Dilemma of Auditory Processing Difficulty

Auditory Processing Difficulty can be puzzling for parents and educators, for several reasons. It is still a relatively unknown condition outside the professional brain science community. Because its symptoms present as focus difficulties, it can easily be confused with attention-deficit/hyperactivity difficulty (ADHD).

This misunderstanding is due in part to the instinctive connection we make between “auditory” and hearing, notes Ali Hashemian, Ph.D. The association is actually much more nuanced. “Hearing is not the same as listening, just as seeing is not same as the ability to read. So giving a child a hearing test does not uncover the problem,” states the neuropsychologist, the founder and Director of the Attention & Achievement Center in Northern California.

Hashemian explains that the brain goes through a very complex—and rapid—

Series of activities to transmit information to the auditory cortex, where auditory sensations are transformed into perception. A glitch along this pathway can slow down that process. Auditory difficulties can be a consequence of multiple ear infections, ear tubes, or a damaged membrane. Even colds or congestion that disrupts a child’s emerging auditory development can trigger eventual comprehension problems.

In the classroom, the child with Auditory Processing Difficulty is likely to miss a step or two of oral instructions and quickly becomes lost or left behind. Teachers tend to interpret this inability to follow directions as a failure to pay attention.

Another associated problem is sound sensitivity, manifested as difficulty understanding speech in a noise-filled background, i.e., the typical classroom. Some children hone in on certain frequencies like lawn mower engines or police sirens. Although the sound is outside, for the sound-sensitive child it can overpower all other speech inside the classroom.

Similarly, a child can have a hard time filtering out the sound of other people talking. In a classroom, this student will not be able to separate multiple voices to focus on the teacher. “When another person’s conversation drifts into yours, you get mixed up,” Hashemian points out. “This can mimic an attention deficit, but the fact that is only aural, and not visual, confirms that it is not ADHD.”

An immature or poorly developing auditory cortex also makes it difficult to understand speech that is less than ideal. When someone has an unfamiliar accent or can only be seen from behind, we should be able to understand speech without looking at the person, according to Hashemian. “If you have to be looking to understand, you are supplementing auditory processing with visual cues.”

Another possible complication is the discrepancy in the way the right and left ears process information. Again, Hashemian emphasizes that this relates not to hearing but to processing and listening. A hearing test that reveals both ears operating in the normal range does not get to the heart of the question of which ear is dominant. In most humans, it’s the right ear, which has a direct path to the brain’s left temporal cortex, where all auditory processing takes place. Information that enters from the left ear goes first to the right temporal cortex and then back to the left, a detour that affects listening and comprehension.

Auditory Processing Difficulty should not be ruled out when a child is suspected of having attention difficulties, especially when medication is being considered. Just as ADHD medication cannot help someone with poor vision, a, prescription is not the solution to an auditory processing problem. The professionals at the Attention & Achievement Center can administer the proper testing to pinpoint the real difficulty. “The key is to make the right diagnosis, and then we can develop the appropriate treatment plan,” Hashemian concludes.

 The Attention and Achievement Center has facilities in five Bay Area locations: Pleasanton, Campbell, San Mateo, San Rafael and Walnut Creek. For more information, visit the website, www.drugfreeadd.com, or call (925) 416-1400.