Auditive Verarbeitungs- und Wahrnehmungsstörung: Symptome, Test & Diagnose

Hearing impairment despite intact hearing

Auditory processing and perception disorder (AVSD/AVS) is diagnosed when the hearing itself is intact, but hearing is nevertheless severely impaired. This is due to the fact that the central processes of perceiving and processing acoustic information are disturbed. Consequently, affected individuals have difficulty distinguishing as well as recognizing and evaluating sounds. In childhood, AVWS is considered a developmental disorder affecting approximately 2-3% of all children, with boys being diagnosed twice as often as girls. However, the disorder may also become apparent later in life

AVWS Causes

AVWS is not due to a disorder of the hearing organ and likewise does not testify to diminished intelligence. Rather, it is thought to result from a combination of genetic predisposition, medical factors, and environmental influences.

Medical factorsEnvironmental factors
  • Long-term middle ear infections as a child
  • Brain damage in early childhood
  • Brain maturation delays
  • Underuse/overuse of auditory stimuli


If AVWS occurs only in adulthood, its cause is probably also rooted in childhood. However, many details of the disorder and its background are unclear. Thus, it is also questionable whether it should be considered part of a language development disorder or independent, since it is occasionally detected in connection with a delay in language development.

AVWS symptoms and consequences

Auditory processing and perception disorder can be suspected based on a variety of symptoms:

  • Limited speech understanding in the presence of background/noise or in conversations with multiple speakers
  • Difficulty discriminating (distinguishing) sounds, tones and noises
  • Difficulties in sound discrimination sometimes lead to impairment of reading and writing.
  • Difficulty focusing on a speaker
  • Limited memory
  • Accompanying:limited ability to summarize what has been said
  • In some cases, abnormalities in pronunciation
  • In children: more difficult acquisition of written language

In principle, depending on the type and severity of the disorder, four potentially impaired areas can be identified:

LocalizationDiscrimination Selection Dichotic listening
Estimate direction and distance of soundsDistinguish sounds from one another Filter out relevant acoustic informationAbility to listen binaurally

The domain of selection is particularly difficult in loud environments in which a variety of noise overlays relevant information. Limitations in the ability to discriminate in turn imply that no distinction can be made between similar sounds. Thus, communicative misunderstandings occur more quickly.

AVWS Diagnosis

To determine an auditory processing and perception disorder, a thorough diagnosis is first necessary. Generally, appropriate tests can be performed for this purpose at a very young age, although a reliable determination is not realistic until 6-7 years of age. Various tests provide information about the presence of an auditory processing and perception disorder:

  • Language comprehension tests
  • Sound discrimination tests
  • Tests of phonological awareness
  • Tests of phonological memory

Furthermore, other disorders as well as a learning disability must be ruled out.

Disability level: does AVWS count as a disability?

AVWS is not considered a disability, but rather a partial performance disorder. Nevertheless, the condition can lead to the determination of a degree of disability (GdB). Today, the term "degree of damage consequences" (GdS) is used to reflect the fact that it is not a disability, but the consequences of the disease lead to severe limitations. The GdB/GdS of 10 to 15% in the case of AVSD is justified by the additional effort required in everyday life and teaching.

Auditory processing and perception disorder: treatment/therapy

After AVWS is diagnosed, options for appropriate therapy and treatment interventions are outlined by the treating clinician. The focus of the intervention depends largely on the specific impairments and is applied to the affected person himself, but equally to his environment. In the case of a child patient, informing caregivers and teachers is crucial. For example, teachers should ensure sufficient eye contact to facilitate localization and selection for the affected child. Parents are advised to call attention to themselves by placing their hand on the table if they wish to talk, as well as to choose a quiet environment for important conversations and homework.

Also, the environment can be addressed in terms of the acoustics of the classroom to reduce noise as much as possible. Seating within the classroom should be allocated accordingly. For additional support, a technical device for wireless hearing can be used. The teacher wears a transmitter and the child wears a receiver. The direct speech transmission of the transmitter is played back to the receiver so that a centered hearing impression is created. Another therapy measure falls within the scope of speech therapy: promoting phonological awareness and learning strategies to relieve the strain on auditory memory contribute to better speech comprehension.