Is it ADD or Auditory Processing Disorder? How to tell the difference

Auditory processing is when the brain cannot “hear”.  “DA” becomes “GA” and “dat” becomes “that” and “three” becomes “free”.  This does not usually show up in reading where some children have difficulties with phonetics when “dragon” becomes “draw”.

And it is acutely different from ADD/ADHD when behavior is the component that is the distracting factor for discriminating directions and organization.  Actually APD can be 3 disorders in one; which is why it is so hard to diagnose.

All of these disorders require that a speech pathologist diagnose these issues correctly. And finding the right clinician is as important, if not more than, as seeking out the right treatment.

The child with APD may be experiencing auditory memory issues, sound discrimination, and sound localization.

A child with APD is literally living in a world of auditory chaos. It as it they are living in a world of constant “hum” that is blocking out essential information so that they are “hearing” their world through a static filter.

In contrast the ADD/ADHD child is experiencing his or her world in “fast forward”. They are catching only “snatches” of what they should be doing so that they need and require multiple repetitions so that complete information can be received and utilized appropriately.

In the clinic these children can look similar but in truth they are very different.  However, both are experiencing neurodevelopmental delays that negatively impact their ability to perform both in academic and social situations.  Both carry with it emotional factors that if misunderstood, can look like oppositional behavior issues.

The ADD/ADHD child has more active random responses to stimuli while the APD child just appears “detached” and “uninvolved”.  The APD child can shut down with too much stimuli and “phase out” while the ADD child often escalates behaviors that are hard to modulate and/or tamper down.

Both however, can be subject to temper tantrums due to frustration and both can be very hard to teach because the “message” is not getting across. With the APD child comprehension is blocked; with the ADD child it is as if the directions are being broadcasted with a lot of static.

With the ADD child creative repetition is an excellent way of teaching new skills and reinforcing old ones. With the APD child multiple sensory and cognitive pathways must be recruited for the child to understand since the auditory route is not giving direct clear information.

Characteristics of the APD and ADD Child –however keep in mind that issues such as fear of failure can be seen in both children and that there is some overlap.  These lists are meant for general clarification not as an absolute.

ADD/ADHD Characteristics	APD Characteristics
There are two main types of ADD ·       Inattentive ·       Hyperactive	Also known as Central Processing Disorder
These children can be: ·       Impulsive ·       Hyperactive ·       Short attention span Doesn’t pay attention to details ·       Makes careless mistakes ·       Has trouble staying focused; is easily distracted ·       Appears not to listen when spoken to ·       Has difficulty remembering things and following instructions ·       Has trouble staying organized, planning ahead, and finishing projects ·       Gets bored with a task before it’s completed ·       Frequently loses or misplaces homework, books, toys, or other items ·       Difficulty with transitions ·       Can be oppositional ·       Can have difficulty sleeping ·       May be tantrum prone ·       May need situational changes in order to shift to different activities ·       May be compulsive ·       May have anger management issues	These children can be: ▪       Easily distracted or unusually bothered by loud or sudden noises? ▪       Noisy environments can be upsetting ▪       Behavior and performance improve in quieter settings? ▪       Difficulty following directions, whether simple or complicated? ▪       Reading, spelling, writing, or other speech-language difficulties? ▪       Abstract information is difficult to comprehend? ▪       Verbal (word) math problems difficult for your child? ▪       Conversations are difficult to follow ▪       Tends to withdraw from social situations (even though they desire to be included) ▪       Over-reactive to corrective remarks ▪       Does not know when to ask questions ▪       Fear of failure ▪       Overly dependent upon teacher/parent/etc. ▪       May have articulation issues ▪       Does not understand jokes and may have difficulty reading facial expressions

Complicating this is the fact that often these two diagnoses can be seen co-existing in one child.  Often children with these issues are best seen in both occupational and speech therapy. When possible, co-treatments are often very beneficial for maximum therapy outcomes.  Children with ADD and/or APD are highly emotionally charged individuals. Therefore all interventions must include activities that respect both the psychological and the neuro-developmental aspects of performance.

Susan N. Schriber Orloff, OTR/L, FAOTA is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the WIN™ Write Incredibly Now™ Program (available through YourTherapy’Source.com).  She is also the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA.  She can be reached through her website at www.childrens-services.com or at susanorloff@childrens-services.com.