Snapshots of a Child: A Critical Look at Auditory Processing Disorder Diagnosis

My son runs across the beach, his laughter echoing through the salty air. I watch, a flicker of concern crossing my mind. One foot, ever so slightly, turns inwards with each stride. It’s subtle but noticeable, especially when fatigue sets in. My husband captures the moment in a flurry of clicks—snapshots of pure joy. Gleeful chases through the sand, toes dipped in tide pools, surrendering to the rhythm of the waves. Every image is a picture of perfection.

But perfection is an illusion, especially when it comes to nuanced realities. In still photographs, I could choose to believe everything is fine. There’s no hard evidence of a problem. Just a whisper of doubt. Maybe it’s my imagination. Maybe I’m just being a hypervigilant mother.

Then November arrives. My son’s Montessori teacher, a seasoned educator, reaches out. She has noticed it too. Not a doctor. Not a physical therapist. Just someone with a trained eye and years of experience who catches what static images miss. At school, we get daily photos—frozen moments in time. None of them show anything wrong.

But the truth is not in stills. It’s in motion. A longer video reveals what those photos cannot. Suddenly, it is clear. This is not something to watch and wait. It is something to act on—now—before a tendency becomes a pattern, before that pattern becomes permanence. But I am an audiologist, not a gait specialist. Can I make that call? Should I?

This is the crux of the problem with diagnosing auditory processing disorder (APD). We rely on snapshots. We see slices of a child’s best moment, not the whole film. We create pristine testing conditions—quiet booths, visual breaks, snacks, encouragement. But life rarely offers such perfectly timed respites.

We base diagnoses on standard scores. We draw the line at two standard deviations below the mean (American Speech-Language-Hearing Association, 2018). But what if the children we compare against are outliers themselves? What if our idea of “normal” is already skewed?

We conduct tests in controlled environments, one variable at a time, and only when the child is fully alert and focused (Chermak & Musiek, 2010). Yet most children with APD also struggle with fatigue, attention, anxiety, or sensory overwhelm. Their challenges do not exist in isolation. But we pretend they do.

We cling to the myth of purity—the idea that APD must stand alone to be valid. That a child with ADHD or dyslexia or autism cannot also have an auditory processing issue. In reality, poor processing can magnify every other difficulty. It can even be a result of those other difficulties (American Academy of Audiology, 2016).

Show me a child who lives in a sound booth. Show me one who listens in perfect silence, always attentive, never tired, never distracted. These are the conditions we base diagnoses on. No wonder so many children “pass.” The real world is messier.

Professionals are trained to stay in their lanes. But this leaves entire layers of a child unexplored. Skillsets go unnoticed. Struggles remain hidden. And potential is lost.

Need proof?

In Australia, the APD test battery is limited to spatial processing. If a child can’t localize sound, they may qualify for support. If they struggle in other auditory domains, they don’t. It’s a narrow gate—and it’s policy. The result? Fewer children qualify for government services (Doyle et al., 2010).

In Ireland, APD is almost invisible. It’s not formally recognized. Parents carry the burden. If they push too hard, they may even face consequences (McCormack et al., 2012).

In the United States, we have no national standard. Testing varies from clinic to clinic, provider to provider. One child might be tested using a 20-year-old CD. Another might get cutting-edge digital tools. It depends on geography, licensure, and what the provider happens to have on hand. The child’s outcome can hinge on who pays the bill.

How can we trust a single snapshot, taken in a quiet booth on a good day, to reflect a child’s true auditory ability? Why are we not testing across time, in natural environments, with real-world distractions? Yes, that would cost more. But what’s the cost of doing nothing? Of missing a diagnosis? Of lost potential?

We need to stop relying on snapshots. We need a system that captures the motion of a child’s life. That reflects real-world listening. That honors complexity instead of denying it.

We need collaboration—between audiologists, educators, speech therapists, psychologists, and occupational therapists. We need flexible, evolving testing batteries that reflect real children. Not just clean data.

We need to listen. Listen to parents. Listen to teachers. Listen to the child. And yes, listen to that inner whisper that says, “Something’s not right.”

The photos of my son still hang on our walls—joyful, beautiful, treasured. But I no longer see them as the whole story. They are the cover image, not the book. The story continues in motion, and we owe it to our children to read every page.

References:

American Academy of Audiology. (2016). Auditory processing disorders. Retrieved from https://www.audiology.org/consumers-and-patients/hearing-and-balance/auditory-processing-disorders/

American Speech-Language-Hearing Association. (2018). Guidelines for the diagnosis and management of auditory processing disorder in school-aged children. Retrieved from https://www.asha.org/public/hearing/understanding-auditory-processing-disorders-in-children/

American Speech-Language-Hearing Association. (2020). Scope of practice in audiology. Retrieved from https://www.asha.org/policy/sp2018-00353/

Chermak, G. D., & Musiek, F. E. (2010). Handbook of auditory processing disorder: Auditory neuroscience and diagnosis (Vol. 1, 2nd ed.). Plural Publishing.