The Difference Between Hearing and Processing
- 3 days ago
- 13 min read
Updated: 3 days ago
You Can Hear Everything — and Still Not Follow
A subtitle can carry the explanation.
“I Thought I Was Losing My Hearing”
When Hearing Tests Are Normal — and the Answer Might Blow Your Mind....
It’s a surprisingly common story.
Someone starts struggling in conversations.
They ask people to repeat themselves.
Group discussions feel exhausting.
Restaurants, meetings, or phone calls become overwhelming.
Eventually, a thought forms:
“Maybe my hearing is getting worse.”
So they book an appointment.
They sit in the booth.
They pass the hearing test.
Perfectly.
And instead of leaving with a hearing aid, they leave with a referral — often for ADHD, auditory processing differences, or another neurodivergent profile.
This is not a diagnostic accident.
It’s a misunderstanding of what “hearing” actually involves.
Hearing vs. Processing: Two Very Different Systems
Hearing is not a single function.
There is:
1. Peripheral hearing
The ear’s ability to detect sound — volume, pitch, frequency.
2. Central auditory processing
The brain’s ability to interpret, prioritize, and use what was heard.
You can have excellent ears and still struggle to:
follow speech in noise
track rapid conversation
distinguish relevant voices from background sound
hold spoken information long enough to respond
When the processing side struggles, the experience feels exactly like hearing loss — even when the ears work perfectly.
This distinction is well documented in clinical research and audiology practice.
Why ADHD Can Feel Like a Hearing Problem
ADHD is not a disorder of attention alone.
It is a difference in how attention, working memory, and sensory input are regulated under load.
Research consistently shows that people with ADHD often experience:
reduced auditory filtering
difficulty sustaining attention to speech
slower or inconsistent processing of verbal input
increased vulnerability to background noise
In other words:the sound arrives — but the brain cannot always organize it efficiently.
Several studies demonstrate that individuals with ADHD perform significantly worse on central auditory processing tasks, despite normal hearing thresholds.
This is why people with ADHD often say:
“I hear you, but I didn’t catch it.”
“I hear everything at once.”
“By the time I process the sentence, the conversation has moved on.”
It is not inattentiveness in the moral sense.
It is bandwidth.
Auditory Processing Disorder (APD): A Related Pathway
Another common outcome of these evaluations is Auditory Processing Disorder (APD).
APD describes a neurological difference in how the brain:
decodes speech sounds
separates speech from noise
processes timing and sequencing in language
People with APD often:
struggle with fast speech
miss words in noisy environments
need repetition even when listening carefully
APD frequently overlaps with ADHD and other neurodivergent profiles, which can complicate diagnosis.The key point: the difficulty is not in the ear, but in the brain’s processing pathways.
Why This Often Goes Unrecognized Until Adulthood
Standard hearing tests measure whether you can hear a tone — not whether you can:
follow a conversation under pressure
process layered sound
sustain verbal working memory
Many people compensate for years by:
lip-reading
context guessing
intense concentration
avoiding noisy environments
Eventually, the cognitive cost becomes visible as fatigue, frustration, or social withdrawal — and the assumption becomes “my hearing must be failing.”
What’s actually happening is that adaptive effort has reached its limit.
What This Is — and What It Is Not
This experience does not mean:
you are imagining things
you are inattentive by choice
you are losing intelligence or competence
It means that:
hearing and understanding are different neurological processes
neurodivergent brains may process sound differently under load
difficulty hearing in real life does not equal poor hearing on a test
Your experience is real — even if the explanation is unexpected.
Why People Leave ENT Offices With an ADHD Referral
When clinicians notice a mismatch between:
normal audiograms
significant real-world listening difficulty
they often suspect a central processing issue rather than a sensory one.
This leads to referrals for:
ADHD evaluation
neuropsychological assessment
auditory processing testing
For many adults, this is the first time their lifelong listening difficulties are explained in a way that actually fits.
An Important Reassurance (That Often Gets Missed)
First things first:
sometimes the explanation really is simple.
For many people, difficulty hearing clearly is caused by something entirely mechanical —earwax buildup, pressure, or blockage — and the solution is just an ear irrigation.
By the way:
ear irrigation is often described as surprisingly pleasant.
Warm water, instant clarity, immediate relief.
No drama. No diagnosis. Just better hearing.
