If a Child Doesn’t Follow Directions Does He/She Have ADD or APD (Auditory Processing Disorder)?

Children with both, Auditory Processing Disorder (APD) or Attention Deficit Disorder (ADD) will seem inattentive and not follow directions, but we can’t rely on observed behavior alone to determine ADD or APD. It is important to administer specific assessment batteries to diagnose either APD or ADD. APD diagnoses are the purview of audiology and ADD should be diagnosed by a psychologist. It is not easy to differentiate among the two conditions, especially because they may coexist in some children.

Children with ADD and ADHD (Attention Deficit Hyperactive Disorder) will typically have difficulty with all aspects of communication unlike the APD child who will mainly struggle with auditory-verbal communication. The APD child might be inattentive because the message received by his/her brain is garbled or unclear, requiring more effort to decipher. The ADD child has difficulty attending in any modality and any kind of task. He/she will start projects, games, sentences, ideas, chores, but is unlikely to finish them. However, there are certain tasks like watching certain TV shows or video games that might enthrall them and they might play/watch for hours.

Each child is different and behavior may vary greatly. The important message to take from this paper is that some kids with APD have erroneously been diagnosed as ADD and have been medicated when no medication was needed. Some kids with APD might also have attention deficit and thus medication helps but it doesn’t take care of the problem as the auditory processing deficit has not been addressed.

To make things even more complicated there are several different kinds of auditory deficits. Following is an abbreviated list of some auditory processing deficits:

  • Sound localization and lateralization
  • Auditory discrimination
  • Phonemic decoding
  • Binaural integration
  • Temporal masking
  • Association deficit
  • Auditory memory
  • Sequencing and organization

Children with APD act as though they can’t hear. They say “what?” a lot, they can’t remember multi-step directions, they seems confused in noisy places and they misunderstand what’s being said.

Like everything else in life things are not black or white, there is a continuum of involvement where at one end a child with APD might have slight difficulty hearing in noise and at the other end of the continuum a child might suffer from an association deficit which makes him/her behave more like a child with mild autism or Asperger’s syndrome.

A child with ADD is likely to:

  • Not pay attention to detail
  • Be forgetful and distracted
  • Not be able to follow instructions
  • Not be able to complete tasks
  • Make careless mistakes

There are therapies that will help both; children with ADD and APD. Because there is no side effect or downside to these therapies (other than the cost of course), I recommend trying therapy before medication. If you suspect your child from having APD/ADD have him/her evaluated by an audiologist and psychologist. Depending on the results and what each professional recommends, these are some of the therapies I’ve used with many children with wonderful results:

  1. FastForWord ( http://www.scientificlearning.com )
  2. Interactive Metronome ( http://www.interactivemetronome.com )
  3. Earobics
  4. BrainTrain

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