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Auditory Processing Disorder: why do some children struggle to make sense of speech?

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Estimates suggest up to seven per cent of children have difficulty listening to sounds, and making sense of what people are saying to them, even though a hearing test shows their ears are working well.1,2 This type of difficulty, known as an Auditory Processing Disorder (APD), is poorly understood, but can seriously affect children’s education and quality of life. Dr Doris-Eva Bamiou, of University College London’s Ear Institute, aims to improve diagnosis of this often unrecognised condition, so children can receive better support.

What is the problem and who does it affect?

Difficulties in understanding speech when there’s a lot of background noise is a hallmark symptom of APD. Children with APD often struggle to make sense of what they can hear, despite being able to hear clearly. This is thought to result from problems with the way sounds are processed in the brain.

“Children with APD may have difficulties listening to things if there is lots of background noise or if a sound is not clear – for example if someone has a strong accent or a telephone line is poor,” explains Dr Bamiou. “The children may find it hard to tell where sounds are coming from. They may mishear words, will frequently ask for things to be repeated, and may take a while to respond to what they are being told. The children’s attention may fluctuate during conversations and they may have trouble remembering long strings of information.”

The children’s education and quality of life can be affected. “Children with APD may have speech and language disorders, problems reading or spelling, and academic difficulties,” says Dr Bamiou. “Because of all these problems, the children may have poor self-confidence, while other people may mistakenly perceive them as naughty, uncooperative or even lacking in intelligence. Unfortunately, there is no ‘gold standard’ in diagnosis and the disorder all too often goes unrecognised.”

What is the project trying to achieve?

“Our main aim is to develop a selection of techniques that can be used together to improve diagnosis of APD,” explains Dr Bamiou. “Children with a clear diagnosis can more easily access the type of support that is most appropriate for them. A clear diagnosis also provides an explanation for children’s difficulties, which can be invaluable in itself and can protect children from mistakenly being perceived as naughty or uncooperative.”

Around 30 children aged eight to 11 years are taking part in this study. Around half have recently been diagnosed with APD. A key part of the study involves asking the children to press a button on a handset in response to sounds that are being transmitted to them via headphones, or earpieces. While doing so, they are wearing head caps fitted with 36 sensors that monitor brain activity using a technique called electroencephalography (EEG).

The team hopes to improve both diagnosis and understanding of the biological basis of APD in terms of brain activity, which could lead to better treatment.

What are the researchers’ credentials?

The researchers are world experts in APD. They care for large numbers of children with APD at London’s Great Ormond Street Hospital, as well as conducting research. They chaired a UK group that was set up to develop national guidelines, and have directed international courses on APD since 2000.


  1. Hind SE et al. Prevalence of clinical referrals having hearing thresholds within normal limits. Int J Audiol 2011; 50: 708-16.
  2. Bamiou D-E et al. Aetiology and clinical presentations of auditory processing disorders—a review. Arch Dis Child 2001;85:361–365.

Project LeaderDoris-Eva Bamiou MD MSc FRCP PhD
Project TeamDr Ifat Yasin BSc MSc PhD MA
Project LocationEar Institute, University College London
Project duration1.5 years
Date awarded12 November 2012
Project start date1 June 2013
Project end date28 February 2016
Grant amount£19,140
Grant codeGN2091


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