This article is not here to make anyone anxious,
and it is not about putting people into boxes.
It’s about understanding why, when hearing tests come back normal, the experience can still feel confusing — and why for some people, that confusion finally makes sense in a different way.
And Sometimes, the Answer Is Processing — Not Hearing
For others, the appointment unfolds differently.
You go in convinced something is wrong with your hearing.
You leave knowing your ears work just fine.
And instead, you hear something unexpected:that attention, auditory processing, or neurodivergent cognition might be involved.
This moment can feel strange —but for many people, it’s also profoundly relieving.
Because suddenly:
the lifelong effort makes sense
the exhaustion has a reason
the misunderstandings weren’t personal failures
There is often a quiet, almost physical shift —Oh. That’s what’s been happening.
That clarity can be deeply liberating.
The Takeaway
If you went to the doctor convinced you had a hearing problem —and came home with an ADHD or neurodivergence explanation —nothing went wrong.
You discovered that:
your ears work
your brain processes sound differently
and most environments were never designed with that processing style in mind
Understanding this distinction is not about labels.
It’s about removing shame.
It’s about realizing that “I struggle to hear” does not always mean something is broken —sometimes it means the system expects one kind of processing,
and your brain simply uses another.
And once that becomes clear,
design becomes possible.
When Sound Feels Like an Attack
ADHD, Neurodivergence, Auditory Processing, and the Invisible Mechanics Behind “I Can’t Listen”
You’re in a meeting. Someone is speaking. You’re trying to focus.
Then someone starts tapping a pen.
Chewing.
Sniffling.
Whispering.
Breathing loudly.
Clicking a keyboard like they’re trying to summon Wi-Fi.
And suddenly your brain isn’t “slightly annoyed.”
It’s on fire.
If you’ve ever felt a full-body surge of irritation, disgust, panic, or rage in response to specific sounds, you’re not alone—and you’re not broken.
What’s often happening isn’t a “sound problem.”
It’s a processing and regulation problem.
And yes: it can show up in ADHD, autism, AuDHD, sensory-sensitive profiles, and in auditory processing differences.
Let’s unpack what’s actually going on—without pathologizing, and without pretending you can “just relax.”
First: “I can’t handle sound” is not one thing
People use the same sentence to describe very different mechanisms.
Three common ones:
1) Auditory Processing Difficulties (APD/CAPD-style)
As mentioned earlier- You hear the words, but your brain struggles to decode and organize them—especially in noise.
2) Decreased Sound Tolerance (Hyperacusis-style)
Sounds feel too loud / too sharp / physically uncomfortable, even when they are objectively ordinary.This is more about intensity sensitivity than meaning.
3) Misophonia (trigger-sound rage/disgust)
Specific sounds (often eating, breathing, sniffing, tapping) trigger disproportionate fight-or-flight—not because they’re loud, but because they carry a particular pattern or meaning to your nervous system.
Misophonia is increasingly recognized by researchers and clinicians, yet it’s still not formally included as a diagnosis in DSM/ICD classification systems.
Many people have a mix: processing difficulty and sound intolerance and misophonia triggers.
Why This Shows Up Across Neurotypes
(Different mechanisms, similar lived experience)
ADHD: the “Bandwidth” problem
In ADHD, the core issue is rarely hearing itself.
It’s bandwidth.
Working memory and attentional control are already heavily engaged — especially in environments that demand constant filtering: background noise, social cues, turn-taking, emotional regulation, and time pressure.
Speech-in-noise processing is cognitively expensive.When resources are already stretched, comprehension drops first.
Research on ADHD consistently shows:
reduced efficiency in auditory attention
higher cognitive load during listening
faster depletion of working memory under sensory or social pressure
Irritation, fatigue, or shutdown often follow — not because the person isn’t listening, but because the system is already operating near capacity.
This is the part nobody tells you:
Your brain may be doing active noise management all day long.
And that effort is costly.
Autism / AuDHD: sensory salience + pattern detection
In autistic and AuDHD profiles, the mechanism is often different.
Here, the challenge is not bandwidth depletion first —it’s sensory salience.
Autistic perception frequently involves:
heightened sensitivity to sound features (pitch, texture, rhythm)
strong pattern detection
reduced automatic filtering of “irrelevant” input
Certain sounds register as high importance — not by choice, but by perception.
Once flagged, they become difficult or impossible to ignore.
