I suspect most people don't want to offend so don't ask what might be awkward questions but, without asking how is knowledge gained and shared.
Assumptions are always dangerous because, not least, they may be completely wrong and so questions do need to be asked and the answers understood.
So, I'll try my best to answer some questions....
Q) Does APD affect speech only or does misunderstanding affect written word?
A) APD is associated with Dyslexia because, in many respects it seems similar.
I don't believe I have difficulty understanding written or spoken word (what I hear), though it is a double-edged sword in many respects.
APD is about processing differently, whereas misunderstanding is understanding incorrectly. It's almost impossible to misunderstand what you haven't heard.
I may not process all or part of an audible comment and so, in order to clarify (or tactically delay... or something), I might repeat what I think may have been said and get it wrong - which could give the erroneous impression that I misunderstood when the reality is that there is part of what was said that I didn't understand and I want to.
If we accept that (at least in the English language) it's possible that one word, phrase, comment or paragraph could carry more meaning. As example, double entendres are often used for humorous effect (they're also more prevalent unconsciously in verbal speech than written).
Written language forms are more likely to be specific, less open to interpretation than verbalised expressions because the author of any written detail has more time to monitor and eliminate (edit) potential implications that are not intended and so additional suggestions/interpretations are included within conscious (and unconscious) reasoning.
In other words, it's usually meant.
I remember English exercises that involved several sentences that had one word missing, the exercise involved placing the correct word (from a list of 20 - probably) in each sentence so that they all made sense.
APD is often like that - the difference being that there maybe more than one word missing and it maybe the key word or words and I have to create my own list.
What I might hear may not give me the full content or context. I've learnt how to mentally record sound(s), associate vocabulary and knowledge and how best to join the two to provide myself a better approximation (if I attempt to guess).
So when I ask, "What?" it maybe a delay tactic to give me time to process. I'm rarely asking for the full speech, but I can't necessarily identify the particular word(s) I want repeated simply because I didn't hear it/them. Any change in the comment will however be noticed because it will Sound different and I'll note the change in sound. This must be a strategical development to compensate for momentary processing losses.
There's a test (I forget what for) that involves flash type cards and questions. For example, you might be asked, "What colour is the word?" and be presented with a card on which is the word - Blue -
(yet it's written in Red).
I don't know how long other people take to answer and how accurate their answers are within the defined parameters of the test, but it's about the processing involved. Perhaps thinking about that test will give an idea of what APD is sometimes like.
Basically I'm analysing every comment, facial expression and all associated gestures to identify any potential gaps in audible comment and the most probable corresponding words in order to place these within the comment and make sense of what was said. That's why I may repeat back to someone, I'm checking if what I think was probably said matches what was Actually said and also monitoring reaction to see if I've changed the words, and the possible meanings.
Processing takes time and so this may be why I don't respond immediately.
I may also appear to day dream - that could be because I'm thinking about what has been said and potential interpretations and their implications. Or I didn't hear at all because I'm totally absorbed in something else. Or there's too much background noise and I've realised there's no way I'm going to hear no matter how many times someone is willing to repeat a comment and anyway, it spoils the flow of conversation in a group conversation - so I may give up.
With regard to understanding written information specifically: - I was always in top sets and achieved high marks in school, particularly in English, Maths, Science and Art
Q) Would paraphrasing assist understanding?
A) Sometimes it would, sometimes that's because - if it's the person who made the comment who then rephrases - I may be able to identify the exact words originally used and what they initially intended me to know or hear.
Sometimes it doesn't help because, - although the person making the comment knows exactly what they mean they may be expecting me to understand when in fact, - they're not explaining or engaging properly.
To give an example, I might be driving my son (who's sat behind me in the car) to school. He makes a comment and I might not hear enough to know what he said in fact, I might not hear him at all. It could be because I'm not processing or he's looking out of the window and mumbling. As I can't see his face lip reading is ruled out and there's a lot of background noise that other people don't notice which I can't switch off - Traffic, engine, weather (rain/wind) etc. If he repeats the comment, he may raise his voice but not the direction (he might be looking at his mobile phone).
People do get bored easily, and frequently annoyed- when repeating a comment - they'll look somewhere else and the key word or combination might still be mumbled, and lack audible emphasis (sufficient enunciation) etc and it's this that makes identifying the intended information more difficult.
Q) Do I hear the word but not the meaning? (like the time I was sent to buy cigarettes)
A) My Mum knew what she wanted me to do - I didn't.
She gave me a lot of money and a huge basket while mentioning sweets -
That is what I heard - the size of the basket along with the amount of money suggested a LOT of sweets.
