Auditory Processing Disorder or ADHD?
Today’s post comes courtesy of a student I recently evaluated. As a current 7th grader, she was referred to me because she was having trouble paying attention in class and keeping up with her teachers’ lectures. She was originally diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) by her family physician in 4th grade and put on various medications to help control it. However, after not seeing positive results from medication, her mother wanted a more comprehensive evaluation to determine if something else was going on.
This particular student, like many, was initially given a diagnosis of ADHD with a very brief assessment of her symptoms by her pediatrician. Unfortunately, in many such cases, these “evaluations” are not comprehensive and often mis-identify symptoms and behaviors.
During my initial in-take interview with this student and her mother, both confirmed symptoms of ADHD, including difficulty maintaining focus in class, forgetting to do certain tasks, and the appearance of “zoning out” in class. Although her grades were very good, she admitted that she does not always enjoy school because it can be difficult. On their own, these symptoms do indeed sound like those of ADHD. Let’s take a closer look.
What are symptoms of ADHD?
Difficulty sustaining attention
Does not always complete tasks
Struggles with organization and time management
Easily distracted by outside stimuli
Does not always listen to others
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a diagnosis of ADHD requires “a persistent pattern of inattention and/or hyperactivity that interferes with functioning or development,” with most symptoms appearing before age 12. That means the symptoms above must be severe enough that they adversely impact a student’s ability either inside or outside of the classroom. Based on input from the student and her mother, his certainly seems to be the case for her.
In addition to the above symptoms, however, both the student and her mother shared additional information, including the student’s sensitivity to loud noises and increased difficulty focusing in loud environments, such as concerts or presentations in large auditoriums. Although these can certainly be tendencies associated with ADHD, they also sound similar to another particular condition: Auditory Processing Disorder (APD).
What is Auditory Processing Disorder?
APD is a medical condition that impacts one’s hearing and processing of auditory stimuli. The causes of APD are not always clear, but it can be related to other underlying medical conditions, such as chronic ear infections or head trauma. While APD typically begins in childhood, it can present later in adulthood. Additionally, only about 3-5% of the U.S. population experiences APD, so it is a relatively rare condition, and it impacts boys more often than girls.
What are symptoms of auditory processing disorder?
Appears as though student is not paying attention
Can seem forgetful
Has difficulty following auditory directions
Ability to focus is impacted by loud noises
Sensitivity to loud noises or loud environments
Difficulty following conversations and formulating responses
Difficulty with language acquisition, particularly in childhood
As you can see, the symptoms of APD can look very similar to those of ADHD. It is important to note that the DSM-V does not contain a diagnosis of APD. Instead, APD must be verified and diagnosed by an audiologist. While ADHD is a neurocognitive disorder, APD is a weakness in the pathways the connect the ear and the central nervous system that processes those sounds. Therefore, treatment of APD is much different that ADHD and does not require the use of medication.
At the conclusion of the student’s evaluation, the evidence strongly suggested a diagnosis of APD rather than ADHD. Although I cannot officially diagnose her, I did refer her to an audiologist for further testing. I also made the recommendation that she consult with her pediatrician to determine if continued medication was necessary.
The good news for her is that most adolescents who struggle with APD see their symptoms dramatically reduced by the time they are 13. This mostly has to do with the natural maturation of those pathways between the ear and the central nervous system. In the event that symptoms do not improve, however, there are many steps to take to help.
If your student is displaying signs or symptoms of ADHD or APD, I strongly recommend you see a psychologist or psychiatrist who can evaluate for both. Although as many as 50% of students have a co-diagnosis, the other 50% do not. Receiving an accurate diagnosis through a thorough evaluation is imperative to your student’s success.