Speech may be perfectly audible, yet drowned out by:
overlapping sounds
irregular noise
competing sensory patterns
The nervous system responds accordingly: overload, irritation, withdrawal, or shutdown.
Research frames this as differences in sensory gating and predictive processing — the brain assigns weight differently, not incorrectly.
HSP (Highly Sensitive Person): depth of processing + low sensory threshold
In HSP research (not a clinical diagnosis, but a well-studied temperament trait), the pattern again shifts.
HSPs tend to show:
deeper cognitive processing of sensory input
lower thresholds for stimulation
stronger physiological responses to noise and complexity
Auditory input is not skimmed — it is processed thoroughly.
This depth has benefits (nuance, empathy, meaning-making), but it also means:
noisy environments become exhausting quickly
speech competes with ambient sound more intensely
comprehension drops when overstimulation rises
Research describes this as depth-of-processing combined with sensory sensitivity, not attentional failure.
The experience can feel like “I can’t hear anymore,”when in reality the system is overloaded by too much input.
Giftedness: complexity bias + meaning-first processing
In gifted profiles, the issue is often priority, not perception.
Gifted cognition tends to favor:
abstraction
meaning
systems and implications
Surface-level input — especially rapid, literal, or repetitive speech — may be deprioritized automatically.
Research on gifted adults describes:
uneven attention allocation
strong top-down processing
higher cognitive load when forced into low-meaning input streams
When speech lacks novelty, relevance, or conceptual weight, it may simply not “stick.”Not because it wasn’t heard — but because it wasn’t selected for storage.
Under noise or pressure, this prioritization becomes more pronounced, and recall or comprehension suffers.
Dyslexia & language-based processing differences: “symbol fatigue”
For dyslexia and related language-based processing profiles, the mechanism is again distinct.
Here, the challenge lies in phonological decoding and symbol processing.
Speech — especially fast, dense, or abstract speech — costs more energy to decode.Words and sounds are not harder to hear, but harder to process efficiently.
Research consistently shows:
increased cognitive effort during language processing
slower or more resource-intensive phonological pathways
higher fatigue during prolonged listening
This is sometimes described as symbol fatigue:
words, sounds, and linguistic structures drain energy faster than images, logic, or spatial reasoning.
Importantly:this has no correlation with intelligence — often the opposite.
It reflects a costlier pathway, not a weaker one.
Where APD Fits — and Why It’s Often Confusing
Auditory Processing Disorder (APD) is the profile where this experience is most literal.
In APD:
the ears detect sound normally
the brain struggles with central auditory processing
especially speech-in-noise, rapid speech, timing, and sequencing
APD is defined as a neurodevelopmental processing difference, not a hearing loss.
This is why people with APD often say:
“I hear the sounds, but they don’t come together.”
Important nuance:
APD is not always a standalone condition.
Research shows:
APD frequently co-occurs with ADHD
it overlaps with autistic sensory processing differences
it can resemble language-based learning differences
it is sometimes misdiagnosed instead of ADHD, or vice versa
So in practice, APD often appears as:
a primary diagnosis
or a processing layer inside another neurodivergent profile
That’s one reason people bounce between audiology, ENT (Eye, Nose & Throat), and neuropsychology before things make sense.
What About Other Neurotypes?
Beyond the ones listed above, this specific “hearing-but-not-processing” pattern is less central, though it can still occur situationally in:
trauma-related hypervigilance (state-based, not structural)
anxiety disorders (attention narrowed by threat)
burnout or chronic stress (temporary bandwidth collapse)
The key difference:In these cases, the difficulty is state-dependent and reversible.
In neurodivergent profiles, it is trait-based and consistent across contexts.
Why These Profiles, Specifically?
Because all of them affect at least one of the following systems:
auditory filtering
working memory
processing speed
sensory salience
meaning vs. label prioritization
language decoding efficiency
When any of these systems work differently, the subjective experience can easily be mistaken for hearing loss.
The Shared Experience — and the Crucial Difference
Across all these profiles, the lived experience can sound identical:
“I hear everything, but I can’t follow.”
“It feels like my hearing is getting worse.”
“I’m exhausted after conversations.”
What differs is why.
