Sometimes difficulty with listening lies not in the environment but in a physical or medical issue. For example, our hearing ability declines with age, affecting our ability to hear words as well as speech tone, pitch, and range (Bellis & Wilber, 2001; Villaume & Brown, 1999). Stereotypes of older adults portray them as unable to engage in normal conversation because of cognitive decline, but the real problem is often that they have to work harder to distinguish sounds (Murphy, Daneman, & Schneider, 2006). Accidents, diseases, stress and anxiety, and physical differences can also cause varying degrees of hearing impairment—for anyone, not just elderly people (Roup & Chiasson, 2010).

Still, hearing loss (even total hearing loss) does not mean that an individual cannot listen competently. Deaf individuals often speak of “listening with their eyes” and research notes that those who cannot hear physically are quite competent at decoding nonverbal behaviors revealing a speaker’s emotions (Grossman & Kegl, 2007). In addition, individuals who use American Sign Language as a primary language also listen to each other and encode and decode messages as do any individuals speaking the same vocal language.

Even someone with perfect hearing can face listening challenges. For instance, a person with attention deficit disorder (ADD) may have difficulty focusing on information and tasks, which can make listening challenging. People with auditory processing disorder, a learning disability that makes it difficult to process information they hear, must use strategies to focus on and understand spoken information: they might adjust their environment, for example, by always sitting in the front of the classroom or always studying in the quietest section of the library. They might rely more heavily on written or visual cues when learning new information, use paraphrasing to confirm that they’ve received and processed messages correctly, and focus on only one listening task at a time.