This is not a chicken-and-egg debate. The chicken—auditory processing—came first, before language processing. Without it, there’s no egg to analyze, decode, or comprehend.

If you’re a parent considering APD testing, please—don’t settle for someone who only looks at the standard deviation and draws a conclusion based solely on test scores. Don’t work with a clinician who mails you a report without ever calling to explain what it means, what to do next, or how it fits with the rest of your child’s experience.

Instead, look for an audiologist who sees the bigger picture. One who works holistically, who is connected to a network of other professionals—speech-language pathologists, occupational therapists, educational specialists—and who values the perspectives of teachers, family members, and even the child themselves.

To me, Auditory Processing Disorder (APD), Sensory Processing Disorder (SPD), ADHD, and autism don’t exist in isolation. They often walk hand in hand—especially in children (and their adult counterparts) who experience the world through the lens of sensory dysregulation.

These are not just kids who are “distracted.” These are kids whose brains are working overtime to filter sensory input—sound, touch, light, movement—and often failing. Their inaccuracy in processing combined with sensory fatigue leads to coping mechanisms that can look like inattention, impulsivity, emotional reactivity, or withdrawal.

They fatigue quickly. They stim. They fidget. They seek movement or sound to stay awake. They distract themselves from the numbness that comes with constant overwhelm. They interrupt—not out of rudeness, but to control a conversation they can no longer track due to competing input. They hurt themselves. They run fast, crash, fall. Their bodies are the collateral damage of their sensory survival strategies.

Just because APD can be tricky to diagnose and treat doesn’t mean it isn’t real. Children and adults with APD need a combination of support — whether that’s hearing devices, speech-in-noise training, environmental accommodations, or visual language scaffolds — to access sound more clearly. And when they get the right support, outcomes improve dramatically.

​The science, clinical practice, and patient experiences all support that APD is a legitimate, meaningful diagnosis. It’s time we stop dismissing it.

I’m neurodivergent—autistic, ADHD, and gifted. I’m also a parent. Because of all that, I often find myself being the first person people ask when they’re trying to figure out if ASL might be a good fit for a child who thinks or learns differently.

It’s a great question. Especially if your child has dyslexia, speech or language delays, auditory processing disorder, or verbal processing difficulties. ASL isn’t necessarily easier—but it is differently difficult. And for the right learner, it can feel like coming home.

ASL is a full, complex language. It doesn’t follow English grammar. It doesn’t rely on sound. It’s spatial. It’s visual. It’s built through the hands, the face, and the body. It uses facial grammar—eyebrow movement, eye gaze, mouth shapes—not just to show emotion, but to express sentence structure. It’s expressive and conceptual, not just a code for English words.

It’s very common for children with auditory processing challenges to have symptoms that worsen under certain conditions, especially during times of stress or when their sensory environment changes.

Background noise, such as HVAC systems, chairs scraping, hallway chatter, or sudden loud sounds like doors slamming or bells ringing, can overwhelm a child’s auditory system. Some children are especially sensitive to sharp or high-pitched noises that might not bother others — and this can trigger discomfort, panic, or even pain. Others experience misophonia-like reactions, where repetitive sounds like breathing, chewing, or pencil tapping become intensely distracting or emotionally upsetting.

Mental stress — such as preparing for exams or facing high-pressure situations — adds even more cognitive load. Fatigue builds up faster for children with auditory challenges because their brains are constantly working harder just to decode everyday sounds. Visual and tactile overload from bright lights, uncomfortable seating, strong smells, or temperature discomfort can add even more strain. And emotional stress, including fear of mistakes or navigating unfamiliar situations, often pushes things over the edge.

When the brain is already working at a high effort level, any additional distraction or stress can cause a full flare-up — making it harder for the child to follow directions, retrieve learned information, or stay regulated.

To reduce these flare-ups, it helps to build a low-stress, supportive environment into the child’s daily rhythm.

“Tell me a bit more about how you knew something wasn’t going well with Alex? When did you first suspect he had Auditory Processing Disorder (APD)?"

"Well," she began, twirling her straight dark hair, "I think it must have been how incredibly tired and emotional he was, whenever we took him anywhere noisy. That and how it seemed like when we spoke to him, or really when he had to listen to anyone, that he'd just not answer right away. It's like there was a few seconds where he had to take it in, time to process what he heard, before he could figure out how to respond."

"Also, he was so fragile. I mean, not just for a boy, but he'd fall into tears when he thought he was missing out on understanding. Or in noisy places. He just didn't do well with picking out what he was trying to hear. His hearing wasn't perfect, but it basically was so close to normal that Kaiser wasn't willing to help us out with anything like hearing aids. They said he essentially was normal. But I knew that wasn't really true.

He acted more like he had a hearing loss. He was constantly melting down, constantly mishearing us and his teachers, and even his friends. He was so upset in school, and as a special education teacher myself, I knew he wasn't performing at his potential. He was SPENT by the end of the day. He'd basically just collapse, either into tears or into bed.”

Misophonia doesn’t just annoy. It teaches rage, disgust, isolation, and fear. It creeps in silently and rewires the nervous system until survival instinct kicks in from something as small as a sound. I was never taught about it in the 1990s as a student, nor did I encounter it in traditional ENT clinics—until one day, I met a boy who had spent an entire year isolated from school, sitting in a hallway to avoid harming his classmates. He hallucinated his auditory triggers, even when I used low-gain hearing aids to try masking them. Eventually, I had to refer him to psychiatry.

As a clinician with personal experience in sensory processing challenges, anxiety, and depression—and someone who takes medication—I knew this child was outside the scope of what I could manage alone. I suspected he might have been suicidal. Even now, I wouldn’t work with someone in that condition without a full, collaborative team.

Misophonia is terrifying. It blends obsessive-compulsive thinking, anxiety, impulsivity, self-isolation, rigidity, guilt, and egocentrism. And perhaps most terrifying—it sometimes appears fully formed, out of nowhere.

In cases where accommodations are effective, or the learning environment is accessible by design, APD still functions as a disability—because the person’s success depends on external support. This is why I argue that APD should be considered a central hearing loss and often a learning disability, especially in mainstream settings.

Standalone FM systems (like the Phonak Roger Focus) are a commonly used intervention, but their effectiveness has limits. While they may amplify a teacher’s voice, they don’t help with peer interaction, background noise, or autonomy over input. In fact, they can create a bubble where the child hears only the teacher, not the group dynamics that make up real-world communication.

Still, FM systems have been shown to help with literacy in kids with dyslexia, APD, and ADHD. Improved access to the teacher’s voice can lead to better language outcomes and behavioral gains. But it’s a passive solution, not a full one.

Most people are annoyed by the scrape of fingernails on a chalkboard or the shrill cry of a toddler. But misophonia isn’t annoyance—it’s a fight-or-flight reaction. It’s visceral. It’s consuming. And until now, I don’t think I truly understood that difference.

“When I hear people slurping or chewing ice, it can feel physically painful,” she told me, adjusting her glasses and rubbing her cheekbone as though bracing herself for what might come next.

We sat side-by-side at a table in Panera, and I was painfully aware that even the smallest sounds from my spoon or cup might be triggering. She caught my hesitation. “Don’t worry about it,” she said gently, noticing me eyeing my wild rice and chicken soup. “I have kids. I have a husband. Do you think they go out of their way to be careful for me?”