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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.

The questionnaire consists of 50 questions, with each question corresponding to a different category of processing difficulty. The questions fall under one of the following categories:

AP

Auditory processing

ATT

Attention

LD

Learning deficit

Lang

Language processing issues

AP/L

Auditory processing & Language processing

AP/ATT

Auditory processing & Attention

Seq/Org

Sequencing and Organizing

HLV

Hearing loss/ Auditory processing/ Auditory neuropathy ( Hearing issues of various kinds)

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.

Your name

E-mail address

Phone number (optional)

Age (in years)

1

Has difficulty or feels confused when listening to conversation in noise

Yes No Sometimes Not Applicable

2

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

Yes No Sometimes Not Applicable

3

Has difficulty hearing words despite having a normal hearing test

Yes No Sometimes Not Applicable

4

Has difficulty identifying the direction of sound

Yes No Sometimes Not Applicable

5

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

Yes No Sometimes Not Applicable

6

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

Yes No Sometimes Not Applicable

7

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

Yes No Sometimes Not Applicable

8

Misunderstands messages and responds inconsistently, inappropriately, or incorrectly

Yes No Sometimes Not Applicable

9

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

Yes No Sometimes Not Applicable

10

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

Yes No Sometimes Not Applicable

11

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

Yes No Sometimes Not Applicable

12

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

Yes No Sometimes Not Applicable

13

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

Yes No Sometimes Not Applicable

14

Has problems related to what is being said with its meaning

Yes No Sometimes Not Applicable

15

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

Yes No Sometimes Not Applicable

16

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

Yes No Sometimes Not Applicable

17

Has trouble remembering or keeping in sequence what is heard

Yes No Sometimes Not Applicable

18

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

Yes No Sometimes Not Applicable

19

Bright and intelligent but has low academic performance at school

Yes No Sometimes Not Applicable

20

Has difficulty attending to classwork or homework

Yes No Sometimes Not Applicable

21

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

Yes No Sometimes Not Applicable

22

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

Yes No Sometimes Not Applicable

23

Is messy and tends to lose things

Yes No Sometimes Not Applicable

24

Needs quietness to study

Yes No Sometimes Not Applicable

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)

Yes No Sometimes Not Applicable

26

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

Yes No Sometimes Not Applicable

27

Has a history of chronic middle ear infections/ tubes

Yes No Sometimes Not Applicable

28

Has short term memory difficulties

Yes No Sometimes Not Applicable

29

Has a case history of APD or presumed APD in family

Yes No Sometimes Not Applicable

30

Is slow to learn to talk

Yes No Sometimes Not Applicable

31

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

Yes No Sometimes Not Applicable

32

Has difficulty with phonics

Yes No Sometimes Not Applicable

33

Cannot always relate what is heard to what is seen

Yes No Sometimes Not Applicable

34

Lacks motivation to learn

Yes No Sometimes Not Applicable

35

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

Yes No Sometimes Not Applicable

36

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

Yes No Sometimes Not Applicable

37

Cannot accurately understand someone while actively performing another task

Yes No Sometimes Not Applicable

38

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

Yes No Sometimes Not Applicable

39

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

Yes No Sometimes Not Applicable

40

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

Yes No Sometimes Not Applicable

41

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

Yes No Sometimes Not Applicable

42

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

Yes No Sometimes Not Applicable

43

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

Yes No Sometimes Not Applicable

44

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

Yes No Sometimes Not Applicable

45

Does not accurately understand words in a telephone conversation

Yes No Sometimes Not Applicable

46

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

Yes No Sometimes Not Applicable

47

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

Yes No Sometimes Not Applicable

48

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

Yes No Sometimes Not Applicable

49

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

Yes No Sometimes Not Applicable

50

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

Yes No Sometimes Not Applicable

Additional Information (Optional)

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