Listening Difficulties in Children – Auditory Processing Disorder (APD)

Patient Experience

  • Reference Number: HEY1418-2023
  • Departments: Audiology
  • Last Updated: 1 August 2023


This leaflet has been written to provide you with information about listening difficulties that can be experienced by children.

Listening difficulties are experienced by many children, especially those who have had glue ear and resultant hearing loss in their formative years.  Auditory Processing Disorder (APD) is a variant of listening difficulty that affects about 3% to 5% of school-aged children.

A diagnoses of APD can only be made by specialist listening and diagnostic tests with the supervision of a child psychologist.  These checks require the child to be at least 7 years.  Whilst APD is defined by a collection of deficits, a greater proportion of children have more discreet listening difficulties which reduce their ability to block out background noise when listening to speech.

What are the symptoms of listening difficulties

A child with listening difficulties:

  • May have difficulties with listening, or making sense of sounds that they hear, particularly in noisy environments.
  • Often ask for things to be repeated and may take time to process verbal instructions.
  • Find it difficult to recall what they have heard and recall the order of sounds and words.
  • Can struggle to stay focused and are easily distracted.
  • May struggle to follow spoken instructions, particularly if there are multiple tasks
  • Find it challenging to distinguish one sound from another.

Are there any tests that my child can have?

Your child will have standard hearing test which will confirm that their hearing is satisfactory.  A test to check for glue ear will also be performed.

Locally, there are no hearing centres that can perform specific tests for APD.  As a parent, you would need to research test provision via private clinics.  Generally, children under the age of 7 are not developmentally suitable for these tests.

How can I help my child at home?

It is important that children with listening difficulties perform activities which will help develop their listening skills.  The following activities can be performed at home in order to develop your child’s listening skills:

  • Shared reading – allow you and your child to read out aloud to each other every day.
  • Ask them to listen to a variety of genres of music on a regular basis.
  • Provide multiple instructions and ask them to repeat what you have said. Start with a single instruction and then gradually increase the number of elements in the instruction.
  • Play “Pass the Message on” with increasingly complex messages.
  • Listen to audio books.
  • Play sequencing games such as “Simon Says” or “I Went to the Shops” but give more complex, 3 or 4, element instructions.
  • Take “listening walks” picking out sounds that can be heard.

How else can you help?

  • Help your child to self-advocate – Encourage your child to tell their friends and other family members that they need time to process what is being said to them and that people need to look at them whilst speaking.
  • Encourage their gifts, talents and interests.
  • Help your child with social skills – Encourage your child to pay attention to body language and facial expression as social cues to aid processing.

Useful links – Listening skills – BBC Teach – Improve Auditory Processing with These Fun Activities – Structured Literacy | Pride Reading Program

How can I help my child at school?

The following suggestions may be helpful for children and young people with listening difficulties in the classroom environment:

  • Ideally the pupil should be sat at the front of the class with the ability to see the teacher; looking and listening is more effective than listening alone.
  • Ensure that the pupil has a clear view of the board as this will ensure that they have a visual reinforcement for what is being discussed.
  • Always gain the pupil’s attention before providing oral instructions. Check that they have heard and understood the instructions.
  • Avoid multiple commands and provide plenty of pauses when giving instructions.
  • When talking to the pupil they may need more time to think and answer therefore give them extra time to respond.
  • Ask open ended questions to check for understanding.
  • Children with listening difficulties benefit from pre-teaching so they are familiar with the concepts to be covered in the next lesson. Providing them with additional reading before the lesson begins can be helpful and this is something that parents can help with at home.
  • Visual aids such as diagrams, charts, and models will provide the pupil with combined visual and auditory stimuli.
  • Encourage the use of homework books/diaries to provide a record of verbal instructions.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.