I want to clarify a common issue I see in school-based hearing support. Children are often fitted with FM or DM microphone systems that allow the teacher’s voice to be sent directly to their hearing aids. While this can improve access to the teacher’s voice, it can also reduce the child’s autonomy and interfere with spatial hearing if it isn’t implemented thoughtfully.

The core issue is control. Many children are given microphone input from a teacher or support staff, but they have no ability to turn it off, adjust the volume, or blend it with environmental sounds. The microphone becomes dominant, and in many systems, raising the volume doesn’t just make things louder, it prioritizes the external microphone input and further suppresses the regular microphones on the hearing aids.

Those regular microphones—typically two on each device—are directional and designed to help children make sense of where sound is coming from. For children with mild hearing losses, these microphones often provide enough access on their own, and they may not need a remote microphone in many settings. But the greater the hearing loss, the more isolation is needed to make the teacher’s voice accessible. It becomes more like having the teacher on the phone, with their voice streamed directly to the child while the rest of the environment fades away.

This has a major impact on spatial hearing. When a child can’t hear where sounds are coming from, they lose orientation to their environment. They may hear the teacher, but not the classmate next to them. They may hear a voice in their head, but have no way to anchor that voice to a location in space.

Audiology is a deeply rule-bound, traditional profession. We are trained to rely on clear metrics: thresholds, decibels, tymps, reflexes, waveforms. In many ways, that precision is a strength. But auditory processing disorder (APD) doesn’t fit cleanly into that model.

It doesn’t give us the same yes/no answers that tone-based audiometry does. It lives in a gray zone where symptoms vary, patterns overlap, and no single test can definitively confirm or rule it out. That discomfort is part of why APD remains one of the most misunderstood and gatekept diagnoses in audiology today.

In some countries, the criteria for APD are tightly defined, requiring individuals to have hearing thresholds no worse than 20 dB HL across frequencies. That threshold exists because the research used it to control the study population. But it’s a mistake to treat it as a clinical truth. There are real problems with assuming “normal” is defined solely by the audiogram.

Our dyslexia therapist suggested we treat his APD, which at the time I didn’t know what that entailed. I looked for support groups and found this group and Dr. Rae StoutThis was the first time I heard about LGHAs and after reading success story after success story and all of Dr. Stouts posts, I knew we needed to look into them for my son. I went to Dr. Stout’s website, looking into her services and what the process looked like. I loved that she could do virtual evaluations and appts bc we are not in the same state.Before making an appt with Dr. Stout, I wanted to see if my son would qualify for HAs through our audiologist, and it turned out he did.

Our audiologist evaluates and diagnoses APD, but she didn’t do any sort of treatment other than providing recommendations. I talked to her about Dr. Stout and she ended up reaching out to her for more information and guidance. My son has had his hearing aids for a year now and he has made AMAZING progress!

Because while yes—hearing clearly for the first time made a huge difference—it’s not the hearing aids that did the learning.

It was him.

The device simply removed a barrier. Like a walking stick helping someone across a rocky creek—it made the path safer, more stable. But the child still had to walk it. He had to be brave enough to try. To risk stumbling. To accept help. To keep going.

“This is the house that Jack built.

This is the malt that lay in the house that Jack built / This is the rat that ate the malt that lay in the house that Jack built…”

The classic nursery rhyme builds verse by verse, layer by layer, into a chaotic structure. By the end, each new problem is tangled in the one before it. And that’s the metaphor we need when we talk about neurodivergent children—particularly those with autism, ADHD, ODD, PDA, auditory processing issues, and sensory integration challenges.

Because this?

This is the house that Jack built…

Only the foundation isn’t malt or bricks. It’s unpredictable sensory access.

For the past year, I’ve been evaluating kids in both alert and fatigued states, something that’s surprisingly rare in clinical practice. We know children—especially neurodivergent children—often run out of auditory stamina as the day goes on. But we almost never test for it. With Meredith, we had a unique opportunity to compare her performance using Acoustic Pioneer, a computerized auditory processing platform that can be administered at home in a natural environment, both when she was fresh and again when she was tired.

The difference was dramatic.

I once worked with a little boy who simply couldn’t learn to ride a bike. He wobbled, oversteered, and never seemed to find his balance. It wasn’t just a motor issue—he was overloaded by sound and unsure of his body in space. After being fit with hearing aids, something shifted. For the first few days, he could only ride when he was wearing the aids. One day, one of them clogged with wax, and just like that—he couldn’t ride again until it was cleaned. But once the skill clicked, it stuck. He never needed to relearn. That’s what happens when the brain finally gets stable input—it can build, integrate, and hold onto new skills that once felt impossible.

It’s like a water balloon under pressure. The child may seem fragile, inflexible, or easily set off. But the problem isn’t the balloon—it’s the pressure. Ease that pressure in one area, and suddenly everything can stretch without breaking. That’s what happens when auditory access is restored: not just better listening, but better behavior, better learning, better connection.

And yes, APD often co-occurs with other diagnoses like autism, ADHD, dyslexia, and language delay. But it is also its own condition—and when treated, it can dramatically improve the outcomes of everything else. Still, many families are told they can’t evaluate for APD if another diagnosis is already in place. Some are told their child’s memory or language is too limited to test. That’s not true—and it’s doing real harm.

Lately, I’ve been told—sometimes directly, sometimes between the lines—that talking about Auditory Processing Disorder (APD), milder forms of Auditory Neuropathy Spectrum Disorder (ANSD), and sensory overload issues such as autism and sensory processing disorders, in spaces dedicated to traditional Deaf education, blindness, or disability rights is “irritating.” That we are pushing too hard. That we are asking for too much. But what we’re asking for is a place at the table—a table that should have always had room.

This group of children and adults has the right to be included, not because they’re convenient to serve, but because they exist. Because they’re struggling. Because they’re being left behind in silence. And the truth is, when we expand the table instead of guarding it, everyone gets stronger. Inclusion doesn’t dilute identity—it amplifies justice.

More than 70% of autistic children exhibit persistent auditory processing differences across early childhood (Lau et al., 2023). These difficulties aren’t subtle—they interfere with basic listening tasks, such as distinguishing speech from noise or keeping up with fast, overlapping talk. Up to 93% of autistic individuals show atypical responses to sound, including hyperacusis (sound sensitivity) and misophonia (sound-triggered distress) (O’Connor, 2012; Schwartz, 2020).

A review by O’Connor (2012) in Neuroscience & Biobehavioral Reviews explains how these differences go beyond sensory tolerance. Autistic individuals often struggle with auditory scene analysis—the ability to filter meaningful sounds from background noise—which leads to overload, missed language input, and frustration. These issues are closely tied to the development of language and executive function.

From my vantage point, there’s no difference in meaning between APD and CAPD—but there’s a major difference in interpretation. Many people use the terms interchangeably, but I’ve noticed that when people use “CAPD,” they often think it sounds more serious or legitimate because it references the brain. Personally, I think it does the opposite. Calling it “CAPD” can actually weaken the impact—making the condition sound rare, overly technical, or so medicalized that it feels detached from real-life functioning.

I prefer the term APD (Auditory Processing Disorder) because the word “central” tends to confuse people. It makes the condition sound narrower than it is. APD can involve breakdowns at multiple levels of the auditory system—not just within the central nervous system. These peripheral breakdowns can cause central issues or worsen them over time.