ADHD → bandwidth depletion
Autism / AuDHD → sensory salience & filtering differences
HSP → depth of processing + overstimulation
Giftedness → meaning-first prioritization
Dyslexia → higher decoding cost
Auditory Processing Disorder (APD) → impaired central auditory integration (hearing intact, processing strained)
Same feeling.
Different mechanisms.
And that distinction matters — because it shifts the story from deficit to design.
Misophonia: when the nervous system treats chewing like a threat
Misophonia is often misunderstood as “being picky.”
But research suggests it can involve atypical activity in auditory processing pathways and strong emotional/physiological reactivity to trigger sounds.
Misophonia also commonly overlaps with stress reactivity and emotion regulation load (which helps explain why it can get worse during burnout).
And importantly: emerging research suggests misophonia symptoms can be associated with neurodivergent-related symptom clusters (including attentional profiles).
So when someone says:
“I have actual murder thoughts when people chew,”
what they typically mean is:
“My nervous system hits fight-or-flight faster than my values can intervene.”
That’s not a character issue.
It’s a threshold + trigger + load issue.
How it can manifest day-to-day (real-life patterns)
“Speech exists, comprehension doesn’t”
You nod, but you’re translating sound into meaning with a lag
In noise, you lose half the sentence
“Certain sounds override everything”
chewing/tapping/breathing becomes the loudest thing in the universe
you can’t hear content because your body is mobilizing
“Noise creates cognitive shutdown”
open offices = slow brain
busy cafés = fatigue
group dinners = irritability + guilt
“After sound exposure: delayed crash”
the meeting was fine
two hours later: exhaustion, irritability, shutdown
The most useful model:
Load → Filtering → Reaction
Try this: instead of asking “What’s wrong with me?”
ask:
How high is my baseline load today?
(sleep, stress, hormones, burnout, emotional labor)
How complex is the listening environment?
(noise, multiple speakers, speed, ambiguity)
What is my nervous system doing?
(regulating, masking, staying socially “on”)
Which sound patterns are triggers?
(repetitive, wet-mouth, high-frequency, unpredictable)
When load is high, tolerance drops.
That isn’t weakness. It’s physiology.
What helps (without pretending you can “mindset” your way out)
Structural supports (high ROI)
captions whenever possible
written agendas + written decisions
one speaker at a time (especially in groups)
fewer parallel channels (Zoom + Slack + side talk = chaos)
quieter seating (back to wall, away from kitchen, away from clacking)
Sensory tools (use with strategy)
earplugs (situational)
noise-canceling headphones (selective)
brown noise / neutral masking noise during deep work
predictable breaks after high-audio exposure
Behavioral scripts (simple, dignified)
“I process best with written follow-up—can you drop that in chat?”
“I’m struggling in the noise—mind repeating the last sentence?”
“I need a quieter spot to focus; I’ll rejoin in a minute.”
Regulation (for the body, not the vibe)
jaw unclench + long exhale
pressure input (weighted lap pad, firm hand pressure)
short movement resets after exposure
If misophonia is severe, evidence-informed approaches often include CBT-style interventions and emotion regulation work—ideally with clinicians familiar with misophonia rather than general “anger management” framing.
A gentle self-check: processing or misophonia—or both?
If you relate to several of these, it might be worth exploring an auditory processing lens:
I do worse with speech in noise than others seem to
I ask for repetition a lot
I’m exhausted after listening-heavy days
I prefer written information
certain sounds trigger instant fight-or-flight
APD/CAPD-style issues are often assessed by audiology/speech-and-hearing professionals (not standard hearing tests).
Practical takeaway: this is not “being sensitive.” It’s being overloaded.
What looks like “overreacting” from the outside can be:
a decoding bottleneck (processing)
a tolerance threshold issue (sound sensitivity)
a trigger response (misophonia)
plus ADHD load dynamics (bandwidth)
That combination is common.And it’s navigable—especially when environments shift from “just cope” to “let’s design.”
⚠️ Disclaimer
This article is educational and not medical advice. If sound intolerance significantly affects your life, consider talking with an audiologist, a speech-and-hearing specialist, or a clinician familiar with misophonia and neurodivergent sensory processing.
Want to go deeper?
If your workplace is full of high performers who “can’t focus in noise,” burn out after meetings, or silently struggle with sensory overload, that is not an individual resilience issue. It is an environment design issue.
I support teams and leaders in building neuroinclusive communication norms, meeting design, and sensory-smart work systems—so people can contribute without spending half their capacity on processing friction.
