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AudiPro Audiology Clinic

Complete Hearing Healthcare

APD Screening Questionnaire

The APD screening questionnaire helps to identify symptoms of auditory processing deficits based on your experience in daily life. After 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 discuss the results with you and if required, 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



36

Has difficulty understanding a speaker when his/her voice is mildly echoing in a room



37

Cannot accurately understand someone while actively performing another task



38

Loses focus when listening to someone in a one-on-one conversation



39

Gets tired easily when listening to a single speaker or a group of speakers



40

Has difficulty understanding a speaker who is facing a different direction (not towards you)



41

Needs the speaker to frequently repeat a few/lot of words when in a quiet environment



42

Needs the speaker to frequently repeat a few/lot of words when in a noisy environment



43

Has trouble understanding someone who does not speak clearly, e.g. someone with a mild speech impediment



44

Has difficulty understanding a speaker when they are talking softly (in a low volume)



45

Does not accurately understand words in a telephone conversation



46

Has difficulty understanding a speaker who is standing further away (distant speaker, like a classroom teacher)



47

Cannot correctly pronounce newly heard words or words heard for the first time



48

Has trouble remembering or identifying key words and/or voice cues during a conversation



49

Needs a loud volume (significantly louder than normal) to hear correctly



50

Cannot maintain focus on listening without the help of a sensory stimulus, e.g. holding an object in hands