I was amazed
I was also approximately 7- 8 years old and I'd never bought cigarettes before.
Realising that I may not have heard her exactly - I repeated the instructions I had heard back to her. The basket was significant. (a huge basket - for what?).
When I repeated the instructions, asking for confirmation, and as far as I was aware my Mum didn't point out that there was any missing item - she agreed and I didn't hear any mention of cigarettes - again.
To answer your question - who made the mistake?
I don't know, at the time I had no idea that cigarettes were involved until my Mum came to the shops to find me.
I've considered the possibility that cigarettes were mentioned and whether or not I simply didn't process, but that would also mean I didn't process a number of associated things - the brand, how many, a recommended shop and that these weren't heard repeatedly. I can not state that isn't possible.
What does seem probable is that, given my age, the word Sweets caught and kept my attention. I was totally distracted by my own thoughts (how many could I buy?) rather than listening to all the instructions my Mum gave.
If that's true, and it's certainly possible, then I'm not sure it's entirely due to APD. However, I can't rule that out.
Q) Do things like tiredness, stress, alcohol have an impact?
A) Yes.
Tiredness, stress and alcohol affect people's speech and terminology. Speech maybe slurred, incoherent and rapid. So THEIR audible comments are more difficult to understand.
For example, if someone with an accent was talking to you with slurred rapid speech how well do you think you'd hear and identify each word?
Whereas, whatever state I'm in (be it tired, stressed or inebriated) I'm highly motivated to comprehend - in other words, by habit I'm keen to know Exactly what's said to or around me.
However, if I'm not processing - I may not realise that I'm not processing.
Q) How long was involved in the diagnosis of APD and what prompted this?
A) About an hour altogether (with a Consultant Audiologist who Knew about APD).
In 2008 I was in a new relationship with a mumbler who complained about repeat requests.
As a child I'd had all the usual school based hearing tests and passed with flying colours (perfect hearing). I'd noticed during their infancy that my two eldest children had some hearing issues and they were investigated (having hearing tests - along with myself). They had grommets inserted and I was told, yet again, that I have perfect hearing.
Asking people to repeat comments causes problems (they're often angry in response).
I went to my GP, in 2008, thinking that, perhaps, the problem was an age related issue - a lot of people suffer some loss of hearing as they age. It seemed possible this was something I had to consider and I was referred to the consultant audiologist for tests.
The consultant informed me that I have perfect hearing, but then went onto explain how it was the processing of sound that randomly affected me and demonstrated by turning off his computer (hard drives have fans that make a lot of noise) and other appliances in his office. He told me how these background sounds make little or no difference for everyone else because they can be filtered out (mentally turned off) whereas I can't do that, so speech sounds are nearly always heard within the context of a host of competing noise - any of which might distract me (causing an apparent occasional random loss of hearing).
In other words, everyone else is generally unaware of background sounds whereas I'm conscious of all sounds in proximity.
Living with APD is a lifetime experience. Dealing with it means developing a range of strategies, a lot of these are primarily avoiding potential anger and so is very hard work. I have had to learn how to consider political implications that I'm unaware of and a host of additional things.
Q) Do different tones of voice make a difference high pitch/low pitch dialect etc
A) Yes, very much so.
All things that affect or are inclusive integral aspects of speech are contributory factors in understanding and conversely associated with difficulty in achieving this.
People maybe laughing, mumbling, shouting, whispering, turning direction (looking away), talking rapidly when making a comment. Gestures:- holding a hand or object in front of the mouth. Intonation, inflection, emphasis etc..... all of this makes it difficult to isolate words.
Telephone conversations are particularly difficult because any one, or combination, of these factors may come into play along with the additional background and 'white noise' of a telephone line. Speech sound quality is also degraded - so I avoid using them wherever possible.
Chicken or egg questions come to mind in several respects....
While making any comment someone is basically producing a sequence of code to express their particular thoughts (along with the underlying process) or to effect a response, share information, understanding, ability, limitations and expectations. Or, conceal any of these.
Q) Am I right in thinking it appears randomly in that the same word may be understood in one context but not in another.
A) Yes, in terms of processing.
But processing involves the ability to recognise sequence and/or specific phraseology implication and the possible variations in definition by context..
Everyone could mistake the intention if a word is used Out of context. or is open to interpretation.
If a word appears to be out of context but informational, I'd question in order to ascertain the specific implication.
Context should readily identify by reference/associaton the meaning of any given word, regardless of the permutations available - unless.... there are a number (by context) that Could be applied. In which case, I will ask specific questions - prompted by the possible alternative meanings.
Having said all that.... if I'm not processing... I may not be aware of the associated expectations and repeating a comment may not help either.
