When you fill out this questionnaire, your responses will be reviewed by our audiologist and we will contact you with an evaluation of your responses. If your responses indicate that you may be a candidate for auditory processing disorder testing, we will contact you via e-mail or phone to set up an appointment for a comprehensive APD assessment session.








Please select the option for whether you (or your child, if you are filling this form on behalf of your child) exhibits the characteristics described by each question.

  • 1
  • Has difficulty or feels confused when listening to conversation in noise





  • 2
  • Gets distracted easily or stays distracted for long periods of time due to loud sounds

  • 3
  • Has difficulty hearing words despite having a normal hearing test





  • 4
  • Has difficulty identifying the direction of sound





  • 5
  • Has difficulty understanding words in competing messages (words spoken at the same time) or when spoken rapidly

  • 6
  • Takes longer time to respond to questions or seem to need more time to process information

  • 7
  • Feels fatigued or loses interest when performing a long or complex activity





  • 8
  • Misunderstands messages and responds inconsistently, inappropriately, or incorrectly

  • 9
  • Has problems carrying out multi-step directions when given orally; needs to hear only one direction or command at a time

  • 10
  • Has difficulty with reading, comprehension, spelling, vocabulary, or other speech/ language difficulties

  • 11
  • Has difficulty distinguishing speech sounds (e.g. hears the word ‘pen’ instead of ‘ten’)

  • 12
  • Has difficulty learning songs, rhymes, and has overall poor music and singing skills

  • 13
  • Has difficulty paying attention or becomes restless even for short periods of time





  • 14
  • Has problems related to what is being said with its meaning





  • 15
  • Has difficulty understanding indirect or abstract speech or take everything very literally (e.g. idioms)

  • 16
  • Frequently depends on lip reading, body language and eye contact to compensate for auditory difficulties

  • 17
  • Has trouble remembering or keeping in sequence what is heard





  • 18
  • Has trouble paying attention to and remembering words and can cope better with visually acquired information

  • 19
  • Bright and intelligent but has low academic performance at school





  • 20
  • Has difficulty attending to classwork or homework





  • 21
  • Voice is too loud or too soft, that is often inappropriate for the situation (e.g. conversation, responding to questions)

  • 22
  • Has behavior problems (e.g. disobedient, lack of interest in playing or hobbies, very stubborn, etc.)

  • 23
  • Is messy and tends to lose things





  • 24
  • Needs quietness to study





  • 25
  • Has trouble maintaining or following a proper sequence of tasks while performing an activity (e.g. frequently follows an incorrect order while playing a game or arranging things)

  • 26
  • Gets tired easily when doing routine activities (e.g. attending school, playing with friends, watching TV, etc.)

  • 27
  • Has a history of chronic middle ear infections/ tubes





  • 28
  • Has short term memory difficulties





  • 29
  • Has a case history of APD or presumed APD in family





  • 30
  • Is slow to learn to talk





  • 31
  • Has poor articulation or had articulation issues (ability to speak in a clear, concise, and coherent manner)

  • 32
  • Has difficulty with phonics





  • 33
  • Cannot always relate what is heard to what is seen





  • 34
  • Lacks motivation to learn





  • 35
  • Often avoids social situations or interaction with peers, strangers and/or family