This perspective — moving from misattribution to clarity —is central to my book
Because understanding how cognition really works changes everything that comes after.
Core Distinction: Hearing vs. Auditory Processing
Mayo Clinic – Auditory Processing Disorder (APD)
Explains the difference between peripheral hearing and central auditory processing. https://www.mayoclinic.org/diseases-conditions/auditory-processing-disorder/symptoms-causes/syc-20555261
American Speech-Language-Hearing Association (ASHA) – Central Auditory Processing Disorder Clinical overview of how sound can be heard normally but processed atypically. https://www.asha.org/public/hearing/central-auditory-processing-disorder/
ADHD & Auditory Processing / “I Hear but Can’t Follow”
Gomes et al. (2019) – Auditory processing in children with ADHD
Demonstrates deficits in central auditory processing despite normal hearing.
Journal of Attention Disorders https://pmc.ncbi.nlm.nih.gov/articles/PMC6624822/
Klingberg et al. (2005) – Working memory and attention control in ADHD
Explains bandwidth depletion and cognitive load effects.
Journal of Child Psychology and Psychiatry
Healthline – ADHD and Auditory Processing Disorder
Accessible overview of overlap and lived experience. https://www.healthline.com/health/adhd/adhd-and-auditory-processing
National Library of Medicine (PMC) — ADHD and Central Auditory Processing https://pmc.ncbi.nlm.nih.gov/articles/PMC6624822/
Springer — Auditory Processing Deficits in ADHD https://link.springer.com/article/10.1186/s43163-023-00557-2
PMC — Neurobiological Correlates of Auditory Attention in ADHD https://pmc.ncbi.nlm.nih.gov/articles/PMC12574008/
Autism / AuDHD: Sensory Salience & Filtering
Robertson & Baron-Cohen (2017) – Sensory perception in autism
Describes heightened sensory salience and differences in filtering.
Nature Reviews Neuroscience
Pellicano & Burr (2012) – When the world becomes “too real”
Predictive processing differences in autism. Trends in Cognitive Sciences
HSP (Highly Sensitive Person) / Sensory Processing Sensitivity
Aron & Aron (1997) – Sensory Processing Sensitivity
Foundational research on HSP as a temperament trait.
Journal of Personality and Social Psychology
Acevedo et al. (2014) – Neural correlates of sensory processing sensitivity
MRI evidence of deeper sensory and emotional processing.
Brain and Behavior https://onlinelibrary.wiley.com/doi/10.1002/brb3.242
Giftedness & Meaning-First Processing
Silverman (2013) – Giftedness 101
Describes abstraction bias, meaning-first cognition, and uneven attention.
Dabrowski’s Theory of Overexcitabilities Frequently cited in gifted research to explain sensory and cognitive intensity.
Subotnik et al. (2011) – Rethinking giftedness
Emphasizes complexity, depth, and asynchronous processing.Psychological Science in the Public Interest
Dyslexia & Language-Based Processing Differences
Shaywitz (2003) – Overcoming Dyslexia
Classic work explaining phonological processing cost vs. intelligence.
Snowling (2000) – Dyslexia
Neurolinguistic explanation of decoding effort and listening fatigue.
National Institute of Child Health and Human Development (NICHD) – Dyslexia overview https://www.nichd.nih.gov/health/topics/dyslexia
Auditory Processing Disorder (APD)
Musiek & Chermak (2014) – Handbook of Central Auditory Processing Disorder
Clinical gold standard for APD mechanisms.
British Society of Audiology (2018) – APD position statemen thttps://www.thebsa.org.uk/resources/auditory-processing-disorder/
ENT, Hearing Tests & Misattribution
ENT Health (American Academy of Otolaryngology) – Normal hearing tests, persistent listening difficulty
Explains why standard audiograms don’t capture processing issues. https://www.enthealth.org/
Amplifon USA – ADHD and hearing difficulties
Practical explanation of why people suspect hearing loss first. https://www.amplifonusa.com/hearing-loss/blog/adhd-hearing-problems
Key Framing Supported by Research
What the literature consistently supports:
Hearing ≠ understanding
Many neurodivergent profiles affect filtering, prioritization, decoding, or bandwidth
The lived experience can feel like hearing loss without any ear pathology
Misattribution is common — clarity is often relieving, not alarming
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