Portland Auditory Processing Diagnostics

09/12/2024

Because Portland APD is only operating on a limited schedule, only persons over the age of 12 are accepted for evaluations. For APD evaluations of children under the age of 12, you can contact Judith Belk at Center for Communication and Learning Skills in Lake Oswego: 503-699-9022 or at

Care for all ages. We serve infants, preschoolers, children, teens and adults with mild to severe problems with speech, language, learning, listening/auditory processing, sound hypersensitivity, reading, thinking, attention, memory, concentration, motivation, and achievement.

09/12/2024

Portland APD offers evaluations of auditory processing skills to adults (which we define as someone over the age of 12). At Portland APD testing is done on Wednesdays in the afternoon, and usually takes about three hours. Portland APD is a participating provider for Providence, Regence (BCBS) and Moda health insurances. If you have another insurance you can pay privately and you will be given an invoice that you can submit to your health insurance company for reimbursement. You can call 503-806-1498 to arrange an appointment. Our hours are limited, so please leave a voicemail with a phone number to call you back. Leaving your email address also helps, as it is a good way to set up a time to talk over the telephone about arranging the evaluation appointment.

09/12/2024

If you suspect you might have an auditory processing disorder, the first step is to verify that you do not actually have a hearing loss. You want your hearing ability to be tested by an audiologist (an audiogram). If you have a hearing loss, then follow that audiologist's recommendations for hearing aids or other medical examinations. If your hearing test is "normal" (normal audiogram), then you may want to schedule an evaluation of auditory processing skills.

09/12/2024

Before we audiologists became more aware of APD and its impacts, people were often told that children with APD as children would "just grow out of it." Nope. Turns out people with APD as children often get better at finding ways around their hearing difficulty, but they still have problems in work environments where it is necessary to carry out instructions in noisy environments, understand multiple simultaneous speakers in the workplace, understand instructions in the midst of machine noise, carry on a conversation in a cubicle surrounded by a hundred other people in near-by cubicles also on the phone talking to people, etc. We expect adults to understand oral directions the first time, to be able to separate the important speech from unimportant speech, to concentrate on paperwork while someone near them is talking, or listen to lectures or meetings and simultaneously take notes. APD makes these tasks hard.

09/12/2024

People who have APD often had a hard time learning to read when in school. Either they learned very late (eight years and up) or they learned to "sight read" because phonics was very hard for them. When the ability to hear fine auditory differences that phonics requires is disrupted, learning to read becomes difficult. We know there is a genetic component to this, but poor hearing as a young child is also a factor. People with APD often have a history of difficulty learning to talk also. Children start out only approximating the speech they hear, but over time they improve their speech ability and become more and more understandable ("intelligible"). Parents usually figure out what young children are saying, but toddlers usually go through stages of being understandable by strangers. Strangers should be able to understand most of what a three-year-old says even though the three-year-old is still using common mis-articulations. After that, we consider that there is a delay in speech, and probably language development too.

09/12/2024

Very high bilirubin levels at birth (which results in "jaundice") is also known to damage one of the way stations in the auditory pathway, and result in auditory processing difficulties (but "normal" audiograms). Many babies have some jaundice at birth, and do not end up with APD. But a baby that has spent time in the Neonatal Intensive Care Unit (NICU) at birth has a higher risk of higher bilirubin levels, as well as low oxygen levels which is also a risk factor for hearing difficulties. Persons with this kind of high bilirubin level are usually identified through blood tests, and receive medical treatment for it. This is not a common cause for APD, but does occur sometimes.

09/12/2024

People often wonder what causes APD. That is hard to pin down. But we do know that people who have a lot of ear infections ("otitis media") tend to have difficulty with APD tasks. The hypothesis is that ear infections at a young age, especially when children are just learning language, altered their hearing because of the fluid in the middle ear that goes along with ear infections, and the two ears often have different amounts of alteration. Almost always otitis media resolves. It is common in babies and young children, but tends to become rare after the age of eight years. Otitis media usually disrupts the Eustachian tube's ability to equalize pressure (and that is also a way that fluid is expelled from the middle ear) because of swelling. Some people don't have ear infections, but the muscle involved in the opening of the Eustachian tube doesn't work, and the result is a build-up of fluid in the middle ear just like what happens with ear infections, causing a mild hearing loss. Ventilation tubes are placed in the eardrum by physicians to keep the pressure on either side of the eardrum equal (which is essential to good hearing). We don't know exactly why, but that disruption, especially at an early age, is correlated with APD later on.

09/12/2024

When someone wants to hear one particular conversation when there are many conversations going on at the same time, the two ears must cooperate. Both cochleas (where the hair cells are that pick up the frequencies of sound) may be working fine, but when the sound signals pass through the auditory pathway (a set of nerves and way stations that start at the cochlea and pass through different areas of the brain before landing in the auditory cortex where the signals are decoded) if the cooperation between the two ears is not typical, the signal that arrives at the brain may be distorted and not understood. There is a lot of redundancy in the auditory pathway. If if there is inefficiency between the two ears, speech in a quiet environment can be understood. But if there is a poor signal (like speech over a cell phone) or multiple simultaneous signals (speech in noisy environment), the signal that arrives at the cortex of the brain may not be easily decipherable. This has been a reason for a lot of problems for people with APD: their audiograms are "normal" and they are often told they have no hearing problem. Their difficulties don't show up until they are tested with more complex stimuli. The testing done during an APD evaluation is NOT the same testing done during an audiogram. We test to see if the two ears are working together, and we test using distorted speech to see where the breakdown occurs. People with APD do not have normal hearing, even though they typically have normal hearing thresholds or normal ability to understand speech in quiet.

09/12/2024

A regular hearing test ("audiogram") cannot be used to diagnose an auditory processing disorder because in that test each ear is tested separately, and the speech recognition task is also performed in quiet one ear at a time. It really only tells us the softest level that people can perceive individual frequencies and whether they can discriminate speech in an ideal listening environment. People with APD usually don't have any problem with those tasks. They have difficulty with complex listening, when the two ears have to cooperate to understand what was said (we call this "dichotic listening") or when the speech signal has been distorted in some way (rapid speech, speakers with accents, speech over a telephone line, robotic speech, etc. )

09/12/2024

Hearing in noise is a complex auditory task because listeners usually want to pay attention to one sound source (like speech) in a situation in which there are multiple sound sources happening simultaneously. Noise could be environmental, such as: road noise when riding in a car, noisy air conditioning units, traffic noise when walking outside. Often the "noise" in a situation is actually a second conversation going on, such as someone listening to a radio at the same time they listen to someone speaking to them. Comprehending speech in a restaurant or other environment in which many different conversations are happing at the same time is usually very difficult for people with APD. Clients tell me that they can't understand what a waitperson is saying when they try to order, can't understand the conversation around the table, or that all of the speech happening simultaneously in the restaurant just seems like a big blur, and none of it makes sense. Listening to a conversation while the radio is playing in a car is another speech-in-noise environment. Even following a lecturer when people around the listener are whispering or chatting can be a difficulty with understanding speech-in-noise.

09/12/2024

The term "Auditory Processing Disorder" is not well understood. People with APD usually have normal ability to hear soft sounds ("normal thresholds") but have difficulty with higher-level hearing, such as comprehending speech in noise, understanding distorted speech, or localizing the source of sound.

09/12/2024

Summer is nearly over, and traditionally people seek APD evaluations more in the fall and winter than in the summer, so I want to add information to this page.