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Auditory Processing Disorder
Auditory Processing Disorder (APD) is a neurological condition where the brain misinterprets sound — not because the ears are broken, but because the wiring between ear and brain doesn’t fire the way it should. Kids with APD routinely pass hearing tests. They still struggle.
At Audiology Island, Dr. Stella Fulman and Dr. Zhanneta Shapiro diagnose and treat APD using therapy programs matched to each child’s specific neurological profile.
What is Auditory Processing Disorder?
Picture sitting in a room full of people speaking perfectly clearly — but what your brain actually receives is something scrambled, patchy, half a second delayed. That’s not a metaphor for a bad day. For children with APD, that’s Tuesday.
Clinically, Auditory Processing Disorder describes a deficit in how the central auditory nervous system handles incoming sound — specifically in tasks like discriminating similar phonemes, tracking the timing of audio signals, separating a target voice from background noise, and sequencing what’s been heard (ASHA, 2005; Bellis, 2003). The ears themselves? Fine. The breakdown happens upstream, in the brain’s interpretation layer.
Here’s what makes APD genuinely hard to catch: it mimics ADHD so convincingly that even experienced clinicians miss it. A child who constantly asks “What?”, loses the thread of spoken instructions, or drifts off during class discussions gets labeled inattentive — sometimes for years — before anyone thinks to look at auditory processing. Research puts the overlap problem in sharp relief: roughly 43% of children referred for ADHD evaluation show concurrent auditory processing deficits (Riccio et al., 1994). Nearly half. That’s not a footnote; that’s a diagnostic crisis hiding in plain sight.
And misdiagnosis carries real consequences. Stimulant medication — the standard pharmacological response to ADHD — does absolutely nothing to correct disordered auditory processing. A child treated for the wrong condition doesn’t just plateau. They fall further behind while the actual problem goes unaddressed. A thorough hearing evaluation is often where the real picture finally emerges.
So How Does This Relate to Your Child?
Teachers say he doesn’t listen. You’ve noticed she follows directions fine when you’re alone together, but falls apart in noisy rooms. Sound familiar?
Children with APD don’t struggle everywhere equally — and that’s the tell. Quiet, one-on-one settings? Often they perform remarkably well. Put them in a cafeteria, a gym, a busy classroom with thirty kids and a humming projector, and the whole thing collapses. Their attention isn’t globally broken. It buckles specifically under auditory load (Musiek & Chermak, 2007).
Other patterns worth watching for: mishearing similar-sounding words without realizing it, reading and spelling gaps that seem weirdly inconsistent with how bright the child clearly is, and what parents often describe as exhaustion — a child who comes home from school genuinely depleted, not from running around, but from the sheer cognitive work of trying to decode speech all day.
That last one, listening fatigue, doesn’t show up on any checklist. But parents know it when they see it.
If any of this sounds like your kid, a behavioral rating scale won’t get you to the truth. Only a comprehensive audiological evaluation — with validated central auditory processing tests administered under controlled acoustic conditions — actually will (Keith, 2000).
Benefits of Auditory Processing Disorder
The auditory cortex in a child is not fixed. It bends, adapts, rewires — which is exactly why early intervention matters so much and why waiting it out is the one strategy almost guaranteed to cost more in the long run (Tallal et al., 1996; Hayes et al., 2003).
What targeted APD therapy actually delivers, across children who receive appropriate treatment:
Reading and academic performance improve as phonological discrimination sharpens. Studies using Fast ForWord have shown statistically significant gains in language comprehension and reading accuracy — gains that held at follow-up, not just immediately after the program ended (Scientific Learning Corporation, 2008).
Emotional weight lifts. The embarrassment of wrong answers. The social withdrawal that comes from never quite following group conversation. The quiet belief that something must be wrong with you. These don’t disappear overnight, but parents consistently report marked increases in confidence once auditory processing stabilizes.
Cognitive bandwidth opens up. When the brain stops spending all its energy just decoding basic speech, it has room to actually think — to reason, to problem-solve, to engage creatively with ideas.
Home life shifts too. Fewer repeated instructions. Less conflict coded as “not listening.” More genuine connection — because the child isn’t just hearing now; they’re processing.
APD Therapy Programs at Audiology Island
This isn’t a general hearing practice that added APD to a dropdown menu. Audiology Island is built around auditory processing, and that specificity matters the moment you walk in.
Dr. Stella Fulman and Dr. Zhanneta Shapiro don’t work from checklists. Their approach to pediatric audiology runs through a full battery of validated central auditory processing tests — dichotic listening tasks, temporal processing measures, speech-in-noise protocols — conducted under proper acoustic conditions. That rigor isn’t procedural formality. It determines everything that comes after, because a treatment plan is only as precise as the diagnosis that shapes it.
Therapy is matched to the individual child’s deficit profile, not assigned from a standard menu. Two children can both carry an APD diagnosis and need completely different interventions. The clinical work here is in that matching — understanding where specifically the processing breaks down, and choosing accordingly.
APD Therapy Programs at Audiology Island
Audiology Island is the only clinic on Staten Island to provide a direct therapy approach. We are very proud to utilize the Buffalo Model of Central Auditory Processing as designed by Dr. Jack Katz, who has been involved in the study of central auditory processing for over five decades. The success we have seen in the children we have worked with (ages five and older) has been tremendous. At Audiology Island on Staten Island, we evaluate a broad range of auditory skills in young children who are typically not formally tested in these areas yet could benefit most from early intervention. The following are therapy programs for Central Auditory Processing Disorder at Audiology Island:
- Fast ForWord. Built from neuroscience research led by Paula Tallal, Fast ForWord modifies acoustic signals to slow the rapid consonant transitions that children with temporal processing deficits can’t catch at natural speech speed — then progressively restores them to normal as the auditory system adapts (Tallal et al., 1996). Brain imaging studies have shown measurable cortical reorganization following the program, with corresponding gains in language and reading (Temple et al., 2003).
- The Listening Program. Psychoacoustically filtered classical music, delivered through bone conduction headphones. The Listening Program (TLP) trains auditory figure-ground discrimination and listening stamina over a structured sequence of sessions — typically 8 to 20 weeks — targeting the pathways responsible for separating meaningful sound from background noise.
- CAPDOTS. Where most programs train broadly, CAPDOTS isolates specific auditory sub-skills and targets them directly. Assessment and remediation run on the same platform, so progress is tracked continuously — not just at the end. That ongoing feedback loop changes what’s possible clinically.
- Interactive Metronome. Timing deficits in the auditory cortex and motor timing difficulties tend to travel together (Merzenich et al., 1996). Interactive Metronome trains rhythmic synchronization with millisecond-level precision, producing downstream improvements in language processing, sequencing, and sustained attention. Clinical trials with children presenting language and attention disorders showed statistically significant gains in motor planning and focus (Shaffer et al., 2001).
- iLs Integrated Listening System. Filtered music plus movement plus vestibular activation — simultaneously. iLs engages auditory, visual, and sensory systems together, which makes it particularly effective for children whose APD co-occurs with anxiety or broader sensory processing difficulties. The vestibular-auditory integration work tends to support nervous system regulation in ways that purely auditory programs don’t reach.
- One on One Auditory Therapy. Software is powerful. It’s also finite. Direct auditory therapy sessions with a licensed audiologist — pulling from dichotic listening training, auditory closure tasks, binaural separation exercises — adapt in real time to what the child is doing in the room right now. For complex profiles, or children who’ve gained skills in structured programs but aren’t generalizing them to real life, this is often where the work gets finished.
All programs at Audiology Island are selected based on current peer-reviewed evidence. Diagnostic procedures comply with ASHA’s ethical guidelines for audiological practice.
Our Doctors of Audiology
Dr. Stella Fulman
Dr. Fulman completed her Doctor of Audiology degree at Northwestern University, followed by specialized fellowship training in vestibular assessment and rehabilitation. Her 22 years of clinical practice spans pediatric through geriatric populations, with particular expertise in complex diagnostic cases and tinnitus management.
Dr. Zhanneta Shapiro
Dr. Shapiro earned her AuD from the University of Florida, subsequently completing advanced training in hearing aid technology and real-ear verification techniques. Over 20 years, she’s fitted thousands of patients with amplification, developing refined strategies for addressing difficult-to-fit configurations and the adjustment process.
Our Office Locations and Hours
Main Office
11 Ralph Place, Suite 304,
Staten Island, NY 10304
Phone: (888) 995-5655
Office Hours
Mon & Thur
8:30AM – 7:00PM
Tue, Wed & Fr
8:30AM – 5:00PM
Sat-Sun
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Request Your Appointment
Auditory Processing Disorder (APD) is very treatable. If you are worried that your child is struggling in school or requires extra help it is important to look at the specific difficulties. Knowing the weaknesses will allow for the proper intervention and decrease your and your child’s frustration. Reach out to us today, to fill out the screening forms and see if your Childs difficulties are auditory related.
Patient Testimonials
Patient Information
What age can APD be diagnosed?
Most audiologists hold off on formal APD testing until age 7, when the central auditory nervous system has matured enough for results to be reliable. Earlier concerns can still be monitored and screened — just not yet definitively tested.
Can adults have APD?
Absolutely. APD can emerge or worsen following head injury, stroke, or through age-related changes in central auditory function. If you pass hearing tests but consistently struggle to follow conversation in noise, an evaluation makes sense.
Is APD the same as hearing loss?
No. Peripheral hearing — the ear’s mechanical function — is typically normal in APD. The deficit is in how the brain interprets what the ears deliver, not in the delivery itself.
Will my child need medication?
APD is treated through auditory training and environmental adjustments, not pharmacologically. If ADHD is also present, medication may address that component — but it won’t touch auditory processing.
How long does therapy take?
Depends on the program and the child. Technology-based programs like Fast ForWord generally run 8–12 weeks; broader integrated approaches can extend to six months or longer. Dr. Fulman and Dr. Shapiro will give you a realistic picture after the evaluation.
Does insurance cover this?
Coverage varies. Audiology Island’s administrative team can verify your benefits and handle prior authorization before your first appointment.
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